CN104363838B

CN104363838B - The tissue thickness compensation part being made up of multiple material

Info

Publication number: CN104363838B
Application number: CN201380027220.7A
Authority: CN
Inventors: F·E·谢尔顿四世; J·S·斯韦兹; J·H·康蒂利亚诺; C·杨; C·E·亨德森; T·W·阿伦霍尔特; C·J·沙伊布; J·L·奥尔德里奇; K·J·施米德
Original assignee: Iscon Medical
Current assignee: Iscon Medical
Priority date: 2012-03-28
Filing date: 2013-03-27
Publication date: 2017-11-21
Anticipated expiration: 2033-03-27
Also published as: MX356930B; JP2015516838A; CN104363838A; BR112014024153B1; RU2638273C2; RU2014143208A; BR112014024153A2; MX2014011770A; JP6153997B2

Abstract

The invention discloses a kind of tissue thickness compensation part, and in various embodiments, tissue thickness compensation part (22770) may include multiple fibers (22773,22774).In at least one embodiment, this fiber may include multiple first fibers (22773) being made up of the first material and multiple second fibers (22774) being made up of the second material.Tissue thickness compensation part can include multiple layers, wherein each layer can be made up of one or more medicines.Disclosed herein is some embodiments for manufacturing the tissue thickness compensation part including such as fiber.

Description

The tissue thickness compensation part being made up of multiple material

Background technology

The present invention relates to a kind of surgical instruments, and in various embodiments, the present invention relates to be designed to cut With the surgery cuts and suture instruments and its nail bin of suture tissue.

The content of the invention

Below for it is claimed or can claimed invention embodiment incomplete row Table.

1. a kind of compensating part for the anvil block that can be attached to fastening instrument, wherein the anvil block includes profiled surface, it is described Compensating part includes：

The first layer being made up of the first fiber and the second fiber, wherein first fiber is made up of the first material and institute State the second fiber to be made up of the second material, wherein first material is different from second material, and wherein described first Fiber and second fiber are present in the first layer according to the first ratio；

The second layer being made up of first fiber and second fiber, wherein first fiber and second fibre Dimension is present in the second layer according to the second ratio, and wherein described first ratio is different from second ratio；With

The attachment of the anvil block can be attached to.

2. according to the compensating part described in embodiment 1, wherein first material includes oxidized regenerated cellulose, and it is described Second material includes absorbable polymer.

3. according to the compensating part described in embodiment 1 or embodiment 2, wherein the institute of first fiber and second fiber It is about 4 to state the first ratio:1, and second ratio of wherein described first fiber and second fiber is about 1:4.

4. according to the compensating part described in embodiment 1 or embodiment 3, wherein the first layer includes tissue contacting surface, and And wherein described second material includes oxidized regenerated cellulose.

5. the compensating part according to any one of previous embodiment, wherein second fiber is woven in described first In first fiber in layer, and wherein described first fiber is woven in second fiber in the second layer It is interior.

6. according to the compensating part described in embodiment 1, in addition to absorb in the described first intrastitial medicine.

7. a kind of compensating part for the anvil block that can be attached to fastening instrument, wherein the anvil block includes profiled surface, it is described Compensating part includes：

Absorbable outer layer, the absorbable outer layer were included being suitable to mainly during the first stage of the agglutination Absorbed first medicine；

Absorbable intermediate layer, the absorbable intermediate layer include being suitable to mainly in the second stage of the agglutination Period absorbed second medicine；With

Internal layer, the internal layer include being suitable to mainly absorbed 3rd medicine during the phase III of the agglutination Thing.

8. according to the compensating part described in embodiment 7, wherein first medicine includes hemostatic material, the second medicine bag Anti-inflammatory material is included, and the 3rd medicine includes collagen-based materials.

9. according to the compensating part described in embodiment 7 or embodiment 8, wherein first medicine includes hemostatic material, it is described Second medicine includes antimicrobial material, and the 3rd medicine includes collagen-based materials.

10. according to the compensating part any one of embodiment 7-9, wherein at least one intermediate layer includes surrounding institute The annulate lamella of internal layer is stated, and wherein described outer layer includes the annulate lamella around at least one intermediate layer.

11. according to the compensating part any one of embodiment 7-10, wherein first healing phases and described second Healing phases are overlapping at least in part, and wherein described second healing phases weigh at least in part with the 3rd healing phases It is folded.

12. according to the compensating part described in embodiment 11, wherein first healing phases and the 3rd healing phases portion Divide overlapping.

13. a kind of method for manufacturing tissue thickness compensation part, methods described include：

Obtaining includes the fiber of substrate and medicine；

Prepare the solution of the first liquid and second liquid；

The fiber is mixed into the solution；

The solution is poured into mould；And

Freeze the solution.

14. according to the method described in embodiment 13, wherein being obtained by using substrate described in the drug coat described Fiber.

15. according to the method described in embodiment 13, wherein by extruding the substrate and medicine simultaneously to obtain the fibre Dimension.

16. according to the method described in embodiment 13, wherein being obtained by using substrate described in the medicine dipping described Fiber.

17. according to the method any one of embodiment 13-16, wherein by the way that the mould is placed on into vacuum chamber In, reduce the atmospheric pressure in the vacuum chamber and reduce the temperature in the vacuum chamber to freeze the solution.

18. according to the method any one of embodiment 13-17, in addition to allow the fiber in the lyophilized solution The bottom of the mould is deposited to before.

19. according to the method any one of embodiment 13-18, wherein described freeze of the solution produces material Piece, and methods described also includes shredding the material piece.

Brief description of the drawings

Refer to the following explanation of the embodiment of the present invention, feature of the invention and advantage and its acquisition side in conjunction with the accompanying drawings Method will become more apparent, and be better understood invention in itself, wherein：

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

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

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

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

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

The end effector that Fig. 4 is Fig. 2 and Fig. 3 begins to pass another local horizontal stroke when end effector promotes in knife bar Side cross-sectional view；

Fig. 5 is another partial cross sectional of Fig. 2-Fig. 4 end effector when knife bar is partly advanced through wherein Surface side view；

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

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

Fig. 7 B be show Fig. 7 A can conquassation staple cartridge body by the schematic diagram of anvil block conquassation；

Fig. 7 C be show Fig. 7 A can conquassation staple cartridge body by the schematic diagram of the further conquassation of anvil block；

Fig. 7 D be show Fig. 7 A nail in be fully formed configuration and Fig. 7 A can conquassation nail bin be in complete conquassation bar The schematic diagram of part；

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

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

Figure 10 is the decomposition diagram of alternative embodiment of compressible nail bin, the compressible nail bin include nail and System for driving nail against anvil block；

Figure 10 A are the partial sectional views of alternative embodiment of Figure 10 nail bin；

Figure 11 is the sectional view of Figure 10 nail bin；

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

Figure 13 is the schematic diagram of staple drivers, and the staple drivers can be lifted by Figure 12 sliding part towards anvil block；

Figure 14 is that the nail bin includes and surgical stapling device according to the perspective view of the nail bin of at least one embodiment of the present invention The rigid support portion and compressible tissue thickness compensation part that tool is used together；

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

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

Figure 17 is another exploded view of Figure 14 nail bin, and the nail bin is not covered with the wrappage of tissue thickness compensation part；

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

Figure 19 is the top perspective of sliding part, and the sliding part can be moved to be followed closely from cartridge deployment in Figure 14 nail bin；

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

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

Figure 22 is the top perspective of driver, and the driver can support one or more follow closely and by Figure 19 sliding part It is lifted up so that nail to be projected from nail bin；

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

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

Figure 25 is the partial sectional view of nail bin, and the nail bin includes rigid support portion and compressible tissue thickness compensates Part, show that never firing position moves to firing position to nail during First ray；

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

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

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

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

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

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

Figure 32 is Figure 31 anvil block and another sectional view of nail bin, in opening after being completed it illustrates percussion sequence The anvil block of position；

Figure 33 is the local detail drawing of Figure 31 nail bin, and it illustrates the nail in non-firing position；

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

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

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

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

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

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

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

Figure 41 is Figure 39 anvil block and the front view of nail bin, and it illustrates be positioned in having not between anvil block and nail bin The tissue of stack pile；

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

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

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

Figure 45 is the schematic diagram for being shown in which the situation that one or more nails do not shape appropriately；

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

Figure 47 is to show showing for the tissue thickness compensation part being positioned in the intersecting tissue regions of plurality of staple line It is intended to；

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

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

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

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

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

Figure 53 is the signal for the tissue for showing the tissue thickness compensation part being trapped in nail and having interior thickness Figure；

Figure 54 is to show the tissue thickness compensation part being trapped in nail and the tissue with another interior thickness Schematic diagram；

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

Figure 56 is the partial sectional view of the end effector of surgery suturing appliance, it illustrates in retraction, do not fire position The trigger shaft and nail percussion sliding part put；

Figure 57 is another partial sectional view of Figure 56 end effector, and it illustrates promote hitting for position in part Send out bar and nail percussion sliding part；

Figure 58 is the sectional view of Figure 56 end effector, and it illustrates in being fully advanced or the percussion of firing position Bar；

Figure 59 is the sectional view of Figure 56 end effector, and it illustrates the trigger shaft that advanced position is in after being fired And stay in the nail percussion sliding part of its complete firing position；

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

Figure 61 is to be promoted just in the end effector of surgical instruments towards distal side to cut the embodiment of the cutter of tissue Perspective cross-sectional view；

Figure 62 is the spy for illustrating the ability to be directed to the material in tissue thickness compensation part on Figure 61 of tissue cutter The cross-sectional side view of sign；

Figure 63 is to promote just in the end effector of surgical instruments to be available for selecting to cut the cutter of tissue towards distal side The perspective cross-sectional view for the embodiment selected；

Figure 64 be just in the end effector of surgical instruments towards distal side promote with cut the cutter of tissue another The perspective cross-sectional view of alternative embodiment；

Figure 65 is illustrated the ability to by the material in the first tissue thickness compensation part and from minor microstructure thickness compensation part The cross-sectional side view of feature on Figure 64 of material mixing cutter；

Figure 66 is illustrated the ability to by the material in the first tissue thickness compensation part and from minor microstructure thickness compensation part The front view of feature on Figure 64 of material mixing cutter；

Figure 67 is illustrated the ability to by the material in the first tissue thickness compensation part and from minor microstructure thickness compensation part The cross-sectional, top view of feature on Figure 64 of material mixing cutter；

Figure 68 be just in the end effector of surgical instruments towards distal side promote with cut the cutter of tissue another The perspective cross-sectional view of alternative embodiment；

Figure 69 is the feature on the cutter for illustrate the ability to Figure 68 that diffusion is included in the material in tissue thickness compensation part Cross-sectional side view；And

Figure 70 is the cross-sectional side view of Figure 68 of positive diffusate cutter.

Figure 71 is the partial cut-away perspective view according to the tissue thickness compensation part of at least one embodiment；

Figure 72 shows the medicine being just loaded into tissue thickness compensation part；

Figure 73 is located at the cross sectional end view of the pipe wherein in the tissue thickness compensation part of Figure 71 containing medicine；

Figure 74 shows the tissue thickness compensation part for the Figure 71 for just being positioned and being compressed against patient tissue；

Figure 75 is the cross sectional end view of the end effector of surgery suturing appliance, and it illustrates just fired through Figure 71 Tissue thickness compensation part nail；

Figure 76 is the curve map for the dissolving for showing to be included in the capsule in tissue thickness compensation part, and wherein capsule includes Multiple medicine layers；

Figure 77 shows the first layer or outer layer of just dissolved Figure 76 capsule；

Figure 78 shows the second layer of just dissolved Figure 76 capsule；

Figure 79 shows the third layer of just dissolved Figure 76 capsule；

Figure 80 shows the 4th layer or internal layer of just dissolved Figure 76 capsule；

Figure 81 is described group according to the partial sectional view of the nail bin including tissue thickness compensation part of at least one embodiment Knitting thickness compensation part includes multiple vertical capsules；

Figure 82 is the perspective view of Figure 81 vertical capsule；

Figure 83 is the partial sectional view of Figure 81 nail bin, it illustrates be included in nail bin in non-firing position Nail；

Figure 84 is the cross-sectional side view of Figure 81 nail bin, and it illustrates just never firing position is moved to firing position Figure 83 nail；

Figure 85 is to include the tissue thickness compensation part for the vertical capsule being positioned in according at least one embodiment Partial sectional view；

Figure 86 is the partial sectional view for the tissue thickness compensation part for including multiple capsules, and the capsule, which has, to be defined in Opening therein；

Figure 87 be according to the cross sectional end view of the end effector of the surgery suturing appliance of at least one embodiment, it is described Surgery suturing appliance includes multiple nails in non-firing position and can make the capsule being included in tissue thickness compensation part Or multiple puncture members of tracheal rupture；

Figure 88 is the front view of the nail of Figure 87 in non-percussion configuration；

Figure 89 is the front view of the nail of Figure 88 in percussion configuration；

Figure 90 is the front view of Figure 87 puncture member；

Figure 91 is the cross sectional end view of Figure 87 end effector, it illustrates the nail in firing position and pierces through structure Part；

Figure 92 is the cross-sectional side view of Figure 87 end effector, and it illustrates just never firing position is moved to percussion The nail and puncture member of position；

Figure 93 is described group according to the top cross-sectional view of the nail bin including tissue thickness compensation part of at least one embodiment Knit multiple vertical capsules that thickness compensation part includes being positioned in；

Figure 94 is the detail drawing of Figure 93 nail bin；

Figure 95 is located at the cross sectional end view of the nail bin of Figure 93 in end effector, and it illustrates be included in nail bin The interior nail in firing position；

Figure 96 is the cross sectional end view of the nail bin of Figure 93 in Figure 95 end effector, and it illustrates be just advanced through The cutting element of capsule in tissue thickness compensation part；

Figure 97 is the perspective view according to the tissue thickness compensation part including longitudinal member of at least one embodiment；

Figure 98 is the sectional view of the mould for the tissue thickness compensation part that can produce Figure 97；

Figure 99 is the cross sectional end view of Figure 98 mould, and it illustrates the Figure 97 of positioning in a mold longitudinal member；

Figure 100 is the cross sectional end view of Figure 98 mould, and it illustrates the tissue being just poured into Figure 98 mould Thickness compensation part material；

Figure 101 is the sectional perspective view according to the tissue thickness compensation part of at least one embodiment；

Figure 102 is the perspective according to the supporting member that can be embedded in tissue thickness compensation part of at least one embodiment Figure；

Figure 103 is the sectional perspective view according to the tissue thickness compensation part of at least one embodiment；

Figure 104 is the cross sectional end view for the mould for showing the tissue thickness compensation part for manufacturing Figure 103；

Figure 105 is the cross-sectional view of Figure 103 tissue thickness compensation part；

Figure 106 is the cross-sectional side view of Figure 104 mould；

Figure 107 is the cross sectional end view according to the tissue thickness compensation part of at least one embodiment；

Figure 108 is the cross sectional end view according to another tissue thickness compensation part of at least one embodiment；

Figure 109 is the detail drawing according to the timbering material of the tissue thickness compensation part of at least one embodiment；

Figure 110 is the detail drawing according to the tissue thickness compensation part in non-extended mode of at least one embodiment；

Figure 111 is the detail drawing of the tissue thickness compensation part of Figure 110 in extended mode；

Figure 112 is the sectional perspective view according to the tissue thickness compensation part of at least one embodiment；

Figure 113 is according to the broken section of the tissue thickness compensation part just manufactured in a mold of at least one embodiment Perspective view；

Figure 114 is the perspective cross-sectional view according to the tissue thickness compensation part of at least one alternative embodiment；

Figure 115 is the cross sectional end view according to the tissue thickness compensation part of at least one alternative embodiment；

Figure 116 is the fragmentary, perspective view according to the tissue thickness compensation part of at least one alternative embodiment；

Figure 117 is performed according to the end of the surgery suturing appliance including tissue thickness compensation part of at least one embodiment The front view of device；

Figure 118 is the exploded view of Figure 117 tissue thickness compensation part, and wherein tissue thickness compensation part includes multiple layers；

Figure 119 is the sectional view of the layer of tissue thickness compensation part；

Figure 120 is the sectional view of another layer of tissue thickness compensation part；

Figure 121 is located at the office of the tissue thickness compensation part of Figure 117 between the anvil block of surgery suturing appliance and nail bin Cross section front view；

Figure 122 is the figure for being trapped in the nail projected from nail bin and being deformed by the anvil block of surgery suturing appliance Another partial cross-section front view of 117 tissue thickness compensation part；

Figure 123 is another partial cross sectional of the tissue thickness compensation part for Figure 117 that tissue is attached to by Figure 122 nail Face front view；

Figure 124 is the perspective view according to the layer of the tissue thickness compensation part of at least one alternative embodiment；

Figure 125 is the perspective view of the end effector for the surgery suturing appliance for including tissue thickness compensation part, the tissue Thickness compensation part includes Figure 124 layer；

Figure 126 is the fragmentary, perspective view according to the tissue thickness compensation part of at least one alternative embodiment；

Figure 127 is the perspective view of the end effector of the surgery suturing appliance for the tissue thickness compensation part for including Figure 126；

Figure 128 is the perspective view of multiple coated fibers；

Figure 129 be show for prepare coated fiber and/or can cutting into coated fiber coating strand extrusion operation Perspective view；

Figure 130 is the perspective cross-sectional view of coated fiber；

Figure 131 be shown with material being deposited on fiber and/or the coating process of intrastitial carrier fluid it is saturating View；

Figure 132 is the perspective view for the nail bin for including tissue thickness compensation part, and the tissue thickness compensation part includes Figure 128's Fiber；

Figure 133 is the partial cut-away perspective view according to the tissue thickness compensation part of at least one embodiment；

Figure 134 is the sectional view according to the medicine wrapped up by water wetted material of at least one embodiment；

Figure 135 is the perspective view of the tissue thickness compensation part for the Figure 133 being positioned in the end effector of surgical instruments；

Figure 136 is the partial cut-away perspective view of Figure 134 medicine, and the medicine is just being exposed to liquid to cause medicine can Flowed out from Figure 133 tissue thickness compensation part；

Figure 137 is the fragmentary, perspective view according to the tissue thickness compensation part of at least one embodiment；

Figure 138 is fragmentary, perspective view of Figure 137 tissue thickness compensation part after liquid is exposed to；

Figure 139 is the perspective view for including being attached to the end effector of Figure 137 of anvil block tissue thickness compensation part；

Figure 140 is the partial cut-away perspective view of the tissue thickness compensation part of the fiber of the medicine and Figure 128 that include Figure 134；

Figure 141 is the fragmentary, perspective view for the nail bin for including tissue thickness compensation part, the tissue thickness compensation part bag Include multiple capsules；

Figure 142 is the side view of Figure 141 nail bin；

Figure 143 shows the capsule for being placed Figure 141 in a mold；

Figure 144 shows Figure 141 of the bottom for the mould for being deposited to Figure 143 capsule；

Figure 145 shows the compensating part material of main part being just poured on Figure 141 capsule；

Figure 146 shows following examples, and wherein Figure 141 capsule is finer and close than compensating part material of main part and keeps On the bottom of Figure 143 mould；

Figure 147 shows following examples, and wherein Figure 141 capsule is not as compensating part material of main part is dense and can float Move the top of Figure 143 mould；

Figure 148 shows the available of the mould of the multiple grooves or recess of the capsule including that can receive Figure 141 Embodiment；

Figure 149 is according to the cross sectional end view of the end effector of the surgery suturing appliance of at least one embodiment, institute Stating surgery suturing appliance includes being positioned in the tissue thickness compensation part above nail bin；

Figure 150 is the cross sectional end view of Figure 149 end effector, and it illustrates fire and extend through from nail bin The nail of Figure 149 tissue thickness compensation part；

Figure 151 shows mould and the multiple medicine capsules being positioned in mould；

Figure 152 is the cross sectional end view of mould, and it illustrates be poured into mould to form tissue thickness compensation part Compensating part material of main part；

Figure 153 is attached to the perspective view of Figure 152 of the anvil block of surgery suturing appliance tissue thickness compensation part；

Figure 154 is the sectional view of the mould for the tissue thickness compensation part that can form Figure 157, and it illustrates be just poured into First layer in mould；

Figure 155 is the sectional view of Figure 154 mould, and it illustrates the capsule of positioning on the first layer；

Figure 156 is the sectional view of Figure 154 mould, and it illustrates the second layer being just poured on capsule；

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

Figure 158 is located at the perspective of the tissue thickness compensation part of Figure 157 in the end effector of surgery suturing appliance Figure；

Figure 159 is the perspective view of the compensating part main body of Figure 162 tissue thickness compensation part；

Figure 160 is the perspective view for the longitudinal hole being limited in Figure 159 compensating part main body；

Figure 161 is the figure of capsule for showing just to be positioned in Figure 160 longitudinal hole；

Figure 162 is performed according to the end of the surgery suturing appliance including tissue thickness compensation part of at least one embodiment The perspective view of device；

Figure 163 is the perspective view of the compensating part main body of Figure 166 tissue thickness compensation part；

Figure 164 is the perspective view for the multiple transverse holes being limited in Figure 163 compensating part main body；

Figure 165 is the figure of capsule for showing just to be positioned in Figure 164 transverse holes；

Figure 166 is performed according to the end of the surgery suturing appliance including tissue thickness compensation part of at least one embodiment The perspective view of device；

Figure 167 is the perspective view for the vertical mould that can manufacture tissue thickness compensation part；

Figure 168 is the perspective view for the capsule being just positioned in Figure 167 mould；

Figure 169 is the perspective view of the capsule for the Figure 168 being just positioned in Figure 167 mould；

Figure 170 is the mould covering placed for being close to Figure 167 and the compensating part main body material being just positioned in mould The perspective view of material；

Figure 171 is the perspective view of Figure 167 mould, and there is shown with Figure 170 covering to be removed；

Figure 172 is shown includes tissue thickness compensation part and tissue thickness compensation part pad according at least one embodiment Nail bin；

Figure 173 is the partial bottom perspective view of Figure 172 tissue thickness compensation part pad；

Figure 174 is the fragmentary top perspective view of Figure 172 tissue thickness compensation part pad；

Figure 175 is just to be illustrated not having by the partial sectional view of Figure 172 of firing member percussion nail bin, wherein nail bin The tissue thickness compensation part being positioned on；

Figure 176 is the tissue thickness compensation part for Figure 172 that the cutting element just engaged by the firing member with Figure 175 is cut The top view of pad, wherein nail bin are illustrated without the tissue thickness compensation part being positioned on；

Figure 177 is the tissue thickness compensation part for Figure 172 that the cutting element just engaged by the firing member with Figure 175 is cut The top view of pad, wherein nail bin are shown having the tissue thickness compensation part being positioned on；

Figure 178 is the circular staple for including circular tissue thickness compensation part pad according at least one alternative embodiment The plan in storehouse；

Figure 179 shows the mould for including multiple chambers, and the multiple chamber being capable of the simultaneously formation group on multiple staple cartridge bodies Knit thickness compensation part；

Figure 180 shows the staple cartridge body for the intracavitary for being positioned at Figure 179 and the one or more sheet materials being just placed on nail bin；

Figure 181 shows Figure 180 of the appropriate position in the mould for being fixed on Figure 179 sheet material；

Figure 182 shows the elongate tubular structure around the multiple post support members curled up in Figure 179 mould；

Figure 183 shows Figure 180 of the appropriate position on the staple cartridge body for being fixed on Figure 179 sheet material；

Figure 184 shows the pipe component of Figure 182 on the sheet material for being positioned at Figure 180；

Figure 185 shows the compensating part material of main part being just poured into Figure 179 mould；

Figure 186 shows the cutting punch die above the mould for being positioned at Figure 179；

Figure 187 shows the cutting punching for moving down the sheet material with the compensating part material of main part of cutting drawing 185 and Figure 180 Mould；

Figure 188, which is shown, to move up with the cutting punch die of the mould away from Figure 179；

Figure 189 is the tissue thickness produced by the manufacturing process summarized in Figure 179-188 according at least one embodiment Spend the cross sectional end view of compensating part；

Figure 190 is the top view according to the nail bin including tissue thickness compensation part of at least one embodiment；

Figure 191 is the perspective view of Figure 190 nail bin；

Figure 192 is the diagram of the manufacture of the tissue thickness compensation part for the nail bin for showing Figure 190；

Figure 193 is to form the diagram of the roller of tissue thickness compensation part according to the pressing tubes of material of at least one embodiment；

Figure 194 is the diagram according to the roller of the formation tissue thickness compensation part of at least one alternative embodiment；

Figure 195 is the fragmentary, perspective view for the nail bin for including the tissue thickness compensation part as the process production described in Figure 194；

Figure 196 is just from the cross-sectional elevational view of the nail of Figure 195 cartridge deployment；And

Figure 197 is just from the cross sectional end view of the nail of Figure 195 cartridge deployment.

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

Embodiment

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

Entitled " SURGICAL INSTRUMENTS WITH RECONFIGURABLE SHAFT SEGMENTS " (agencies People file number END6734USNP/100058) U.S. Patent Application Serial Number 12/894,311；

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

Entitled " JAW CLOSURE ARRANGEMENTS FOR SURGICAL INSTRUMENTS " (attorney dockets Number END6736USNP/100060) U.S. Patent Application Serial Number 12/894,327；

Entitled " SURGICAL CUTTING AND FASTENING INSTRUMENTS WITH SEPARATE AND DISTINCT FASTENER DEPLOYMENT AND TISSUE CUTTING SYSTEMS " (attorneys END6839USNP/100524 U.S. Patent Application Serial Number 12/894,351)；

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

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

Entitled " IMPLANTABLE FASTENER CARTRIDGE COMPRISING MULTIPLE LAYERS " (generations Manage people file number END6842USNP/100527) U.S. Patent Application Serial Number 12/894,312；

Entitled " SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE " (agents File number END6843USNP/100528) U.S. Patent Application Serial Number 12/894,377；

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

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

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

Entitled " SURGICAL STAPLE CARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES AND SURGICAL STAPLING INSTRUMENTS WITH SYSTEMS FOR PREVENTING ACTUATION MOTIONS WHEN A CARTRIDGE IS NOT PRESENT " (attorney END6855USNP/100540) U.S. State's patent application serial number 12/894,350；

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

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

Entitled " FASTENERS SUPPORTED BY A FASTENER CARTRIDGE SUPPORT " (attorneys Reel number END6858USNP/100543) U.S. Patent Application Serial Number 12/894,345；

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

Entitled " FASTENER SYSTEM COMPRISING A PLURALITY OF CONNECTED RETENTION MATRIX ELEMENTS " (attorney END6860USNP/100546) U.S. Patent Application Serial Number 12/894, 318；

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

Entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX " (attorneys END6862USNP/100548 U.S. Patent Application Serial Number 12/894,361)；

Entitled " FASTENING INSTRUMENT FOR DEPLOYING A FASTENER SYSTEM COMPRISING A RETENTION MATRIX " (attorney END6863USNP/100549) U.S. Patent application Sequence number 12/894,367；

Entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND A COVER " (generations Manage people file number END6864USNP/100550) U.S. Patent Application Serial Number 12/894,388；

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

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

Entitled " TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER " (attorneys Reel number END6736USCIP1/100060CIP1) U.S. Patent Application Serial Number 13/097,936；

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

Entitled " STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN A COMPRESSIBLE PORTION THEREOF " (attorney END6841USCIP1/100526CIP1) United States Patent (USP) Patent application serial numbers 13/097,856；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING DETACHABLE PORTIONS " The U.S. Patent Application Serial Number 13/097,928 of (attorney END6842USCIP1/100527CIP1)；

Entitled " TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISING AN ADJUSTABLE ANVIL " (attorney END6843USCIP1/100528CIP1) U.S. Patent Application Serial Number 13/097,891；

Entitled " STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISTAL PORTION " (agencies People file number END6847USCIP1/100532CIP1) U.S. Patent Application Serial Number 13/097,948；

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

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

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

Entitled " COMPRESSIBLE STAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS " (generations Manage people file number END6856USCIP1/100541CIP1) U.S. Patent Application Serial Number 13/097,917；

Entitled " STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTION " (attorneys END6857USCIP1/100542CIP1 U.S. Patent Application Serial Number 13/097,873)；

Entitled " STAPLE CARTRIDGE COMPRISING COMPRESSIBLE DISTORTION RESISTANT COMPONENTS " (attorney END6858USCIP1/100543CIP1) U.S. Patent Application Serial Number 13/097, 938；

Entitled " STAPLE CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR " (generations Manage people file number END6859USCIP1/100544CIP1) U.S. Patent Application Serial Number 13/097,924；

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

Entitled " CURVED END EFFECTOR FOR A STAPLING INSTRUMENT " (attorneys END6841USCIP3/100526CIP3 U.S. Patent Application Serial Number 13/242,066)；

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

Entitled " STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT " (agencies People file number END7019USNP/110375) U.S. Patent Application Serial Number 13/241,912；

Entitled " SURGICAL STAPLER WITH STATIONARY STAPLE DRIVERS " (attorneys END7013USNP/110377 U.S. Patent Application Serial Number 13/241,922)；

Entitled " SURGICAL INSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING MULTIPLE ACTUATION MOTIONS " (attorney END6888USNP3/110378) U.S. Patent application sequence Row number 13/241,637；With

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

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

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

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

Entitled " EXPANDABLE TISSUE THICKNESS COMPENSATOR " (attorneys END6843USCIP2/100528CIP2 U.S. Patent Application Serial Number) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _.

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A RESERVOIR " (attorneys Reel number END6843USCIP3/100528CIP3) U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

Entitled " RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR " (generations Manage people file number END6843USCIP4/100528CIP4) U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

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

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

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

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

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING RESILIENT MEMBERS " (generations Manage people file number END6843USCIP9/100528CIP9) U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

Entitled " METHODS FOR FORMING TISSUE THICKNESS COMPENSATOR ARRANGEMENTS FOR SURGICAL STAPLERS " (attorney END6843USCIP10/100528CP10) U.S. Patent application sequence Row number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

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

Entitled " LAYERED TISSUE THICKNESS COMPENSATOR " (attorneys END6843USCIP12/100528CP12 U.S. Patent Application Serial Number) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

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

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING CAPSULES DEFINING A LOW PRESSURE ENVIRONMENT " (attorney END7100USNP/110601) U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

Entitled " MOVABLE MEMBER FOR USE WITH A TISSUE THICKNESS COMPENSATOR " (generations Manage people file number END7107USNP/110603) U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

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

Entitled " TISSUE THICKNESS COMPENSATOR AND METHOD FOR MAKING THE SAME " The U.S. Patent Application Serial Number of (attorney END7103USNP/110605) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS " (attorneys END7104USNP/110606 U.S. Patent Application Serial Number) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _；

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

Entitled " DEVICES AND METHODS FOR ATTACHING TISSUE THICKNESS COMPENSATING MATERIALS TO SURGICAL STAPLING INSTRUMENTS " (attorneys END7106USNP/110608 U.S. Patent Application Serial Number) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _.

Some exemplary embodiments will now be described, to understand the knot of apparatus and method as disclosed herein on the whole Structure, function, manufacture and purposes.One or more examples of these embodiments are shown in the drawings.Those of ordinary skill in the art It should be understood that the apparatus and method for specifically describing and being illustrated by drawings in text are unrestricted exemplary embodiment.With reference to one The structure that exemplary embodiment shows or described can be combined with the structure of other embodiments.This modification and variations It is included within the scope of the invention.

It is disclosed herein or claimed be used to manufacturing, formed or in other words article of manufacture or product Any one in method can be used for manufacturing, formed or in other words producing whole or the portion in considered product or product Point, and be used to manufacture, in the case of the part that is formed or in other words produce considered product or product in such method, The remainder of product or product can be in any way (including the use of disclosed herein or claimed for making Make, formed or in other words any one in other methods of article of manufacture or product) produce, and will can so produce Various pieces be combined in any way.Similarly, disclosed herein or claimed any product or Product can individualism, or can exist with reference to any other product or product disclosed in this invention that are compatible with, or Person can exist as the integral part of any other product or product disclosed in this invention that are compatible with.Therefore, with reference to Special characteristic, structure or the characteristic that a kind of product, product or method show or described can completely or partially (without limitation) It is combined with feature, structure or the characteristic of one or more other compatible products, product or method.This modification and Variations are included within the scope of the invention.

Herein by reference to the open the particular embodiment of the present invention of certain figures or other means, or particular product, product Or in the case that method may include specific structure, characteristic or feature, reader should be understood, it means that these structures, characteristic, Or feature can be implemented in considered product, product or method in any suitable combination.Specifically, multiple optionally knots Such disclosure of structure, characteristic or feature should be understood to disclose whole combinations of these structures, characteristic or feature, exception Situation is to be published as the structure, characteristic or feature of mutual alternate forms.It is disclosed in this class formation, characteristic or feature In the case of mutual alternate forms, this should be understood open these alternate forms as mutual substitute.

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

Various exemplary means and method are provided to perform laparoscopic type and minimally invasive surgical procedures.However, reader Will readily appreciate that, various method and apparatus disclosed herein can be used for a variety of surgical operations and application (including with it is open outer Section's operation combines) in.With continued reference to present embodiment, reader will be further understood that, various apparatuses disclosed herein can In any way in insertion body, for example, by natural cavity, pass through the otch being formed in tissue or puncturing hole etc..The work of apparatus Patient's body can be inserted directly into or can be inserted by the device that enters with service aisle by making part or end effector portion, outside The end effector and slender axles of section's apparatus can be promoted by the service aisle.

Accompanying drawing is gone to, wherein in multiple views, similar numeral represents similar component, and Fig. 1, which is shown, to be put into practice The surgical instruments 10 of some unique benefits.Surgery suturing appliance 10 is designed to manipulate and/or activated and is operationally attached Arrive the end effector 12 of various forms and size thereon.In Fig. 1-Fig. 1 E, such as end effector 12 includes elongated lead to Road 14, the elongated passageway form the lower jaw 13 of end effector 12.Elongated passageway 14 can support " implanted " nail bin 30 simultaneously And support the anvil block 20 of the upper jaw 15 as end effector 12 with can also moving.

Elongated passageway 14 can be made up of such as 300＆400 series, 17-4＆17-7 stainless steels, titanium etc., and can be with being spaced apart Side wall 16 formed together.Anvil block 20 can be made up of such as 300＆400 series, 17-4＆17-7 stainless steels, titanium etc., and can have There is nail shaped lower face (being generally designated as 22), the nail shaped lower face has multiple nail shapes pits formed therein 23.Referring to Figure 1B-Fig. 1 E.In addition, anvil block 20 have from its to nearside it is raised be divided into two-part slide assemblies 24.Anvil block pin 26 from each side extending projections of slide assemblies 24, with the respective slots or opening 18 being contained in the side wall 16 of elongated passageway 14 It is interior, so as to be advantageous to by anvil block pin it is movable or be pivotably attached to the respective slots or opening on.

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

In use, once end effector 12 positions adjacent to target tissue, end effector 12 is just manipulated to target Tissue capture is clamped between the top surface 36 of nail bin 30 and the nail profiled surface 22 of anvil block 20.Nail 32 is in the following way Shaping：Anvil block 20 is set to be moved in the path for being arranged essentially parallel to elongated passageway 14, so that nail profiled surface 22 and more specifically Nail shapes pit 23 therein is set substantially simultaneously to contact the top surface 36 of nail bin 30.When anvil block 20 continues to move to nail bin 30 When middle, follow closely 32 leg 34 contacted in anvil block 20 corresponding to nail shapes pit 23, the nail shapes pit be used for bend nail leg 34 So that nail 32 is configured to " B shapes ".The further motion of anvil block 20 towards elongated passageway 14 will compress further nail 32 and make its shaping For desired final forming height " FF ".

Above-mentioned nail forming process is substantially illustrated in Figure 1B-Fig. 1 E.For example, Figure 1B shows end effector 12, wherein target Tissue " T " is located between anvil block 20 and the top surface 36 of implanted nail bin 30.Fig. 1 C show the initial clamped position of anvil block 20, Wherein anvil block 20 is closed up to target tissue " T ", and target tissue " T " is clamped in the top surface 36 of anvil block 20 and nail bin 30 Between.Fig. 1 D show initial nail shaping, and wherein anvil block 20 has started to compress nail bin 30 so that the leg 34 for following closely 32 begins through anvil block Nail shapes pit 23 in 20 and shape.Fig. 1 E are shown through target tissue " T " and the nail 32 in final molding condition, are clear For the sake of removed anvil block 20.Once nail 32 shapes and is fastened to target tissue " T ", surgeon just makes anvil block 20 move to open position Put, to enable warehouse 31 and nail 32 remain attached to target tissue when withdrawing from end effector 12 from patient.When two jaws During 13,15 common clamping, end effector 12 makes all nails while shaped.Remaining " by conquassation " material of main part 31 is used as only Blood agent (ORC) and staple line reinforcing agent (other film compositions 38 of PGA, PDS or any of above).Further, since nail 32 is in the shaping phase Between need not leave warehouse 31, therefore follow closely 32 possibilities for being changed into deformity during shaping and be minimized.As used herein, term " implanted " refers in addition to nail, and the warehouse material of support nail also would be held in patient's body and finally can be inhaled by patient body Receive.Such implanted nail bin is different from previous nail bin structure, and the previous nail bin construction is still complete afterwards by percussion at it Site preparation is positioned in end effector.

In various specific implementations, end effector 12 can be connected to the Slender axles assembly from the projection of shank assembly 100 40.End effector 12 (in closure) and elongation assembly 40 can have similar shape of cross section, and its size is set It is fixed into passing through trocar tube or service aisle with another access instruments formal operations.As used herein, term is " operationally Through " refer to that passage can be inserted or may pass through at least a portion of end effector and Slender axles assembly by passage or tube opening Or tube opening, and it can be manipulated to complete surgery stitching operation if necessary in passage or tube opening.When in closure During position, the jaw 13 and 15 of end effector 12 can provide the shape of cross section of substantial circular in favor of it for end effector Through path/opening of circle.It is contemplated, however, that the end effector and Slender axles assembly of the present invention are provided with other cross sections Shape, entering path and opening with non-circular transverse cross-section are passed through so as to other modes.Therefore, the end of closure The overall dimension of the cross section of actuator by end effector intend through passage or opening size it is related.Therefore, one Individual end effector is for example referred to alternatively as " 5mm " end effector, and this refers to that it operationally can be at least about through diameter 5mm opening.

Slender axles assembly 40 can have the external diameter of substantially equal with the external diameter of end effector 12 in the close position.Example Such as, 5mm end effectors can be connected to the Slender axles assembly 40 with 5mm cross-sectional diameters.It is however, specific real with continued reference to this Apply mode, it will be apparent that, the present invention can be effectively combined various sizes of end effector and use.For example, 10mm ends Portion's actuator could attach to the slender axles with 5mm cross-sectional diameters.On the contrary, opened for wherein providing 10mm or bigger entrance For the application of mouth or passage, Slender axles assembly 40 can have 10mm (or bigger) cross-sectional diameter, but can also activate 5mm Or 10mm end effectors.Therefore, the external diameter of outer shaft 40 can be with the external diameter phase for the end effector 12 for being attached to closure thereon It is same or different.

As illustrated, Slender axles assembly 40 is distally extending substantially along straight line from shank assembly 100, to limit longitudinal direction Axis A-A.For example, Slender axles assembly 40 can be about 9-16 inches (229-406mm) length.However, Slender axles assembly 40 is settable For other length, or there can be joint wherein or can otherwise be advantageous to end effector 12 relative to axle or handle The other parts of parts carry out joint motions, and following article will be discussed in more detail.Slender axles assembly 40 includes ridge component 50, should Ridge component extends to end effector 12 from shank assembly 100.The proximal extremity of the elongated passageway 14 of end effector 12 has Lug 17 is kept from a pair of its projection, this is sized to receive in the distal end of ridge component 50 to holding lug In the corresponding lug opening or support 52 that are provided, so that end effector 12 can removedly couple Slender axles assembly 40.Ridge component 50 can be by being made such as 6061 or 7075 aluminium, stainless steel, titanium.

Shank assembly 100 includes pistol grasping type shell, and the pistol grasping type shell can be made into for assembling purpose Two or more parts.For example, shank assembly 100 as depicted is included by polymer or plastic material molding or with other Mode is manufactured and is designed to right hand housing member 102 and the left hand housing member (not shown) being combined together.It can pass through The snap in features structure, bolt and the pod that mold or otherwise formed wherein, and/or will by adhesive, screw etc. Such housing member is attached together.Ridge component 50 has proximal extremity 54, formed with flange 56 in the proximal extremity.Flange 56 can be pivotally supported in groove 106, and the groove is by from each cooperation to inner process in housing member 102,104 Rib 108 is formed.Such construct is advantageous to ridge component 50 and is attached to shank assembly 100, while enables ridge component 50 relative to handle Parts 100 rotate along 360 ° of paths around longitudinal axis A-A.

As in Fig. 1 it can further be shown that ridge component 50 is through axle bush 60 and is supported by axle bush 60, the installation Axle bush 60 is pivotally attached to shank assembly 100.Axle bush 60 have proximal flange 62 and distal lip 64, and it limits rotation Turn groove 65, the leading edge portion 101 of shank assembly 100 can be rotatably received within therebetween by the rotated trench.This construction Axle bush 60 are enable to be rotated relative to shank assembly 100 around longitudinal axis A-A.Ridge component 50 can not be revolved by ridge pin 66 Turn ground pin joint to axle bush 60.In addition, knob 70 is attached to axle bush 60.For example, knob 70 has hollow mounting flange Portion 72, the hollow mounting flange portion are sized to accommodate a part for axle bush 60 wherein.Knob 70 can be by Such as glass or carbon filled nylon, makrolon,Etc. being made, and axle bush are attached to also by ridge pin 66 60.In addition, the holding flange 74 to inner process, which is formed in mounting flange portion 72 and can extend to, is formed at axle bush 60 In radial groove 68 in.Therefore, surgeon can by firmly grasping knob 70 and it is rotated relative to shank assembly 100, and Ridge component 50 (and be attached to end effector 12) thereon is set to be rotated around longitudinal axis A-A along 360 ° of paths.

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

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

Trigger system 109 also includes firing trigger 130, and the firing trigger is used to control firing tube 110 in ridge component Axial direction traveling on 50.Referring to Fig. 1.The such axial direction for firing and interacting with anvil block 20 is formed along the distal direction of firing tube 110 Motion is referred to herein as " firing action ".As can be seen in Figure 1, firing trigger 130 by pivot pin 132 movingly Or it is pivotally coupled to shank assembly 100.Firing trigger 130 is biased away from shank assembly using torsionspring 135 100 pistol grip portion 107 and reach " opening " or original position not activated.As can be seen in Figure 1, firing trigger 130 have top 134, and the top is movingly attached (pin joint) and arrives percussion chain link 136, and the percussion chain link is movingly attached (pin joint) arrives support lining ring 120.Therefore, firing trigger 130 is from original position (Fig. 1) towards the pistol of neighbouring shank assembly 100 The motion of the final position of formula grip portion 107 will cause percussion yoke 114 and firing tube 110 to be moved along distal direction " DD ".Hit The motion (under bias force of torsionspring 135) for sending out pistol grip portion 107 of the trigger 130 away from shank assembly 100 will Percussion yoke 114 and firing tube 110 is caused to be moved in ridge component 50 along proximal direction " PD ".

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

A kind of method that end effector 12 is removably coupled to ridge component 50 will be explained now.By that elongated will lead to Start connection process in the lug support 52 in holding lug 17 insertion ridge component 50 on road 14.Then, surgeon will Firing trigger 130 promotes towards the pistol grip 107 of casing assembly 100, by the percussion adapter of firing tube 110 and first 140 are advanced distally on the proximal end portions 47 of elongated passageway 14, so as to which lug 17 is maintained at into its respective support In 52.Such position of first percussion adapter 140 on lug 17 is referred to herein as " coupled position ".The present invention can also have There is end effector locked component for firing trigger 130 being locked after being attached to ridge component 50 in end effector 12 It is scheduled on appropriate location.

More particularly, one embodiment of end effector locked component 160 includes retaining pin 162, the retaining pin quilt It is movably supported in the top 134 of firing trigger 130.As described above, firing tube 110 must be distad pushed into first To coupled position, wherein the holding lug 17 of end effector 12 is maintained in ridge component 50 by the first percussion adapter 140 In lug support 52.Surgeon is held in the mouth by pulling firing trigger 130 from original position towards pistol grip 107 and will fire Connect son 140 and be advanced distally into coupled position.When firing trigger 130 is activated first, the distal motion of retaining pin 162, Until the first percussion adapter 140 is advanced to coupled position by firing tube 110, now retaining pin 162, which is biased to, is formed at shell In latch well 164 in body component.Optionally, when retaining pin 162 enters in latch well 164, pin 162 can send audible " clicker " sound or other sound, and provide the tactile that end effector 12 has been " locked " in ridge component 50 for surgeon Instruction.As long as in addition, retaining pin 162 intentionally is not biased out into latch well 164, surgeon just will not continue unintentionally to activate Firing trigger 130 is to start to make the nail 32 in end effector 12 to shape.Similarly, if surgeon's release is in connection The firing trigger 130 of position, then retaining pin 162 firing trigger 130 can be made to be maintained at the position, to prevent firing trigger 130 are back to original position and therefore discharge end effector 12 from ridge component 50.

The present invention may also include trigger system locking press button 137, and the trigger system locking press button is with can be pivotably It is attached to shank assembly 100.In one form, trigger system locking press button 137 has the door bolt formed in its distal end Lock 138, the breech lock are oriented to engage percussion yoke 114 when firing release button and being in the first position latching.As in Fig. 1 may be used Find out, late spring 139 is used to trigger system locking press button 137 being biased to the first position latching.In all cases, breech lock 138 are used to engage percussion yoke 114 at following point：At this point, the position correspondence of the percussion yoke 114 in ridge component 50 is in wherein First percussion adapter 140 will be advanced to the point in the clamping slideway 28 on anvil block 20 towards distal side.It should be appreciated that with first Axially to promoting in clamping slideway 28, anvil block 20 will move percussion adapter 140 along path so that nail forming surface portion 22 It is arranged essentially parallel to the top surface 36 of nail bin 30.

After end effector 12 is connected to ridge component 50, opened by depressing trigger system locking press button 137 first Begin nail forming process so that percussion yoke 114 can in ridge component 50 further distal motion and most anvil block 20 compresses at last Into nail bin 30.After trigger system locking press button 137 is depressed, surgeon, which continues to activate towards pistol grip 107, to be fired Trigger 130, so as to which the driving of the first nail lining ring 140 is shaped on slideway 29 to corresponding nail, to force anvil block 20 and nail bin The shaping contact of nail 32 in 30.Trigger system locking press button 137 prevents from being not intended to before surgeon is ready to start the process Ground shapes nail 32.In this embodiment, surgeon must depress before firing trigger 130 can be further actuated and hit System lock button 137 is sent out to start to follow closely forming process.

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

Cutter conveyer also includes the second cutter tooth wheel 194, and second cutter tooth wheel is pivotally supported on second gear axle And engaged with first cutter tooth wheel 192.Second cutter tooth wheel 194 engages with the 3rd gear shaft 196 being supported on the 3rd gear shaft.The Four cutter tooth wheels 198 are also supported on the 3rd gear shaft 195.4th cutter tooth wheel 198 can be driven the nearside for being bonded on knife bar 180 A series of gear teeths or ring on end.Therefore, this construction enable 4th cutter tooth wheel 198 along distal direction " DD " or Proximal direction " PD " axially trigger shaft 180, while make trigger shaft 180 surround longitudinal axis relative to 4th cutter tooth wheel 198 A-A rotates.Therefore, surgeon can by towards shank assembly 100 pistol grip 107 pull cutter traveling trigger 200 and Make trigger shaft 180 axially promote and most all morning distal side promote cutter component 172.

Present invention additionally comprises cutter locking system 210, the cutter locking system prevents the propulsion of cutter component 172, unless percussion is touched Hair device 130 has been pulled to complete firing position.Therefore, this structure will prevent the activation of knife propulsion system 170, unless nail is Fired or formed in tissue first.As can be seen in Figure 1, the various specific implementations of cutter locking system 210 are locked including knife Fixed pole 211, the cutter securing rod is can pivotably be supported in the pistol grip portion 107 of shank assembly 100.Knife locks Bar 211 has activated end 212, and when firing trigger 130 is in complete firing position, activated end 212 can be triggered by percussion Device 130 engages.In addition, cutter securing rod 211 has on the other end thereof keeps suspension hook 214, the holding suspension hook can be with suspension hook side Latch bar 216 on formula engagement the first cutting gear 192.Cutter securing rod 211 is biased to by " lock using Lock spring 218 It is fixed " position, wherein keep suspension hook 214 to keep engaging with latch bar 216, so as to prevent the actuating of cutter traveling trigger 200, unless Firing trigger 130 is in complete firing position.

After nail is " fired " (shaping) into target tissue, surgeon can depress percussion trigger release button 167, So that firing trigger 130 can be back to original position under the biasing of torsionspring 135, so that anvil block 20 can be in bullet The biasing of spring 21 biases downwards into open position.When in open position, surgeon can withdraw from end effector 12 and leave Implanted nail bin 30 and nail 32.In the application for passing through passage, service aisle etc. in wherein end effector and being inserted into, surgery doctor Life will make anvil block 20 be back to closing position by activating firing trigger 130, so that end effector 12 can be by logical Road or service aisle are withdrawn by.However, if surgeon wants to cut target tissue after percussion nail, more than surgeon The mode of stating activates cutter traveling trigger 200, reaches the end of end effector through target tissue with trigger shaft 172.Then, outside The releasable cutter traveling trigger 200 of section doctor, so that percussion return spring 202 can make percussion conveyer return knife bar 172 It is back to starting and (does not activate) position.Once knife bar 172 is back to original position, surgeon can open end effector jaw 13rd, 15, implanted storehouse 30 is released to patient's body and then withdraws from end effector 12 from patient's body.Therefore, it is such Surgical instruments be advantageous to using can be by relatively small service aisle and passage to be inserted into small implanted nail bin, simultaneously Following selection is provided for surgeon：Also cut after percussion nail in the case of not cutting tissue or if necessary in percussion nail Tissue.

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

Optionally, the amount with reference to the firing action for above, being applied to removable anvil block depends on the actuating of firing trigger Degree.If for example, surgeon go for only part shaping nail, only need towards pistol grip 107 partly to Interior pressure firing trigger.More nail shapings are obtained, surgeon only needs further to compress firing trigger so that anvil block Contacted by further driving with being formed with nail.As used herein, term " shaping contact " refer to follow closely profiled surface or nail into Shape pit has contacted the end of nail leg and has had started to that leg is shaped or bent to shaping position.The degree of nail shaping refers to nail leg quilt The degree of folding and the forming height for finally referring to nail referred to above.Those skilled in the art will further manage Solution, because when applying firing action to anvil block 20, anvil block 20 is moved with the relation substantially parallel with nail bin, so Nail substantially simultaneously shapes and has substantially the same forming height.

Fig. 2 and Fig. 3 shows alternative end effector 12 ", except the following difference that can accommodate knife bar 172 ' Outside, end effector 12 " is similar to above-mentioned end effector 12 '.Knife bar 172 ' is connected to knife bar 180 or prominent from knife bar 180 Rise, and in addition operated in a manner of above in connection with described in knife bar 172.However, in this embodiment, knife bar 172 ' long enoughs do not use single distal blade to traverse the whole length of end effector 12 " in end effector 12 " Component.Knife bar 172 ' has the upper cross member 173 ' being formed thereon and lower cross member 175 '.The upper quilt of cross member 173 ' The respective elongated slit 250 slidably traversed in anvil block 20 " is orientated to, and lower cross member 175 ' is oriented to traverse end Elongated slot 252 in the elongated passageway 14 " of actuator 12 ".Depart from slit (not shown) to be also disposed in anvil block 20 " so that When knife bar 172 ' has been driven to the final position in end effector 12 ", upper cross member 173 ' is dropped through corresponding Slit departs from the tissue of suture and cutting to allow anvil block 20 " to move to open position.Anvil block 20 " can in addition with it is above-mentioned Anvil block 20 is identical, and elongated passageway 14 " can be in addition identical with above-mentioned elongated passageway 14.

In these embodiments, anvil block 20 " is biased to fully open position by spring or other open configuration (not shown) (Fig. 2).Advance and in open position and clamping completely the axial direction that anvil block 20 " is carried out in the above described manner by percussion adapter 150 Moved between position.Once percussion adapter 150 is advanced into fully clamped position (Fig. 3), surgeon can be then with above-mentioned Mode promotes knife bar 172 " towards distal side.If surgeon wants end effector carrying out manipulating tissue as grasp device, Percussion adapter can proximally be moved, to allow anvil block 20 " to be moved away from elongated passageway 14 ", as shown in phantom in figure 4. In this embodiment, as knife bar 172 " moves towards distal side, upper cross member 173 ' and lower cross member 175 ' pull anvil together Seat 20 " and elongated passageway 14 ", to realize that desired nail shapes when knife bar 172 " promotes through end effector 12 " towards distal side. Referring to Fig. 5.Therefore, in this embodiment, nail shaping is and tissue cutting while occurred, but nail in itself can be in knife bar 172 " towards remote Side sequentially shapes when driving.

The various surgery nail bins of the present invention and unique and new feature structure of surgical instruments make the nail in the nail bin One or more line linearly or nonlinearly can be arranged in.A plurality of this staple line, institute can be provided with each side of elongated slot State elongated slot to be centrally arranged in nail bin, for accommodating the tissue cutting element passed through.In one kind constructs, example As nail into a line can be substantially parallel to the nail in the adjacent lines of nail but deviate with it.As other alternate forms, One or more staple line can be essentially nonlinear.That is, the base portion of at least one nail in staple line can be along substantially Traverse the axis extension of the base portion of other nails in same staple line.For example, staple line of the elongated slot per side can have outside zigzag See.

According to the present invention, nail bin may include warehouse and the multiple nails being stored in warehouse.In use, nail bin can be introduced In operative site and it is located at the side of handled tissue.In addition, can be by nail shaping anvil positioning in the relative of tissue On side.Anvil block can be carried by the first jaw and nail bin can be carried by the second jaw, wherein the first jaw and/or the second jaw can Moved towards another jaw.Once nail bin and anvil block are positioned relative to tissue, then nail can be projected from staple cartridge body so that nail can pierce Wear tissue and contact stud shaping anvil block.Once disposing nail from staple cartridge body, then and then staple cartridge body can be removed from operative site.Nail bin Or implantable at least a portion of nail bin there is nail.For example, following article is more fully described, nail bin may include warehouse, work as anvil When seat moves to closing position from open position, the warehouse can be compressed by anvil block, crushes and/or collapse.When warehouse compressed, is pressed When bursting and/or collapsing, the nail being positioned in warehouse can be deformed by anvil block.Alternatively, the pincers of nail bin are supported Mouth can move to closing position towards anvil block.Two kinds of situations it is any in, when nail is positioned at least partially in warehouse, nail It is deformable.In some cases, nail can not project from nail bin, and in other cases, nail can in company with warehouse a part together Projected from nail bin.

Referring now to Fig. 6 A- Fig. 6 D, compressible nail bin (such as nail bin 1000) for example may include compressible, implanted warehouse 1010, and the multiple nails 1020 being also located in compressible warehouse 1010, but Fig. 6 A- Fig. 6 D only show a nail 1020. Fig. 6 A show the nail bin 1000 supported by nail bin supporting member or staple cartridge channel 1030, and wherein nail bin 1000 is shown in uncompressed Condition.In this uncompressed condition, anvil block 1040 is accessible or does not contact tissue T.In use, anvil block 1040 can be from opening Position moves to contact tissue T, as shown in Figure 6B, and tissue T is positioned against warehouse 1010.Even if anvil block 1040 can be by group Knit the tissue contacting surface 1019 that T is located against staple cartridge body 1010, but referring again to Fig. 6 B, staple cartridge body 1010 now can be through By few (if any) compression stress or pressure, and follow closely 1020 and be positively retained at unshaped or do not fire condition.Such as Fig. 6 A Shown in Fig. 6 B, staple cartridge body 1010 may include one or more layers, and follows closely 1020 nail leg 1021 to may pass through these layers upward Extension.Warehouse 1010 may include first layer 1011, the second layer 1012, third layer 1013 and the 4th layer of 1014, the wherein second layer 1012 can be positioned among first layer 1011 and third layer 1013, and wherein third layer 1013 can be positioned on the second layer 1012 and the 4th Among layer 1014.For example, the base portion 1022 of nail 1020 can be positioned in the cavity 1015 in the 4th layer 1014, and nail leg 1021 It can upwardly extend from base portion 1022 and through the 4th layer 1014, third layer 1013 and the second layer 1012.Optionally, it is each variable Shape leg 1021 may include top, such as sharp top 1023, such as when nail bin 1000 is in uncompressed condition, this is sharp Top can be positioned in the second layer 1012.For example, top 1023 can be not extend to and/or through first layer 1011, wherein working as nail When storehouse 1000 is in uncompressed condition, top 1023 not projecting can pass through tissue contacting surface 1019.When nail bin is in uncompressed During condition, sharp top 1023 can be positioned in third layer 1013 and/or any other suitable layer.Alternatively select To select, the warehouse of nail bin can have any suitable number of layers, such as less than four layers or more than four layers.

Optionally, following article is more fully described, and first layer 1011 can be by buttress material and/or plastic material (example Such as, polydioxanone (PDS) and/or polyglycolic acid (PGA)) form, and the second layer 1012 can be by bioabsorbable Foamed material and/or compressible hemostatic material (for example, oxidized regenerated cellulose (ORC)) are formed.Optionally, first layer 1011, Nail 1020 can be maintained in staple cartridge body 1010 by the second layer 1012, third layer 1013 and the 4th layer one or more of 1014, And nail 1020 can be made to keep being mutually aligned in addition.Third layer 1013 can be by buttress material or quite incompressible or non-ballistic Property material form, the material can by follow closely 1020 nail leg 1021 be held in place by relative to each other.In addition, it is positioned at The second layer 1012 and the 4th layer of 1014 motion that can stablize or reduce nail 1020 on three layer 1013 of opposite side, even if the second layer 1012 and the 4th layer 1014 can be made up of compressible foam or elastomeric material.The screw top end 1023 of nail leg 1021 can be at least partly In ground insertion first layer 1011.For example, first layer 1011 and third layer 1013 can be collaboratively and firmly by nail legs 1021 are held in place by.First layer 1011 and third layer 1013 can be respectively by such as bioabsorbable material (such as with business Polyglycolic acid (PGA), PLA (PLA or PLLA), polydioxanone (PDS), the poly- hydroxyl chain of name of an article Vicryl sales Alkanoic acid ester (PHA), with trade name Monocryl sell Poliglecaprone 25 (PGCL), polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL and/or PCL compound) thin slice form, and the second layer 1012 and the 4th layer 1014 can be distinguished It is made up of at least one hemostatic material or styptic.

Although first layer 1011 can be compressible, but the second layer 1012 can more be pressed substantially than first layer 1011 Contracting.For example, the compressibility of the second layer 1012 can be about twice, about three times, about four times, about five times of first layer 1011 and/or About ten times.In other words, for given power, the compression degree of the second layer 1012 can be about twice of first layer 1011, about three Again, about four times, about five times, and/or about ten times.The compressibility of the second layer 1012 for example can about twice of first layer 1011 with Between about ten times.The second layer 1012 may include to be defined in multiple air gaps therein, wherein the amount of the air gap in the second layer 1012 and/ Or size can be controlled to provide the expectation compressibility of the second layer 1012.It is similar to the above, although third layer 1013 can be can Compression, but the 4th layer 1014 can substantially have more compressibility than third layer 1013.For example, the 4th layer of 1014 presses Contracting can be about twice, about three times, about four times, about five times, and/or about ten times of third layer 1013.In other words, for given Power, the 4th layer 1014 of compression degree can be about twice, about three times, about four times, about five times of third layer 1013, and/or about Ten times.4th layer 1014 of compressibility can be between about twice of third layer 1013 and about ten times.It may include for 4th layer 1014 Multiple air gaps therein are defined in, wherein the amount and/or size of the air gap in the 4th layer 1014 can be controlled to provide the 4th The expectation compressibility of layer 1014.In all cases, can (that is, layer be directed to what the power of given size was compressed by compression ratio Distance) express the compressibility of warehouse or warehouse layer.For example, compared with the layer compared with little compressible, there is high compression rate Layer will compress bigger distance for the compression stress applied to the given size of this layer.For so, the second layer 1012 is comparable First layer 1011 has higher compression ratio；Similarly, there is higher compression ratio than third layer 1013 for the 4th layer 1014.The Two layer 1012 and the 4th layer 1014 can be made up of and can have identical compression ratio identical material.The second layer 1012 and the 4th Layer 1014 can be made up of the material with different compression ratios.Similarly, first layer 1011 and third layer 1013 can be by identical materials Material forms and can have identical compression ratio.First layer 1011 and third layer 1013 can be by the material structures with different compression ratios Into.

When anvil block 1040 is advanced towards its closing position, anvil block 1040 can contact tissue T and tissue T and nail bin 1000 applied Compressive forces, as shown in Figure 6 C.In this case, anvil block 1040 can push down on warehouse 1010 towards nail bin supporting member 1030 Top surface or tissue contacting surface 1019.Nail bin supporting member 1030 may include storehouse stayed surface 1031, and it can be in nail bin 1000 support nail bin 1000 when being compressed between storehouse stayed surface 1031 and the tissue contacting surface 1041 of anvil block 1040.Due to The pressure applied of anvil block 1040, warehouse 1010 can be compressed and the accessible nail 1020 of anvil block 1040.More particularly, warehouse The moving downward of 1010 compression and tissue contacting surface 1019 can make the top 1023 of nail leg 1021 pierce through the of warehouse 1010 In forming pit 1042 in one layer 1011, puncture tissue T and entrance anvil block 1040.When warehouse 1010 enters one by anvil block 1040 During step compression, the accessible wall for limiting forming pit 1042 in top 1023, and for example therefore leg 1021 can be deformed inward or roll up Song, as shown in Figure 6 C.When nail leg 1021 is deformed, equally as shown in Figure 6 C, the base portion 1022 for following closely 1020 can contact nail bin branch Support member 1030 is supported by nail bin supporting member 1030.Optionally, as described in greater detail below, nail bin supporting member 1030 may include Multiple support feature structures, such as nail support trenches, slit or groove 1032, the multiple support feature structure can be in nails 1020 When being deformed support nail 1020 or at least nail 1020 base portion 1022.Equally as shown in Figure 6 C, apply to the pressure of staple cartridge body 1010 Contracting power can make the cavity 1015 in the 4th layer 1014 collapse.In addition to cavity 1015, staple cartridge body 1010 may also include one or more Individual space (such as space 1016), such as may include in one or more of spaces or do not include the one of nail being positioned in Part, one or more of spaces can allow for warehouse 1010 to collapse.Cavity 1015 and/or space 1016 can collapse, and make The wall that cavity and/or wall must be limited deflects down and contacts storehouse stayed surface 1031 and/or contact warehouse 1010 is positioned at chamber Layer below body and/or space.

In relatively Fig. 6 B and Fig. 6 C, it is clear that the second layer 1012 and the 4th layer of 1014 compression applied by anvil block 1040 Pressure is substantially compressed.It may also be noted that first layer 1011 and third layer 1013 are also compressed.When anvil block 1040 moves to its closure During position, anvil block 1040 can continue further compression by pushing down on tissue contacting surface 1019 towards nail bin supporting member 1030 Warehouse 1010.When warehouse 1010 is further compressed, anvil block 1040 can make nail 1020 be deformed into it to be fully formed shape, such as scheme Shown in 6D.Referring to Fig. 6 D, the leg 1021 of each nail 1020 can deform downwards towards the base portion 1022 of each nail 1020, so as to by tissue T, first layer 1011, the second layer 1012, third layer 1013 and the 4th layer 1014 at least a portion are captured in deformable leg 1021 Between base portion 1022.In relatively Fig. 6 C and Fig. 6 D, more obviously, the second layer 1012 and the 4th layer 1014 are further by anvil block 1040 compression pressures applied are significantly compression.In relatively Fig. 6 C and Fig. 6 D it may also be noted that first layer 1011 and third layer 1013 are also further compressed.Nail 1020 by completely or at least fully shape after, anvil block 1040 can away from tissue T and by Lift, and nail bin supporting member 1030 can it is remote and/or depart from nail bin 1000 move.As shown in Figure 6 D and due to described above, Warehouse 1010 is implantable nail 1020.In various embodiments, the warehouse 1010 being implanted can be along staple line supporting tissue.At some In the case of, styptic and/or any other suitable medicine that the warehouse 1010 of implantation includes can elapse over time To handle tissue.Styptic as described above can reduce the tissue bleeding of suture and/or cutting, while bonding agent or tissue adhesion Agent can over time elapse and provide intensity for tissue.The warehouse 1010 being implanted into can be by such as ORC (oxidized regenerated cellulose), thin Extracellular protein (such as collagen), the polyglycolic acid (PGA) sold with trade name Vicryl, PLA (PLA or PLLA), poly- dioxy Heterocycle hexanone (PDS), polyhydroxyalkanoatefrom (PHA), with trade name Monocryl sell Poliglecaprone 25 (PGCL), gather oneself The material of lactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL and/or PCL compound is formed.In some cases, storehouse Body 1010 may include the antibiosis and/or anti-biotic material that can for example reduce the possibility of surgical site infection, such as collargol and/ Or triclosan.

The layer of warehouse 1010 can be connected with each other.For example, using at least one adhesive (such as fibrin and/or Protein hydrogel) second layer 1012 is adhered to first layer 1011, third layer 1013 is adhered to the second layer 1012, and by It is adhered to third layer 1013 for four layer 1014.Although being not shown, the layer of warehouse 1010 can be connected by interlocking machine feature structure Together.For example, first layer 1011 and the second layer 1012 can each include corresponding interlocking features structure, such as tenon groove structure And/or dovetail structure.Similarly, the second layer 1012 and third layer 1013 can each include corresponding interlocking features structure, Third layer 1013 and the 4th layer 1014 can each include corresponding interlocking features structure simultaneously.Although being not shown, nail bin 1000 may include for example one or more rivets, and one or more rivets can extend across the one or more of warehouse 1010 Layer.For example, each rivet may include the first end that adjacent first layer 1011 positions or head and it is neighbouring 4th layer 1014 and Second head of positioning, the 4th layer of second end that can be assembled into rivet or is formed by the second end of rivet.For example, by In the compressible character of warehouse 1010, rivet compressible warehouse 1010 so that the head of rivet can be relative to the group of warehouse 1010 Knit contact surface 1019 and/or lower surface 1018 is recessed.For example, rivet can be by bioabsorbable material (such as with commodity Polyglycolic acid (PGA), PLA (PLA or PLLA), polydioxanone (PDS), the poly- hydroxyalkanoate that name Vicryl is sold Acid esters (PHA), with trade name Monocryl sell Poliglecaprone 25 (PGCL), polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL and/or PCL compound) form.In addition to nail 1020 accommodated in by warehouse 1010, warehouse 1010 Layer can not be connected to each other.For example, being frictionally engaged between nail leg 1021 and warehouse 1010 can for example protect the layer of warehouse 1010 Hold together, and once nail shaping, then the layer, which can be trapped in, follows closely in 1020.At least a portion of nail leg 1021 may include The roughened surface or rough coatings of the frictional force between nail 1020 and warehouse 1010 can be increased.

As described above, surgical instruments may include the first jaw and the second jaw, the first jaw includes nail bin supporting member 1030, Second jaw includes anvil block 1040.Optionally, described in greater detail below, nail bin 1000 may include one or more holding knots Structure, one or more holding structures can engage nail bin supporting member 1030 and therefore releasably hold nail bin 1000 Nail bin supporting member 1030.For example, it be able to will be followed closely by least one adhesive (such as, fibrin and/or protein hydrogel) Storehouse 1000 adheres to nail bin supporting member 1030.In use, in the case of at least one, especially in laparoscopic type and/or interior In sight glass type operation, the second jaw is moveable to the closing position relative with the first jaw, such as causes the first jaw and second Jaw can be inserted into operative site by trochar.For example, trochar can limit about 5mm hole or intubation, the first jaw It can be inserted into the second jaw by it.Second jaw is moveable to the part in an open position between closing position and closed Position is closed, the partial closed position can allow the first jaw and the second jaw to be inserted into through trochar, without making staple cartridge body Nail 1020 accommodated in 1010 deforms.For example, when the second jaw is in the centre position of its part closure, anvil block 1040 can Do not apply compression stress to staple cartridge body 1010, but when the second jaw is in the centre position of its part closure, anvil block 1040 can press Contracting staple cartridge body 1010.Although the compressible nail bin body 1010 when anvil block 1040 is in this centre position, but anvil block 1040 can Incompletely compress staple cartridge body 1010 so that the contact stud 1020 of anvil block 1040 and/or nail 1020 is deformed by anvil block 1040.One The jaw of denier first and the second jaw are inserted into operative site by trochar, then the second jaw can be opened again, and Anvil block 1040 and nail bin 1000 can be positioned relative to target tissue as described above.

Referring now to Fig. 7 A- Fig. 7 D, the end effector of surgical stapling device may include to be positioned at anvil block 1140 and nail bin branch Implanted nail bin 1100 among support member 1130.Similar to the above, anvil block 1140 may include tissue contacting surface 1141, nail bin 1100 may include tissue contacting surface 1119, and nail bin supporting member 1130 may include the support surface that can support nail bin 1100 1131.Referring to Fig. 7 A, tissue T is located against the tissue contacting surface 1119 of nail bin 1100 without making using anvil block 1140 Nail bin 1100 deforms, and when anvil block 1140 is in this position, tissue contacting surface 1141 can be positioned so that and nail bin branch The distance 1101a of surface 1131 is supportted, and tissue contacting surface 1119 can be positioned so that with nail bin support surface 1131 apart Distance 1102a.Then, when anvil block 1140 moves towards nail bin supporting member 1130, referring now to Fig. 7 B, anvil block 1140 can push down on The top surface or the first layer 1111 and the second layer 1112 of tissue contacting surface 1119 and nail bin support member 1110 of dynamic nail bin 1100. As layer 1111 and layer 1112 are compressed, referring again to Fig. 7 B, the second layer 1112 can be by conquassation, and the leg 1121 of nail 1120 can Pierce through first layer 1111 and enter in tissue T.For example, nail 1120 can be positioned at least partially at the nail cavity in the second layer 1112 Or in space 1115, and when the second layer 1112 is compressed, nail cavity 1115 is collapsible and therefore allows the second layer 1112 to surround Nail 1120 is collapsed.The second layer 1112 may include cover 1116, and the cover may extend away on nail cavity 1115 and surround or extremely Partially surround nail cavity 1115.Fig. 7 B show the covering part 1116 for being pressed downward and bursting in nail cavity 1115.The second layer 1112 It may include one or more weakening parts, it can be advantageous to collapsing for the second layer 1112.Optionally, such weakening part may include Such as the controllable cut collapsed, perforation and/or the thin cross section of warehouse 1110 can be advantageous to.First layer 1111 may include energy Enough be advantageous to one or more weakening parts that nail leg 1121 penetrates first layer 1111.Optionally, such weakening part may include Such as cut, perforation and/or the thin cross section that can be alignd with nail leg 1121 or at least substantially align.

Referring again to Fig. 7 A, when anvil block 1140 is in the non-firing position of part closure, anvil block 1140 can be positioned so that With the distance 1101a of storehouse stayed surface 1131 so that define gap therebetween.This gap can be by with nail bin height 1102a Nail bin 1100 and tissue T filling.When anvil block 1140 is moved downward to compress nail bin 1100, referring again to Fig. 7 B, tissue connects Touching the distance between surface 1141 and storehouse stayed surface 1131 can be limited by the distance 1101b for being shorter than distance 1101a.In various feelings Under condition, the gap limited by distance 1101b between the tissue contacting surface 1141 and storehouse stayed surface 1131 of anvil block 1140 can More than original undeformed nail bin height 1102a.Referring now to Fig. 7 C, when anvil block 1140 is moved to closer to storehouse stayed surface When 1131, the second layer 1112 can continue to collapse and the distance between nail leg 1121 and forming pit 1142 can reduce.Similarly, The distance between tissue contacting surface 1141 and storehouse stayed surface 1131 can be reduced to distance 1101c, and the distance can be greater than, equal to Or less than original not deformed storehouse height 1102a.Referring now to Fig. 7 D, anvil block 1140 is moveable to final firing position, its Middle nail 1120 is fully formed or is at least shaped to Desired Height.In this position, the tissue contacting surface 1141 of anvil block 1140 Can be with the distance 1101d of storehouse stayed surface 1131, wherein distance 1101d can be shorter than original not deformed storehouse height 1102a.Together As illustrated in fig. 7d, nail cavity 1115 can completely or at least substantially be collapsed sample, and nail 1120 can completely or at least substantially be collapsed The second layer 1112 of contracting surrounds.In all cases, anvil block 1140 can be moved then away from nail bin 1100.Once for example, anvil block 1140 depart from from nail bin 1100, then warehouse 1110 for example, at least can partly spread over various positions (that is, adjacent nail again Position between 1120) in.The warehouse 1110 of conquassation may not extend resiliently again.The nail 1120 of shaping is determined with other Warehouse 1110 of the position between adjacent nail 1120 can apply pressure or compression stress to tissue T, and this can provide various treatment benefits.

As described above, referring again to Fig. 7 A, each nail 1120 may include the nail leg 1121 extended from.For example, although nail 1120 to be shown be to include two nail legs 1121, but can also be used may include a nail leg or alternatively include The various nails of more than two nail legs (such as three nail legs or four nail legs).As shown in Figure 7 A, each nail leg 1121 can be embedded in In the second layer 1112 of warehouse 1110 so that nail 1120 is fixed in the second layer 1112.Nail 1120 can be inserted into warehouse 1110 Nail cavity 1115 in so that the top 1123 of nail leg 1121 is advanced into cavity 1115 base portion 1122.In the quilt of top 1123 Insert after cavity 1115, top 1123 can be pressed against in cover 1116 and cut the second layer 1112.Nail 1120 can be sat Put enough depths in the second layer 1112 so that nail 1120 is not moved relative to the second layer 1112 or do not transported at least substantially It is dynamic.Nail 1120 can be rested upon enough depths into the second layer 1112 so that base portion 1122 is positioned or embedded nail cavity 1115 In.Alternatively, base portion 1122 can not be positioned or be embedded in the second layer 1112.Referring again to Fig. 7 A, base portion 1122 can extend below the lower surface 1118 of warehouse 1110.Base portion 1122 can be bearing in storehouse stayed surface 1130 or directly Positioned against storehouse stayed surface 1130.Storehouse stayed surface 1130 may include from its extension and/or be limited to support feature therein Structure, for example, nail 1120 base portion 1122 can be positioned in such as one or more of nail bin supporting member 1130 support trenches, Supported in slit or groove 1132 or by one or more support trenches, slit or groove 1132, as described in more detail below.

Referring now to Fig. 8 and Fig. 9, nail bin (such as nail bin 1200) for example may include compressible implanted warehouse 1210, The warehouse includes outer layer 1211 and internal layer 1212.Similar to the above, nail bin 1200 may include to be positioned at multiple in warehouse 1210 Nail 1220.Optionally, each nail 1220 may each comprise base portion 1222 and one or more nail legs 1221 from its extension.Example Such as, nail leg 1221 can be inserted into internal layer 1212 and be rested upon to for example making the base portion 1222 of nail 1220 abut and/or neighbouring internal layer The depth that 1212 lower surface 1218 positions.In figs. 8 and 9, internal layer 1212 does not include can receive nail 1220 one The nail cavity divided, and alternatively, internal layer 1212 may include such nail cavity.Further described above, internal layer 1212 can be by can allow for the compressible material that warehouse 1210 is collapsed when applying compressive load to it (such as bioabsorbable Foam and/or oxidized regenerated cellulose (ORC)) form.Internal layer 1212 can be by for example including PLA (PLA) and/or PVOH The freeze dried foam of sour (PGA) is formed.ORC can be commercially available with trade name Surgicel and may include loose Woven fabric (as surgical sponge), loose fiber (as cotton balls) and/or foam.Internal layer 1212 can by including and/or on Material of the face coated with medicine (fibrin ferment and/or fibrin that are such as freeze-dried) is formed, and the medicine can for example be suffered from Fluid water activation and/or activation in person's body.For example, the fibrin ferment and/or fibrin of freeze-drying are positively retained at for example In Vicryl (PGA) matrix.However, in some cases, such as when nail bin 1200 is inserted into the operative site of patient's body When, activable medicine can be activated inadvertently.Referring again to Fig. 8 and Fig. 9, outer layer 1211 can be by fluid-tight or at least basic Upper material impervious to water is formed so that liquid does not contact or not contacted at least substantially internal layer 1212, until warehouse 1210 by Compress and nail leg has been penetrated after outer layer 1211 and/or after outer layer 1211 cut in some manner.For example, outer layer 1211 can be by buttress material and/or plastic material (such as polydioxanone (PDS) and/or polyglycolic acid (PGA)) structure Into.Outer layer 1211 may include the wrappage of wrappage around internal layer 1212 and nail 1220.More particularly, nail 1220 can be inserted into internal layer 1212 and outer layer 1211 in and around include internal layer 1212 and follow closely 1220 sub-component and be wrapped and be subsequently sealed.

As described herein, when anvil block moves to closing position, the nail of nail bin can be fully formed by anvil block.As other one Kind selection, referring now to Figure 10-Figure 13, such as nail of the nail bin of nail bin 4100 for example can be by moving to closing position when anvil block When anvil block, and additionally by make nail towards closure anvil block move Staple drivers system and deform.Nail bin 4100 may include Compressible warehouse 4110, the compressible warehouse for example by foamed material and can be positioned at least partially at compressible warehouse Multiple nails 4120 in 4110 are formed.Staple drivers system may include driver clamper 4160, be positioned at driver clamper Staple drivers 4162 can be maintained at driving by multiple staple drivers 4162 and cartridge tray 4180 in 4160, the cartridge tray In device clamper 4160.For example, staple drivers 4162 can be positioned on one or more of driver clamper 4160 slit In 4163, wherein the side wall of slit 4163 can help to boot up staple drivers 4162 towards anvil block.Nail 4120 can be by staple drivers 4162 are supported in slit 4163, wherein when following closely 4120 and staple drivers 4162 are in its non-firing position, nail 4120 can be complete It is positioned at entirely in slit 4163.Alternatively, when following closely 4120 and staple drivers 4162 are in its non-firing position, The openend 4161 that at least a portion of nail 4120 may pass through slit 4163 upwardly extends.For example, referring now primarily to Figure 11, nail 4120 base portion can be positioned in driver clamper 4160, and the top of nail 4120 can be embedded in compressible warehouse 4110 It is interior.About 1/3rd height of nail 4120 can be positioned in driver clamper 4160, and follow closely about 2/3rds of 4120 Height can be positioned in warehouse 4110.It is may also include referring to Figure 10 A, such as nail bin 4100 around warehouse 4110 and driver folder The water impervious wrappage or film 4111 of holder 4160.

In use, for example, nail bin 4100 can be positioned in staple cartridge channel, and anvil block can be moved to towards nail bin 4100 and closed Close position.When anvil block moves to its closing position, anvil block can contact and compress compressible warehouse 4110.When anvil block is in it During closing position, anvil block can not contact stud 4120.When anvil block moves to its closing position, the leg of the accessible nail 4120 of anvil block is simultaneously And at least in part deform nail 4120.In any case, nail bin 4100 may also include one or more sliding parts 4170, institute Stating one or more sliding parts can be in nail bin 4100 along being longitudinally propelling so that sliding part 4170 can then engage staple drivers 4162 And staple drivers 4162 and nail 4120 is set to be moved towards anvil block.Sliding part 4170 can cartridge tray 4180 and staple drivers 4162 it Between slide.In the case where the closure of anvil block starts the forming process of nail 4120, nail 4120 moves upwards towards anvil block can be complete Into forming process and nail 4120 is set to be deformed into height or at least desired height that it is fully formed.Do not make nail in the closure of anvil block In the case of 4120 deformations, nail 4120 moves upwards towards anvil block can start and complete forming process and nail 4120 is deformed into it The height or at least desired height being fully formed.Sliding part 4170 can be advanced to nail bin 4100 from the proximal extremity of nail bin 4100 Distal end so that before the nail 4120 in the distal end for being positioned at nail bin 4100 is fully formed, be positioned at nail bin Nail 4120 in 4100 proximal extremity is fully formed.Referring to Figure 12, sliding part 4170 can each include at least one angled Or inclined surface 4711, it can slide below staple drivers 4162 and lift staple drivers 4162 as shown in figure 13.

Further described above, nail 4120 can be formed, so as to by least a portion of tissue T and nail bin 4100 Compressible warehouse 4110 at least a portion capture wherein.After the shaping of nail 4120, the anvil block and nail of surgical stapling device Warehouse channel 4130 can move away from the nail bin 4100 being implanted into.In all cases, nail bin can be fixedly engaged in storehouse dish 4180 Passage 4130, wherein as a result, when staple cartridge channel 4130 is pulled away from the warehouse 4110 being implanted into, storehouse dish 4180 can be with that can press The warehouse 4110 of contracting separates.Referring again to Figure 10, storehouse dish 4180 may include relative side wall 4181, and warehouse 4110 can be removed Ground is positioned between the relative side wall 4181.For example, compressible warehouse 4110 can be compressed between side wall 4181 so that Warehouse 4110 can be removably retained in therebetween during use, and when storehouse dish 4180 are pulled away from, and warehouse 4110 is from storehouse dish 4180 releasedly depart from.For example, driver clamper 4160 may be connected to storehouse dish 4180 so that when storehouse dish 4180 are from Surgery When displacement removes, driver holder 4160, driver 4162 and/or sliding part 4170 are positively retained in storehouse dish 4180.Driver 4162 can project and stay in operative site from driver clamper 4160.For example, driver 4162 can be by bioabsorbable Material (such as with trade name Vicryl sell polyglycolic acid (PGA), PLA (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoatefrom (PHA), the Poliglecaprone 25 (PGCL) sold with trade name Monocryl, polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL and/or PCL compound) form.Driver 4162 could attach to nail 4120 so that driver 4162 is deployed with nail 4120.For example, each driver 4162 may include for example accommodate nail 4120 The groove of base portion, wherein the groove can in a manner of pressure cooperation and/or snap fit accommodate base portion.

Further described above, driver clamper 4160 and/or sliding part 4170 can project from storehouse dish 4180. For example, sliding part 4170 can slide between storehouse dish 4180 and driver clamper 4160 so that when sliding part 4170 promote with When driving up staple drivers 4162 and nail 4120, sliding part 4170 also can make driver clamper 4160 move upward to storehouse dish Outside 4180.For example, driver clamper 4160 and/or sliding part 4170 can be by bioabsorbable materials (such as with commodity Polyglycolic acid (PGA), PLA (PLA or PLLA), polydioxanone (PDS), the poly- hydroxyalkanoate that name Vicryl is sold Acid esters (PHA), with trade name Monocryl sell Poliglecaprone 25 (PGCL), polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL and/or PCL compound) form.Sliding part 4170 can be integrally formed and/or be attached to driving rod or cut Cut component, the driving rod or cutting element and promote sliding part 4170 through nail bin 4100.In this case, sliding part 4170 can not be projected from storehouse dish 4180 and can be kept together with surgical stapling device, and sliding part 4170 is not attached to wherein In other situations of driving rod, sliding part 4170 can be stayed in operative site.In any case, to further being retouched above To state, the compressibility of warehouse 4110 can allow to use thicker nail bin in the end effector of surgical stapling device, because When the anvil block closure of stitching unstrument, warehouse 4110 is compressible or collapses.Deformed at least in part as being followed closely when anvil block closes Result, higher nail (such as with about 0.18 " nail of staple height), such as wherein about 0.12 can be used " staple height can quilt Be positioned in compressible stratum 4110, and wherein compressible stratum 4110 can have about 0.14 " uncompressed height.

As described herein, multiple nails can be included in nail bin wherein.Optionally, such nail can be by being deformed into substantially U Shape configuration and the metal wire rod composition with two nail legs.It is contemplated that wherein nail may include that various configuration (is such as engaged with Together and with three or more nail legs two or more wire rods) alternate forms.For forming one or more followed closely Individual wire rod may include cross section that is circle or at least substantially justifying.Staple line material may include any other suitable cross section, such as The cross section of square and/or rectangle.Nail can be made up of plastic wire.Nail can be made up of the metal wire rod coated with plastics.Root According to the present invention, storehouse may include the fastener for any suitable type that in addition to nail or substitution is followed closely.For example, this fastener may include Pivotable arm, the arm can be folded when being engaged by anvil block.Two-part fastener can be used.For example, nail bin may include Multiple first fastener portions, and anvil block may include multiple second fastener portions；When anvil block is compressed against nail bin, second Fastener portion is connected to the first fastener portion.As described above, sliding part or driver can be promoted in nail bin to complete nail Forming process.Sliding part or driver can be promoted in anvil block, to make one or more formed parts move downwardly to and phase To nail bin and nail or the fastener that is positioned in nail bin engage.

As described herein, nail bin may include to be stored in four nails row therein.Four nails row can be configured to two Inner side nail row and two outside nail rows.For example, inner side nail row and outside nail row can be positioned in cutting element or knife in nail bin On first side of slit；Similarly, inner side nail row and outside nail row can be positioned on the second side of cutting element or cutter slit. Nail bin may not include cutting element slit wherein；However, the replacement as nail bin slit, this nail bin may include can be by cutting element The specified portions of incision.Similarly, inner side nail row can be arranged in nail bin so that its with cutting element slit wherein equidistantly or extremely It is few to be substantially equally spaced.Similarly, outside can be followed closely into row to be arranged in nail bin so that it is equidistant with cutting element slit wherein Ground is at least substantially equally spaced.According to the present invention, nail bin, which may include to be stored in nail bin, is more or less than four Nail row.Nail bin may include six nail rows.Gone for example, nail bin can include three nails on the first side of cutting element slit wherein, and Include three nails on the second side of cutting element slit wherein to go.Nail bin may include odd number nail row.For example, nail bin can be in cutting structure Include two nails on first side of part slit to go, and include three nails on the second side of cutting element slit wherein and go.Staple can Including with identical or at least substantially identical unshaped staple height nail.Alternatively, one or more nails Row may include the nail with the unshaped staple height different from other nails.For example, the nail on the first side of cutting element slit wherein can With the first unshaped height, and the nail on the second side of cutting element slit wherein can have the second unshaped height, and this second Unshaped is highly different from the first height.

Optionally, as described above, nail bin may include warehouse, the warehouse is limited to nail cavity therein including multiple.Warehouse can Including platform and top platform surface, wherein each nail cavity can limit the opening in platform surface.As also described above, nail can be determined Position is in each nail cavity so that nail is stored in warehouse until it is shot up from warehouse.Before being shot up from warehouse, nail can It is accommodated in warehouse so that nail is not projecting to platform surface top.In such cases, when nail is positioned under platform surface Fang Shi, nail can be reduced and be damaged and/or the possibility of premature contact destination organization.In all cases, nail can not fire position Put and moved between firing position, in non-firing position, it is not from warehouse projection, and in firing position, it reveals from warehouse Go out and can contact the anvil block for being positioned in nail bin opposite.Anvil block and/or the forming pit being defined in anvil block can be positioned so that away from Preset distance above platform surface so that when nail is disposed from warehouse, nail is deformed into predetermined forming height.In certain situation Under, the thickness variable for the tissue being trapped between anvil block and nail bin, therefore, thicker tissue can be trapped in some nails And relatively thin tissue can be trapped in other some nails.In either case, by nail be applied to tissue clamping pressure or Power for example can be different because of nail, or changes between the nail on the nail and the other end of nail row on one end of nail row.In some situations Under, it can control the gap between anvil block and nail bin platform so that nail applies a certain minimum clamping pressure in each nail.But In some such cases, the significant changes of the clamping pressure in different nails may possibly still be present.Surgery suturing appliance exists The United States Patent (USP) No.7 that on June 3rd, 2008 announces, has in 380,696 disclosed, and the complete disclosure of the patent is with the side of reference Formula is incorporated herein.For the illustrative multi-stroke handle of surgical stapling and cutting off apparatus in CO-PENDING and jointly owned name Referred to as " SURGICAL STAPLING INSTRUMENT INCORPORATING A MULTISTROKE FIRING POSITION Carried out in INDICATOR AND RETRACTION MECHANISM " U.S. Patent application No.10/374,026 in more detail Description, the disclosure of the patent application is incorporated by reference in its entirety accordingly.Meeting the other application of the present invention can combine Single firing schedule, such as in CO-PENDING and jointly owned entitled " SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS " U.S. Patent applications No.10/441,632 Described in, the disclosure of the patent application is incorporated by reference in its entirety accordingly.

As described herein, nail bin may include following device：The device is used for the tissue to being captured out of cartridge deployment nail Thickness compensate.Referring to Figure 14, nail bin (such as nail bin 10000) for example may include that rigid Part I (such as supports Part 10010) and compressible Part II (such as thickness compensation part 10020).Referring first to Figure 16, support section 10010 may include warehouse, top platform surface 10011 and multiple nail cavities 10012.Wherein, it is similarly as described above, each nail cavity 10012 can limit the opening in platform surface 10011.Nail 10030 can be for example removably positioned in each nail cavity 10012 In.For example, each nail 10030 may include base portion 10031 and the one or more deformation legs 10032 extended from base portion 10031. Nail 10030 is by before deployment, and also as described in more detail below, the base portion 10031 for following closely 10030 can be by being positioned at support section Staple drivers support in 10010, while, following closely 10030 leg 10032 can at least be partly accommodated in nail cavity 10012. Nail 10030 can be disposed between non-firing position and firing position so that leg 10032 moves across tissue thickness compensation part 10020, the top surface of tissue thickness compensation part 10020 is penetrated, penetrates tissue T, and contacts that to be positioned in nail bin 10000 right The anvil block in face.When leg 10032 is against deflection, the leg 10032 of each nail 10030 can capture tissue thickness compensation part A part for 10020 part and the tissue T in each nail 10030, and apply compressive force to tissue.To entering above Row further describes, and the leg 10032 of each nail 10030 can be made to be deformed downwardly toward the base portion 10031 of nail, to form nail retention region 10039, in the nail retention region, tissue T and tissue thickness compensation part 10020 can be captured.In all cases, nail retention area Domain 10039 can be limited between the inner surface of strained leg 10032 and the inner surface of base portion 10031.Nail retention region Size may depend on a number of factors, such as the diameter of the length of leg, leg, the width of base portion, and/or such as degree of leg deformation.

Before this, surgeon usually needs to select to have the appropriate nail of appropriate staple height for the tissue being just sewn. It is used together and select low nail to be used together with thin tissue with thick tissue for example, high nail may be selected in surgeon.But In some cases, the tissue being just sewn does not have consistent thickness, and therefore, some nails can not realize desired percussion structure Type.For example, Figure 48 is shown for compared with the higher nail in thin tissue.Referring now to Figure 49, when tissue thickness compensation part (such as Tissue thickness compensation part 10020) for example when thin tissue is used together, such as larger nail can shape as desired percussion structure Type.

Due to the compression ratio of tissue thickness compensation part, the thickness for the tissue that tissue thickness compensation part can be to capture in each nail Degree compensates.More specifically, referring now to Figure 43 and Figure 44, tissue thickness compensation part (such as tissue thickness compensation part 10020) each nail 10030 can be for example occupied according to the thickness and/or type of the tissue accommodated in nail retention region 10039 The larger and/or smaller portions of nail retention region 10039.For example, it is trapped in compared to thicker tissue T in nail 10030 Situation, if relatively thin tissue T is trapped in nail 10030, tissue thickness compensation part 10020 can occupy nail retention region 10039 major part.Correspondingly, the situation in nail 10030 is trapped in compared to relatively thin tissue T, if thicker group Knit T to be trapped in nail 10030, then tissue thickness compensation part 10020 can occupy the smaller portions of nail retention region 10039.This Sample, tissue thickness compensation part can compensate for compared with thin tissue and/or compared with thick tissue, and ensure that compression stress is applied to tissue, regardless of whether No matter the or tissue thickness being at least substantially trapped in nail.In addition to the above, tissue thickness compensation part 10020 can compensate to the different type or the tissue of different compression ratios being trapped in different nails 10030.Referring now to figure 44, tissue thickness compensation part 10020 can apply compressive force to the vascular tissue T that may include blood vessel V, and therefore limit blood stream Less compressible blood vessel V is crossed, but desired compression pressure is still applied to the tissue T of surrounding.In all cases, it is right It is described further above, tissue thickness compensation part 10020 can also compensate for strained nail.Referring to Figure 45, various nails 10030 Deformation can cause to be limited to larger nail retention region 10039 in such nail.Due to returning for tissue thickness compensation part 10020 Elastic force, it is fixed even if being limited at such nail retention region 10039 become in staple 10030 can be extended referring now to Figure 46 Enough compression stresses can be still applied to tissue having become the tissue thickness compensation part 10020 in staple 10030 by position.In various feelings Under condition, the tissue thickness compensation part 10020 among adjacent nail 10030 can have been become appropriate shaping around staple 10030 Nail 10030 biased against tissue T, and therefore compression pressure is applied to for example to surround and/or be trapped in and has become staple Tissue in 10030.In all cases, tissue thickness compensation part can compensate for different tissue densities, the different tissue Density can be produced for example due to classification, zone of fiber, and/or the previous tissue for having sutured or having handled.

According to the present invention, tissue space fix or unmodifiable can be limited between support section and anvil block, because No matter how the thickness of this tissue being trapped in nail can make nail be deformed into predetermined height.When tissue thickness compensation part is used When such situation, tissue thickness compensation part is suitable for the tissue being trapped between anvil block and support section nail bin, and by In the screen resilience of tissue thickness compensation part, additional compression stress can be applied to tissue by tissue thickness compensation part.Referring now to figure 50-55, formed nail 10030 is predetermined height H.Reference picture 50, tissue thickness compensation part is not used, and tissue T Occupy whole nail retention region 10039.Reference picture 57, a part for tissue thickness compensation part 10020 have been trapped in nail In 10030, tissue T is compressed, and has occupied at least a portion of nail retention region 10039.Referring now to Figure 52, thin group T is knitted to be trapped in nail 10030.In this embodiment, the tissue T compressed has about 2/9H height, and is compressed Tissue thickness compensation part 10020 there is e.g., from about 7/9H height.Referring now to Figure 53, there is the tissue T of interior thickness It is trapped in nail 10030.In this embodiment, the tissue T compressed has about 4/9H height, and the tissue compressed Thickness compensation part 10020 has e.g., from about 5/9H height.Referring now to Figure 54, the tissue T with interior thickness has been captured In nail 10030.In this embodiment, the tissue T compressed has about 2/3H height, and the tissue thickness compressed is mended Repaying part 10020 has e.g., from about 1/3H height.Referring now to Figure 53, thick tissue T has been trapped in nail 10030.In the reality Apply in example, the tissue T compressed has about 8/9H height, and the tissue thickness compensation part 10020 compressed has for example About 1/9H height.In all cases, tissue thickness compensation part may include compression height, and the compression height includes：E.g., from about 10% nail retention height, about 20% nail retention height, about 30% nail retention height, about 40% nail retention height, about 50% nail retention height, about 60% nail retention height, about 70% nail retention height, about 80% nail retention height and/ Or about 90% nail retention height.

Nail 10030 may include any suitable unshaped height.Nail 10030 may include for example between about 2mm and about 4.8mm Between unshaped height.Nail 10030 may include e.g., from about 2.0mm, about 2.5mm, about 3.0mm, about 3.4mm, about 3.5mm, about 3.8mm, about 4.0mm, about 4.1mm, and/or about 4.8mm unshaped height.Following closely deformable height H can be by support section The distance between 10010 platform surface 10011 and relative anvil block determine.The tissue of platform surface 10011 and anvil block connects It may be, for example, about 0.097 to touch the distance between surface ".Height H can also be determined by the depth for the forming pit being limited in anvil block. Forming pit can be for example with the depth measured from tissue contacting surface.Optionally, as described in more detail below, nail bin 10000 Staple drivers are may also include, the staple drivers 10030 can lift nail towards anvil block, and nail be lifted or " excessively driving " is to flat The top of platform surface 10011.In this case, the distance that 10030 forming height H can be also overdriven by nail 10030 is followed closely To determine.For example, nail 10030 can be overdriven e.g., from about .028 ", and nail 10030 can be caused to be shaped as e.g., from about 0.189 " height.Nail 10030 can be shaped as e.g., from about 0.8mm, about 1.0mm, about 1.5mm, about 1.8mm, about 2.0mm and/ Or about 2.25mm height.Nail can be shaped as the height for example between about 2.25mm and about 3.0mm.To entering to advance above One step is described, and the height of the nail retention region of nail can be determined by the width and diameter of the forming height followed closely and the wire rod including nail It is fixed.The height of the nail retention region 10039 of nail 10030 may include that the forming height H of nail subtracts two diameter widths of wire rod.Nail Wire rod may include e.g., from about 0.0089 " diameter.Staple line material may include for example between about 0.0069 " and about 0.0119 " Diameter.For example, the forming height H of nail 10030 can be about 0.189 ", and follow closely gauge or diameter of wire can be about 0.0089 ", so as to for example The nail retention height of generation about 0.171 ".

Further described above, tissue thickness compensation part may include height that is unpressed or disposing in advance, and Can be deformed into multiple compression heights one.Tissue thickness compensation part may include e.g., from about 0.125 " uncompressed height. Tissue thickness compensation part may include to be greater than or equal to about 0.080 " uncompressed height.Tissue thickness compensation part may include not The height of compression or pre- deployment, this is highly more than the non-firing height of nail.The unpressed or pre- portion of tissue thickness compensation part The height of administration is for example high by about 10% than the non-firing height of nail, high by about 20%, high by about 30%, high by about 40%, high by about 50%, high About 60%, it is high by about 70%, high by about 80%, high about 90%, and/or high by about 100%.Tissue thickness compensation part it is unpressed or pre- Non- firing height height such as at most about 100% of the height of deployment than nail.The unpressed or pre- portion of tissue thickness compensation part The height of administration is than the non-firing height height followed closely for example more than 100%.Tissue thickness compensation part may include not firing equal to nail The uncompressed height of height.Tissue thickness compensation part may include the uncompressed height of the non-firing height less than nail.Tissue thickness Compensating part unpressed or the height disposed in advance are for example low than the non-firing height of nail about 10%, low about 20%, low about 30%th, low about 40%, low about 50%, low about 60%, low about 70%, low about 80%, and/or low about 90%.Compressible second Part may include uncompressed height, and the uncompressed height is higher than the uncompressed height for the tissue T being just sewn.Tissue thickness compensates Part may include uncompressed height, and the uncompressed height is equal to the uncompressed height for the tissue T being just sewn.Tissue thickness compensation part It may include uncompressed height, the uncompressed height is less than the uncompressed height for the tissue T being just sewn.

As described above, whether thick tissue or thin tissue are trapped in nail, tissue thickness compensation part can be multiple Compressed in forming nail.For example, the nail deformation in staple line or nail row can be made so that the nail retention region each followed closely is included e.g., from about 2.0mm height, wherein tissue T and tissue thickness compensation part can be compressed within the height.In some cases, tissue T It may include the compression height of the about 1.75mm in nail retention region, and tissue thickness compensation part may include in nail retention region About 0.25mm compression height, so as to obtain adding up to e.g., from about 2.0mm nail retention region height.In some cases, Tissue T may include the compression height of the about 1.50mm in nail retention region, and tissue thickness compensation part may include to retain in nail The compression height of about 0.50mm in region, so as to obtain adding up to e.g., from about 2.0mm nail retention region height.In some feelings Under shape, tissue T may include the compression height of the about 1.25mm in nail retention region, and tissue thickness compensation part may include following closely The compression height of about 0.75mm in retention area, so as to obtain adding up to e.g., from about 2.0mm nail retention region height.At certain Under a little situations, tissue T may include the compression height of the about 1.0mm in nail retention region, and tissue thickness compensation part may include The compression height of about 1.0mm in nail retention region, so as to obtain adding up to e.g., from about 2.0mm nail retention region height. In some cases, tissue T may include the compression height of the about 0.75mm in nail retention region, and tissue thickness compensation part can It is included in the compression height of the about 1.25mm in nail retention region, so as to obtain adding up to e.g., from about 2.0mm nail retention region Highly.In some cases, tissue T may include the compression height of the about 1.50mm in nail retention region, and tissue thickness is mended Repaying part may include the compression height of the about 0.50mm in nail retention region, be cut so as to obtain adding up to e.g., from about 2.0mm nail Stay region height.In some cases, tissue T may include the compression height of the about 0.25mm in nail retention region, and organize Thickness compensation part may include the compression height of the about 1.75mm in nail retention region, so as to obtain adding up to e.g., from about 2.0mm Nail retention region height.

Further described above, tissue thickness compensation part may include the uncompressed height of the firing height less than nail Degree.Tissue thickness compensation part may include the uncompressed height of the firing height equal to nail.Tissue thickness compensation part may include to be higher than The uncompressed height of the firing height of nail.For example, the uncompressed height of tissue thickness compensation part may include for example following thickness, should Thickness for forming nail height about 110%, about the 120% of forming nail height, about the 130% of forming nail height, forming nail height About 140%, about the 150% of forming nail height, about the 160% of forming nail height, about the 170% of forming nail height, forming nail About the 180% of height, about the 200% of about the 190% of forming nail height, and/or forming nail height.Tissue thickness compensation part can wrap Uncompressed height is included, the uncompressed height is more than twice of the firing height of nail.Tissue thickness compensation part may include that compression is high Degree, the compression height are about the 85% to about 150% of such as forming nail height.Optionally, as described above, tissue thickness compensation part It can be compressed between uncompressed thickness and compressed thickness.The compressed thickness of tissue thickness compensation part may be, for example, that it is not pressed About the 10% of contracting thickness, about the 20% of its uncompressed thickness, about the 30% of its uncompressed thickness, the pact of its uncompressed thickness 40%th, its uncompressed thickness about 50%, about the 60% of its uncompressed thickness, its uncompressed thickness about 70%, its is uncompressed About the 90% of about the 80% of thickness, and/or its uncompressed thickness.The uncompressed thickness of tissue thickness compensation part can be pressed for example than it About twice, about ten times, about 50 times, and/or about 100 times of contracting thickness thickness.The compressed thickness of tissue thickness compensation part can be between it Between about the 60% of uncompressed thickness and about 99%.The uncompressed thickness of tissue thickness compensation part is than its compressed thickness thickness at least 50%.The uncompressed thickness of tissue thickness compensation part is than at most 100 times of its compressed thickness thickness.Compressible Part II can To be elastic, or at least partly elasticity, and tissue T can be biased against the deformation leg of nail.For example, compressible second Point can between tissue T and the base portion of nail resilient expansion, so as to against the leg pushes against tissue T of nail.The further detailed institute of following article State, tissue thickness compensation part can be positioned among tissue T and deformation nail leg.In all cases, due to described above, tissue Thickness compensation part can eliminate any gap in nail retention region.

Tissue thickness compensation part may include the material characterized by one or more of following characteristics：For example, bio-compatible Property, bioresorbable, bioresorbability, biological durability, biological degradability, compressibility, fluid absorbency, swellability, Self-expanding, bioactivity, medicine, pharmaceutical activity, Adhesion Resistance, hemostatic, antibiotic property, microbial resistance, antiviral property, battalion Nourish one's nature, cohesive, permeability, hydrophily, and/or hydrophobicity.It can be wrapped according to the present invention, including the surgical instruments of anvil block and nail bin The tissue thickness compensation part related to anvil block and/or nail bin is included, the tissue thickness compensation part is included in following material at least It is a kind of：Styptic (for example, fibrin and fibrin ferment), antibiotic (for example, doxycpl) and medicine are (for example, matrix is golden Proteases (MMP)).

Tissue thickness compensation part may include synthesis and/or non-synthetic materials.Tissue thickness compensation part may include polymer group Compound, the polymer composition include one or more synthetic polymers and/or one or more non-synthetic polymers.Synthesis Polymer may include the absorbable polymer of synthesis and/or the non-absorbable polymer of synthesis.Polymer composition can wrap Include such as biocompatible foam.Biocompatible foam may include for example porous open celled foam and/or porous closed pore bubble Foam.Biocompatible foam can be with uniform pore morphology or can be with gradient pore form (whole foam i.e., in one direction On thickness, gradually increase becomes macropore to orifice size).Polymer composition may include porous support, porous matrix, gel base Matter, hydrogel matrix, solution matrix, thread matrix, tubulose matrix, composite interstitial substance, membrane matrix, Biostatic polymer and Ke Sheng One or more and combinations thereof in the polymer of thing degraded.For example, tissue thickness compensation part may include by thread The foam of matrix enhancement, or may include the foam with additional hydrogel layer, the additional hydrogel layer is in the presence of body fluid Extension, organizationally to further provide for compressing.According to the present invention, tissue thickness compensation part can also be by material and/or the second layer Or the coating in third layer is formed, the coating extends in the presence of body fluid, organizationally to further provide for compressing.Such layer can For hydrogel, the hydrogel can be synthesis and/or natural source material, and for example can be that biology is durable and/or can biology Degraded.Tissue thickness compensation part may include microgel or nanogel.Hydrogel may include to carry out the micro- solidifying of self-carbon water compound Glue and/or nanogel.The usable fibrous nonwoven material or web that additional flexibility, rigidity, and/or intensity can be provided Eye type element strengthens tissue thickness compensation part.According to the present invention, tissue thickness compensation part has porous form, the porous State shows gradient-structure, such as aperture on a surface and larger hole on the other surface.Such form It is even more ideal for tissue growth or hemostasis behavior.In addition, gradient can also be combined with the bio-absorbable section of change.It is short Phase absorption profile can be preferable, and to solve the problems, such as hemostasis, and Long-term absorption section can solve to make tissue under ne-leakage situation more The problem of healing well.

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

It is the example including but not limited to poly- (lactic acid) (PLA) of absorbable material of synthesis, PLLA (PLLA), poly- Caprolactone (PCL), polyglycolic acid (PGA), PTMC (TMC), polyethylene terephthalate (PET), Polyhydroxyalkanoatefrom (PHA), the copolymer of glycolide and 6-caprolactone (PGCL), glycolide and trimethylene carbonate are total to Polymers, poly- (decanedioic acid glyceride) (PGS), poly- (dioxanone) (PDS), polyester, poly- (ortho esters), polyoxy acid ester, Polyether ester, makrolon, polyesteramide, condensing model, polysaccharide, poly- (ester-acid amide), tyrosine-based polyarylate, polyamine, tyrosine-based Poly- imido-carbonic ester, tyrosine-based polycarbonate, poly- (D, L- lactide-carbamate), poly- (butyric ester), poly- (B- Butyric ester), poly- (E- caprolactones), polyethylene glycol (PEG), poly- [two (carboxyphenoxy) phosphonitriles], poly- (amino acid), intend it is poly- (amino acid), absorbable polyurethane, poly- (phosphine piperazine), polyphosphazene, polyoxyalkylene, polyacrylamide, polymethylacrylic acid hydroxyl second Ester, polyvinylpyrrolidone, polyvinyl alcohol, poly- (caprolactone), polyacrylic acid, poly- acetic acid esters, polypropylene, aliphatic polyester, glycerine, Be copolymerized (ether-ester), poly- oxalic acid alkylidene diol ester, polyamide, poly- (iminocarbonic ester), poly- oxalic acid alkylidene diol ester and Combinations thereof.Polyester may be selected from polylactide, PGA, trimethylene carbonate, polydioxanone, gather oneself in Ester, polybutester and combinations thereof.

The absorbable polymer of synthesis may include for example can with brand name VICRYL (polyglactic910) from Ethicon, Inc. commercially available 90/10 poly- (glycolide-L- lactides) copolymer, can with brand name DEXON from Commercially available American Cyanamid Co. PGA, can be commercially available from Ethicon, Inc. with brand name PDS Polydioxanone, can with brand name MAXON from American Cyanamid Co. it is commercially available it is poly- (glycolide- Trimethylene carbonate) statistic copolymer, can with brand name MONOCRYL from Ethicon companies it is commercially available 75/ One or more in 25 poly- (glycolide-s-caprolactone-poliglecaprolactone 25) copolymers.

The non-absorbable material of synthesis includes but is not limited to polyurethane, polypropylene (PP), polyethylene (PE), poly- carbonic acid It is ester, polyamide, such as nylon, polyvinyl chloride (PVC), polymethyl methacrylate (PMMA), polystyrene (PS), polyester, poly- Ether ether ketone (PEEK), polytetrafluoroethylene (PTFE) (PTFE), polytrifluorochloroethylene (PTFCE), polyvinyl fluoride (PVF), PEP (FEP), polyacetals, polysulfones and combinations thereof.The non-absorbable polymer of synthesis may include but be not limited to elastomer bubble Foam plastics and porous elastomers, such as siloxanes, polyisoprene and rubber.Synthetic polymer may include can be with brand name GORE-TEX soft-tissue patch is from W.L.Gore＆Associates, expanded PTFE commercially available Inc. (ePTFE), And can be with brand name NASOPORE from co-poly ether-ether urethane foam plastic commercially available Polyganics.

Polymer composition may include such as by weight about 50% to about 90% PLLA polymer composition and By weight about 50% to about 10% PCL polymer composition.Polymer composition may include for example by weight about 70% PLLA and by weight about 30% PCL.Polymer composition may include such as by weight about 55% to about The polymer composition of 85% PGA polymer composition and by weight 15% to 45% PCL.Combination of polymers Thing may include such as by weight about 65% PGA and by weight about 35% PCL.Polymer composition may include example Such as by weight about 90% to about 95% PGA polymer composition and by weight about 5% to about 10% PLA Polymer composition.

The absorbable polymer of synthesis may include bioabsorbable, biocompatibility elastomer copolymer.Properly Bioabsorbable, biocompatibility elastomer copolymer include but is not limited to the copolymer of 6-caprolactone and glycolide (mol ratio of 6-caprolactone and glycolide is preferably about 30:70 to about 70:30, it is therefore preferable to 35:65 to about 65:35, it is more excellent Selection of land is 45:55 to 35:65)；6-caprolactone and lactide (including L- lactides, D- lactides, their blend or lactic acid Copolymer) elastomer copolymer (mol ratio of 6-caprolactone and lactide is preferably about 35:65 to about 65:35, and more Preferably 45:55 to 30:70)；To dioxanone (1,4- dioxane -2- ketone) and lactide (including L- third Lactide, D- lactides and lactic acid) elastomer copolymer (mol ratio of dioxanone and lactide is preferably about 40:60 to about 60:40)；6-caprolactone and to the elastomer copolymer of dioxanone (6-caprolactone with to dioxa hexamethylene The mol ratio of ketone is preferably about 30:70 to about 70:30)；The elastomer of dioxanone and trimethylene carbonate is total to Polymers (is preferably from about 30 to the mol ratio of dioxanone and trimethylene carbonate:70 to about 70:30)；Trimethylene carbon (mol ratio of trimethylene carbonate and glycolide is preferably from about 30 to the elastomer copolymer of acid esters and glycolide:70 to about 70: 30)；The elastomer copolymer of trimethylene carbonate and lactide, including L- lactides, D- lactides, they blend or (mol ratio of trimethylene carbonate and lactide is preferably from about 30 to lactic acid copolymer:70 to about 70:30)；And they are total to Mixed thing.Elastomer copolymer can be for the copolymer of glycolide and 6-caprolactone alternatively, and elastomer copolymer is The copolymer of lactide and 6-caprolactone.

Be published on November nineteen ninety-five 21 it is entitled " ELASTOMERIC MEDICAL DEVICE " United States Patent (USP) 5, 468,253 and it is published in entitled " the FOAM BUTTRESS FOR STAPLING APPARATUS " on December 4th, 2001 For the disclosure of United States Patent (USP) 6,325,810 be each hereby incorporated herein by full.

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

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

Polymer composition may include pharmaceutically active agents.The pharmaceutical activity of the releasable therapeutically effective amount of polymer composition Agent.Pharmaceutically active agents can discharge when polymer composition is desorbed or is absorbed.Pharmaceutically active agents, which can be released to, flows through polymerization It is on compositions or interior through the fluid (for example, blood) of polymer composition.The example of pharmaceutically active agents may include but not It is limited to styptic and medicine, such as fibrin, fibrin ferment and oxidized regenerated cellulose (ORC)；Antiinflammatory medicine, for example, it is double Chlorine sweet smell acid, aspirin, naproxen, sulindac and hydrocortisone；Antibiotic and antimicrobial agents or antimicrobial, example Such as triclosan, ionic silver, ampicillin, gentamicin, polymyxin B, chloramphenicol；And anticancer, such as cis-platinum, mitogen Mycin, adriamycin.

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

The polymer composition of tissue thickness compensation part is characterised by such as percent porosity, hole size, and/or hard Degree.Polymer composition can have such as about 30% to about 99% percent porosity by volume.Polymer composition can have There is such as about 60% to about 98% percent porosity by volume.Polymer composition can have such as by volume about 85% To about 97% percent porosity.Polymer composition may include such as by weight about 70% PLLA and by weight about 30% PCL, and may include such as about 90% porosity by volume.For example, therefore, polymer composition will include pressing The copolymer of stereometer about 10%.Polymer composition may include such as by weight about 65% PGA and by weight about 35% PCL, and can have such as about 93% to about 95% percent porosity by volume.Polymer composition may include It is more than 85% porosity by volume.Polymer composition can have e.g., from about 5 microns to about 2000 microns of hole size.It is poly- Polymer composition can have the hole size for example between about 10 microns to about 100 microns.For example, polymer composition can wrap Include such as PGA and PCL copolymer.Polymer composition can have for example between about 100 microns to about 1000 microns Hole size.For example, polymer composition may include such as PLLA and PCL copolymer.

According to some aspects, the hardness of polymer composition can be represented with Shore hardness.The Shore hardness can be defined as The tolerance of the permanent indenture to material such as determined by sclerometer.In order to assess the durometer value of given material, According to entitled " Standard Test Method for Rubber Property-Durometer Hardness " ASTM Program D2240-00, material is applied pressure to hardness head pressure feet, its full text is hereby incorporated herein by.Can be by firmly Degree meter pressure head pin is administered to material and continues enough a period of times, such as 15 seconds, for example, wherein reading is read from suitable scale Take.According to scale type used, when pressure head pin completely penetrates through material, reading 0 can be obtained, and when material is not pierced When, reading 100 can be obtained.The reading dimensionless.Can for example according to ASTM D2240-00 using any suitable scale (for example, A classes and/or OO classes scale) determine hardometer.The polymer composition of tissue thickness compensation part can have about 4A to about 16A's Shore A Hardness value, the Shore A Hardness value is for example in about 45OO to about 65OO Shore OO scopes.For example, polymer composition can Including such as PLLA/PCL copolymers or PGA/PCL copolymers.The polymer composition of tissue thickness compensation part, which can have, to be less than 15A Shore A Hardness value.The polymer composition of tissue thickness compensation part can have the Shore A Hardness value less than 10A.Tissue The polymer composition of thickness compensation part can have the Shore A Hardness value less than 5A.Polymeric material can have e.g., from about 35OO To about 75OO Shore OO composition values.

Polymer composition can have at least two in the above-mentioned characteristic identified.Polymer composition can have above-mentioned At least three kinds in the characteristic identified.Polymer composition can have such as 85% to 97% porosity, 5 micro- by volume Rice is to 2000 microns of hole size and 4A to 16A Shore A Hardness value and 45OO to 65OO shore OO hardness value.Polymerization Compositions may include by weight 70% PLLA polymer composition and by weight 30% PCL polymer group Compound；The polymer composition have for example by volume 90% porosity, 100 microns to 1000 microns of hole size, With 4A to 16A Shore A Hardness value and 45OO to 65OO shore OO hardness value.Polymer composition may include by weight The polymer composition of 65% PGA polymer composition and by weight 35% PCL；The polymer composition tool There are such as 93% to 95% porosity, 10 microns to 100 microns of hole size and 4A to 16A Xiao A hardness by volume The shore OO hardness value of value and 45OO to 65OO.

Thickness Tissue compensating part may include the material of extension.As described above, tissue thickness compensation part may include uncompressed Or the compression material extended during deployment.Tissue thickness compensation part may include to be formed in situ from expansion material.Tissue thickness compensates Part may include at least one precursor, and the precursor is chosen so as to contacting at least one of other precursors, water, and/or body fluid When be spontaneously crosslinked.According to the present invention, other accessible one or more precursors of the first precursor are expansible and/or can be formed The tissue thickness compensation part of swelling.Tissue thickness compensation part may include the swollen composition of fluid-soluble, for example, the group of water-swellable Compound.Tissue thickness compensation part may include hydrogel.

Tissue thickness compensation part may include the biodegradable foam with packaging part, and the packaging part includes being embedded Dried hydrogel particle or granule.Without wishing to be bound by any specific theory, the packaging part in foam can be by making hydrogel The organic solution contact of the aqueous solution and biocompatible materials of precursor is formed with forming foam.Aqueous solution and organic molten Liquid can form micella.Aqueous solution and organic solution can be dried to encapsulate dried hydrogel precursor or the granule in foam. For example, hydrogel precursor (such as hydrophilic polymer) is dissolvable in water water to form the dispersion of micella.Aqueous solution can contact The organic solution of dioxane including poly- (glycolic) and polycaprolactone.Aqueous solution and organic solution can be lyophilized from And formed with the biodegradable foam for disperseing dried hydrogel particle therein or granule.Not by any particular theory Constraint, it is believed that micelle forma-tion packaging part, the packaging part have the dried hydrogel particle that is dispersed in foaming structure or Granule.The packaging part is rupturable, and hydrogel particle or granule can contact fluid (such as body fluid) and extend.

Optionally, as described above, tissue thickness compensation part may include original depth and extension thickness.Tissue thickness compensation part Original depth may be, for example, its extend thickness about 0.001%, its extend thickness about 0.01%, its extend thickness pact 0.1%th, its extend thickness about 1%, its extend thickness about 10%, its extend thickness about 20%, its extend thickness pact 30%th, its extend thickness about 40%, its extend thickness about 50%, its extend thickness about 60%, its extend thickness pact 70%th, it extends about the 90% of about 80%, and/or its extension thickness of thickness.The extension thickness of tissue thickness compensation part can example It is such as thicker than its original depth about 2 times, about 5 times, about 10 times, about 50 times, about 100 times, about 200 times, about 300 times, about 400 times, about 500 times, about 600 times, about 700 times, about 800 times, about 900 times, and/or about 1000 times.The original depth of tissue thickness compensation part Up to its extend thickness 1%, up to its extend thickness 5%, up to its to extend 10% and up to its extension of thickness thick The 50% of degree.The extension thickness of tissue thickness compensation part is than its original depth thickness at least 50%, thicker than its original depth at least 100%th, thicker than its original depth at least 300% and thicker than its original depth by least 500%.As described above, in various situations Under, tissue thickness compensation part can eliminate any gap in nail retention region.

As described above, tissue thickness compensation part may include hydrogel.Hydrogel may include homopolymer hydrogel, copolymer water Gel, multipolymer hydrogel, interpenetrating polymer hydrogel and combinations thereof.Hydrogel may include microgel, nanometer Gel and combinations thereof.Hydrogel can generally include the hydrophilic polymer network that can absorb and/or retain fluid. Hydrogel may include noncrosslinking hydrogel, the hydrogel of crosslinking and combinations thereof.Hydrogel may include to be chemically crosslinked Agent, Physical crosslinking agent, hydrophobic patch and/or the undissolved fragment of water.Hydrogel can by polymerisation, small molecule crosslinking and/ Or Polymer-Polymer is crosslinked to be chemically crosslinked.Hydrogel can pass through ionic interaction, hydrophobic interaction, hydrogen bond knot Interaction, stereocomplex and/or supramolecular chemistry are closed to be physically crosslinked.Hydrogel can because crosslinking agent, hydrophobic patch and/or The undissolved fragment of water and be essentially insoluble solution, but be expansible because absorbing and/or keeping fluid and/or swelling. Precursor can be crosslinked with endogenous material and/or tissue.

Hydrogel may include enviromental sensitive hydrogel (ESH).ESH may include molten with the fluid related to environmental condition The material of swollen property characteristic.Environmental condition may include but be not limited to the physical condition in operative site, biotic factor and/or chemical bar Part.For example, in response to temperature, pH, electric field, ionic strength, enzyme and/or chemical reaction, electricity and/or Neural stem cell, and other lifes Reason and environment variable, hydrogel is swellable or shrinks.ESH may include polyfunctional acrylate, hydroxyethyl methacrylate second The monomer of ester (HEMA), elastomeric acrylate and correlation.

Tissue thickness compensation part including hydrogel may include in non-synthetic materials described above and synthetic material extremely Few one kind.Hydrogel may include to synthesize hydrogel and/or non-synthetic hydrogel.Tissue thickness compensation part may include multiple layers.It is more Individual layer may include porous layer and/or non-porous layer.For example, tissue thickness compensation part may include non-porous layer and porous layer.And for example, organize Thickness compensation part may include the porous layer among the first non-porous layer and the second non-porous layer.And for example, tissue thickness compensation part may include Non-porous layer among first porous layer and the second porous layer.Non-porous layer and porous layer can be relative to nail bin and/or the tables of anvil block Face positions in any order.

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

The example of synthetic material may include but be not limited to poly- (lactic acid), poly- (glycolic), poly- (butyric ester), poly- (phosphine Piperazine), polyester, polyethylene glycol, PEO, PEO-polypropylene oxide copolymers, copolymerization oxirane, polyoxygenated Alkene, polyacrylamide, poly hydroxy ethyl acrylate, PVP, polyvinyl alcohol, poly- (caprolactone), poly- (dioxy Heterocycle hexanone), polyacrylic acid, poly- acetic acid esters, polypropylene, aliphatic polyester, glycerine, poly- (amino acid), copolymerization (ether-ester), poly- grass Sour alkylidene diol ester, polyamide, poly- (iminocarbonic ester), polyoxy acid ester, poe, polyphosphazene and their group Close.It conventional method can be used synthetically to prepare above-mentioned non-synthetic materials, such as synthesize hyaluronic acid.

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

Hydrogel can be formed by single precursor or multiple precursors.Hydrogel can be formed by the first precursor and the second precursor.The One hydrogel precursor and the second hydrogel precursor can be in situ in contact or form hydrogel in vivo.Hydrogel precursor typically may be used Refer to polymer, functional group, macromolecular, small molecule and/or reaction can be participated in form the crosslinking agent of hydrogel.Precursor may include Such as homogeneous solution, the uneven or solution that is separated in appropriate solvent, such as water or buffer solution.The pH of buffer solution can be E.g., from about 8 to about 12, such as about 8.2 to about 9.The example of buffer solution may include but be not limited to borate buffer solution.Precursor can be In emulsion.According to the present invention, the first precursor can form hydrogel with the second precursors reaction.First precursor can be before contact second Spontaneously it is crosslinked during body.According to the present invention, first group of electrophilic functional group on the first precursor can be with second group on the second precursor Nucleophilic functional group is reacted.(for example, when related to pH, temperature and/or solvent when during precursor is blended in the environment for allowing reaction When), functional group can be reacted with each other to form covalent bond.At least some and more than one others precursors reaction in precursor When, precursor can turn into crosslinking.

Tissue thickness compensation part may include at least one monomer, and the monomer is selected from 3- sulfopropyl acrylic acid sylvite (" KSPA "), PAA (" NaA "), N- (three (hydroxymethyl) methyl) acrylamides (" triacryl ") and 2- acryloyls Amine -2- methyl isophthalic acids-propane sulfonic acid (AMPS).Tissue thickness compensation part may include copolymer, and the copolymer includes two or more Selected from KSPA, NaA, triacryl, AMPS monomer.Tissue thickness compensation part may include from KSPA, NaA, three propylene The homopolymer of acyl group, AMPS.Tissue thickness compensation part may include the hydrophilically modified monomer that can be copolymerized with it.Hydrophilically modified list Body may include methyl methacrylate, butyl acrylate, cyclohexyl acrylate, styrene, styrene sulfonic acid.

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

Tissue thickness compensation part may include acrylate and/or methacrylate function hydrogel, biocompatibility light At least one of initiator, alkyl-cyanoacrylate, isocyanate-functional macromonomer, optionally include amine function Macromonomer, succinimide ester function macromonomer, optionally include amine and/or Mercaptofunctional macromonomer, ring Epoxide function macromonomer, the mixing for optionally including amine function macromonomer, protein and/or polypeptide and aldehyde cross-linking agent Carbodiimides, anion polysaccharide and the polyvalent cation of thing, Geniposide (Genipin) and water dissolvable.

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

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

Tissue thickness compensation part may include the layer for including reinforcing material.The porous layer of tissue thickness compensation part and/or non-porous Layer may include reinforcing material.For example, porous layer may include reinforcing material and non-porous layer may not include reinforcing material.Enhancement layer can Including the internal layer among the first non-porous layer and the second non-porous layer.Enhancement layer may include the outer layer of tissue thickness compensation part.Enhancement layer It may include the outer surface of tissue thickness compensation part.

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

According to the present invention, multiple reinforcement materials can be oriented to random direction and/or common direction.Common direction can exemplified by It is one of such as parallel with staple line and vertical with staple line.For example, monofilament and/or multifilament weave fabric can with random direction and/or altogether Equidirectional orientation.Monofilament and multifilament weave fabric can be associated with non-porous layer and/or porous layer.Tissue thickness compensation part may include The multiple reinforcing fibers being orientated in non-porous layer with random direction.Tissue thickness compensation part may include in non-porous layer with common direction Multiple reinforcing fibers of orientation.

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

Tissue thickness compensation part can be formed in situ.Hydrogel can be formed in situ.Tissue thickness compensation part can by covalently from Son and/or hydrophobic bond are formed in situ.(non-covalent) crosslinking of physics can be mutual by complexing, hydrogen bonding, desolvation, Van der Waals Effect, ionic bonding and combinations thereof cause.(covalent) crosslinking of chemistry can pass through any one of following number of mechanisms To realize：Radical polymerization, polycondensation, anion or cationic polymerization, step growth polymerization, the reaction of electrophilic material-nucleophile, And combinations thereof.

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

Tissue thickness compensation part may include the one or more packaging parts or list that can store at least one component wherein Member.Packaging part can store hydrogel precursor wherein.For example, packaging part can store two kinds of components therein.Packaging part energy Enough store the first hydrogel precursor and the second hydrogel precursor therein.First packaging part can store the first hydrogel therein Precursor and the second packaging part can store the second hydrogel precursor therein.As described above, packaging part can be alignd with nail leg or At least substantially alignment so as to the puncture packaging part when nail leg contacts packaging part and/or otherwise ruptures packaging part.When During deployment nail, the packaging part can be compressed, conquassation, is collapsed and/or is otherwise ruptured.After packaging part rupture, it is stored In component can flow out packaging part.Store component therein and can contact other components, the layer of tissue thickness compensation part and/or group Knit.Other components may be from identical or different packaging part, provides in the layer of tissue thickness compensation part and/or is cured by clinic Life is used for operative site.As above-described result, the component being stored in packaging part can provide tissue thickness compensation part Extension and/or swelling.

Tissue thickness compensation part may include the layer containing packaging part.Packaging part may include the space associated with layer, pit, Fornix, pipe and combinations thereof.Packaging part may include the space in layer.Layer may include that mutual two layers can be invested, its Middle packaging part can be defined between two layers.Packaging part may include the fornix in layer surface.For example, at least a portion of packaging part It can be positioned in the fornix upwardly extended from layer.Packaging part may include the pit formed in layer.The Part I of packaging part It may include fornix, and the Part II of packaging part may include pit.Packaging part may include the pipe being embedded in layer.Pipe may include this Non-synthetic materials and/or synthetic material described in text, such as PLA.Tissue thickness compensation part may include the foam of biological absorbable, Such as ORC, the foam of the biological absorbable includes the PLA pipes being embedded, and the pipe can encapsulate such as hydrogel.Encapsulation Part may include mutual unconnected separate unit.One or more of packaging part can be via the one or more for extending through layer Path, conduit, and/or passage and be in fluid communication with each other.

The release rate of component from packaging part can be controlled by as described below：Such as tissue thickness compensation part thickness, The part of tissue thickness compensation part, the size of component, the hydrophily of component, and/or the physics and/or change in component Learn interaction, the part, and/or surgical instruments of tissue thickness compensation part.Layer may include one or more thin section or weak Change part (such as local perforations), such as one or more of thin section or weakening part can be advantageous to cut layer and make packaging part Rupture.Local perforations can not extend fully through layer, and in some cases, perforation may extend entirely through layer.

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

Tissue thickness compensation part may be adapted to be used together with surgical instruments.As described above, tissue thickness compensation part can be with nail Storehouse and/or anvil block are associated.Tissue thickness compensation part may be configured to be adapted for engagement with any shape, the size of nail bin and/or anvil block And/or dimension.As described herein, tissue thickness compensation part can be releasably attached to nail bin and/or anvil block.In sewing process Before and during sewing process, tissue thickness compensation part can keep tissue thickness compensation part and nail bin and/or anvil The tactile any mechanical and/or chemical mode of seated connection is attached to nail bin and/or anvil block.Nail pierce through tissue thickness compensation part with Afterwards, it can be removed from nail bin and/or anvil block or discharge tissue thickness compensation part.When nail bin and/or anvil block move away from tissue thickness When spending compensating part, it can be removed from nail bin and/or anvil block or discharge tissue thickness compensation part.

Referring now to Figure 14, nail bin (such as nail bin 10000) for example may include support section 10010 and compressible tissue Thickness compensation part 10020.Referring now to Figure 16-Figure 18, support section 10010 may include platform surface 10011 and be limited to branch Multiple nail cavities 10012 in support part point 10010.The size of each nail cavity 10012 can for example be set to and can be removable wherein Followed closely except ground stores, such as follow closely 10030.Nail bin 10000 may also include multiple staple drivers 10040, when nail 10030 and staple drivers 10040 when being in its non-firing position, and each staple drivers can support one or more nails 10030 in nail cavity 10012.Example Such as, referring first to Figure 22 and Figure 23, each staple drivers 10040 may include for example one or more supports or groove 10041, the branch Frame or groove support nail and can limit the relative motion between nail 10030 and staple drivers 10040.Referring again to Figure 16, nail bin 10000 may also include nail percussion sliding part 10050；The nail percussion sliding part can move to nail from the proximal extremity 10001 of nail bin The distal end 10002 in storehouse, so as to successively by staple drivers 10040 and nail 10030 from its non-firing position to be positioned in nail The anvil block on the opposite of storehouse 10000 lifts.Referring first to Figure 16 and Figure 18, each nail 10030 may include base portion 10031 and from base portion One or more legs 10032 of 10031 extensions, wherein each nail can be at least one of for example substantially U-shaped and basic V-shaped. Nail 10030 is enabled to when nail 10030 is in its non-firing position, and the top of nail leg 10032 is relative to support section 10010 Platform surface 10011 be recessed.Nail 10030 is enabled to when nail 10030 is in its non-firing position, the top of nail leg 10032 End flushes relative to the platform surface 10011 of support section 10010.Nail 10030 is enabled to when nail 10030 does not fire in it During position, the top of nail leg 10032 or at least certain part of nail leg 10032 extend to the platform surface of support section 10010 10011 tops.In this case, when nail 10030 is in its non-firing position, nail leg 10032 may extend into simultaneously quilt It is embedded into tissue thickness compensation part 10020.For example, nail leg 10032 can for example extend to the top of platform surface 10011 about 0.075".Nail leg 10032 can for example extend to the distance between top of platform surface 10011 about 0.025 " and about 0.125 ".It is right It is described further above, tissue thickness compensation part 10020 may include uncompressed between e.g., from about 0.08 " and about 0.125 " Thickness.

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

As described above and referring to Figure 33, when nail 10030 is in its non-firing position, following closely 10030 nail leg 10032 can prolong Reach the top of platform surface 10011 of support section 10010.With further reference to the percussion sequence shown in Figure 27, nail 10030e and 10030f is illustrated at its non-firing position, and its nail leg 10032 extends to the top of platform surface 10011 and extended to In tissue thickness compensation part 10020.When nail 10030 is in its non-firing position, the top of nail leg 10032 or nail leg 10032 Any other part convex may not wear the top tissue contacting surface 10021 of tissue thickness compensation part 10020.Such as Figure 27 institutes Show, when nail 10030 moves to its firing position from its non-firing position, the end of nail leg convex can wear tissue contacting surface 10032.The top of nail leg 10032 may include the sharp top that can cut and penetrate tissue thickness compensation part 10020.Tissue Thickness compensation part 10020 may include multiple holes, and the multiple hole can accommodate nail leg 10032 and allow nail leg 10032 relative Slided in tissue thickness compensation part 10020.Support section 10010 may also include the multiple guiding extended from platform surface 10011 Device 10013.Guider 10013 can be positioned so that the nail cavity opening of neighbouring platform surface 10011 so that nail leg 10032 can be at least Partly supported by guider 10013.Guider 10013 can be positioned in the proximal extremity and/or distal end of nail cavity opening Place.According to the present invention, the first guider 10013 can be positioned in the first end of each nail cavity opening, and the second guider 10013 can be positioned in the second end of each nail cavity opening so that the sustainable nail 10030 of each first guider 10013 First nail leg 10032, and the second nail leg 10032 of the sustainable nail of each second guider 10013.Referring to Figure 33, each lead It may include that groove or slit, such as groove 10016, such as nail leg 10032 can be slidingly received in the groove to device 10013 In 10016.Optionally, each guider 10013 may include to extend and may extend into tissue thickness's benefit from platform surface 10011 Repay anti-skid stud, projection, and/or the spike in part 10020.As described in more detail below, anti-skid stud, projection, and/or spike can subtract Relative motion between cell thickness compensation part 10020 and support section 10010.The top of nail leg 10032 can be positioned in It can not extended on the top surface of guider 10013 in guider 10013 and when following closely 10030 and being in its non-firing position Side.For example, guider 10013 can limit guiding height, and this can not be extended to when following closely 10030 and being in its non-firing position Above guiding height.

According to the present invention, tissue thickness compensation part (such as tissue thickness compensation part 10020) for example can be by single material piece Form.Tissue thickness compensation part may include continuous sheet, and the continuous sheet can cover the whole top of support section 10010 Platform surface 10011, or alternatively, covering is less than whole platform surface 10011.Material piece can cover supporting part Nail cavity opening in points 10010, but alternatively is that material piece may include can to align with nail cavity opening or at least The opening of section aligned.According to the present invention, tissue thickness compensation part can be made up of for example multiple material layers.Referring now to Figure 15, Tissue thickness compensation part may include compressible core and the wrappage around compressible core.Wrappage 10022 can be by compressible core Releasably hold support section 10010.For example, support section 10010 may include for example from the one or more of its extension Protuberance, such as protuberance 10014 (Figure 18), the protuberance may be housed in one or more holes and/or slit, such as limit In hole 10024 in wrappage 10022.Protuberance 10014 and hole 10024 enable to protuberance 10014 can be by wrappage 10022 remain to support section 10010.The end of protuberance 10014 for example can be deformed by heating processing, prominent to expand Go out the end in portion 10014, and therefore limit the relative motion between wrappage 10022 and support section 10010.Wrappage 10022 may include one or more perforation 10025, and it can be advantageous to discharge wrappage 10022 from support section 10010, such as Shown in Figure 15.Referring now to Figure 24, tissue thickness compensation part may include wrappage 10222, and the wrappage includes multiple holes 10223, its mesopore 10223 can align with the nail cavity opening in support section 10010 or at least partly align.Tissue thickness compensates The core of part may also include the hole alignd with the hole 10223 in wrappage 10222 or at least partly alignd.Alternatively select Select, the core of tissue thickness compensation part may include continuous main body and may extend into below hole 10223 so that continuous main body covering Nail cavity opening in platform surface 10011.

Optionally, as described above, tissue thickness compensation part may include to be used to compressible core releasably holding support The wrappage of part 10010.For example, with reference to Figure 16, nail bin may also include retainer fixture 10026, and the retainer fixture can Suppress wrappage and compressible core prematurely separates with support section 10010.Optionally, each retainer fixture 10026 can wrap The hole 10028 of the protuberance 10014 extended from support section 10010 can be accommodated by including so that retainer fixture 10026 can be protected Hold support section 10010.Retainer fixture 10026 can each include at least one flat of bottom 10027, and the flat of bottom can Extend to below support section 10010 and in the inner support of support section 10010 and keep staple drivers 10040.As described above, Tissue thickness compensation part can be removably attachable to support section 10010 by nail 10030.More particularly, as also described above, When following closely 10030 and be in its non-firing position, follow closely 10030 leg and may extend into tissue thickness compensation part 10020, and therefore general Tissue thickness compensation part 10020 releasably holds support section 10010.The leg of nail 10030 can its corresponding nail cavity 10012 side wall contact, wherein, due to the friction between nail leg 10032 and side wall, nail 10030 and tissue thickness compensation part 10020 can be maintained at appropriate location, until nail 10030 is disposed from nail bin 10000.After nail 10030 is disposed, tissue is thick Degree compensating part 10020 can be trapped in nail 10030 and is kept against the tissue T of suture.Beaten when anvil block is subsequently moved into When open position is to discharge tissue T, support section 10010 is movable away from the tissue thickness compensation part 10020 for having been secured to tissue. It can be used adhesive that tissue thickness compensation part 10020 removedly is remained into support section 10010.Usable two parts glue Mixture, wherein, the Part I of adhesive can be placed on platform surface 10011, and the Part II of adhesive can quilt It is placed into tissue thickness compensation part 10020 so that when tissue thickness compensation part 10020, which is close to platform surface 10011, places, Part I can contact Part II to enable adhesive and tissue thickness compensation part 10020 is separably bonded into supporting part Divide 10010.Optionally, it can be used any other suitable method that tissue thickness compensation part is separably remained to the branch of nail bin Support part point.

Further described above, sliding part 10050 proximally can be advanced to distal end in end 10001 10002 are accommodated in all nails 10030 in nail bin 10000 with complete deployment.Referring now to Figure 56-Figure 60, sliding part 10050 It can be pushed away in the longitudinal cavity 10016 in support section 10010 by the knife bar 10052 of firing member or surgical stapling device towards distal side Enter.In use, nail bin 10000 can be inserted into the staple cartridge channel in the jaw of surgical stapling device, such as staple cartridge channel 10070 It is interior, and firing member 10052 can be advanced to and be contacted with sliding part 10050, as shown in figure 56.When sliding part 10050 is by hitting Hair component 10052 towards distal side promotes when, sliding part 10050 can contact the staple drivers or driver 10040 of recent side, and general Nail 10030 is fired or projected from warehouse 10010, as described above.As shown in figure 56, firing member 10052 may also include cutting blade 10053, when nail 10030 is fired, the cutting blade can be pushed into by the cutter slit in support section 10010 towards distal side.According to The present invention, corresponding cutter slit can extend across the anvil block for being positioned in the opposite of nail bin 10000 so that cutting blade 10053 can be in anvil Extend and cut tissue and the tissue thickness compensation part being positioned in therebetween between seat and support section 10010.In various situations Under, sliding part 10050 can be promoted by firing member 10052 towards distal side, until sliding part 10050 reaches the distal side of nail bin 10000 End 10002, as shown in figure 58.Now, firing member 10052 can proximally bounce back.Sliding part 10050 can be with firing member 10052 proximally bounce back, but referring now to Figure 59, when firing member 10052 bounces back, sliding part 10050 can be left on nail In the distal end 10002 in storehouse 10000.Once firing member 10052 fully bounces back, anvil block can be opened again, and tissue is thick Degree compensating part 10020 can separate with support section 10010, and exhaust the remaining non-implanted portion of nail bin 10000, including Support section 10010, it can be removed from staple cartridge channel 10070.

When exhausted nail bin 10000 from staple cartridge channel be removed after, further described above, new nail bin 10000 or any other suitable nail bin can be inserted into staple cartridge channel 10070.Further described above, nail bin leads to Road 10070, firing member 10052, and/or nail bin 10000 may include cooperative structures, and the cooperative structures can be in new non-percussion nail Storehouse 10000 prevents firing member 10052 to be pushed into again or then towards distal side when being not located in staple cartridge channel 10070. More particularly, referring again to Figure 56, when firing member 10052, which is advanced to, to be contacted with sliding part 10050, and when slip When part 10050 is in its nearside non-firing position, the support nose 10055 of firing member 10052 can be positioned in sliding part On support lugn 10056 on 10050 and/or on so that firing member 10052 is maintained at position upward enough, with Prevent from falling into the lock crossbeam being limited in staple cartridge channel from the lock or crossbeam 10054 of the extension of firing member 10052.Due to lock 10054 when will not fall into lock crossbeam, and in such cases, when firing member 10052 is pushed into, lock 10054 can not abut lock The distal side side wall 10057 of groove.When firing member 10052 promotes sliding part 10050 towards distal side, firing member 10052 can Its upward firing position is supported on due to leaning against the support nose 10055 on support lugn 10056.Work as firing member 10052 relative to sliding part 10050 when bouncing back, and as described above and as shown in figure 59, is being slided when support nose 10055 does not rely on When on the support lugn 10056 of part 10050, firing member 10052 can fall from its upward position.For example, surgical staples may include Firing member 10052 can be biased to the spring 10058 and/or any other suitable biasing element of its down position.One Denier firing member 10052 has been fully retracted, and as shown in figure 60, firing member 10052 can not again pass through the nail bin 10000 used up It is pushed into towards distal side.More particularly, when the sliding part 10050 for being now in operation order has been left on the remote of nail bin 10000 When at side end 10002, firing member 10052 can not be maintained at its upper position by sliding part 10050.Therefore, as described above, If firing member 10052 is re-advanced in the case of no replacement nail bin, lock beams 10054 will contact lock crossbeam Side wall 10057, this will prevent firing member 10052 to be advanced to again towards distal side in nail bin 10000.In other words, once with Most nail bin 10000 is replaced by new nail bin, and for new nail bin by with proximally-oriented sliding part 10050, this is proximally-oriented Sliding part firing member 10052 can be maintained to its upward position, and firing member 10052 is pushed away again towards distal side Enter.

As described above, sliding part 10050 can be by staple drivers 10040 in the first non-firing position and the second firing position Between move, so as to which nail 10030 is projected from support section 10010.It has been shot up from support section 10010 in nail 10030 After, staple drivers 10040 can be accommodated in nail cavity 10012.Support section 10010 may include that staple drivers can be prevented The 10040 one or more holding structures for projecting or dropping out from nail cavity 10012.Alternatively, sliding part 10050 Staple drivers 10040 can be projected from the support section 10010 with nail 10030.For example, staple drivers 10040 can be by Such as bioabsorbable and/or biocompatible materials is formed, such as PEI (Ultem).Staple drivers attach To nail 10030.For example, staple drivers can be molded into it is each nail 10030 base portion on and/or surrounding so that driver with Nail is integrally formed.Entitled " the SURGICAL STAPLES HAVING COMPRESSIBLE OR that September in 2006 is submitted on the 29th CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME " U.S. Patent applications No.11/541,123 is incorporated by reference in its entirety herein.

As described above, surgery suturing appliance may include that the staple cartridge channel of nail bin can be accommodated, be rotationally coupled to nail bin The anvil block of passage and the firing member including blade, the firing member can move relative to anvil block and staple cartridge channel.Using In, nail bin can be positioned in staple cartridge channel, and after nail bin is consumed at least in part, nail bin can remove from staple cartridge channel And replaced by new nail bin.For example, the staple cartridge channel of surgery suturing appliance, anvil block, and/or firing member can be with replacing nail bin one Rise and be reused.Alternatively, nail bin may include part disposable loading unit component, the disposable loading list First component for example may include staple cartridge channel, anvil block, and/or firing member, and these can be used as and replace disposable loading unit component A part be replaced with nail bin.Some disposable loading unit components are disclosed on 2 15th, 2008 titles submitted For " END EFFECTOR COUPLING ARRANGEMENTS FOR A SURGICAL CUTTING AND STAPLING INSTRUMENT " U.S. Patent application No.12/031, in 817, the complete disclosure of the patent application is by reference simultaneously Enter herein.

Tissue thickness compensation part may include composition that is extrudable, can casting and/or can be molded, and it includes as described herein At least one of synthetic material and/or non-synthetic materials.Tissue thickness compensation part may include the film with two layers or more layer Or piece.Tissue thickness compensation part can be used conventional method obtain, such as mixing, blending, combination, spraying, wicking, solvent evaporation, Dipping, brushing, gaseous phase deposition, extrusion, calendering, casting, molding etc..During extrusion, opening can include at least one opening The form of mould is that the extrudate exposed assigns shape.During calendering, opening may include the roll gap between two rollers.Conventional molding Method may include but be not limited to be blow molded, be molded, foam injection, compression moulding, hot forming, extrusion, foaming extrusion, film blow blowing, calendering, Spinning, solvent welding, coating method such as dip-coating and spin coating, solution curtain coating and film casting, plastisol processing (including scraper Coating, roller coat and casting), and combinations thereof.During injection, opening may include nozzle and/or passage/runner and/or mould Cavity and feature structure.During compression moulding, composition can be positioned in cavity body of mould, be heated to suitable temperature, and by relative Compressed and shaped under high pressure.During casting, composition may include liquid or slurries, and it, which injects or otherwise provided, arrives mould The inside of tool or object, above and/or surrounding, with the feature structure of copy mold or object.After casting, composition can be done It is dry, cool down and/or be cured to form solid.

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

Referring now to Figure 71, tissue thickness compensation part 21020 may include compensating part main body 21022 and be positioned in more Individual capsule or pipe 21024.Each in pipe 21024 may include to be limited to cavity 21026 therein, the cavity 21026 One or more medicines can be included wherein.As described in more detail below, can be for example by the way that pipe 21024 be placed in a mold simultaneously And the compensating part main body 21022 around pipe 21024 is formed to manufacture tissue thickness compensation part 21020.It can be placed by pipe 21024 Come one or more medicines being placed in pipe 21024 in a mold so that for example hard in compensating part main body 21022 Change, after lyophilized, and/or solidification, pipe 21024 can be encapsulated in compensating part main body 21022.Alternatively, it is existing Referring to Figure 72, tissue thickness compensation part 21120 may include to be positioned at multiple capsules or pipe in compensating part main body 21122 21124, wherein later loading one or more medicines around pipe 21124 can be had been formed in compensating part main body 21122 Into pipe 21124.For example, tissue thickness compensation part 21120 may include port 21123, the port 21123 can be with pipe 21124 are in fluid communication and can for example allow one or more drug injections to pipe 21124 using syringe 21125 It is interior.In some cases, tissue thickness compensation part 21120 only can inserted in patient it by surgeon or other clinicians Come to load one or more medicines in inlet pipe 21124.There is long store up when tissue thickness compensation part 21120 can be desired or needed for When depositing time or storage life, these can be particularly useful.

Referring now to Figure 73, the compensating part main body 21022 of tissue thickness compensation part 21020 can be by for example bioabsorbable material Material is formed.Compensating part main body 21022 can be made up of any suitable material, for example, PGA and/or PCL.Pipe 21024 can be by for example Any suitable bioabsorbable material is formed.Pipe 21024 can be made up of any suitable material, for example, hyaluronic acid, bright Glue, PDS, and/or oxidized regenerated cellulose (ORC).The one or more medicines 21025 being included in cavity 21026 may include Fluid, for example, fortimicin.For example, each in pipe 21024 can be sealing so that medicine 21025 can be stored in pipe In 21024, until at least a portion of pipe 21024 has for example been dissolved and/or bio-absorbable.During use, referring now to Figure 74, pipe 21024 can be made exposed to can contact and dissolve the body fluid of pipe 21024, for example, blood.Referring to Figure 75, when for example logical When crossing anvil block 21060 and/or 21030 compression organization T of multiple nails and tissue thickness compensation part 21020, it can be squeezed out from tissue T Body fluid.According to the present invention, compensating part main body 21022 can be encapsulated or is at least partially enveloping using bioabsorbable wrappage. For example, wrappage can be made up of such as hyaluronic acid and/or ORC.

Referring now to Figure 77, capsule or pipe 21224 may include such as multiple layers of 21224a-21224d.Each pipe 21224 It may include such as outer layer or first layer 21224a, second layer 21224b, third layer 21224c and internal layer 21224d.Outer layer 21224a can be made up of hemostatic material, for example, fibrin ferment.Second layer 21224b can be made up of antimicrobial and/or anti-biotic material, For example, fortimicin and/or gentamicin.Third layer 21224c can be made up of anti-inflammatory material, for example, Diclofenac and/or NSAIDS.Internal layer 21224d can be made up of Healing material, for example, powdered collage synthesis material.Referring again to Figure 77, pipe 21224 can be constructed and arranged to so that outer layer 21224a dissolves in second layer 21224b or dissolved before dissolving at least in part Or at least significantly dissolve.Referring to Figure 76, outer layer 21224a can be begun to dissolve one exposed to body fluid.This moment is illustrated as Time t0.Outer layer 21224a can fully dissolve within several minutes, period of a few hours and/or a couple of days, wherein forming outer layer 21224a material can reach maximum effect or concentration at the time of time t1 is shown as.At some moment later, outer layer 21224a Fully or at least can significantly it be dissolved when at the time of instruction by time t2.

When outer layer 21224a is just dissolved, body fluid reaches second layer 21224b, and starts to dissolve at least in part Second layer 21224b.Similarly as described above, second layer 21224b can be within several minutes, period of a few hours and/or a couple of days Fully dissolve, wherein maximum effect or concentration can be reached at the time of time t3 is shown as by forming second layer 21224b material. In all cases, body fluid may pass through outer layer 21224a to reach second layer 21224b so that outer layer 21224a and the second layer 21224b simultaneously or at least substantially simultaneously can start to dissolve.Under any circumstance, reader is it may be noted that form outer layer 21224a material, which reaches its maximum effect or the time t1 of concentration, can occur before a time t 3.At some moment later, Two layers of 21224b fully or at least can significantly dissolve when at the time of instruction by time t5.When reader is further noted that Between t5 can occur after the time t 2.When second layer 21224b is just dissolved, body fluid reaches third layer 21224c, and opens Begin to dissolve third layer 21224c at least in part.It is similarly as described above, third layer 21224c can several minutes, a few hours and/ Or fully dissolved in the period of a couple of days, wherein forming third layer 21224c material can reach at the time of time t6 is shown as Maximum effect or concentration.In all cases, body fluid may pass through outer layer 21224a and second layer 21224b to reach third layer 21224c so that outer layer 21224a, second layer 21224b, and/or third layer 21224c can simultaneously or at least substantially simultaneously Ground starts to dissolve.Under any circumstance, reader is it may be noted that the material for forming second layer 21224b reaches its maximum effect or concentration Time t3 can occur before time t 6.At some moment later, third layer 21224c can to by time t8 indicate when Fully or at least significantly dissolved during quarter.Reader is further noted that time t8 can occur after time t 5.

When third layer 21224c is just dissolved, body fluid reaches the 4th layer of 21224d, and is being indicated by time t4 Moment starts to dissolve the 4th layer of 21224d at least in part.It is similarly as described above, the 4th layer of 21224d can several minutes, number it is small When and/or a couple of days period in fully dissolve, wherein form the 4th layer of 21224b material can be shown as time t7 when Reach maximum effect or concentration quarter.In all cases, body fluid may pass through outer layer 21224a, second layer 21224b and third layer 21224c is to reach the 4th layer of 21224c so that outer layer 21224a, second layer 21224b, third layer 21224c, and/or the 4th layer 21224d simultaneously or at least substantially simultaneously can start to dissolve.Under any circumstance, reader is it may be noted that form third layer 21224c material, which reaches its maximum effect or the time t6 of concentration, can occur before time t7.At some moment later, Four layers of 21224d fully or at least can significantly dissolve when at the time of instruction by time t9.When reader is further noted that Between t9 can occur after time t 8.Optionally, due to the above situation, the stage release of medicine can occur.

Referring now to Figure 81 and Figure 83, nail bin 21300 may include warehouse 21310, and the warehouse 21310 includes multiple nail cavities 21312 and multiple nails 21330 for being positioned in.Nail bin 21300 may also include tissue thickness compensation part 21320, the tissue Thickness compensation part 21320 may include that the compensating part main body 21322 of the positioning of warehouse 21310 can be close to and be positioned at compensating part master Multiple discrete capsules 21324 in body 21322.Capsule 21324 can be vertically oriented, and when nail 21330 is in During its non-percussion configuration, as shown in Figure 83, each capsule 21324 can be positioned between the nail leg 21322 of nail 21330.For example, When nail 21330 is in its non-firing position, nail leg 21322 can be extended at least partly into tissue thickness compensation part 21320 And rupture capsule 21324.When nail 21330 is moved into its firing position from its non-firing position, referring now to figure 84, nail 21330 can rupture capsule 21324 and be stored at least one medicine therein so as to discharge.More particularly, When nail 21330 is lifted up, nail 21330 can be deformed by the forming pit 21062 being limited in anvil block 21060, So that nail leg 21332 downwardly and inwardly can be crimped or deformed towards the capsule 21324 positioned therebetween.Can be by including driving The trigger system of device 21340 and sliding part 21345 is lifted up nail 21330, and wherein sliding part 21345 can traverse longitudinally The staple drivers 21340 and nail 21330 that nail bin 21000 and then lifting and percussion are all positioned on.Under any circumstance, Nail leg 21332 can pierce and/or conquassation capsule 21324 so that the inner chamber 21326 being limited in capsule 21324 is rupturable And one or more medicines included in inner chamber 21326 can be released from.One or more medicines may include for example Include one or more powder and/or fluid in the inner.Nail bin 21300 may also include cutting element 21380, the cutting structure Part 21380 can together with sliding part 21345 towards distal side promote so as to it is crosscutting be positioned at such as nail bin 21300 and anvil block 21060 it Between tissue T.Cutting element 21380 can pass through the cutter slit 21314 being limited in warehouse 21310, wherein, for example, one Or multiple capsules (for example, capsule 21324) can be positioned within cutter slit 21314 and/or on so that cutting element 21380 can crosscutting such capsule 21324.Under any circumstance, tissue thickness compensation part 21320, which may also include, is positioned at warehouse Layer 21321 on 21322 top and/or bottom, the layer 21321 can for example be made up of such as hyaluronic acid and can make storehouse Body 21322 and/or nail 21330 stabilize.For example, cutting element 21380 can be advanced through nail bin in cutting element 21380 Crosscutting layer 21321 when 21300, as described above.

Referring now to Figure 85, tissue thickness compensation part 21420 may include compensating part main body 21422 and be positioned in more Individual capsule 21444.It is similarly as described above, each capsule 21444 may include wherein can releasedly to store it is a kind of or The seal cavity 21446 of multi-medicament.Each in capsule 21444 may include such as taper and/or wedge shaped end 21447.For example, when warehouse 21422 is just around capsule formation, wedge shaped end 21447 can be used for keeping capsule 21444 It is fixed.According to the present invention, mould may include to receive and multiple holes of stationary wedge end 21447 and/or impression so that when When pouring into compensating part material around capsule 21444, mould can make capsule 21444 keep fixing.It is further to carrying out above Description, capsule 21444 can for example be positioned and be arranged so that they can not rupture or burst, until during use hitting nail Send out into and/or fire through tissue thickness compensation part 21420.

Alternatively, referring now to Figure 86, tissue thickness compensation part 21520 may include to be positioned at compensating part master Multiple capsules 21524 in body 21522.Capsule 21524 can each include being limited to one or more of its outer wall hole 21528, its mesopore 21528 can allow for one or more medicines 21525 from the cavity 21526 being defined in capsule 21524 Effusion.The size and construction in hole 21528 can be set to the speed that control medicine 21525 escapes from cavity 21526.It is for example, larger Hole 21528 can allow the very fast release of medicine 21525, and smaller hole 21528 can for example allow the relatively On The Drug Release of medicine 21525. The outer wall of each capsule 21524 can be made up of pipe, and the pipe has the end 21527 of closing and/or sealing.Capsule 21524 outer wall can be made up of for example one or more Bioabsorbable polymerics, and can for example utilize rivet hot Welding, heat Welding procedure and/or laser welding process are closed and/or seal end 21527.Glue can be manufactured using injection molding process The outer wall or shell of wafer 21524, can be by one or more openend by one kind wherein after shell has been formed Or multi-medicament is navigated in shell.Then, the openend in shell can be coated using such as polymer solution.In capsule In the case that 21524 wall is made up of bioabsorbable material, being defined in hole 21528 therein can increase over time. For example, the speed that medicine 21525 discharges from cavity 21526 can increase over time.

Compensating part main body 21522 can be made up of such as gelatin, and can be manufactured into foam material using such as lyophilized technique Material.Capsule 21524 can be inserted in compensating part main body 21522, wherein, for example, compensating part main body 21522 can be formed to have There is the hole for being capable of admission capsules agent 21524.For example, then layer or film can be placed on compensating part main body 21522 to coat Or encapsulating capsule 21524 therein.Capsule 21524 can be positioned in mould, and can be at least partly around capsule Agent 21524 forms compensating part material to form compensating part main body 21522.Under any circumstance, compensating part main body 21552 can wrap Include one or more keyings or index feature, the keying or index feature can make the alignment of tissue thickness compensation part 21520 and It is orientated the warehouse of nail bin so that capsule 21524 is positioned at required position.

Referring now to Figure 87, surgical stapling system may include nail bin 21600 and anvil block 21060, wherein nail bin 21600 and anvil Seat 21060 can be positioned on the opposite side of tissue T.Similar to other nail bins disclosed herein, nail bin 21600 may include warehouse 21310, the warehouse 21310 may include multiple nail cavities 21312 and position multiple nails 21330 therein.During use, referring to Figure 91,21330 never firing position liftings can will be followed closely by driver 21340 and arrive firing position so that they abut anvil block 21060 and deform, more particularly, deform in the forming pit 21062.When nail 21330 is just fired, exist in nail 21330 Before being deformed between its non-percussion configuration (Figure 88) and its percussion configuration (Figure 89), nail 21330 can pierce tissue T and be attached to anvil The tissue thickness compensation part 21620 of seat 21060.For example, nail 21330 can be by any suitable of such as stainless steel and/or titanium etc Material form, and tissue thickness compensation part 21620 and tissue T can be abutted and apply compression stress or chucking power.Such as Figure 87 institutes Show, nail 21330 can be arranged to multirow, wherein a nail 21330 can be set in each nail cavity 21312.Nail bin 21300 can also wrap Puncture member 21635 (Figure 90) is included, the puncture member 21635 can engage and pierce through such as tissue T, tissue thickness compensation part 21620, and/or one or more medicine capsules for being positioned in tissue thickness compensation part 21620.For example, puncture member 21635 can be positioned in nail cavity 21312, wherein by driver 21340 puncture member 21635 can be made to be hit from nail cavity 21312 Hair projects.Further described above, some nail cavities 21312 of nail bin 21600 may include the nail being positioned in 21330, and other nail cavities 21312 may include the puncture member 21635 being positioned in.Nail bin 21600 may include rows of nail Chamber 21312, some of rows only have the nail 21330 being positioned in, and some rows only have the puncture member being positioned in 21635, and/or some rows are with the nail 21330 and puncture member 21635 being positioned in.As illustrated, referring to figure 91, the row of inner side four of nail cavity 21312 can only include nail 21330 wherein, and the outer skidding of nail cavity 21312 can include nail wherein 21330 and puncture member 21635.Nail 21330 and puncture member 21635 in the outer skidding of nail cavity 21312 can be for example arranged Into alternate configuration.Referring now to Figure 92, nail 21330 and puncture member 21635 pattern can be arranged as follows, the pattern bag Include such as two nail 21330, be puncture member 21635 afterwards, be afterwards another two nail 21330, be puncture member 21635 afterwards Etc..

Referring primarily to Figure 90, each puncture member 21635 may include base portion 21638 and from the relatively lateral of base portion 21638 The leg 21637 of upper extension.Referring now to Figure 91, driver 21340 can each include groove 21348, and the groove 21348 can be received With the base portion 21638 of support puncture member 21635.When pressing upwards on driver 21340 by sliding part 21345, join now See Figure 92, sliding part 21345 can continuously percussion nail 21330 and puncture member 21635.Referring now to Figure 91, nail 21330 can be tight Deformed by anvil block 21060, and puncture member 21635 can not contact anvil block 21060.Referring primarily to Figure 90, for example, each thorn One or two worn in the leg 21636 of component 21635 may include tip 21639 and at least one hangnail 21637, the tip 21639 can pierce through tissue T and/or tissue thickness compensation part 21620, and at least one hangnail 21637 can be by leg 21636 It is maintained in such as tissue T and/or tissue thickness compensation part 21620.Tissue thickness compensation part can be not used completely.Puncture member 21635 leg 21636 can be to be insufficient to length, so as to be not enough to pass completely through tissue T, let alone contact anvil block 21060.Leg 21636 can be sufficiently long so that their accessible anvil blocks 21060, and may be deformed to different configurations.

Puncture member 21635 can different materials be formed by following closely 21330 material from forming.Puncture member 21635 can be by At least one Bioabsorbable polymeric is formed, for example, PGA.Puncture member 21635 can each include at least one medicine, example Such as, antiseptic, antiinflammatory, pain medication, and/or MMP inhibitor.Although puncture member 21635 can be positioned in staple line, example Such as when puncture member 21635 is just being dissolved and/or during bio-absorbable, puncture member 21635 can provide one or more medicines Tissue T in staple line and/or near staple line.Puncture member 21635 can be coated with one or more medicines.Puncture member 21635 may include to be embedded in one or more medicines in structured substrate, and the structured substrate includes puncture member 21635.For example, some puncture members 21635 can be made up of first structure substrate and/or the first medicine, and other pierce through structure Part 21635 can be made up of the second or differently structured substrate and/or second or different pharmaceutical.For example, using injection molding Technique manufactures puncture member 21635.

Referring now to Figure 93 and Figure 94, nail bin 21700 may include warehouse 21710 and tissue thickness compensation part 21720, described Tissue thickness compensation part 21720 is positioned on or near the platform surface 21711 of warehouse 21710.It is similarly as described above, storehouse Body 21710 may include multiple nail cavities 21312 and the multiple capsules being positioned in.For example, warehouse 21710 may also include slit 21714, the slit 21714 can receive cutting element wherein, such as cutting element 21380 (Figure 95) etc.Make With period, as shown in Figure 95, cutting element 21380 crosscutting can be positioned at the tissue T between anvil block 21060 and nail bin 21700. Referring again to Figure 93 and Figure 94, tissue thickness compensation part 21720 may include compensating part main body 21722 and be positioned at compensating part master Multiple medicine bags or capsule 21724 in body 21722.Capsule 21724 can position or be arranged in compensating part main body 21722 In so that capsule 21724 is placed on the slit 21714 being limited in warehouse 21710.During use, referring primarily to Figure 96, Cutting element 21380 can cut capsule 21724 when cutting element 21380 is advanced through nail bin 21700.For example, capsule Agent 21724 can be sealing before being cut component 21380 and cutting, and after capsule 21724 has been cut into, comprising It can be released in one or more medicines therein.Because capsule 21724 is positioned on slit 21714, one or more medicines Thing can be released to be cut on the part of the crosscutting tissue T of component 21380.One kind for being contained in capsule 21724 or Multi-medicament may include the biological reagent of such as powder type.One or more medicines in capsule 21724 may include for example Oxidized regenerated cellulose, alginate esters, and/or calcium.

Referring again to Figure 93 and Figure 94, capsule 21724 can include identical medicine wherein.Alternatively select Select, one or more of capsule 21724 can include one or more different medicines wherein.Individual capsule more than first 21724 can include the first medicine wherein, and individual capsule 21724 more than second can include the second medicine wherein.For example, glue Wafer 21724 can be arranged along the longitudinal path of cutting element 21380 with alternate configuration so that for example including the first medicine Capsule 21724 after can be the capsule 21724 for including the second medicine, can be the capsule for including the first medicine afterwards 21724 etc..Cutting element 21380 can be when cutting element 21380 be advanced through nail bin 21300 by the first medicine and second Medicine mixes.Referring again to Figure 93 and Figure 94, tissue thickness compensation part 21720 may also include from each capsule The 21724 one or more passages 21726 to stretch out.Passage 21726 can allow for the medicine in capsule 21724 in capsule Agent 21724 moves to tissue thickness compensation part 21720 and is close in the tissue T of its positioning after being cut off.Capsule 21724 It is configurable to it is not ruptured when applying compressive load by anvil block 21060.Referring primarily to Figure 93 and Figure 96, warehouse 21710 may include multiple grooves 21715, and the groove 21715 can each be capable of at least the one of admission capsules agent wherein 21724 Part.For example, groove 21715 can allow for the slide downward when being applied in compressive load of capsule 21724 so that capsule 21724 can not rupture.Alternatively, one or more of capsule 21724 can be only when being applied to it Just ruptured when compression stress is met or exceeded to a certain degree.For example, capsule 21724 can be subjected to the folder applied by anvil block 21060 Compaction forces, but can be broken when the clamping pressure applied to it increases because such as cutting element 21380 is advanced through nail bin 21700 Split.Capsule 21724 can include lubricant wherein, and the lubricant can be advantageous to cutting element 21380 when in nail bin 21700 Motion when interior propulsion and/or retraction.

Referring now to Figure 97, tissue thickness compensation part 21820 may include compensating part main body 21822 and through the longitudinal direction of extension Pipe 21824.Similarly as described above, pipe 21824 may include to be defined in longitudinal cavity 21826 therein and be positioned at cavity One or more medicines 21825 in 21826.Longitudinal pipe 21824 may also include the one or more legs to stretch out from it 21827, the leg 21827 being capable of support tube 21824.For example, referring now to Figure 98, supporting leg 21827 can support pipe 21824 In mould 21890, while compensating part main body 21822 is formed around pipe 21824., can be by structure referring now to Figure 99 and Figure 100 Material (for example, PGA and/or PCL) into compensating part main body 21822 is poured into around pipe 21824, and then for example freeze, Foamed, and/or solidification.Referring again to Figure 98, the material for forming compensating part main body 21822 can be poured into around pipe 21824 Cavity 21891 in, wherein cavity 21891 can be closed then by covering 21892.Referring to Figure 97, the end of supporting leg 21827 The material covering that can not poured into, and can be flushed with the lower surface 21821 of compensating part main body 21822.Supporting leg 21827 And/or pipe 21824 can be made up of soluble and/or bioabsorbable material, for example, gelatin, hyaluronic acid, PDS and/ Or ORC.Leg 21827 can rapidly be dissolved by such as body fluid and/or saline solution, wherein can leave in tissue thickness compensation part The groove or passage extended between 21820 neighboring and inside.Such passage can be produced to allow to be positioned in pipe 21824 One or more medicines 21825 are rapidly dissolved and/or absorbed.Alternatively, tissue thickness compensation part 21920 Such as may include compensating part main body 21922 and the pipe 21924 with multiple supporting legs 21927, as shown in Figure 101.Referring to figure 102, supporting leg 21927 can be the larger supporting network or structuring grid 21928 that can extend across compensating part main body 21922 Part.

Referring again to Figure 97, the leg 21827 extended from pipe 21824 can also include one or more medicines wherein.Work as leg 21827 when being dissolved and/or absorbing, as described above, one or more medicines in leg 21827 can be to suturing and/or incision group Knit and the first medication reaction is provided, and one or more medicines 21825 in pipe 21824 can provide second or subsequent administrations reaction. Referring now to Figure 103 and Figure 105, tissue thickness compensation part 22020 may include compensating part main body 22022 and extend through compensating part Longitudinal medication tube 22024 of main body 22022.Similarly as described above, pipe 22024 can limit longitudinal cavity 22026a, described vertical The one or more medicine 22025a for including being positioned in cavity 22026a.Otherwise similar to described above, pipe 22024 can Including the multiple longitudinal leg support members 22027 that can extend along the length of pipe 22024.Optionally, it is every in leg support member 22027 One can limit longitudinal cavity (for example, cavity 22026b and 22026c) wherein, and the longitudinal chamber each can include wherein One or more medicines, for example, medicine 22025b and 22025c.Leg support member 22027 can be by quickly can be dissolved and/or absorbed Material form so that medicine 22025b and 22025c can rapidly be discharged.Then, supporting leg 22027 and pipe 22024 can quilts Further dissolve and/or absorb so that medicine 22025a can be subsequently released.Medicine 22025a, 22025b, and/or 22025c can be made up of identical material.Alternatively, medicine 22025a, 22025b, and/or 22025c can be by not Same material is formed.Medicine 22025b and 22025c can be made up of identical material, and the material may differ from forming medicine 22025a material.

Further described above, pipe 22024, leg 22027, and/or limit can be manufactured using injection molding process It is scheduled on cavity 22026a-22026c therein.Pipe 22024, leg 22027, and/or cavity can be manufactured using such as expressing technique 22026a-22026c, wherein, therefore, this category feature may include continuous cross section along its length.Thus such technique, pipe 22024 and leg 22027 may be integrally formed.Then, medicine 22025a-22025c can be positioned at cavity 22026a- respectively In 22026c.For example, medicine 22025a-22025c can be each for example by one or more powder and/or one or more fluids Form.Referring now to Figure 106, cavity 22026a-22026c end 22029 can be sealed so that includes medicine wherein 22025a-22025c.Under any circumstance, pipe 22024 then for example can be positioned at mould (for example, mould as described above 21890) in, wherein can by form compensating part main body 22022 material be poured into around pipe 22024 (as shown in Figure 104) with Form tissue thickness compensation part 22020.Various alternative alternative solutions are shown in Figure 107 and Figure 108.Referring to Figure 107, group Knit multiple longitudinal pipes 22124 that thickness compensation part 22120 may include compensating part main body 22122 and link together.Pipe 22124 In each can limit longitudinal cavity 22126 wherein, the longitudinal cavity 22126 each can include a kind of or more wherein Kind medicine 22125.Longitudinal cavity 22126 can not be in fluid communication each other, but or one or more of longitudinal cavity 22126 that This is in fluid communication.Similarly as described above, compensating part 22120 may also include leg 22127, and the leg 22127 is downward from pipe 22124 Extend and can each include longitudinal cavity 22126 and at least one medicine 22125 wherein.Pipe 22124 and/or supporting leg 22127 can be by can be formed with the material of different rates dissolving and/or bio-absorbable.For example, supporting leg 22127 can be by under for example Material composition is stated, the dissolving of the material and/or absorption rate can be faster than the material for forming pipe 22124.Referring now to Figure 108, Tissue thickness compensation part 22220 may include compensating part main body 22222 and longitudinal pipe 22224, and its middle pipe 22224 may include to prolong from it The multiple supporting legs 22227 stretched.Single longitudinal cavity 22226 can be limited in pipe 22224 and may extend into supporting leg 22227 It is interior.Similarly as described above, cavity 22226 may include the one or more medicines 22225 being positioned in.

Referring again to Figure 97, supporting leg 21827 can be made up of one or more materials described below, and the material can absorb stream Body, for example, blood and/or saline solution.Fluid can be wicked into pipe 21824 and including one kind therein by supporting leg 21827 Or multi-medicament 21825.This wicking can allow medicine 21825 in agglutination earlier dissolving and/or bio-absorbable.Branch The end of support leg 21827 can be not compensated for part main body 21822 and cover and can be exposed to fluid.This wicking process can for example lead to Capillarity is crossed to carry out and can be carried out on the premise of regardless of the orientation of tissue thickness compensation part 21820.

Referring now to Figure 112, tissue thickness compensation part 22320 may include compensating part main body 22322 and be positioned in Multiple pipes 22324.For example, compensating part main body 23222 can be made up of reproducibility organization bracket foam, for example, acellular nethike embrane is given birth to Thing matrix, nethike embrane timbering material, and/or ACell.Nethike embrane timbering material may include the hydrophilic sex vesicle manufactured by Skeleton nethike embrane Foam, and can be compressible in some cases.When exposed to a fluid, nethike embrane timbering material is expansible and to being close to it The tissue of positioning applies pressure.ACell is to provide extracellular matrix or support network to promote the regeneration that cell is bred and migrated Property product.Such as stem cell, PRP or growth factor can be loaded with by forming the organization bracket of compensating part main body 22322.Form and mend Repaying the organization bracket of part main body 22322 can be coated in such as collagen stroma.The organization bracket base of compensating part main body 22322 Matter can be made up of fibre substrate, and fibre substrate can be made up of randomly-oriented fiber.In some cases, by random orientation Fiber form fibre substrate can not can provide in compensating part main body 22322 it is required elasticity or screen resilience.To solve this Problem, randomly-oriented fiber can be made up of hydrophilic material and/or coated with hydrophilic materials, so that exposed to liquid It can be extended after body and required compression stress is provided to the elasticity needed for fibre substrate offer and/or to tissue.Various In the case of, fibre substrate can be not exposed in liquid, until it is captured against tissue by multiple nails, as described above.For example, mend Repaying part main body 22322 may include the impermeable wrappage of liquid, and the wrappage can for example be destroyed, pierced during use Wear, cut, and/or tear, to allow liquid to enter compensating part main body 22322 and touch hydrophilic fibre.In any situation Under, when the backing substrate that liquid is trapped in nail absorbs, backing substrate is expansible, to be applied to the tissue also captured in nail Compressive forces and elapse over time and adapt to the tissue ingrowth in tissue scaffolding matrix.

Further described above, the pipe 22324 of tissue thickness compensation part 22320 can be made up of degradation material, The degradation material can dissolve and/or bio-absorbable.It is similarly as described above, each pipe 22324 may include including There are sealing inner chamber and the one or more supporting legs 22327 of one or more medicines, the supporting leg 22327 can degrade And the passage or flow path for reaching the medicine being stored in pipe 22324 are provided for liquid.Such degraded of supporting leg 22327 The time can be expended, and therefore, the medicine in pipe 22324 not can discharge immediately.In some sense, fluid Degraded leg 22327 can need the time cycle, wherein, therefore, leg 22327 can be used as being designed to delay the medicine in pipe 22324 Release insurance thing.Therefore, in all cases, have long length and/or thicker cross section leg 22327 can provide compared with Long delays, and the leg 22327 with short length and/or relatively thin cross section can provide shorter delay.Pipe 22324 can be by fast Speed and/or the material dissolved at a slow speed are formed；However, in any case, a period of time may be present in the degraded of pipe 22324, and this can Delay to be contained in the release of one or more medicines in pipe 22324.According to the present invention, the first pipe 22324 can be by with the first speed First material of rate degraded is formed, and the second pipe 22324 can be made up of the second material with second or different rates degraded. In the case of such, the first medicine being contained in the first pipe 22324 can be for example in the second medicine being contained in the second pipe 22324 Discharged before.First pipe 22324 can have the outer wall thinner than the second pipe 22324, and this can allow such as the first pipe 22324 Medicine of the medicine degraded faster than the second pipe 22324 and allow to be contained in the first pipe 22334 in the second pipe 22324 Discharge before.Due to described above, for example, the first pipe 22324 can discharge the first medicine, the second pipe in first time point 22324 can discharge the second medicine in second or later point, and the 3rd pipe 22324 can be at the 3rd or even more late Between point release the 3rd medicine.

Referring now to Figure 113 and Figure 114, tissue thickness compensation part 22420 may include compensating part main body 22422 and be positioned at Sealing container 22424 in compensating part main body 22422.Similarly as described above, container 22424 can limit longitudinal cavity 22426 With the one or more medicines 22425 being positioned in longitudinal cavity 22426.Container 22424 can be elastic, so that proper tissue When thickness compensation part 22420 is by compression or pressing, as shown in Figure 114, container 22424 can attempt to resilience or keep it initially unchanged The shape of shape.For example, container 22424 may include the spring member being positioned in compensating part main body 22422.Container 22424 can Change shape without rupturing.For example, container 22424 for example can degrade when exposed to liquid, as described herein.

Referring now to Figure 115, tissue thickness compensation part 22520 may include compensating part main body 22522 and multiple sealing containers 22524a-22524c.For example, each in container 22524a-22524c can limit neighboring, the neighboring can increase Add, minimize, and/or optimize the surface area of the container contacted with liquid (for example, blood and/or saline solution).In various feelings Under condition, the container with large surface area can be exposed to larger amount of liquid, and therefore speed can be dissolved faster And/or bio-absorbable.Therefore, the container with small surface area can be exposed to small amount of liquid, and therefore can be slower Speed dissolved and/or bio-absorbable.Container 22524a-22524c can by such as gelatin, hyaluronic acid, PDS, and/or ORC is formed.It is similarly as described above, container 22524a-22524c can be elasticity and resilience or elastic bias force can be provided. Referring now to Figure 116, tissue thickness compensation part 22620 may include compensating part main body 22622 and be positioned at compensating part main body 22622 Interior multiple elastic layer zoarium components 22624.Each in lamilate component 22624 may include the inner passage sealed, institute State one or more medicines that inner passage includes being positioned in.

Referring now to Figure 117, the end effector of surgery suturing appliance may include anvil block 21060 and nail bin 22700.Anvil block 21060 may include to be attached to tissue thickness compensation part 22770 thereon, and nail bin 22700 may include warehouse 22710 and tissue Thickness compensation part 22720.Referring now to Figure 118, tissue thickness compensation part 22770 may include multiple layers, and wherein tissue thickness is mended Repaying part 22720 may include first layer 22771 and the second layer 22772, but be contemplated that wherein tissue thickness compensation part may include not The only alternate forms of two layers.Optionally, one or more layers of tissue thickness compensation part may include weaving material.First layer 22771 can be made up of multiple lines 22774 of First Line 22773 and second, and the First Line 22773 is made up of the first material, described Second line 22774 is made up of second or different materials.Similarly, the second layer 22772 can be by multiple First Lines 22773 and multiple Two wires 22774 is formed.The concentration of the line 22774 of First Line 22773 and second in first layer 22771 can with the second layer 22772 First Line 22773 it is identical with the concentration of the second line 22774.The line 22774 of First Line 22773 and second in first layer 22771 Concentration can be different from the concentration of the line 22774 of First Line 22773 and second in the second layer 22772, such as will in more detail below It is described.

Further described above, First Line 22773 can by such as Bioabsorbable polymeric (for example, PGA, PDS, PCL, and/or PLA) form, and the second line 22774 can be made up of such as oxidized regenerated cellulose (ORC).First layer 22771 may include the outer layer of tissue thickness compensation part 22770, and may include tissue contacting surface.First layer 22771 may include Than 22774 more First Lines 22773 of the second line.For example, first layer 22771 may include e.g., from about 80% First Line 22773 With the ratio of about 20% the second line 22774.First layer 22771 may include e.g., from about 60% First Line 22773 and about 40% The ratio of the second line 22774, the ratio of about 67% First Line 22773 and about 33% the second line 22774, the of about 70% Ratio, about 75% First Line 22773 and about 25% the second line 22774 of one line 22773 and about 30% the second line 22774 Ratio, and/or about 90% First Line 22773 with about 10% the second line 22774 ratio.

Further described above, First Line 22773 can be made up of materials described below, the material is to be slower than composition Speed dissolving, bio-absorbable, and/or the change state of the material of two wires 22774.For example, the second line 22774 can be by ORC line structures Into the ORC lines can become gel from solid-state for example when exposed to liquid and for example can occur when exposed to blood platelet React and become gel from solid-state.However, in such cases, first layer 22773 can be mainly by bioabsorbable polymer Line is formed, and the bioabsorbable polymer line can be much slower than the speed of ORC lines and liquid reacts, therefore, first Layer 22773 can contact tissue or body fluid without losing its overall shape and structure on multiple positions.In other words, first layer 22773 ORC lines can react in contact liq first and/or tissue；However, ORC gels can at least in part or greatly Partly it is maintained in first layer 22773.

The second layer 22772 may include the internal layer of tissue thickness compensation part 22770, and may not include directly tissue contact Surface.The second layer 22772 may include the First Line 22773 less than the second line 22774.For example, the second layer 22772 may include example The ratio of such as from about 20% First Line 22773 and about 80% the second line 22774.The second layer 22772 may include e.g., from about 40% First Line 22773 with about 60% the ratio of the second line 22774, about 33% First Line 22773 with about 67% the second line 22774 ratio, the ratio of about 30% First Line 22773 and about 70% the second line 22774, about 25% First Line 22773 with about 75% the second line 22774 ratio, and/or about 10% First Line 22773 with about 90% the second line 22774 ratio.

Further described above, the second layer 22772 may include it is for example more more than Bioabsorbable polymeric line ORC lines.The second layer 22772 may include ORC lines more more than first layer 22771.When the second layer 22772 is not outer layer, liquid The second layer 22772 can not be contacted immediately, because liquid will have to first pass through first layer before the second layer 22772 is contacted 22771.In such cases, the second layer 22772 may include the ORC lines of higher density, because in second, protected layer 22772 ORC lines will not be immediately turned into gel.Even if the ORC lines in the second layer 22772 by contact liq and become gel, ORC coagulates Glue also can be by first layer 22771 and included in tissue thickness compensation part 22770, the first layer 22771 can be at least most Just keep its overall shape and provide supporting network for the second layer 22772, as described above.Although optionally use ORC fibers With bioabsorbable fiber, but other suitable materials can be used.

Further described above, referring now to Figure 121 to Figure 123, tissue thickness compensation part 22770 can be positioned on Among anvil block 21060 and tissue T, wherein before 21330 nail bins 22700 of nail are fired, tissue thickness compensation part 22770 can be tight It is compressed by tissue T.It has been fired to capture tissue T and the He of tissue thickness compensation part 22720 wherein in nail 21330 After 22770, the anvil block 21060 and warehouse 22710 of nail bin 22700 are moved away from compensating part 22720,22770 and tissue T simultaneously And it can be removed from operative site.Referring now to Figure 119, the layer 22871 of tissue thickness compensation part may include woven wire 22873, institute Stating woven wire 22873 may include cross section that is for example elongated or flattening.Referring now to Figure 120, the layer of tissue thickness compensation part 22971 may include woven wire 22973, and the woven wire 22973 may include for example circular cross section.

Various alternative alternative solutions are shown in Figure 124-127.Referring now to Figure 125, the end of surgery suturing appliance Portion's actuator may include anvil block 21060 and the tissue thickness compensation part 22770 ' being positioned on.Referring to Figure 124, tissue thickness Compensating part 22270 ' may include layer 22771 ', and the layer 22771 ' may include together with the weaving of multiple second fibers 22774 ' Multiple first fibers 22773 '.For example, the first fiber 22773 ' can be faster than the speed of the second fiber 22774 ' dissolving and/or Bio-absorbable.Gap, opening, and/or pit can be limited between the first fiber 22773 ' and the second fiber 22773 ", so as to Liquid is allowed to flow through layer 22771 '.Referring now to Figure 127, the end effector of surgery suturing appliance may include to be attached to anvil block 21060 tissue thickness compensation part 22770 ".Referring to Figure 126, tissue thickness compensation part 22770 " may include to be embedded in and/or wrap The weaving layer for the line 22771 " being enclosed in substrate 22772 ".Although the exposure of line 22771 " can be made, alternatively, Before making the exposure of line 22771 ", it must not can not dissolve and/or at least a portion of bio-absorbable substrate 22772 ".For example, form The material of substrate 22772 " can be filled in any gap, opening or the pit limited between online 22771 ".

Referring now to Figure 132, nail bin 23000 may include tissue thickness compensation part 23020.As described herein, tissue thickness Compensating part can be manufactured using such as lyophilized technique.Solution for example including PGA and/or PCL can be poured into mould, wherein The solution can allow to become open celled foam in the presence of vacuum atm environment and/or low temperature.For example, PGA materials can be relative Existed in solution in PLA material with by weight about 64/36 ratio., can be by fiber and/or filament 23021 referring to Figure 128 Such as it is mixed into solution.PGA fibers can be for example dispersed in solution before solution is poured into mould so that PGA is fine Dimension for example can equably or be at least substantially uniform distributed in whole tissue thickness compensation part 23020.In other cases, For example PGA fibers can be placed in solution and/or are directly placed in mould, make it that PGA fibers are precipitable or are deposited to Such as the bottom of mould.In other cases, PGA fibers can float to the top of solution.Under any circumstance, such as dioxy The solvent of azacyclohexane solvent etc may be present in solution, and the solution can help to lyophilized technique.Dioxane can Not with or do not reacted with the PGA fibers in solution at least substantially.

Further described above, fiber 23021 can utilize one before being mixed into solution or being mixed with solution Kind or multi-medicament are coated.Referring to Figure 130, each fiber 23021 may include substrate 23022, and the substrate 23022 can profit With any suitable manufacturing process come applying coating 23023 at least in part.Referring to Figure 129, can be manufactured using expressing technique Fiber 23021, wherein for example at least one medication coat is arranged in PGA substrates.These substrates are used especially for can be through By the medicine of the high temperature of expressing technique.Referring to Figure 131, can for example using carrier fluid (for example, supercritical carbon dioxide) come coat and/ Or dipping fiber 23021.Under any circumstance, the fiber 23021 that can be coated with medicine is mixed with solution so that fiber 23021 are embedded in tissue thickness compensation part 23020.Therefore, in all cases, the coating of fiber 23021 can start molten Solve and discharge the one or more medicines being contained therein.It is positioned to the periphery of closer tissue thickness compensation part 23020 Fiber 23021 can start to dissolve before the fiber 23021 of inside of closer tissue thickness compensation part 23020 is positioned to. In the case of such, the fiber 23021 of dissolving can leave multiple cavities or cavity network in tissue thickness compensation part 23020, its In such cavity the cell or tissue in tissue thickness compensation part 23020 can be allowed inwardly to grow up.Tissue thickness compensation part can wrap Multiple first fibers are included, first fiber can be faster than the speed dissolving of multiple second fibers.For example, the first fiber may include Such as the PGA fibers through gamma-radiation.Optionally, the PGA fibers through gamma-radiation can for example be faster than the PGA fibers without gamma-radiation Speed dissolving.

Optionally, one or more colouring agents can be added in above-mentioned solution so that the tissue thickness as made from solution Compensating part can have suitable color.It can it is expected that tissue thickness compensation part has the color being contrasted with its surrounding environment.Example Such as, tissue thickness compensation part can be for example green and/or blue.

Referring now to Figure 133 and Figure 135, tissue thickness compensation part 23120 may include compensating part main body 23122 and be distributed in Multiple drug particles 23121 in whole compensating part main body 23122.Compensating part main body 23122 can be made up of hydrophobic material.Example Such as, compensating part main body 23122 can be made up of such as material including PCL/PGA, and wherein PCL and PGA can be according to by weight 65/ 35 ratio is present in material.Referring now to Figure 134, drug particles 23121 may include one or more medicines 23123, example Such as, fortimicin, percarbonate and/or ascorbyl phosphate, the medicine 23123 can be encapsulated and/or be attached to by for example In the housing or shell 23124 that hydrophilic material is formed.Shell 23124 can by such as low molecular weight gelatine, hyaluronic acid and/ Or CMC is formed.Medicine 23121 can be manufactured into microparticle, the microparticle can be distributed in solution and by the solution It is poured into mould, can then freezes for example described solution in the mold, as described above.Once tissue thickness compensation part 23120 are exposed to liquid during use, and fluid 23129 (Figure 136) can enter compensating part main body 23122 and dissolve And/or absorb the hydrophily shell 23124 of such as drug particles 23121.Referring now to Figure 139, tissue thickness compensation part 23220 It may include first layer 23222 and the second layer or outer layer 23224, the second layer or outer layer 23224 for example may include to be dispersed in it In multiple coatings drug particles 23221.It is similarly as described above, particle 23221 can from the second layer 23224 be dissolved and/ Or absorb and such as opening or capillary pathway 23225 can be for example left in the second layer 23224.Referring now to Figure 140, group Knitting thickness compensation part 23320 may include compensating part main body 23322, and the compensating part main body 23322 includes for example being distributed wherein Multiple drug particles 23121 and multiple fibers 23021.

Referring now to Figure 141 and Figure 142, nail bin 23400 may include that such as warehouse 23410 and the tissue being positioned on are thick Spend compensating part 23420.Tissue thickness compensation part 23420 may include to be positioned at multiple capsules in compensating part main body 23422 23421.Capsule 23421 can be manufactured using such as emoulism or capstan technique, and capsule 23421 may include for example The microsphere of solid and/or liquid bio meterological.Capsule 23421 may include one or more adhesives, described adhesive Fixing organization sealing is can help to when being discharged from capsule 23421.Capsule 23421 may include such as styptic.It is in office In the case of what, capsule 23421 can be distributed in compensating part main body 23422 in any suitable manner.Referring now to Figure 143, Capsule 23421 can be for example placed in the cavity body of mould 21891 being defined in mould 21890, wherein capsule 23421 can It is deposited to the bottom 21893 of mould 21890.Referring to Figure 144, can swing die 21890 to cause capsule 23421 can be in bottom Uniform or at least substantially uniform layer is formed on 21893.Referring now to Figure 145, compensating part main body 23422 can will be formed Material is poured into the cavity body of mould 21891 with capsule 23421.Capsule 23421 more causes than compensating part material of main part It is close, and therefore capsule 23421 is positively retained at the bottom 21893 of mould 21890, as shown in Figure 146.For example, with reference to figure 148, the bottom 21893 of mould 21890 may include multiple grooves, indenture, and/or the recess for being capable of admission capsules agent 23421 21899.Alternatively, referring to Figure 147, capsule 23421 can be not so good as the densification of compensating part material of main part, and can float Move the top of mould 21890.Optionally, as described in greater detail below, the density of capsule 23421 can be selected as making Obtaining capsule 23421 can float in whole compensating part material of main part.

It has suitably been poured into mould 21890 in the mixture including capsule 23421 and compensating part material of main part Afterwards, such as lyophilized technique can be subjected the blend to form tissue thickness compensation part 23420.For example, capsule 23421 can be consolidated Determine and freeze the appropriate location in compensating part main body 23422.Then, can be by tissue thickness compensation part referring again to Figure 141 23420 remove from mould 21890, and are subsequently fitted to the warehouse 23410 of nail bin 23400.As shown in Figure 141, tissue thickness Compensating part 23420, which can be positioned and be arranged so that capsule 23421, can limit or be positioned adjacent to tissue thickness compensation part 23420 tissue contacting surface or top layer 23425.Capsule 23421 can be made up of such as hydrophilic material at least in part, institute State hydrophilic material can for example tissue thickness compensation part 23420 against tissue positioned after by rapidly dissolve and/ Or bio-absorbable.In capsule 23421 each can by can over time and dissolve and/or bio-absorbable multiple materials Layer is formed.For example, the outer layer of capsule 23421 may include the first medicine, first medicine can be dissolved and/or bio-absorbable To expose the second layer or internal layer, the second layer or internal layer include for example being then dissolved and/or the second medicine of bio-absorbable Thing.Some in capsule 23421 can be oriented so that promoting cutting element towards distal side to cut tissue and/or tissue thickness When spending compensating part 23420, these capsules are cut component incision, such as described elsewhere herein.Capsule 23421 can reduce group The density of thickness compensation part 23420 is knitted, this, which can be reduced, for example promotes needed for cutting element through tissue thickness compensation part 23420 Power or energy.

As described above, tissue thickness compensation part 23420 may include the one side or the multi-lateral being positioned in compensating part main body 23422 Or the capsule 23421 on one or more top layers.Also as described above, tissue thickness compensation part 23420 may include to disperse Capsule 23421 in whole compensating part main body 23422.For example, capsule 23421 can have and compensating part material of main part phase Same density so that capsule 23421 can float in compensating part material of main part.Capsule 23421 is dispersible or is uniformly distributed In whole compensating part material of main part, wherein can then settle in capsule 23421 or be deposited to the bottom of mould at least in part Portion comes to cool down the mixture.

Referring now to Figure 149, tissue thickness compensation part 23520 may include shell 23522 and be positioned in shell 23522 Multiple movable units 23524.Shell 23322 can limit the space (for example, cavity 23523) of encapsulating and/or sealing for can Mobile unit 23524 can be mobile in it.Movable units 23254 can be for example spherical, and can be for example relative to that This slides and/or rolled.Tissue thickness compensation part 23520 can be positioned to the top of warehouse 21310 of nail bin, wherein following closely 21330 From percussion and tissue thickness compensation part 23520 can be passed through from nail bin, as shown in Figure 150.In all cases, movable units 23524 can be moved to and just be fired side through the nail 21330 of tissue thickness compensation part 23520 so that unit 23524 can Do not ruptured during percussion.For example, shell 23522 can be made up of elastomeric material, the elastomeric material can be bent and/or partially Move to adapt to the motion of movable units 23524 and the dynamically power of redistribution generation in the inner.Shell 23522 can be encapsulated Medium.For example, medium may include for example one or more powder, liquid, other, fluid and/or gel be for movable units 23524 can be mobile in it.Movable units 23524 can be by for example can dissolve and/or bioabsorbable material and be contained in One or more medicines therein are formed.For example, such construct can provide delaying and/or persistently releasing for one or more medicines Put.Alternatively, although being not shown, tissue thickness compensation part 23520 can be positioned on such as tissue T and anvil block Between 21060.Under any circumstance, tissue thickness compensation part 23520 may include " beans bag " construction of encapsulating.Shell 23522 can It is constructed such that it does not rupture or not ruptured at least substantially, until cutting element (for example, cutting element 21380) is therefrom worn Cross.Now, one or more of movable units 23524 can escape from shell 23522.

Referring now to Figure 153, tissue thickness compensation part 23620 may include compensating part main body 23622 and wrap at least in part Multiple capsules 23624 with which.Referring now to Figure 151, tissue thickness compensation part can be manufactured using mould 23690 23620.For example, multiple ball-type capsule agent 23624 can be positioned in the cavity 23691 being defined in mould 23690, wherein glue Transverse movement of the wafer 23624 in mould 23690 for example by the lateral sidewalls 23694 of mould 23690 and can extend in transverse direction Transverse stop 23693 between side wall 23694 is prevented or stopped.Lateral sidewalls 23694 and transverse stop 23693 can limit Multiple pits, capsule 23624 can be positioned and accommodated in the pit.Capsule 23624 can rest on mould 23690 In lower surface 23699.Alternatively, it may also include one or more referring to Figure 151 and Figure 152, mould 23690 Vertical supports 23692, the vertical supports 23692 being capable of floating capsules 23624 so that they can not contact mould 23690 lower surface 23699.For example, vertical supports 23692 can be positioned in lower surface 23699, while as in addition One kind selection, referring to Figure 152, vertical supports 23692 can be positioned on horizontal support piece 23693.

Referring again to Figure 151 and Figure 152, the material that form compensating part main body 23622 can be poured into the chamber of mould 23690 In body 23691 so that capsule 23624 is surrounded by the material at least in part.Referring primarily to Figure 153, capsule 23624 Part can protrude from the compensating part main body 23622 of tissue thickness compensation part 23620.Horizontal support piece 23693 and/or longitudinal bracing Part 23692 for example can have been withdrawn from compensating part main body 23622 during and/or after by lyophilized technique from mould 23691.This When, capsule 23624 can be suspended in compensating part main body 23622 in the case of in the absence of structural support part.As in addition One kind selection, horizontal support piece 23693 and/or vertical supports 23692 are positively retained in compensating part main body 23622.It is for example, horizontal It can be made up of to support member 23693 and/or vertical supports 23692 such as bioabsorbable material.Support member 23692 and/or Support member 23693 may include the elastic component being positioned in compensating part main body 23622, and the elastic component, which can increase, for example to be compensated The elasticity of part main body 23622.

Referring now to Figure 157, tissue thickness compensation part 23720 may include compensating part main body, and the compensating part main body has Part I 23722a and Part II 23722b and at least one capsule 23724 being positioned between both.It is available Such as mould 21890 manufactures tissue thickness compensation part 23720.Referring now to Figure 154, the first material can be poured into mould To form the Part I 23722a of compensating part main body in 21890.Then, referring to Figure 155, capsule 23724 can be positioned at On Part I 23722a.Can for example a period of time after and/or the first material by lyophilized technique later by capsule Agent 23724 is positioned on Part I 23722a.Referring now to Figure 156, the second material can be poured into mould 21890 with shape Into the Part II 23722b of compensating part main body.Can for example a period of time after and/or the second material by lyophilized technique Afterwards, tissue thickness compensation part 23720 is removed from mould 21890 and entered with reference to the nail bin 23700 for example as shown in Figure 158 Exercise and use.Second material may differ from the first material, while alternatively, the second material can be with the first material phase Together.In any case, the first material and/or the second material can be made up of bioabsorbable material, and capsule 23724 can It is made up of for example, at least a kind of medicine.

Referring now to Figure 162, nail bin 23800 may include tissue thickness compensation part 23820, the tissue thickness compensation part 23820 may include compensating part main body 23822 and the longitudinal capsule 23824 being positioned in.Referring now to Figure 159 and Figure 160, Longitudinal hole 23821 can be formed by any appropriate process of such as mechanical drilling process and/or laser drilling process etc In compensating part main body 23822.Once longitudinal hole 23821 is formed, so that it may which longitudinal capsule 23824 is positioned at longitudinal hole In 23821, as shown in Figure 161.Referring now to Figure 166, nail bin 23900 may include tissue thickness compensation part 23920, the tissue Thickness compensation part 23920 may include compensating part main body 23922 and the multiple capsules 23924 being positioned in.Referring now to figure 163 and Figure 164, can be by any appropriate process of such as mechanical drilling process and/or laser drilling process etc by transverse direction Hole 23921 is formed in compensating part main body 23922.Once transverse holes 23921 are formed, so that it may determine multiple capsules 239824 Position is in transverse holes 23921, as shown in Figure 165.

Figure 167-171 is shown using vertical mould 24090 to manufacture the alternative of tissue thickness compensation part 23820 Method.Referring primarily to Figure 167, mould 24090 may include the cavity 24091 limited by side wall 24092 and bottom end wall 24093. Referring to Figure 168, end wall 24093 may include hole 24094, and the hole 24094 can receive the end of longitudinal capsule 23824 and incite somebody to action Capsule 23824 is maintained at erection position, as shown in Figure 169.Then, referring now to Figure 170, can by covering 24095 come Closing and/or the open side of seal cavity 24091 so that compensating part master can will be formed by the openend of mould 24090 The material of body 23822 is poured into cavity 24091.For example harden, solidified, and/or frozen in the material for forming compensating part main body After dry, tissue thickness compensation part 23820 can be removed from mould 24090.

Referring now to Figure 172, nail bin 24100 may include that warehouse 24110, the platform surface 24111 against warehouse 24110 are determined Position tissue thickness compensation part pad 24170 and be positioned at tissue thickness compensation part pad 24170 top tissue thickness compensation Part 24120.Tissue thickness compensation part 24120 and tissue thickness compensation part pad 24170 can together or independently compensate capture from The change of the thickness for the tissue in nail (for example, 21330 (Figure 175) of nail) that nail bin 24100 fires.Referring primarily to Figure 172 and figure 173, compensating part pad 24170 may include the lower surface 24171 for being capable of abutment platforms surface 24111 and from lower surface The attachment flange or guide rail 24174 of 24171 extensions, the attachment flange or guide rail 24174 can securely be received in and be defined in In cutter slit 24114 in warehouse 24110.Compensating part pad 24170 may also include multiple packages 24172, and the package 24172 can Extend transversely through compensating part pad 24170.For example, each in package 24172 can be limited along axis of pitch, it is described Axis of pitch is transverse to and/or perpendicular to the longitudinal axis that is limited by cutter slit 24114, as shown in Figure 176.Compensating part pad 24170 may include multiple layers, and package 24172 can be limited between the multiple layer.For example, the layer can by such as PDS and/or Collagen is formed.Each package 24172 can store one or more medicines wherein, for example, fortimicin, coagulating agent, and/or Antimicrobial material.

Referring again to Figure 175, tissue thickness compensation part pad 24170 can be positioned relative to warehouse 24110 so that package 24172 are placed in the nail cavity 21312 being limited in warehouse 24110.More particularly, each package 24172 can be positioned and cloth Being set to makes it extend between the nail leg 21332 of nail 21330.Compensating part pad 24170 may include multiple holes and/or through hole, described Hole and/or through hole can for example receive the end of nail 21330.These through holes can be for example positioned near package 24172.Work as nail 21330 when never firing position is moved to firing position, and as shown in Figure 175, nail 21330 can capture package 24172 wherein. For example, nail 21330 and package 24172 can be constructed and arranged to so that package 24172 is not pierced when nail 21330 is just fired Break or do not rupture.In such cases, package 24172 can provide screen resilience or compression stress to the tissue T captured in nail 21330 And the gap that can be consumed between such as tissue T and nail 21330.Referring again to Figure 176, worn when cutting element 21380 is pushed into When crossing the cutter slit 24114 being defined in warehouse 24110, tissue T, and/or compensating part pad 24170, cutting element 21380 can be cut Enter package 24172.Reader is it may be noted that tissue thickness compensation part 24120 is not illustrated in Figure 175 and Figure 176.It is it is contemplated that following each Kind embodiment, wherein nail bin 24100 include tissue thickness compensation part pad 24170 and do not include tissue thickness compensation part 24120, Alternatively, referring now to Figure 177, nail bin 24100 may include such as He of tissue thickness compensation part pad 24170 simultaneously Tissue thickness compensation part 24120.

Alternative implementation of nail bin is illustrated in Figure 178.According to the present invention, circular nail bin 24200 may include circle Warehouse 24210, the circular warehouse 24210 include for example being arranged to multiple nail cavities 21312 of concentric circles.For example, nail bin 24200 The circular tissue thickness compensation part pad 24270 being positioned on warehouse 24210 is may also include, wherein compensating part pad 24270 may include Such as the package 24272 to extend radially outwardly.Similarly as described above, package 24272 can be along the side being placed in nail cavity 21312 To extension so that package 24272 can extend between the leg for the nail 21330 being positioned in nail cavity 21312.Otherwise similar to above Described, nail 21330 captures package 24272 wherein when can be fired following closely 21330 from nail bin 24200.

Referring now to Figure 189, nail bin 24300 may include warehouse 24310 and tissue thickness compensation part 24320, the tissue Thickness compensation part 24320 includes compensating part main body 24322 and the multiple tubular elements being positioned in compensating part main body 24322 24324.For example, nail bin 24300 may also include the group being for example positioned among tissue thickness compensation part 24320 and warehouse 24310 Knit thickness compensation part layer or sheet material 24370.Referring now to Figure 179, multiple nail bins can be manufactured simultaneously using mould 24390 24300.Mould 24390 may include multiple cavities 24391, and the cavity 24391 each can wherein receive warehouse 24310, as shown in Figure 180.Then, the big material piece of one or more including tissue thickness compensation part layer 24370 can be placed On warehouse 24310.Mould 24390 may include the multiple supporting pins upwardly extended or post 24392, and wherein sheet material 24370 can be tight Positioned by post 24392, then pushed downwards so that post 24392 can pierce sheet material 24370, such as Figure 181 and Figure 183 It is shown.Referring now to Figure 182 and Figure 184, elongated tubular 24324 can be curled up around and between post 24392 so that pipe 24324 passes through Cross each warehouse 24310 at least once.Pipe 24324 can be curled up around and between post 24392 so that pipe 24324 is by each Warehouse 24310 such as six times.Pipe 24324 can be allowed to rest on sheet material 24370, while can be tight around and between post 24392 Tightly curl up pipe 24324 so that pipe 24324 is tightened up and can be suspended on sheet material 24370.Once pipe 24324 has obtained suitably Ground is positioned, referring primarily to Figure 185, so that it may which the material for forming compensating part main body 24322 is poured into the mould at the top of sheet material 24370 In 24390.Warehouse 24310 can be protected or sheltered to sheet material 24370, and compensating part material of main part 24322 can be prevented to enter example Such as it is defined in the nail cavity 21312 in warehouse 24310.According to the present invention, the compensating part material of main part 24322 of sufficient amount can be inclined Note in mould so that compensating part material of main part 24322 covers elongated tubular 24322.

Further described above, compensating part material of main part 24322 can then carry out for example solidify, harden, and/or Freeze to form tissue thickness compensation part 24320 at the top of warehouse 24310.Then, referring now to Figure 186, using cutting Punch die 24395 cuts compensating part material of main part 24322, tissue thickness compensation part sheet material 24370 and elongated tubular 24322.Now Referring to Figure 187, cutting punch die 24395 may include multiple cutter 24396, and the cutter 24396 can split and separation group Knit thickness compensation part 24320 and tissue thickness compensation part sheet material 24370.Cutting punch die 24395 may include multiple wells recessed 24397, The well recessed 24397 can be removed between the tissue thickness compensation part 24320 of segmentation and tissue thickness compensation part sheet material 24370 Any excess material, as shown in Figure 188.Cutting punch die 24935 and/or any other suitable punch die may include such as one or Multiple heating element heaters, the heating element heater are capable of the end and/or edge of seal tissue thickness compensation part 24320.Pipe 24324 can Filled with one or more fluids.In such cases, cutter 24396 can cut pipe 24324, while sealed bundle contains The end of tube portion in tissue thickness compensation part 24320.Then, the multiple nail bin 24300 can be removed from mould.

Referring now to Figure 190 and Figure 191, nail bin 24400 may include warehouse 24410, and the warehouse 24410 can be wherein Removedly store multiple nails.In addition, nail bin 24400 may also include tissue thickness compensation part 24420.Tissue thickness compensation part 24420 may include the compensating part main body that is made up of multiple layers 24422, wherein the layer 24422 can be made up of such as cellulose membrane. As shown in Figure 192 a, material 24424 can be positioned between two or more adjacent layers 24422, wherein material 24424 can make Adjacent layer 24422 is spaced apart from each other.Material 24424 may include polyblend biomedics extrudates, and material 24424 may include such as hemostatic material, anti-inflammatory material, and/or anti-biotic material.Referring now to Figure 192, distributor can be passed through Material 24424 is administered to layer 24422 by 24490 with such as waveform pattern, wherein the waveform pattern can be configured so that Material 24424, which can be positioned on, to be defined in above one or more of warehouse 24410 nail cavity.In such cases, material 24424 It can be trapped in the nail projected from nail cavity, and elastic bias force can be provided to the tissue being also trapped in nail.Any In the case of, one or more of layer 24422 for example can be vacuum formed and/or is heat sealed on material 24424 to produce tissue Thickness compensation part 24420.Tissue thickness compensation part 22420 can then be cut into length-specific.It is contemplated that following various realities Example is applied, wherein tissue thickness compensation part 22420 is positioned against the platform surface of nail bin and another tissue thickness compensates Part 22420 is positioned against anvil block.

Referring now to Figure 195, nail bin 24600 may include the one or more tissue thicknesses for being positioned at the top of warehouse 24610 Compensating part 24620.Referring primarily to Figure 194, each tissue thickness compensation part 24620 may include multiple layers 24622 and be positioned at layer Compressible or collapsible component 24624 between 24622.Collapsible component 24624 may include corrugated component, described corrugated Component includes being defined in multiple pits therein, wherein one or more medicines can be stored in pit.For example, can be by first Medicine is placed in the pit of the first side of corrugated component, and the second medicine can be placed on to the of for example corrugated component In the pit of two sides.When for example layer 24622 and compressible member 24624 being compressed together by roller 24590 can form group Knit thickness compensation part 24620.Referring now to Figure 193, tissue thickness compensation part 24520 can be formed by such as tubes of material, the material Expects pipe is for example rolled into the flat shape in part by roller 24590.Referring now to Figure 196 and Figure 197, it is positioned in warehouse 24610 Nail 21330 can be projected from warehouse so that nail 21330 can capture at least one of tissue thickness compensation part 24620 wherein Point.In such cases, compressible member 24624 can abut the tissue T application elasticity being also trapped in nail 21330 partially Put power.The layer 24622 of tissue thickness compensation part 24620 can also abut tissue T and apply elastic bias force.Nail 21330 is pierceable One or more medicines that the pit of corrugated component 24624 and release are contained therein.

Tissue thickness compensation part described above can include material wherein.The material may include such as coagulating agent, medicine Thing, and/or antiinflammatory.The material can be liquid, but other forms can also be presented, for example, solid and/or gel.For bag For the surgical device for including such tissue thickness compensation part, it can be advantageous that surgical device includes material being guided out tissue thickness Spend the feature of compensating part.For example, material can be directed to the tissue of incision and suture from tissue thickness compensation part.And for example, first Tissue thickness compensation part may include the first material, and second thickness compensating part may include the second material, wherein can pass through surgery Device mixes the first material and the second material.And for example, material can be directed to such as nail bin and/or surgery dress away from one another The anvil block put.

Figure 39 0-391 show surgical stapling system, and the surgical stapling system includes cutter 19000, and (it includes cutting Cut sword 19016), nail bin 19002, anvil block 19008, the and of the first tissue thickness compensation part 19004 being positioned on nail bin 19002 The minor microstructure thickness compensation part 19006 being positioned on anvil block 19008.During use, cutter 19000 are along arrow D's Direction moves towards distal side, is mended with cutting patient tissue T and the first tissue thickness compensation part 19004 and minor microstructure thickness Repay part 19006.The material S that the first tissue thickness compensation part 19004 is included therein, and minor microstructure thickness compensation part The 19006 material S ' being included therein.The first tissue thickness compensation part 19004 includes encapsulation object, and the encapsulation object is at it Include material S.Encapsulation object may include the material membrane opened by the cutter 19000 of cutting film, and wherein material S opens in film When be released.Minor microstructure thickness compensation part 19006 may include similar encapsulation object, and works as and cut by cutter 19000 During the encapsulation object of minor microstructure thickness compensation part 19006, releasable second material S '.When knife 19000 is moved distally, it is oriented to Device 19030 and 19022 can be individually directed or be shifted from the first tissue thickness compensation part 19004 and minor microstructure thickness compensation part 19006 material S and material S '.For example, material S and S ' can be directed to the tissue T of incision.Knife 19000 can be connected to axle 19012, the axle 19012 can be subsequently connected to actuating mechanism, and the actuating mechanism indicates along distal direction D and by arrow P Proximal direction move knife 19000.

Material S from the first tissue thickness compensation part 19004 can be directed to the tissue T of incision by guider 19030.Lead It is can be positioned on to the mirror image of device 19030 on the opposite face of knife 19000.Guider 19030 may include limit channel C therebetween two Boss ridge 19032 and 19034.When surgical staples position against tissue T, the distal end 19035 of channel C can be close to the first tissue The proximal extremity 19037 of thickness compensation part 19004 and channel C can be close to tissue T.During use, when the edge of cutter 19000 When distal direction D movements, the material S from the first tissue thickness compensation part 19004 enters passage at distal end 19035 C, channel C and the leaving channel C at adjacent tissue T proximal extremity 19037 are flowed through.

Material S ' from minor microstructure thickness compensation part 19006 can be directed to the tissue T of incision by guider 19022. Guider 19022 includes the projection 19025 with inclined surface 19023.As shown in Figure 61, projection 19025 is pierceable or cuts Minor microstructure thickness compensation part 19006 is with h substance S '.When knife 19000 moves towards distal side D, inclined surface 19025 can incite somebody to action Material S ' is directed to tissue T.

Material S and S ' can mix when being directed into tissue T.Material S and S ' can be different and can be sent out in mixing Raw reaction.For example, in mixing chemical reaction can occur for material S and S ' to form novel substance S ".Novel substance S " can be such as medicine Thing, antibiotic, coagulating agent, and/or material any other suitable type material.Fitted along distal direction D in knife 19000 After locality promotes, knife 19000 can be returned by proximally P movements, and the nearside movement of wherein knife 19000 can also compounding substances S and S '.

Alternatively, guider 19022 and 19030 can guide material S and S ' away from tissue T.Such as Material S can be directed to nail bin 19002 by guider 19030, and material S ' can be directed to anvil block by guider 19022 19008.This construction can be in the following cases favourable, for example, the first tissue thickness compensation part 19004 passes through junction surface Adhesive at 19005 remains to nail bin 19002 and minor microstructure thickness compensation part 19906 is for example, by junction surface 19007 The adhesive at place remains to anvil block 19008.Material S and S ' can dissolve or neutralize adhesive, so as to respectively from nail bin 19002 and anvil Seat 19008 discharges the first tissue thickness compensation part 19004 and minor microstructure thickness compensation part 19006 at least in part.

Figure 63 shows alternative guider 19030 ', wherein channel C ' by the depression on the surface of knife 19014 or Groove limits.Channel C ' it may include single passage or may include multiple passages.

Figure 64-67 show including cutter 19060 and cutting edge 19056, the first tissue thickness compensation part 19004, with And another surgical stapling system of minor microstructure thickness compensation part 19006.Knife 19060 may include first positioned at knife 19060 The first projection 19062 on side, is walked to knife 19060 wherein the first projection 19062 limits from the first side of knife 19060 The aperture 19064 of second side.First projection 19062 and spray orifice 19064 can be aligned with the first tissue thickness compensation part 19004. During use, when knife 19060 is moved distally, at least a portion of the material S in tissue thickness compensation part 19004 can be worn Cross the first aperture 19064.Optionally, the profile of the first projection 19062 material S can be directed to knife 19060 second side and/ Or tissue T.

Knife 19060 may also include the second projection 19066 in the second side of knife 19060, wherein the second projection limits The fixed aperture 19068 walked from the second side of knife 19060 to the first side of knife 19060.Second projection 19066 and the second hole Mouth can be aligned with minor microstructure thickness compensation part 19006.During use, when knife 19060 proximally moves, tissue thickness is mended At least a portion for repaying the material S ' in part 19006 may pass through the second aperture 19068.Optionally, the profile of the second projection 19066 Material S ' can be directed to the second side and/or tissue T of knife 19060.

Referring primarily to Figure 64 and Figure 65, axle 19059 may include surface characteristics, for example, recess 19070, the surface characteristics Material S and material S ' turbulent flow and/or movement can be increased.This increased turbulent flow and/or movement can for example cause material S and S ' Greater part contacted to each other.Recess 19070 can be proximally positioned relative to aperture 19064 and 19068.Present dynasty distal side When promoting knife 19000, recess 19070 can be located at the downstream in aperture 19064 and 19068；However, present dynasty's proximal retraction knife 19000 When, recess 19070 can be located at the upstream in aperture 19064 and 19068.

Figure 68-70 is shown including knife 19100 and cutting edge 19108, the first tissue thickness compensation part 19120, Yi Ji Another surgical stapling device of two tissue thickness compensation parts 19122.The first tissue thickness compensation part 19120 may include the first material S and the second material S '.For example, the first material S can be included in the first encapsulation object, as described above.Second material S ' can be loaded in In second encapsulation object, second encapsulation object can be neighbouring and/or surrounds the first encapsulation object.Minor microstructure thickness compensation part 19122 It may include the 3rd material S ".Minor microstructure thickness compensation part 1922 may include the 4th material S " '.3rd material S " and the 4th material S " ' can be loaded in encapsulation object, encapsulation object as described above.Knife 19100 may include the first side positioned at knife 19100 Texturizing surfaces 19110 on 19102, wherein material S, S ', S " and S " ' can spread on the texturizing surfaces 19110.Separately One texturizing surfaces can be positioned on the relative second side (not shown) of knife 19100.Texturizing surfaces 19110 may include A series of fracture characteristics, for example, being cut, delineating, etch and/or being otherwise formed into the ditch in first surface 19102 Groove.Fracture characteristic may also include a series of protruding features on first surface 19102, for example, convex ridge.As shown in Figure 68-70, line The fracture characteristic on physics and chemistry surface 19110 may include the regular repeating pattern of fracture characteristic.Fracture characteristic can also non-repeating pattern It is arranged or is arranged in random fashion.

Knife 19100 may also include relative to the proximally positioned second surface 19104 of first surface 19102.Second surface 19104 relative to first surface 19102 can be raised.Junction surface between first surface 19102 and second surface 19104 can The 3rd surface 19106 is limited, wherein the 3rd surface 19106 at an angle can be positioned relative to the longitudinal axis of knife 19100. Knife 19100 can cause the first end 19107 on the 3rd surface 19106 to lead over the 3rd surface 19106 along distal direction D motion Second end 19109.Therefore, as shown in Figure 70, the 3rd surface 19106 may be such that from the first tissue thickness compensation part 19120 material S and S ' are directed to the tissue T of incision.Knife is can be positioned on similar to the surface 19105 of second surface 19104 In 19100 relative second side.

Knife 19100 shown in Figure 68-70 can be used in following surgical devices, and the surgical device is included shown in Figure 61-67 The first tissue thickness compensation part 19004 and minor microstructure thickness compensation part 19006.As described above, texturizing surfaces 19110 can Material S and material S ' respectively from tissue thickness compensation part 19004 and 19006 are distributed on the first surface 19102 of knife, So that they can mix and can be positioned near tissue T.

Knife 19100 shown in Figure 68-70 can be additionally used in following surgical devices, and the surgical device includes Figure 68-70 institutes The first tissue thickness compensation part 19120 and minor microstructure thickness compensation part 19122 shown.The first tissue thickness compensation part 19120 It may include the interior section 19121 containing the first material S.When the first tissue thickness compensation part 19120 is by the cutting edge of knife 19100 , can be from the h substance S of interior section 19121 during 19108 cutting.When knife 19100 moves relative to tissue thickness compensation part 19120 When, material S can be spread on texturizing surfaces 19110, and material S can be directed to tissue T by the 3rd surface 19106.As above Described, the first tissue thickness compensation part 19120 may include the second material S ' of the internally positioned outside of part 19121.When first group It when knitting thickness compensation part 19120 and being cut by the cutting edge 19108 of knife 19100, can be distributed in the first material S and the second material S ' On texturizing surfaces 19110.Distribution on texturizing surfaces 19110 can cause the first material S and the second material S ' to mix.First Material S and the second material S ' can react (for example, chemical reaction) in mixing to form novel substance.3rd surface 19106 First material S and the second material S ' can be directed to tissue.As described above, minor microstructure thickness compensation part 19122 may include Three material S ".When minor microstructure thickness compensation part 19122 is cut by the cutting edge 19108 of knife 19100, the 3rd material S " can be made It is distributed on texturizing surfaces 19110, wherein the 3rd material can mix and led with the first material S and/or the second material S ' To tissue T.As described above, minor microstructure thickness compensation part 19122 may include the 4th material S " '.When minor microstructure thickness is mended When repaying part 19122 and being cut by the cutting edge 19108 of knife 19100, the 3rd material S " and the 4th material S " ' can be made to be distributed in veining On surface 19110, wherein the 3rd material and the 4th material can mix and are directed to the first material S and/or the second material S ' To tissue T.

Further described above, tissue thickness compensation part can be made up of biocompatible materials.Biocompatibility Material (for example, foam) may include tackifier, surfactant, filler, crosslinking agent, pigment, dyestuff, antioxidant and other Stabilizer, and/or combinations thereof, so as to provide required characteristic for material.Biocompatible foam may include surface-active Agent.Surfactant can be administered to the surface of material and/or be dispersed in material.Without wishing to be bound by any specific theory, apply The surface tension of fluid of contact material can be reduced by using the surfactant of biocompatible materials.For example, surfactant The surface tension of the water of contact material can be reduced, to promote water penetration in material.Water may act as catalyst.Surfactant can Increase the hydrophily of material.

Surfactant may include anion surfactant, cationic surfactant, and/or non-ionic surface active Agent.It is fine that surfactant example includes but is not limited to polyacrylic acid, methalose, methylcellulose, ethyl cellulose, propyl group Tie up element, hydroxyethyl cellulose, carboxymethyl cellulose, polyoxyethylene cetyl base ether, polyoxyethylene lauryl ether, polyoxethylene octylphenyl Ether, NONIN HS 240, polyoxyethylene oleyl ether, polyoxyethylene sorbitol monolaurate, polyoxyethylene stearyl Base ether, ethylene nonyl phenyl ether, dialkylphenoxypoly (ethylene oxy) ethanol, poloxamer and combinations thereof.Table Face activating agent may include the copolymer of polyethylene glycol and polypropylene glycol.Surfactant may include non-phospholipid surfactants.Phosphatide Surfactant can provide antibacterial stability characteristic (quality), and/or other materials can be dispersed in biocompatible materials.

Tissue thickness compensation part may include at least one medicine.Tissue thickness compensation part may include natural material as described herein One or more in material, non-synthetic materials, and/or synthetic material.Tissue thickness compensation part may include biocompatible foam, The biocompatible foam includes gelatin, collagen, hyaluronic acid, oxidized regenerated cellulose, polyglycolic acid, polycaprolactone, poly- Lactic acid, polydioxanone, polyhydroxy-alkanoates, Poliglecaprone and combinations thereof.Tissue thickness compensation part can wrap Include the film containing at least one medicine.Tissue thickness compensation part may include the biodegradable film containing at least one medicine.Medicine Thing may include liquid, gel, and/or powder.Medicine may include anticarcinogen, for example, cis-platinum, mitomycin, and/or adriamycin.

Tissue thickness compensation part may include Biodegradable material, with when Biodegradable material is degraded provide described in extremely A kind of controlled elution of few medicine.It is biodegradable when the agent of Biodegradable material contact activation (for example, activator fluid) Material is degradable, decomposable asymmetric choice net or loss structure integrality.Activator fluid may include such as saline solution or any other electrolysis Matter solution.Biodegradable material can be sharp to contact by routine techniques (including but not limited to spray, impregnate, and/or brush) Agent fluid living.In use, for example, surgeon can perform the end including the tissue thickness compensation part containing at least one medicine Device and/or nail bin are impregnated into activator fluid (including salting liquid, for example, sodium chloride, calcium chloride, and/or potassium chloride).Work as group When knitting thickness compensation part degraded, tissue thickness compensation part releasable medicaments.Medicine can be by fast from the elution of tissue thickness compensation part The initial elution rates and slower lasting elution rate of speed characterize.

According to the present invention, tissue thickness compensation part can be for example made up of biocompatible materials, the biocompatibility material Material may include oxidant.Oxidant may include organic peroxide and/or inorganic peroxide.The example of oxidant may include but It is not limited to hydrogen peroxide, urea peroxide, calper calcium peroxide and peromag and SODIUM PERCARBONATE.Oxidant may include peroxy oxygen Agent and hypochlorous acid base oxidant, for example, hydrogen peroxide, hypochlorous acid, hypochlorite, hypocodites and percarbonate.Oxidation Agent may include alkali metal chlorite, hypochlorite and perborate, for example, chloritization sodium, sodium hypochlorite and sodium perborate.Oxygen Agent may include vanadate.Oxidant may include ascorbic acid.Oxidant may include active oxygen product.According to the present invention, group Knitting support may include the biocompatible materials containing oxidant.

Biocompatible materials may include liquid, gel, and/or powder.Oxidant may include such as particulate and/or nanometer Particle.For example, oxidant can be ground into particulate and/or nano particle.Can be by making oxidant be suspended in polymer solution Oxidant is incorporated into biocompatible materials.Oxidant can be incorporated into biocompatibility in lyophilization process In material.After lyophilized, oxidant could attach to the cell-wall of biocompatible materials, with contact when with tissue phase Interaction.Oxidant not can be chemically bonded to biocompatible materials.Percarbonate dry powder can be embedded in biocompatibility In foam, to provide long-term biological effects by the slow release of oxygen.Percarbonate dry powder can be embedded in and be knitted with non- Make in the polymer fiber of structure, to provide long-term biological effects by the slow release of oxygen.Biocompatible materials can Including oxidant and medicine, for example, fortimicin and ascorbic acid.

Biocompatible materials may include the oxidant of quick release and/or the oxidant of slower sustained release.Oxidant It can be characterized from the elution of biocompatible materials by quick initial elution rates and slower lasting elution rate.Work as oxidation When agent contacts body fluid (for example, water), oxidant can produce oxygen.The example of body fluid may include but be not limited to blood, blood plasma, peritonaeum Liquid, celiolymph, urine, lymph, synovia, vitreous humor, saliva, gastrointestinal cavity content, and/or bile.Not by any tool The theoretical constraint of body, oxidant can reduce cell death, enhancing organizational vitality and/or keep to cut and/or suturing The mechanical strength of tissue-tissue of period infringement.

Biocompatible materials may include at least one particulate and/or nano particle.Biocompatible materials may include this The one or more in natural material, non-synthetic materials and synthetic material described in text.Biocompatible materials may include have The particle of the average diameter of about 10nm to about 100nm and/or about 10 μm to about 100 μm (such as 45-50nm and/or 45-50 μm). Biocompatible materials may include biocompatible foam, and the biocompatible foam includes being embedded at least one micro- Grain and/or nano particle.Particulate and/or nano particle not can be chemically bonded to biocompatible materials.Particulate and/or nanometer Particle can provide the controlled release of medicine.Particulate and/or nano particle may include at least one medicine.Particulate and/or nanometer Grain may include such as styptic, antimicrobial, and/or oxidant.Tissue thickness compensation part may include biocompatible foam, The biocompatible foam includes the styptic containing oxidized regenerated cellulose, anti-micro- containing fortimicin and/or gentamicin Biological agent, and/or the oxidant containing percarbant.Particulate and/or nano particle can provide the medicine of such as at most three days by Controlled release is put.

Particulate and/or nano particle can be embedded into biocompatible materials during manufacturing process.For example, bio-compatible Property polymer (for example, PGA/PCL) can contact solvent (for example, dioxane) to form mixture.Biocompatibility gathers Compound can be ground to form particle.The dry particle for containing or not contain ORC particles can contact mixture to form suspension Liquid.Suspension can be freezed to form biocompatible foam, the biocompatible foam includes PGA/PCL, the PGA/PCL With dry particle and/or the ORC particles being embedded.

Tissue thickness compensation part disclosed herein or layer can be made up of such as absorbable polymer.Tissue thickness compensates Part can be made up of for example following material：Foam, film, fiber weaving thing, fiber non-woven thing PGA, PGA/PCL (it is poly- (glycolic- Co- caprolactone)), PLA/PCL (poly- (lactic acid -co- polycaprolactone)), PLLA/PCL, PGA/TMC (poly- (glycolic -co- Sanya Methyl carbonic)), the absorbable polyurethane of PDS, PEPBO or other, polyester, makrolon, poe, polyanhydride, polyester Acid amides, and/or polyoxy acid ester.According to the present invention, tissue thickness compensation part is by such as PGA/PLA (poly- (glycolic -co- breasts Acid)) and/or PDS/PLA (poly- (p- dioxanone -co- lactic acid)) compositions.According to the present invention, tissue thickness compensation part can be by Such as organic material is formed.Tissue thickness compensation part can by such as carboxymethyl cellulose, mosanom, cross-linked-hyaluronic acid, and/or Oxidized regenerated cellulose is formed.According to the present invention, tissue thickness compensation part may include such as 3-7 Xiao A hardness (30-50 Shores OO hardness) in the range of hardometer, wherein maximum rigidity is 15 Xiao A hardness (65 Shore OO hardness).Tissue thickness compensation part 40% compression can occur under 3lbf loads, 60% compression can occur under 6lbf loads, and/or born in 20lbf 80% compression can occur under lotus.One or more gases (for example, air, nitrogen, carbon dioxide, and/or oxygen) can be roused Enter in tissue thickness compensation part and/or may be housed in tissue thickness compensation part.Tissue thickness compensation part can wrap wherein Include particle, the particle can account for about the 50% of the material hardness for forming tissue thickness compensation part to more than 75%.

According to the present invention, tissue thickness compensation part may include for example hyaluronic acid, nutrient, fibrin, fibrin ferment, Rich in hematoblastic blood plasma, SASP (- 5ASA+ sulfapryidines azo bond))-pro-drug-colon Bacterium (azo reductase), aminosalicylic acid (have be used for delay release different pro-drug structures 5ASA), (- the pH of 5ASA+ acrylic resins-S coatings>7 (coating dissolvings)),(coating of 5ASA+ ethyl celluloses-when Between/pH dependent sustained releases),(- the pH of 5ASA+ acrylic resins-L coatings>6), Olsalazine (5ASA+5ASA- Colon bacteria (azo reductase)), Balsalazide (5ASA+4 amino benzoyl-B- alanine)-colon bacteria (azo reduce Enzyme)), granular aminosalicylic acid, Lialda (sustained release and SR preparations of aminosalicylic acid), HMPL-004 (can forbid TNF-α, interleukin- 1 β and core-κ B activation herbal mixture), CCX282-B (interference T lymphocytes transport in intestinal mucosa orally becoming Change cytokine receptor antagonist), rifaximin (broad-spectrum antibiotic of nonabsorable), infliximab, murine Chymieric (targets the monoclonal antibody of TNF-α, the TNF-α is approved for reducing sign/symptom, keeping in taking The clinical remission of adult/child patient of equivalent/severe amount phenobarbital and to it is insufficient reaction conventional therapy Crohn Sick fistulization), adalimumab, human IgG1 (anti-TNF-alpha monoclonal antibodies-be approved for reduce Crohn disease sign/symptom And available for reduction and the holding moderate with insufficient reaction conventional therapy/severe activity Crohn diseases or English is not tolerated The clinical remission of the adult patients of husband's profit former times monoclonal antibody), Certolizumab pegoll, the anti-TNF FAB ' of peopleization (be linked to The monoclonal antibody fragment of polyethylene glycol-be approved sign/symptom for reducing Crohn diseases and can be used for reducing and keeping The reaction of the adult patients of moderate/severe disease with insufficient reaction conventional therapy), natalizumab, the first non-TNF-α Inhibitor (being approved the biologic artifact for Crohn diseases), the monoclonal IgG4 antibody of peopleization (target α -4 integrins - By FDA check and approve for induce and keep with exist inflammatory signs moderate/severe disease and it is insufficient reaction or can not Be resistant to clinical response and the alleviation of the patient of conventional Crohn treatment and TNF-α inhibitor), may be together with infliximab The concomitant immunity modulator of administration), imuran -6-MP (purine synthetic inhibitor-pro-drug), methotrexate (MTX) (knot Close dihydrofolate reduction (DHFR) enzyme, it participates in tetrahydrofolic acid Lipase absobed, suppresses all purine synthetics), allopurinol and Imuran treatment, PPI, suppress to protect healing H2, C-Diff-Flagyl of line, vancomycin (at excrement transposition for acid Reason；Probioticses；Flora breeds again in normal chamber), and/or rifaximin (treatment (the significantly liver property of bacterial overgrowth Encephalopathic)；Do not absorbed by intestines and stomach and do not act on bacterium in tube chamber).

As described herein, tissue thickness compensation part can for example compensate the change of tissue thickness, the tissue be trapped in from In the nail that nail bin projects and/or it is accommodated in staple line.In other words, some nails in staple line can capture the thicker of tissue Point, and other nails in staple line can capture the thinner part of tissue.In such cases, tissue thickness compensation part can be in nail Existing different height or thickness, and tissue of the capture in nail can be applied compressive force to, it is thick but regardless of the tissue captured It is or thin.According to the present invention, tissue thickness compensation part can compensate for the change of tissue hardness.For example, some nails in staple line can be caught The high compression part of tissue is obtained, and other nails in staple line can capture the relatively low compression section of tissue.In such cases, group Knitting thickness compensation part for example can capture with compared with less height is presented in the nail of little compressible or the tissue of higher hardness Degree, and accordingly, larger height is presented in the nail captured with higher compression ratio or compared with the tissue of soft. In any case, tissue thickness compensation part is for example regardless of whether the change of compensation tissue thickness and/or tissue hardness change can claim For such as " Tissue compensating part " and/or " compensating part ".

Device disclosed in this invention can be designed as being handled after being intended for single use, or can be designed as them can It is used for multiple times.However, in either case, described device can be repaired, to be reused after use at least once. Again any combination that may include following steps is recovered：Dismantle the device and then cleaning or substitute some parts and subsequent group Dress.Particularly, described device can be dismantled, and it is any number of optionally can to substitute or remove in any combination the device Specific component or part.After cleaning and/or replacement specific part, the device can be re-assemblied so as to subsequent at restoration facilities Use, or re-assemblied before it will carry out surgical operation by surgical team.Those skilled in the art will be appreciated that, fill The reparation put can utilize it is a variety of be used to dismantling, the technology for cleaning/substitute and re-assembly.The uses of these technologies and gained Prosthetic device is within the scope of the present invention.

Preferably, invention as described herein will be handled before the surgery.First, new or used dress is obtained Put, and device is cleaned when necessary.Then device is carried out disinfection.In a kind of disinfection technology, the device is placed in In the container for closing and sealing, such as in plastics or TYVEK bag.Then the spoke of the container can be penetrated by being placed in container and device Penetrate area, such as γ radiation, x- rays or high energy electron.The bacterium on device and in container is killed in radiation.Then after sterilizing Device be stored in disinfecting container.Apparatus is kept sterile by the sealing container, until opening the container in Medical Devices.

By reference in full or any patent, the patent that are partly incorporated herein disclose or other open materials only exist The material being incorporated in existing definition of the present invention, statement or the afoul scope of other open materials with not being incorporated to this Text.Thus, under necessary degree, the disclosure that herein explicitly illustrates will substitute be herein incorporated by reference it is any Afoul material.If according to state be herein incorporated by reference but with it is as described herein it is existing definition, statement or other disclosures Afoul any material of material or part thereof, only do not produce conflict between the material and existing open material being incorporated to It is incorporated herein under degree.

Although being described the present invention as exemplary design, it is also possible in spirit and scope of the present disclosure It is interior that the present invention will be further modified.Therefore present patent application be intended to using its general principles any modification, Purposes or adaptive version.In addition, present patent application is intended to come from known in art of the present invention or is used to have practical framework The interior pattern away from the disclosure.

Claims

A kind of 1. compensating part for the anvil block that can be attached to fastening instrument, wherein the anvil block includes profiled surface, the compensation Part includes：

The first layer being made up of the first fiber being mutually independent and the second fiber, wherein first fiber is by the first material Form and second fiber is made up of the second material, wherein first material is different from second material, and its Described in the first fiber and second fiber be present according to the first ratio in the first layer；

The second layer being made up of first fiber being mutually independent and second fiber, wherein first fiber and Second fiber is present in the second layer according to the second ratio, and wherein described first ratio and second ratio It is different；And

The attachment of the anvil block can be attached to,

Wherein, in the first layer, together with second fiber is interweaved with first fiber, and wherein in institute State in the second layer, together with first fiber is interweaved with second fiber.
2. compensating part according to claim 1, wherein first material includes oxidized regenerated cellulose, and described Two materials include absorbable polymer.
3. the compensating part according to claim 1 or claim 2, wherein the institute of first fiber and second fiber It is about 4 to state the first ratio:1, and second ratio of wherein described first fiber and second fiber is about 1:4.
4. compensating part according to claim 1, wherein the first layer includes tissue contacting surface, and wherein described Two materials include oxidized regenerated cellulose.
5. compensating part according to claim 1, in addition to absorb in the described first intrastitial medicine.