CN103717151B

CN103717151B - Comprise the nail bin of compressible resistance to deformation parts

Info

Publication number: CN103717151B
Application number: CN201280031903.5A
Authority: CN
Inventors: F·E·谢尔顿四世; C·O·巴克斯特三世; T·W·阿伦霍尔特; J·E·杨
Original assignee: Ethicon Endo Surgery Inc
Current assignee: Ethicon Endo Surgery Inc
Priority date: 2011-04-29
Filing date: 2012-04-13
Publication date: 2016-05-04
Anticipated expiration: 2032-04-13
Also published as: JP2014519355A; CA2834424A1; BR112013027896A2; CN103717151A; AU2012250141A1; AU2012250141B2; RU2013152959A; CA2834424C; RU2613603C2; BR112013027896B1; JP6009543B2

Abstract

Securing member storehouse can comprise support section, with respect to tissue thickness's compensating part of described support section location and be positioned at described support section and/or described tissue thickness compensating part in can be used for multiple securing members of fastening tissue. In use, securing member storehouse can be positioned in the first jaw of surgery fastener, and wherein the second jaw or anvil block can be positioned in the opposite of described the first jaw. For disposing securing member, nail is disposed member and is pushed into through described securing member storehouse so that securing member moves towards anvil block. In the time that securing member is deployed, described securing member can be caught at least a portion of tissue thickness's compensating part wherein, together with at least a portion of just fastened tissue.

Description

Comprise the nail bin of compressible resistance to deformation parts

The cross reference of related application

This non-provisional patent application is according to submitting on September 30th, 2010 of 35U.S.C. § 120Name be called the United States Patent (USP) of " FastenersSupportedByaFastenerCartridgeSupport "The part continuation application of patent application serial numbers 12/894,345, its whole disclosures side to quote accordinglyFormula is incorporated to herein.

Background technology

The present invention relates to a kind of surgical instruments, and relate in various embodiments and be designed to cutCut surgery cutting and suture instruments and nail bin thereof with suture tissue.

Brief description of the drawings

The logical following explanation coming by reference to the accompanying drawings with reference to the embodiment of the present invention, feature of the present invention and advantage andIts acquisition methods will become more apparent, and can understand better invention itself, wherein:

Fig. 1 is the cutaway view of surgical instruments embodiment;

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

Figure 1B-1E shows the multiple portions with the end effector of the clamping of implanted nail bin and suture tissuePoint;

Fig. 2 is the partial cross-section side that is connected to another end effector of a part for surgical instrumentsView, wherein end effector support surgery nail bin and its anvil block are in an open position;

Fig. 3 is another partial cross-section side-looking in the close position of the end effector shown in Fig. 2Figure;

Fig. 4 is that the end effector shown in Fig. 2 and Fig. 3 starts to advance through end effector at knife barTime another partial cross-sectional side view;

To be the end effector shown in Fig. 2 to Fig. 4 partly advanced through wherein time at knife bar Fig. 5Another partial cross-sectional side view;

Fig. 6 is mounted in the perspective of the alternative nail bin embodiment in surgery cutting and stitching devicesFigure;

Fig. 7 is the surgery nail bin of Fig. 6 shown device and the top view of elongated passageway;

Fig. 8 is mounted in the top of another surgery nail bin embodiment in the elongated passageway of end effectorView;

Fig. 9 is the bottom view of anvil block;

Figure 10 is the fragmentary, perspective view that forms multiple nails of a part for nail row;

Figure 11 is another fragmentary, perspective view that the nail of Figure 10 is capable, and it is followed closely as to be cut and to be stitched by surgeryAfter the anvil block contact of locking device is shaped;

Figure 12 is the fragmentary, perspective view that forms alternative nail of a part for another nail row;

Figure 13 is the fragmentary, perspective view that forms alternative nail of a part for another nail row;

Figure 14 is the partial perspective that forms alternative nail of a part of another nail row embodimentFigure;

Figure 15 is the cutaway view that supports the end effector of nail bin;

Figure 16 is that the elongated passageway portion of end effector shown in Figure 15 is removing implanted nail bin master from itBody divide and follow closely after cutaway view;

Figure 17 is the cutaway view that supports the end effector of another nail bin;

Figure 18 A-18D describes to be positioned at according at least one embodiment the surgical staples that can collapse in nail bin bodyDistortion;

Figure 19 A illustrates the schematic diagram that is positioned at the nail in can conquassation nail bin body;

Figure 19 B be illustrate shown in Figure 19 A can conquassation nail bin body by the schematic diagram of anvil block conquassation;

Figure 19 C be illustrate shown in Figure 19 A can conquassation nail bin body by the signal of the further conquassation of anvil blockFigure;

Figure 19 D illustrates that the nail shown in Figure 19 A is in being shaped completely shown in configuration and Figure 19 ACan the schematic diagram of conquassation nail bin in complete conquassation state;

Figure 20 illustrates the nail of locating against nail bin stayed surface and nail and nail bin stayed surface is shownBetween the schematic diagram of potential relative motion;

Figure 21 is the surface-supported cutaway view of nail bin, and described nail bin stayed surface comprises slit or groove,To stablize the base portion of the nail shown in Figure 20;

Figure 22 is according to the cutaway view of the nail of at least one alternative embodiment, and described nail comprisesThe bizet of overmolding and can hold slit or the groove of a part of described bizet;

Figure 23 is according to the top view of the nail bin of at least one embodiment, and described nail bin comprises that embedding canThe nail of collapsing in nail bin body;

Figure 24 is the front view of nail bin shown in Figure 23;

Figure 25 is according to the front view of the nail bin of at least one embodiment, and described nail bin comprises around fixedPosition is at the protective layer of the nail in nail bin body of can collapsing;

Figure 26 is the cutaway view of nail bin shown in the Figure 25 intercepting along the line 26-26 in Figure 25;

Figure 27 is according to the front view of the nail bin of at least one embodiment, and described nail bin comprises at least portionDivide and extend can the collapse external nail of nail bin and the protective layer around described nail bin body;

Figure 28 is the cutaway view of nail bin shown in the Figure 27 intercepting along the line 28-28 in Figure 27;

Figure 29 is according to the partial cutaway view of the nail bin of at least one embodiment, and described nail bin comprisesEmbed at least in part the nail that can collapse in nail bin body, described nail is positioned at described nail bin body at least in partIn nail lacuna in;

Figure 30 is the cutaway view of nail bin shown in the Figure 29 intercepting along the line 30-30 in Figure 29;

Figure 31 is according to the partial cutaway view of the nail bin of at least one embodiment;

Figure 32 is according to the partial cutaway view of the nail bin of at least one embodiment, and described nail bin comprisesEmbed at least in part the nail that can collapse in nail bin body and connect described nail and make described nail with respect to thatThe alignment matrix of this alignment;

Figure 33 is the cutaway view of nail bin shown in the Figure 32 intercepting along the line 33-33 in Figure 32;

Figure 34 is the partial cutaway view of the internal layer of compressible nail bin body;

Figure 35 shows showing of between transfer plate and the gripper shoe internal layer shown in compressed Figure 34Intention;

Figure 36 illustrates that nail is inserted into the schematic diagram in the compressed internal layer shown in Figure 35;

Figure 37 is the schematic diagram that illustrates that shown in Figure 35, gripper shoe is removed from internal layer;

Figure 38 illustrates to comprise internal layer shown in Figure 34 and be inserted into the subgroup of following closely shown in the Figure 36 in skinThe schematic diagram of part;

Figure 39 illustrates the outer sealed schematic diagram with formation sealing nail bin shown in Figure 38;

Figure 40 is the cutaway view that seals nail bin shown in Figure 39;

Figure 41 is according to the cutaway view of the nail bin of at least one embodiment and nail bin passage;

Figure 42 is the schematic diagram of a part in deformation state that nail bin shown in Figure 41 is shown;

Figure 43 is the front view of the end effector of surgical stapling device, and described end effector comprises placeIn the anvil block of open position be positioned at the nail bin in nail bin passage;

Figure 44 is the front view of end effector shown in Figure 43, and it illustrates anvil block in the close positionAnd be compressed in the nail bin between anvil block and nail bin passage;

Figure 45 is the front view of end effector shown in Figure 43, and it illustrates that the nail bin shown in Figure 43 is to replaceBe positioned at nail bin passage for mode;

Figure 46 is the cutaway view of the end effector of surgical stapling device, and described end effector comprises positionCompressible nail bin in nail bin passage and a backing material that is attached to anvil block;

Figure 47 is the cutaway view of end effector shown in Figure 46, and it illustrates anvil in the close positionSeat;

Figure 48 is the cutaway view of alternative embodiment of the end effector of surgical stapling device, instituteState end effector and comprise the nail bin with impermeable stratum;

Figure 49 is the analysing and observe of another alternative embodiment of the end effector of surgical stapling deviceFigure;

Figure 50 is the cutaway view of alternative embodiment of the end effector of surgical stapling device, instituteState the nail bin that end effector comprises staged anvil block and has staged warehouse;

Figure 51 is the analysing and observe of another alternative embodiment of the end effector of surgical stapling deviceFigure;

Figure 52 is the cutaway view of alternative embodiment of the end effector of surgical stapling device, instituteState the tissue contacting surface that end effector comprises inclination;

Figure 53 is the analysing and observe of another alternative embodiment of the end effector of surgical stapling deviceFigure, described end effector comprises the tissue contacting surface of inclination;

Figure 54 is the cutaway view of alternative embodiment of the end effector of surgical stapling device, instituteState end effector and comprise the support insert that can support nail bin;

Figure 55 is the cutaway view of alternative embodiment of the end effector of surgical stapling device, instituteState end effector and comprise the nail bin with multiple compressible stratums;

Figure 56 is the cutaway view of alternative embodiment of the end effector of surgical stapling device, instituteState end effector and comprise the nail bin with the compressible warehouse of staged;

Figure 57 is the analysing and observe of another alternative embodiment of the end effector of surgical stapling deviceFigure, described end effector comprises the nail bin with the compressible warehouse of staged;

Figure 58 is the cutaway view of alternative embodiment of the end effector of surgical stapling device, instituteState end effector and comprise the nail bin with bending tissue contacting surface;

Figure 59 is the cutaway view of alternative embodiment of the end effector of surgical stapling device, instituteState the nail bin that end effector comprises the tissue contacting surface with inclination;

Figure 60 is the cutaway view of compressible nail bin, and described compressible nail bin comprises nail and wherein storesAt least one medicament;

Figure 61 illustrates that the nail compressed and that wherein held of the compressible nail bin shown in Figure 60 is out of shape itAfter schematic diagram;

Figure 62 is according to the partial cutaway view of the nail bin of at least one embodiment;

Figure 63 is the cutaway view of nail bin shown in Figure 62;

Figure 64 is according to the perspective view of the nail bin of implanting of at least one alternative embodiment;

Figure 65 is the cutaway view of the nail bin of implanting shown in Figure 64;

Figure 66 is the perspective view of alternative embodiment of nail bin, and described nail bin comprises from nail binThe outer deformable member extending;

Figure 67 is the perspective view of alternative embodiment of nail bin, in described nail bin comprises and being assembled toThe nail bin skin of layer;

Figure 68 is the cutaway view of alternative embodiment of nail bin, described nail bin comprise multiple nails,Compressible stratum and degreasing cotton layer;

Figure 69 is the perspective view of degreasing cotton layer shown in Figure 68;

Figure 70 be the absorbent cotton that is partitioned into from the degreasing cotton layer shown in Figure 68 and with absorbent cotton ditchThe perspective view of the nail of groove alignment;

Figure 71 is the perspective view from two connected absorbent cotton of degreasing cotton layer shown in Figure 68;

Figure 72 is that the absorbent cotton support frame of degreasing cotton layer shown in Figure 68 is by the absorbent cotton from being partitioned intoThe perspective view removing;

Figure 73 is the decomposition diagram of alternative embodiment of compressible nail bin, described compressibleNail bin comprise nail and for drive the system of nail against anvil block;

Figure 73 A is the partial cutaway view of alternative embodiment of nail bin shown in Figure 73;

Figure 74 is the cutaway view of nail bin shown in Figure 73;

Figure 75 can traverse the nail bin shown in Figure 73 and make facing of the nail sliding part of advancing towards anvil blockFigure;

Figure 76 is the schematic diagram that staple drivers is shown, described staple drivers can be by the slip shown in Figure 75Part promotes towards anvil block;

Figure 77 is the excision view according to the nail bin of at least one alternative embodiment, described nailStorehouse comprises the nail that is positioned at staple drivers;

Figure 78 is the cutaway view of the nail bin shown in Figure 77 while being positioned at nail bin passage;

Figure 79 is the cutaway view of nail bin shown in Figure 77, and it illustrates and moves to the anvil block of closing position and lead toCross anvil block and be out of shape be contained in the nail in nail bin;

Figure 80 is the cutaway view of nail bin shown in Figure 77, and it illustrates the nail moving upward towards anvil block;

Figure 81 is the perspective view of alternative embodiment of nail bin, and described nail bin comprises connection nail binThe band of each flexible sides;

Figure 82 is the perspective view of sliding part and cutting element assembly;

Figure 83 illustrates to promote shown in Figure 77 with the sliding part shown in Figure 82 and cutting element assemblyThe schematic diagram of the nail of nail bin;

Figure 84 is that illustrate can jointing nail and promote the sliding part of nail and can optionally make towards anvil blockThe schematic diagram of the locking system of sliding part distal motion;

Figure 85 A-85C illustrates nail is inserted to the process in nail bizet;

Figure 86 is the cutaway view that comprises the nail bin of supporting disk or retainer;

Figure 87 is according to the broken section of the compressible nail bin of at least one alternative embodimentFigure;

Figure 88 illustrates the schematic diagram of the nail bin shown in Figure 87 in the time of implanting state;

Figure 89 looks according to the local excision of the compressible nail bin of at least one alternative embodimentFigure;

Figure 90 is the partial sectional view of nail bin shown in Figure 89;

Figure 91 illustrates the schematic diagram of the nail bin shown in Figure 89 in the time of implanting state;

Figure 92 be according at least one alternative embodiment can conquassation nail bin broken sectionFigure;

Figure 93 is according to the collapsed nail bin that comprises multiple crushable members of at least one embodimentPartial cutaway view;

Figure 94 is the perspective view of the crushable member shown in Figure 93 in the time of non-collapsed state;

Figure 95 is the perspective view of the crushable member shown in Figure 94 in the time of collapsed state;

Figure 96 A is the partial sectional view of the end effector of surgery suturing appliance, described end effectorThe nail bin passage that comprises jaw, relatively locate with described jaw and be positioned at described nail bin passageNail bin, wherein said jaw comprises the maintenance matrix that is attached to jaw;

Figure 96 B is the partial sectional view of end effector shown in Figure 96 A, and it illustrates towards nail bin row of passagesThe jaw that enters, by anvil block with keep nail bin and the nail of matrix compression, described nail prolongs at least in partStretch the tissue keeping in the middle of matrix and nail bin through being positioned at;

Figure 96 C is the partial sectional view of end effector shown in Figure 96 A, and it illustrates in final positionJaw and the maintenance matrix closing with the nail joint shown in Figure 96 B;

Figure 96 D is the partial sectional view of end effector shown in Figure 96 A, and it illustrates that jaw and nail bin lead toRoad is away from the nail bin of implanting and keep matrix motion;

Figure 97 is according to the perspective of the retaining hole of the maintenance matrix of at least one alternative embodimentFigure, described retaining hole comprises multiple retaining members, extends through the tight of described retaining hole for engagingFirmware supporting leg;

Figure 98 is according to the perspective of the retaining hole of the maintenance matrix of at least one alternative embodimentFigure, described retaining hole comprises six retaining members;

Figure 99 is according to the perspective of the retaining hole of the maintenance matrix of at least one alternative embodimentFigure, described retaining hole comprises eight retaining members;

Figure 100 is according to the perspective of the retaining hole of the maintenance matrix of at least one alternative embodimentFigure, described retaining hole comprises multiple retaining members, extends through the tight of described retaining hole for engagingFirmware supporting leg;

Figure 101 is according to the perspective of the retaining hole of the maintenance matrix of at least one alternative embodimentFigure, described retaining hole comprises six retaining members;

Figure 102 is according to the perspective of the retaining hole of the maintenance matrix of at least one alternative embodimentFigure, described retaining hole comprises eight retaining members;

Figure 103 is according to the perspective of the retaining hole of the maintenance matrix of at least one alternative embodimentFigure, described retaining hole comprises the multiple retaining members that are stamped to form by sheet metal;

Figure 104 is according to the perspective of the retaining hole of the maintenance matrix of at least one alternative embodimentFigure, described maintenance matrix comprises multiple holes of extending along the periphery of described retaining hole;

Figure 105 is according to the top view of the retaining hole of the maintenance matrix of at least one alternative embodimentFigure;

Figure 106 is according to the top view of the retaining hole of the maintenance matrix of at least one alternative embodimentFigure;

Figure 107 is according to the top view of the retaining hole of the maintenance matrix of at least one alternative embodimentFigure;

Figure 108 is according to the top view of the retaining hole of the maintenance matrix of at least one alternative embodimentFigure;

Figure 109 is according to the top view of the retaining hole of the maintenance matrix of at least one alternative embodimentFigure;

Figure 110 is according to the top view of the retaining hole of the maintenance matrix of at least one embodiment, described guarantorHold hole and comprise the maintenance inserted sheet extending in described retaining hole;

Figure 111 is according to the top view of the retaining hole of the maintenance matrix of at least one alternative embodimentFigure, described retaining hole comprises the maintenance inserted sheet extending in described retaining hole;

Figure 112 is the perspective view of fastening system, described fastening system comprise multiple nails, with described nail jointThe maintenance matrix closing and the alignment matrix that can align described nail;

Figure 113 is the perspective view that keeps matrix shown in Figure 112;

Figure 114 is the perspective view of alignment matrix shown in Figure 112;

Figure 115 is the local top view of the nail joint shown in the maintenance matrix shown in Figure 112 and Figure 112 while closingFigure;

Figure 116 is that the partial bottom of the nail joint shown in the maintenance matrix shown in Figure 112 and Figure 112 while closing lookedFigure;

Figure 117 is the partial elevation view of fastening system shown in Figure 112;

Figure 118 is the fragmentary, perspective view of fastening system shown in Figure 112;

Figure 119 is the broken section of the nail joint shown in the maintenance matrix shown in Figure 112 and Figure 112 while closingFigure;

Figure 120 is the partial sectional view of fastening system shown in Figure 112;

Figure 121 is the perspective view of fastening system shown in Figure 112, and described fastening system also comprises and being assembled toThe protective cap of nail leg;

Figure 122 is the bottom perspective view of the structure of fastening system shown in Figure 121;

Figure 123 is the fragmentary, perspective view of the structure of fastening system shown in Figure 121;

Figure 124 is the partial sectional view of the structure of fastening system shown in Figure 121;

Figure 125 is according to the front view of the end effector of at least one embodiment, and carry out described endDevice comprises jaw in an open position, be arranged in the maintenance matrix of jaw and multiple protective cap andBe arranged in the nail bin of nail bin passage;

Figure 126 is the front view of the end effector shown in Figure 125 time in the close position;

Figure 127 is the front view of the end effector shown in Figure 125 in the time of firing position;

Figure 128 is that the maintenance matrix shown in Figure 125 and protective cap are while being assembled to the nail bin shown in Figure 125Front view;

Figure 129 is the detail drawing of structure shown in Figure 128;

Figure 130 is the front view of end effector shown in Figure 125, and it illustrates pincers in an open positionMouthful and keep between matrix and nail bin compared with thin tissue;

Figure 131 is the front view of end effector shown in Figure 125, and it illustrates against shown in Figure 130Compared with thin tissue and jaw in the close position;

Figure 132 is the front view of end effector shown in Figure 125, its illustrate in firing position withKeep catching the jaw compared with thin tissue shown in Figure 130 between matrix and nail bin;

Figure 133 keeps matrix and protective cap are assembled to the nail bin shown in Figure 125 and make shown in Figure 125Front view when thin tissue shown in Figure 130 is therebetween;

Figure 134 is the detail drawing of structure shown in Figure 133;

Figure 135 is the protective cap on nail leg end that is positioned at according at least one alternative embodimentCutaway view;

Figure 136 is the perspective view that is embedded in the multiple protective caps in material piece;

Figure 137 is the perspective view of jaw, and described jaw comprises that multiple depressed parts are for by multiple protectionsCap is contained in wherein;

Figure 138 is the detail drawing of a part for jaw, and a described part comprises for covering and is positioned at figureThe thin slice of the protective cap shown in 137 in jaw;

Figure 139 is the protective cap on nail leg end that is positioned at according at least one alternative embodimentCutaway view, wherein said protective cap comprises inner profiled surface;

Figure 140 is another cutaway view of protective cap shown in Figure 139, and it illustrates against profiled surface and becomesThe nail leg of shape;

Figure 141 is the top view that keeps alternative embodiment of matrix, and described maintenance matrix comprisesMultiple connected matrix elements;

Figure 142 is the top view that keeps alternative embodiment of matrix, and described maintenance matrix comprisesMultiple connected matrix elements;

Figure 143 is the top view that keeps alternative embodiment of matrix, and described maintenance matrix comprisesMultiple connected matrix elements;

Figure 144 is the top view that keeps alternative embodiment of matrix array, described maintenance matrixArray comprises multiple connected matrix elements;

Figure 145 is the top view that keeps alternative embodiment of matrix, and described maintenance matrix comprisesMultiple connected matrix elements;

Figure 146 is the decomposed view that comprises the jaw that keeps matrix, and described maintenance matrix comprises canCompression cover;

Figure 147 is the detail drawing that keeps matrix shown in Figure 146;

Figure 148 is the partial sectional view that comprises the fastening system that keeps matrix, and described maintenance matrix comprisesCompressible stratum and multiple unit of sealing one or more medicines;

Figure 149 is the signal that illustrates that nail leg pierces through unit shown in Figure 148 in the time engaging with maintenance matrixFigure;

Figure 150 is the partial sectional view that comprises the fastening system that keeps matrix, and described maintenance matrix comprisesCompressible stratum;

Figure 151 is the front view of securing member storehouse plug-in package, and described securing member storehouse plug-in package comprises folderHold device, the first securing member storehouse and the second securing member storehouse;

Figure 152 is the front view of the end effector of surgical stapling device, and described surgical stapling device comprisesOne jaw and the second jaw, described the second jaw is shown in open configuration;

Figure 153 is the front view of end effector shown in Figure 152, and it illustrates in of closed configurationTwo jaws and be used to the first jaw to load the first storehouse and be Figure 151 that the second jaw loads the second storehouseShown securing member storehouse plug-in package;

Figure 154 is the front view of end effector shown in the Figure 153 having loaded, and it illustrates from end and holdsStorehouse plug-in package that row device removes, the second jaw in open configuration and be positioned at the first pincers againMouthful with the tissue of the second jaw centre;

Figure 155 is the end effector that loaded shown in Figure 154 front view in percussion configuration;

Figure 156 is the first storehouse in implanting state and the front view in the second storehouse;

Figure 157 is the front view of end effector shown in Figure 152, and it implements to illustrate according at least oneGo out the part in the first storehouse still engaging with the first jaw;

Figure 158 is the front view of alternative embodiment of securing member storehouse plug-in package, described fasteningPart storehouse plug-in package comprises clamper, the first securing member storehouse and the second securing member storehouse;

The first jaw that Figure 159 is used to end effector loads the first storehouse and is that the second jaw loadsThe front view of the plug-in package of securing member storehouse shown in the Figure 158 in the second storehouse;

Figure 160 is the cutaway view that has loaded end effector shown in Figure 159;

Figure 161 is the surgical stapling that comprises bottom jaw and top jaw according at least one embodimentThe perspective view of device, wherein some part of surgical stapling device is removed;

Figure 162 is the perspective view that has removed surgical stapling device shown in Figure 161 of top jaw;

Figure 163 is the perspective of the slidably anvil block system of the top jaw of surgical stapling device shown in Figure 161Figure, described slidably anvil block system comprises the first slidably anvil block of anvil block and second slidably;

Figure 164 is the end-view of anvil block system slidably shown in Figure 163;

Figure 165 is the top view of anvil block system slidably shown in Figure 163;

Figure 166 illustrates the signal of the slidably anvil block system shown in Figure 163 in the state of not pulling the triggerFigure;

Figure 167 be illustrate shown in Figure 163 slidably first of anvil block system slidably anvil block in not hittingThe nail of sending out position and be positioned at bottom jaw is in the schematic diagram of deployed position not;

Figure 168 illustrates that the nail that is arranged in bottom jaw is in disposing shown in configuration and Figure 167 firstSlidably anvil block is pulled to nearside so that the schematic diagram of the nail leg distortion of first group of nail;

Figure 169 illustrates shown in Figure 168 to follow closely the schematic diagram that is deformed into the state of being badly deformed for first group;

Figure 170 be illustrate shown in Figure 163 slidably second of anvil block system slidably anvil block be pushed to farSide is so that the schematic diagram of second group of nail leg distortion;

Figure 171 is according to the partial perspective of anvil block of comprising of at least one embodiment of multiple shaping pitsFigure;

Figure 172 is the cross sectional end view of anvil block shown in Figure 171;

Figure 173 is the schematic diagram that the first step of manufacturing the pit that is shaped shown in Figure 171 is shown;

Figure 174 is the schematic diagram that the second step of manufacturing the pit that is shaped shown in Figure 171 is shown;

Figure 175 is the top view of the shaping bowl configurations of anvil block shown in Figure 171;

Figure 176 is the schematic diagram illustrating for the manufacture of the first step of the manufacturing process of anvil block;

Figure 177 is the schematic diagram that the second step of manufacturing process shown in Figure 176 is shown;

Figure 178 is the schematic diagram that the third step of manufacturing process shown in Figure 176 is shown;

Figure 179 is the front, left perspective view of surgical stapling and cut-out apparatus, and wherein shank part comprises connecting rodThe automatic retracted mechanism and the ratchet manual retrieving mechanism that trigger;

Figure 180 is the surgical stapling of Figure 179 and cuts off the right back perspective view of apparatus, wherein slender axlesThe part right side half shell cut and shank shell is removed to show the automatic firing end retraction machine of advancingStructure and manually pull the trigger cam mechanism;

Figure 181 is the right back of the surgical stapling of Figure 179 and the shank part of cutting off apparatus and slender axlesDepending on decomposition view;

Figure 182 is the surgical stapling of Figure 31 and cuts off the right back perspective view of apparatus, wherein right half shell andThe outside of tools section is removed to show closure and the firing lock in original state;

Figure 183 is the surgical stapling of decomposed and the right side elevational view of cut-out apparatus of Figure 182;

Figure 184 is the surgical stapling of decomposed and the right back perspective view of cut-out apparatus of Figure 182, itsMiddle close mechanism is closed and clamp, and gemmule pawl firing lock completes the first stroke, and hand whereinMoving cam mechanism is removed to show the distally connecting rod of link-type tooth bar, and this distally connecting rod triggers percussion lockThe automatic retracted of structure;

Figure 185 is the surgical stapling of decomposed and the right back perspective view of cut-out apparatus of Figure 183, itsMiddle gemmule pawl firing lock departs from and distally connecting rod approaches automatic retracted;

Figure 186 be Figure 183 in original state decomposed surgical stapling and cut off apparatusLeft side elevational view, in the time of this original state, end effector is opened and Anti-backup mechanism is connectClose;

Figure 187 is the right side half shell of shank part and the thin portion in left side of anti-retrogression trip lever of Figure 186Figure;

Figure 188 is the surgical stapling of decomposition and the thin portion in the left side elevational view of cut-out apparatus of Figure 179,Wherein closure trigger is clamped, last stroke carried out by percussion trigger and distally connecting rod is positionedBecome to trigger automatic retracted;

Figure 189 is that distally connecting rod activates and locks towards anti-retrogression trip lever, thereby makes link-typeThe thin portion in the left side elevational view of the surgical stapling of the decomposition of the Figure 188 after tooth bar retraction and cut-out apparatus;

Figure 190 be Figure 179 surgical stapling and cut off apparatus manual retrieving mechanism idler gear andThe right resolution perspective view of backgear and manual retrieving lever and ratchet pawl;

Figure 191 is the right perspective view of the manual retrieving mechanism of Figure 190, and wherein manual retrieving lever is by portionCut divided by the ratchet gear that exposes small diameter on the backgear at engages ratchet pawl;

Figure 192 is the left side elevational view of the surgical stapling of Figure 179 and the decomposed of cut-out apparatus,Wherein Anti-backup mechanism joins the link-type tooth bar of percussion completely to, at the manual retrieving lever of Figure 190Before braking, the tension force of this link-type tooth bar and combination/Compress Spring departs from;

Figure 193 is the left side elevational view of the surgical stapling of Figure 192 and the decomposed of cut-out apparatus,Wherein anti-retrogression trip lever, backgear and the hidden parts of manually pulling the trigger trip lever are with dotted lineShow;

Figure 194 has made the figure after link-type tooth bar manual retrieving when the actuating of manually pulling the trigger trip leverThe left side elevational view of the decomposed of 193 surgical stapling and cut-out apparatus;

Figure 195 is the left side elevational view of the surgical stapling of Figure 194 and the decomposed of cut-out apparatus,Wherein link-type tooth bar is omitted, and shows manual percussion trip lever and Anti-backup mechanism and departs from;

Figure 196 is for the surgical stapling of Figure 179 and cuts off alternative anti-retrogression release of apparatusThe left side detail drawing of lever and shank shell;

Figure 197 is that alternative anti-retrogression of Figure 196 discharges thick stick, backgear axle and automatic retractedThe left perspective disassembled view of cam;

Figure 198 is the right side elevational view of alternative anti-retrogression relieving mechanism of Figure 196, whereinLink-type tooth bar is in advanced position, and anti-retrogression trip lever is positioned in to join to towards nearside and hitsSend out in the anti-retrogression plate of connecting rod;

Figure 198 A is that the right side of backgear, automatic retracted cam and farthest side connecting rod of Figure 198 is thinPortion's elevational view;

Figure 199 is the right side facade of the anti-retrogression relieving mechanism of the Figure 198 after the first percussion strokeView;

Figure 199 A is the thin portion in right side of backgear, automatic retracted cam and the second connecting rod of Figure 199Elevational view;

Figure 200 is the right side facade of the anti-retrogression relieving mechanism of the Figure 199 after the second percussion strokeView;

Figure 200 A is the thin portion in right side of backgear, automatic retracted cam and the third connecting rod of Figure 200Elevational view;

Figure 20 1 is the right side of the anti-retrogression relieving mechanism of the Figure 200 after the 3rd percussion and last strokeSide elevation view;

Figure 20 1A is the right side of backgear, automatic retracted cam and recent side the 4th connecting rod of Figure 20 1The thin portion of side elevational view;

Figure 20 2 makes automatic retracted cam slide towards distally and lock anti-retrogression at another percussion strokeTrip lever, thus with the automatic releasing mechanism shown in Figure 20 1 of anti-retrogression relieving mechanism after separatingRight side elevational view;

Figure 20 3 is front, left perspective view that the nail opened is used assembly, the wherein right-hand part of replaceable nail binDivide and be included in nail groove;

Figure 20 4 has complete replaceable nail bin and an axle configuration of non-joint motions shown in Figure 20 3Nail use the decomposition diagram of assembly;

Figure 20 5 is split type cutter and trigger shafts (E type crossbeam) that the nail shown in Figure 20 3 is used assemblyPerspective view;

Figure 20 6 is perspective views that nail is used the wedge-shaped slides of the nail bin of assembly;

Figure 20 7 be use assembly along the nail shown in Figure 20 3 center line 207-207 at longitudinal cross-sectionThe left side elevational view of middle intercepting;

Figure 20 8 is perspective views that the nail of opening shown in Figure 20 3 is used assembly, does not wherein have replaceableThe part of the nail groove of the intermediate pin of nail bin, contiguous split type cutter and trigger shaft, and do not follow closely grooveDistal part;

Figure 20 9 is that the center line 209-209 that uses assembly along the nail shown in Figure 20 3 cuts in cross sectionThe front elevational view of getting, shows the each of the inside staple drivers of nail bin and split type cutter and trigger shaftPart;

Figure 21 0 is the longitudinal axis 207-207 that roughly uses assembly along the closed nail shown in Figure 20 3The left side elevational view intercepting, to comprise the center contact between split type cutter and wedge-shaped slidesPoint, but also Strategic Lateral Offset so that nail and the staple drivers in nail bin to be shown;

Figure 21 1 is the thin portion in the left side elevational view that the nail shown in Figure 21 0 is used assembly, wherein split typeCutter retraction is slightly many, and this is typical situation for nail bin is replaced;

Figure 21 2 is the thin portion in left side elevational view that the nail shown in Figure 21 1 is used assembly, wherein split typeCutter starts percussion, corresponding to the configuration shown in Figure 21 0;

Figure 21 3 is closed towards shown in the Figure 21 0 after the percussion of distally at split type cutter and trigger shaftNail is used the left side section elevational view of assembly;

Figure 21 4 is the closures shown in the Figure 21 3 after the retraction of the percussion of nail bin and split type cutterNail use the left cross sectional elevational view of assembly;

Figure 21 5 is left cross sectional elevational view that the nail shown in Figure 21 4 is used assembly, wherein amalgamationFormula cutter is allowed to fall into latched position;

Figure 21 6 is according to the perspective view of the nail bin of at least one embodiment of the present invention, nail bin comprise withThe rigid support part that surgery suturing appliance uses together and compressible tissue thickness compensating part;

Figure 21 7 is decomposed figure of the nail bin shown in Figure 21 6;

Figure 21 8 is complete exploded views of the nail bin shown in Figure 21 6;

Figure 21 9 is another exploded views of the nail bin shown in Figure 21 6, this nail bin do not cover organize thickThe wrappage of degree compensating part;

Figure 22 0 is the warehouse of the nail bin shown in Figure 21 6 or the perspective view of support section;

Figure 22 1 is the top perspective of sliding part, and this sliding part can be in the nail bin shown in Figure 21 6Motion, to dispose nail from nail bin;

Figure 22 2 is bottom perspective view of the sliding part shown in Figure 22 1;

Figure 22 3 is front views of the sliding part shown in Figure 22 1;

Figure 22 4 is top perspective of driver, and this driver can support one or more nails, alsoUpwards lifted that by the sliding part shown in Figure 22 1 nail is penetrated from nail bin;

Figure 22 5 is bottom perspective view of the driver shown in Figure 22 4;

Figure 22 6 be can be at least in part around the parcel of the compressible tissue thickness compensating part of nail binThing;

Figure 22 7 is partial sectional views of nail bin, and nail bin comprises rigid support part and compressible tissueThickness compensation part, show nail during First ray never firing position move to firing position;

Figure 22 8 is front views of the nail bin shown in Figure 22 7;

Figure 22 9 is thin portion front views of the nail bin shown in Figure 22 7;

Figure 23 0 is the cross sectional end view of the nail bin shown in Figure 22 7;

Figure 23 1 is the bottom view of the nail bin shown in Figure 22 7;

Figure 23 2 is thin portion bottom views of the nail bin shown in Figure 22 7;

Figure 23 3 is longitudinal sectional views of nail bin and anvil block in the close position, and nail bin comprises that rigidity props upThe compensating part with compressible tissue thickness is divided in support part, shows nail never percussion during First rayPut and move to firing position;

Figure 23 4 is another cutaway views of the anvil block shown in Figure 23 3 and nail bin, shows when percussion orderAnvil block in an open position after being listed as;

Figure 23 5 is local detail drawings of the nail bin shown in Figure 23 3, shows in firing position notNail;

Figure 23 6 is cross-sectional elevational view of nail bin, and this nail bin comprises rigid support part and compressibleTissue thickness's compensating part, shows in the nail of firing position not;

Figure 23 7 is detail drawings of the nail bin shown in Figure 23 6;

Figure 23 8 is front views of nail bin and anvil block in an open position, and nail bin comprises rigid support portionPoint and compressible tissue thickness compensating part, show in the nail of firing position not;

Figure 23 9 is front views of nail bin and anvil block in the close position, and nail bin comprises rigid support portionPoint and compressible tissue thickness compensating part, show the nail in firing position not and be trapped inTissue between anvil block and tissue thickness's compensating part;

Figure 24 0 is the detail drawing of the anvil block shown in Figure 23 9 and nail bin;

Figure 24 1 is the front view of nail bin and anvil block in the close position, and nail bin comprises rigid support portionPoint and compressible tissue thickness compensating part, show in the nail of firing position not, show by fixedThe thicker tissue of position between anvil block and nail bin;

Figure 24 2 is detail drawings of the anvil block shown in Figure 24 1 and nail bin;

Figure 24 3 is front views of the anvil block shown in Figure 24 1 and nail bin, show be positioned in anvil block andThe tissue with different-thickness between nail bin;

Figure 24 4 is detail drawings of the anvil block shown in Figure 24 1 and nail bin, as shown in Figure 24 3;

Figure 24 5 shows organizing of being captured in that different tissues thickness in different nails compensates thickThe schematic diagram of degree compensating part;

Figure 24 6 shows tissue thickness's compensating part to being applied by one or more blood vessel of nail row crosscutThe schematic diagram of compression pressure;

Figure 24 7 shows the not schematic diagram of appropriate situation about being shaped of wherein one or more nails;

Figure 24 8 shows the schematic diagram of tissue thickness's compensating part that can compensate appropriately not become staple;

Figure 24 9 shows the tissue thickness's compensation being positioned in the capable crossing tissue regions of multiple nailsThe schematic diagram of part;

Figure 25 0 shows the schematic diagram that is captured in the tissue in nail;

Figure 25 1 shows the tissue that is captured in nail and the schematic diagram of tissue thickness's compensating part;

Figure 25 2 shows the schematic diagram that is captured in the tissue in nail;

Figure 25 3 shows the thick tissue that is captured in nail and the schematic diagram of tissue thickness's compensating part;

Figure 25 4 shows the thin tissue that is captured in nail and the schematic diagram of tissue thickness's compensating part;

Figure 25 5 shows the tissue thickness's compensating part being captured in nail and the group with interior thicknessThe schematic diagram of knitting;

Figure 25 6 shows the tissue thickness's compensating part being captured in nail and has another interior thicknessThe schematic diagram of tissue;

Figure 25 7 shows the thick tissue that is captured in nail and the schematic diagram of tissue thickness's compensating part;

Figure 25 8 is partial sectional views of the end effector of surgery suturing appliance, shows in returningContracting, not trigger shaft and the nail percussion sliding part of firing position;

Figure 25 9 is another partial sectional views of the end effector shown in Figure 25 8, show inLocal trigger shaft and the nail percussion sliding part that advances position;

Figure 26 0 is the cross-sectional schematic of the end effector shown in Figure 25 8, shows in pushing away completelyEnter or the trigger shaft of firing position;

Figure 26 1 is the cutaway view of the end effector shown in Figure 25 8, show by percussion after inThe trigger shaft of advanced position and stay the nail percussion sliding part of its complete firing position;

Figure 26 2 is detail drawings of the trigger shaft in advanced position shown in Figure 26 1;

Figure 26 3 is the partial sectional views that comprise the end effector of the surgery suturing appliance of nail bin, this nailStorehouse comprises tissue thickness's compensating part and is positioned at least partly nail wherein;

Figure 26 4 is another partial sectional views of the end effector shown in Figure 26 3, shows relativelyThe nail that moves and/or rotate at least partly in the anvil block that is positioned in nail bin opposite;

Figure 26 5 is according to the partial cutaway of the end effector of the surgery suturing appliance of at least one embodimentView;

Figure 26 6 is according to the broken section of the end effector of at least one alternative embodimentFigure;

Figure 26 7 is according to the partial sectional view of the end effector of another alternative embodiment;

Figure 26 8 is according to the perspective of the end effector of the surgery suturing appliance of at least one embodimentFigure;

Figure 26 9 is broken sections of the end effector shown in the Figure 26 8 being depicted as in deflectedFigure;

Figure 27 0 is the partial sectional view of the end effector shown in the Figure 26 9 in release conditions;

Figure 27 1 is the perspective view that comprises the end effector of tissue thickness's compensating part cover;

Figure 27 2 is rear views of the tissue thickness's compensating part cover in Figure 27 1;

Figure 27 3 is the perspective views that comprise the end effector of multiple guide rails, and the plurality of guide rail is from support portionPoint and there is the tissue thickness compensating part that is defined in longitudinal cavity wherein and extend;

Figure 27 4 is perspective views of the tissue thickness's compensating part shown in Figure 27 3;

Figure 27 5 is perspective views of end effector, this end effector comprise from support portion and and itsMultiple tusks that the tissue thickness's compensating part engaging extends;

Figure 27 6 is according to the perspective view of the anvil block that comprises pit array of at least one embodiment;

Figure 27 7 is local detail drawings of the anvil block shown in Figure 27 6;

Figure 27 8 is local longitudinal sectional views of the anvil block shown in Figure 27 6;

Figure 27 9 is transverse sectional view of the anvil block shown in Figure 27 6;

Figure 28 0 comprises the front view of the percussion nail of B shape configuration substantially;

Figure 28 1 comprises facing of following closely to the percussion of an enterolithic leg and the outside leg being out of shapeFigure;

Figure 28 2 is the front views that comprise the percussion nail of two legs of outside shaping;

Figure 28 3 is fragmentary, perspective views of the support section of nail bin, and this nail bin comprises detachable and/or can replaceThe nail leg guider changing;

Figure 28 4 is partial sectional views of the nail bin shown in Figure 28 3, shows the nail of disposing from nail bin;

Figure 28 5 is detail drawings of the cutaway view shown in Figure 28 4 after nail bin is by percussion;

Figure 28 6 is the exploded views that comprise the nail bin of tissue thickness's compensating part, this tissue thickness's compensating part bagDraw together the space being defined in wherein;

Figure 28 7 shows against organizing showing of the tissue thickness's compensating part shown in implanted Figure 28 6Intention;

Figure 28 8 shows against organizing the another of the tissue thickness's compensating part shown in implanted Figure 28 6A schematic diagram;

Figure 28 9 is the perspective cross-sectional view that comprise the nail bin of side direction retaining member, this side direction retaining memberExtend from its support section, tissue thickness's compensating part can be held in place;

Figure 29 0 is the cutaway view for the nail bin shown in Figure 28 9 of suture tissue;

Figure 29 1 is another cutaway view of the nail bin shown in Figure 28 9, shows positive motion away from implantationThe support section of tissue thickness's compensating part;

Figure 29 2 is perspective cross-sectional view of nail bin, and this nail bin comprises and tissue thickness's compensating part can be protectedHold the side direction retaining member of support section;

Figure 29 3 is the cutaway views for the nail bin shown in Figure 29 2 of suture tissue;

Figure 29 4 is another cutaway views of the nail bin shown in Figure 29 2, shows positive motion away from implantationThe support section of tissue thickness's compensating part;

Figure 29 5 is the supports that tissue thickness's compensating part remained to nail bin according at least one embodimentThe cross section detail drawing of the retainer of part;

Figure 29 6 is the nail bins according to comprising of at least one embodiment with the staple drivers of differing heightsPartial sectional view;

Figure 29 6A shows the staple drivers shown in Figure 29 6 and supported having not thereonWith the schematic diagram of not pulling the trigger the nail of height;

Figure 29 7 show comprise variable thickness tissue thickness's compensating part, there is the nail of differing heightsDriver and there is the schematic diagram of the nail of different unshaped height;

Figure 29 8 shows showing of the nail shown in Figure 29 7 of implanted tissue and tissue thickness's compensating partIntention;

Figure 29 9 is according to tissue thickness's compensating part comprising of at least one embodiment with variable thicknessThe partial sectional view of nail bin;

Figure 30 0 is the cutaway view of the end effector of the surgery suturing appliance in opening configuration;

Figure 30 1 is analysing and observe of the end effector shown in the Figure 30 0 being depicted as in partly pulling the trigger configurationFigure;

Figure 30 2 is analysing and observe of the end effector shown in the Figure 30 0 being depicted as in again opening configurationFigure;

Figure 30 3 is analysing and observe according to the end effector of the surgery suturing appliance of at least one embodimentFigure, this surgery suturing appliance comprises the staple drivers with differing heights and wavy platform surface;

Figure 30 4 is analysing and observe according to the end effector of the surgery suturing appliance of at least one embodimentFigure, this surgery suturing appliance comprises the staple drivers with differing heights and staged platform surface;

Figure 30 5 uses nail bin application device to be loaded into nail bin in the actuator of surgery suturing appliancePerspective view;

Figure 30 6 is bottom perspective view of the nail bin application device shown in Figure 30 5;

Figure 30 7 is the side views that are assembled into the nail bin application device shown in Figure 30 5 of nail bin;

Figure 30 8 is cutaway views of the assembly shown in Figure 30 7;

Figure 30 9 is according to the perspective view of the nail bin application device assembly of at least one embodiment, this nail binApplication device assembly also comprises the top tissue thickness benefit on the top surface that is positioned at nail bin application deviceRepay part;

Figure 31 0 is the decomposition that thickness compensation part and nail bin application device are organized in the top shown in Figure 30 9Figure;

Figure 31 0A is the exploded view that comprises the nail bin application device assembly of tractive member, this tractive memberCan make the top that is attached to nail bin application device organize thickness compensation part to separate;

Figure 31 1 is according to the part of the nail bin application device assembly of at least one alternative embodimentExploded view;

Figure 31 2 is perspective views of nail bin application device assembly, and this nail bin application device assembly comprises topTissue thickness's compensating part and nail bin, top organizes thickness compensation part to comprise the multiple maintenance knots from its extensionStructure and nail bin comprise that bottom organizes thickness compensation part;

Figure 31 3 is front views of the nail bin application device assembly shown in Figure 31 2, this nail bin application deviceAssembly is positioned in nail bin passage and on nail bin application device assembly in closed anvil block;

Figure 31 4 is the anvil blocks shown in the Figure 31 3 in open position again and is just carrying out from endThe front view of the nail bin application device shown in Figure 31 2 that device is removed;

Figure 31 4A is positioned in the top shown in Figure 31 2 to organize thickness compensation part and bottom to organize thickThe cutaway view of the tissue in the middle of degree compensating part;

Figure 31 4B shows by cutting element and is seamed to tissue, and cut top tissueThe cutaway view of thickness compensation part is organized in thickness compensation part and bottom;

Figure 31 5 inserts tissue thickness's compensating part in anvil block according to showing of at least one embodimentSchematic diagram;

Figure 31 6 is cutaway views of the tissue thickness's compensating part shown in Figure 31 5;

Figure 31 7 is according to tissue thickness's compensating part of at least one alternative embodiment and anvil blockExploded view;

Figure 31 8 is according to the perspective view of the nail bin application device assembly of at least one embodiment, this nail binApplication device assembly comprises that the top that can be attached to anvil block organizes thickness compensation part;

Figure 31 9 is front views of the nail bin application device assembly shown in Figure 31 8, this nail bin application deviceAssembly is positioned in nail bin passage and just in the anvil block of thickness compensation part motion is organized on top;

Figure 32 0 shows on top and organizes after thickness compensation part engaged with anvil block, just holds from endNail bin application device shown in Figure 31 8 that row device is removed;

Figure 32 1 is the cross section of organizing the anvil block of thickness compensation part motion towards the top shown in Figure 31 8End-view;

Figure 32 2 is cross sectional end view of organizing the anvil block that thickness compensation part engages with top;

Figure 32 3 is the cutaway views that comprise the end effector of the surgery suturing appliance of nail bin, this nail bin bagDraw together the tissue thickness's compensating part that is attached to the sectional of the support section of nail bin by multiple securing members;

Figure 32 4 is cutaway views of the end effector shown in Figure 32 3, shows in part percussion positionThe firing member of putting;

Figure 32 5 is cutaway views of the end effector shown in Figure 32 3, shows positive motion away from partThe support section of tissue thickness's compensating part of implanting;

Figure 32 6 is fragmentary, perspective views of the support section shown in Figure 32 3;

Figure 32 7 is perspective views of disposing sliding part according to the nail of at least one embodiment;

Figure 32 8 is front views of the sliding part shown in Figure 32 7;

Figure 32 9 is the perspective views that comprise the end effector of the surgery suturing appliance of nail bin, this nail bin bagDraw together tissue thickness's compensating part and be positioned at the multiple nail guiders on tissue thickness's compensating part;

Figure 33 0 is the tissue thickness's compensating part shown in the Figure 32 9 in not pulling the trigger configuration and nail guiding dressThe partial sectional view of putting;

Figure 33 1 is the tissue thickness's compensating part shown in the Figure 32 9 in percussion configuration and nail guiderPartial sectional view;

Figure 33 2 is the nails that comprise tissue thickness's compensating part and support section according at least one embodimentThe cutaway view in storehouse;

Figure 33 3 is offices of tissue thickness's compensating part, nail guide layer and the nail in firing position notPortion's cutaway view;

Figure 33 4 is according to tissue thickness's compensating part of at least one alternative embodiment, nail guidingLayer and in the partial sectional view of the nail of firing position not;

Figure 33 5 is according to tissue thickness's compensating part of at least one alternative embodiment, nail guidingLayer and in the partial sectional view of the nail of firing position not;

Figure 33 6 is according to tissue thickness's compensating part of at least one alternative embodiment, nail guidingLayer and in the partial sectional view of the nail of firing position not;

Figure 33 7 is according to tissue thickness's compensating part of at least one alternative embodiment, nail guidingLayer and in the partial sectional view of the nail of firing position not;

Figure 33 8 is according to tissue thickness's compensating part of at least one alternative embodiment, nail guidingLayer and in the partial sectional view of the nail of firing position not;

Figure 33 9 is according to tissue thickness's compensating part of at least one alternative embodiment, nail guidingLayer and in the partial sectional view of the nail of firing position not;

Figure 34 0 is the detail drawing around the region of the end of the nail shown in Figure 33 9;

Figure 34 1 is according to tissue thickness's compensating part of at least one alternative embodiment, nail guidingLayer and in the partial sectional view of the nail of firing position not;

Figure 34 2 is the detail drawings around the region of the end of the nail shown in Figure 34 1;

Figure 34 3 is according to tissue thickness's compensating part of at least one alternative embodiment, nail guidingLayer and in the partial sectional view of the nail of firing position not;

Figure 34 4 is according to the nail guide layer of at least one alternative embodiment with in not pulling the trigger positionThe perspective view of multiple nails of putting;

Figure 34 5 is looking closely of tissue thickness's compensating part that can use together with circular surgical stapling deviceFigure;

Figure 34 6 is the tissue thickness's compensating part shown in Figure 34 5 and the perspective view of circular surgical stapling device;

Figure 34 7 is can be together with circular surgical stapling device according at least one alternative embodimentThe end-view of the tissue thickness's compensating part using;

Figure 34 8 is the tissue thickness's compensating part shown in Figure 34 7 and the perspective view of circular surgical stapling device;

Figure 34 9 is looking closely of tissue thickness's compensating part that can use together with circular surgical stapling deviceFigure;

Figure 35 0 is looking closely of the tissue thickness's compensating part shown in the Figure 34 9 in local extended configurationFigure;

Figure 35 1 is according to the front view of the surgery suturing appliance that comprises nail bin of at least one embodiment;

Figure 35 2 is the end-views with respect to the surgery suturing appliance shown in Figure 35 1 of tissue location;

Figure 35 3 is end-views of the surgery suturing appliance shown in Figure 35 1, and this surgery suturing appliance also wrapsDraw together the tissue thickness's compensating part being positioned between nail bin and tissue;

Figure 35 4 never has the surgery suturing appliance shown in Figure 35 1 of tissue thickness's compensating part to disposeTo the fragmentary, perspective view of nail in tissue;

Figure 35 5 is that the surgery suturing appliance shown in the Figure 35 1 from having tissue thickness's compensating part is deployed toThe fragmentary, perspective view of the nail in tissue;

Figure 35 6 is partial sectional views of the end effector of the surgery suturing appliance shown in Figure 35 1, bagDraw together the anvil block plate in primary importance;

Figure 35 7 is partial sectional views of the end effector of the surgery suturing appliance shown in Figure 35 1, showsGo out the anvil block plate shown in the Figure 35 6 in the second place;

Figure 35 8 is the cutaway views that comprise the end effector of the surgery suturing appliance of nail bin, this nail bin bagDraw together gap setting member;

Figure 35 9 shows the perspective view of firing member, and this firing member is in the percussion punching of firing memberGap setting member when journey finishes shown in cutting drawing 358;

Figure 36 0 is the cutaway view that comprises the end effector of the surgery suturing appliance of nail bin, this nail bin bagDraw together flexible nose;

Figure 36 1 is the cutaway view of the end effector shown in Figure 36 0, shows in deflection configurationNose;

Figure 36 2 is the cutaway views that comprise the end effector of the surgery suturing appliance of nail bin, this nail bin bagDraw together slidably part;

Figure 36 3 is cutaway views of the end effector shown in Figure 36 2, show towards distally slide canSlipper;

Figure 36 4 is that carry out the end that comprises the surgery suturing appliance of support section and tissue thickness's compensating partThe cutaway view of device, this support section comprises that the platform surface of inclination and this tissue thickness's compensating part compriseThe thickness changing;

Figure 36 5 is that carry out the end that comprises the surgery suturing appliance of support section and tissue thickness's compensating partThe cutaway view of device, this support section comprises that the platform surface of inclination and this tissue thickness's compensating part compriseConsistent thickness;

Figure 36 6 is the perspective views that comprise the nail bin of tissue thickness's compensating part with variable thickness;

Figure 36 7 is end-views of the nail bin shown in Figure 36 6;

Figure 36 8 is the perspective cross-sectional view that comprise tissue thickness's compensating part of longitudinal layer;

Figure 36 9 mends according to the tissue thickness of multiple layers that comprises of at least one alternative embodimentRepay the perspective cross-sectional view of part;

Figure 37 0 is the perspective view of disposable loading unit, and this disposable loading unit comprises can be by groupKnit the retaining member that thickness compensation part remains to it releasedly;

Figure 37 1 is the perspective view of tissue thickness's compensating part, and this tissue thickness's compensating part comprises can be by groupKnit the retaining member that thickness compensation part remains to disposable loading unit releasedly;

Figure 37 2 be attached to the tissue thickness's compensating part shown in Figure 37 1 of disposable loading unit thoroughlyView;

Figure 37 3 is end-views of the disposable loading unit shown in Figure 37 2;

Figure 37 4 is perspective views of tissue thickness's compensating part, and this tissue thickness's compensating part comprises can be by groupKnit the retaining member that thickness compensation part remains to disposable loading unit releasedly;

Figure 37 5 be attached to the tissue thickness's compensating part shown in Figure 37 4 of disposable loading unit thoroughlyView;

Figure 37 6 is end-views of the disposable loading unit shown in Figure 37 5;

Figure 37 7 is perspective views of tissue thickness's compensating part, and this tissue thickness's compensating part comprises can be by groupKnit the retaining member that thickness compensation part remains to disposable loading unit releasedly;

Figure 37 8 be attached to the tissue thickness's compensating part shown in Figure 37 7 of disposable loading unit thoroughlyView;

Figure 37 9 is that the tissue thickness's compensating part being positioned in the actuator of disposable loading unit is used dressThe perspective view of putting;

Figure 38 0 is the top perspective of the tissue thickness's compensating part application device shown in Figure 37 9;

Figure 38 1 is the bottom perspective view of the tissue thickness's compensating part application device shown in Figure 37 9;

Figure 38 2 is positioned at holding of disposable loading unit according at least one alternative embodimentThe perspective view of the tissue thickness's compensating part application device in row device;

Figure 38 3 is top perspective of the tissue thickness's compensating part application device shown in Figure 38 2;

Figure 38 4 is bottom perspective view of the tissue thickness's compensating part application device shown in Figure 38 2;

Figure 38 5 is front views of disposable loading unit, and this disposable loading unit comprises and can supportNail bin can pivotable jaw;

Figure 38 6 is according to the cutaway view of the nail bin of at least one embodiment, and this nail bin comprises and is attached to nailTissue thickness's compensating part of the support section in storehouse;

Figure 38 7 is according to the cutaway view of the nail bin of at least one embodiment, and this nail bin comprises and is attached to nailTissue thickness's compensating part of the support section in storehouse;

Figure 38 8 is according to the cutaway view of the nail bin of at least one embodiment, and this nail bin comprises and is attached to nailTissue thickness's compensating part of the support section in storehouse; And

Figure 38 9 is perspective views of the tissue thickness's compensating part shown in Figure 38 7.

Run through multiple views, corresponding reference symbol is indicated corresponding parts. The example illustrating herein withA kind of form shows some embodiment of the present invention, and this type of example should be interpreted as with anyMode limits the scope of the invention.

Detailed description of the invention

The application's applicant also has following U.S. Patent application, and these patent applications were in 2010 9The moon 30 was submitted to, and each being incorporated to completely separately by reference herein:

Name is called " SurgicalStaplingInstrumentWithaVariableStapleFormingSystem " U.S. Patent Application Serial Number 12/894,360;

Name is called " SurgicalStaplingInstrumentWithInterchangeableStapleCartridgeArrangements " U.S. Patent Application Serial Number 12/894,322;

Name is called " SurgicalCuttingandFasteningInstrumentsWithSeparateandDistinctFastenerDeploymentandTissueCuttingSystems " U.S. Patent application orderRow number 12/894,351;

Name is called " SurgicalStaplingInstrumentWithCompactArticulationControlArrangement " U.S. Patent Application Serial Number 12/894,339;

It is special that name is called U.S. of " JawClosureArrangementsForSurgicalInstruments "Profit patent application serial numbers 12/894,327;

Name is called " SurgicalInstrumentsWithReconfigurableShaftSegments's "U.S. Patent Application Serial Number 12/894,311;

Name is called " SurgicalStapleCartridgesSupportingNon-LinearlyArrangedStaplesandSurgicalStaplingInstrumentsWithCommonStaple-FormingPockets " U.S. Patent Application Serial Number 12/894,340;

Name is called " SurgicalStapleCartridgesWithDetachableSupportStructuresandSurgicalStaplingInstrumentsWithSystemsForPreventingActuationMotionsWhenaCartridgeisNotPresent " U.S. Patent Application Serial Number12/894,350；

Name is called " ImplantableFastenerCartridgeHavingaNon-UniformArrangement " U.S. Patent Application Serial Number 12/894,338;

Name is called " ImplantableFastenerCartridgeComprisingMultipleLayers's "U.S. Patent Application Serial Number 12/894,312;

Name is called the U.S. of " SelectivelyOrientableImplantableFastenerCartridge "Patent application serial number 12/894,377;

Name is called " ImplantableFastenerCartridgeComprisingBioabsorbableLayers " U.S. Patent Application Serial Number 12/894,383;

Name is called the U.S. Patent Application Serial Number of " CompressibleFastenerCartridge "12/894,389；

It is special that name is called U.S. of " FastenersSupportedByaFastenerCartridgeSupport "Profit patent application serial numbers 12/894,345;

Name is called the U.S. Patent Application Serial Number of " CollapsibleFastenerCartridge "12/894,306；

Name is called " FastenerSystemComprisingaPluralityofConnectedRetentionMatrixElements " U.S. Patent Application Serial Number 12/894,318;

Name is called " FastenerSystemComprisingaRetentionMatrixandanAlignmentMatrix " U.S. Patent Application Serial Number 12/894,330;

Name is called the United States Patent (USP) Shen of " FastenerSystemComprisingaRetentionMatrix "Please sequence number 12/894,361;

Name is called " FasteningInstrumentForDeployingaFastenerSystemComprisingaRetentionMatrix " U.S. Patent Application Serial Number 12/894,367;

Name is called " FastenerSystemComprisingaRetentionMatrixandaCover's "U.S. Patent Application Serial Number 12/894,388;

Name is called " FastenerSystemComprisingaPluralityofFastenerCartridges "U.S. Patent Application Serial Number 12/894,376; And

Name is called " ImplantableFastenerCartridgeComprisingaSupportRetainer "U.S. Patent Application Serial Number 12/894,369.

The application's applicant also has following U.S. Patent application, and these patent applications and the application are sameWithin one day, submit to, and be eachly incorporated to completely separately herein with way of reference:

Name is called the U.S. Patent application order of " CompressibleStapleCartridgeAssembly "Row number _ _ _ _ _ _ _ _ _ _ _, attorney is END6848USCIP1/100533CIP1;

Name is called " TissueThicknessCompensatorComprisingPortionsHavingDifferentProperties " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, attorney isEND6849USCIP1/100534CIP1；

Name is called the U.S. of " StapleCartridgeComprisinganAdjustableDistalPortion "State's patent application serial number _ _ _ _ _ _ _ _ _ _ _, attorney isEND6847USCIP1/100532CIP1；

Name is called the U.S. of " TissueThicknessCompensatorForaSurgicalStapler "Patent application serial number _ _ _ _ _ _ _ _ _ _ _, attorney isEND6736USCIP1/100060CIP1；

Name is called " SurgicalStaplerAnvilComprisingaPluralityofFormingPockets " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, attorney isEND6735USCIP1/100059CIP1；

Name is called the U.S. Patent Application Serial Number of " StapleCartridgeLoadingAssembly "_ _ _ _ _ _ _ _ _ _ _, attorney is END6855USCIP1/100540CIP1;

Name is called " StapleCartridgeComprisingaVariableThicknessCompressiblePortion " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, attorney isEND6840USCIP1/100525CIP1；

Name is called " TissueThicknessCompensatorComprisingDetachablePortions " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, attorney isEND6842USCIP1/100527CIP1；

Name is called " TissueThicknessCompensatorForaSurgicalStaplerComprisingAnAdjustableAnvil " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, attorneyFor END6843USCIP1/100528CIP1;

Name is called " CompressibleStapleCartridgeComprisingAlignmentMembers " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, attorney isEND6856USCIP1/100541CIP1；

Name is called the United States Patent (USP) of " StapleCartridgeComprisingaReleasablePortion "Patent application serial numbers _ _ _ _ _ _ _ _ _ _ _, attorney is END6857USCIP1/100542CIP1;

Name is called " StapleCartridgeComprisingaTissueThicknessCompensator "U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, attorney isEND6859USCIP1/100544CIP1；

Name is called " StapleCartridgeComprisingStaplesPositionedWithinaCompressiblePortionThereof " U.S. Patent Application Serial Number _ _ _ _ _ _ _ _ _ _ _, agencyPeople's file number is END6841USCIP1/100526CIP1.

Some exemplary embodiment will be described now, with understand on the whole device disclosed herein andStructure, function, manufacture and the purposes of method. One or more examples of these embodiment in the accompanying drawingsIllustrate. Those of ordinary skill in the art will be understood that, special description and illustrated in the accompanying drawings hereinApparatus and method are nonrestrictive exemplary embodiment, and the scope of various embodiments of the invention onlyBe defined by the claims. The feature that illustrates or describe with regard to an exemplary embodiment, canCombine with the feature of other embodiment. This modification and version are intended to be included in thisWithin bright scope.

" various embodiment ", " some embodiment ", " an enforcement that this description is quoted in the whole textExample " or " embodiment " etc., refer to specific features, structure or the characteristic described in conjunction with described embodimentComprise at least one embodiment. Therefore the phrase that, this description occurs is in the whole text " in multiple enforcementIn example ", " in certain embodiments ", " in one embodiment " or " in an embodiment " etc.Might not all refer to identical embodiment. In addition, in one or more embodiments, specific features,Structure or characteristic can combine in any suitable way. Therefore, in unconfined situation, in conjunction with oneIndividual embodiment illustrates or specific features, structure or the characteristic described can be whole or in part and one or manyFeature, structure or the characteristic combination of individual other embodiment. This modification and version are intended to bagDraw together within the scope of the present invention.

Term used herein " nearside " and " distally " are with respect to manipulation of surgical apparatus shank partClinician's. Term " nearside " refers to the most close clinician's part, and term is " far awaySide " refer to the part away from clinician. It is also understood that for succinct and clear for the purpose of, herein canTo use by reference to the accompanying drawings the space art such as " vertically ", " level ", "up" and "down"Language. But surgical instruments uses in many directions and position, and these terms non-limitingAnd/or absolute.

Provide various exemplary means and method to carry out abdominal cavity mirror and micro-wound surgical operation operation.But those skilled in the art will readily appreciate that, the whole bag of tricks disclosed herein and dressPut and can be used for many surgical procedures and application and (for example comprise and open surgery operation knot mutuallyThe application of closing) in. Continue to consult this detailed description of the invention, those skilled in the art will enterOne step is understood, and various apparatuses disclosed herein in insertosome, for example, pass through nature by any wayCavity, by being formed at otch or the puncturing hole etc. in tissue. Carry out the working portion of apparatus or endDevice part can directly be inserted in patient body and maybe can be inserted by the access to plant with service aisle, outerThe end effector of section's apparatus and slender axles can advance by described service aisle.

Referring to accompanying drawing, wherein in multiple views, the similarly similar element of digitized representation, Fig. 1 showsGo out to put into practice the surgical instruments 10 of the peculiar multiple beneficial effect of the present invention. Surgery suturing appliance10 are designed to handle and/or activate the various shapes that are operationally attached to surgery suturing appliance 10The end effector 12 of formula and size. In the embodiment shown in Fig. 1-1E, for example end effector12 comprise elongated passageway 14, and this elongated passageway forms the lower jaw 13 of end effector 12. Elongated logicalRoad 14 can support " implanted " nail bin 30 and support actively as end effector 12The anvil block 20 of upper jaw 15.

In various embodiments, elongated passageway 14 can be by for example 300 and 400 series, 17-4 and 17-7 stainless steels, titanium etc. are made, and form together with spaced-apart sidewalls 16. Anvil block 20 can be by for example 300Make with 400 series, 17-4 and 17-7 stainless steel, titanium etc., and there is nail shaping lower surface, logicalOften be labeled as 22, described nail shaping lower surface has multiple nail shaping pits 23 that are formed at wherein.Referring to Figure 1B-1E. In addition, anvil block 20 has from being divided into of its proximad projection of two-part skid assembliesPart 24. Anvil block pin 26 is from each cross side projection of slide assemblies 24, to be contained in elongated passageway 14Sidewall 16 in respective slots or opening 18 in, thereby be conducive to movable anvil block pin or can pivotTurn and be attached to described respective slots or opening.

Various forms of implanted nail bins can be together with the various embodiment of surgical instruments disclosed hereinUse. Below will discuss in more detail specific nail bin configuration and structure. But, shown in Figure 1AEmbodiment in, show implanted nail bin 30. In at least one embodiment, nail bin 30 hasMain part 31, is supported with the unfashioned pegs 32 of many rows in this main part, main part byCompressible hemostatic material (for example oxidized regenerated cellulose (ORC) or foam that can bio-absorbable)Composition. In some embodiment at least, for anti-non-magnetic shim is influenced and prevent that hemostatic material from introducing and fixedPosition is activated during process, and whole storehouse can be coated with or be enclosed with biodegradable film 38, for example withTrade markSix cyclic ketones films of selling or with polyglycereol sebacate (PGS) film or with by PGA(polyglycolic acid, with trade mark Vicryl sell), PCL(polycaprolactone), PLA or PLLA(PLA), PHA(polyhydroxyalkanoatefrom), PGCL(Poliglecaprone 25, with trade markMonocryl sell) or is formed by the compound of PGA, PCL, PLA, PDS other can biologyThe film of degraded, described film is only just permeable in the time breaking. The size of the main body 31 of nail bin 30 is setBecome to be supported on removedly in elongated passageway 14 as shown in the figure, make when anvil block 20 be driven toWhen nail bin 30 shaping contact, each nail 32 is wherein all right with nail shaping pit 23 corresponding in anvil blockTogether.

In use, once end effector 12 is close to target tissues and locates, end effector 12 justThe top surface 36 of being handled target tissue is caught or to be clamped in nail bin 30 is shaped with the nail of anvil block 20Between surface 22. Nail 32 is shaped in the following way: be arranged essentially parallel to elongated passageway 14 roadMotion anvil block 20 in footpath, so that nail profiled surface 22 nail shaping pit 23 especially wherein substantiallyContact the top surface 36 of nail bin 30 simultaneously. In the time that anvil block 20 continues to move in nail bin 30, nail32 leg 34 contacts corresponding nail shaping pit 23 in anvil block 20, and this nail shaping pit is used for making nailLeg 34 is bending so that nail 32 is configured as " B shape ". Anvil block 20 is towards the further fortune of elongated passageway 14Moving will further compress nail 32, and make to follow closely the 32 final forming heights " FF " that are configured as expectation.

Above-mentioned nail forming process is illustrated in Figure 1B-1E substantially. For example, Figure 1B illustrates end executionDevice 12, wherein target tissue " T " be positioned at anvil block 20 and implanted nail bin 30 top surface 36 itBetween. Fig. 1 C illustrates the initial clamped position of anvil block 20, and wherein anvil block 20 is closed up to target tissue" T " is upper, with target tissue " T " is clamped in anvil block 20 and nail bin 30 top surface 36 itBetween. Fig. 1 D illustrates that initial nail is shaped, and wherein anvil block 20 has started to compress nail bin 30, makes to follow closely 32Leg 34 start to be shaped by the nail shaping pit 23 in anvil block 20. Fig. 1 E illustrates through target groupKnit " T " and nail 32 in final shaped state has removed anvil block 20 for clarity. Once nail32 are shaped and are fastened to target tissue " T ", surgeon just motion anvil block 20 to open position, withIn the time that withdrawing from end effector 12, patient make warehouse 31 and nail 32 can keep being attached to target tissue. WhenWhen two common clampings of jaw 13,15, end effector 12 is shaped all nails simultaneously. All the other" by conquassation " material of main part 31 as styptic (ORC) and nail row strengthening agent (PGA,PDS or any above-mentioned other film compositions 38). In addition, because nail 32 needn't at shapingLeave warehouse 31, therefore follow closely 32 and become lopsided possibility at shaping and be minimized. As hereinUsed, term " implanted " refers to except nail, also will be kept for the warehouse material of support nailIn patient body, also can finally be absorbed by patient body. This type of implanted nail bin is different from previous nail binStructure, this previous nail bin is configured in it and after percussion, is still intactly positioned at end effectorIn.

In various concrete enforcement, end effector 12 can be connected to from shank assembly 100 outstandingSlender axles assembly 40. End effector 12(is in the time of closure) and slender axles assembly 40 can there is phaseLike shape of cross section, and its size is set for operationally through sleeve pipe needle tubing or is another and entersThe service aisle of apparatus form. As used herein, it is that finger ends is carried out that term " operationally passes "At least a portion of device and slender axles assembly can be inserted and maybe can be passed passage or pipe by passage or tube openingOpening, and can in passage or tube opening, handle surgery stitching operation to it.In certain embodiments, when time in the close position, the jaw 13 and 15 of end effector 12 can beEnd effector provides the shape of cross section of circular to be beneficial to it through circular passage/opening. SoAnd end effector and the slender axles assembly embodiment that can imagine various embodiment of the present invention haveOther shape of cross sections, thus can be through admission passage and the opening with non-circular transverse cross-section.Therefore, the overall dimension of the cross section of closed end effector is by logical by what pass with end effectorThe Size dependence of road or opening. Therefore, an end effector for example can be called as " 5mm " endActuator, this refers to that it can operationally be at least the opening of about 5mm through diameter.

In multiple embodiment, slender axles assembly 40 can have with end in the closed position to be heldThe external diameter that the external diameter of row device 12 equates substantially. For example, 5mm end effector can be connected to and haveThe slender axles assembly 40 of 5mm cross-sectional diameter. But, continue to consult this detailed description of the invention, willIt is evident that, various embodiment of the present invention can be effectively in conjunction with the end effector of different sizeUse. For example, 10mm end effector can be attached to the slender axles with 5mm cross-sectional diameter.On the contrary, for 10mm or the larger application that enters opening or passage are wherein provided, slender axlesAssembly 40 can have 10mm(or larger) cross-sectional diameter, but also can activate 5mm or10mm end effector. Therefore, the external diameter of outer shaft 40 can be carried out with the closed end that is attached to itThe external diameter of device 12 is identical or different.

As shown in the figure, slender axles assembly 40 distad extends generally along straight line from shank assembly 100,To limit longitudinal axis A-A. In various embodiments, for example slender axles assembly 40 can be about 9-16 inches (229-406mm) is long. But slender axles assembly 40 can be set to other length, andAnd in other embodiments, in slender axles assembly, can there is joint or in other words can be conducive to endActuator 12 carries out hinged with respect to other parts of axle or shank assembly, below will discuss in more detailState. In various embodiments, slender axles assembly 40 comprises ridge member 50, and this ridge member is from shank groupPart 100 extends to end effector 12. The near-end of the elongated passageway 14 of end effector 12 have fromThe a pair of maintenance lug 17 of its projection, this is contained in ridge member 50 to keeping the size of lug to set forFar-end in the corresponding lug opening or support 52 that provide, so that end effector 12 canConnect removedly slender axles assembly 40. Ridge member 50 can be by for example 6061 or 7075 aluminium, stainlessSteel, titanium etc. are made.

In various embodiments, shank assembly 100 comprises that pistol grasps shell body, and described pistol graspsShell body can be processed to two or more parts for assembling. For example, shank as shown in the figureAssembly 100 comprise by polymer or molded of plastic material or be in other words processed into and be designed toThe right hand housing member 102 being combined together and left hand housing member (not shown). Can pass through at itIn snap arrangement, bolt and pod molded or that in other words form and/or by adhesive, screwDeng and this type of housing member is attached to together. Ridge member 50 has near-end 54, shape on this near-endBecome to have flange 56. Flange 56 can be supported in groove 106 rotatably, and this groove is by from housing structureEach in part 102,104 forms to the fit ribs 108 of inner process. This structure is conducive to ridge structurePart 50 is attached to shank assembly 100, makes the ridge member 50 can be with respect to shank assembly 100 edges simultaneously360 ° of paths rotate around longitudinal axis A-A.

As can be further found out in Fig. 1, ridge member 50 is through installation axle bush 60 and by axle bush is installed60 support, and this installation axle bush is rotatably attached to shank assembly 100. Axle bush 60 is installed and is there is nearsideFlange 62 and distal lip 64, this proximal flange and distal lip limit rotation groove 65, this rotationGroove can rotatably be contained in the leading edge portion of shank assembly 100 101 therebetween. This structureMaking to install axle bush 60 can rotate around longitudinal axis A-A with respect to shank assembly 100. Ridge member50 by ridge pin 66 non-rotatably pin joint to axle bush 60 is installed. In addition, rotation knob 70 is attached toAxle bush 60 is installed. In one embodiment, rotation knob 70 has hollow mounting flange portion 72, shouldThe size of hollow mounting flange portion is set for the part that axle bush 60 is installed is contained in wherein. VariousIn embodiment, rotation knob 70 can by for example glass or carbon filled nylon, Merlon,DengProcess, and be also attached to axle bush 60 is installed by ridge pin 66. In addition, to the guarantor of inner processHolding flange 74 is formed in mounting flange portion 72 and can extends to the footpath being formed in installation axle bush 60In groove 68. Therefore, surgeon can be by promptly rotating knob 70 and making it with respect to shankAssembly 100 rotates and makes ridge member 50(and be attached to the end effector 12 of ridge member 50) aroundLongitudinal axis A-A rotates along 360 ° of paths.

In various embodiments, anvil block 20 is remained on by anvil block spring 21 and/or another biasing structureOpen position. Anvil block 20 can by trigger system from open position optionally move to various closures orClamped position and firing position, described trigger system is generally marked as 109. Trigger system 109Comprise " firing member " 110, in various embodiments, should " firing member " comprise hollow percussionPipe 110. Hollow firing tube 110 can axially-movable on ridge member 50, therefore forms slender axles assembly40 outside. Firing tube 110 can be formed by polymer or other suitable materials processing, and has attachedReceive the near-end of the percussion yoke 114 of trigger system 109. For example in various embodiments, percussion yokeThe 114 moldable near-ends to firing tube 110. But, also can adopt other fastener constructions.

As can be seen in Figure 1, percussion yoke 114 can rotatably be supported on and support lining ring 120In, this support lining ring can axially-movable in shank assembly 100. In various embodiments, supportLining ring 120 has a pair of fin extending laterally, and this size to fin is set for slidably and heldIn the fin slit being formed in left hand housing member and right hand housing member. Therefore, support lining ring120 can slide axially in shank housing 100, make to pull the trigger yoke 114 and firing tube 110 can simultaneouslyRotate around longitudinal axis A-A with respect to supporting lining ring 120. In various embodiments, through percussionPipe 110 is provided with longitudinal slit, so that ridge pin 66 can extend to ridge member 50 through longitudinal slitIn, be conducive to firing tube 110 simultaneously and axially advance on ridge member 50.

Trigger system 109 also comprises percussion trigger 130, and this percussion trigger is used for controlling firing tube110 axially advancing on ridge member 50. Referring to Fig. 1. This type of firing tube 110 is in distal directionAxially-movable generation and the percussion of anvil block 20 interact and be referred to herein as " percussion motion ". AsIn Fig. 1, can find out, percussion trigger 130 is movable or connection pivotly by pivot pin 132To shank assembly 100. Adopt torsionspring 135 setover percussion trigger 130 make it away from shankThe pistol grip portion 107 of assembly 100 and arrive do not activate " opening " or original position. AsIn Fig. 1, can find out, percussion trigger 130 has top 134, and this top is attached (pin movinglyConnect) to percussion chain link 136, this percussion chain link movingly attached (pin joint) arrives support lining ring120. Therefore, the hand of percussion trigger 130 from original position (Fig. 1) to adjacent hub parts 100The end position motion of rifle formula handle portion 107 will make to pull the trigger yoke 114 and firing tube 110 along distal direction" DD " motion. Percussion trigger 130 is away from the fortune of the pistol grip portion 107 of shank assembly 100Moving (under the bias of torsionspring 135) will make to pull the trigger yoke 114 and firing tube 110 at ridge structureOn part 50, move along proximal direction " PD ".

Various embodiment of the present invention can use together with the implanted nail bin of different size and configuration. ExampleAs, in the time being combined with the first percussion adapter 140, surgical instruments 10 can with for supporting implantationThe 5mm end effector 12 of about 20mm long (or having other length) of formula nail bin 30 togetherUse. This end effector size can be particularly well-suited in for example realizing relatively meticulous dissection andManagement of blood vessels. But, as below institute is described in more detail, for example, also can pass through the first percussion adapter140 be replaced by the second percussion adapter and by surgical instruments 10 end effector and the nail with other sizesStorehouse is combined with. In further embodiments, slender axles assembly 40 only can be attached to a kind of form orThe end effector of size.

Now by a kind of for end effector 12 being connected to removedly to the side of ridge member 50 explainationMethod. By the maintenance lug 17 on elongated passageway 14 is inserted to the lug support 52 in ridge member 50In start connection process. Subsequently, surgeon by percussion trigger 130 towards casing assembly 100Pistol grip 107 advances, so that firing tube 110 and the first percussion adapter 140 are advanced towards distallyOn the proximal part 47 of elongated passageway 14, thereby lug 17 is remained on to its support separatelyIn 52. First percussion adapter 140 this type of position on lug 17 is called as " connection in this articleConnect position ". Various embodiment of the present invention also can have end effector locked component, forEnd effector 12 will be pulled the trigger trigger 130 locks in place after being attached to ridge member 50.

More specifically, an embodiment of end effector locked component 160 comprises retaining pin 162,This retaining pin is supported in the top 134 of percussion trigger 130 movingly. As mentioned above, percussionFirst pipe 110 must be advanced coupled position towards distally, and wherein, the first percussion adapter 140 willThe maintenance lug 17 of end effector 12 remains in the lug support 52 in ridge member 50. SurgeryDoctor will be by pulling the trigger linking from original position towards pistol grip 107 tractive percussion triggers 130Son 140 distad marches to coupled position. In the time that first percussion trigger 130 activates, retaining pin162 towards distal movement, until firing tube 110 is advanced to the first percussion adapter 140 to connect positionPut, now retaining pin 162 is biased in the latch well 164 being formed in housing member. VariousIn embodiment, when retaining pin 162 enters in latch well 164, pin 162 can send and can hear" click clatter " sound or other sound, and can be " locked " for surgeon provides end effector 12Sense of touch to ridge member 50 is indicated. In addition, only otherwise wittingly retaining pin 162 is setovered out to lockingChamber 164, surgeon just can not activate unintentionally percussion trigger 130 to start to make end effectorNail 32 in 12 is shaped. Similarly, if the percussion that surgeon discharges in coupled position triggersDevice 130, retaining pin 162 can make to pull the trigger trigger 130 and remain on this position, tactile to prevent percussionHair device 130 is back to original position and therefore discharges end effector 12 from ridge member 50.

Various embodiment of the present invention also can comprise trigger system locking press button 137, this trigger system lockSet button is attached to shank assembly 100 in mode that can pivotable. In one form, trigger systemLocking press button 137 has the breech lock 138 forming on its far-end, and this breech lock is oriented to when pulling the trigger and releasesPut button breech lock 138 in the time of the first position latching and engage percussion yoke 114. As seen in Fig. 1Go out, late spring 139 is for being biased to the first position latching by trigger system locking press button 137. ?In various situations, breech lock 138 is for engaging percussion yoke 114 at following some place: at this some place, ridge structureThe position of the percussion yoke 114 on part 50 is corresponding to wherein first pulling the trigger adapter 140 by before distallyEnter the point on the clamping slideway 28 on anvil block 20. Should be appreciated that along with the first percussion adapter140 axially advance to clamping on slideway 28, and anvil block 20 will move along path, make to follow closely shaping tableFace portion 22 is arranged essentially parallel to the top surface 36 of nail bin 30.

After end effector 12 is connected to ridge member 50, by first depressing trigger system lockingButton 137 and start to follow closely forming process so that percussion yoke 114 can be on ridge member 50 further toDistal movement the most at last anvil block 20 are compressed in nail bin 30. Depressing trigger system locking press buttonAfter 137, surgeon continues to activate percussion triggers 130 towards pistol grip 107, thereby by theOne nail lining ring 140 is driven on corresponding nail shaping slideway 29, to force in anvil block 20 and nail bin 30Nail 32 shaping contact. Trigger system locking press button 137 prevents from being ready to start to follow closely into surgeonBefore shape process, make to follow closely 32 unexpected shapings. In this type of embodiment, surgeon must trigger in percussionBefore device 130 can be further actuated, depressing trigger system locking press button 137 was shaped to start nailJourney.

Surgical instruments 10 can optionally and only be used as tissue apposition device. But, of the present invention variousEmbodiment also can comprise and organize diced system, and this tissue diced system is generally marked as 170. ExtremelyIn few a kind of form, organize diced system 170 to comprise cutter member 172, can advance tactile by activating cutterHair device 200 optionally pushes away this cutter member from the unactuated position of the near-end of adjacent end actuator 12Enter actuated position. Cutter member 172 is supported on actively in ridge member 50 and is attached to knife bar 180Or in other words from knife bar 180 projections. Cutter member 172 can be by for example having the 38HRC(of being greater than RockwellHardness C level) 420 or 440 stainless steels of hardness process, and can have and be formed at its far-endOn 174, organize cutting edge 176, and can extend through slidably slit in anvil block 20 withAnd the slit 33 of setting placed in the middle in nail bin 30, wear to cut the group being clamped in end effector 12Knit. In various embodiments, knife bar 180 extends through ridge member 50 and has with cutter conveyer and passesThe proximal part of moving handing-over, this cutter conveyer is operationally attached to the cutter trigger 200 of advancing. ?In various embodiment, the cutter trigger 200 of advancing is attached to pivot pin 132, makes the cutter trigger of advancing200 can carry out pivotable or in other words activated without activate percussion trigger 130 in the situation that.In various embodiments, the first cutter tooth wheel 192 is also attached to pivot pin 132, makes the cutter triggering of advancingThe actuating of device 200 also makes the first cutter tooth take turns 192 pivotables. The first cutter tooth wheel 192 and shank housing 100Between be attached with percussion return spring 202, with trigger 200 that cutter is advanced be biased to original position orUnactuated position.

The various embodiment of cutter conveyer also comprise the second cutter tooth wheel 194, and this second cutter tooth wheel can revolveTurn to be supported on the second gear shaft and with the first cutter tooth wheel 192 and engage. The second cutter tooth wheel 194 withThree cutter tooth wheel 196 engagements of support on the 3rd gear shaft. Four blade gear 198 is also supported on the 3rdOn gear shaft 195. Four blade gear 198 can transmission engage one on the near-end that is positioned at knife bar 180Series of annular gear teeth or ring. Therefore, this structure makes the four blade gear 198 can be along distal direction" DD " or proximal direction " PD " axially drive knife bar 180, make simultaneously trigger shaft 180 with respect toFour blade gear 198 rotates around longitudinal axis A-A. Therefore, surgeon can pass through towards shank groupThe pistol grip 107 tractive cuttves of part 100 are advanced trigger 200 and trigger shaft 180 are axially pushed awayEnter and all morning distally promotes cutter member 172.

Various embodiment of the present invention also comprises cutter locking system 210, and this cutter locking system prevents cutter structureThe propelling of part 172, unless percussion trigger 130 has been pulled to complete firing position. Therefore, thisPlant structure and will prevent the activation of cutter propulsion system 170, unless first nail is pulled the trigger or form in tissueIn. As can be seen in Figure 1, the various concrete enforcement of cutter locking system 210 comprises cutter securing rod211, this cutter securing rod is supported on the pistol grip portion of shank assembly 100 in mode that can pivotableIn 107. Cutter securing rod 211 has activated end 212, when percussion trigger 130 is in pulling the trigger position completelyWhile putting, activated end 212 can be engaged by percussion trigger 130. In addition, cutter securing rod 211 is at itOn the other end, have the suspension hook 214 of maintenance, this maintenance suspension hook can engage the first cutting teeth in suspension hook modeLatch bar 216 on wheel 192. Adopt cutter locking spring 218 that cutter securing rod 211 is biased to" locking " position. In this " locking " position, keep suspension hook 214 to keep connecing with latch bar 216Close, thereby prevent the advance actuating of trigger 200 of cutter, unless percussion trigger 130 is in hitting completelySend out position.

Be " fired " at nail (shaping) to target tissue after, surgeon can depress percussion triggerDevice release-push 167, so that percussion trigger 130 can be under the bias of torsionspring 135Be back to original position, thereby make anvil block 20 bias downwards into and to open at the bias of spring 21Position. When time in an open position, surgeon can withdraw from end effector 12 and leave implanted nailStorehouse 30 and nail 32. In the application that end effector inserts through passage, service aisle etc. therein,Surgeon will pull the trigger trigger 130 by activation makes anvil block 20 be back to closing position, so that endPortion's actuator 12 can be withdrawn from by described passage or service aisle. But, if surgeon thinksAfter percussion nail, cut target tissue, surgeon activates the cutter trigger of advancing in the above described manner200, to drive knife bar 172 to arrive the end of end effector through target tissue. Subsequently, surgeonCan discharge the cutter trigger 200 of advancing so that percussion return spring 202 can make to pull the trigger conveyer willThat knife bar 172 is back to is initial (not activating) position. Once knife bar 172 is back to original position, outerThe doctor of section just can open end effector jaw 13,15, so that implanted storehouse 30 is released in patient bodyAnd in patient body, withdraw from end effector 12 subsequently. Therefore, this type of surgical instruments be conducive to use canThe little implanted nail bin inserting by relatively little service aisle and path is surgery doctor simultaneouslyRaw provide following selection: percussion nail or after percussion nail in the situation that not cutting and organizingAlso cut and organize.

Various uniqueness of the present invention and new embodiment adopt compressible nail bin, described compressible nailStorehouse is supported in fixed position substantially for the nail by anvil block shaping contact. At various embodimentIn, anvil block is driven in unshaped nail. Wherein, at least one this type of embodiment, institute reachesThe degree that is shaped of nail depend on how far anvil block is driven in nail. This class formation makes surgeon's energyEnough adjusting is applied to the shaping of nail or the size of percussion pressure, thereby changes the final forming height of nail.In other various embodiment of the present invention, surgical stapling structure can adopt nail driving element, and this nail drivesMoving element can lift nail towards anvil block. Below this type of embodiment is described in more detail.

In various embodiments, with reference to the embodiment of foregoing detailed description, be applied to hitting of movable anvil blockThe moving size of shipping depends on the degree of the actuating of pulling the trigger trigger. For example,, if surgeon wantsObtain only partially-formed nail, only need partly inwardly to depress percussion towards pistol grip 107 and triggerDevice. Want to obtain more nail and be shaped, surgeon only needs further to compress percussion trigger, makesAnvil block is further driven to form and to contact with nail. As used herein, term " shaping contact "Refer to nail profiled surface or nail shaping pit contact stud leg end and started leg to be shaped or bendingTo shaping position. The degree that nail is shaped refers to the degree that nail leg is folded and finally refers to mentioned aboveThe forming height of nail. Those skilled in the art will be further understood that, because to anvil block20 apply when motion percussion, and anvil block 20 is to move with the substantially parallel relation of nail bin, instituteSubstantially be shaped simultaneously and there is substantially the same forming height with nail.

Fig. 2 and Fig. 3 show alternative end effector 12 ", except holding below knife barOutside 172 ' difference, end effector 12 " be similar to above-mentioned end effector 12 '. Knife bar 172 'Be connected to knife bar 180 or from knife bar 180 projections, and in addition with above about knife bar 172Described mode operates. But in this embodiment, knife bar 172 ' long enough is to traverse endActuator 12 " whole length, therefore end effector 12 " in do not adopt independent distal blade member.On knife bar 172 ', be formed with crosscut member 173 ' and lower crosscut member 175 '. Upper crosscut member 173 ' quiltBe orientated to crosscut anvil block 20 slidably " middle corresponding elongated slot 250, and lower crosscut member175 ' is oriented to crosscut end effector 12 " elongated passageway 14 " in elongated slot 252. Also existAnvil block 20 " in provide and depart from slit (not shown), make to carry out when knife bar 172 ' is driven to endDevice 12 " in end position time, upper crosscut member 173 ' falls by corresponding slit, makes anvil block 20 "Can move to open position, depart from the tissue that is sewn and cuts. Anvil block 20 " can be in addition withAbove-mentioned anvil block 20 is identical, and elongated passageway 14 " can be in addition and above-mentioned elongated passageway 14 phasesWith.

In these embodiments, anvil block 20 " be biased to by spring or other Unclosing structure (not shown)Fully open position (Fig. 2). Anvil block 20 " by the above side of stating of axially advancing of percussion adapter 150Formula is moved between open position and complete clamped position. Once percussion adapter 150 is advanced into completelyClamped position (Fig. 3), surgeon just can make knife bar 172 subsequently in the above described manner towards distally " push awayEnter. If surgeon wants end effector to carry out manipulating tissue as grasp device, can will hitSend out adapter towards proximal movement, to allow anvil block 20 " away from elongated passageway 14 " motion, in Fig. 4Shown in dotted line. In this embodiment, when knife bar 172 " during towards distal movement, upper crosscut member 173 ' andLower crosscut member 175 ' tractive anvil block 20 simultaneously " and elongated passageway 14 ", with at knife bar 172 " through endPortion's actuator 12 " obtain the nail of expecting while advancing towards distally and be shaped. Referring to Fig. 5. Therefore, in this enforcementIn example, nail is shaped and occurs with tissue cutting simultaneously, but nail itself can be at knife bar 172 " driven towards distallyShi Yixu is shaped.

Unique and the novel structure of various surgery nail bin of the present invention and surgical instruments makes in described nail binNail can be arranged in one or more linearities or nonlinear row. In each side of elongated slot, can establishBe equipped with multiple these type of nail row, described elongated slot is arranged in nail bin between two parties, described thin for passingLong slit and hold and organize cutting element. In a kind of arrangement mode, for example the nail in a row can be largeOn body, be parallel to and be arranged in the nail that adjacent nail is capable but stagger with it. In further embodiments, one orMultiple nails are capable be essentially nonlinear. In other words, the base portion of at least one nail in nail row canAlong the Axis Extension of the base portion crosscut of other nails in substantially capable with same nail. For example,, as below willDiscuss in more detail, in alternative embodiment, nail in each side of elongated slot is capable can haveThere is sawtooth appearance. Compared with the various linear nail arrangement modes that adopt in the nail bin of prior art,This type of nonlinear nail arrangement mode can use nail acquisition still less better to organize fastening result.

Fig. 6 shows the use of end effector embodiment 612 ' Chinese and foreign department nail bin embodiment 900. AsIn Fig. 6 and Fig. 7, can find out, the embodiment of surgery nail bin 900 has warehouse 902, this warehouse toolHave the elongated slot 904 of setting placed in the middle, this elongated slot extends to and far-end 905 through near-end 903Adjacent region. Elongated slot 904 can be allowed during organizing cutting operation in the above described mannerCutter main body is through elongated slot 904 axially-movables. In at least one embodiment, warehouse 902 is by exampleAs oxidized regenerated cellulose (ORC) or for example by PGA(polyglycolic acid, with trade mark, Vicryl goes outSell), PCL(polycaprolactone), PLA or PLLA(PLA), PDS(is poly-to dioxy hexamethyleneKetone), PHA(polyhydroxyalkanoatefrom), PGCL(Poliglecaprone 25, with trade mark MonocrylSell) or the compound of PGA, PCL, PLA and PDS process can bio-absorbable foamEtc. compressible hemostatic material composition, in described compressible hemostatic material, be supported with unshaped nail922 row 920,930 that form. But warehouse 902 also can be processed by other materials, this materialFor unshaped nail 922 is supported on and expects orientation, make when anvil block 910 ' and unshaped nail 922When contact, unshaped nail 922 can be compressed. The same with above-mentioned various other embodiment, nail bin 900For implanted, and after suture operation completes, keep being attached to the tissue being sewn. At least certainIn a little embodiment, for anti-non-magnetic shim 922 is influenced and hemostatic material quilt during introducing and position fixing processActivation, whole storehouse 900 can be coated with or be wrapped in biodegradable film 906, for example, with trade markThe six cyclic ketones films of selling or polyglycereol sebacate (PGS) film or for example by the poly-second of PGA(Alkyd, sells with trade mark Vicryl), PCL(polycaprolactone), the poly-breast of PLA or PLLA(Acid), PHA(polyhydroxyalkanoatefrom), PGCL(Poliglecaprone 25, with trade mark MonocrylSell) or the film that forms of the compound of PGA, PCL, PLA, PDS, described film is only breakingTime just permeable. The size of the warehouse 902 of nail bin 900 is set for and is supported on removedly end executionIn the elongated passageway of device 612 '.

In the embodiment shown in Fig. 6, Figure 10 and Figure 11, surgery nail bin 900 operationally existsThe first row 920 that on a cross side 907 of elongated slot 904, support nail 922 forms, and carefullyThe second row 930 that on another cross side 909 of long slit 904, support nail 922 forms. In various realitiesExecute in example, nail 922 can for example, by titanium for example, titanium alloy (6Al-4V titanium, 3al-2.5V titanium), noMetal material processing such as rust steel etc. forms and has nail base portion 924 and from nail base portion 924 projections twoUpright nail leg 926. On each nail leg 926, can be formed with tissue and pierce through end 928. Nail 922 shapesIn the first row 920 becoming, the nail base portion 924 of at least one nail 922 and the nail base portion of another nail 922Overlapping. In a preferred embodiment, except the last nail being positioned on the capable 920 each ends of the first nailOutside 922 base portion 924, the nail base portion 924 of each nail 922 is the nail of nail 922 adjacent with two allBase portion 924 is overlapping. Referring to Figure 10. Therefore, the first nail row 920 has nonlinear shape substantiallyShape. More specifically, in the time observing from top, the first nail row 920 have substantially zigzag outsideSee.

As found out in Fig. 9, anvil block 90 has longitudinal nail shaping pit 912 of two orders, everyIndividual longitudinal nail shaping pit 912 has corresponding basic of the shape of the first rows 920 that forms with nail 922Upper zigzag shape, makes when anvil block 910 and follows closely 922 to form while contacting the leg 926 of nailBe shaped as shown in figure 11. Therefore, the far leg of a nail is total to the near leg of next nail in the verticalEnjoy same pit. This structure can form more intensive pit pattern, even reaches nail and self carries outThe degree of interaction (for example stride across each other and fold). In the nail bowl configurations of prior art,In general, between one group of pit and next group pit, must have 0.005 inch to 0.015 inch itBetween metal/space. But for example this type of embodiment of the present invention has the interference of 0 to 0.02 inch(") in essence, a-0.020, this is because a nail coordinates with next nail to/section gap structure.This structure makes it possible to comprise in identical space the nail that has more 15% to 30%. In addition, when respectivelyWhen nail interlocking, multiple side direction nail rows' demand is reduced. Existing structure is being organized line of cut conventionallyIn each side, adopt three nails, with the open approach that prevents from existing blood to flow through. Interlocking nail row formsThe possibility in the path that blood can flow through is less. Another that various interlocking pin structure of the present invention providesSignificantly advantage relates to " breaking by force of the improvement relevant to the size of tearing the required power of nail row openingDegree ".

Another nail shaping pit structure can comprise shared nail shaping pit. As used herein, term" shared nail shaping pit " refer to, arranges solely with the each leg for each preformation staple whereinThe anvil design difference of the vertical prior art that forms pit, shaping pit can make single nail in capableAll nails are shaped.

Figure 12 illustrates another nail embodiment 922 ', and wherein base portion 924 ' has offset part 929, is beneficial toEach base portion 924 ' carries out overlapping more closely. As mentioned above, nail bin 900 has the elongated slot of being supported onThe second row 930 of the nail 922 on the second cross side 909 of 904. The second row 930 and the nail of nail 922922 the first row 920 is substantially the same. Therefore, anvil block 910 has corresponding to the second nail capable 930Second share nail shaping pit 912, with capable 930 shaping contact of the second nail. But, can supplyIn the embodiment selecting, the second row 930 of nail 922 can also may followed closely difference on number in shapeIn the first nail capable 920.

Fig. 8 illustrates surgery nail bin 900 ', except being supported on row that nail 922 wherein forms 920 ', 930 'Outside, surgery nail bin 900 ' is substantially the same with above-mentioned nail bin 900. For example, in this embodiment,The line 920 ' of nail 922 is relative to each other set the base portion axis S-that makes at least one nail base portion 924 forS is the base portion axis S-S of the nail base portion 924 of at least one another adjacent nail 922 of crosscut substantially. When fromWhen top is observed, this type of predetermined nail pattern comprises zigzag arrangement substantially. Shown in Figure 13In embodiment, on each base portion 924 of nail 922, overmolding has base support member 927 in addition,As shown in the figure. In various embodiments, base support member 927 can be by the plastics of for example nonabsorable(for example polyether-ether-ketone " PEEK ") or absorbable plastics (for example polyglycolic acid " PGA ", poly-Lactic acid " PLA " or " PLLA ", PPDO " PDS ", PCL(gather in oneselfEster), PHA(polyhydroxyalkanoatefrom), PGCL(Poliglecaprone 25, with trade mark MonocrylSell) or the various compound mixtures of PGS, PDS, PLA, PGA and PCL) processing andBecome. Base support member 927 is conducive to self make to carry out between each nail overlapping in the situation that not making to follow closelyInterlocking. Therefore, this class formation can be configured as nail overlapping in the case of not making to follow closely self leg" B " shape or " W " shape of falling. But, because bizet is connected by base support member, therefore hatPortion works as overlapping nail. This class formation make to combine pit have for two of each leg fromLoose path.

Embodiment shown in Figure 14 adopts nail row 920 ", at nail row 920 " in, the leg of contiguous nail 922926 are linked together by the coupling part 929 that is attached to leg 926 with molded or other modes.Each coupling part 929 can be (for example poly-by for example polyether-ether-ketone " PEEK " or absorbable plasticsGlycolic " PGA ", PLA " PLA " or " PLLA ", PPDO" PDS ", PCL(polycaprolactone), PHA(polyhydroxyalkanoatefrom), the poly-Kapp of PGCL(Grand 25, sell with trade mark Monocryl) or PGS, PDS, PLA, PGA and PCL's is eachPlant compound mixture) process. In the time observing from top, this type of follows closely row 920 " have substantially and sawThe outward appearance of profile of tooth. Although making for explaining various surgery nail bins enforcement in conjunction with end effector 612 'Example 900,900 ', but should be appreciated that nail bin 900,900 ' can be effectively with mentioned above various itsHis end effector and surgical instruments use together. It is suitable wherein in the anvil block of these apparatuses, to be provided withNail shaping bowl configurations, is shaped to move at anvil block the nail that reaches expectation when following closely shaping contactAmount.

Figure 15 and Figure 16 show another in the elongated passageway 14 that is supported on surgical instruments 10Surgery nail bin 940 embodiment. In at least one embodiment, surgery nail bin 940 comprises warehouse942, this warehouse has the elongated slot 944 of setting placed in the middle, and this elongated slot is at least in part through storehouseBody 942 extends. Elongated slot 944 can be allowed during organizing cutting operation in the above described mannerThe cutter main body of surgical instruments 10 is axially moved through elongated slot 944. In various embodiments, storehouseBody 942 above-mentioned or following type by for example oxidized regenerated cellulose (ORC) can bio-absorbableThe compressible hemostatic material composition such as foam, is supported with unshaped nail 922 and forms in described hemostatic materialRow 946,948,950, and 952. In some embodiment at least, for anti-non-magnetic shim 922 influenced withAnd hemostatic material introduce and position fixing process during be activated, whole storehouse 940 can be coated with or be wrapped inIn biodegradable film 954, for example, with trade markThe six cyclic ketones films of selling or polyglycereol last of the ten Heavenly stems twoAcid esters (PGS) film or for example by PGA(polyglycolic acid, sells with trade mark Vicryl), PCL(polycaprolactone), PLA or PLLA(PLA), PHA(polyhydroxyalkanoatefrom),PGCL(Poliglecaprone 25, sells with trade mark Monocryl) or PGA, PCL, PLA, PDSThe film that forms of compound, described film is only just permeable in the time breaking.

In the embodiment shown in fig. 15, storehouse 940 also comprises the storehouse supporting member that is connected to warehouse 942960. In various embodiments, storehouse supporting member 960 can be by for example titanium, stainless steel, aluminium, above-mentioned materialThe rigid metals such as any alloy that material forms process, and can partly embed in warehouse 942. ?In various embodiment, storehouse supporting member 960 can be held in place by for example film 954. Restricted at needsIn conjunction with other embodiment in, can be sporadicly with cyanoacrylate adhesive by two elements" gummed " together. In further embodiments, warehouse 942 can be heated also " welding " or" melting " is to storehouse supporting member 960. In various embodiments, storehouse supporting member 960 forms warehouseAt least a portion of 942 lower surface is to coordinate with elongated passageway 14. At at least one embodimentIn, storehouse supporting member 960 has the one or more snap arrangement 962 from its projection, for by storehouseSupporting member 960 is connected to elongated passageway 14 releasedly. Can adopt other forms of snap arrangement/Storehouse supporting member 960 is connected to releasedly elongated passageway 14 by fastener constructions.

In various embodiments, on storehouse supporting member 960, be formed with a series of support ridges 964,966,968,970,972,974,976, with the base portion 924 of the nail 922 in nail row 946,948,950,952Provide some lateral support, as shown in figure 15. Therefore, in some embodiment at least, support ridge withNail row is substantially coextensive. Figure 17 illustrates alternative nail bin embodiment substantially the same with storehouse 940940 ', difference is, nail bin embodiment 940 ' comprises respectively from support ridge 964,966,968,970,972,976 projections are with to following closely the 922 upright fin parts 978,979 that extra lateral support is provided,980,981,982,983. In various embodiments, fin part can be formed as with storehouse supporting member 960One, and it highly can be about 1/2 or be less than storehouse height. Therefore, in various embodiments,For example for support solid height that any rising structure of foam all cannot extend to foam withOn. Therefore, if storehouse is designed to for example be compressed to 1/3 of its original height when by percussion,Fin by compression height not 66% on the way down to compression height not 10% between.

In use, be shaped by contacting in the above described manner anvil block 20 once follow closely 922, by anvilSeat 20 is opened and end effector 12 is pulled away to the tissue through sewing up. When end effector 12 is pulled away fromThrough sew up organize time, warehouse 942 keeps being fastened to the tissue through sewing up, and subsequently with keep connectingStorehouse supporting member 960 to elongated passageway 14 separates. In various embodiments, storehouse supporting member 960Color be different from the color of the material that comprises warehouse 942 and the color of elongated passageway 14. This type of clothBe set to surgeon the instruction that can easily identify that does not have nail bin in end effector is provided. Therefore,Surgeon can by mistake not attempt in end effector, do not installing new nail bin againInsert/use end effector. For this reason, surgeon only needs to make the snap arrangement of storehouse supporting member 960The storehouse supporting member 960 of new nail bin 940 departs from elongated passageway 14, so that can be placed on carefullyIn long-channel 14. Although explain nail bin 940,940 ' in conjunction with surgical instruments 10, but should manageSeparate, do not deviating under the condition of the spirit and scope of the invention, these storehouses can institute be public effectively with hereinMany other surgical instruments embodiment that open use together.

In various embodiments, nail bin can comprise warehouse and be stored in the multiple nails in warehouse. UsingIn, can nail bin be introduced in operative site and be located in the side of handled tissue. In addition,Nail shaping anvil block can be positioned on the opposite side of tissue. In various embodiments, anvil block can be by firstJaw carrying and nail bin can be carried by the second jaw, and wherein the first jaw and/or the second jaw can be towards anotherJaw motion. Once nail bin and anvil block, with respect to tissue location, can penetrate nail from nail bin body, makeMust follow closely can piercing tissue contact stud shaping anvil block. Once from nail bin body, dispose nail, can be from operationPosition removes nail bin body. In various embodiment disclosed herein, at least one portion of nail bin or nail binImplantable in point have a nail. In at least one this type of embodiment, as below described in more detail, nailStorehouse can comprise warehouse, and in the time that anvil block moves to closing position from open position, described warehouse can be by describedAnvil block compression, conquassation and/or collapse. When warehouse is compressed, conquassation and/or while collapsing, be positioned at warehouseIn nail can be out of shape by anvil block. Alternatively, can court for the jaw that supports nail binAnvil block moves to closing position. In any of two kinds of situations, in various embodiments, when nail extremelyWhile being positioned at warehouse to small part, nail deformable. In certain embodiments, not quilt from nail bin of nailPenetrate, and in certain embodiments, nail can be penetrated together with a part for warehouse from nail bin.

Referring now to Figure 18 A-18D,, compressible nail bin (for example nail bin 1000) for example can comprise and can pressContracting, implanted warehouse 1010, and be arranged in addition multiple nails 1020 of compressible warehouse 1010,But Figure 18 A-18D only illustrates a nail 1020. Figure 18 A illustrates by nail bin support member or nail bin passage1030 nail bins 1000 that support, wherein nail bin 1000 is illustrated in uncompressed state. At this type of notIn compressive state, anvil block 1040 can contact or contact tissue T not. In use, anvil block 1040 canMove to contact tissue T from open position, as shown in Figure 18 B, and by tissue T against warehouse1010 location. Even if anvil block 1040 can be positioned to tissue T the tissue contact against nail bin body 1010Surface 1019, but refers again to Figure 18 B, that nail bin body 1010 now can be subject to is few (ifSome words) compression stress or pressure, and nail 1020 can remain on unshaped or not pull the trigger state. As figureShown in 18A and Figure 18 B, nail bin body 1010 can comprise one or more layers, and the nail of nail 1020Leg 1021 can upwards extend through these layers. In various embodiments, warehouse 1010 can comprise firstLayer 1011, the second layer 1012, the 3rd layer 1013 and the 4th layer 1014, wherein the second layer 1012 canBe positioned between ground floor 1011 and the 3rd layer 1013, wherein can be positioned in for the 3rd layer 1013Between two layer 1012 and the 4th layer 1014. In at least one embodiment, for example follow closely 1020 base portionIn 1022 chambeies 1015 that can be positioned in the 4th layer 1014, and nail leg 1021 can be from base portion1022 upwards extend and pass the 4th layer 1014, the 3rd layer 1013 and the second layer 1012. In various realitiesExecute in example, each deformable leg 1021 can comprise end, and for example sharp end 1023 is for example worked asNail bin 1000 is in the time of uncompressed state, and sharp end 1023 for example can be positioned in the second layerIn 1012. In at least one this type of embodiment, end 1023 can not extend to and/or pass firstLayer 1011, wherein at least one embodiment, when nail bin 1000 is during in uncompressed state, endEnd 1023 not projection passes tissue contacting surface 1019. In certain embodiments, when nail bin inWhen uncompressed state, sharp end 1023 can be positioned in the 3rd layer 1013 and/or any other closesIn suitable layer. In various alternative embodiment, the warehouse of nail bin can have any suitable numberLayer, be for example less than four layers or more than four layers.

In various embodiments, as below described in more detail, ground floor 1011 can be by fidMaterial and/or plastic material (for example PPDO (PDS) and/or polyglycolic acid (PGA))Form, and the second layer 1012 can be by foamed material and/or compressible hemostatic material that can bio-absorbableMaterial (for example oxidized regenerated cellulose (ORC)) forms. In various embodiments, ground floor1011, one or more in the second layer 1012, the 3rd layer 1013 and the 4th layer 1014 can be by nail1020 remain in nail bin body 1010, and can make in addition to follow closely 1020 maintenances and mutually align. VariousIn embodiment, the 3rd layer 1013 can comprise backing material or quite incompressible or non-elastic material,Described material can relative to each other be held in place the nail leg 1021 of nail 1020. In addition, be positioned atNail can be stablized or reduce to the second layer 1012 on the relative both sides of three layer 1013 and the 4th layer 10141020 motion, even if the second layer 1012 and the 4th layer 1014 can comprise compressible foam or elasticityMaterial. In certain embodiments, the nail end 1023 of nail leg 1021 can embed first at least in partIn layer 1011. In at least one this type of embodiment, ground floor 1011 and the 3rd layer 1013 canCollaboratively and firmly nail leg 1021 is held in place. In at least one embodiment, ground floor1011 and the 3rd layer 1013 can comprise respectively and can (for example go out with trade name Vicryl by bioabsorbable materialPolyglycolic acid (PGA), PLA (PLA, PLLA), the PPDO sold(PDS), polyhydroxyalkanoatefrom (PHA), with trade name Monocryl sell Poliglecaprone25(PGCL), polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA,The compound of PGCL and/or PCL) thin slice that forms, and the second layer 1012 and the 4th layer1014 can comprise respectively at least one hemostatic material or styptic.

Although it is compressible that ground floor 1011 can be, but the second layer 1012 can be substantially than ground floor1011 is more compressible. For example, the compressibility of the second layer 1012 can be about two of ground floor 1011Doubly, about three times, about four times, about five times and/or about ten times. In other words, for givenPower, the compression degree of the second layer 1012 can be ground floor 1011 about twice, about three times,About four times, about five times and/or about ten times. In certain embodiments, the second layer 1012Compressibility can be between about twice of ground floor 1011 and about ten times. At at least one embodimentIn, in the second layer 1012, can be limited with multiple air gaps, wherein the amount of the air gap in the second layer 1012 and/Or size can be controlled to provide the expectation compression of the second layer 1012. To similar above, although the 3rd layer1013 can be compressiblely, but the 4th layer 1014 can substantially have more and can press than the 3rd layer 1013Contracting. For example, the compressibility of the 4th layer 1014 can be about twice of the 3rd layer 1013, approximatelyThree times, about four times, about five times and/or about ten times. In other words, for given power,The compression degree of the 4th layer 1014 can be about twice, about three times, about four of the 3rd layer 1013Doubly, about five times and/or about ten times. In certain embodiments, the 4th layer 1014 compressibleProperty can be between about twice of the 3rd layer 1013 and about ten times. In at least one embodiment,In four layer 1014, can be limited with multiple air gaps, wherein amount and/or the size of the air gap in the 4th layer 1014Can be controlled to provide the expectation compression of the 4th layer 1014. In all cases, can pass through compression ratio(, layer is for the distance of compressing to the power of sizing) expresses the compressible of warehouse or warehouse layerProperty. For example, with have compared with little compressible layer compared with, have high compression rate layer for being applied to thisThe compression stress of giving sizing of layer is by distance larger compression. So, the second layer 1012 comparable theOne deck 1011 has higher compression ratio; Similarly, the 4th layer 1014 comparable the 3rd layer 1013 hasHigher compression ratio. In various embodiments, the second layer 1012 and the 4th layer 1014 can comprise identicalMaterial and can there is identical compression ratio. In various embodiments, the second layer 1012 and the 4th layer1014 can comprise the material with different compression ratios. Similarly, ground floor 1011 and the 3rd layer 1013Can comprise identical material and can there is identical compression ratio. In certain embodiments, ground floor 1011With the 3rd layer 1013 can comprise the material with different compression ratios.

In the time that anvil block 1040 is advanced towards its closing position, anvil block 1040 can contact tissue T and to tissueT and nail bin 1000 apply compression stress, as shown in Figure 18 C. In this case, anvil block 1040 canPromote top surface or the tissue contacting surface 1019 of warehouse 1010 downwards towards nail bin support member 1030.In various embodiments, nail bin support member 1030 can comprise storehouse stayed surface 1031, when nail bin 1000Storehouse described in while being compressed between storehouse stayed surface 1031 and the tissue contacting surface 1041 of anvil block 1040Stayed surface 1031 can support nail bin 1000. Due to 1040 applied pressures of anvil block, warehouse1010 can be compressed and anvil block 1040 can contact stud 1020. More specifically, in various embodiments,The downward motion of the compression of warehouse 1010 and tissue contacting surface 1019 can make to follow closely the end of leg 10211023 pierce through ground floor 1011, the piercing tissue T of warehouse 1010 and enter the one-tenth in anvil block 1040In shape pit 1042. In the time that warehouse 1010 is further compressed by anvil block 1040, end 1023 can connectTouch the wall that limits shaping pit 1042, and therefore for example leg 1021 can be to internal strain or curling, asShown in Figure 18 C. In the time that nail leg 1021 is out of shape, as shown in Figure 18 C, follow closely 1020 base portion equally1022 can contact nail bin support member 1030 or be supported by nail bin support member 1030. At various embodimentIn, as described in more detail below, nail bin support member 1030 can comprise multiple supporting constructions, for exampleNail support trenches, slit or groove 1032, when described multiple supporting constructions can be worked as nail 1020 distortionSupport nail 1020 or at least follow closely 1020 base portion 1022. As shown in Figure 18 C, be applied to nail bin equallyThe compression stress of body 1010 can make the chamber 1015 in the 4th layer 1014 collapse. Except chamber 1015, nailWarehouse 1010 also can comprise one or more spaces (for example space 1016), for example described one orIn multiple spaces, can be positioned with or no-fix has the part of nail, described one or more spaces can permitBeing permitted warehouse 1010 collapses. In various embodiments, can collapse in chamber 1015 and/or space 1016,So that limit the downward deflection of wall in chamber and/or space and contact storehouse stayed surface 1031 and/or contact warehouse1010 the layer that is positioned at chamber and/or below, space.

In the time of comparison diagram 18B and Figure 18 C, obviously, the second layer 1012 and the 4th layer 1014 are by anvil block1040 compression pressures that apply compress substantially. Also can note ground floor 1011 and the 3rd layer1013 is also compressed. In the time that anvil block 1040 moves to its closing position, anvil block 1040 can pass through towards nailStorehouse support member 1030 promotes tissue contacting surface 1019 downwards and continues further compression warehouse 1010.In the time that warehouse 1010 is further compressed, anvil block 1040 can make to follow closely 1020 and be deformed into its shape that is shaped completelyShape, as shown in Figure 18 D. Referring to Figure 18 D, the leg 1021 of each nail 1020 can be towards each nail 1020Base portion 1022 be out of shape downwards so that by tissue T, ground floor 1011, the second layer 1012, the 3rdLayer 1013 and at least a portion of the 4th layer 1014 be captured in deformable leg 1021 and base portion 1022 itBetween. In the time of comparison diagram 18C and Figure 18 D, more obvious, the second layer 1012 and the 4th layer 1014 enter oneThe compression pressure that step is applied by anvil block 1040 significantly compresses. In the time of comparison diagram 18C and Figure 18 D alsoCan note, ground floor 1011 and the 3rd layer 1013 are also further compressed. At nail 1020 by completely orAfter being shaped at least fully, anvil block 1040 can be lifted away from tissue T, and nail bin supportsPart 1030 can away from and/or depart from nail bin 1000 move. As shown in Figure 18 D and due to mentioned above,Warehouse 1010 is implantable nail 1020. In various embodiments, implanted warehouse 1010 can be along nailRow supporting tissue. In some cases, the styptic holding in implanted warehouse 1010 and/or appointWhat he can process tissue by suitable medicine in time. Styptic as above can reduce instituteOrganizing of sewing up and/or cut is hemorrhage, and As time goes on bonding agent or tissue adhesive can be simultaneouslyFor tissue provides intensity. The warehouse 1010 of implanting can comprise for example ORC(oxidation regeneration fiberElement), albumen substrate, with trade name Vicryl sell polyglycolic acid (PGA), PLA(PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom(PHA), with trade name Monocryl sell Poliglecaprone 25(PGCL), polycaprolactoneAnd/or the compound of PGA, PLA, PDS, PHA, PGCL and/or PCL etc. (PCL)Material. In some cases, warehouse 1010 can comprise the possibility that can reduce surgical site infectionAnti-biotic material and/or antimicrobial material, for example collargol and/or triclosan.

In various embodiments, each layer of warehouse 1010 can interconnect. At at least one embodimentIn, can utilize at least one adhesive (for example fibrin and/or protein hydrogel) by the second layer1012 adhere to ground floor 1011, adhere to the second layer 1012 by the 3rd layer 1013, and by the 4th layer1014 adhere to the 3rd layer 1013. In certain embodiments, although not shown, but warehouse 1010Each layer can link together by interlocked mechanical structure. In at least one this type of embodiment, firstLayer 1011 and the second layer 1012 can comprise corresponding interlocking structure, for example tenon groove structure and/or swallow separatelyTail tenon structure. Similarly, the second layer 1012 and the 3rd layer 1013 can comprise corresponding interlocking knot separatelyStructure, the 3rd layer 1013 and the 4th layer 1014 can comprise corresponding interlocking structure separately simultaneously. At someIn embodiment, although not shown, but nail bin 1000 can for example comprise one or more rivets, described inThe extensible one or more layers through warehouse 1010 of one or more rivets. At at least one, this type of is realExecute in example, each rivet can comprise first end or head and the vicinity that adjacent first layer 1011 is locatedThe 4th layer 1014 and the second head of location, described the 4th layer of the second end that can be assembled into rivet orThe second end by rivet forms. Due to the compressible character of warehouse 1010, at least one embodimentIn, the compressible warehouse 1010 of for example rivet, so that the head of rivet can be with respect to the group of warehouse 1010Knit contact surface 1019 and/or lower surface 1018 caves in. In at least one this type of embodiment, eachRivet can comprise the polyglycolic acid (PGA), the PLA (PLA that for example sell with trade name VicrylOr PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), with businessName of an article Monocryl sell Poliglecaprone 25(PGCL), polycaprolactone (PCL) and/orThe compound of PGA, PLA, PDS, PHA, PGCL and/or PCL etc. can bio-absorbable materialMaterial. In certain embodiments, except the nail 1020 by holding in warehouse 1010, warehouseEach layer of 1010 can not be connected to each other. In at least one this type of embodiment, nail leg 1021 and warehouseBeing frictionally engaged between 1010 for example can keep together each layer of warehouse 1010, once and nailBe shaped, each layer can be trapped in nail 1020. In certain embodiments, nail leg 1021 at leastA part can comprise can increase nail 1020 and warehouse 1010 between frictional force roughened surface orRough coatings.

As mentioned above, surgical instruments can comprise the first jaw and the second jaw, and the first jaw comprises nail binSupport member 1030, the second jaws comprise anvil block 1040. In various embodiments, as below more detailedThin description, nail bin 1000 can comprise one or more holding structures, described one or more holding structuresCan engage nail bin support member 1030 and therefore nail bin 1000 be remained to nail bin support member releasedly1030. In certain embodiments, can pass through at least one adhesive (for example, fibrin and/or eggPlain boiled water gel) nail bin 1000 is adhered to nail bin support member 1030. In use, at least oneIn situation, especially, in abdominal cavity mirror and/or endoscopic procedure, for example the second jaw is moveable toThe closing position relative with the first jaw, makes the first jaw and the second jaw to pass through trochar and quiltInsert in operative site. In at least one this type of embodiment, trochar can limit about 5mm'sHole or intubate, the first jaw and the second jaw can be inserted into by described hole or intubate. Real at someExecute in example, the second jaw is moveable to the part closed position between in an open position and closing positionPut, described part closing position tolerable the first jaw and the second jaw are inserted into through trochar, andBe out of shape without the nail 1020 that makes to hold in nail bin body 1010. In at least one this type of embodiment,In the time of the centre position of the second jaw in its part closure, anvil block 1040 can be to nail bin body 1010Apply compression stress, and in some other embodiment, when the centre of the second jaw in its part closureWhen the position, the compressible nail bin body 1010 of anvil block 1040. Although when anvil block 1040 is in this type of interpositionCompressible nail bin body 1010 while putting, but anvil block 1040 can compress nail bin body 1010 by halves, withMake anvil block 1040 contact studs 1020 and/or make to follow closely 1020 to be out of shape by anvil block 1040. Once the first pincersMouth and the second jaw are inserted in operative site by trochar, and the second jaw can be beaten againOpen, and anvil block 1040 and nail bin 1000 can position with respect to target tissue as mentioned above.

Referring now to Figure 19 A-19D,, in various embodiments, the end effector of surgical stapling device canComprise the implanted nail bin 1100 between anvil block 1140 and nail bin support member 1130. With phase aboveSeemingly, anvil block 1140 can comprise tissue contacting surface 1141, and nail bin 1100 can comprise tissue contacting surface1119, and nail bin support member 1130 can comprise the stayed surface 1131 that can support nail bin 1100.Referring to Figure 19 A, can utilize anvil block 1140 that tissue T is positioned to make its tissue against nail bin 1100Contact surface 1119 and do not make nail bin 1100 be out of shape, and when anvil block 1140 is during in this type of position,Tissue contacting surface 1141 can be oriented to and nail bin stayed surface 1131 distance 1101a, andAnd tissue contacting surface 1119 can be oriented to and nail bin stayed surface 1131 distance 1102a.Subsequently, in the time that anvil block 1140 moves towards nail bin support member 1130, referring now to Figure 19 B, anvil block1140 can promote top surface or the tissue contacting surface 1119 of nail bin 1100 downwards and compress warehouse1110 ground floor 1111 and the second layer 1112. When layer 1111 and layer 1112 are when compressed, againReferring to Figure 19 B, the second layer 1112 can be by conquassation, and the leg 1121 of nail 1120 can pierce through ground floor1111 and enter tissue T. In at least one this type of embodiment, nail 1120 can be determined at least in partIn the nail chamber or space 1115 of position in the second layer 1112, and in the time that the second layer 1112 is compressed,Can collapse and therefore allow that the second layer 1112 is around nail 1120 and collapse in nail chamber 1115. In various enforcementIn example, the second layer 1112 can comprise cover part 1116, and this cover part is extensible in nail chamber 1115On and around or at least in part around nail chamber 1115. Figure 19 B shows to be pressed downward and bursts to following closely chamberCover part 1116 in 1115. In certain embodiments, the second layer 1112 can comprise one or manyIndividual weakening part, described one or more weakening parts can be conducive to collapsing of the second layer 1112. RespectivelyPlant in embodiment, this type of weakening part can comprise that for example can be conducive to warehouse 1110 carries out controlled collapsingCut, perforation and/or thin cross section. In at least one embodiment, ground floor 1111 canComprise one or more weakening parts that can be conducive to follow closely leg 1121 and penetrate ground floor 1111. RespectivelyIn kind of embodiment, this type of weakening part can comprise and for example can align with nail leg 1121 or at least substantiallyCut, perforation and/or the thin cross section of alignment.

Refer again to Figure 19 A, when anvil block 1140 is during in the closed not firing position of part, anvil block1140 can be oriented to and storehouse stayed surface 1131 distance 1101a, between making to be limited with therebetweenGap. This gap can be filled by nail bin 1100 and the tissue T with nail bin height 1102a. Work as anvil block1140 while moving downward to compress nail bin 1100, refers again to Figure 19 B, tissue contacting surface 1141And the distance between storehouse stayed surface 1131 can be limited by the distance 1101b being shorter than apart from 1101a. ?In various situations, between the tissue contacting surface 1141 of anvil block 1140 and storehouse stayed surface 1131 byThe gap limiting apart from 1101b can be greater than original undeformed nail bin height 1102a. Referring now toFigure 19 C, in the time that anvil block 1140 moves to more close storehouse stayed surface 1131, the second layer 1112 can continueContinuous distance of collapsing and follow closely between leg 1121 and shaping pit 1142 can reduce. Similarly, tissue connectsThe distance of touching between surface 1141 and storehouse stayed surface 1131 can be decreased to apart from 1101c, variousIn embodiment, can be greater than, equal or be less than original not distortion storehouse height apart from 1101c1102a. Referring now to Figure 19 D,, anvil block 1140 is moveable to final firing position, finalIn firing position, nail 1120 is shaped completely or is at least shaped to Desired Height. In this type of position, anvilSeat 1140 tissue contacting surface 1141 can with storehouse stayed surface 1131 distance 1101d, whereinCan be shorter than original not distortion storehouse height 1102a apart from 1101d. As shown in Figure 19 D, follow closely chamber equally1115 can collapse completely or at least substantially, and nail 1120 can be collapsed completely or at least substantiallyThe second layer 1112 around. In all cases, anvil block 1140 can be transported away from nail bin 1100 subsequentlyMoving. Once anvil block 1140 departs from nail bin 1100, warehouse 1110 can be for example at least in part againBe stretched in various positions (, the position between adjacent nail 1120). At at least one embodimentIn, the warehouse 1110 of conquassation may not stretch with elastic type again. In various embodiments, be shapedNail 1120 and in addition the warehouse 1110 between adjacent nail 1120 can exert pressure to tissue TOr compression stress, this can provide various useful results for the treatment of.

As mentioned above, refer again to the embodiment shown in Figure 19 A, each nail 1120 can comprise from itThe nail leg 1121 extending. Although nail 1120 is illustrated as comprising two nail legs 1121, but also can profitFor example, with comprising a nail leg or comprise and exceed two nail legs (three nail legs or four as another selectionIndividual nail leg) various nails. As shown in Figure 19 A, each nail leg 1121 all can embed warehouse 1110In the second layer 1112, make to follow closely 1120 and be fixed in the second layer 1112. In various embodiments, nail1120 can be inserted in the nail chamber 1115 of warehouse 1110, make the end 1123 of following closely leg 1121 at baseBefore portion 1122, enter in chamber 1115. In various embodiments, 1123 be inserted into chamber endwaysAfter 1115, end 1123 can be pressed in cover part 1116 and cut the second layer 1112. ?In various embodiment, nail 1120 enough depths that can be sealed in the second layer 1112, make nail1120 do not move or at least substantially do not move with respect to the second layer 1112. In certain embodiments,Nail 1120 enough depths that can be sealed in the second layer 1112, base portion 1122 is positioned orEmbed in nail chamber 1115. In various other embodiment, base portion 1122 can not be positioned or embedIn two layer 1112. Refer again to Figure 19 A, in certain embodiments, base portion 1122 can be at warehouseExtend 1110 lower surface 1118 belows. In certain embodiments, base portion 1122 can be bearing on storehouseOn stayed surface 1130 or directly, locate against storehouse stayed surface 1130. In various embodiments, storehouseStayed surface 1130 can comprise from its extension and/or be limited to supporting construction wherein, wherein at leastIn this type of embodiment, the base portion 1122 of nail 1120 can be positioned in for example nail bin support member 1130In one or more support trenches, slit or groove 1132 in or by described one or more support ditchesGroove, slit or groove 1132 support, as described in more detail below.

To being above described further, referring now to Figure 20, the base portion 1122 of nail 1120 can be directAgainst the stayed surface 1131 of nail bin support member 1130 and locate. In various embodiments, comprise asLower embodiment: wherein follow closely base portion 1122 and comprise circle or arcuate shaped bottom surface 1124, for example, follow closely base portion1122 can move or slide along nail bin stayed surface 1131. When anvil block 1140 is during nail forming processWhile being compressed the end 1123 of following closely leg 1121, can there is this type of slip. In certain embodiments, as aboveDescribed and referring now to Figure 21, in nail bin support member 1130, can comprise one or more support slits1132, described one or more support slits can be eliminated or at least reduce nail base portion 1122 and support with storehouseRelative motion between surface 1131. In at least one this type of embodiment, each support slit1132 all can be limited by surface profile, described surface profile be arranged in and support the nail of slit 1132 at the bottom ofThe profile on portion surface matches or at least substantially matches. For example, the base portion 1122 shown in Figure 21Lower surface 1124 can comprise circle or circular surface at least substantially, and support slit1132 also can comprise circle or circular surface at least substantially. In at least one this type of embodiment,Can be by being more than or equal to the radius of curvature that limits lower surface 1124 for the surface that limits slit 1132Radius of curvature limit. Although slit 1132 can contribute to prevent or reduce nail 1120 and support with nail binThe motion of relative sliding between part 1130, however slit 1132 also can prevent or reduce nail 1120 withRelative rotary motion between nail bin support member 1130. More specifically, at least one embodiment,Slit 1132 can closely hold base portion 1122, to prevent or reduce nail 1120 around axis1129 rotation, for example so that nail 1120 time can not rotate or distortion in distortion.

In various embodiments, to being above described further, each nail 1120 all can be by justifyingOr round wire rod forms at least substantially. In certain embodiments, the leg of each nail and base portion all can be byThe wire rod for example, with non-circular cross sections (rectangular cross section) forms. In at least one this type of enforcementIn example, nail bin support member 1130 can comprise corresponding non-circular slit (for example rectangular slot), described inNon-circular slit can hold the base portion of this type of nail. Referring now to Figure 22,, in various embodiments, everyIndividual nail 1120 all can comprise that overmolding is to bizet such as the bizet 1125 on base portion 1122, wherein everyIndividual bizet 1125 all can be positioned in the support slit in nail bin support member 1130. At at least oneIn this type of embodiment, each bizet 1125 all can comprise the cross section of for example square and/or rectangle,Described cross section can be contained in square in nail bin support member 1130 for example and/or the slit of rectangleIn 1134. In various embodiments, bizet 1125 can comprise can bio-absorbable plastics (for example withPolyglycolic acid (PGA), PLA (PLA or PLLA), poly-right that trade name Vicryl sellsDioxy cyclohexanone (PDS), polyhydroxyalkanoatefrom (PHA), sell with trade name MonocrylPoliglecaprone 25(PGCL), polycaprolactone (PCL) and/or PGA, PLA, PDS,The compound of PHA, PGCL and/or PCL), and can be by injection moulding process for example around nail 1120Base portion 1122 form. Various bizets and the method that is used to form various bizets are disclosed in 2006 9The name of submitting to by the moon 29 is called " SURGICALSTAPLESHAVINGCOMPRESSIBLEORCRUSHABLEMEMBERSFORSECURINGTISSUETHEREINANDSTAPLINGINSTRUMENTSFORDEPLOYINGTHESAME " United States Patent (USP) ShenIn please sequence number 11/541,123. Refer again to Figure 22, slit 1134 also can comprise introduction part or obliqueAngle 1135, this introduction part or oblique angle can be conducive to bizet 1125 to insert in slit 1134. RespectivelyIn kind of embodiment, in the time that nail bin 1100 is assembled to nail bin support member 1130, the base portion of nail 1120 and/ or bizet can be positioned in slit 1134. In certain embodiments, when nail bin 1100 is assembled toWhen nail bin support member 1130, the bizet 1125 of nail 1120 can align with slit 1134. At least oneIn individual this type of embodiment, bizet 1125 can not enter in slit 1134, until nail leg 1121 is appliedBase portion and/or the bizet of compression stress and nail 1120 are pushed down in slit 1134.

Referring now to Figure 23 and Figure 24,, in various embodiments, nail bin such as nail bin 1200 for example canComprise compressible implanted warehouse 1210, this warehouse comprises skin 1211 and internal layer 1212. With aboveSimilar, nail bin 1200 can comprise the multiple nails 1220 that are positioned at warehouse 1210. At various embodimentIn, one or more nail legs that each nail 1220 all can comprise base portion 1222 and extend from base portion1221. In at least one this type of embodiment, nail leg 1221 can insert in internal layer 1212 also sealedFixed to the lower surface 1218 that for example makes to follow closely 1220 base portion 1222 adjacency and/or be close to internal layer 1212Position. In the embodiment shown in Figure 23 and Figure 24, internal layer 1212 does not comprise can hold nail 1220The nail chamber of a part, and in other embodiments, internal layer 1212 can comprise this type of nail chamber. VariousIn embodiment, to being above described further, internal layer 1212 can comprise can allow warehouse 1210The compressible material of collapsing in the time that it is applied to compressive load (foam and/or oxygen that for example can bio-absorbableChange regenerated cellulose (ORC)). In various embodiments, internal layer 1212 can for example comprise and comprisesThe freeze dried foam of PLA (PLA) and/or polyglycolic acid (PGA). ORC can trade nameSurgicel is commercially available and can comprise loose weaven goods (similar surgery is used sponge), staple in bulk(similar cotton balls) and/or foam. In at least one embodiment, internal layer 1212 can be by wherein comprisingAnd/or be coated with the material structure of medicine (for example cryodesiccated fibrin ferment and/or fibrin) aboveBecome, described medicine for example can be by fluid water activation and/or the activation in patient body. At at least one this type ofIn embodiment, cryodesiccated fibrin ferment and/or fibrin can remain on for example Vicryl(PGA)In matrix. But, in some cases, for example, when nail bin 1200 inserts the operative site in patient bodyWhen middle, activable medicine can by mistake be activated. Refer again to Figure 23 and Figure 24, in various realitiesExecute in example, outer 1211 can be by water impervious or water impervious material structure at least substantiallyBecome, so that liquid does not contact or at least substantially do not contact internal layer 1212, until warehouse 1210 is pressedAfter contracting and nail leg penetrate outer 1211 and/or outer 1211 be cut open in some way after. RespectivelyPlant in embodiment, skin 1211 can comprise backing material and/or plastic material is (for example poly-to dioxy ringHexanone (PDS) and/or polyglycolic acid (PGA)). In certain embodiments, skin 1211 canComprise the wrappage around internal layer 1212 and nail 1220. More specifically, at least one embodimentIn, nail 1220 can be inserted in internal layer 1212 and outer 1211 and around comprising internal layer 1212 and nail1220 sub-component and be wrapped and sealed subsequently.

Referring now to Figure 25 and Figure 26,, in various embodiments, nail bin such as nail bin 1300 for example canComprise compressible implanted warehouse 1310, this warehouse comprises skin 1311 and internal layer 1312. With aboveSimilar, nail bin 1300 also can comprise the nail 1320 that is positioned at warehouse 1310, wherein each nail 1320All can comprise base portion 1322 and the one or more legs 1321 that extend from base portion 1322. Be similar to nailStorehouse 1200, the base portion 1322 of nail 1320 can extend below the lower surface of internal layer 1,312 1318,And outer 1311 can be around base portion 1322. In at least one this type of embodiment, outer 1311 canThere is enough flexibilities and surround each nail base portion 1322, make outer 1311 to conform to base portion 1322Profile. Refer again to Figure 24, at least one alternative embodiment, outer 1211 canThere is enough rigidity, make it extend and not conform to each base portion 1222 around base portion 1222.In any case, in various embodiments, outer 1311 can be positioned in the base portion of nail 13201322 with for example, for supporting the nail bin stayed surface (stayed surface 1031 or 1131) of nail bin 1300Between. In at least one this type of embodiment, outer 1311 can be positioned in base portion 1322 and limitFor example, between the support slit (slit 1032 or 1132) in nail bin stayed surface. At least oneIn individual this type of embodiment, to being above described further, outer 1311 can limit base portion 1322Motion and/or increase base portion 1322 and nail bin stayed surface and/or support slit between coefficient of frictionTo reduce relative motion therebetween. Referring now to Figure 27 and Figure 28,, in various alternative realitiesExecute in example, the skin of nail bin such as nail bin 1400 can be by halves around the nail being positioned at wherein. At leastIn this type of embodiment, in nail 1420 nail leg 1421 inserts warehouse 1410 before, compressibleThe skin 1411 of implanted warehouse 1410 can be assembled to internal layer 1412. Due to mentioned above, nail1420 base portion 1422 is extensible in outer 1411 outside, and at least one this type of embodimentIn, for example base portion 1422 can directly be positioned at the support slit in nail bin stayed surface 1031 or 1131In 1032 or 1132. In various embodiments, when nail leg 1421 inserts through outer 1411 time,Nail leg 1421 can cut outer 1411. In all cases, the hole being formed by nail leg 1421 can be tightGround is around nail leg 1421, makes to follow closely between leg 1421 and outer 1411, to leak few (if existenceWords) fluid, this can reduce or prevent the medicine that holds in nail bin body 1410 by activation prematurely and/ or leak out the possibility of warehouse 1410.

As mentioned above, refer again to Figure 23 and Figure 24, the leg 1221 of nail 1220 can embed warehouseIn 1210, and the base portion 1222 of nail 1220 can be from the lower surface of internal layer 1,212 1218 to extensionStretch. In various embodiments, to being above described further, internal layer 1212 can not comprise and can holdReceive nail 1220 nail chamber. Referring now to Figure 29 and Figure 30,, in various other embodiment, nail bin is allAs nail bin 1500 for example can comprise compressible implanted warehouse 1510, this warehouse comprises can be thereinHold the nail chamber 1515 of at least a portion of nail 1520. In at least one this type of embodiment, nailThe top of 1520 nail leg 1521 can embed in internal layer 1512, and bottom and the base portion of nail leg 15211522 can be positioned in nail chamber 1515. In certain embodiments, base portion 1522 can be positioned at completelyIn nail chamber 1515, and in certain embodiments, base portion 1522 can be at least in part at internal layer 1512Extend lower surface 1518 belows. To similar above, outer 1511 can and be positioned at around internal layer 1512Nail 1520 in internal layer 1512. Referring now to Figure 31,, in some other embodiment, nail bin 1600Can comprise the nail 1620 in the nail chamber 1615 that is arranged in compressible implanted warehouse 1610, wherein nailAt least a portion of 1620 is not surrounded by outer 1611. In at least one this type of embodiment, eachNail 1620 all can comprise the nail leg 1621 that embeds at least in part in internal layer 1612 and around skin1611 outward extending base portions 1622.

Referring now to Figure 32 and Figure 33,, in various embodiments, nail bin such as nail bin 1700 for example canComprise compressible implanted warehouse 1710 and be positioned at least in part multiple nails of warehouse 17101720. Warehouse 1710 can comprise skin 1711, internal layer 1712 and alignment matrix 1740, this alignmentMatrix can and/or be held in place nail 1720 alignment in warehouse 1710. At at least one embodimentIn, internal layer 1712 can comprise the depressed part 1741 that can hold therein alignment matrix 1740. RespectivelyPlant in embodiment, alignment matrix 1140 can be press-fit in depressed part 1741 and/or in other words and utilize extremelyFew a kind of adhesive (for example, fibrin and/or protein hydrogel) is fixed to internal layer rightly1712. In at least one embodiment, depressed part 1741 can make the bottom of alignment matrix 1740Align with the lower surface 1718 of internal layer 1712 or substantial alignment at least in surface 1742. Real at someExecute in example, the lower surface 1742 of alignment matrix can be with respect to the lower surface of the second layer 1,712 1718Cave in and/or extend from lower surface 1718. In various embodiments, each nail 1720 all can compriseBase portion 1722 and the one or more legs 1721 that extend from base portion 1722, wherein follow closely leg 1721At least a portion is extensible through alignment matrix 1740. Alignment matrix 1740 for example also can comprise extendsThrough multiple holes and/or slit wherein, described multiple holes and/or slit can hold nail leg therein1721. In at least one this type of embodiment, each hole all can closely hold nail leg 1721, makesMust follow closely very little (if any) relative motion of generation between leg 1721 and the sidewall in hole. At someIn embodiment, alignment matrix hole can not exclusively extend through alignment matrix 1740, and when nail leg1721 while being pushed through alignment matrix 1740, and nail leg 1721 can cut alignment matrix 1740.

In certain embodiments, alignment matrix 1740 can be made up of molded plasticity main body, at leastIn an embodiment, the comparable internal layer 1712 of described molded plasticity main body and/or outer 1711 harder orCompressibility is lower. In at least one this type of embodiment, alignment matrix 1740 can comprise plastic materialAnd/or any other suitable material (for example PPDO (PDS) and/or polyglycolic acid(PGA)). In certain embodiments, alignment matrix 1740 can be assembled to internal layer 1712, andFollowing closely subsequently leg 1721 can insert through alignment matrix 1740 and embed in internal layer 1712. In various enforcementIn example, the lower surface 1742 of alignment matrix 1740 can comprise can hold nail 1720 at least in partOne or more grooves, slit or the groove of base portion 1722. To similar above, outer 1711 canBe placed on comprise internal layer 1712, alignment matrix 1740 and nail 1720 sub-component around. AsAnother is selected, and outer 1711 can be placed on the subgroup that comprises internal layer 1712 and alignment matrix 1740Part around, wherein follow closely 1720 can insert subsequently through outer 1711, alignment matrix 1740 and inLayer 1712. In arbitrary situation, due to mentioned above, internal layer 1712, alignment matrix 1740 and/Or outer 1711 can be held in place nail 1720, until anvil block makes to follow closely 1720 distortion as mentioned above,And/or after anvil block makes to follow closely 1720 distortion as mentioned above, internal layer 1712, alignment matrix 1740 and/ or outer 1711 nail 1720 can be held in place. In at least one this type of embodiment, alignment squareBattle array 1740 before being used in the implanted patient body of nail bin 1700 is held in place nail 1720, andEdge nail row fixing organization after nail bin 1700 is implanted. In at least one embodiment, for example nail1720 can be fixed in alignment matrix 1740 and not embed in internal layer 1712 and/or outer 1711.

Referring now to Figure 34-40,, in various embodiments, can by compression internal layer 1812, will follow closely allAs follow closely in 1820 insertion internal layers 1812, and to assemble nail bin by outer 1811 wrapping inner layer 1812 allAs nail bin 1800. First referring to Figure 34, compressible internal layer 1812 is shown as including and is limited to whereinMultiple nails chamber 1815, do not comprise nail chamber but can dream up as mentioned above internal layer 1812 wherein yetOther embodiment. Referring now to Figure 35,, compressible internal layer 1812 can be positioned in transfer plate 1850And between gripper shoe 1860 and be compressed in respectively compressive surfaces 1852 and the gripper shoe of transfer plate 1850Between 1860 compressive surfaces 1862. As shown in figure 35, the top surface of internal layer 1812 and bottomSurface can be compressed toward each other, and in response to this, internal layer 1812 can outwards expand along side direction. At certainIn a little embodiment, internal layer 1812 can be compressed into about 1/3rd height of for example its original heightPlace, and in its compressive state, can have for example height between about 0.06 " to about 0.08 " orThickness. Equally as shown in figure 35, transfer plate 1850 also can comprise and is for example positioned at multiple nail wells 1853Multiple nails such as nail 1820. In addition, transfer plate 1850 also can comprise multiple drivers 1851, instituteStating multiple drivers can be by nail 1820 upwards outside push nail well 1853. Referring now to Figure 36,, can profitWith driver 1851, nail 1820 nail leg 1821 is pushed in the internal layer 1812 of compression and it is passedThe internal layer 1812 of compression. In various embodiments, driver 1851 can make when nail 1820 is from passingSend while deployment completely in the nail well 1853 of plate 1850, the top surface of driver 1851 is oriented toFlush or at least almost flush with the compressive surfaces 1852 of transfer plate 1850. In certain embodiments,Equally as shown in figure 36, gripper shoe 1860 can comprise multiple accommodation holes 1861, described multiple accommodation holes1861 can hold nail leg 1821 or at least follow closely after nail leg 1821 is pushed through internal layer 1812The end of leg 1821. Internal layer 1812 has been compressed into the At The Height that is shorter than nail 1820 height thereinIn embodiment, it is essential that accommodation hole 1861 or similar structures can be, therefore when nail 1820 is from nail wellWhile ejaculation completely in 1853, nail leg 1821 can be from the top surface projection of the internal layer 1812 of compression.In some other embodiment, internal layer 1812 can be compressed into the At The Height higher than nail 1820 height,Therefore do not need the accommodation hole 1861 in gripper shoe 1860.

Referring now to Figure 37,, nail 1820 be inserted into internal layer 1812 in after, gripper shoe 1860 canMove away from transfer plate 1850, to allow that internal layer 1812 reduces pressure. In this case, internal layer1812 can extend to its original not compression height or at least approach original not pressure by elastic type againContracting height. In the time that internal layer 1812 stretches again, the height of internal layer 1812 can increase to and exceed nail 1820Height and nail 1820 nail leg 1821 no longer from the top surface projection of internal layer 1812. In various feelingsUnder condition, accommodation hole 1861 can by nail leg 1821 be held in place, at least until gripper shoe 1860 transportedMove to enough far making leg 1821 no longer be positioned at accommodation hole 1861. In this case, accommodation hole1861 can contribute to the nail 1820 in internal layer 1812 to keep relatively right in the time that internal layer 1812 stretches againTogether. In all cases, internal layer 1812 and the nail 1820 being positioned at wherein can comprise sub-component 1801,Referring now to Figure 38,, sub-component 1801 can for example be inserted in outer 1811. At at least one this type ofIn embodiment, outer 1811 can comprise the cavity 1802 being limited to wherein, and described cavity can be at itIn hold sub-component 1801. In all cases, can utilize instrument for example tweezers 1855 by skin1811 tractives are to sub-component 1801. Referring now to Figure 39,, once outside sub-component 1801 is positioned at completelyIn layer 1811, skin 1811 can be sealed. In various embodiments, can utilize to outer 1811A part apply heat energy and carry out sealable outer 1811. More specifically, at least one embodiment, outerLayer 1811 can comprise plastic material, and the openend of its ectomesoderm 1811 can be heated by one or moreElement or iron 1856 hot melts so that by the periphery of outer 1811 openend in conjunction with and/or be sealed inTogether. Referring now to Figure 40,, at least one this type of embodiment, outer 1811 redundance1857 can be removed, and can as described hereinly use nail bin 1800 subsequently.

As mentioned above, nail bin can be arranged in nail bin attachment and/or be fixed to nail bin attachment. Ginseng nowSee Figure 41 and Figure 42, in various embodiments, nail bin attachment can comprise that nail bin passage is such as nail binPassage 1930, this nail bin passage for example can hold at least one of nail bin such as nail bin 1900 thereinPart. In at least one embodiment, nail bin passage 1930 can comprise bottom support surface 1931,The first lateral support wall 1940 and the second lateral support wall 1941. In use, nail bin 1900 can quiltBe positioned in nail bin passage 1930, make nail bin 1900 against and/or adjacent bottom stayed surface 1931Location, and between the first lateral support wall 1940 and the second lateral support wall 1941. At someIn embodiment, between the first lateral support wall 1940 and the second lateral support wall 1941, can be limited with sideTo gap. In at least one this type of embodiment, nail bin 1900 can comprise lateral width 1903, shouldThe width of the sideshake limiting between lateral width and supporting walls 1940 and 1941 is identical and/or wideThe sideshake limiting between supporting walls 1940 and 1941, plants the compressible of nail bin 1900Entering formula warehouse 1910 can be matched with between wall 1940 and 1941 securely. At some other embodimentIn, the lateral width 1903 of nail bin 1900 can be shorter than the first side wall 1940 and the second sidewall 1941 itBetween the gap that limits. In various embodiments, wall 1940 and 1941 and bottom support surfaceAt least a portion of 1931 can be limited by the metal passage of punching press, and at least one embodiment, sideAt least a portion to supporting walls 1940 and/or lateral support wall 1941 (for example can comprise flexible materialElastomeric material). First referring to Figure 41, the first side wall 1940 of nail bin passage 1930 and the second sideWall 1941 all can be by from the upwardly extending rigid element 1933 of bottom support surface 1931 and from rigidityThe upwardly extending flexible portion 1934 of part 1933 forms.

In various embodiments, to being above described further, the warehouse 1910 of nail bin 1900 canFormed by one or more compressible for example ground floor 1911 of layer and the second layer 1912. Work as warehouse1910 while being compressed in the above described manner abuts against bottom stayed surface 1931 by anvil block, the sidepiece of warehouse 1910Can laterally stretch. In the embodiment that nail bin 1930 is made up of rigid sidewalls therein, rigid sidewalls canPrevent or at least limit the lateral extension of warehouse 1910, therefore in warehouse 1910, can produce significant quantityInternal pressure or stress. In the embodiment being formed by flexible sidewall at least a portion of nail bin 1930,Laterally deflection of flexible sidewall is also allowed the sidepiece lateral extension of warehouse 1910, thereby reduces warehouse1910 interior produced internal pressure or stress. Do not comprise sidewall or included sidewall phase at storehouse passageBe shorter than over the ground in the embodiment of nail bin, the sidepiece of nail bin can be not suppressedly or be at least substantially not suppressedSystem ground is along lateral extension. Referring now to Figure 42,, in any case, nail bin passage 2030 can compriseSidewall 2040 and 2041, this sidewall can comprise flexible material completely, such as elastomeric material. Nail binPassage 2030 also can comprise the side direction of extending along the limit of the bottom support surface 2031 of nail bin passage 2030Slit 2033, this side direction slit can hold and fixed sidewall 2040 and 2041 at least one thereinPart. In certain embodiments, sidewall 2040 and 2041 can be via snap fit and/or press-fit structureAnd be fixed in slit 2033, and at least some embodiment, sidewall 2040 and 2041 can pass throughOne or more adhesives are fixed in slit 2033. In at least one embodiment, sidewall 2040Can separate with bottom support surface 2031 during use with 2041. In any case, work as warehouseIn 2010 implant have nail 2020 o'clock, compressible implanted warehouse 2010 can with sidewall 2040 and 2041Separate and/or depart from.

Referring now to Figure 43,, in various embodiments, surgical instruments can comprise axle 2150 and from axleThe end effector that 2150 far-end extends. To similar above, end effector can comprise nail bin passageThe anvil block 2140 that 2130, can move between open position and closing position and be positioned at nail bin passage2130 and anvil block 2140 between nail bin 2100. Be similar to equally above, nail bin 2100 can comprise canCompress implanted warehouse 2110 and be arranged in multiple nails 2120 of warehouse 2110. At various embodimentIn, nail bin passage 2130 can comprise bottom support surface 2131, far-end 2135 and near-end 2136, nailCan abuts against bottom stayed surface 2131 and locates in storehouse 2100. In at least one embodiment, as Figure 43Shown in, nail bin 2100 can comprise first end 2105 and the second end 2106, described first end2105 can be positioned in the far-end 2135 of nail bin passage 2130, and described the second end 2106 can quiltBe positioned in the near-end 2136 of nail bin passage 2130. In various embodiments, nail bin passage 2130Far-end 2135 can comprise at least one distally holding structure (for example keeping wall 2137); Similarly,Near-end 2136 can comprise at least one nearside holding structure (for example keeping wall 2138). At least oneIn individual this type of embodiment, distally keeps wall 2137 and nearside to keep can limiting between wall 2138 seamedGap, described gap can be equal to or less than the length of nail bin 2100, makes to be inserted into nail when nail bin 2100In storehouse passage 2130 time, nail bin 2100 can be matched with in nail bin passage 2130 securely.

Refer again to Figure 23 and Figure 24, in various embodiments, nail bin such as nail bin 1200 for example canComprise flat or flat tissue contacting surface 1219 at least substantially. At at least one this type of embodimentIn, the nail bin body 1210 of nail bin 1200 can comprise first end 1205 and the second end 1206, instituteStating first end can be limited by the first height or thickness 1207, and described the second end 1206 can be by secondHeight or thickness limit, and wherein the first height 1207 can equal or at least be substantially equal to second highly1208. In certain embodiments, warehouse 1210 can first end 1205 and the second end 1206 itBetween comprise constant or at least height or the thickness of substantial constant. At at least one this type of embodimentIn, tissue contacting surface 1219 can be parallel or at least substantially parallel to the lower surface of warehouse 12101218. Refer again to Figure 43, in various embodiments, the first end of the warehouse 2110 of nail bin 2100Portion 2105 can 2107 be limited by the first height, and this first is highly different from second of the second end 2106Height 2108. In the embodiment shown, the first height 2107 is greater than the second height 2108, butIn alternative embodiment, the second height 2108 can be greater than the first height 2107. In various enforcementIn example, the height of warehouse 2110 can be between first end 2105 and the second end 2106 linearly and/ or several where reducing. In at least one this type of embodiment, at first end 2105 and the second endThe tissue contacting surface 2119 of extending between 2106 can be along first end 2105 and the second end 2106Between limit angle be orientated. In at least one this type of embodiment, tissue contacting surface 2119Can be not parallel to the lower surface 2118 of warehouse 2110 and/or be not parallel to propping up of nail bin passage 2130Support surface 2131.

Refer again to Figure 43 and Figure 44, in various embodiments, anvil block 2140 can comprise tissue contactSurface 2141, in the time that anvil block 2140 is in the close position, tissue contacting surface 2141 can be parallel to orAt least substantially parallel to the stayed surface 2131 of nail bin passage 2130, as shown in figure 44. Work as anvil block2140 time in the close position, the compression journey of the first end 2105 of anvil block 2140 to nail bin 2100Degree can be greater than the second end 2106, and this is because the height of first end 2105 is higher, and the second endThe height of portion 2106 is lower. In some cases, comprise be wherein positioned at tissue contacting surface 2119 withTissue T between 2141 has the constant or situation of the thickness of substantial constant at least, tissue T andThe pressure producing in the far-end place of end effector in storehouse 2100 can be greater than the near-end at end effectorThe pressure that place produces. More specifically, the tissue T between anvil block 2140 and nail bin 2100 hasWhen the thickness of substantial constant, be positioned at the far-end 2145 of anvil block 2140 and the first end of nail bin 2100The compressed degree of tissue T between 2105 can be greater than the near-end 2146 and the nail bin that are positioned at anvil block 2140Tissue T between 2100 the second end 2106. In various embodiments, end effector is nearIn tissue T between end and far-end, can produce barometric gradient. More specifically, at least one embodimentIn, the tissue T between anvil block 2140 and nail bin 2100 has thickness and the nail bin of substantial constantWhen 2100 height reduces linearly from end effector distal-to-proximal, the pressure in tissue T canReduce linearly to the near-end of end effector from the far-end of end effector. Similarly, at least oneIn individual embodiment, the tissue T between anvil block 2140 and nail bin 2100 has the thick of substantial constantWhere degree and the height of nail bin 2100 during from distal-to-proximal several the reducing of end effector, tissue TIn pressure can be from the far-end of end effector to end effector several where reducing of near-end.

Refer again to Figure 43, in various embodiments, between nail bin 2100 and anvil block 2140Tissue T can not have constant from start to finish thickness. In at least one this situation, be positioned at anvil blockTissue T between 2140 near-end 2146 and the second end 2106 of nail bin 2100 can be thicker than and be positioned atTissue T between the far-end 2145 of anvil block 2140 and the first end 2105 of nail bin 2100. CauseThis, in this case, thicker tissue T can be usually located at the lower near-end of nail bin 21002106 tops, and thinner tissue T can be usually located at higher far-end 2105 tops. UsingIn, the percussion lining ring 2152 of axle 2150 can advance along axle ridge 2151 towards distally, makes to pull the trigger lining ring2152 engage the cam portion 2143 of anvil block 2140, and anvil block 2140 is rotated towards nail bin 2100,As shown in figure 44. Once anvil block 2140 rotations are to completely closed position, tissue T can be compressedBetween tissue contacting surface 2119 and 2141, although and the height of nail bin 2100 can hold in endNon-constant between the near-end of row device and far-end, but be applied to the pressure of tissue T or compression stress at tissueIn T, can be constant or substantial constant at least. More specifically, when thinner tissue T can with nailThe higher height correlation in storehouse 2100, and thicker tissue T can with the lower height of nail bin 2100When degree is relevant, what the cumulative height of tissue T and nail bin 2100 or height sum can be at end effectorsBetween near-end and far-end, be constant or substantial constant at least, therefore anvil block 2140 is cumulative high to thisBeing compressed in of degree can be constant or substantial constant at least in cumulative height.

Refer again to Figure 43 and Figure 44, in various embodiments, nail bin 2100 can comprise asymmetric structureType. In at least one this type of embodiment, for example nail bin 2100 is at the height at its first end 2105 placesDegree can be higher than nail bin 2100 height at its second end 2106 places. In certain embodiments, nail bin2100 and/or nail bin passage 2130 can comprise one or more alignment and/or holding structure, described oneOr multiple alignment and/or holding structure can guarantee that nail bin 2100 is only along direction (a, Qi ZhongFar-end 2135 and the second end 2106 that one end 2105 is arranged in nail bin passage 2130 are positioned at near-endDirection in 2136) be positioned in nail bin passage 2130. In various alternative embodiment,Nail bin 2100 and/or nail bin passage 2130 can comprise one or more alignment and/or holding structure, described inOne or more alignment and/or holding structure can allow that nail bin 2100 is positioned at along a more than directionIn nail bin passage 2130. Referring now to Figure 45,, for example nail bin 2100 can be positioned in nail bin passageIn 2130, so that the first end 2105 of nail bin 2100 can be positioned in the near of nail bin passage 2130End 2136 in and the second end 2106 can be positioned in far-end 2135. Therefore, at various embodimentIn, the nail bin 2100 of lower height can be close to distally and keep wall 2137 to locate, and the nail of high heightStorehouse 2100 can be close to nearside and keep wall 2138 to locate. In at least one this type of embodiment, nail bin2100 can be set appropriately with to having compared with thickness portion and hold in end in the far-end of end effectorThe tissue T in the near-end of row device with thinner part applies the constant or at least clamping of substantial constantPressure. In various embodiments, nail bin 2100 for example can optionally be got in nail bin passage 2130To. In at least one this type of embodiment, alignment and/or the holding structure of nail bin 2100 can be symmetry, and surgeon can be interior right at nail bin passage 2130 along the direction shown in for example Figure 43 and Figure 45Nail bin 2100 is selectively orientated.

To being above described further, implanted warehouse 2110 can comprise longitudinal axis 2109, whenWhen nail bin 2100 is positioned in nail bin passage 2130, what longitudinal axis 2109 can be at end effectorBetween near-end and far-end, extend. In various embodiments, the thickness of warehouse 2110 can be at first end2105 and the second end 2106 between longitudinally axis 2109 roughly reduce and/or roughly increase. ExtremelyIn few this type of embodiment, the distance between lower surface 2118 and tissue contacting surface 2119 orHeight can roughly reduce and/or roughly increase between first end 2105 and the second end 2106. ?In some embodiment, the thickness of warehouse 2110 longitudinally axis 2109 both can increase also and can reduce. ?In at least one this type of embodiment, the thickness of warehouse 2110 can be included in of increasing on thickness or manyIndividual part and one or more parts that can reduce on thickness. In various embodiments, nail bin2100 can comprise the multiple nails 2120 that are positioned at wherein. In use, as mentioned above, work as anvil block2140 while moving to closing position, nail 2120 deformables. In certain embodiments, each nail 2120Can there is identical or at least substantially the same height. In at least one this type of embodiment, can exampleAs the bottom from nail base portion, to nail, the top of high leg or end are measured the height of nail.

In various embodiments, the nail in nail bin can have different staple heights. At at least one this type ofIn embodiment, nail bin can comprise having first group of the first staple height nail and have the of the second staple heightTwo groups of nails, described first group of nail is positioned in the Part I of compressible warehouse, and second group of nail quiltBe positioned in the Part II of compressible warehouse. In at least one embodiment, the first staple height can be highIn the second staple height, and first group of nail can be positioned in the first end 2105 of nail bin 2100,And second group of nail can be positioned in the second end 2106. Alternatively, higher by firstGroup nail can be positioned in the second end 2106 of nail bin 2100, and second group of lower nail can be by fixedPosition is in first end 2105. In certain embodiments, can utilize multiple nail groups, wherein each group eachFrom thering is different staple heights. In at least one this type of embodiment, there is the 3rd of middle staple heightGroup can be positioned in warehouse 2110 between first group of nail and second group of nail. In various embodiments,Each nail in nail row in nail bin can comprise different staple heights separately. At at least one embodimentIn, the Gao Ding in nail row can be positioned on nail row's first end, and minimum nail can be positioned onOn this nail row's opposite end. In at least one this type of embodiment, between the highest nail and minimum nailNail can be arranged so that staple height for example declines between the highest nail and minimum nail.

Referring now to Figure 46,, in various embodiments, the end effector of surgical stapling device can comprise anvilSeat 2240, nail bin passage 2230 and the nail bin 2200 being supported by nail bin passage 2230. Nail bin2200 can comprise compressible implanted warehouse 2210 and be positioned in the multiple nails in warehouse 2210,Such as nail 2220a and nail 2220b. In various embodiments, nail bin passage 2230 can comprise storehouse supportSurface 2231 and the multiple nails that are limited in storehouse stayed surface 2231 support slit, narrow such as supportingGroove 2232a and 2232b. In at least one this type of embodiment, nail bin 2200 can comprise two outsidesNail 2220a row and two inner side nail 2220b rows, wherein supporting slit 2232a can support nail2220a, and support slit 2232b can support nail 2220b. Referring to Figure 46 and Figure 47, anvil block2240 can comprise the multiple nail shaping pits 2242 that are limited to wherein, when anvil block 2240 is towards nail bin 2200When motion, described multiple nail shaping pits 2242 can hold nail 2220a and 2220b and make its changeShape. In at least one this type of embodiment, the lower surface that supports slit 2232a can be shaped recessed with nailHole 2242 top surface at a distance of first apart from 2201a, can and support the lower surface of slit 2232bTop surface second distance 2201b apart with nail shaping pit 2242. In at least one this type of enforcementIn example, owing to being wherein limited with the platform in the stayed surface 2231 that supports slit 2232b with risingRank, therefore support the more close anvil block 2240 of slit 2232b and locate. Owing to thering is different distances2201a and 2201b, therefore in various embodiments, outside nail 2220a row and inner side nail 2220b rowCan be deformed to different forming heights. In all cases, being deformed into the nail of differing formed height can be rightThe tissue T of sewing up applies different clamping pressures or clamping force. Except mentioned above, nail can beOriginally there is different unshaped staple heights. Refer again to Figure 46, at least one this type of embodimentIn, the initial unshaped that the initial unshaped height of outer nail 2220a can be greater than inner side nail 2220b is highDegree. As shown in Figure 46 and Figure 47, unshaped height is lower than the inner side nail 2220b of outside nail 2220aAlso can there is the forming height lower than outside nail 2220b. In various alternative embodiment, inSide nail 2220b can have than the outside nail high unshaped height of 2220a and have than outside nail 2220aLow distortion staple height.

In various embodiments, to being above described further, anvil block 2240 is moveable to closureIn position, as shown in figure 47, to compress warehouse 2210 and make to follow closely 2220a and 2220b distortion.In certain embodiments, the surgical stapling device that comprises end effector shown in Figure 46 and Figure 47 is for example gone backCan comprise cutting element, described cutting element can crosscut between anvil block 2240 and nail bin 2200Tissue T. In at least one this type of embodiment, anvil block 2240, nail bin passage 2230 and/or nailStorehouse 2200 can limit slit, and described slit can hold cutting element therein slidably. More specificallyGround, anvil block 2240 can comprise slotted portion 2249, nail bin passage 2230 can comprise slotted portion2239, and nail bin 2200 can comprise slotted portion 2203, when anvil block 2240 is in the close position orAt least substantially when closed position, slotted portion 2249, slotted portion 2239 and slotted portion2203 can align or substantial alignment at least mutually. In various embodiments, in anvil block 2240 closuresAnd nail 2220a, after 2220b distortion, cutting element can be carried out towards end from the near-end of end effectorThe distal movement of device. In at least one embodiment, cutting element can with nail deformation process not phaseThe mode of closing is moved. In certain embodiments, cutting element can be pushed in nail distortion. ?In any situation, at least one embodiment, cutting element can be along being positioned at inner side nail 2220b rowBetween path incised tissue.

In various embodiments, as shown in figure 47, inner side nail 2220b can be shaped to lower than outside and follow closelyThe height of 2220a, wherein inner side nail 2220b can be adjacent to the line of cut forming with cutting elementTissue applies larger clamping pressure or clamping force. In at least one this type of embodiment, inner side nailThe larger clamping pressure that 2220b forms or clamping force can provide various useful results for the treatment of, for exampleMake to be cut open tissue T and reduce hemorrhagely, and the less clamping pressure that nail 2220a in outside forms can beIn the tissue of sewing up, provide flexibility. Refer again to Figure 46 and Figure 47, in various embodiments, anvilSeat 2240 also can comprise at least one backing material that is attached to anvil block 2240, such as backing material2260. In at least one this type of embodiment, nail 2220a, the leg of 2220b can be worked as nail bin 2200 quiltsWhen anvil block 2240 compressions also contact the nail shaping pit 2242 in anvil block 2240 subsequently, nail 2220a,The leg of 2220b cuts backing material 2260 and/or passes the hole in backing material 2260. Work as nail2220a, when the leg of 2220b is out of shape, described leg can contact and/or cut backing material 2260 again. ?In various embodiment, backing material 2260 can improve the hemostatic capability of institute's suture tissue and/or by being stitchedCharge-coupled knitting provides intensity.

Refer again to Figure 46 and Figure 47, in various embodiments, the lower surface of warehouse 2210 can be wrappedDraw together stepped profile, described stepped profile is mated with the stepped profile of storehouse stayed surface 2231 or extremelyFew coupling substantially. In certain embodiments, the lower surface deformable of warehouse 2210 with coupling or extremelyFew profile that substantially mates storehouse stayed surface 2231. Referring now to Figure 48,, at various embodimentIn, the end effector that is similar to end effector shown in Figure 46 for example can comprise the nail being positioned at whereinStorehouse 2300. Nail bin 2300 can comprise the compressible implanted master with internal layer 2312 and outer 2311Body 2310. Wherein to being above described further, at least one embodiment, outer 2311Can comprise water impervious material. In various embodiments, outer 2311 can be around nail 2220a,2220b extends and can lay respectively at nail 2220a, and 2220b and support slit 2232a, between 2232b. ExistingReferring to Figure 49, in various embodiments, be similar to the end execution of end effector shown in Figure 46Device for example can comprise the nail bin 2400 being positioned at wherein. Be similar to nail bin 2300, nail bin 2400 canCompression implanted warehouse 2410 can comprise internal layer 2412 and outer 2411; But, real at least oneExecute in example, warehouse 2410 can not comprise cutting element slit wherein. In at least one this type of enforcementIn example, cutting element for example can need to cut in the time that it is pushed into through nail bin internal layer 2412 and/orOuter 2411.

Referring now to Figure 50,, in various embodiments, the end effector of surgical stapling device can comprise anvilSeat 2540, nail bin passage 2530 and be positioned at the nail bin 2500 in nail bin passage 2530. With upperLiterary composition is similar, nail bin 2500 can comprise compressible implanted warehouse 2510, outside nail 2220a row, withAnd inner side nail 2220b row. Nail bin passage 2530 can comprise flat or flat storehouse support table at least substantiallyFace 2531 and the nail being limited in storehouse stayed surface 2531 support slit 2532. Anvil block 2540 can wrapDraw together staged surface 2541 and be limited to the multiple nail shaping pits in staged surface 2541, exampleAs be shaped pit 2542a and 2542b. To similar above, shaping pit 2542a and support slitBetween 2532, can be limited with distance, described distance is greater than shaping pit 2452b and supports slit 2532Between distance. In various embodiments, anvil block 2540 also can comprise the rank that are attached to anvil block 2540A backing material 2560 on ladder type surface 2541. In at least one this type of embodiment, fidMaterial 2560 can conform to or at least substantially conform to staged surface 2541. At various embodimentIn, backing material 2560 can pass through at least one adhesive (for example, fibrin and/or albumen waterGel) be attached to removedly surperficial 2541. In certain embodiments, warehouse 2510 also can compriseStaged profile, at least one embodiment, described staged profile is parallel to or at least substantiallyBe parallel to the staged surface 2541 of anvil block 2540. More specifically, at least one embodiment,Anvil block 2540 can comprise the step 2548 extending towards nail bin 2500, and wherein step 2548 can comprise platformRank height, described shoulder height equals or is at least substantially equal to the step extending from warehouse 25102508 shoulder height. In at least one this type of embodiment, due to mentioned above, for example compressibleWarehouse 2510 can be trapped in amount in the first nail 2220a can be different from compressible warehouse 2510 can quiltBe captured in the amount in the second nail 2220b.

Referring now to Figure 51,, in various embodiments, end effector can comprise anvil block 2640, nailStorehouse passage 2530 and the nail bin 2600 between anvil block 2640 and nail bin passage 2530. Nail bin2600 can comprise compressible implanted warehouse 2610, and warehouse 2610 comprises internal layer 2612, skin2611 and be positioned at the multiple nails (for example following closely 2220a and 2200b) in warehouse 2610. RespectivelyPlant in embodiment, anvil block 2640 can comprise multiple nail shaping pits 2642 on surface 2641, andNail bin passage 2530 can comprise the multiple nail shaping slits 2532 that are limited in stayed surface 2531. AsShown in Figure 51, anvil faces 2641 can be parallel to or at least substantially parallel to storehouse stayed surface2531, wherein each shaping pit 2642 can be oriented to and relative and corresponding nail support slit2532 at a distance of equating or equal distance at least substantially. In various embodiments, 2600 of nail binsThe nail comprising can have identical or at least substantially the same initial unshaped staple height and identical or extremelyFew substantially the same shaping staple height. In some other embodiment, outside nail row can comprise nail2220a and inner side nail row can comprise nail 2220b, and wherein described above, nail 2220a and 2220b can be hadThere is different unshaped staple heights. In the time that anvil block 2640 moves to closing position towards nail bin 2600, nail2220a and 2220b can be shaped as and make to follow closely 2220a and 2220b and have identical or phase at least substantiallySame shaping staple height. In at least one this type of embodiment, due to mentioned above, outside nail is shaped2220a and inner side nail 2220b can have identical, or at least substantially the same quantity be contained in itIn compressible warehouse 2610; But, for example because having than inner side, follows closely outside nail 2220aThe unshaped staple height that 2220b is higher, but can there is identical shaping staple height, outside nail 2220aIn can generate the larger clamping pressure than inner side nail 2220b.

Referring now to Figure 52,, in various embodiments, the end effector of surgical stapling device can comprise anvilSeat 2740, nail bin passage 2530 and be positioned at the nail bin 2700 in nail bin passage 2530. With upperLiterary composition is similar, and nail bin 2700 can comprise compressible implanted warehouse 2710, and this warehouse comprises internal layer2712, outer 2711 and be positioned at multiple nails in warehouse 2710 (for example follow closely 2220a and2220b). In at least one embodiment, the thickness of warehouse 2710 can occur on its whole widthChange. In at least one this type of embodiment, warehouse 2710 can comprise central part 2708 and sidepiece2709, wherein the thickness of central part 2708 can be greater than the thickness of sidepiece 2709. At various embodimentIn, the thickest part of warehouse 2710 can be positioned at central part 2708 places, and warehouse 2710 is the thinnestPart can be positioned at sidepiece 2709 places. In at least one this type of embodiment, the thickness of warehouse 2710 canBetween central part 2708 and sidepiece 2709, reduce gradually. In certain embodiments, warehouse 2710Thickness can be between central part 2708 and sidepiece 2709 linearly and/or several where reducing. At least oneIn individual this type of embodiment, the tissue contacting surface 2719 of warehouse 2710 can comprise from central part 2708 courtsTwo inclinations or the angled surface that sidepiece 2709 is downward-sloping. In various embodiments, anvil block2740 can comprise two inclinations or angled surface, surface described two inclinations or angledBe parallel to or at least substantially parallel to tilt tissue contacting surface 2719. At at least one embodimentIn, anvil block 2740 also can comprise at least one backing material of the inclined surface that is attached to anvil block 27402760。

In various embodiments, to being above described further, the inner side nail row in nail bin 2700Can comprise higher nail 2220a, and outside nail row can comprise lower nail 2220b. At at least oneIn embodiment, higher nail 2220a can be positioned in thicker central part 2708 and/or and centerPortion 2708 is adjacent, and nail 2220b can be positioned in sidepiece 2709 and/or with sidepiece 2709 phasesAdjacent. In at least one this type of embodiment, due to mentioned above, higher nail 2220a can be lowerNail 2220b catch the material of more implanted warehouse 2710. This situation can make to follow closely 2220a ratioNail 2220b applies larger clamping pressure to tissue T. In certain embodiments, although higher nailNail 2220b that can be lower in 2220a catches the material of more warehouse 2710, but owing to following closely intoShape pit 2742a and 2742b have the structure of inclination, and therefore higher nail 2220a can be lowerNail 2220b has higher shaping staple height. Can utilize this type of Consideration nail 2220a andIn the tissue that 2220b catches, obtain the clamping pressure of expecting, therefore for example follow closely the clamping in 2220aPressure can be greater than, is less than or equals to follow closely the clamping pressure that 2220b applies tissue. Shown in Figure 52In various alternative embodiment of end effector, lower nail 2220b can be positioned in warehouseIn 2710 thicker central part 2708 and/or contiguous central part 2708, and higher nail 2220aCan be positioned in thinner sidepiece 2709 and/or adjacent side portion 2709. In addition, although nail bin 2700Be depicted as and comprise inner side and outside nail row, but nail bin 2700 can comprise additional nail row, for example positionNail row between inner side nail row and outside nail row. In at least one this type of embodiment, for example middleNail row's unshaped staple height can be between the unshaped staple height of nail 2220a and the unshaped of following closely 2220bBetween staple height, and middle nail row's shaping staple height can between the shaping staple height of nail 2220a withBetween the shaping staple height of nail 2220b.

Referring now to Figure 53,, in various embodiments, the end effector of surgical stapling device can comprise anvilSeat 2840, nail bin passage 2530 and be positioned at the nail bin 2800 in nail bin passage 2530. With upperLiterary composition is similar, and nail bin 2800 can comprise compressible implanted warehouse 2810, and this warehouse comprises internal layer2812, outer 2811 and be positioned at multiple nails in warehouse 2810 (for example follow closely 2220a and2220b). In at least one embodiment, the thickness of warehouse 2810 can occur on its whole widthChange. In at least one this type of embodiment, warehouse 2810 can comprise central part 2808 and sidepiece2809, wherein the thickness of central part 2808 can be less than the thickness of sidepiece 2809. At various embodimentIn, the thinnest part of warehouse 2810 can be positioned at central part 2808 places, and warehouse 2810 is the thickestPart can be positioned at sidepiece 2809 places. In at least one this type of embodiment, the thickness of warehouse 2810 canBetween central part 2808 and sidepiece 2809, increase gradually. In certain embodiments, warehouse 2810Thickness can be between central part 2808 and sidepiece 2809 linearly and/or several where increase. At least oneIn individual this type of embodiment, the tissue contacting surface 2819 of warehouse 2810 can comprise from central part 2808 courtsAcclivitous two inclinations of sidepiece 2809 or angled surface. In various embodiments, anvil block2840 can comprise two inclinations or angled surface, surface described two inclinations or angledBe parallel to or at least substantially parallel to tilt tissue contacting surface 2819. At at least one embodimentIn, anvil block 2840 also can comprise at least one backing material of the inclined surface that is attached to anvil block 28402860. In various embodiments, to being above described further, the outside nail row in nail bin 2800Can comprise higher nail 2220a, and inner side nail row can comprise lower nail 2220b. At at least oneIn embodiment, higher nail 2220a can be positioned in thicker sidepiece 2809 and/or and sidepiece2809 is adjacent, and nail 2220b can be positioned in central part 2808 and/or with central part 2808 phasesAdjacent. In at least one this type of embodiment, due to mentioned above, higher nail 2220a can be lowerNail 2220b catch the material of more implanted warehouse 2810.

As described in the embodiment above with reference to Figure 46, for example, nail bin passage 2230 can comprise stagedStayed surface 2231, this staged stayed surface can with respect to anvil block 2240 will follow closely 2220a and2220b is supported on differing heights place. In various embodiments, nail bin passage 2230 can be by metal structureBecome, and step in stayed surface 2231 can be formed at stayed surface by for example grinding operationIn 2231. Referring now to Figure 54,, in various embodiments, the end effector of surgical instruments can compriseNail bin passage 2930, this nail bin passage comprises the support insert 2935 being positioned at wherein. More specificallyGround, at least one embodiment, nail bin passage 2930 can be formed make it have for example flat orAt least substantially, flat stayed surface 2931, this stayed surface can support insert 2935, thisSupport insert comprises the rank for the nail 2220a of nail bin 2200 and 2220b being supported on to differing heights placeLadder type surface. In at least one this type of embodiment, insert 2935 can comprise flat or at least basicUpper flat lower surface, described lower surface can be located against stayed surface 2931. Insert 2935Also can comprise and support slit, groove or groove 2932a and 2932b, support slit, groove or groove2932a and 2932b can be supported on respectively differing heights place by nail 2220a and 2220b. With phase aboveSeemingly, insert 2935 can comprise the cutter slit 2939 being limited to wherein, and this cutter slit can be allowed and cutCutting member passes wherein. In various embodiments, nail bin passage 2930 can be by being same or different from supportThe material of insert 2935 forms. In at least one this type of embodiment, nail bin passage 2930 andBoth all can for example be made up of support insert 2935 metal, and in other embodiments, nail bin passage2930 can for example be made up of metal, and support insert 2935 can for example be made up of plastics. RespectivelyIn kind of embodiment, supporting insert 2935 can be fastened and/or be welded in nail bin passage 2930. ?In some embodiment, supporting insert 2935 can snap fit and/or be press fitted into nail bin passage 2930In. In at least one embodiment, can use adhesive that support insert 2935 is fixed on to nail bin logicalIn road 2930.

Referring now to Figure 55,, in various embodiments, the end effector of surgical stapling device can comprise anvilSeat 3040, nail bin passage 3030 and be arranged in the compressible implanted nail bin of nail bin passage 30303000. To similar above, anvil block 3040 can comprise the multiple nail shaping pits 3042 that are limited to whereinAnd cutting element can be slidably received within to cutter slit 3049 wherein. Be similar to equallyLiterary composition, nail bin passage 3030 can comprise that the multiple nails that are limited to wherein support slit 3032 and also canCutting element is slidably received within to cutter slit 3039 wherein. In various embodiments, nail bin3000 can comprise ground floor 3011, the second layer 3012 and be positioned at the multiple nails in nail bin 3000(for example following closely 3020a and 3020b). In at least one embodiment, the unshaped nail of nail 3020aHeight can be higher than the unshaped staple height of nail 3020b. In various embodiments, ground floor 3011 can wrapContaining the first compressible material, and the second layer 3012 can comprise the second compressible material. In some enforcementIn example, the compression ratio of the first compressible material can be higher than the second compressible material, and other are real at someExecute in example, the compression ratio of the first compressible material can be lower than the second compressible material. Real at least oneExecute in example, the first compressible material can be made up of the elastomeric material that can comprise the first flexible ratio, andThe second compressible material can be made up of the elastomeric material that can comprise the second flexible ratio, described the second elasticityRatio is different from described the first flexible ratio. In various embodiments, the spring of the first compressible materialStiffness factor can be greater than the flexible ratio of the second compressible material. In some other embodiment, firstThe flexible ratio of compressible material can be less than the flexible ratio of the second compressible material. At various embodimentIn, the first compressible stratum can comprise the first rigidity, and the second compressible stratum can comprise the second rigidity,Wherein the first rigidity is different from the second rigidity. In various embodiments, the rigidity of the first compressible stratum canBe greater than the rigidity of the second compressible stratum. In some other embodiment, the rigidity of the first compressible stratum canBe less than the rigidity of the second compressible stratum.

Refer again to Figure 55, in various embodiments, the second layer 3012 of nail bin 3000 can be whole at itOn individual width, comprise the constant or thickness of substantial constant at least. In at least one embodiment,The thickness of one deck 3011 can change on its whole width. In at least one this type of embodiment,Ground floor 3011 can comprise one or more steps 3008, and this step can be in some portion of warehouse 3010Divide the thickness that for example, increases warehouse 3010 in (central part). Refer again to Figure 55, lower nail3020b can be positioned in step 3008(be warehouse 3010 compared with thickness portion) in or with step 3008Alignment, and higher nail 3020a can be positioned in the thinner part of warehouse 3010 or with describedThin section aligned. In various embodiments, due to warehouse 3010 compared with thickness portion and thinner part, storehouseBody 3010 can be greater than along outside nail 3020a row's rigidity along inner side nail 3020b row's rigidity. VariousIn embodiment, ground floor 3011 can be connected to the second layer 3012. At at least one this type of embodimentIn, ground floor 3011 and the second layer 3012 can comprise interlocking structure, described interlocking structure can be by layer3011 and 3012 keep together. In certain embodiments, ground floor 3011 can comprise that first is laminatedThing and the second layer 3012 can comprise second layer compound, and wherein ground floor compound can pass through one or moreAdhesive adheres to second layer compound. In various embodiments, nail bin 3000 can comprise cutter slit3003, this cutter slit can hold cutting element therein slidably.

Referring now to Figure 56,, in various embodiments, nail bin 3100 can comprise compressible implanted storehouseBody 3110, this warehouse comprises individual layer compressible material and is positioned at the multiple nails in warehouse 3110(for example, nail 3020b). In at least one embodiment, the thickness of warehouse 3110 can be whole at itOn width, change. In at least one this type of embodiment, warehouse 3110 can comprise and extending along its sidepieceStep 3108. Referring now to Figure 57,, in various embodiments, nail bin 3200 can comprise compressible plantingEnter formula warehouse 3210, this warehouse comprises individual layer compressible material and is positioned at many in warehouse 3210Individual nail (for example, nail 3020b). In at least one embodiment, the thickness of warehouse 3210 can be at itOn whole width, change. In at least one this type of embodiment, warehouse 3210 can comprise along its central partThe step 3208 extending. Referring now to Figure 58,, in various embodiments, nail bin 3300 can comprise canCompression implanted warehouse 3310, wherein to similar above, the thickness of warehouse 3310 can be whole wide at itOn degree, change. In at least one embodiment, the thickness of warehouse 3310 can be at the sidepiece of warehouse 3310And several where increase between central part. In at least one this type of embodiment, the thickness of warehouse 3310 canLimit and can comprise arc or bending tissue contacting surface 3319 by arc or bending profile. At certainIn a little embodiment, the profile of the thickness of warehouse 3310 and tissue contacting surface 3319 can be by for example oneRadius of curvature or limited by multiple radius of curvature as another selection. Referring now to Figure 59,, in various realitiesExecute in example, nail bin 3400 can comprise compressible implanted warehouse 3410, the wherein thickness of warehouse 3410Can between the sidepiece of warehouse 3410 and central part, increase to substantial linear linearly or at least.

Referring now to Figure 60,, in various embodiments, nail bin 3500 can comprise compressible implanted storehouseBody 3510 and be positioned at multiple nails 3520 wherein. Implanted warehouse 3510 can comprise the first internal layer3512, the second internal layer 3513 and outer 3511. In at least one embodiment, the first internal layer3512 can comprise the first thickness and the second internal layer 3513 can comprise the second thickness, wherein the second internal layer3513 can be thicker than the first internal layer 3512. In at least one alternative embodiment, the first internal layer3512 can be thicker than the second internal layer 3513. In another alternative embodiment, the first internal layer 3512Can there is identical or at least substantially the same thickness with the second internal layer 3513. In certain embodiments,One or more deformable legs that each nail 3520 can comprise base portion 3522 and extend from base portion 35223521. In various embodiments, each leg 3521 can comprise the end embedding in the first internal layer 35113523, in addition, each base portion 3522 of nail 3520 can embed in the second internal layer 3512. At least oneIn individual embodiment, the first internal layer 3512 and/or the second internal layer 3513 can comprise and being stored in wherein at leastA kind of medicine, and in various embodiments, outer 3511 can seal and seal the first internal layer 3512With the second internal layer 3513, make to only have medicine after outer 3511 quilt nails 3520 pierce through just can flow outNail bin body 3510. More specifically, to being above described further, can abut against against nail bin3500 tissue contacting surface 3519 and location tissue promote anvil block downwards, make warehouse 3510 quiltsCompression and surface 3519 move downward and are following closely below end 3523 at least in part towards nail end 3523Motion, makes end 3523 make outer 3511 break or pierce through outer 3511. Make at nail leg 3521After skin 3511 breaks, at least one medicine M can be from flowing around the warehouse 3510 of nail leg 3521Go out. In all cases, the additional compression of warehouse 3510 can be extruded warehouse by additional medicine M3510, as shown in Figure 61.

Refer again to Figure 60, in various embodiments, outer 3511 can comprise water impervious orAt least substantially, impermeable wrappage, described wrappage can 1) prevent that medicine from flowing out prematurelyNail bin 3500; And 2) prevent that the fluid in operative site for example from entering in nail bin 3500 prematurely.In certain embodiments, the first internal layer 3512 can comprise stores or is absorbed in the first medicine wherein, andAnd the second internal layer 3513 can comprise to be stored or is absorbed in the second medicine wherein, and wherein the second medicine can be notBe same as the first medicine. In at least one embodiment, warehouse 3510 make outer 3511 break at the beginning ofBeginning compression can make the first internal layer 3512 discharge the first medicine conventionally, and the follow-up pressure of warehouse 3510Contracting can make the second internal layer 3513 discharge the second medicine conventionally. But, in this type of embodiment, firstSome part of medicine and the second medicine can be released simultaneously, but the major part of initial d/d medicineCan be formed by the first medicine, and the major part of d/d medicine can be made up of the second medicine subsequently.In certain embodiments, to being above described further, the first internal layer 3512 can be by than the second internal layer3513 have larger compressible material forms, make can be lower than subsequent compression power or pressure initialCompression stress or pressure can produce than larger initially scratching in the second internal layer 3513 in the first internal layer 3512Qu Liang. This type of larger initial deflection amount in the first internal layer 3512 can make from the first internal layer 3512The part of the first medicine discharging is greater than the second medicine discharging from the second internal layer 3513. ExtremelyIn a few embodiment, comparable the second internal layer 3513 of the first internal layer 3512 porous and/or have more soft moreProperty. In at least one this type of embodiment, the first internal layer 3512 can comprise the multiple holes that are limited to whereinOr space 3508, and the second internal layer 3513 can comprise the multiple holes or the space that are limited to wherein3509, wherein in various embodiments, hole 3508 can be by the first medicament storage at the first internal layerIn 3512, and hole 3509 can be by the second medicament storage in the second internal layer 3513. Real at someExecute in example the size in the hole 3509 in the hole 3508 in the first internal layer 3512 and the second internal layer 3513And density can be selected to results needed as herein described is provided.

Refer again to Figure 60 and Figure 61, in various embodiments, skin 3511, the first internal layer3512 and/or second internal layer 3513 can be formed by material that can bio-absorbable. In at least one enforcementIn example, the first internal layer 3512 can comprise first can bio-absorbable material, the second internal layer 3513 can wrapContaining second can bio-absorbable material, and outer 3511 can by the 3rd can bio-absorbable material structureBecome, wherein first can bio-absorbable material, second can bio-absorbable material and/or the 3rd can give birth toThe material that thing absorbs can be made up of different materials. In certain embodiments, first can bio-absorbableMaterial can first rate by bio-absorbable, second can bio-absorbable material can the second speed be given birth toThing absorbs, and the 3rd can bio-absorbable material can third speed by bio-absorbable, wherein firstSpeed, the second speed and/or third speed can be different. In at least one this type of embodiment, work as materialMaterial is with specific speed during by bio-absorbable, and this type of speed can be defined by within the unit interval by patientThe amount of the quality of materials that health absorbs. As everyone knows, the speed that different patients' health can be different is inhaledReceive different materials, therefore this type of speed can be expressed as Mean Speed to explain this type of changeability. ?In any situation, compared with slower speed, speed can be more matter within the unit interval fasterMeasure absorbed speed. Refer again to Figure 60 and Figure 61, in various embodiments, the first internal layer3512 and/or comparable outer 3511 the constituent material of constituent material of the second internal layer 3513 given birth to quicklyThing absorbs. In at least one this type of embodiment, the first internal layer 3512 and/or the second internal layer 3513 canBy foam that can bio-absorbable, organize sealant and/or hemostatic material (for example oxidized regenerated cellulose(ORC)) form, and outer 3511 can be by backing material and/or plastic material (for example, with businessPolyglycolic acid (PGA), PLA (PLA, PLLA), poly-to dioxy that name of an article Vicryl sellsCyclohexanone (PDS), polyhydroxyalkanoatefrom (PHA), gathering with trade name Monocryl saleCaprone 25(PGCL), polycaprolactone (PCL) and/or PGA, PLA, PDS,The compound of PHA, PGCL and/or PCL) form. In this type of embodiment, the first internal layer3512 and/or second internal layer 3513 for example can directly process tissue can reducing organize hemorrhage, its China and foreign countriesLayer 3514 can provide long-term support structure speed that can be slower by bio-absorbable.

To being above described further, due to outer 3511 can bio-absorbable speed slower,Therefore outer 3511 can be in nail row organization healing time supporting tissue or structurally strengthen tissue. ?In some embodiment, one of them constituent material of the first internal layer 3512 and the second internal layer 3513 is comparableThe constituent material of another one is quickly by bio-absorbable. In at least one embodiment, one deck whereinCan provide the initial release for the treatment of material, and another layer can provide identical treatment material and/or not rule togetherTreat the slowly-releasing of material. In at least one this type of embodiment, treatment material can be from layer 3512,3513 quiltThe speed discharging can be depending on the absorbability that wherein absorbs or be dispersed with the bottom of medicine. For example,In at least one embodiment, comprise comparable second internal layer 3513 that comprises of substrate of the first internal layer 3512Substrate quickly by bio-absorbable, the speed that therefore for example medicine discharges from the first internal layer 3512 can be fastIn the speed of the release from the second internal layer 3513. In various embodiments, as described herein, warehouseOne or more at least one adhesive that pass through in 3510 layer 3511,3512 and 3513(for example, fibrin and/or protein hydrogel) adheres to mutually. In certain embodiments, adhesiveCan be can be water-soluble and can work as nail bin 3500 when implanted and/or release after implanted certain periodConnection between each layer. In at least one this type of embodiment, adhesive can than outer 3511, theOne internal layer 3512 and/or the second internal layer 3513 are quickly by bio-absorbable.

Referring now to Figure 62 and Figure 63,, in various embodiments, nail bin (for example, nail bin 3600)For example can comprise warehouse 3610, this warehouse comprises compressible ground floor 3611, is attached to ground floor3611 the second layer 3612 and be attached to the removable compressible stratum 3613 of the second layer 3612.In at least one this type of embodiment, for example ground floor 3611 can be made up of compressible foamed material,The second layer 3612 can comprise the laminated material that utilizes one or more adhesives to adhere to ground floor 3611Material, and the 3rd layer 3613 can comprise and utilize one or more adhesives to adhere to removedly the second layer3612 compressible foam material. In various embodiments, nail bin 3600 also can comprise and be positioned at warehouseMultiple nails (for example following closely 3620) in 3610. In at least one this type of embodiment, for example each nail3620 can comprise be arranged in the base portion 3622 of the 3rd layer 3613 and from base portion 3622 through the second layer3612 and extend upwardly to the one or more deformable legs 3621 in ground floor 3611. UsingIn, to being above described further, the top surface 3619 of nail bin body 3610 can be downward by anvil blockPromote, until nail leg 3621 penetrates top surface 3619 and target tissue and contacts anvil block. At nail leg3621 be badly deformed after, anvil block can move away from nail bin 3600, makes the compressible of nail bin 3600Layer can stretch at least in part again. In all cases, when nail inserts through tissue, can make tissueHemorrhage. In at least one embodiment, the 3rd layer 3613 can for example, by absorbing material (albumen water-settingGlue) form, described absorbing material can be absorbed blood from the tissue being sewn. Except above or conductSubstituting above, can and/or organize sealant (for example, through freezing dry by hemostatic material for the 3rd layer 3613Dry fibrin ferment and/or fibrin) form described hemostatic material and/or organize sealant to subtractOrganize less hemorrhage. In certain embodiments, the 3rd layer 3613 can be to ground floor 3611 and the second layer3612 provide support structure, wherein can and/or can not give birth to by material that can bio-absorbable for the 3rd layer 3613The material that thing absorbs forms. In any case, in various embodiments, implanted at nail bin 3610Afterwards, the 3rd layer 3613 can separate with the second layer 3612. Comprise having for the 3rd layer 3613 therein and plantEnter in the embodiment of material of formula characteristic, surgeon can select whether to remove the 3rd layer of warehouse 36103613. In at least one embodiment, the 3rd layer 3613 can be with integral form from the second layer 3612Remove.

In various embodiments, ground floor 3611 can be made up of the first foamed material, and the 3rd layer3613 can be made up of the second foamed material, and the second foamed material can be different from the first foamed material. ExtremelyIn a few embodiment, the first foamed material can have the first density and the second foamed material can haveThe second density, wherein the first density can be different from the second density. In at least one this type of embodiment,The second density can be higher than the first density, the therefore compressibility of the 3rd layer of 3613 comparable ground floor 3611Less or there is lower compression ratio. In at least one alternative embodiment, the first density canHigher than the second density, therefore the compressibility of comparable the 3rd layer 3613 of ground floor 3611 is less or haveLower compression ratio. Referring now to Figure 64 and Figure 65,, in various embodiments, be similar to nail bin3600, nail bin 3700 can comprise warehouse 3710, and this warehouse comprises the first compressible froth bed3711, be attached to the second layer 3712 of ground floor 3711 and be attached to removedly the second layerDismountable the 3rd compressible foam layer 3713 of 3712. In at least one this type of embodiment, the 3rdLayer 3713 can comprise that multiple nails hold slit or otch 3709, and described multiple nails hold slit or otchCan hold therein respectively at least a portion (for example following closely base portion 3622) of nail 3620. At certainIn a little embodiment, nail 3620 can hold in slit 3709 and slide at nail, or in other words, for exampleIn the time that nail bin 3700 is located and compressed by anvil block against target tissue, the 3rd layer 3713 can be with respect toNail 3620 slides. In at least one embodiment, hold slit 3709 can make to follow closely 3620 with holdBetween the sidewall of slit 3709, there is space. In at least one this type of embodiment, due to institute aboveState, in the time of nail 3620 distortion, nail 3620 can not be captured in the part of the 3rd layer 3713 wherein,As shown in Figure 64 and Figure 65. In some other embodiment, nail holds the vicinity second of slit 3709Layer 3712 end can be by the part closure of the 3rd layer 3713, therefore in the time that nail 3620 is out of shape, theAt least a portion of three layer 3713 can be trapped in nail 3620. In any case, the 3rd layer3713 for example can comprise one or more perforation and/or cut 3708, described one or more perforation and/Or cut can allow that the 3rd layer 3713 is moved from the second layer 3712 with two parts or more partRemove, as shown in Figure 64. In Figure 64, the wherein part of the 3rd layer 3713 is illustrated as passing through instrument3755 remove. In various embodiments, perforation 3708 can be along being arranged in the first nail and the second nailBetween line setting.

Refer again to Figure 64 and Figure 65, in various embodiments, the base portion 3622 of nail 3620 can positionIn holding slit 3709, wherein at least one embodiment, hold the sidewall energy of slit 3709Enough contact stud legs 3621 are also held in place nail leg 3621 releasedly. In certain embodiments, to the greatest extentManage not shownly, but the 3rd layer 3713 can comprise around the elongated slot of all nails in nail row. At leastIn this type of embodiment, the nail bin that comprises four nail rows for example can comprise with nail bin bottom in eachThe elongated slot of nail row alignment. To being above described further, nail bin 3600 and/or nail bin 3700At least a portion can implanted patient body in, and at least a portion of nail bin can be moved in patient bodyRemove. Refer again to Figure 64 and Figure 65, at least one embodiment, ground floor 3711 and the second layer3712 can be trapped in nail 3620 and can be implanted together with 3620 with nail, and the 3rd layer 3713 canOptionally from nail bin 3700, be removed or separate. In all cases, remove and implant one of nail binPart can reduce the amount of the material that patient body must absorb, and this can provide various useful treatments effectsReally. In the situation that for example by abdominal cavity mirror instrument 3755, a part for nail bin is separated and removed,The nail bin part separating can be for example, by trochar (having the trochar in 5mm hole) from SurgeryPosition is removed. In certain embodiments, warehouse can comprise the more than one layer being removed. ExampleAs, warehouse 3710 can comprise the 4th layer, wherein the 3rd of warehouse 3710 the layer 3713 can be by hemostatic materialForm, and the 4th layer can be made up of supporting layer. In at least one this type of embodiment, surgeonFor example removable supporting layer also selects whether to remove hemostatic layer subsequently.

Referring now to Figure 66,, in various embodiments, nail bin (for example, nail bin 3800) for example canComprise warehouse 3810, this warehouse comprises skin 3811 and internal layer 3812. Internal layer 3812 can be by compressibleFoamed material form, and outer 3811 can wrap up around internal layer 3812 at least in part.In at least one embodiment, outer 3811 can comprise Part I 3811a and Part II3811b, this Part I can be positioned in the first side of internal layer 3812, and this Part II can be determinedPosition is in the second side of internal layer 3812, and wherein Part I 3811a and Part II 3811b can pass throughFlexible hinge (for example hinge 3809) connects. In at least one this type of embodiment, can be to internal layerThe first side of 3812 and/or the second side apply at least one adhesive (for example, fibrin and/or eggPlain boiled water gel) with by outer 3811 some partial fixing to the first side and/or the second side. VariousIn embodiment, outer 3811 one or more clamp structures that can comprise from its extension. At at least oneIn this type of embodiment, outer 3811 can comprise that extend and can be placed in from a side of outer 3811 canMultiple deformable legs 3821 in compression internal layer 3812. In at least one this type of embodiment, leg3821 can be not from the second lateral process of internal layer 3812, and at least one alternative embodimentIn, leg 3821 can be at least in part from internal layer 3812 projections. When compressible warehouse 3810 compressedTime, in use, leg 3821 can pierce through the Part II of internal layer 3812 and outer 38113811b. In certain embodiments, outer 3811 Part II 3811b can comprise and being limited to whereinHole (for example hole 3808), described hole can hold nail leg 3821. In certain embodiments, nailAt least some part in storehouse 3800 can comprise cutter slit 3803, and this cutter slit can be therein slidablyGround holds cutting element. In at least one this type of embodiment, cutter slit 3803 can not exclusively pass storehouseThe thickness of body 3810 and extending, therefore in the time that cutting element moves with respect to warehouse 3810, cutting structurePart can cut warehouse 3810.

Referring now to Figure 67,, in various embodiments, similar to nail bin 3800, nail bin 3900 can wrapDraw together warehouse 3910, this warehouse comprises internal layer 3812 and skin 3811, and its ectomesoderm 3811 can comprise neighbourSecond of the first side of nearly internal layer 3812 and the Part I 3811a that locates and contiguous internal layer 3812Side and the Part II 3811b that locates. In at least one embodiment, to similar above, skin3811 can comprise the one or more clamp structures from its extension. In at least one this type of embodiment,Outer 3811 can comprise that a side of outer 3811 is extended and can be placed in compressible internal layer 3812 certainlyMultiple deformable legs 3921. In certain embodiments, each deformable leg 3921 can comprise from itAt least one suspension hook of projection or barb 3923, described at least one suspension hook or barb can engage skinTherefore 3811 Part II 3811b also remains to internal layer 3812 by skin 3811. At at least oneIn this type of embodiment, barb 3923 can and extend through skin from the second lateral process of internal layer 3812Hole 3808 in 3811 Part II 3811b, make barb 3923 can engage outer 3811 outsideSurface also locks onto internal layer 3812 by skin 3811. For structure nail bin 3900, internal layer 3812 can be by extremelyThe compression of small part ground, so that barb is gone forward side by side hand-hole 3808 from internal layer 3812 projections. At at least oneIn this type of embodiment, for example, in the time that nail bin 3900 is inserted in nail bin, nail bin 3900 can be by portion at leastDivide ground precommpression. In certain embodiments, to being above described further, leg 3921 at least onePart can embed in the Part I 3811a of skin 3811, wherein at least one embodiment, outerLayer 3811 can for example, by plastic material (PPDO (PDS) and/or polyglycolic acid(PGA)) form, and described plastic material can be around the overlapping note of at least a portion of leg 3921Mould.

Referring now to Figure 68-72,, in various embodiments, nail bin (for example, nail bin 4000) can wrapDraw together warehouse 4010, this warehouse comprises compressible ground floor 4011, the second layer 4012 and locationMultiple nails 4020 in warehouse 4010. Referring to Figure 70, in certain embodiments, each nail 4020At least one deformable leg 4023 that can comprise base portion 4022 and extend from base portion 4022. Referring to figure68, at least one embodiment, nail bin 4000 can be positioned in nail bin passage 4030 and surgery seamClose between the anvil block 4040 of end effector of device, wherein the second layer 4012 of warehouse 4010 and/orThe base portion 4022 of nail 4020 can be located against nail bin passage 4030. Referring now to Figure 69,, variousIn embodiment, the second layer 4012 can comprise one deck absorbent cotton 4060, and described one deck absorbent cotton is by de-The cotton support frame 4061 of fat interconnects each other. In at least one this type of embodiment, absorbent cotton 4060 andAbsorbent cotton support frame 4061 can for example, by molded plastic material (polyglycolic acid (PGA)) structureBecome. Each absorbent cotton 4060 can comprise one or more holes or slit 4062, described one or moreHole or slit can hold the nail leg 4021 extending through wherein, as shown in Figure 70 and Figure 71. EachAbsorbent cotton 4060 also can comprise be limited to wherein hold slit 4063, this holds slit and can holdThe base portion 4022 of nail 4020. Refer again to Figure 69, in various embodiments, absorbent cotton 4060 and/Or absorbent cotton support frame 4061 can comprise multiple cuts, perforation or similar structures, described multiple strokesTrace, perforation or similar structures can allow that absorbent cotton 4060 is at desired location place and absorbent cotton support frame4061 separate. Similarly, referring to Figure 71, one or more absorbent cotton 4060 for example can be worn along comprisingThe line of hole and/or cut 4064 is connected to each other. In use, compressible froth bed 4011 can be againstTarget tissue T and locating, and warehouse 4010 can be compressed so that anvil block 4040 can make by anvil block 4040Nail 4020 distortion. When 4020 whens distortion of nail, the nail leg 4021 of each nail 4020 can by tissue T,A part for ground floor 4011 and absorbent cotton 4060 are captured in the nail of distortion. When nail bin passage4030 when move away from the nail bin 4060 of having implanted, for example absorbent cotton support frame 4061 can with degreasingCotton 4060 separation and/or each absorbent cotton 4060 can be separated from one another. In some cases, when nail 4020While distortion in the above described manner by anvil block 4040, absorbent cotton 4060 can and/or divide each other with framework 4061From.

In various embodiment as herein described, in the time that anvil block moves to closing position, the nail of nail bin canBe shaped completely by anvil block. Referring now to Figure 73-76,, in various other embodiment, nail bin (for exampleNail bin 4100) nail for example can by move to the anvil block of closing position and make nail towards closed anvil blockMotion staple drivers system and be out of shape. Nail bin 4100 can comprise compressible warehouse 4110, and this can be pressedContracting warehouse can be for example by foamed material and be positioned at least in part multiple nails of compressible warehouse 41104120 form. In various embodiments, staple drivers system can comprise driver clamper 4160, positionMultiple staple drivers 4162 in driver clamper 4160 and nail bin dish 4180, this nail binDish can remain on staple drivers 4162 in driver clamper 4160. At at least one, this type of is realExecute in example, staple drivers 4162 can be positioned in one or more narrow in driver clamper 4160In groove 4163, wherein the sidewall of slit 4163 can help upwards to guide staple drivers 4162 towards anvil block.In various embodiments, nail 4120 can be supported in slit 4163 by staple drivers 4162, Qi ZhongIn at least one embodiment, when nail 4120 and staple drivers 4162 are in it not when firing position, nail4120 can be arranged in slit 4163 completely. In some other embodiment, when nail 4120 and nail drivingDevice 4162 is not in it when firing position, and at least a portion of nail 4120 can opening through slit 4163Mouth end 4161 upwards extends. , first referring to Figure 74, at least one this type of embodiment, follow closely now4120 base portion can be positioned in driver clamper 4160, and the end of nail 4120 can embedIn compressible warehouse 4110. In certain embodiments, about 1/3rd of nail 4120 height canBe positioned in driver clamper 4160, and about 2/3rds height of nail 4120 can quiltBe positioned in warehouse 4110. Referring to Figure 73 A, at least one embodiment, for example nail bin 4100Also can comprise around water impervious wrappage or the film of warehouse 4110 and driver clamper 41604111。

In use, for example, nail bin 4100 can be positioned at nail bin passage, and anvil block can be towards nail bin4100 move to closing position. In various embodiments, in the time that anvil block moves to its closing position, anvilSeat can contact and compress compressible warehouse 4110. In certain embodiments, when anvil block is in its closed positionWhile putting, anvil block is contact stud 4120 not. In some other embodiment, when anvil block moves to its closure, the leg that anvil block can contact stud 4120 also makes to follow closely 4120 distortion at least in part when the position. In arbitrary feelingsIn shape, nail bin 4100 also can comprise one or more sliding parts 4170, described one or more slipsPart can longitudinally advance in nail bin 4100, makes sliding part 4170 jointing nail driver subsequently4162 and staple drivers 4162 and nail 4120 are moved towards anvil block. In various embodiments, sliding part4170 can slide between nail bin dish 4180 and staple drivers 4162. The closure of anvil block makes thereinIn the embodiment that the forming process of nail 4120 starts, nail 4120 moves upward and can complete shaping towards anvil blockProcess also makes to follow closely 4120 height that are deformed into its height being shaped completely or at least expect. Anvil block thereinClosure do not make to follow closely in the embodiment of 4120 distortion, nail 4120 moves upward and can start and complete towards anvil blockBecome forming process and make to follow closely 4120 height that are deformed into its height being shaped completely or at least expect. RespectivelyPlant in embodiment, sliding part 4170 can be advanced to from the near-end of nail bin 4100 far-end of nail bin 4100,Made before the nail 4120 of far-end that is arranged in nail bin 4100 is shaped completely, be positioned at nail bin 4100Nail 4120 in near-end is shaped completely. Referring to Figure 75, at least one embodiment, sliding part4170 can comprise the surface 4711 that at least one is angled or tilt separately, and it can be at staple drivers4162 slid underneath also promote staple drivers 4162 as shown in Figure 76.

In various embodiments, to being above described further, nail 4120 can be formed, so thatAt least a portion of the compressible warehouse 4110 of at least a portion of tissue T and nail bin 4100 is caughtTherein. After nail 4120 is shaped, the anvil block of surgical stapling device and nail bin passage 4130 can be away fromThe nail bin 4100 of having implanted moves. In all cases, storehouse dish 4180 can fixed form jointing nailStorehouse passage 4130, therefore, in the time that nail bin passage 4130 is pulled away from the warehouse 4110 of having implanted, coil in storehouse4180 can separate with compressible warehouse 4110. Refer again to Figure 73, in various embodiments, storehouse dish4180 can comprise relative sidewall 4181, and this warehouse 4110 can be positioned at relative side removedlyBetween wall 4181. In at least one this type of embodiment, compressible warehouse 4110 can be compressed in sideBetween wall 4181, make during use warehouse 4110 can remain on removedly sidewall 4181 itBetween, and in the time that storehouse dish 4180 is pulled away from, warehouse 4110 departs from releasedly from storehouse dish 4180. ExtremelyIn few this type of embodiment, driver clamper 4160 can be connected to storehouse dish 4180, makes to work as storehouseCoil 4180 in the time that operative site is removed, driver holder 4160, driver 4162 and/or slidingMoving part 4170 can remain in storehouse dish 4180. In some other embodiment, driver 4162 can be fromIn driver clamper 4160, penetrated and stayed in operative site. At at least one this type of embodimentIn, each driver 4162 can be by the polyglycolic acid (PGA) of for example selling with trade name Vicryl, poly-Lactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom(PHA), with trade name Monocryl sell Poliglecaprone 25(PGCL), polycaprolactoneAnd/or the compound of PGA, PLA, PDS, PHA, PGCL and/or PCL etc. (PCL)Material that can bio-absorbable forms. In various embodiments, driver 4162 can be attached to nail4120, make driver 4162 be deployed with nail 4120. In at least one this type of embodiment, eachDriver 4162 can comprise the groove of the base portion that for example can hold nail 4120, wherein real at least oneExecute in example, described groove can hold nail base portion with press-fit and/or snap fit mode.

In certain embodiments, to being above described further, driver clamper 4160 and/orSliding part 4170 can coil 4180 and be penetrated from storehouse. In at least one this type of embodiment, sliding part4170 can storehouse coil 4180 and driver clamper 4160 between slide, make when sliding part 4170Advance upwards drive staple drivers 4162 and nail 4120 o'clock, sliding part 4170 also can make driver folderHolding device 4160 moves upward to outside storehouse dish 4180. In at least one this type of embodiment, driverClamper 4160 and/or sliding part 4170 can be by the polyglycolic acids of for example selling with trade name Vicryl(PGA), PLA (PLA or PLLA), PPDO (PDS), poly-hydroxylAlkanoate (PHA), the Poliglecaprone 25(PGCL selling with trade name Monocryl), poly-Caprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL answerCompound etc. can bio-absorbable material form. In various embodiments, sliding part 4170 can overall landformBecome and/or be attached to driving rod or cutting element, described driving rod or cutting element are through nail bin 4100And promotion sliding part 4170. In this type of embodiment, not quilt from the dish 4180 of storehouse of sliding part 4170Penetrate and can keep together with surgical stapling device, and not being attached to its of driving rod at sliding part 4170In he embodiment, sliding part 4170 can be stayed in operative site. In any case, to above carrying outFurther describe, the compressibility tolerable of warehouse 4110 makes in the end effector of surgical stapling deviceWith thicker nail bin, this is because when anvil block when closure of stitching unstrument, and warehouse 4110 is compressible or collapseContracting. In certain embodiments, because nail in the time that anvil block is closed is out of shape at least in part, therefore can makeFor example, with higher nail (have about 0.18 " nail of staple height), for example wherein about 0.12 " nailHeight can be positioned in compressible stratum 4110, and wherein compressible stratum 4110 can have approximately0.14 " not compression height.

Referring now to Figure 77-80,, in various embodiments, nail bin (for example, nail bin 4200) for exampleCompressible warehouse 4210 be can comprise, multiple nails 4220, the Yi Jiduo of compressible warehouse 4210 are arranged inThe lateral supports 4234 of individual flexibility. Referring now to Figure 78,, in various embodiments, nail bin4200 can be positioned in the middle of anvil block 4240 and nail bin passage 4230, wherein at least one embodimentIn, lateral support member 4234 can be attached to nail bin passage 4230. When anvil block 4240 move downward withWhen compression warehouse 4210 also makes to follow closely 4220 distortion at least in part, as shown in Figure 79, warehouse 4210Sidepiece can laterally expand and outwards promote lateral support member 4234. In at least one this type of enforcementIn example, lateral support member 4234 can be attached to warehouse 4210, and when warehouse 4210 described aboveWhile laterally expansion, lateral support member 4234 can separate with warehouse 4210, as shown in Figure 79. ?In at least one embodiment, lateral support member 4234 can utilize at least one adhesive (for example, fibreFibrillarin and/or protein hydrogel) adhere to warehouse 4210. To similar above, anvil block 4240 closuresTime can only partly make to follow closely 4220 distortion, wherein can be by advancing through nail bin 4200 as shown in Figure 80One or more sliding parts 4270 complete the shaping of nail 4220. Referring now to Figure 82 and Figure 83,,In various embodiments, sliding part 4270 can be cut the near-end propelling of member 4280 from nail bin 4200To the far-end of nail bin 4200. In at least one this type of embodiment, cutting element 4280 can comprise to be cutCut element or cutter 4283, described cutting element or cutter 4283 can pass tissue T and/or compressible warehouse4210 and advance. In certain embodiments, cutting element 4280 can comprise cam member 4282, shouldCam member can advance and described jaw is moved or just kept along the outer surface of jaw 4230 and 4240Position. In various embodiments, due to mentioned above, nail 4220 can be when tissue T be cut openOr be at least substantially shaped to its net shape simultaneously. In at least one this type of embodiment, slidePart 4270 can be positioned in distally with respect to cutter 4283, only makes at the propulsive units quilt of organizing completelyWhen stitching, tissue T is just cut open.

Refer again to Figure 82 and Figure 83, in various embodiments, sliding part 4270 can comprise independentSlidable member, described slidable member is advanced by cutting element 4280 together. At at least one this type ofIn embodiment, sliding part 4270 can be accommodated in nail bin 4200, and cutting element 4280 can quiltTrigger shaft 4281 is advanced in nail bin 4200, makes cutting element 4280 engage sliding part 4270 alsoAdvance sliding part 4270 towards distally. In certain embodiments, each sliding part 4270 can be connected to each other.In any situation, each sliding part 4270 can comprise angled surface or cam 4271, shouldAngled surface or cam can be lifted at the nail 4220 of alignment in nail row. In certain embodiments,Angled surperficial 4271 can be formed as entirety with cutting element 4280. Refer again to Figure 82 and Tu83, at least one embodiment, each nail 4200 can comprise base portion and bizet 4229, at least oneIndividual deformable member extends from base portion, and bizet 4229 overmoldings to nail 4200 base portion and/orIn at least a portion of deformable member and/or around described at least a portion, locate. In various realitiesExecute in example, for example this type of bizet 4229 can directly be driven by sliding part 4270. More specifically, existIn at least one embodiment, nail 4220 bizet 4229 can make angled at sliding part 4270Surface 4271 and bizet 4229 between no-fix have in the situation of staple drivers, angled surface4271 can contact in bizet 4229 slid underneath and directly bizet 4229. In this type of embodiment, everyThe surface that individual bizet 4229 includes the angled of at least one cooperation or tilts, described at least one associationThe surface angled or that tilt of doing can be engaged by angled surperficial 4271 of sliding part 4270, makesProper sliding part 4270 is in the time of nail 4220 slid underneath, and the angled surface of cooperation can upwards drive nail4220。

Referring now to Figure 81,, in various embodiments, nail bin (for example, nail bin 4300) for example canComprise compressible main body 4310 and be positioned at the multiple nails 4320 in compressible main body 4310.To similar above, nail bin 4300 can comprise flexible lateral supports 4334, and this flexible side direction is propped upSupport member can be attached to nail bin passage and/or adhere to compressible main body 4310. Except person mentioned above itOutward, flexible lateral supports 4334 can be connected to by one or more pillars or connecting elements 4335Together, described one or more pillar or connecting elements 4335 can keep lateral supports 4334Together. In use, connecting elements 4335 can prevent or at least suppress lateral supports 4334Separate with warehouse 4310 prematurely. In certain embodiments, connecting elements 4335 can be at nail bin4300 compressed by anvil block after, this connecting elements keeps together lateral supports 4334. At thisIn class embodiment, lateral supports 4334 can be resisted lateral expansion or the position of the sidepiece of warehouse 4310Move. In certain embodiments, cutting element (for example cutting element 4280) can be worked as cutting element4280 in warehouse 4310 during towards distal movement, and cutting element can crosscut connecting elements 4335. ExtremelyIn few this type of embodiment, cutting element 4280 can promote towards distally one or more sliding parts(for example sliding part 4270), is shaped against anvil block to make to follow closely 4320. Sliding part 4270 can drawLead cutting blade 4283, make the cutting element 4280 can crosscut connecting elements 4335, connect until contiguousThe nail 4320 of member 4335 is shaped completely or is at least shaped to Desired Height. In all cases, connectConnection member 4335 cooperates with lateral supports 4334 and can prevent or at least reduce compressible warehouse 4310Lateral movement also prevents simultaneously or at least reduces the lateral movement of the nail 4320 that is positioned at warehouse 4310.In this case, connecting elements 4335 can be held in place nail 4320, until nail 4320 distortion,And connecting elements 4335 can cut to discharge the sidepiece of warehouse 4310 subsequently. As mentioned above, side directionSupport member 4334 can be connected to nail bin passage, therefore after nail bin 4300 is implanted, and lateral supportPart 4334 can be removed from operative site together with nail bin passage. In certain embodiments, lateral supportPart 4334 can be formed and can be left in operative site by implanted material. At at least one embodimentIn, connecting elements 4335 can be positioned in the middle of warehouse 4310 and tissue T, and at connecting elements4335 with lateral supports 4334 after separatings, connecting elements 4335 can keep in patients with implantation body.In at least one this type of embodiment, connecting elements 4335 can be made up of implanted material, and at certainIn a little embodiment, connecting elements 4335 can be for example by the material structure identical with lateral support member 4334Become. In various embodiments, connecting elements 4335 and/or lateral supports 4334 can be by for example with businessPolyglycolic acid (PGA), PLA (PLA or PLLA), poly-to two that name of an article Vicryl sellsOxygen cyclohexanone (PDS), polyhydroxyalkanoatefrom (PHA), sell with trade name MonocrylPoliglecaprone 25(PGCL), polycaprolactone (PCL) and/or PGA, PLA, PDS,What the compounds of PHA, PGCL and/or PCL etc. were flexible can bio-absorbable material form. RespectivelyPlant in embodiment, connecting elements can comprise the material piece for connecting each lateral supports 4334. At certainIn a little embodiment, nail bin can comprise the connecting elements of the top surface that extends through warehouse 4310 and encloseAround the lower surface of warehouse 4310 and the connecting elements extending.

Referring now to Figure 84,, in various embodiments, nail bin can comprise nail (for example, nail4420), described nail for example can comprise the wire rod portion being inserted in bizet. At at least one embodimentIn, wire rod portion can be for example, by metal (titanium and/or stainless steel) and/or plastics (for example poly-to dioxy ringHexanone (PDS) and/or polyglycolic acid (PGA)) form. In at least one embodiment, bizetCan for example, for example, by metal (titanium and/or stainless steel) and/or plastics (PPDO (PDS)And/or polyglycolic acid (PGA)) form. In certain embodiments, the wire rod portion of each nail 4420The deformable leg 4421 that can comprise base portion 4422 and extend from base portion 4422, wherein each nail 4420Bizet can comprise bizet 4429, this bizet can hold at least one portion of base portion 4422 thereinPoint. Referring now to Figure 85 A-85C,, for assembling the each several part of each nail 4420, can be by the leg of wire rod portionPortion 4421 inserts in the opening 4426 in bizet 4429, and its split shed 4426 can draw leg 4421Be directed in base portion chamber 4427. Wire rod portion also can be inserted in bizet 4429, and leg 4421 is leftThe base portion 4422 of base portion chamber 4427 and wire rod portion enters in base portion chamber 4427. At at least one thisIn class embodiment, base portion chamber 4427 can make in the time that base portion 4422 enters base portion chamber 4427,Wire rod portion rotates in bizet 4429 so that nail leg 4421 point to upwards or at least substantially upwardsDirection. Refer again to Figure 84, in various embodiments, bizet 4429 can comprise outlet opening4425, this outlet opening can hold nail leg 4421 therein.

In various embodiments, to being above described further, surgical stapling device can comprise sliding part4470, this sliding part can traverse nail bin 4400 and nail bin passage 4430 and make that warehouse 4410 is interior to be heldThe nail 4420 of receiving moves towards anvil block. In all cases, sliding part 4470 can be from nail bin passage 4430Near-end move to the far-end of storehouse passage 4430, to implant warehouse 4410 and nail 4420. In some feelingsIn shape, sliding part 4470 regractings or turn back to the near-end of storehouse passage 4430, and another nail bin4400 can be inserted in storehouse passage 4430. Once new nail bin 4400 is positioned in storehouse passage 4430In, sliding part 4470 can advance towards distally again. In various embodiments, surgical stapling device can wrapDraw together one or more latch-up structures, described one or more latch-up structures can be uncertain in storehouse passage 4430Position has anti-skidding part 4470 in the situation of new nail bin 4400 again to advance towards distally. Refer again toFigure 84, at least one this type of embodiment, nail bin passage 4430 can comprise locking shoulder 4439,This locking shoulder can prevent or at least limit slippage part 4470 towards distal movement. More specifically, unlessSliding part 4470 is upwards promoted and exceedes shoulder 4439 at least in part by lift structure 4428, otherwise slidingMoving part 4470 can be in abutting connection with shoulder 4439, lift structure 4428 for example in nail bin 4400 recentlyBetween side nail 4420, extend. In other words, when there not being recent side nail 4420 in new nail bin 4400Time, sliding part 4470 cannot advance. Therefore, when there being used nail bin in storehouse passage 4430While there is not any nail bin 4400 in or storehouse passage 4430 at 4400 o'clock, sliding part 4470 cannot be in storehouseIn passage 4430, advance.

Referring now to Figure 86,, to being above described further, nail bin (for example, nail bin 4500)For example can be positioned in nail bin passage 4530 and can comprise compressible warehouse 4510, be positioned at warehouseMultiple nails 4520 in 4510 and storehouse dish or retainer 4580. In various embodiments, can pressContracting warehouse 4510 can comprise skin 4511 and internal layer 4512, wherein at least one embodiment, outerLayer 4511 can surround internal layer 4512 by sealing means. In at least one this type of embodiment, skin4511 can extend between internal layer 4512 and storehouse dish 4580. In some other embodiment, skin4511 can be only partly around internal layer 4512, and at least one this type of embodiment, skin4511 and storehouse dish 4580 can cooperate to surround or at least substantially surround internal layer 4512. In various enforcementIn example, to being above described further, nail 4520 can coil 4580 supports by storehouse, wherein storehouse dish4580 can comprise can support nail 4520 one or more nail support passage. At some embodimentIn, storehouse dish 4580 can be attached to warehouse 4510, wherein at least one this type of embodiment, and warehouse4510 can laterally be compressed between 4580 relative sidewall is coiled in storehouse. In various embodiments,The sidewall of storehouse dish 4580 can laterally support warehouse 4510, at least one this type of embodiment, and storehouseDish 4580 can comprise from bottom support 4583 and extends upwardly to the one or more walls warehouse 4510Or fin 4582. In at least one this type of embodiment, in warehouse 4510, can comprise one or moreSlit or passage, described one or more slits or passage can hold wall 4582 and/or with wall 4582Interlocking. In various embodiments, wall 4582 can partly or almost extend through warehouse fully4510. In at least one this type of embodiment, wall 4582 can be in the first nail 4520 and the second nailExtending longitudinally through nail bin 4500 between 4520.

In various embodiments, warehouse 4510 and/or storehouse dish 4580 can comprise cooperation holding structure, instituteState cooperation holding structure can storehouse coil 4580 and warehouse 4510 between snap fit is provided. Real at someExecute in example, nail bin 4500 can be positioned in storehouse passage 4530, makes storehouse dish 4580 against storehouse passage4530 and location and/or be attached to storehouse passage 4530. In at least one embodiment, 4580 energy are coiled in storehouseEnough be connected to separably storehouse passage 4530, make compressed and follow closely by anvil block 4540 at nail bin 4500After 4520 distortion, storehouse dish 4580 can with 4530 separation of storehouse passage and can be together with warehouse 4510 byImplant. In at least one this type of embodiment, storehouse dish 4580 can be by for example selling with trade name VicrylPolyglycolic acid (PGA), PLA (PLA or PLLA), PPDO(PDS), polyhydroxyalkanoatefrom (PHA), with trade name Monocryl sell Poliglecaprone25(PGCL), polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA,The compound of PGCL and/or PCL etc. can bio-absorbable material form. In certain embodiments,Surgical stapling device also can comprise firing lock and/or driver, and described firing lock and/or driver canOn storehouse dish 4580, in the middle slip of nail bin passage 4530 and bottom drive surfaces, described bottom drivesSurface can promote or penetrate storehouse dish 4580 from storehouse passage 4530. In certain embodiments, warehouse4510 can be connected to storehouse dish 4580 separably, make to be compressed by anvil block 4540 at nail bin 4500 andAfter nail 4520 distortion, warehouse 4510 can coil from storehouse 4580 separation. At at least one this type of embodimentIn, storehouse dish 4580 can keep engaging storehouse passage 4530 with fixed form, makes storehouse dish 4580 and storehouse logicalRoad 4530 is removed from operative site together. In certain embodiments, surgical stapling device also can comprise and hittingSend out mechanism and/or driver, described firing lock and/or driver can be at nail bin dishes on warehouse 45104580 slide with bottom drive surfaces is middle, and described bottom drive surfaces can be coiled 4580 and carry from storehouseRise or penetrate warehouse 4510. In at least one this type of embodiment, nail bin 4500 also can comprise and being positioned atStorehouse dish 4580 and the staple drivers of following closely in the middle of 4520, make in the time that firing lock slides towards distally, nailDriver and nail 4520 can upwards be driven towards anvil block. In at least one this type of embodiment, nail drivesDevice can embed in compressible warehouse 4510 at least in part.

In various embodiments, to similar above, nail bin 4500 can comprise latch-up structure, described lockFixed structure can prevent or at least limit cutting element towards distal movement, unless in nail bin passage 4530Be positioned with the not nail bin 4500 of percussion. In certain embodiments, nail bin dish 4580 can for example comprise and usingIn upwards promoting cutting element and make it exceed the surface of locking surface in nail bin passage 4530. At itIn middle storehouse passage 4530, do not exist in the situation of the nail bin 4500 that comprises storehouse dish 4580, cutting element withoutMethod advances. In at least one embodiment, the recent side in nail bin 4500 nail and/or any other closeSuitable nail can comprise lifting surface, and described lifting surface can completely promote cutting element to exceed locking listFace. Except mentioned above or substitute mentioned above, the each several part of nail bin 4500 can be by having different faceThe material of look forms. In this type of embodiment, surgeon can visually identify nail bin passageIn 4530, when there is the nail bin of not pulling the trigger and/or pulling the trigger. In at least one this type of embodiment, storehouseThe skin 4511 of body 4510 can have the first color, and storehouse dish 4580 can have the second color, and nailStorehouse passage 4530 can have the 3rd color. See in the situation of the first color surgery doctor surgeonLife can know that the storehouse 4500 of percussion is not present in nail bin passage 4530; See second surgeonIn the situation of color, surgeon can know that the storehouse 4500 of percussion is present in nail bin passage 4530,And remaining storehouse dish 4580 need to remove; And see in the situation of the 3rd color surgeon,Any part of the known road of surgeon nail bin 4500 does not remain in nail bin passage 4530.

Referring now to Figure 87,, in various embodiments, nail bin (for example, nail bin 4600) for example canComprise compressible implanted warehouse 4610 and be positioned at the multiple nails 4620 in warehouse 4610. Warehouse4610 can comprise skin 4611 and internal layer 4612. In certain embodiments, internal layer 4612 can comprise limitFix on multiple pits (for example pit or chamber 4615) wherein, described multiple pits can be conducive to warehouse4610 collapse. In at least one this type of embodiment, internal layer 4612 can comprise corrugated or honeycombThe dot matrix of configuration, described dot matrix can bear compression stress or pressure, as long as this compression stress or pressure are not superCross specific threshold value. In the time not exceeding threshold value, internal layer 4612 can be with respect to applied compression stressPressure and with linearity or at least speed distortion of substantial linear. Exceed threshold in compression stress or pressureAfter value, internal layer 4612 can be yielded to suddenly large deflection and collapse or bending due to compressive load. ?In various embodiment, the dot matrix of internal layer 4612 can be by multiple sublayers 4612a structure that can connect togetherBecome. In at least one embodiment, each sublayer 4612a can comprise multiple ditches that replace and ridge orRipple, described multiple ditches that replace and ridge or ripple can with the ditch replacing and the ridge pair of adjacent sublayers 4612aTogether. In at least one this type of embodiment, the ditch of the first sublayer 4612a can be oriented to and the second sonThe ridge of layer 4612a is adjacent; Similarly, the ridge of the first sublayer 4612a can be oriented to and the second sublayerThe ditch of 4612a is adjacent. In various embodiments, adjacent sublayer 4612a can be sticky by least oneMixture (for example, fibrin and/or protein hydrogel) adheres to and/or adheres to skin mutually4611. Figure 88 shows at warehouse 4610 and has collapsed and followed closely 4620 and be out of shape with against warehouse4610 and catch and keep the nail bin 4600 after tissue T.

Referring now to Figure 89-91,, in various embodiments, nail bin (for example, nail bin 4700) for exampleCan comprise compressible implanted warehouse 4710 and be positioned at the multiple nails 4720 in warehouse 4710. WithSimilar above, warehouse 4710 can comprise skin 4711 and internal layer 4712, and wherein internal layer 4712 can wrapDraw together multiple sublayer 4712a. Same to similar above, each sublayer 4712a can comprise ditch alternately4717 and ridge 4718, the described zastrugi replacing can align to limit betwixt pit or chamber mutually4715. In at least one this type of embodiment, ditch 4717 and/or ridge 4718 can along be parallel to each other and/Or be parallel to the Axis Extension of longitudinal axis 4709. In various embodiments, nail 4720 can be multipleAlignment in nail row, described multiple nails rows can along be parallel to each other and/or be parallel to longitudinal axis 4709Axis Extension. Refer again to Figure 87 and Figure 88, in various alternative embodiment, warehouseThe nail 4620 holding in 4600 can be along Axis Extension, described axis across or perpendicular to by sublayerThe axis that the zastrugi of 4612a limits. Refer again to Figure 89-91, nail 4720 is extensible through ditch4717 and ridge 4718, wherein follow closely 4720 and sublayer 4712a between frictional force can keep by nail 4720In warehouse 4710. In certain embodiments, described multiple sublayer 4712a can by backing material and/Or plastic material (for example PPDO (PDS) and/or polyglycolic acid (PGA)) structureBecome, described backing material and/or plastic material can for example can remain on upright getting by nail 4720To and/or nail 4720 is held in relative to each other to alignment, as shown in Figure 89 and Figure 90. Figure 91Being illustrated in warehouse 4710 has collapsed and has followed closely 4720 and be out of shape catch and keep against warehouse 4710Nail bin 4700 after tissue T.

Refer again to Figure 89-91, in various embodiments, in the time that warehouse 4710 is compressed, warehouse4710 can be with resilience ground or collapse with elastic type. In at least one this type of embodiment, work as warehouse4710 when compressed, and the ripple that ditch 4717 and ridge 4718 form in each sublayer 4712a can be put downChange or at least substantially by graduation, this can make the cavity 4715 limiting between ditch 4717 and ridge 4718Collapse or at least substantially collapse. In all cases, when removing compression stress or pressure from warehouse 4710Afterwards, at least multiple parts of warehouse 4710 or warehouse 4710 can be with resilience ground or with elastic typeAgain stretch. In at least one this type of embodiment, in the time that warehouse 4710 is compressed, adjacent sublayersBeing connected between the ditch 4717 of 4712a and ridge 4718 can keep not impaired or at least substantially not be subject toDamage, make after warehouse 4710 removes compression stress, sublayer 4712a can setover ditch 4717 withRidge 4718 itself makes it away from each other, and therefore makes warehouse 4710 again stretch at least in part. ?In some embodiment, in the time that warehouse 4710 is compressed, it can plasticity mode be out of shape or by conquassation, because ofThis is after warehouse 4710 removes compression stress or pressure, and warehouse 4710 can not stretch again. ExistingReferring to Figure 92, in certain embodiments, nail bin (for example nail bin 4800) for example can comprise and can pressRouted warehouse 4810, the warehouse that this can conquassation comprises outer 4811 and internal layer 4812, wherein internal layer4812 can comprise dot matrix corrugated, honeycomb configuration, and described dot matrix has limit therein multiplePit or chamber 4815. In various embodiments, the wall of the dot matrix of restriction internal layer 4812 can comprise oneOr cross section 4819 multiple reductions or thin, described one or more reductions or thin cross section4819 can tolerance bound the wall of fixed point battle array in the time that warehouse 4810 is compressed, break. In this case,In the time that nail bin 4800 is implanted, warehouse 4810 can be by conquassation.

Referring now to Figure 93-95,, in various embodiments, nail bin (for example, nail bin 4900) for exampleCan comprise warehouse 4910, this warehouse comprises skin 4911 and is positioned at outer 4911 top and the endMultiple crushable members 4912 between portion. First referring to Figure 93 and Figure 94, nail bin 4900 also can wrapDraw together multiple nails 4920, wherein each nail 4920 can be positioned in crushable member 4912. More specificallyGround, each crushable member 4912 can comprise Part I 4912a, Part II 4012b and theThree part 4012c, described Part I 4912a, Part II 4012b and Part III 4012c canLimit therein collaboratively cavity 4915, described cavity can hold nail 4920. In use, rightAbove be described further, nail bin 4900 can be positioned in also can be to organizing contact table in nail bin passageFace 4919 applies compression stress with compression warehouse 4910. In the time that tissue contacting surface 4919 moves downward,Crushable member 4912 can be collapsed. In this case, second of each crushable member 4912Divide 4912b can be collapsed in corresponding Part I 4912a; Similarly, each crushable member4912 Part III 4912c can be collapsed in corresponding Part II 4912b. When warehouse 4910When compressed and crushable member 4912 is collapsed, the nail 4920 that is arranged in crushable member 4912 is variableShape, as shown in Figure 95. In various embodiments, the Part II of each crushable member 4912The Part I 4912a that 4912b can be frictionally engaged corresponding and/or be press-fit in corresponding Part IIn 4912a, once the compression stress that makes the crushable member 4912 to apply exceedes for by Part I4912a and Part II 4912b remain on the confining force in its extended position (Figure 94), and firstPart 4912a and Part II 4912b can start relative to each other to slide. Similarly, each collapsingPart II 4912b and/or pressure that the Part III 4912c of contracting element 4912 can be frictionally engaged correspondingBe assigned in corresponding Part II 4912b, once make the compression stress that crushable member 4912 is appliedExceed for Part II 4912b and Part III 4912c are remained on to its extended position (Figure 94)In confining force, Part II 4912b and Part III 4912c can start relative to each other to slideMoving.

In many embodiment as herein described, in nail bin, can comprise multiple nails. At various embodimentIn, this type of nail can be made up of the metal wire rods that are deformed into U-shaped configuration substantially and have two nail legs.Can dream up wherein nail and can comprise that isomorphism type (is not for example joined together and has three or moreNail leg two or more wire rods) other embodiment. In various embodiments, be used to form nailOne or more wire rods can comprise round or round cross section at least substantially. In at least one enforcementIn example, nail wire rod can comprise the cross section that any other is suitable, for example square and/or rectangle transversalFace. In certain embodiments, nail can be made up of plastic wire. In at least one embodiment, nail canFormed by the metal wire rod that is coated with plastics. In various embodiments, replacing except nail or as nailIn generation, storehouse can comprise the securing member of any adequate types. In at least one this type of embodiment, this type of is tightFirmware can comprise pivotable arm, and described arm can be folded in the time being engaged by anvil block. At some embodimentIn, can utilize and be divided into two-part securing member. In at least one this type of embodiment, nail bin can compriseMultiple the first securing member parts, and anvil block can comprise multiple the second securing member parts; When anvil block againstNail bin and when compressed, the second securing member part is connected to the first securing member part. At some embodimentIn, as mentioned above, can in nail bin, advance sliding part or driver to complete the forming process of nail.In certain embodiments, can in anvil block, advance sliding part or driver, to make one or more one-tenthShape member moves downward to engaging with relative nail bin and nail or the securing member that is arranged in nail bin.

In various embodiment as herein described, nail bin can comprise four nail rows that are stored in wherein. ?In at least one embodiment, described four nail rows can be configured to two inner side nail rows and two outside nailsRow. In at least one this type of embodiment, inner side nail row and outside nail row can be positioned in nail binIn the first side of cutting element or cutter slit; Similarly, inner side nail row and outside nail row can be positioned inIn the second side of cutting element or cutter slit. In certain embodiments, nail bin can not comprise cutting structurePart slit; But this type of nail bin can comprise that the specific part that can be cut member incision is to substitute nailStorehouse slit. In various embodiments, each inner side nail row can be arranged in nail bin, make itself and cuttingMember slit equidistantly or at least substantially equidistantly spaced apart. Similarly, each outside nail row can be establishedPut in nail bin, make itself and cutting element slit equidistantly or at least substantially equidistantly spaced apart.In various embodiments, nail bin can comprise greater or less than four nail rows and being stored in nail bin. At leastIn an embodiment, nail bin can comprise six nail rows. In at least one this type of embodiment, nail bin canIn the first side of cutting element slit, comprise three nail rows, and in the second side of cutting element slitOn comprise three nail rows. In certain embodiments, nail bin can comprise odd number nail row. For example, nail binCan in the first side of cutting element slit, comprise two nail rows, and at second of cutting element slitIn side, comprise three nail rows. In various embodiments, nail row can comprise have identical or at least substantiallyThe nail of identical unshaped staple height. In some other embodiment, one or more nail rows can compriseThere is the nail of different unshaped staple heights from other nails. For example, at least one this type of embodiment,Nail in the first side of cutting element slit can have the first unshaped height, and cutting element slitThe second side on nail can there is the second unshaped height, described in described the second unshaped height is different fromThe first height.

Referring now to Figure 96 A-96D,, in various embodiments, the end effector of surgical stapling device canComprise: storehouse attachment (for example, nail bin passage 5030); Be positioned at removedly nail bin passage 5030In securing member storehouse (for example, nail bin 5000); And with nail bin 5000 and nail bin passage 5030 phasesThe jaw 5040 of location over the ground. Nail bin 5000 can comprise compressible body 5010 and multiple nail 5020,And/or be arranged at least in part any other suitable securing member of compressible body 5010. ExtremelyIn few this type of embodiment, each nail 5020 can comprise base portion 5022 and from base portion 5022 upwardsThe leg 5021 extending, wherein at least a portion of leg 5021 can be embedded in warehouse 5010. VariousIn embodiment, compressible body 5010 can comprise top surface or tissue contacting surface 5019 and bottomSurface 5018, wherein lower surface 5018 can be against the stayed surface of nail bin passage 5,030 5031 andLocation is also supported by stayed surface 5031. To similar above, stayed surface 5031 for example can comprise limitFix on multiple support slit 5032(Figure 96 D wherein), described multiple support slits 5032 canHold the also base portion 5022 of support nail 5020. In various embodiments, hold the end of surgical stapling deviceRow device also can comprise maintenance matrix (for example keeping matrix 5050), and described maintenance matrix can jointing nail5020, and tissue is captured in and is kept between matrix and nail 5020. At at least one this type of embodimentIn, keep matrix 5050 can be installed to removedly jaw 5040. In use, once nail bin5000 are positioned in nail bin passage 5030, jaw 5040 and be attached to the maintenance of jaw 5040Matrix 5050 can move towards nail bin 5000 and nail bin passage 5030. In at least one embodiment, pincersMouthfuls 5040 can move downward along axis 5099, make in the time of jaw 5040 closure, jaw 5040 andNail bin passage 5030 remains parallel to each other or is at least substantially parallel. More specifically, at least one thisIn class embodiment, jaw 5040 can be closed, so that in the time that jaw 5040 moves towards nail bin 5000,Keep the tissue contacting surface 5051 of matrix 5050 to be parallel to or at least substantially parallel to nail bin 5000Tissue contacting surface 5019.

Referring now to Figure 96 A,, in various embodiments, keep matrix 5050 to consolidate separablySurely arrive jaw 5040, make, in the time keeping matrix 5050 to be attached to jaw 5040, to keep matrix 5050And between jaw 5040, there is very little (if any) relative motion. At at least one embodimentIn, jaw 5040 can comprise one or more holding structures, described one or more holding structures canMaintenance matrix 5050 is held in place. In at least one this type of embodiment, maintenance matrix 5050 canSnap fit and/or be press-fit in jaw 5040. In certain embodiments, can utilize at least one stickyMaintenance matrix 5050 is adhered to jaw 5040 by mixture. In any case, jaw 5040 is movableExtremely as in upper/lower positions: wherein keep matrix 5050 contact tissue T and tissue T against nail bin 5000Tissue contacting surface 5019 and locating. When tissue T is positioned to against nail bin 5000 by jaw 5040Time, the compressible body 5010 of described nail bin 5000 can be compressed by jaw 5040 or can be not by its pressureContracting. In any situation, in various embodiments, the leg 5021 of nail 5200 can not pass nail bin5000 tissue contacting surface 5019 projections, as shown in Figure 96 A. In addition, same as Figure 96 A instituteShow, retaining matrix 5050 not jointing nail 5020 in the situation that, jaw 5040 can be against compressibleMain body 5010 keeps tissue T. Repeatedly open and close jaw of this type of embodiment tolerable surgeon5040, to for example obtain end effector in the situation that not damaging tissue T in operative siteExpected location. But, imagine other embodiment, wherein following closely end 5023 can be at warehouse 5010Compressed before from tissue contacting surface 5019 projections by anvil block 5040. Referring now to Figure 96 B,, onceEnd effector is located rightly, and jaw 5040 can move downward towards nail bin passage 5030, makesObtain compressible body 5010 and compressed by anvil block 5040, and make tissue contacting surface 5019 with respect to nail5020 are pushed down. In the time that tissue contacting surface 5019 is pushed down, the end of nail leg 50215023 can also at least a portion of piercing tissue T of piercing tissue contact surface 5019. In this situationIn, keep matrix 5050 can be positioned in nail 5020 tops, make to keep the retaining hole of matrix 50505052 align or substantial alignment at least with the end 5023 of nail leg 5021.

Referring now to Figure 96 C,, in the time promoting to keep matrix 5050 downwards along axis 5099, nail 5020Nail leg 5021 can enter in retaining hole 5052. In various embodiments, nail leg 5021 can engage guarantorHold the sidewall in hole 5052. In certain embodiments, as being below described in more detail, keep matrix5050 can comprise and extending in retaining hole 5052 and/or around one or more maintenances of retaining hole 5052Member, described one or more retaining members can jointing nail leg 5021. In any situation, nailLeg 5021 can be maintained in retaining hole 5052. In all cases, the end of nail leg 50215023 can enter in retaining hole 5052 and the sidewall in can be frictionally engaged retaining member and/or hole 5052. WhenWhile keeping matrix 5050 to be pushed towards the base portion 5022 of nail 5020, nail leg 5021 can be with respect to sidewallAnd/or retaining member slides. Due to mentioned above, between nail leg 5021 and maintenance matrix 5050, can produceRaw force of sliding friction, wherein this type of force of sliding friction can be resisted and keep matrix 5050 to be inserted into nail 5020On. In various embodiments, when nail leg 5021 down slidings that keep matrix 5050 along nail 5020Time, keep matrix 5050 and follow closely force of sliding friction between 5020 and can be constant or at least substantiallyConstant. In certain embodiments, owing to for example following closely leg 5021, retaining hole 5052 and/or extendingTo retaining hole 5052 and/or the variation in geometry around the retaining member of retaining hole 5052,In the time keeping matrix 5050 along nail leg 5021 down sliding, force of sliding friction can increase and/or reduce.In various embodiments, the compressible body 5010 of nail bin 5000 also can be resisted and be kept matrix 5050 to insertEnter in nail 5020. More specifically, compressible body 5010 can for example be made up of elastomeric material, described inElastomeric material can be to keeping matrix 5050 to apply drag; When the compressed distance of compressible body 5010When increase, described drag increases. In at least one this type of embodiment, what produced by warehouse 5010 is anti-The increase of power can be proportional or at least become to substantial linear linearly with the compressed distance of warehouse 5010Ratio. The increase of the drag being produced by warehouse 5010 in certain embodiments, can with warehouse 5010 quiltsThe geometric distance ground of compression is proportional.

In various embodiments, to being described further, can and keep square to jaw 5040 aboveBattle array 5050 applies enough percussion forces, to overcome above-mentioned drag and frictional force. In use, keep squareBattle array 5050 can be seated to any suitable depth with respect to nail 5020. At at least one embodimentIn, keep matrix 5050 to be seated to a depth with respect to the base portion 5022 of nail 5020, so thatTwo-layer or more multi-layered tissue is secured together and produces compression stress or pressure in tissue. In various feelingsUnder condition, comprise and keep the system tolerable surgeon of matrix 5050 and nail 5020 to keep by selectionThe degree of depth that matrix 5050 is placed is selected the compression stress that applies of tissue or the size of pressure. For example,Keep matrix 5050 to be pushed down towards the nail base portion 5022 of nail 5020, until keep matrix5050 be seated to and the bottom of supporting slit 5032 at a distance of certain depth 5011, wherein more shallow darkDegree 5011 can produce the higher compression stress or the pressure that are applied to tissue T, and the darker degree of depth 5011Can produce the lower compression stress or the pressure that are applied to tissue T. In various embodiments, be applied to groupCompression stress or the pressure of knitting T can be proportional linearly with the degree of depth 5011 that keeps matrix 5050 to be placedOr at least substantial linear ground is proportional. In all cases, be applied to compression stress or the pressure of tissue TPower can be depending at the thickness that keeps the tissue T between matrix 5050 and nail bin 5020. More specificallyGround, for given distance 5011, the existence that the existence of thicker tissue T can be compared thin tissue T producesHigher compression stress or pressure.

In all cases, to being above described further, surgeon's capable of regulating keeps matrix5050 degree of depth that are placed to be to cause being positioned at the thicker and/or thinner tissue of end effector, andTissue T is applied to specific or predetermined pressure with tissue thickness irrelevant mode. For example,, when tightlyGu when thinner tissue T, surgeon can will keep matrix 5050 to be seated to the more shallow degree of depth5011, or in the time of the tissue T of fastening thicker, be seated to the darker degree of depth 5011, so that at tissueInside reach identical or at least substantially the same compression stress. In certain embodiments, to above enteringOne step is described, surgeon optionally determine to be positioned at keep matrix 5050 and nail bin 5010 itBetween the size of the compression stress that applies of tissue T. In all cases, surgeon can will keep matrix5050 engage with nail 5020, and will keep matrix 5050 to be positioned to and base portion 5022 phases of following closely 5020Apart from the first distance, to tissue is applied to the first compression pressure. Alternatively, surgery doctorLife can will keep matrix 5050 to be positioned to and base portion 5022 second distance apart, and described second distance is shortIn described the first distance, to tissue is applied to the second compression pressure that is greater than the first pressure. As separatelyOuter a kind of selection, surgeon can will keep matrix 5050 to be positioned to base portion 5022 at a distance of the 3rd distanceFrom, described the 3rd distance is shorter than described second distance, to tissue is applied and is greater than the of the second pressureThree compression pressures. In various embodiments, comprise the fastening system that keeps matrix 5050 and nail 5020Can allow that surgeon applies the compression pressure of wide region to target tissue.

Referring now to Figure 96 D,, in various embodiments, nail leg 5021 can be through keeping matrix 5050And be inserted into, make to follow closely leg end 5023 and extend to the top surface top that keeps matrix 5050. AgainInferior to Figure 96 C, at least one embodiment, jaw 5040 also can comprise be limited to wherein betweenLyriform pore 5042, in the time that nail leg end 5023 passes the retaining hole 5052 keeping in matrix 5050, shouldMesopore can hold nail leg end 5023. In at least one this type of embodiment, mesopore 5042Can align with retaining hole 5052, make not contact jaw 5040 of leg 5021. In various embodiments,Mesopore 5042 can have enough degree of depth, no matter make the distance that keeps matrix 5050 to be placed beWhat, all contact jaws 5040 not of nail leg 5021. Referring now to Figure 96 D,, keep matrix 5050 withAfter nail 5020 engages and is placed to desired location, nail bin passage 5030 and jaw 5040 can be away fromTissue T motion. More specifically, nail bin passage 5030 can separate with implanted nail bin 5000, andAnd anvil block 5040 can separate with implanted maintenance matrix 5050. When jaw 5040 is away from keeping matrix5050 and advance and follow closely support member 5032 away from nail base portion 5022 while moving, although jaw 5040 HesNail bin passage 5030 no longer provides support maintenance matrix 5050 and base portion 5022, but still can keepKeep the distance 5011 between matrix 5050 and the bottom of base portion 5022. In various embodiments, to the greatest extentManage compressed warehouse 5010 and/or compressed tissue T to keeping matrix 5050 to apply bias force,But follow closely leg 5021 and keep the stiction between matrix 5050 can be enough to maintenance matrix 5050 to be protectedHold in place. In at least one this type of embodiment, warehouse 5010 can be made up of elastomeric material, described bulletProperty material when compressed, can, to keeping matrix 5050 and nail 5020 apply elastic bias force, make instituteState elastic bias force be propulsive keep matrix 5050 and nail 5020 so that its separately, but this type of fortuneMove and be subject to following closely leg 5021 and keep the opposing being frictionally engaged between matrix 5050.

In various embodiments, as mentioned above, keep matrix can comprise multiple retaining holes, wherein eachRetaining hole can be held the leg of securing member therein. In at least one embodiment, referring now to figure97, shown in it, keep the part of matrix 5150, this part to comprise being limited by periphery 5156Retaining hole 5152. In various embodiments, the periphery 5156 in hole 5152 can comprise circle or base at leastCircular profile and/or any other suitable profile in basis. In certain embodiments, keep matrix5150 can comprise one or more retaining members (for example retaining member 5153), described one or moreWhen retaining member extends in hole 5152 and can work as in securing member supporting leg patchhole 5152, described hole5152 engage this securing member supporting leg. In at least one this type of embodiment, each retaining member 5153Can comprise towards central axis 5159(, towards the center in hole 5152) cantilever that extends internally. RespectivelyPlant in embodiment, each cantilever can comprise first end and the second end, and described first end is attached toKeep matrix main body 5158, described the second end forms the periphery 5156 of retaining hole 5152. At someIn embodiment, the periphery 5156 of retaining hole 5152 can be limited by the first diameter or width, and fasteningPart supporting leg can be limited by Second bobbin diameter or width, and wherein said Second bobbin diameter can be greater than described first straightFootpath. In at least one this type of embodiment, securing member supporting leg can contact one in retaining member 5153Individual or multiple and make its deflection, to make retaining hole in the time that securing member supporting leg inserts in retaining hole 51525152 diameter increases. In certain embodiments, to being above described further, securing member supporting legThe periphery limiting can be greater than the periphery 5156 of retaining hole 5152, makes to insert week when securing member supporting legIn limit 5156 time, securing member supporting leg can make periphery 5156 expand.

Refer again to Figure 97, in various embodiments, hole 5152 can be limit by deformable member 5153Fixed, wherein each deformable member 5153 can with respect to or be independent of other deformable members 5153Deflection. In at least one this type of embodiment, adjacent deformable member 5153 can be by slit 5154Separately, this slit can allow that each deformable member 5153 is with respect to other deformable members 5153Deflection. In certain embodiments, each slit 5154 can comprise being arranged in and keeps matrix main body 5158First end 5155, lead to the second end of retaining hole 5152 and first end 5155 withExtend between the second end constant or at least width of substantial constant. At various other embodimentIn, the width of each slit 5154 can be inconsistent, and each slit 5154 its first end withWidth between the second end can increase and/or reduce. In certain embodiments, of slit 5154One end 5155 can comprise amplifier section (for example circular portion), and described amplifier section both can be attachedBase portion to the deformable member 5153 that keeps matrix main body 5158 provides tension force to discharge, and also can increaseThe flexibility of deformable member 5153. In various embodiments, deformable member 5153 and/or slit5154 geometry can be selected to deformable member 5153 provides the flexibility of expectation. At someIn embodiment, for example slit 5154 can be lengthened out, to form longer deformable member 5153, and shouldThe comparable deformable member 5153 with shorter length of longer deformable member has more flexibility. At leastIn an embodiment, the width of each deformable member 5153 can be selected to it the soft of expectation is providedProperty. More specifically, there is the comparable deformable structure with thicker width of deformable member of thinner widthPart has more flexibility. Refer again to Figure 97, in certain embodiments, the cantilever of deformable member 5153Be attached to and keep the first end of matrix main body 5158 can be wider than the second end of cantilever. At least oneIn individual this type of embodiment, cantilever can be with linear or at least basic between its first end and the second endThe mode of Linear is tapered.

Refer again to Figure 97, in various embodiments, keep matrix main body 5158 can comprise thering is groupKnit the flat of contact surface 5151 and top surface 5157 or flat material piece at least substantially. ExtremelyIn few this type of embodiment, tissue contacting surface 5151 can be parallel to each other with top surface 5157 orAt least substantially, be parallel to each other. In various embodiments, each deformable member 5153 can comprise firstPart 5153a and Part II 5153b, wherein Part I 5153a can extend along first direction,And Part II 5153b can extend along different directions or second direction. In at least one this type of enforcementIn example, keep matrix main body 5158 can limit plane, and the Part I of deformable member 51535153a can be positioned at this plane. In various embodiments, the Part II of deformable member 51535153b can angularly extend with respect to Part I 5153a. At at least one this type of embodimentIn, Part II 5153b can be along the direction of the top surface 5157 away from maintenance matrix main body 5158Extend, and in certain embodiments, Part II 5153b can be towards the central axis of retaining hole 51525159 assemble. In any case, in various embodiments, when securing member supporting leg is through Part II5153b and while being inserted into, Part II 5153b can be away from central axis 5159 deflections. ThereinThe nail leg 5021 of nail 5020 inserts in the embodiment in retaining hole 5152, and deformable member 5153 canAlong the Direction distortion away from nail 5120 base portion 5122 roughly. Therefore, in certain embodiments, canDeformation element 5153 can be along identical or at least substantially the same with the direction that is inserted into of nail leg 5021 largeCause direction deflection.

Refer again to figure BD, in various embodiments, the Part II of deformable member 51535153b for example can comprise sharp end separately, and described sharp end can be worked as nail leg 5021 and be insertedWherein time, described end slides against nail leg 5021. If nail leg 5021 in opposite direction (,The direction that nail leg 5021 is removed from retaining hole 5052) be pulled the point of Part II 5153bSharp end also can interlock to following closely in leg 5021. In some cases, Part II 5153b can be relativeTilt to be greater than the angle of 90 degree in the limit of nail leg 5021, therefore when nail leg 5021 is subject to being tending towards from keepingWhile withdrawing from the power of nail leg 5021 in hole 5052, Part II 5153b can dig or be dug into nail leg 5021Limit in. In certain embodiments, nail leg 5021 can comprise on its surface impression and/or concavity(for example micro-indentations), described impression and/or concavity can for example be held deformable member therein5053 end. In at least one this type of embodiment, when nail leg 5021 is applied while withdrawing from power,The end of deformable member 5053 can be confined in or be dug in the impression of nail leg 5021. In various enforcementIn example, because Part II 5153b is dug in nail leg 5021, for remove nail from retaining hole 5022The leg 5021 and power of effect can only be seated to Part II 5153b the more depths of nail in leg 5021 alsoIncrease the power that nail leg 5021 is expected that removes. In addition, due to Part II, 5153b is inclined upwardly, thereforeIn at least one embodiment, Part II 5153b can more allow that nail leg 5021 inserts retaining holeIn 5152 and more withdrawing from of opposing nail leg 5021. Therefore, at least one embodiment, will follow closely leg5021 power of inserting expectation in retaining hole 5022 can be less than to remove from retaining hole 5022 follows closely leg 5021The power of expecting. In various embodiments, for example from retaining hole 5022, removing nail leg 5021 expectsPower is comparable inserts by nail leg 5021 power about 50% of expecting in retaining hole 5022. In various other realitiesExecute in example, for example, remove the power that the comparable insertion nail of the power expected of nail leg 5021 leg 5021 expects aboutBetween 10% to about 100%. In certain embodiments, for example removing the power expected of nail leg 5021 canFor inserting about 100%, about 150%, about 200% and/or ratio of the power expected of nail leg 5021Insert the power about 200% that nail leg 5021 is expected.

Refer again to Figure 97, in certain embodiments, Part II 5153b can be around 5152 edges, holeCircumference setting also can limit pit between Part II 5153b and hole 5152. More specifically, secondPart 5153b can limit pit 5160, and this pit can be worked as securing member supporting leg and is inserted into retaining hole 5152When middle, pit 5160 holds the end of securing member supporting leg. In various embodiments, deformable member5153 Part II 5153b can comprise annular or at least substantially annular profile, described profileFor example can limit collaboratively the annular of pit 1560 or the profile of annular at least substantially. At least oneIn individual this type of embodiment, Part II 5153b can limit pit taper or truncated cone shape. VariousIn embodiment, pit can be limited by the deformable member of suitable number, for example four deformable members5153(Figure 97), six deformable member 5153(Figure 98) or eight deformable members 5153(Figure 99). Referring now to Figure 100,, in certain embodiments, keep matrix (for example to keep matrix5250) deformable member for example can form cone shape or at least be essentially the shape of cone. ?In various embodiment, keep matrix 5250 for example can comprise multiple retaining holes (for example retaining hole5252), described multiple retaining hole can be limited by periphery 5256. In various embodiments, periphery5256 can comprise polygonal or be at least essentially polygonal profile and/or other suitable outsideShape. In certain embodiments, keep matrix 5250 can comprise one or more retaining members (for example guarantorHold member 5253), described one or more retaining members extend in hole 5252 and can work as fasteningIn part supporting leg patchhole 5252 time, described hole 5252 engages this securing member supporting leg. At at least one thisIn class embodiment, towards central axis 5259(each retaining member 5253 can comprise, towards hole 5252Center) cantilever that extends internally. In various embodiments, each cantilever can comprise first end andThe second end, described first end is attached to and keeps matrix main body 5258, and described the second end forms guarantorHold the periphery 5256 in hole 5252. In certain embodiments, the periphery 5256 of retaining hole 5252 can be byThe first diameter or width limit, and securing member supporting leg can limit by Second bobbin diameter or width, Qi ZhongsuoState Second bobbin diameter and can be greater than described the first diameter. In at least one this type of embodiment, securing member supporting legCan contact one or more in retaining member 5253 and make its deflection, to insert at securing member supporting legWhile entering in retaining hole 5252, make the diameter of retaining hole 5252 increase. In certain embodiments, to aboveBe described further, the periphery that securing member supporting leg limits can be greater than the periphery of retaining hole 52525256, make in the time that securing member supporting leg inserts in periphery 5256, securing member supporting leg can make periphery 5256Expansion.

Refer again to Figure 100, in various embodiments, hole 5252 can be limit by deformable member 5253Fixed, wherein each deformable member 5253 can with respect to or be independent of other deformable members 5253Deflection. In at least one this type of embodiment, adjacent deformable member 5253 can be by slit 5254Separately, slit 5254 can allow that each deformable member 5253 is with respect to other deformable members5253 deflections. In various embodiments, keep matrix main body 5258 can comprise thering is the contact of organizing tableFace 5251 and top surface 5257 flat or at least substantially flat material piece. At at least one thisIn class embodiment, tissue contacting surface 5251 can be parallel to each other with top surface 5257 or be at least basicOn be parallel to each other. In various embodiments, each deformable member 5253 can comprise Part I5253a and Part II 5253b, wherein Part I 5253a can extend along first direction, and theTwo part 5253b can extend along different directions or second direction. In at least one this type of embodiment,Keep matrix main body 5258 can limit plane, and the Part I 5253a of deformable member 5253Can be positioned at this plane. In various embodiments, the Part II 5253b of deformable member 5253 canWith respect to Part I, 5253a angularly extends. In at least one this type of embodiment, secondDivide 5253b to extend along the direction of the top surface 5257 away from keeping matrix main body 5258, andIn certain embodiments, Part II 5253b can be towards 5259 meetings of the central axis of retaining hole 5252Poly-. In any case, in various embodiments, Part II 5253b can work as securing member supporting legWhile being inserted into through Part II 5253b, Part II 5253b can scratch away from central axis 5259Bent. Refer again to Figure 100, in certain embodiments, Part II 5253b can be around 5252 edges, holeCircumference setting also can limit pit between Part II and hole. More specifically, Part II 5253bCan limit pit, in the time that securing member supporting leg is inserted in retaining hole 5252, described pit can hold tightlyThe end of firmware supporting leg. In various embodiments, the Part II 5253b example of deformable member 5253As limited polygon or at least be essentially polygonal pit. In various embodiments, pit canDeformable member by suitable number limits, for example, can limit foursquare four deformable members 5253(Figure 100), can limit hexagonal six deformable member 5253(Figure 101), maybe can limitOctagonal eight deformable member 5253(Figure 102).

Referring now to Figure 103,, in various embodiments, keep matrix (for example, to keep matrix5350) for example can for example, by flat or flat material (, titanium and/or stainless steel) thin slice at least substantiallyForm. In at least one this type of embodiment, can keep matrix by one or more punching coursesIn 5350 main body 5358, form multiple holes 5352. Material piece can be positioned in diel, instituteState mould and some part of material can be stamped out in the time activating, to form for example slit 5354, narrowThe hole 5355 of groove 5354 and/or the periphery 5356 of retaining hole 5352. Diel also can be by canDeformation element 5353 bends to suitable configuration. In at least one this type of embodiment, diel canPart II 5353b is upwards out of shape with respect to Part I 5353a along broken line 5353c. Ginseng nowSee Figure 104, in various embodiments, keep matrix (for example, keeping matrix 5450) for example can wrapDraw together multiple retaining holes 5452. To similar above, the periphery 5456 of each retaining hole 5452 can be by by narrowThe isolated multiple deformable members 5453 of groove or slit 5454 limit. In at least one this type of enforcementIn example, the entirety of each deformable member 5453 all can be bent upwards, comprising deformable memberThe free end of 5453 cantilever can limit periphery 5456. In various embodiments, keep matrix 5450Can comprise around or at least substantially around multiple holes 5455 of retaining hole 5452. At at least one thisIn class embodiment, hole 5455 can around or surround by the stiff end of the cantilever of deformable member 5453 and limitFixed periphery and be arranged to circular array. In certain embodiments, each hole 5455 can comprise circleOr circular periphery and/or any other suitable periphery at least substantially. In use, hole 5455Both the base portion that can be the deformable member 5453 that is attached to maintenance matrix main body 5458 provides tension force to releasePut, can increase again the flexibility of deformable member 5453. In various embodiments, larger hole 5455Can make deformable member 5453 have more flexibility compared with less hole 5455. In addition, more close variableThe hole 5455 of shape member 5453 can provide larger flexibility compared with farther hole 5455.

Referring now to Figure 105,, in various embodiments, keep matrix (for example, to keep matrix5550) for example can comprise multiple retaining holes 5552. Each retaining hole 5552 all can comprise elongated slot5554, this elongated slot has the circular of amplification or circular end 5555 at least substantially. At leastIn this type of embodiment, end 5555 can be limited by the diameter that is wider than slit 5554. Real at someExecute in example, elongated slot 5554 and end 5555 longitudinally axis 5559 are located and/or between two parties.In various embodiments, slit 5554 and end 5555 can limit two relative inserted sheets 5553, instituteState the leg that two relative inserted sheets 5553 can jointing fastener, and at securing member supporting leg through inserted sheet5553 and while being inserted into, deflections can occur described two relative inserted sheets 5553. Real at least oneExecute in example, the end 5555 with larger girth or diameter can limit longer inserted sheet 5553, described inThe inserted sheet 5553 that the comparable end 5555 with less girth or diameter of inserted sheet 5553 limits has more softProperty. In various embodiments, end 5555 can have identical girth and diameter, and at least oneIn individual this type of embodiment, each inserted sheet 5553 can be about vertical with longitudinal axis 5559 or at least basicUpper vertical axis symmetry. Alternatively, end 5555 can have different girths and/Or diameter, wherein at least one embodiment, each inserted sheet 5553 can be not in relation to its axis symmetry.At at least one in this type of alternative embodiment, when securing member supporting leg is through retaining hole 5552 and quiltWhen insertion, inserted sheet 5553 can be around its axis distortion. Referring now to Figure 106,, in various embodiments,Keep matrix (for example, keeping matrix 5650) for example can comprise multiple retaining holes 5652. Each guarantorHold hole 5652 and all can comprise elongated slot 5654, this elongated slot comprises circle or at least substantially roundThe end 5655 of shape. In at least one this type of embodiment, elongated slot 5654 and end 5655 canLongitudinally axis 5659 is located and/or between two parties. In various embodiments, each end 5655 all can be byThe diameter identical or at least substantially the same with the width of slit 5654 limits.

Referring now to Figure 107,, in various embodiments, keep matrix (for example, to keep matrix5750) for example can comprise multiple retaining holes 5752. Each retaining hole 5752 can comprise having the end of amplificationMultiple slits (for example slit 5754) of end 5755. In at least one this type of embodiment, slit5754 and end 5755 longitudinally axis 5759 locate and/or between two parties. In various embodiments, axleLine 5759 can along perpendicular to or extend transverse to direction each other. In certain embodiments, slit5754 and end 5755 can for example limit four inserted sheets 5753, described four inserted sheets 5753 can engageSecuring member supporting leg, and in the time that securing member supporting leg is inserted into through retaining hole 5752, insert for described fourThere is deflection in sheet 5753. In at least one embodiment, each inserted sheet 5753 can comprise leg-of-muttonOr be at least essentially leg-of-mutton configuration (for example equilateral triangle). Referring now to Figure 108,,In various other embodiment, keep matrix (for example keeping matrix 5850) for example can comprise multiple maintenancesHole 5852. Each retaining hole 5852 can comprise multiple slits (for example slit with end 58555854), wherein slit 5854 and end 5855 longitudinally axis 5859 locate and/or between two parties.In various embodiments, axis 5859 can along perpendicular to or extend transverse to direction each other. At someIn embodiment, slit 5854 and end 5855 can limit inserted sheet 5853, and inserted sheet 5853 can engageSecuring member supporting leg, and in the time that securing member supporting leg is inserted into through retaining hole 5852, inserted sheet 5853There is deflection. In at least one embodiment, each inserted sheet 5853 can comprise arc profile. Have moreBody ground, different from the sharp end shown in Figure 105, each inserted sheet 5853 can comprise bending endEnd, described end can touch fastener supporting leg.

Referring now to Figure 109,, in various embodiments, keep matrix (for example, to keep matrix5950) for example can comprise multiple retaining holes 5952. Each retaining hole 5952 can comprise multiple slits(for example slit 5954), wherein each slit 5954 can extend and/or between two parties along axis 5959. ?In various embodiment, axis 5959 can be transverse to each other, and at least one this type of embodiment,Axis 5959 can be configured such that all axis 5959 extend through the center of retaining hole 5952 and thatThis equidistantly or at least substantially equidistantly spaced apart. In at least one embodiment, each slit5954 can comprise towards the openend at the center of retaining hole 5952 and be positioned at the end relatively of slit 5954Or the closed ends 5955 at end place. To similar above, slit 5954 and end 5955 can for example be limitFixed three inserted sheets 5953, described three inserted sheets 5953 can jointing fastener supporting leg, and when fasteningWhen part supporting leg is inserted into through retaining hole 5952, there is deflection in described three inserted sheets 5953. RespectivelyIn kind of embodiment, each inserted sheet 5953 can be included between the adjacent end 5955 of slit 5954 and extendArcuate configuration. Referring now to Figure 110,, in various embodiments, keep matrix (for example, to keepMatrix 6050) for example can comprise multiple retaining holes 6052. Each retaining hole 6052 can comprise inserted sheet6053, described inserted sheet can jointing fastener supporting leg, and is inserted into retaining hole when securing member supporting legIn 6052 time, there is deflection in inserted sheet 6053. In at least one this type of embodiment, inserted sheet 6053 canComprise be fixed to keep the base portion of matrix main body 6058 and comprise arc or curved profile 6056 fromBy holding, described free end can touch fastener supporting leg. In certain embodiments, securing member supporting leg canThe nail leg that the circular wire rod of serving as reasons forms, wherein bending profile 6056 can with the bending of circular wire rod outsideSurface matching or at least substantially coupling.

Refer again to Figure 110, in various embodiments, keep matrix main body 6058 to comprise multiple narrowGroove 6054 and hole 6055, described multiple slits 6054 and hole 6055 can limit inserted sheet 6053 and protectHold the various piece in hole 6052. In at least one embodiment, inserted sheet 6053 can comprise rectangle structureType, described rectangular configuration comprises parallel or at least substantially parallel limit. Referring now to Figure 111,,In certain embodiments, keep matrix (for example keeping matrix 6150) for example can comprise multiple retaining holes6152. Each retaining hole 6152 can comprise inserted sheet 6153, and this inserted sheet can jointing fastener supporting leg,And in the time that securing member supporting leg is inserted in retaining hole 6152, this inserted sheet generation deflection. At at least oneIn this type of embodiment, inserted sheet 6153 can comprise the base portion and the bag that are fixed to maintenance matrix main body 6158Draw together free end arc or curved profile 6156, described free end can touch fastener supporting leg. RespectivelyPlant in embodiment, keep matrix main body 6158 can comprise multiple slits 6154 and hole 6155, described manyIndividual slit 6154 and hole 6155 can limit the various piece of inserted sheet 6153 and retaining hole 6152. ?In at least one embodiment, inserted sheet 6153 can comprise tapered configuration, described tapered structureType comprises arc limit. In at least one this type of embodiment, where inserted sheet 6153 can severally become graduallyCarefully, for example make base portion be wider than free end.

In various embodiments, as mentioned above, fastening system can comprise multiple nails, described multiple nail bagsDraw together the nail leg being inserted into through keeping the multiple retaining holes in matrix. In certain embodiments, as followsLiterary composition is described in more detail, and nail can be maintained in the first jaw, and keeps matrix to be maintained atIn the second jaw, wherein at least one in the first jaw and the second jaw can move towards another one. ?In various situations, the nail that is arranged in the first jaw can be fixed on wherein, makes when keeping matrix and nailWhen leg engages, nail leg aligns with retaining hole. Referring to Figure 112 and Figure 113, in certain embodiments,Closure system can comprise the nail bin 6200 of the first jaw that is for example arranged in surgical stapling device and for exampleBe arranged in the maintenance matrix 6250 of the second jaw of surgical stapling device. Referring now to Figure 119 and Tu,120, to being described further, keep matrix 6250 can comprise multiple retaining holes 6252 above, itsIn each retaining hole 6252 can comprise the periphery being limited by one or more deflection members 62536256. In at least one this type of embodiment, to being above described further, each for limitingThe deflection member 6253 in hole 6252 can limit pit 6201. In various embodiments, each pit6201 can comprise for example bending and/or concave surface, and described bending and/or concave surface for example can beNail leg is unjustified with retaining hole 6252 and first contact deflection member 6253 and/or tissue contacting surfaceIn 6251 situation, the end of nail leg is guided in hole 6252.

In various embodiments, to being above described further, fastening system also can comprise multiple nails6220, described multiple nails 6220 comprise and can be inserted through keeping the retaining hole 6252 in matrix 6250The nail leg 6221 entering. In at least one this type of embodiment, each nail 6220 can comprise for example basicThe upper configuration for U-shaped, described configuration comprises base portion 6222, described nail leg 6221 can be from base portion 6222Upwards extend. Referring now to Figure 115 and Figure 116,, in various embodiments, keep in matrix 6250Retaining hole 6252 can be arranged to for example two parallel or at least substantially parallel stringers, described inStringer can be along keeping the longitudinal axis of matrix or being parallel to described longitudinal axis extension. At some embodimentIn, the retaining hole 6252 in first row can be setovered or mistake with respect to the retaining hole 6252 in second rowRow. In at least one this type of embodiment, each nail 6220 can comprise the retaining hole that is positioned at first rowIn 6252 first are followed closely leg 6221 and are arranged in the second nail leg of the retaining hole 6252 of second row6221, therefore base portion 6222 can extend along the direction of the longitudinal axis across keeping matrix 6250. ?In at least one this type of embodiment, nail 6220 can be parallel to each other or at least substantially be parallel to each other. Have moreBody ground, the base portion 6222a that for example follows closely 6220a can be parallel to or at least substantially parallel to nail 6220bBase portion 6222b, the base portion 6222b of described nail 6220b can be parallel to or at least substantially parallel toThe base portion 6222c of nail 6220c. In at least one embodiment, for example follow closely the nail leg 6221a of 6220aThe plane limiting can be parallel to or limit at least substantially parallel to the nail leg 6221b of nail 6220bPlane, and the plane that limits of nail leg 6221b of nail 6220b can be parallel to or at least substantiallyBe parallel to and follow closely the plane that the nail leg 6221 of 6220c limits.

Referring now to Figure 112 and Figure 114,, in various embodiments, nail bin 6200 can comprise multiple nails6220 and comprise the alignment matrix in multiple alignment guide (for example, slit, groove and/or hole)6260, described multiple alignment guide can be alignd and be followed closely 6220. In all cases, alignment matrix6260 can make before keeping matrix 6250 jointing nail legs 6221, the nail leg 6221 of nail 6220Align with the retaining hole 6252 in maintenance matrix 6250. Referring now to Figure 117 and Figure 118,, respectivelyPlant in embodiment, alignment matrix 6260 can comprise multiple aligned holes 6262, described multiple aligned hole energyEnough nail legs 6221 that closely holds nail 6220. In at least one this type of embodiment, each nail6220 two nail legs 6221, the wherein nails that can comprise base portion 6222 and extend from base portion 62226220 base portion 6222 can extend around the lower surface 6264 that keeps matrix 6260, and nail leg6221 can upwards extend through aligned hole 6262. In certain embodiments, each aligned hole 6262Can be circularly or at least substantially circular, and the diameter that limits aligned hole 6262 can equal or slightlyBe greater than through wherein and the diameter of nail leg 6221 extending. In various embodiments, alignment matrix6260 also can comprise the member 6263 of multiple projections, and the member of described multiple projections can be from alignment matrix6260 top surface 6261 upwards extend and around or at least in part around aligned hole 6262. ?In some embodiment, the member 6263 of projection can provide longer aligned hole 6262, wherein variousIn situation, the hole 6262 that longer hole 6262 can the be shorter alignment of control nail leg 6221 better.

In use, in various embodiments, the first jaw that supports nail bin 6200 can be positioned at quiltIn one side of the tissue of sewing up, and support keeps the second jaw of matrix 6250 can be positioned in tissueOpposite side on. In certain embodiments, once jaw be properly positioned with respect to tissue,Two jaws and maintenance matrix 6250 can move towards nail bin 6200. In various embodiments, when nail leg6221 while being inserted into, keep the group of matrix 6250 through keeping the retaining holes 6252 of matrix 6250Knitting contact surface or lower surface 6251 can contact tissue and tissue is pressed against to alignment matrix 6260On tissue contacting surface or top surface 6261. In various other embodiment, as below will be more detailedGround is described, and nail bin 6200 also can for example comprise top surface 6261 tops that are positioned at alignment matrix 6260And compressible warehouse that can contact tissue. Refer again to Figure 114 and Figure 118, at some embodimentIn, alignment matrix 6260 also can comprise and is limited to one or more hole 6203; When alignment squareWhen battle array 6260 is located against tissue, described one or more holes can hold of tissue thereinPoint. Compressible warehouse is positioned at alignment matrix 6260 tops and/or against alignment matrix 6260 thereinIn embodiment, in the time that warehouse is compressed, a part for compressible warehouse can enter in hole 6203. SimilarGround, keeps matrix 6250 can comprise multiple holes 6202, when keeping matrix 6250 to locate against tissueTime, described multiple holes 6202 can hold at least a portion of tissue therein.

To being above described further, when nail 6220 nail leg 6221 is through keeping matrix 6250Retaining hole 6252 and while being inserted into, the end of nail leg 6221 can be from keeping the top surface of matrix 62506257 to upper process. In all cases, as mentioned above, the end of nail leg 6221 can pass guarantorHold hole 6252 and after being inserted into, keep not bending. Referring now to Figure 121-124,, at some embodimentIn, comprise nail bin 6200 and keep the fastening system of matrix 6250 can comprise multiple protective caps or lid(for example cap 6270), described multiple protective caps or lid can be mounted to be projected on and keep on matrix 6250The nail leg 6221 of side. In various embodiments, each cap 6270 can cover completely or at least in partThe sharp-pointed end of nail leg 6221, makes described sharp-pointed end can not contact the tissue being adjacent. NowReferring to Figure 124, at least one embodiment, each cap 6270 can comprise the hole being limited to wherein6271, this hole can closely hold the end of following closely leg 6221 therein. In various embodiments, cap6270 can for example, by elastomeric material (siloxanes, polyisoprene, Sanoprene and/or natural rubberGlue) form. In at least one embodiment, the girth in hole 6271 or diameter can be less than insertion whereinGirth or the diameter of nail leg 6221. In at least one this type of embodiment, the hole in protective cap 62706271 can expand to hold therein nail leg 6221. In various alternative embodiment, cap6270 can not comprise hole, and in the time that leg 6221 inserts cap 6270, the end of nail leg 6221 canCut cap 6270. In any case, in various embodiments, each cap 6270 all can be placedTo following closely on leg 6221, until base portion 6272 adjacency or the contiguous top that keeps matrix 6250 of cap 6270Portion surface 6257 and locating. In all cases, cap 6270 can make it be closely seated toOn the end of nail leg 6221, so that it can not be removed from described end easily. In some enforcementIn example, each cap 6270 can for example comprise taper or the outer surface of taper at least substantially. VariousIn embodiment, cap 6270 can comprise any suitable shape, for example, comprise parabola shaped or at least basicThe shape of upper parabola shaped outer surface.

In various embodiments, for example can dispose with the surgical stapling device shown in Figure 125-127For example above-mentioned closure system. In various embodiments, end effector can comprise the first jaw or nailStorehouse passage 6230 and the second jaw 6240, the first jaws or nail bin passage 6230 can be by nail bins 6200Be supported on wherein, and the second jaw 6240 can support maintenance matrix 6250 and described multiple protectionCap 6270. First referring to Figure 125, it illustrates the second jaw 6240 in opening configuration, jaw6230 and 6240 can be positioned such that tissue T is positioned at maintenance matrix 6250 and nail with respect to tissue TBetween storehouse 6200. In various embodiments, as mentioned above, nail bin 6200 also can comprise compressible storehouseBody (for example warehouse 6210), can be positioned with nail 6220 and alignment matrix in described compressible warehouse6260. In at least one this type of embodiment, tissue T can be against the top surface of warehouse 6210 andLocation. In certain embodiments, the second jaw 6240 can comprise multiple depressed parts or hole 6245 andOne or more holding structures or retainer, described multiple depressed parts or hole 6245 can hold multiple guarantorsHelmet 6270, and described one or more holding structure or retainer can will with respect to cap 6270Keep matrix 6250 to be held in place. In at least one this type of embodiment, maintenance matrix 6250 canCap 6270 is remained in hole 6245. Referring now to Figure 137,, in various embodiments, Mei Gekong6245 all can be contained in part or all of cap 6270 wherein. In certain embodiments, hole6245 size is sufficiently set for and can for example be made can be by being press-fitted and/or snap fit is tiedAt least one in structure is fixed on cap 6270 in hole 6245. In certain embodiments, can utilize extremelyFew a kind of adhesive is fixed on cap 6270 in hole 6245. In at least one this type of embodiment,This type of adhesive can be selected such that cap 6270 jointing nail legs 6221 and the second jaw 6240 away fromAfter the fastener assembly motion of having implanted, cap 6270 can separate with the second jaw 6240. Ginseng nowSee Figure 138, in certain embodiments, the second jaw 6240 also can comprise at least one emulsion sheet6246, described at least one emulsion sheet can be assembled to the second jaw 6240 and can above cap 6270, prolongStretch and cap 6270 is remained in hole 6245. In at least one this type of embodiment, for example, can utilizeAt least a portion of emulsion sheet 6246 is fixed to jaw 6240 by least one adhesive. UsingIn, at least one embodiment, before end effector is inserted into operative site, emulsion sheet6246 can separate with jaw 6240 at least in part. In certain embodiments, emulsion sheet 6246 can be byImplanted material (for example PDS and/or PGA) forms, when nail leg 6221 is from keeping matrix 6250When demonstration, described implanted material can be cut by nail leg 6221. In at least one this type of embodiment,Emulsion sheet 6246 can and keep at lid 6270 being fixed in fastening system between matrix 6250.

Referring now to Figure 126,, to being above described further, jaw 6240 can be transported from open positionMove closing position, in closing position, tissue T is against keeping matrix 6250 and warehouse 6210Location. In this type of position, keep not jointing nail 6220 of matrix 6250. At various embodimentIn, jaw 6240 can be transported by actuator 6235 between its open position and its closing positionMoving. In at least one this type of embodiment, jaw 6240 can comprise the distal pin 6243 from its extensionWith proximal pin 6244, wherein distal pin 6243 can be at the distally slit being limited in storehouse passage 6230In 6233, vertically or at least substantially perpendicularly slide, and wherein proximal pin 6244 can be equallyBe limited in the nearside slit 6234 in nail bin passage 6230 and vertically or at least substantially perpendicularly slideMoving. In use, actuator 6235 can be towards proximal retraction, so that pin 6243 and 6244 is urged to itIn the upper end of corresponding slit 6233 and 6234, as shown in Figure 126. In at least one this type of enforcementIn example, actuator 6235 can comprise that distally drives slit 6236 and nearside to drive slit 6237, whereinDrive slit 6236 can contact respectively distal pin 6243 and proximal pin 6244 with 6237 sidewall,And at actuator 6235 drive pin 6243 and 6244 upwards during towards proximal movement. More specifically, when causingMoving device 6235 is during towards proximal movement, distal pin 6243 can make distally drive slit 6236 inclination thePart 6236a upward sliding is to mid portion or Part II 6236b; Similarly, proximal pin6244 can make distally drive the Part I 6237a upward sliding of inclination of slit 6237 to pars intermediaPoint or Part II 6237b in. When pin 6243 and 6244, both all move upward, jaw 6240Can be rotated down to closing position towards tissue T.

Referring now to Figure 127,, to being above described further, actuator 6235 can be further towards closelySide is pulled, with promote downwards towards the first jaw 6230 the second jaws 6240, compression warehouse 6210,And make to keep matrix 6250 and multiple protective cap 6270 to engage with the nail leg of nail 6220. At at least oneIn this type of embodiment, the additional proximal movement of actuator 6235 can make to drive slit 6236 and 6237Respectively contact plug 6243 and 6244 of sidewall, and downward towards the bottom of slit 6233 and 6234 respectivelyDrive pin 6243 and 6244. In this case, actuator 6235 can be pulled towards nearside, makesDistal pin 6243 is left and is driven the Part II 6236b of slit 6236 and enter the Part III of inclination6236c, and similarly, proximal pin 6244 leave drive slit 6237 Part II 6237b alsoEnter the Part III 6237c of inclination. When pin 6243 and 6244, both all move downward, secondJaw 6240 can move downward to firing position towards the first jaw 6230. In at least one this type of enforcementIn example, the second jaw 6240 can move downward, and makes to keep matrix 6250 to remain parallel to or at leastBe arranged essentially parallel to the top surface of warehouse 6210 and/or be parallel to or at least substantially parallel to alignmentMatrix 6260. In any case, once keep matrix 6250 and protective cap 6270 jointing nails 6220Nail leg 6221, as shown in Figure 129, the second jaw 6240 can be back to open or base at leastThe position of opening in basis. In at least one this type of embodiment, actuator 6235 can be pushed away towards distallyMoving, pin 6243 and 6244 is urged to respectively to the end of slit 6233 and 6234, and subsequentlyOnce pin is through corresponding mid portion 6236b and the 6237b that drives slit 6236 and 6237,Actuator 6235 is driven downwards towards the bottom of slit 6233 and 6234. Once the second jaw 6240Be opened, the first jaw 6230 can separate with the nail bin 6200 of implanting, and the first jaw6230 and second jaw 6240 can remove from the fastener assembly of having implanted, as shown in Figure 128.

Refer again to Figure 127, keep matrix 6250 and cap 6270 to engage although reader it should be noted thatNail leg 6221, but pin 6243 and 6244 is not depicted as and is placed in its respective slots in figureIn 6233 and 6234 bottommost. When thick tissue T be positioned at keep matrix 6250 and warehouse 6210 itBetween time can there is this situation. Referring now to Figure 130,, be positioned at maintenance matrix compared with thin tissue T therein6250 and warehouse 6210 between situation in, pin 6243 and 6244 can further be driven downwards toIn its corresponding slit 6233 and 6234, as shown in Figure 132. In general, at least one thisIn class embodiment, actuator 6235 can be pulled towards nearside, so that by above-mentioned and Figure 130-132The process of showing is come upwards and downward drive pin 6243 and 6244, and because tissue T is thinner, keepsMatrix 6250 and protective cap 6270 can further be driven on the nail leg 6221 of nail 6220, as figure133 and Figure 134 shown in. In various embodiments, due to the capable of regulating that keeps matrix 6250 to provideProperty, the tissue no matter being captured in end effector is thick or thin, all can be in fastening groupKnit the identical or at least substantially the same compression pressure of middle acquisition. In certain embodiments, keep squareThe battle array 6250 adjustable tolerable surgeons that provide keep matrix 6250 to be placed by selectionThe degree of depth select tissue to apply the compression pressure that larger compression pressure is still less. At least oneIn individual this type of embodiment, the scope that keeps matrix 6250 can be seated on nail leg 6221 for example can be led toCrossing length or the scope of slit 6233 and 6234 determines.

In various embodiments, as mentioned above, protective cap 6270 can be by for example can promptly following closely legSoft or the flexible material formation of 6221 end. In certain embodiments, protective cap 6270Can by plastics that can bio-absorbable (polyglycolic acid (PGA) for example sold with trade name Vicryl,PLA (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom(PHA), with trade name Monocryl sell Poliglecaprone 25(PGCL), polycaprolactone(PCL) and/or the compound of PGA, PLA, PDS, PHA, PGCL and/or PCL)And/or biocompatibility metal (for example titanium and/or stainless steel) forms. As shown in Figure 124, extremelyIn a few embodiment, each cap 6270 can be not attached to other caps 6270. In some other enforcementIn example, one or more caps 6270 can be mounted to and keep matrix 6250. At at least one, this type of is realExecute in example, cap 6270 can be for example connected to and be kept matrix 6250 by least one adhesive, whereinCan align with the retaining hole 6252 in maintenance matrix 6270 or be at least basic in hole 6271 in cap 6270Upper alignment. Referring now to Figure 135,, in various embodiments, protective cap (for example cap 6370) for exampleCan limit inner chamber or fornix 6374, inner chamber or fornix 6374 for example can hold the end of nail leg 6221Be contained in wherein. In at least one this type of embodiment, cap 6370 can comprise bottom 6372 and extension wearCross the hole 6371 of bottom 6372. In various embodiments, hole 6371 can be by one or more deflectionsMember 6373 limit, when nail leg 6221 is when being wherein inserted into, described one or more canCan there is deflection in the member 6373 of deflection. In certain embodiments, for example two or more caps6370 can be joined together to form the array of cap 6370. Referring now to Figure 136,, at least one thisIn class embodiment, multiple caps 6370 can link together by material piece 6375. In some enforcementIn example, sheet 6375 can have enough rigidity to keep arrangement and/or the alignment of the expectation of cap 6370Mode. In at least one embodiment, cap 6370 can by biocompatibility metal (for example titanium and/orStainless steel) form, and sheet 6375 can be by plastics that can bio-absorbable (for example, with trade name VicrylPolyglycolic acid (PGA), PLA (PLA or PLLA), the PPDO sold(PDS), polyhydroxyalkanoatefrom (PHA), with trade name Monocryl sell Poliglecaprone25(PGCL), polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA,The compound of PGCL and/or PCL) form. In various embodiments, sheet 6375 can be by whereinStorage and/or be dispersed with antiseptic (for example collargol and/or triclosan) can bio-absorbable materialForm, for example, at sheet 6375 during by bio-absorbable, described antiseptic can be released.

In various embodiments, to being described further, for example, can utilize injection moulding process by sheet above6375 injection mouldings, around cap 6370, are embedded in sheet 6375 cap 6370. At some, other are realExecute in example, for example, can utilize injection moulding process to carry out molded tablet 6375, wherein for example during injection moulding process and/ or injection moulding process after, can utilize process for stamping in sheet 6375, to form hole 6376. In any feelingsIn shape, can by cap 6370 patchholes 6376 and utilize be press-fitted and/or snap fit interconnecting method and/orAt least one adhesive is fixed in hole 6376. In certain embodiments, each cap 6370 canComprise around or at least in part around the ring-shaped groove of cap 6370 peripheries, described ring-shaped groove can be byThe periphery in hole 6376 is contained in wherein. In certain embodiments, sheet 6375 can be by allowing capFlexibility and/or the pliable material of between 6370, carrying out relative motion form. In at least one this type of enforcementIn example, flexible sheets 6375 can be made up of for example rubber, plastics and/or silicone compositions, and cap6370 can for example, be made up of rigid material (metal). In at least one this type of embodiment, with aboveSimilar, flexible material can be overmolded to around cap 6370. In certain embodiments, for example can be by cap6370 are pressed in molded in advance sheet 6375. In various embodiments, can be by flexible material hardThe rigidity that provides sheet 6375 to expect is provided degree. In certain embodiments, sheet 6375 can be configured toComprise flexible band. In any case, sheet 6375 can be conducive to that cap 6370 is assembled to end and holdsIn row device, this is because can multiple caps 6370 be located and/or are aligned in end effector simultaneously.In addition, once implanted for the sheet 6375 of attachment cap 6370, can be for example strengthen along nail row orSupport nail. Except the thin slice for attachment cap 6370 or as described thin slice substitute, cap 6370Can link together by multiple chain links. In at least one this type of embodiment, this type of chain link can be softProperty and tolerable cap 6370 between carry out relative motion.

Referring now to Figure 139 and Figure 140,, in various embodiments, protective cap (for example, cap6470) can comprise profiled surface, described profiled surface can make to follow closely the end distortion of leg. At least oneIn individual this type of embodiment, cap 6470 can comprise base portion 6472, and this base portion can comprise and extending through whereinHole 6471. In various embodiments, hole 6471 can be for example, by nail leg (following closely leg 6221) tightBe contained in wherein. In at least one this type of embodiment, the diameter of limiting hole 6471 or girth can waitIn or be greater than diameter or the girth of following closely leg 6221. In various embodiments, cap 6470 also can comprise chamberOr fornix 6474, this chamber or fornix can be worked as nail leg 6221 and be held nail leg while being inserted in cap 64706221 end. First referring to Figure 140, cap 6470 also can comprise anvil block or profiled surface 6473,This anvil block or profiled surface can make to follow closely leg 6221 deflections distortion. In some cases, profiled surface6473 for example can be bending and/or spill, and can work as to follow closely when leg 6221 is inserted into cap 6470 and makeNail leg 6221 is curling. In certain embodiments, nail leg 6221 can be out of shape fully so that it cannotWithdrawn from through hole 6471, therefore cap 6470 can be locked to nail leg 6221. At at least one thisIn class embodiment, the base portion 6472 of cap 6470 can limit around hole 6471 and the antelabium that extends, described inAntelabium can prevent that strained nail leg 6221 is removed from chamber 6474. In all cases, due toMentioned above, one or more caps 6470 can prevent or suppress to keep matrix (for example to keep matrix6250) fall back or depart from from following closely 6220. In various embodiments, although not shown, but cap6470 can form symmetrically or at least substantially symmetrically, and hole 6471 can be along prolonging through cap 6470The central axis 6479 of stretching is located. Refer again to Figure 139, in various alternative embodiment,Can setover with respect to central axis 6479 in hole 6471. In at least one this type of embodiment, biasingHole 6471 tolerable nail legs 6221 contact a side of profiled surface 6473 and are crimped onto profiled surface6473 opposite side, instead of the center of contact profiled surface 6473, as established in above-mentioned comprising between two partiesContingent the same in the embodiment in the hole 6471 of putting.

In various embodiments, as mentioned above, keep the matrix (for example, keeping matrix 6250) can be byMaterial piece and multiple retaining holes 6252 of extending through described material piece form. In at least some enforcementIn example, form and keep the material piece of matrix 6250 can be rigidity or deflection not substantially. At certainIn a little other embodiment, maintenance matrix can be by the array of maintenance matrix element and for connecting described guarantorMultiple flexible connecting members or the chain link of holding matrix element form. Referring now to Figure 141,, in various enforcementIn example, keep matrix or keep a part for matrix 6550 can comprise multiple element bodies 6505, instituteStating multiple element bodies can be linked together by one or more connecting links 6507. Real at least oneExecute in example, each element body 6505 all can comprise multiple deformable members 6553, described multiple canDeformation element can limit retaining hole 6552 therein. In certain embodiments, keep matrix 6550Element body 6505 and connecting link 6507 can form as one and can comprise integral type material block. ?In various embodiment, maintenance matrix 6550 can be for example for example, by metal material (titanium and/or stainless steel)Punching press or casting form. In at least one embodiment, keep matrix 6550 to be formed by plastics, exampleThe polypropylene sold as polyether-ether-ketone (PEEK), with trade name Pu Liling (Prolene), poly-Ester, the PETG of selling with trade name Ethibond and Mersilene, partially poly-Difluoroethylene, polyvinylidene fluoride-altogether-hexafluoropropene, the poly-hexafluoro third of selling with trade name PronovaAlkene-VDF and/or the long-chain fat adoption compound nylon of selling with trade name Ethilon and Nurolon6 and nylon 6,6, and can form by for example injection moulding process. In certain embodiments, element body6505 can not form one with connecting link 6507. In various embodiments, can produce multiple singleElement body 6505, described multiple single element bodies 6505 are joined together and quilt subsequentlyEmbed and keep in matrix. In at least one this type of embodiment, element body 6505 can be by metal material(for example titanium and/or stainless steel) is stamped to form and is placed in plastic injection mould, wherein can will mouldProperty material inject mould with form around or at least in part around the edge of element body 65056506 and the connecting link 6507 that extends from edge 6506. In some other embodiment, oneOr multiple connector dot matrix can be formed and comprise the hole being limited in multiple edges 6506, wherein eachThis type of hole all can be contained in element body 6505 wherein. In at least one embodiment, Mei GeyuanPart main body 6505 can comprise circular or at least be essentially circular neighboring; Similarly, Mei GebianIn edge 6506, can be limited with circular or at least be essentially circular hole, the diameter in wherein said hole canBe equal to or less than the diameter of element body 6505. In at least one this type of embodiment, element body6505 can be press-fitted or built-in edge 6505 in hole in. In certain embodiments, can utilize at least onePlanting adhesive is fixed on element body 6505 in hole.

In certain embodiments, to being described further, keep matrix can comprise multiple elements aboveMain body 6505 and multiple connecting link 6507, described multiple connecting links 6507 can be any suitableArray (for example, those shown in Figure 142-145) carry out Connection Element main body 6505. No matter arrayPattern why, in various embodiments, connecting link 6507 can allow element body 6505 withRetaining hole 6552 is relative to each other moved. In at least one this type of embodiment, form and keep squareOnce the element body 6505 of battle array 6550 and the dot matrix of connecting link 6507 engage just and can draw with tissueStretch, distortion, collapse and/or in other words deflection, to allow in-house at least some motionsResisted organize is carried out larger motion simultaneously. In various embodiments, each connecting link 6507 can wrapDraw together flexible member, described flexible member can stretching, distortion and/or is collapsed, to for example allow guarantorHold matrix 6550 and keeping deflection between matrix element 6505. Refer again to Figure 141, limit from limitThe width of each chain link 6507 that edge 6506 extends can be narrower than element body 6505 and/or edge 6506Width. Referring to Figure 142-145, in certain embodiments, one or more chain links 6507 can compriseStraight part, described straight part is for example extended along the line between adjacent element body 6506. ExtremelyIn few this type of embodiment, each chain link 6507 can comprise and is attached to first of the first edge 6506End and the second end that is attached to the second edge 6506. Refer again to Figure 141, at some embodimentIn, two or more chain links 6507 can be connected to each other. For example, at least one this type of embodiment,Two or more chain links 6507 can be connected to middle hinge 6509 places. In various embodiments,For example, compared with the tranverse sectional thickness of the tranverse sectional thickness of hinge 6509 and chain link 6507 can be along one or manyIndividual direction reduces, and the connected chain link 6507 of this tolerable relative to each other moves. At some embodimentIn, keep matrix 6550 also can comprise hinge 6508, hinge 6508 can be connected to chain link 6507Edge 6506 and allow chain link 6507 and edge 6506 between relative motion. With hinge 6509 phasesSeemingly, for example, compared with the tranverse sectional thickness of the tranverse sectional thickness of hinge 6508 and chain link 6507 can be along oneOr multiple directions reduce.

In various embodiments, to being above described further, connected chain link 6507 can be along notSame direction is extended. In at least one this type of embodiment, the first chain link 6507 can prolong along first directionStretch, and the second chain link 6507 can extend along second direction, wherein said first direction can be different from instituteState second direction. In certain embodiments, the first chain link 6507 can extend along the first row, and secondChain link 6507 can extend along the second row, wherein said the first row and described the second row can be angled (for exampleAbout 30 degree, about 45 degree, about 60 degree and/or about 90 degree) intersect. In various realitiesExecute in example, hinge 6508 and/or hinge 6509 can comprise hinges, described hinges tolerableChain link 6507 relative to each other repeatedly moves and can not rupture. In certain embodiments, hinge 6508And/or hinge 6509 can comprise the part of frangible or easy fracture, described part frangible or easy fracture canIn the time of excessive deflection and/or the deflection of too much number of times ground, rupture. In at least one this type of embodiment, this type ofOne or more parts that frangible part tolerable keeps matrix 6550 with keep another of matrix 6550Part disconnects. In various embodiments, hinge 6508 and/or hinge 6509 for example can comprise maintenance squareThe section that the ratio of battle array 6550 keeps other parts of matrix 6550 more easily to cut. More specifically, plantThe maintenance matrix entering and can often being cut for various reasons by the fastening tissue of the maintenance matrix of having implantedCut member and cut, and in order to be conducive to carry out this type of crosscut, hinge 6508 and/or hinge 6509 examplesAs approach or thin layer can be provided, cutting element can more easily pass and keep through described approach or thin layerMatrix 6550. In various embodiments, to being above described further, connecting link 6507 canComprise and be for example limited to one or more cast structure or material upsetting, described one or moreCast structure or material upsetting can be conducive to bending, fracture and/or the cutting of connecting link 6507.

In various embodiments, keep matrix can comprise multiple maintenance matrix element (for example, matrix elementsPart main body 6505), described multiple maintenance matrix elements can embed in piece of flexible material or material webs. ?In at least one embodiment, piece of flexible material can for example, by elastomeric material (silica that can bio-absorbableAlkane) form, wherein said flexible flake can produce the multiple holes that are limited to wherein. At at least oneIn this type of embodiment, can be molded into solid flexible flake and form many in described flexible flake middle punchIndividual hole. In various alternative embodiment, can molded flexible flake and form in molding processBe limited to hole wherein. In any situation, keep matrix element 6505 for example can be inserted into and to protectBe held in flexible flake. In some other embodiment, to similar above, flexible flake can be formed atAround matrix element 6505. In at least one embodiment, flexible flake can be for example by woven net and/Or any other suitable material forms. To being above described further, this type of woven net can be easy toCrosscut.

Referring now to Figure 146 and Figure 147,, in various embodiments, comprise and (for example, keep matrixKeep matrix 6250) closure system also can comprise lid (for example, lid 6670), when following closely legWhen 6221 end extends to top surface 6257 top that keeps matrix 6250, described lid can coverDescribed end. In various embodiments, lid 6670 can be attached to and keep matrix 6250. Real at someExecute in example, lid 6670 and/or maintenance matrix 6250 can comprise holding structure, and described holding structure canLid 6670 is remained to and keeps matrix 6250. In at least one embodiment, can utilize at least oneAdhesive adheres to lid 6670 to keep matrix 6250. In at least one embodiment, lid 6670 canFormed by single layer, but lid 6670 is shown as and comprises two layers, as below retouched in more detailState. In various embodiments, first referring to Figure 147, the end of nail leg 6221 is extensible through lid6670 lower surface 6673; But lid 6670 can comprise enough thickness, makes to follow closely end notExtend through the top surface 6675 that covers 6670. Therefore, at least one this type of embodiment, nailThe end of leg 6221 can be from not covering 6670 projections. In various embodiments, lid 6670 can comprise multipleLayer. In at least one this type of embodiment, lid 6670 can comprise ground floor 6671 and the second layer6672. In at least one embodiment, ground floor 6671 and the second layer 6672 can be attached to each other, itsIn at least one embodiment, the second layer 6672 can comprise the bottom table that is attached to ground floor 6671Face 6676. In various embodiments, ground floor 6671 and the second layer 6672 can comprise different thickDegree, and in certain embodiments, it can comprise identical thickness. In at least one embodiment,One deck 6671 can comprise substantially the same width and/or length with the second layer 6672. AvailableEmbodiment in, layer 6671 and 6672 can comprise different width and/or length.

In various embodiments, to being above described further, ground floor 6671 can be by can be byCompressible foam, Web materials and/or hydrogel that nail leg 6211 cuts form. At at least oneIn embodiment, the second layer 6672 can for example, by more tough and tensile material or skin (PGA and/or PDS)And/or any suitable backing material forms. In at least one this type of embodiment, nail leg 6221 energyEnough penetrate ground floor 6671; But in various embodiments, nail leg 6221 possibly cannot penetrate theTwo layer 6672. In certain embodiments, the second layer 6672 can be by having enough elasticity and/or toughnessMaterial forms, and the described material tolerable second layer 6672 is contacted and is shifted by nail legs 6221, but not byThe nail end of nail leg 6221 cuts or is only marginally cut. Although not shown, but lid can wrapDraw together more than two layers, wherein one or more in these layers can be resistance to puncture-proof. At at least oneIn this type of embodiment, in use, keep matrix 6250 can be against tissue location with fastened and towards farSide promotes, and makes to follow closely 6220 nail leg 6221 through tissue T and keeps the retaining hole in matrix 62506252 and be pushed, and enter in the ground floor 6271 that covers 6270. In various embodiments, nail leg6221 end can not enter or at least substantially not enter in the second layer 6272 that covers 6270. ProtectingHold after matrix 6250 is properly positioned, jaw 6240 can be opened, and lid 6670 and keepingMatrix 6250 can separate with jaw 6240, as shown in Figure 146. As shown in Figure 146, jaw 6640Can keep more than one to keep matrix 6250 and lid 6670. In at least one this type of embodiment,Jaw 6640 can comprise two passages 6679, and described two passages 6679 can hold respectively thereinReceive cover 6670 and with respect to lid 6670 location maintenance matrixes 6250, make each maintenance matrix6250 tissue contacting surface 6251 is dangled downwards from the bottom of jaw 6240. At at least one this type ofIn embodiment, keep matrix 6250 and lid 6270 in each side of cutter slit 6678, to be contained in pincersIn mouth 6640. In use, keep matrix 6250 and lid 6670 both can be deployed simultaneously and/orFor example, be deployed in the identical degree of depth with respect to the relative nail bin (storehouse 6200) of locating through itPlace. Subsequently, in various embodiments, can be cut along line of cut by the cutting element that traverses cutter slit 6678Open fastened tissue, wherein jaw 6640 can be opened subsequently again. In certain embodiments, lid6670 can not be attached to maintenance matrix 6250. In at least one this type of embodiment, lid 6670 can quiltBe positioned in passage 6679 and can be by being fixed to the maintenance matrix 6250 of jaw 6640 quiltRemain in passage 6679. In various embodiments, each maintenance matrix 6250 can be wider than and/or be longIn its corresponding lid 6670, make to keep matrix 6250 can be covered 6670 entirety and be held in place.In certain embodiments, for example its corresponding lid 6670 of each maintenance matrix 6250 comprises identicalWidth and/or length.

In various embodiments, as mentioned above, closure system can comprise can be attached to maintenance matrixThe material layer of (for example, keeping matrix 6250). Referring now to Figure 150,, at least one embodimentIn, material layer 6870 can be attached to the lower surface 6251 that keeps matrix 6250. At some embodimentIn, layer 6870 and/or maintenance matrix 6250 can comprise holding structure, described holding structure can be by layer6870 remain to maintenance matrix 6250. In at least one embodiment, can utilize at least one adhesiveLayer 6870 is adhered to and keeps matrix 6250. In any case, layer 6870 can comprise lower surfaceOr tissue contacting surface 6873, lower surface or tissue contacting surface 6873 can be worked as and keep matrix6250 towards nail 6220 move downward so that retaining hole 6252 with follow closely leg 6221 while engaging, lower surfaceOr tissue contacting surface 6873 contact tissue T. In at least one this type of embodiment, layer 6870 canFor example, be made up of the compressible material foam of bio-absorbable (can), described compressible material can be compressedIn keeping between the lower surface 6251 and tissue T of matrix 6250. In various embodiments, layer6870 also can comprise storage and/or be absorbed at least one medicine wherein, described at least one medicineCan in the time that layer 6870 is compressed, from layer 6870, discharge. In at least one embodiment, described medicineCan comprise at least one organize sealant, styptic and/or anti-biotic material (for example ionic silver and/orTriclosan). In various embodiments, the compression of layer 6870 can be extruded medicine from layer 6870, makesTissue T surperficial whole or be coated with at least greatly medicine. In addition, when layer 6870Compressed and nail leg 6221 penetrate tissue T and layer 6870 o'clock, medicine for example can along nail leg 6221 flow downAnd treatment is by the tissue that cut of nail leg 6221. In various embodiments, keep the master of matrix 6250Body can comprise the ground floor for example, being made up of biocompatible materials (titanium and/or stainless steel), and the endLayer 6870 can comprise by can bioabsorbable material (for example oxidized regenerated cellulose (ORC), asBioactivator, the glycerine such as (liquid or be frozen dry) fibrin and/or fibrin ferment, locateAbsorbed pig gelatin and/or such as ionic silver and/or triclosan etc. in fluffy or foam configuration are antibacterialThing) form the second layer. In addition for example can bioabsorbable material can comprise SurgicelNu-Knit,SurgicelFibrillar, taking trade name Promogran sell collagen/ORC(its as with collagen matrixThe mixture of form construction), the polyglycolic acid (PGA) of selling with trade name Vicryl, poly-breastAcid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom(PHA), with trade name Monocryl sell Poliglecaprone 25(PGCL), polycaprolactoneAnd/or the compound of PGA, PLA, PDS, PHA, PGCL and/or PCL (PCL).Although a layer 6870 is only shown in Figure 150, but can use the layer of any suitable number. At leastIn an embodiment, comprise that the ground floor of the first medicine can be attached to maintenance matrix 6250, and compriseThe second layer of the second medicine or different pharmaceutical can be attached to ground floor. At at least one this type of embodimentIn, can use multiple layer, wherein each layer can comprise the different pharmaceutical that is contained in wherein and/or differentDrug regimen.

Referring now to Figure 148,, in various embodiments, closure system can comprise and is attached to maintenance squareThe material layer 6770 of the lower surface 6251 of battle array 6250. In certain embodiments, layer 6770 and/orKeep matrix 6250 can comprise holding structure, described holding structure can remain to maintenance by layer 6770Matrix 6250. In at least one embodiment, can utilize at least one adhesive that layer 6770 is adhered toTo keeping matrix 6250. In any case, layer 6770 can comprise lower surface or organize contact tableFace 6773, lower surface or tissue contacting surface 6773 can be worked as maintenance matrix 6250 towards nail 6220Move downward so that retaining hole 6252 with nail leg 6221 while engaging, lower surface or tissue contacting surface6773 contact tissue T. In at least one this type of embodiment, layer 6770 can be by compressible materialThe foam of bio-absorbable (for example can) forms, and described compressible material can be compressed in maintenance matrixBetween 6250 surface 6251 and tissue T. In various embodiments, layer 6770 also can comprise oneOr multiple capsules or born of the same parents 6774, described one or more capsules or born of the same parents 6774 can store at least one thereinPlant medicine. Referring to Figure 149, in certain embodiments, capsule 6774 can align with retaining hole 6252 orAt least substantial alignment, makes in the time that nail leg 6221 is pushed through tissue T and layer 6770 nailLeg 6221 can pierce through capsule 6774 and/or in other words make capsule 6774 break. Break it at capsule 6774After, at least one the medicine M being stored in capsule 6774 can flow out in tissue T. At at least oneIn this type of embodiment, medicine M can comprise fluid, and described fluid can flow down or pass through along nail leg 6221The tissue T that nail leg drainage treatment have just been cut by nail leg. Due to mentioned above, be stored in capsule 6774Medicine can provide topical therapeutic to tissue. In certain embodiments, the capsule 6774 in thin slice 6770In can store different medicines. For example, in first group of capsule 6774, can store the first medicine or firstDrug regimen, and can store different medicines or different drug regimens in second group of capsule. RespectivelyPlant in embodiment, layer 6770 can be made up of flexible siloxanes thin slice, and capsule 6774 can represent siliconSpace in oxygen alkane thin slice. In at least one this type of embodiment, siloxanes thin slice can comprise can phaseTwo attached layers mutually, wherein capsule 6774 can be limited between described two layers. At various embodimentIn, layer 6770 can comprise one or more thin layers or weakening part (for example local perforations), described oneIndividual or multiple thin layers or weakening part can be conducive to leg 6221 and cut layer 6770 and capsule 6774 is broken.In certain embodiments, at least a portion of capsule 6774 can be positioned in fornix 6777, wherein vaultGallery 6777 can upwards be extended from thin slice 6770. In at least one this type of embodiment, fornix 6777 Hes/ or at least a portion of capsule 6774 can be positioned in and keep the pit 6201 that forms in matrix 6250In. In certain embodiments, capsule 6774 can comprise independently born of the same parents not connected to one another. At some otherIn embodiment, in capsule 6774 one or more can via extend through layer 6770 one or morePath, conduit and/or passage and mutually fluid be communicated with. Be published on August 24th, 2010 and titleFor the United States Patent (USP) 7,780,685 of " ADHESIVEANDMECHANICALFASTENER "Disclosure be incorporated herein by reference in full accordingly.

In various embodiments, to being above described further, comprising warehouse, nail and/orThe nail bin of alignment matrix can be loaded in the first jaw of end effector, and similarly, keepsMatrix and/or one or more lid can be loaded in the second jaw of end effector. Referring now to figure,151, in certain embodiments, can use apparatus (for example storehouse loader 6990) by two or moreInsert in end effector simultaneously in individual securing member storehouse. In at least one embodiment, for example storehouse loader6990 can comprise shank 6991 and storehouse carrier 6992, and wherein storehouse carrier 6992 can comprise the first maintaining partWith the second maintaining part, described the first maintaining part can remain to storehouse by the warehouse of nail bin 6,200 6210 and carryBody 6992, and described the second maintaining part can keep warehouse 6980, and this warehouse 6980 props up thereinSupport multiple protective caps 6270 and support and keep matrix 6250 along the lower surface of warehouse 6980. VariousIn embodiment, the first maintaining part and the second maintaining part can comprise one or more retaining members, institute separatelyState one or more retaining members and can engage releasedly warehouse 6210 and 6980. Referring now to figure,152 and Figure 153, in use, end effector can comprise the first jaw or bottom jaw 6230 HesThe second jaw or top jaw 6940, wherein nail bin 6200 can be loaded in the first jaw 6230,And warehouse 6980 can be loaded in the second jaw 6940. In all cases, top jaw6940 can rotate to closing position (figure from open position (Figure 152) by actuator 6235153), wherein the operation of actuator 6235 is described above, repeats no more for simplicity's sake herein. ExistingReferring to Figure 153, once top jaw 6940 in its closing position, storehouse carrier 6992 is far awayEnd 6993 can be inserted in end effector, makes the far-end of nail bin 6200 through the first jaw 69306938 and slide in the first attachment or passage 6939 in the first jaw 6230. Similarly, storehouseThe far-end 6993 of carrier 6992 can be inserted in end effector, makes warehouse 6980 through the second pincersMouthfuls 6940 far-end 6948 and slide into the second attachment or the passage 6949 in the second jaw 6940In. Surgeon or other clinicians of the shank 6991 of hand-held storehouse loader 6990 can wear respectivelyCross passage 6939 and 6949 and promote nail bin 6200 and warehouse 6980, until nail bin 6200 and warehouse6980 are placed in passage 6939 and 6949 completely.

In the time that nail bin 6200 and warehouse 6980 are placed, nail bin 6200 and warehouse 6980 can connect respectivelyClose the one or more maintaining parts in its corresponding jaw 6230 and 6940, as below in more detailDescribe. Referring now to Figure 154,, in any case, once nail bin 6200 and warehouse 6980 are pacifiedPut, storehouse loader 6990 can separate and move from end effector with nail bin 6200 and warehouse 6980Remove. In at least one this type of embodiment, for nail bin 6200 being remained on to the first jaw 6230Confining force can be greater than the confining force for nail bin 6200 being remained to storehouse carrier 6992, make to work as storehouseWhen carrier 6992 is pushed out end effector towards distally, nail bin 6200 can remain on the first jaw 6230Rear. Similarly, can be greater than for the confining force that warehouse 6980 is remained on to the second jaw 6940For warehouse 6940 being remained to the confining force of storehouse carrier 6992, make when storehouse carrier 6992 is towards distallyWhile being pushed out end effector, warehouse 6940 can remain on the second jaw 6940 rears. Once storehouse addsCarry device 6990 and be removed from end effector, the first jaw 6230 of loading and load theTwo jaws 6940 can be with respect to the tissue T being sewn is positioned. Referring now to Figure 155,, secondJaw 6940 can move to firing position (Figure 155) from open position (Figure 154), to make storehouseThe maintenance matrix 6250 that body 6980 carries and described multiple protective cap 6270 be positioned at nail bin 6200In nail 6220 engage.

Referring now to Figure 156 and Figure 157,, the second jaw 6940 can be opened again, and described manyIndividual protective cap 6270 and maintenance matrix 6250 can separate with warehouse 6980, make cap 6270 and keepMatrix 6250 can engage with tissue T and nail bin 6200 in maintenance. In at least one embodiment, warehouse6980 can comprise multiple pits and one or more maintenance slit, and described multiple caps 6270 can moveRemove and be positioned in described multiple pit, and described one or more maintenance slit can keep squareBattle array 6250 remains to warehouse 6980 removedly. In various embodiments, 6940 dozens of the second jawsAfter opening, the retaining member engaging with warehouse 6980 of the second jaw 6940 can keep warehouse 6980In the second jaw 6940. In certain embodiments, warehouse 6980 can be worked as 6940 dozens of the second jawsWhile opening, tear, a part for warehouse 6980 is planted together with cap 6270 and maintenance matrix 6250Enter, and a part for warehouse 6980 is retained in the second jaw 6940. Similarly, refer again toFigure 156 and Figure 157, after the second jaw 6940 is opened, the first jaw 6230 and warehouse6210 retaining members that engage can remain on warehouse 6210 in the first jaw 6230. In some enforcementIn example, warehouse 6210 can be worked as when the first jaw 6230 is pulled away from the storehouse 6200 of having implanted and tornSplit, make a part for warehouse 6210 implanted together with nail 6220 and alignment matrix 6260, andA part for warehouse 6210 remaines in the first jaw 6230. Referring now to Figure 158-160,, respectivelyPlant in embodiment, nail bin (for example nail bin 6900) for example can comprise the length extension along warehouse 6910One or more longitudinal maintenance slit 6913, be for example inserted in jaw 6930 when nail bin 6900Time, described one or more longitudinal maintenance slits 6913 can hold therein from jaw 6930 and extendOne or more longitudinal maintenance guide rail 6916. In use, at least one embodiment, for exampleBefore sliding, keep slit 6913 through keeping the far-end 6938 of passage 6939 at nail bin 6900End can align with keeping the far-end of guide rail 6916.

Refer again to Figure 160, in various embodiments, jaw 6940 can comprise that two keep passage6949, wherein each maintenance passage 6949 can hold therein and comprise multiple caps 6270 and maintenance squareThe warehouse 6980 of battle array 6250. In certain embodiments, each warehouse 6980 can comprise one or moreLongitudinally keep shoulder 6917, described one or more longitudinal maintenance shoulders can be worked as warehouse 6980 and be insertedWhile entering in its corresponding maintenance passage 6949 in jaw 6940, described one or more longitudinal maintenancesShoulder 6917 slides along one or more longitudinal maintenance guide rail 6918 of the second jaw 6940. VariousIn embodiment, when warehouse 6980 be stored in cap 6270 wherein and keep separating on matrix 6250Time, keep guide rail 6918 and keep shoulder 6917 collaboratively warehouse 6980 to be remained on to the second jawIn 6940. Referring now to Figure 159,, in various embodiments, the second jaw 6940 also can comprise from itExtend one or more distally projection or retaining member 6915, described one or more distally projection orRetaining member can be locked in warehouse 6980 its corresponding maintenance in passage removedly. At least oneIn individual this type of embodiment, the second jaw 6940 can comprise distally projection 6915, distally projection 6915 phasesBe configured and be located to be inserted into passage 6949 when warehouse 6980 for each maintenance passage 6949When middle, each warehouse 6980 can be around projection 6915 deflections, wherein, just at warehouse 6915 by completelyWhile being placed in passage 6949, the far-end of warehouse 6980 can be crossed projection 6915 and by being buckled in projection6915 tops. For being removed after crossing at warehouse 6980, as mentioned above, can be by warehouse6980 are withdrawn into projection 6915 tops and it are removed from maintenance passage 6949. To similar above,The first jaw 6930 can comprise the one or more distally maintenance projections 6914 from its extension, works as nail bin6900 when laid completely, and described one or more distally keep projections can be contained in warehouse 6910In one or more maintenance grooves or slit 6912(Figure 158) in.

In various embodiments, to being described further, be wherein positioned with multiple first fastening aboveThe first securing member storehouse of part can be positioned in the first jaw of surgery fastener, and wherein locatesThere is the second securing member storehouse of multiple the second securing members can be positioned in the second jaw of surgery fastenerIn. In use, the one in the first jaw and/or the second jaw can be moved towards another one, to makeThe first securing member engages and tissue is fixed on therebetween with the second securing member. In certain embodiments, whenWhen the first securing member engages with the second securing member, the first securing member storehouse can engage with the second securing member storehouse.In at least one embodiment, the main body in the first securing member storehouse can be made up of the first compressible material, andAnd the main body in the second securing member storehouse can be made up of the second compressible material, wherein the first main body and/or secondMain body can be against fastened tissue and is compressed. Organize fastened after, the first jaw can be away fromThe first securing member storehouse motion of having implanted, and the second jaw can be away from the second securing member storehouse of having implantedMotion. Subsequently, the first jaw can be loaded with another the first securing member storehouse or like again, andAnd the second jaw can load another the second securing member storehouse or like again, and outside can reusingSection's fastening instrument. Although can use in certain embodiments nail, comprise other classes but also can dream upIts of the securing member of type (for example lock together in the time being bonded with each other be divided into two-part securing member)He is embodiment. In at least one this type of embodiment, the first securing member storehouse can comprise for storing firstThe first storage part of securing member part, and the second securing member storehouse can comprise for storing the second securing memberThe second storage part of part. In various embodiments, fastening system as herein described can utilize comprise appointWhat material of adequate types and/or securing member of form. In certain embodiments, securing member can comprise and wearingMember thoroughly. This type of penetrates member and can for example be made up of polymer, compound and/or multiple field substrate.The example of multiple field substrate can be wire rod or the sheet substrate with elastomer or polymer coating. It canFor thin thin slice, and be formed make to penetrate member be oriented to perpendicular to or at least substantially hang downDirectly in connecting elements. Penetrate profile, semicircular profile and/or any horizontal stroke that member can comprise rectangleBeam profile. In various embodiments, can utilize any suitable method (for example wire rod extrusion method)Manufacture securing member as herein described. Another kind of possibility is to form hollow with precision machining methodPenetrate member. These penetrate member can be by the side that is different from wire rod extrusion method and uses combination of materialsMethod processes.

As mentioned above, the end through keeping matrix projection of nail leg can be by one or more caps and/or lidCover. In certain embodiments, the end of nail leg is inserting through deformable after keeping matrix. ?In at least one embodiment, for keep the jaw of matrix also can comprise being positioned at retaining hole top and/Or the anvil block pit aliging with retaining hole, described anvil block pit can be projected on and keep on matrix at nail leg, make to follow closely leg distortion when the side. In various embodiments, the nail leg of each nail can be for example towards each other and/or towards nailCenter inwardly curling. In some other embodiment, one or more in the nail leg of nail can be away fromOther follow closely leg and/or outwards curling away from Ding center. In various embodiments, no matter follow closely leg along whichOne direction is curling, and the end of nail leg all can contact and keeps the main body of matrix and can again not enter and be followed closelyIn fastening tissue. In at least one embodiment, nail leg can in the distortion of passing after keeping matrixMaintenance matrix is locked in location.

Referring now to Figure 161 and Figure 162,, in various embodiments, surgery suturing appliance (for example,Surgical stapling device 7000) can comprise the first jaw 7030 and the second jaw 7040, wherein the second jaw7040 can be by the motion of actuator 6235 towards with move away from the first jaw 7030. Actuator6235 operation is described above, repeats no more for simplicity's sake herein. In various embodiments, firstJaw 7030 can comprise far-end 7031 and near-end 7032, and wherein the first jaw 7030 can be limited to farThe passage extending between end 7031 and near-end 7032, described passage can hold nail bin. For ease of figureShow, in Figure 161, do not show the warehouse of this type of nail bin, but this type of nail bin can comprise warehouse, be positioned atNail 6220 in warehouse and be positioned at nail 6220 belows staple drivers 7012. At some embodimentIn, although for simplicity's sake not shown in Figure 161, but the second jaw 7040 can will keep squareBattle array (for example keeping matrix 6250) remains on nail 6220 and/or moves as mentioned above maintenance matrixMove to the leg of following closely 6220 and engage. In at least one embodiment, surgical stapling device 7000 also canComprise the sliding part 7010 that is for example arranged in the first jaw 7030, sliding part 7010 can be from the first jaw7030 far-end 7031 slides and promotes nail towards the maintenance matrix of the second jaw 7040 towards near-end 7032Driver 7012 and be supported on the nail 6220 on staple drivers 7012. In various other embodiment,For example sliding part 7010 can move towards far-end 7031 from near-end 7032, to dispose nail 6020. ?In at least one embodiment, sliding part 7010 can comprise slope or the cam of one or more inclinations7011, the slope of described one or more inclinations or cam can be in staple drivers 7012 slid underneath alsoUpwards promote staple drivers 7012. In various embodiments, surgical stapling device 7000 also can comprise exampleAs being operationally connected to pull bar or the push rod of sliding part 7010, described pull bar or push rod can be by being positioned atActuator on shank and/or the axle of surgical stapling device 7000 and towards nearside and/or towards distal movement.

Refer again to Figure 161, in various embodiments, the second jaw of surgical stapling device 70007040 can comprise framework 7041, far-end 7048 and the near-end 7049 with far-end 7048 relative positionings.In certain embodiments, the second jaw 7040 also can comprise guidance system, and described guidance system comprises edgeOne or more guide rails (for example guide rail 7045 and 7046) that the longitudinal axis of framework 7041 extends,As below described in more detail, described one or more guide rails can guide can be at the nail of nail 6220Leg 6221 is through keeping the nail leg of jointing nail 6220 after matrix and making one or more anvils of its distortionSeat or cam. In at least one this type of embodiment, guide rail 7045 and 7046 can comprise leading line orCable, described leading line or cable for example along the top of framework 7041 or surface, around distally post7047 and return along the top of framework 7041 or surface and extending. As mentioned above, and now firstReferring to Figure 163 and Figure 165, in various embodiments, the second jaw 7040 also can comprise one or manyIndividual anvil block or cam (for example the first anvil block 7050 and the second anvil block 7060), described one or moreAnvil block or cam can longitudinally move along the second jaw 7040, to pass and keep at the leg of nail 6220After matrix, make described leg distortion. In at least one embodiment, surgical stapling device 7000 also can compriseBe connected to and/or be operationally connected to the first anvil block driver or actuator of the first anvil block 70507051, this first anvil block driver or actuator can be towards nearside tractive the first anvil block 7050 and/or courtsDistally promotes the first anvil block 7050. Similarly, at least one embodiment, surgical stapling device7000 also can comprise that the second anvil block that is connected to and/or is operationally connected to the second anvil block 7060 drivesDevice or actuator, described the second anvil block driver or actuator can promote towards distally the second anvil block 7060And/or towards nearside tractive the second anvil block 7060. In various embodiments, the first anvil block 7050 can compriseGuide groove 7052, and the second anvil block 7060 can comprise guide groove 7062, this guide groove 7052 and guide groove7062 can be slidably received within guide rail 7045 or guide rail 7046 wherein respectively. At least oneIn individual this type of embodiment, guide rail 7045 and 7046 can be closely contained in guide groove 7052 and 7062In, make to prevent or at least limit guide rail 7045 and 7046 and guide groove 7052 and 7062 between send outThe lateral movement that looks is right or side-to-side movement.

In certain embodiments, to being described further, can pull the first anvil block towards nearside above7050 also can pull towards distally the second anvil block 7060. Referring to Figure 161, at least one embodiment,Guide rail 7045 and 7046 and distally post 7047 can comprise pulley system, described pulley system can be towards farSide tractive the second anvil block 7060 and/or towards nearside tractive the second anvil block 7060. At at least one, this type of is realExecute in example, guide rail 7045 and guide rail 7046 can comprise around distally post 7047 and the continuous wire that extendsOr cable, a part for wherein said continuous wire can be pulled so that wire rod around distally post 7047 andWheel turns. In various embodiments, guide rail 7046 for example can be mounted to the second anvil block 7060, makesIn the time that continuous cable turns along first direction wheel, the second anvil block 7060 can be towards the far-end of jaw 7,040 7048And be pulled to distally, and in the time that continuous cable turns along second direction or rightabout wheel, the second anvil block7060 can be pulled to nearside towards near-end 7049. Referring now to Figure 163,, at least one embodimentIn, guide rail 7046 can be fixed in guide groove 7062, makes to transmit betwixt pulling force. At leastIn this type of embodiment, guide rail 7045 can slide in another guide groove 7062. In various enforcementIn example, the first anvil block 7050 can be to work with the irrelevant mode of the second anvil block 7060, and pulleySystem and be limited to guide groove 7052 in the first anvil block 7050 can hold slidably guide rail 7045 and7046, make to allow between pulley system and guide groove 7052 and guide rail 7045 and 7046 and carry out relative fortuneMoving. In various embodiments, forming the continuous cable of guide rail 7045 and 7046 can have enough softProperty, to adapt to opening and closure of top jaw 7040. Cable also can have enough flexibilities continuouslySo that adapt to the second jaw 7060 towards and away from the moving both vertically of bottom jaw 7030, below will be moreDescribe in detail.

Refer again to Figure 163 and Figure 165, in various embodiments, the first anvil block 7050 can comprise fromThe cam follower 7055 of its extension, described cam follower 7055 can ride in being limited to secondFor example cam slot 7070 of one or more cam slot in the framework 7041 of jaw 7040 or guide groove(Figure 166) in. More specifically, at least one embodiment, framework 7041 can comprise along frameworkThe first cam slot 7070 that the first side of 7041 is extending longitudinally and along the second side of framework 7041 orThe second cam 7070 that opposite side is extending longitudinally, wherein extends from the first side of the first anvil block 7050Cam follower 7055 can ride in the first cam slot 7070, and from the first anvil block 7050The cam follower 7055 that the second side is extended can ride in the second cam slot 7070. At least oneIn individual this type of embodiment, the profile of each cam slot 7070 can be identical or at least substantially the same, and can mutually align or substantial alignment at least. Similarly, in various embodiments, the second anvilSeat 7060 cam followers 7065 that can comprise from its extension, described cam follower 7065 can be riddenAcross the cam slot 7070(Figure 166 being limited in the framework 7041 of the second jaw 7040) in.More specifically, at least one embodiment, from the second anvil block 7060 first side extend cam fromMoving part 7065 can ride in the first cam slot 7070, and from the second side of the second anvil block 7060The cam follower 7065 extending can ride in the second cam slot 7070. In use, firstThe cam follower 7055 of anvil block 7050 and the cam follower 7065 of the second anvil block 7060 can be protrudingWheel slit 7070 interior slip, make when the first anvil block 7050 and the second anvil block 7060 be pulled to nearside and/ or while being pushed to distally, the first anvil block 7050 and the second anvil block 7060 are along the wheel of cam slot 7070Wide propelling. In various embodiments, each cam slot 7070 can comprise multiple portion or top of resting7071 and multiple driver portion or bottom 7072, described multiple portion or top 7071 and institutes of restingStating multiple driver portion or bottom 7072 can be at anvil block 7050 and 7060 longitudinally (, at frameBetween the far-end 7048 and near-end 7049 of frame 7041) motion time vertically (, towards and far awayFrom bottom jaw 7030) motion anvil block 7050 and 7060, as below described in more detail.

When surgical stapling device 7000 is not in the time pulling the trigger state, referring to Figure 166, the first anvil block 7050Can be positioned on the far-end 7048 of framework 7041, and the second anvil block 7060 can be positioned on framework 7041Near-end 7049; In addition, referring now to Figure 167, when surgical stapling device 7000 is in the state of not pulling the triggerTime, the nail 6220 that is positioned at the first jaw 7030 may not insert tissue T and/or locates thereonKeep matrix. Referring now to Figure 168,, in use, staple drivers 7012 can be in the nail chamber of nail binIn 7033, upwards drive nail 6220; In addition, the first anvil block 7050 can be from the far-end of framework 70417048 towards far-end 7049 proximal motion, so that the nail leg 6221 of jointing nail 6220. At at least oneIn embodiment, before engaging with the nail leg 6221 of nail 6220, the first anvil block 7050 can upwards drive nail6220. In various embodiments, before the first anvil block 7050 is advanced into contact stud leg 6221, slidingMoving part 7010 can be to all nails 6220 of deploy, or alternatively, sliding part 7010Can the first anvil block 7050 towards in proximal movement towards proximal movement, but sliding part 7010 can fillDivide ground guiding the first anvil block 7050 nail 6220 is deployed in to the first anvil block 7050 fronts. In various realitiesExecute in example, as shown in Figure 168, cam slot 7070 can or be arranged such that for example when first is protrudingWheel 7050 passes while resting portion or top, profiled surface (for example profiled surface of the first cam 7050Or cam face 7053 and 7054) at least some in can contact stud leg 6221. In various situationsUnder, the cam follower 7055 of the first anvil block 7050 can be positioned in respectively stopping of cam slot 7070Have a rest in portion 7071, make the position of profiled surface 7053 and 7054 in raising, and make to work as anvil block7050 thus through in rest position time, and nail leg 6221 is partly distortion only. When the first cam 7050While further moving along cam slot 7070, as shown in Figure 169, the cam of the first anvil block 7050 fromMoving part 7055 can be driven in the drive division or bottom 7072 of cam slot 7070, makes shaping tableFace 7053 and 7054 moves downward vertically towards nail leg 6021, to nail leg 6021 is urged to itIn the configuration being shaped eventually. Subsequently, when the first anvil block 7050 further advances along cam slot 7070Time, the first anvil block 7050 can be rested portion by vertical drive to another group of cam slot 7070 upwardsIn 7071. As shown in Figure 168 and Figure 169, reader it should be noted that the first anvil block 7050 can only engageSome is followed closely leg and is not engaged other nail legs. In at least one this type of embodiment, the first anvil block 7050 energyEnough one group of nail leg distortion that for example only makes the distally nail leg 6221 that comprises nail 6220. At at least one thisIn class embodiment, the first anvil block 7050 can make the center distortion of distally nail leg 6221 towards nail 6220.In various embodiments, each nearside nail leg 6221 all can twice by the first anvil block 7050(, quiltThe first profiled surface 7053 and the second profiled surface 7054 aliging with the first profiled surface 7053) connectTouch. In at least one this type of embodiment, in the time that the first anvil block 7050 is in the portion of resting or top,The first profiled surface 7053 can make distally nail leg 6221 be deformed into part deformed configuration, and when firstWhen anvil block 7050 moves in drive division or bottom, the second profiled surface 7054 can make distally nail leg6221 are deformed into the configuration that is shaped completely. Referring now to Figure 163 and Figure 164,, in various embodiments,The first anvil block 7050 can comprise multiple the first profiled surfaces 7053 and multiple the second profiled surface 7054,To be arranged to a more than row or make to follow closely 6220 distally nail leg 6221 when a line become at nail leg 6221Shape. In various embodiments, as below described in more detail, for example the second anvil block 7060 can make nail6020 nearside nail leg 6221 is out of shape.

In various embodiments, to being above described further, the first anvil block 7050 can be from framework7041 far-end 7048 moves to near-end 7049, to make to follow closely all distally nail leg 6221 of 6220Distortion. Reader it should be noted that the first anvil block 7050 can be with respect to undeformed nearside nail leg 6221 upwardsAnd move downward, and for adapting to this type of relative motion, in various embodiments, the first anvil block 7050Can comprise one or more clearance slot 7057(Figure 165), described one or more clearance slot7057 can work as and when the first anvil block 7050 makes distally nail leg 6221 bending, hold unbent nearside nail leg6221. Similarly, refer again to Figure 163, the second anvil block 7060 can comprise clearance slot 7067, shouldClearance slot can be worked as the first anvil block 7050 and rests while moving between portion and drive division suitable at it as mentioned aboveMoving both vertically of first cam actuator 7051 that should move up and down. At all distally nail leg 6221 quiltsAfter bending, at least one embodiment, anvil block actuator 7061 can make the second anvil block 7060 fromThe near-end 7049 of framework 7041 moves to far-end 7048. To similar above, referring now to Figure 170,The cam follower 7065 of for example the second anvil block 7060 can be in the interior slip of cam slot 7070, makesTwo anvil blocks 7060 move between the portion of resting or top and drive division or bottom, to make nearside nail leg6221 centers towards nail 6220 are to internal strain. To similar above, the second anvil block 7060 can comprise multipleFirst is shaped or cam face 7063 and multiple the second shaping or cam face 7064, described multipleThe first shaping or cam face 7063 and described multiple second are shaped or cam face 7064 can be distinguishedCan make one or more in nearside nail leg 6021 be out of shape at least in part and/or be badly deformed. AgainInferior to Figure 164, the second anvil block 7060 can comprise multiple the first profiled surfaces 7063 and multiple secondProfiled surface 7064, described multiple the first profiled surfaces 7063 and described multiple the second profiled surface7064 can make the nearside nail leg 6221 of the nail 6220 that is arranged in multiple rows or multiple row be out of shape. EquallyAs shown in Figure 164, the first profiled surface 7063 of the second anvil block 7060 and the second profiled surface 7064Can not align with the first profiled surface 7053 and second profiled surface 7054 of the first anvil block 7050, because ofThe near leg 6221 of this nail 6220 can be positioned at different rows or row from the far leg 6221 of nail 6220In. Reader it shall yet further be noted that the second anvil block 7060 can push away when the second anvil block 7060 is during towards distal movementMoving the first anvil block 7050. In at least one this type of embodiment, the second anvil block 7060 can be by the first anvilSeat 7050 pushes back in the far-end 7048 of framework 7041, makes the first anvil block 7050 can be back to itInitial position or not firing position. After all nearside nail legs 6221 of nail 6220 are all out of shape, theTwo anvil blocks 7060 can and be back to its initial position or firing position not towards proximal retraction. Thus,Surgical stapling device 7000 can reset to and make in the first jaw 7030, to locate new nail bin, and canIn the second jaw 7040, locate new maintenance matrix, to reuse surgical stapling device 7000.

In various embodiments, as mentioned above, surgical stapling device can comprise two or more anvil blocks,Described two or more anvil blocks can longitudinally be advanced so that along the leg that laterally engages multiple nails. At someIn embodiment, surgical stapling device can comprise the anvil block towards proximal movement, for example, so that the change of first group of nail legShape also for example makes the distortion of second group of nail leg. In at least one this type of embodiment, this type of anvil block can compriseFor example, towards the profiled surface of nearside and towards the profiled surface in distally.

Referring now to Figure 171,, in various embodiments, anvil block such as anvil block 7140 can comprise bottom tableFace or tissue contacting surface 7141 and be limited to lower surface or tissue contacting surface 7141 in manyIndividual shaping pit 7142. In at least one embodiment, anvil block 7140 can comprise and can be welded to frameA more than plate in frame 7144, for example crater plate 7143. In at least one this type of embodiment,Each crater plate 7143 all can be positioned in the plate passage 7145 in framework 7144 and wear by extensionCross the welding slit 7146 of framework 7144 and be soldered to framework 7144 to form longitudinal weldment7147. In various embodiments, longitudinal weldment 7147 for example can comprise edge welding slit 7146It is a series of in space that the length of the sequential welding fitting that whole length is extended or edge welding slit 7146 is extendedUpper isolated pad. In various embodiments, each crater plate 7143 all can comprise solderedTo two or more plate portions together. In at least one this type of embodiment, each crater plate7143 all can comprise can be along seam 7148 the first plate portion 7143a and the second plate welded togetherPart 7143b. In various embodiments, be soldered to the plate passage in framework 7144 at plate 7143Before in 7145, the first plate portion 7143a and the second plate portion 7143b of each plate 7143 can quiltsWelded together. In at least one this type of embodiment, the first plate portion 7143a and the second plate portion7143b can comprise the cooperation profile that can fit together to form impervious seam 7148, for example figureDentation profile shown in 171. In at least one embodiment, each plate 7143 can comprise for example largeAbout .02 " height, described height can, higher than the degree of depth of plate passage 7145, make the tissue of plate 7143Contact surface 7141 extends from the framework 7044 of anvil block 7040. Referring now to Figure 172,, real at someExecute in example, plate 7143 can be for example by being positioned at least one weldment 7149 of far-end of plate 7143And connect together.

As shown in Figure 171 and Figure 172, each crater plate 7143 all can comprise and is limited at wherein manyIndividual shaping pit 7142. In various embodiments, can (for example grind by any suitable manufacture methodMill method and/or electrode combustion method) forming shaped pit 7142 in plate 7143. Referring now to figure,173 and Figure 174, at least one this type of embodiment, for example, can manufacture by the following method eachShaping pit 7142: first form deep-well 7150, form subsequently arc or curved around deep-well 7150Bent surface 7151 then forms nail leg guide groove 7152 in curved surface 7151. RespectivelyPlant in other embodiment, can any suitable order carry out these steps. Referring now to figure,175, in various embodiments, nail shaping pit 7142 can be formed the inner edge of the pit that makes to be shaped7153 by consistent or consistent gap 7154 is spaced apart at least substantially. At at least one, this type of is realExecute in example, gap 7154 can be for example about .008 ". In addition, at least one this type of embodimentIn, shaping pit 7142 can be along two or more row or line location, the center of shaping pit 7142Line can be by consistent or consistent spacing 7155 is spaced apart at least substantially. In at least one this type of enforcementIn example, the spacing 7155 between center line can be for example about .035 ". Refer again to Figure 175, respectivelyIn kind of embodiment, each shaping pit 7142 can be between narrow width 7156 and wide width 7157Be tapered. In at least one this type of embodiment, for example narrow width 7156 can be greatlyAbout .045 ", and wide width 7157 can be about .075 ". In various embodiments, plate 7143 canFormed by the material identical with framework 7144. In at least one this type of embodiment, plate 7143 and frameFrame 7144 both all can be for example by stainless steel (for example stainless steel of 300 series or 400 series) and/Or titanium forms. In various other embodiment, plate 7143 and framework 7144 can be by different material structuresBecome. In at least one this type of embodiment, plate 7143 can for example be made up of ceramic material, and framework7144 can for example be made up of stainless steel and/or titanium. In all cases, according to used material,For example except above-mentioned welding method or as above-mentioned welding method substitute, also can use at least oneBraze welding method is fixed on plate 7143 in framework 7144.

Referring now to Figure 176-178,, in various embodiments, anvil block 7240 can comprise framework 7244And can be inserted into the multiple crater plate 7243 in framework 7244. To similar above, each crater plate7243 can comprise the multiple shaping pits 7242 that are limited to wherein. In at least one embodiment, anvil blockFramework 7244 can comprise the maintenance slit 7246 being limited to wherein, and this maintenance slit can hold from recessedThe maintenance guide rail 7247 that hole plate 7243 extends. For crater plate 7243 is assembled into anvil block framework 7244,The sidewall 7245 of this anvil block framework 7244 is deflection or expansion (as shown in Figure 177) outwards, so thatKeep slit 7246 to broaden, thereby make each maintenance slit 7246 can hold therein crater plate 7243Maintenance guide rail 7247. Keep in slit 7246 sidewall once keep guide rail 7247 to be positioned in7245 can be released (as shown in Figure 178), thereby allow that framework 7244 retracts with elastic typeAnd/or be back to its not deflected. In this case, keep slit 7246 regractings also thereforeMaintenance guide rail 7247 is captured in wherein. In certain embodiments, keep guide rail 7247 and/or keepSlit 7246 can comprise the conical surface of one or more cooperations; At maintenance slit 7246 quilts of deflectionAfter release, the conical surface of described one or more cooperations can form and can will keep guide rail 7247 to protectBeing held in the taper lock keeping in slit 7246 engages. To similar above, crater plate 7243 can by with frameThe identical or different material of frame 7244 forms. In at least one this type of embodiment, plate 7243 can exampleAs being made up of ceramic material, and framework 7244 can for example be made up of stainless steel and/or titanium. VariousIn situation, according to used material, for example, can use at least one braze welding method and/or at least onePlanting welding method is fixed on plate 7243 in framework 7244.

In Figure 179 and 180, surgical stapling and cut-out apparatus 8010 can comprise anvil block 8014, shouldAnvil block can be around it to the pivotal attachment of elongated nail groove 8016 and by open and close repeatedly. Nail is used groupPart 8012 can comprise anvil block 8014 and groove 8016, and wherein assembly 8012 can be attached to formation towards nearsideThe slender axles 8018 of tools section 8022. In the time that nail is used assembly 8012 closure, or at least substantiallyWhen closed, tools section 8022 can present enough little cross section, and this cross section is suitable for making nail to use groupPart 8012 inserts by trochar. In various embodiments, assembly 8012 can be by being connected to axle 8018Shank 8020 handle. Shank 8020 can comprise that user control is such as rotation knob 8030, this rotationKnob makes slender axles 8018 and nail use the longitudinal axis rotation of assembly 8012 around axle 8018. ClosedTrigger 8026 can be depressed and use assembly 8012 with closure nail, and this closure trigger can be at pistol typeHandle 8036 front walls are around the closure trigger pin 8152(figure engaging across shank shell 8154 side direction181) pivotable. In various embodiments, in the time that closure trigger 8026 is clamped, closed release pressedButton 8038 can outwards be present on shank 8020, makes release-push 8038 can be depressed to unclamp to closeClose trigger 8026 and open nail and use assembly 8012, as described in more detail below. Can touch in closureThe percussion trigger 8034 of hair device 8026 front pivotables can make nail use assembly 8012 and cut off simultaneously and sew upBe clamped in tissue wherein. In all cases, as described in more detail below, can use percussion to touchHair device 8034 adopts multiple percussion strokes need to be by surgical hand applied force to reduce every strokeSize. In certain embodiments, shank 8020 can comprise the rotatable right side that can indicate percussion progressIndicator wheel 8040 and/or left indicator wheel 8041(Figure 181). For example, pulling the trigger stroke completely canPull the trigger stroke completely for three that can need to pull the trigger trigger 8034, thereby indicator wheel 8040,8041 is eachFrom can 1/3rd turning at the most in the every stroke rotation of percussion trigger 8034. As more detailed institute belowState, if needed, manually pull the trigger trip lever 8042 and can allow trigger system to pull the trigger stroke completely completeRetraction before becoming, and in addition, if trigger system is blocked and/or was lost efficacy, percussion trip lever8042 can allow surgeon or other clinicians to make trigger system retraction.

In conjunction with Figure 179 and Figure 181, slender axles 8018 can comprise external structure, and this external structure comprisesReciprocating closure tube 8024 in the vertical, this closure tube triggers in response to the closure of shank 8020The nearside of device 8026 presses down and makes anvil block 8014 towards its closing position pivotable. Elongated slot 8018 can lead toCross framework 8028(Figure 181 of closure tube 8024 inside) be connected to shank 8020. Framework 8028 canBe engaged to rotatably shank 8020, make to rotate knob 8030(Figure 179) the rotation portion that can make toolDivide 8022 rotations. Specifically, referring to Figure 181, rotation knob 8030 can be made up of two and half shells, and these are two years oldIndividual half shell can comprise one or more inside protuberances 8031, and this protuberance is extensible through closure tubeOne or more elongated side opening 8070 engage frame 8028 in 8024. Therefore, rotation is revolvedButton 8030 and framework 8028 can together with or be rotated simultaneously, the position of rotation of knob 8030 is determinedThe position of rotation of tools section 8022. In various embodiments, the longitudinal length of longer opening 8070Long enough, to allow longitudinal closing motion of closure tube 8024 and to open motion. About producing closure tube8024 closing motion, first referring to Figure 181 and Figure 183, the top of closure trigger 80268160 can promote forward closed yoke 8162 by closed connecting rod 8164. Closed connecting rod 8164 is at its far-endPlace is attached to closed yoke 8162 by closed yoke pin 8166 in mode that can pivotable, and near at itEnd place is attached in mode that can pivotable by closed link pin 8168. In various embodiments, closureTrigger 8026 can be closed trigger extension spring 8246 and be advanced into open position, this extension springBe connected to the top 8160 of closure trigger 8026 and by right half shell 8156 and left half shell towards nearsideThe 8158 shank shells 8154 that form. The tension force being applied by extension spring 8246 can be applied to closureThe closing force of trigger 8026 overcomes, so as to advance towards distally yoke 8162, closed connecting rod 8164 andClosure tube 8024.

As mentioned above, in the time that closure trigger 8026 activated or depresses, if needed, closure is releasedPut button 8038 can be positioned such that surgeon or other clinicians can press closed discharge byButton 8038, and make the remainder of closure trigger 8026 and surgical instruments not be back to actuatingState. In various embodiments, closed release-push 8038 can connect to pivot 8173 by center sideBe connected to pivotable lock arm 8172, make between release-push 8038 and lock arm 8172, to transmit fortuneMoving. Refer again to Figure 181, Compress Spring 8174 can be by inclined to one side towards nearside closed release-push 8038Put, that is, as observed from the right side, setover clockwise to pivot 8173 around center side, and closed touchingThe top 8160 of hair device 8026 can comprise the nearside tooth top 8170 with rear recess 8171. Work as closureWhen trigger 8026 is depressed, pivotable lock arm 8172 can straddle on nearside tooth top 8170, andIn the time that closure trigger 8026 arrives its complete depressing position, should be appreciated that rear recess 8171 existsBelow pivotable lock arm 8172, this pivotable lock arm falls into also forcing of Compress Spring 8174Recess 8171 after locking. Now, manually pressing down of closed release-push 8038 makes pivotable lock arm8172 upwards and from rear recess 8171 rotate, thereby by closure trigger 8026 releases and make to closeClose trigger 8026 and be back to its not clamped position.

Once closure trigger 8026 is clamped towards nearside, as mentioned above, pull the trigger trigger 8034Can be pulled to pistol grip 8036, to advance percussion connecting rod 8032 from shank 8020 towards distally.In various embodiments, percussion trigger 8034 can be around percussion trigger pin 8202 pivotables, and this hitsSending out trigger pin is horizontally through the right side half shell 8156 and left half shell 8158 of shank 8020 and engages.In the time activateding, percussion trigger 8034 can advance link-type transmission firing lock 8150. Link-typeTransmission firing lock 8150 can by spring 8184 be forced to retraction, firing position not. This spring:1) be attached to the pistol grip 8036 of shank 8020; And 2) be attached to for example link-type transmissionOne of them connecting rod of firing lock 8150, as described in more detail below. Spring 8184 can comprise and connectingBe connected to the non-motion end 8186 of shell 8154 and be connected to the motion of the near-end 8190 of steel band 8192End 8188. The end that is arranged at distally 8194 of steel band 8192 can be attached to multiple connecting rod 8196a-Attachment structure 8195 on front rod 8196a in 8196d, described multiple connecting rods form link-type toothBar 8200. Link-type tooth bar 8200 can be flexible, makes it to be easily retracted into pistol type and holds8036 and minimize the length of shank 8020, but form the tooth bar assembly of straight rigidity, this toothBar assembly can be passed to significant percussion force and/or pass percussion connecting rod 8032. As below more detailedDescribed, percussion trigger 8034 can percussion trigger 8034 the first period of energization between and first connecting rod8196a engages, between the second period of energization of percussion trigger 8034, engages with second connecting rod 8196b,Between the 3rd period of energization of percussion trigger 8034, engage with third connecting rod 8196c, and touch in percussionBetween the 4th period of energization of hair device 8034, engage with the 4th connecting rod 8196d, wherein pull the trigger trigger 8034Each actuating link-type tooth bar 8200 can be advanced to the amount increasing progressively towards distally. In various embodiments,To being above described further, multiple strokes of percussion trigger 1034 can make right indicator wheel1040 and left indicator wheel 1041 rotate, with the distance of indicating link-type tooth bar 8200 to advance.

Referring now to Figure 181 and Figure 183,, Anti-backup mechanism 8250 can prevent from combining stretching/compressing bulletSpring 8184 bounces back link-type tooth bar 8200 between percussion stroke. In various embodiments, connectSliding tube 8131 is in abutting connection with first connecting rod 8196a and be connected to percussion connecting rod 8032 to transmit percussion fortuneMoving. Percussion connecting rod 8032 extends the near-end of framework 8028 and extends through anti-retrogression plate towards nearside8266 through hole 8408. The size of through hole 8408 is set for when with percussion connecting rod 8032 vertical alignmentHold slidably percussion connecting rod 8032, in through hole, roll tightly motionless and make to pull the trigger connecting rod in the time tilting. UnderPortion's inserted sheet attachment 8271 extends towards nearside from the lower lip of the near-end of framework 8028, extends through anti-The hole 8269 of falling back on the lower limb of plate 8266. This bottom inserted sheet attachment 8271 is by anti-retrogression plate8266 bottom is drawn to contiguous framework 8028, makes in the time that percussion connecting rod 8032 is pushed into towards distallyAnti-retrogression plate 8266 is vertical, and when percussion connecting rod 8032 anti-retrogression plate 8266 while attempting to bounce backCan make top recede to bound state. Anti-retrogression Compress Spring 8264 is near by framework 8028End is towards distally constraint, and top towards nearside in abutting connection with anti-retrogression plate 8266, thereby by anti-retrogression plate8266 are biased to lock-out state. Anti-retrogression cam tube 8268 antagonistic springs biasings and slidably around connectionConnect sliding tube 8131 and in abutting connection with anti-retrogression plate 8266. Be attached to anti-retrogression cam tube 8268 towards closelySide-prominent anti-retrogression yoke 8256 extends beyond closed yoke 8162.

Referring to Figure 181, the automatic retracted mechanism 8289 that connecting rod triggers is attached to surgical stapling and cutterIn tool 8010, so that cutter finishes time retraction pulling the trigger stroke completely. For this reason, distally connecting rod 8196d bagDraw together tang 8290, when distally, connecting rod 8196d is advanced the rach slot being formed in closed yoke 81628291(Figure 181) in time tang to upper process. Align this tang 8290 to start anti-retrogression release thick stickBar 8248(Figure 186) on bottom proximal cam 8292. Specifically referring to Figure 186 and Figure 187, shapeBe formed in the fortune of the structural constraint anti-retrogression trip lever 8248 in right half shell 8156 and left half shell 8158Moving. Be formed at respectively pin socket 8296 and circular pegs between right half shell 8156 and left half shell 81588293 are received through longitudinal slot 8294, and this hole is formed at proximal cam 8292 distally, bottomAnti-retrogression trip lever 8248 in, thereby allow longitudinal translation and revolving around circular pegs 8293Turn. In right half shell 8156, the groove 8295 of opening towards nearside comprise with up and towards distally angulationThe nearside horizontal component 8295a that the part 8295b of degree is communicated with, this up and angled towards distallyPart 8295b holds near the rear pin 8297(figure to the right of near-end of anti-retrogression trip lever 8248187), thus in the time that anti-retrogression trip lever 8248 arrives the farthest side part of its translations, this upwardsGround and towards distally, angled part 8295b gives rotation upwards. Once anti-retrogression trip lever8248 is assembled, is formed at the blocking junction in the right side half shell 8156 of contiguous anti-retrogression trip lever 8248Structure prevents that anti-retrogression trip lever 8248 is towards proximal movement, so that rear pin 8297 to the right remains on courtIn the groove 8295 that nearside is opened.

To being above described further, as shown in Figure 187 and Figure 188, anti-retrogression trip lever8248 far-end 8254 thereby towards distally and be driven downwards, makes front pin 8298 to the right fall into formationIn the hierarchic structure of opening towards distally 8299 in right half shell 8156, this joint will be by compressing bulletSpring 8300(Figure 188) be fixed between front pin 8298 and longitudinal slot 8294 to the rightAnti-retrogression trip lever 8248 on hook left 8301 and realize. Another of Compress Spring 8300End is attached to and is formed at the immediately above nearer and lower position at closed yoke 8266 in right half shell 8156Hook 8302(Figure 186, Figure 188, the Figure 189 at place). Compress Spring 8300 thereby anti-retrogression is releasedDownwards and backward tractive of the far-end 8254 of putting lever 8248, makes front pin 8298 to the right towards distally quiltWhen propelling, lock onto in the hierarchic structure 8299 of opening towards distally. Therefore, once released, referring to figure189, anti-retrogression trip lever 8248 keeps forward, vertically keeps anti-retrogression plate 8266, thereby makesLink-type tooth bar 8200 bounces back. When at free end actuator 8012 in the situation that closed yoke 8266 withWhen rear retraction, the reset tang 8303 to upper process on closed yoke 8266 contacts anti-retrogression and discharges thick stickThe bottom distal cam 8305 of bar 8248, the ladder knot by front pin 8298 to the right from opening towards distallyIn structure 8299, lift, make the anti-retrogression Compress Spring 8264 can be by anti-retrogression cam tube 8268 and anti-downMove back trip lever 8248 and be pushed to its advanced position (Figure 186) towards nearside.

In various embodiments, referring to Figure 179 and Figure 189, percussion trigger 8034 can be with anySuitable mode is operatively engaged to link-type tooth bar 8200. Specifically referring to Figure 180 and Figure 185,Percussion trigger 8034 is around percussion trigger pin 8202 pivotables that are connected to shell 8154. Work as percussionWhen trigger 8034 is depressed towards pistol grip 8036, enclose on the top 8204 of percussion trigger 8034Shielding is sent out trigger pin 8202 towards distal movement, thereby by the percussion trigger stretching bullet of placing towards nearsideSpring 8206(Figure 181) stretch, this extension spring is connected to the top of percussion trigger 8034 towards nearside8204 and shell 8154 between. During each percussion trigger presses down, percussion trigger 8034Top 8204 is via the side pawl mechanism 8210 engagement link formula tooth bars 8200 of spring biasing. When hittingSend out trigger while being released, side pawl mechanism separates with link-type tooth bar 8200, and percussion triggersDevice can be back to not to be depressed or firing position not. In use, each by connecting rod 8196a-8196dIn the right rail of the inclination that forms towards nearside and inclined-plane to the right 8284 by side pawl assembly8285 engage. Particularly, pawl slide block 8270(Figure 181 and Figure 183) there is lower left quarter guide railWith right lower quadrant guide rail 8272, this lower left quarter guide rail and right lower quadrant guide rail are being formed at rach slot respectivelyLeft track 8274(Figure 181 in the closed yoke 8266 of 8291 belows) in and at closed yoke guide railIn right track 8275 in 8276, slide. Closed yoke guide rail 8276 is parallel to rach slot 8291 attachedBe connected to rach slot lid 8277, this rach slot lid is closed rach slot 8291 in closed yoke 8266 to the rightOpen part, the described distally of advancing that is partly positioned at pawl slide block 8270 of opening to the right. At figure181, in Figure 182 and Figure 185, Compress Spring 8278 is attached at the top on closed yoke guide rail 8276Hook on hook 8279 in portion's proximal position and the far-end right side of pawl slide block 8,270 8280 itBetween, this makes pawl slide block 8270 connect with the top 8204 of percussion trigger 8034 towards nearside downwardsTouch.

Specifically, referring to Figure 181, pawl piece 8318 is positioned on pawl slide block 8270, around verticallyRear pin 8320 pivotables, this rear pin is near through the left side of pawl piece 8318 and pawl slide block 8270Side turning. Kick out of in the distal part of top surface that piece groove 8322 is formed at piece 8318, to holdReceive by normal pin 8326 with mode that can pivotable be fixed on wherein kick out of piece 8324, this normal pinBottom end extend to the pawl spring groove 8328 on the top surface of pawl slide block 8270In. Pawl spring 8330 in pawl spring groove 8328 extends to vertical front pin 8326Right side, force pawl piece 8318 from above be rotated counterclockwise while observing to the right rail tilting8282 engage. Kick out of little wind spring 8332 in piece groove 8322 force kick out of piece 8324 fromSide turns clockwise while observation, and its near-end is forced to and the closed yoke that is formed at rach slot 8291 topsWavy antelabium 8334 in 8266 contacts. As shown in Figure 184, pawl spring 8330 is compared to littleThe stronger mechanical dominance that has of wind spring 8332 mean that pawl piece 8318 is easy to suitableThe piece 8324 of kicking out of of hour hands rotation engages. In Figure 185, when percussion trigger 8034 is pressed completelyWhen descending and starting to be released, kick out of piece 8324 and in the time that pawl slide block 8270 bounces back, run into wavy antelabium8334 ridge 8336, force kick out of piece 8324 from above turn clockwise while observing, thereby will makeBull stick piece 8318 is kicked out of and the engaging of link-type tooth bar 8200. The shape of kicking out of piece groove 8322 makes to playGo out turning clockwise of piece 8324 and stop, making it in the direction perpendicular to wavy antelabium 8334,Thereby during retraction, keep this disengaging to eliminate ratchet noise completely.

In Figure 181, Figure 183, Figure 190 and Figure 195, surgical stapling and cut-out apparatus 8010 canComprise manual retrieving mechanism 8500, this manual retrieving mechanism provides the manual releasing of firing lock, manuallyRetraction, and in a kind of pattern (Figure 196-202) pull the trigger completely when stroke finishes, also carry out fromMoving retraction. Referring now to Figure 181, Figure 190 and Figure 191,, particularly, front idler gear 8220 withThe surface, dentation upper left 8222 of link-type tooth bar 8200 engages, and wherein front idler gear 8220 also engagesThere is the rear idler gear 8230 of less right side ratchet gear 8231. Front idler gear 8220 and rear skyTurning gear 8230 is rotationally attached to and lays respectively at front idler axle 8232 and rear idler wheel axle 8234On shank shell 8154. Every end of rear idler wheel axle 8232 extends through corresponding right half shell 8156With left half shell 8158, and be attached to left indicator wheel 8040 and right indicator wheel 8041, and byRotate freely in shank shell 8154 in hind axle 8234 and be engaged to backgear in bonding mode8230, therefore indicator wheel 8040,8041 is rotated together with backgear 8230. The advantageously company of selectionGear relation between rod-type tooth bar 8200, idler gear 8220 and backgear 8230, makes dentationUpper surface 8222 has the teeth size that intensity is suitable, and makes at link-type transmission firing lockDuring 8150 the stroke of percussion completely, the rotation of backgear 8230 is no more than a circle. Gear mechanism8502 except indicating intuitively percussion stroke or progress, and gear mechanism 8502 also can be used for making cutterManual retrieving. In various embodiments, the less right side ratchet gear of rear idler gear 82308231 extend in the wheel hub 8506 of manual retrieving lever 8042, particularly with by right wheel hub 8506The vertical longitudinal aligned slots 8508(Figure 190 dividing) alignment. The side direction through hole of wheel hub 85068510 and upper grooves 8512 be communicated with. Anterior 8514 are shaped as the locking system of holding towards nearside guidingBull stick 8516, this locking pawl is around the side being to the right formed in the far-end of upper grooves 8512To pin 8518 pivotables. Rear portion 8520 is shaped as and holds L-type spring inserted sheet 8522, this spring inserted sheetForce the downward ratchet gear 8231 less with right side of locking pawl 8516 to engage. Barrier structure8524(Figure 186 and Figure 193) project into upper grooves 8512 from right half shell 8156; When manuallyWhen retraction lever 8042 is downward (Figure 193), this barrier structure stops locking pawl 8516 to engageLess right side ratchet gear 8231. Wind spring 8525(Figure 181) force manual retrieving lever 8042Downwards.

In use, as shown in Figure 192 and Figure 193, combination stretching/compressing spring 8184 can be with fixedPosition departs from the link-type tooth bar in distally. In Figure 194 and Figure 195, when manual retrieving lever 8042While lifting, locking pawl 8516 turns clockwise and is no longer blocked structure 8524 and stops, and connectsClose less right side ratchet gear 8231, thereby make rear idler gear 8230 suitable in the time observing from left sideHour hands rotation. Therefore, front idler gear 8220 responds counterclockwise, makes link-type tooth bar 8200 timesContracting. In addition, curved ridges 8510 is to the right outstanding from wheel hub 8506, and its size is set contact forAnd towards distal movement anti-retrogression trip lever 8248, with in the time that manual retrieving lever 8042 rotates, shouldAnti-retrogression trip lever discharges Anti-backup mechanism 8250.

In Figure 196-202, the automatic retracted mechanism 8600 of surgical stapling and cut-out apparatus 8010a canAutomatic retracted is attached to the front idler gear 8220a with tooth 8602 pulling the trigger completely when stroke finishesIn; The circular groove 8604 interior motion of this front idler gear in cam 8606, until corresponding toThing 8608 meets with obstruction after the omnidistance rotation nearly of three percussion strokes. In such cases, to the rightRidge 8610 rotate up contact bottom cam groove 8612, to discharge towards distal movement anti-retrogressionLever 8248a. Specifically, referring to Figure 197, anti-retrogression trip lever 8248a comprises operation as described in the precedingFar-end 8254. Be formed at respectively the circular pegs 8293 between right half shell 8156 and left half shell 8158Pass and be formed in bottom cam 8192 anti-retrogression trip lever 8248a below with pin socket 8296The hole 8294a of essentially rectangular be received, thereby allow longitudinal translation and anti-retrogression trip leverThe downward lock motion of the far-end 8254 of 8248a. In right half shell 8156, the beating towards nearside of levelThe groove 8295a opening holds near the rear pin 8297 to the right of near-end of anti-retrogression trip lever 8248a.

In operation, before the percussion in Figure 198,198A, link-type tooth bar 8200 and anti-downMove back cam tube 8268 in advanced position, make anti-retrogression plate thereby work as anti-retrogression Compress Spring 82648266 when tilt towards nearside, and Anti-backup mechanism 8250 is locked. Automatic retracted mechanism 8600 at the beginning ofBeginning state, wherein anti-retrogression trip lever 8248a retraction, connecting rod 8196a and front idler gear8220a contact. The position of tooth 8602 in six o'clock sharps, wherein the total travel of circular groove 8604 is contraryHour hands carry out, just adjacent teeth 8602 of ridge 8610 to the right. In Figure 199, Figure 199 A, send outA raw percussion stroke, moves upward to a distally connecting rod 8196b and front idler gear 8220aContact. Tooth 8602 has been advanced and 1/3rd has been turned by the circular groove 8604 of stationary cam 8606.In Figure 200, Figure 200 A, there is second percussion stroke, by another connecting rod 8196c upwardsMove to front idler gear 8220a and contact. Tooth 8602 is by the circular ditch of stationary cam 8606Groove 8604 has advanced and 2/3rds has turned. In Figure 20 1, Figure 20 1A, there is the 3rd percussion punchingJourney, moves upward to a distally connecting rod 8196d with front idler gear 8220a and contacts. Tooth 8602Advance to bar 8608 and contact around circular groove 8604 whole process, thus starting cam 8606Be rotated counterclockwise (in the time observing from right side), thereby make ridge 8608 to the right discharge thick stick with anti-retrogressionBar 8248a contact. In Figure 20 2, anti-retrogression trip lever 8248a transports towards distally as responseMoving, thus front pin 8298 to the right locked onto in the hierarchic structure 8299 of opening towards distally and releasePut Anti-backup mechanism 8250. Similar surgery suturing appliance is disclosed in announcement on August 1st, 2006United States Patent (USP) 7,083, in 075, whole disclosures of this patent are incorporated herein by reference.

Referring to Figure 20 3, the nail of surgery suturing appliance 9010 is used assembly 9012 and is achieved as follows function:Clamp organizationally, pass through along axle 9,016 two kinds of differences with respect to pedestal 9070 longitudinal going downsMotion drives nail and cuts off tissue. Pedestal 9070 is attached to the shank of surgery suturing appliance towards nearsideAnd be attached to it, to rotate around longitudinal axis. Be used for surgical stapling and cut off the illustrative many of apparatusStroke shank is called " SURGICALSTAPLING in name common unsettled and that own togetherINSTRUMENTINCORPORATINGAMULTISTROKEFIRINGPOSITIONINDICATORANDRETRACTIONMECHANISM " U.S. Patent Application Serial NumberIn 10/374,026, describe in more detail, the disclosure of this patent application is in full with the side of quotingFormula is incorporated to. Other application according to the invention can be sent out a stroke in conjunction with clicking, for example common unsettled andThe name of owning together is called " SURGICALSTAPLINGINSTRUMENTHAVINGSEPARATEDISTINCTCLOSINGANDFIRINGSYSTEMS " U.S. Patent applicationDescribed in sequence number 10/441,632, the disclosure of this patent application is in full with the side of quotingFormula is incorporated to.

Specifically, referring to Figure 20 4, the distal attachment of pedestal 9070 is to following closely groove 9018. Anvil block 9022 hasNearside hub switch side 9072, this nearside hub switch side is contained in the near of nail groove 9018 in mode that can pivotableIn end 9074, be just in time positioned at the distally at itself and pedestal 9070 attached places. When the downward pivotable of anvil block 9022Time, anvil block 9022 makes tissue contacting surface 9028 move towards relative nail bin with shaping pit 9026,As below further described in more detail. The hub switch side 9072 of anvil block 9022 comprises closing structure 9076,This closing structure contiguous its with the attached place of nail groove 9018 but at it distally with the nail attached place of groove. CauseThis, its far-end of closure tube 9078(comprises the shape of a hoof hole 9080 that engages this closing structure 9076) choosingDuring nearside lengthwise movement, will open to selecting property motion and give anvil block 9022, and in closure tubeDuring 9078 distally lengthwise movement, give anvil block 9022 by closing motion, this closure tube 9078 respondsSlide on pedestal 9070 in closure trigger, be similar to mentioned above. Pedestal 9070 impels alsoGuiding percussion motion is passed longitudinal reciprocating split type cutter and trigger shaft 9090 from shank. SpecificallyGround, pedestal 9070 comprises longitudinal trigger shaft slit 9092, this longitudinal trigger shaft slit holds split typeThe portions of proximal of cutter and trigger shaft 9090, is in particular the trigger shaft 9094 of laminated convergent. Should manageSeparate, the trigger shaft 9094 of laminated convergent can be by solid trigger shaft and/or any other suitable materialReplace.

E type crossbeam 9102 is the distal part of split type cutter and trigger shaft 9090, and it is conducive to separatelyClosed and percussion, and during pulling the trigger by spaced apart to anvil block 9022 and elongated nail groove 9018. SpecificallyReferring to Figure 20 4 and Figure 20 5, except any attached processing example is as solder brazing and adhesive, cutter and hittingSend out bar 9090 and also formed by the vertical attachment hole 9104 of spill being formed in E type crossbeam 9102, this holeHold the corresponding convex attachment members 9106 being presented in distally by the trigger shaft 9094 of laminated convergent,Thereby make each part for example, by being suitable for the selected of its difference in functionality (intensity, pliability, frictional force)Materials and methods form. E type crossbeam 9102 can be advantageously by the material shape with suitable material characteristicBecome, to form a pair of top pin 9110, a pair of intermediate pin 9112 and base pins or leg 9114,And can obtain sharp knife edges 9116. In addition hold, the one of each vertical end of blade 9116Moulding and also define group towards the outstanding top guide device 9118 of nearside and intermediate guide 9120Knit assembly area 9122, contribute to will guide to sharp knife edges 9116 before cut-out tissue. InBetween guider 9120 also for by abutting connection with wedge-shaped slides 9126(Figure 20 6) staged central authoritiesMember 9124 engages and pulls the trigger nail application equipment 9012, realizes thereby use assembly 9012 by nailThe formation of nail, as described in more detail below. Than being assembled by multiple parts, with EType crossbeam 9102 integrally forms these structures (for example, top pin 9110, intermediate pin 9112 and endPortion's leg 9114) be conducive to relative to each other more under the tolerance limit of tight ness rating, manufacturing, thus guaranteeDuring using the effective interaction of various latch-up structures of assembly 9012 in percussion and/or with nail, enterThe operation that the departure date hopes.

In Figure 20 7 and Figure 20 8, nail uses that assembly 9012 is illustrated as opening, wherein E type horizontal strokeBeam 9102 bounces back completely. At assembly process, the lower leg 9114 of E type crossbeam 9102 is through expandingHole 9130 falls into nail groove 9018, and E type crossbeam 9102 is pushed into subsequently, makes E type crossbeam9102 slide towards distally along the lower railway 9132 being formed in nail groove 9018. Particularly, lower railway9132 comprise slit 9133, and it opens as expanding slit 9134 on the lower surface of nail groove 9018,To form the T-shaped of reversion in lateral cross section, as shown in concrete in Figure 20 8 and Figure 20 9; ShouldSlit 9133 is communicated with expanded hole 9130. Once assembled, be attached to hitting of laminated convergent at nearsideThe parts of sending out bar 9094 do not allow lower leg 9114 again to march to expanded hole 9130 to permit towards nearsidePermitted to depart from. Referring to Figure 21 0, the trigger shaft 9094 of laminated convergent is conducive to nail to use assembly 9012Insert through trochar. Particularly, in the time that E type crossbeam 9102 bounces back completely, more distally is downwardProtuberance 9136 lift E type crossbeam 9102. This bit sends out at certain by downward protuberance 9136Raw displacement realizes; At this some place, the nearside of the expanded hole 9130 of this protuberance in nail groove 9018Cam upwards on edge. Referring now to Figure 21 1,, the trigger shaft 9094 of laminated convergent also strengthens some lockThe operation of fixed structure, described latch-up structure can be by comprising that more the protuberance upwards 9138 of nearside is tiedBe incorporated in nail groove 9018; Described protuberance percussion stroke initial part during by pedestal 9070 toUnder order about. Particularly, lateral rod 9140 is limited at pedestal 9070(Figure 20 4) in a square shapedBetween hole 9142. The clip spring 9144 that surrounds lateral rod 9140 downwards forces the percussion of laminated convergentA part for bar 9094 is outstanding towards distally from longitudinal trigger shaft slit 9092, guarantees suitable timeSome favourable latch-up structure is engaged. When protuberance 9138 contact clip sub-springs 9144 upwardsTime, this motive force more obviously or is only confined to pull the trigger the part of stroke.

In Figure 20 7 and Figure 20 8, E type crossbeam 9102 bounces back, and its top pin 9110 is positioned at anvil blockIn near anvil block pit 9,150 9022 pivotable near-end. The vertical anvil block slit 9152 of opening downwardsAnvil block 9022 side direction are expanded into anvil block inner tracks 9154 by (Figure 20 3), when E type crossbeam 9102Top pin 9110 while advancing towards distally during pulling the trigger, anvil block inner tracks is caught E type crossbeam9102 top pin 9110, as shown in Figure 21 0 and Figure 21 1, anvil block 9022 is disconnected with nail groove 9018So spaced apart. Therefore,, when after E type crossbeam 9102 retractions, surgeon can play open and close repeatedlyDowel is used assembly 9012, until to being trapped in placement and the orientation of wherein waiting the tissue of sewing up and cutting offPlease oneself, and E type crossbeam 9102 is even for having the diameter of minimizing and correspondingly reducing justThe nail of degree is used the appropriate location that assembly 9012 also contributes to tissue. Figure 20 3, Figure 20 4,In Figure 20 6, Figure 20 7, Figure 20 9 and Figure 21 5, nail is used assembly 9012 and is depicted as and has the wedge of comprisingThe replaceable nail bin 9020 of shape sliding part 9126. Longitudinally alignment and parallel multiple wedges of opening downwardsShape slit 9202(Figure 20 9) hold the essential corresponding wedge 9204 of wedge-shaped slides 9126.In Figure 20 9-211, therefore multiple staple drivers 9206 of cam upwards of wedge-shaped slides 9126, instituteStating multiple staple drivers can vertically slide in staple drivers groove 9208. In this illustrative pattern,Each staple drivers 9206 comprises two vertical contact pins, and each vertical contact pin upwards moves to corresponding nailIn hole 9210 or cavity 9024, leaning against nail profiled surface 9214(Figure 21 1 of anvil block 9022)On nail 9023 upwards extrude and make its distortion. Be limited in the contiguous nail bin 9020 of following closely groove 9018Central authorities percussions groove 9216(Figure 20 4) allow the bottom level part 9218 of wedge-shaped slides 9126The intermediate pin 9112 of (Figure 20 6) and E type crossbeam 9102 passes through. Particularly, nail bin pallet9220(Figure 20 4, Figure 20 9) be attached to polymer nail bin body 9222 and be positioned at below it; This polymerizationIt is recessed that thing nail bin body has the staple drivers groove 9208, nail hole 9210 and the central authorities' percussion that are formed at whereinGroove 9216. When nail 9023 is therefore in the time that either side is shaped, sharp knife edges 9116 enters vertical groove9230, except the only distal-most end of this vertical groove, this vertical groove is longitudinal through nail bin 9020Axis.

As shown in Figure 21 1, when by split type cutter and trigger shaft 9090 towards nearside tractive until downwardProtuberance 9136 is by the intermediate guide 9120 on E type crossbeam 9102 upwards and backward when cam,Start percussion nail and use assembly 9012, thereby in the time that anvil block 9022 is opened as Figure 20 3 and 207, makeNew nail bin 9020 inserts in nail groove 9018. In Figure 21 2, split type cutter and trigger shaft 9090 areBe pushed into a bit of distance towards distally, thereby make to act on hitting of laminated convergent when clip spring 9144While sending out the protuberance 9138 upwards of bar 9094, downward protuberance 9136 falls into lower railway 9132Expanded hole 9130 in. Intermediate guide 9120 prevents owing to being resisted against wedge-shaped slides 9126What in staged central member 9124, produce is further rotated down, thereby by E type crossbeamIntermediate pin 9112 remains in central authorities' percussion groove 9216. In Figure 21 3, split type cutter and percussionBar 9090 is pulled the trigger towards distally, thereby advances wedge-shaped slides 9126, will be clamped in anvil block to work as9022 and have when tissue 9242 between the nail bin 9020 of sharp knife edges 9116 cuts off and make to follow closely 9023Be shaped. Subsequently, in Figure 21 4, split type cutter and trigger shaft 9090 bounce back, and make wedge-shaped slides9126 locate in distally. In Figure 21 5, intermediate pin 9112 is allowed to move to downwards and is formed at nailGroove 9018(also can be referring to Figure 20 8, Figure 21 1) in latch recess 9240 in. Therefore, work as wedge shapeSliding part 9126(is not shown in Figure 21 5) in nearside location, (for example, nail bin 9020 does not lackMistake or nail bin 9020 exhaust) time, if intermediate pin 9112 runs into the far lateral side of latch recess 9240Edge, operator will receive sense of touch instruction. Similarly surgery suturing appliance was June 3 in 2008In the United States Patent (USP) 7,380,696 of day announcing, have disclosedly, whole disclosures of this patent are with the side of quotingFormula is incorporated to herein.

In various embodiments, as mentioned above, nail bin can comprise warehouse, and this warehouse comprises multiple at itThe nail chamber of middle restriction. Warehouse can comprise platform and top platform surface, and wherein each nail chamber can limit flatOpening in platform surface. Also described above, nail can be positioned in each nail chamber, and nail is storedIn warehouse until its penetrated from warehouse. In various embodiments, before being penetrated from warehouse,Nail can be accommodated in warehouse, makes nail not be projected into platform surface top. In this type of embodiment,When nail is positioned in platform surface when below, can reduce nail damaged and/or contact too early target tissue canCan property. In all cases, nail can not move between firing position and firing position. In not percussion, it is not outstanding from warehouse when the position, and in the time of firing position, it exposes and can contact by fixed from warehousePosition is at the anvil block on nail bin opposite. In various embodiments, anvil block and/or be defined in nail in anvil block and be shapedPit can be oriented to anomaly platform surface one preset distance, makes in the time that nail is deployed from warehouse,Nail is deformed into a predetermined forming height. In some cases, be trapped between anvil block and nail binTissue thickness variable, therefore, compared with thick tissue can be trapped in some nail in and thinner tissueCan be trapped in some other nail. In any situation, be applied to the clamping pressure of tissue by nailOr compaction forces for example can be different because of nail, or nail on nail on one end of nail row and nail row's the other endBetween change. In some cases, can control the gap between anvil block and nail bin platform, nail is existedIn each nail, apply the clamping pressure of a certain minimum. But in some these type of situations, at different nailsThe marked change of interior clamping pressure may still exist.

In various embodiment as herein described, nail bin can comprise as lower device: this device is used for quiltThe thickness of the tissue that the nail of disposing from nail bin is caught compensates. In various embodiments, referring to figure216, the Part I that nail bin such as nail bin 10000 for example can comprise rigidity is such as support section10010, and compressible Part II is such as thickness compensation part 10020. At at least one embodimentIn, first referring to Figure 21 8, support section 10010 can comprise warehouse, top platform surface 10011With multiple nails chamber 10012. Wherein, be similar to mentioned abovely, each nail chamber 10012 can limit platformOpening in surface 10011. Nail 10030 for example can be positioned at each nail chamber 10012 removedlyIn. In at least one this type of embodiment, first referring to Figure 24 5 and as described in more detail below,One or more legs that each nail 10030 can comprise base portion 10031 and extend from base portion 1003110032. Before nail 10030 is deployed, also as described in more detail below, the base portion of nail 1003010031 can be supported by the staple drivers being positioned in support section 10010, and simultaneously, nail 10030Leg 10032 can be at least partly contained in nail chamber 10012 in. In various embodiments, nail10030 can not be deployed between firing position and firing position, and leg 10032 is moved through groupKnit thickness compensation part 10020, the top surface of penetrate tissue thickness compensation part 10020, penetrate tissueT, and contact is positioned in the anvil block on nail bin 10000 opposites. When leg 10032 is out of shape against anvil blockTime, the part that the leg 10032 of each nail 10030 can capture tissue thickness compensation part 10020 andA part for tissue T in each nail 10030, and compression stress is applied to tissue. To above enteringRow further describes, and can make the leg 10032 of each nail 10030 become towards the base portion 10031 of nail downwardsShape, holds back region 10039 to form nail, holds back region at this nail, tissue T and tissue thickness's compensationPart 10020 can be hunted down. In all cases, nail is held back region 10039 and can be limited at and be out of shapeThe inner surface of leg 10032 and the inner surface of base portion 10031 between. The size that nail is held back region is desirableCertainly in some factors, the width of the length of for example leg, the diameter of leg, base portion and/or for example leg distortionDegree.

In previous embodiment, surgeon usually need to select to have for the tissue being just sewnThe suitably suitable nail of staple height. For example, surgeon can select high nail to use together with thick organizingAnd select low nail to use together with thin tissue. But in some cases, the tissue being just sewnDo not have consistent thickness, therefore, some nails cannot be realized the percussion configuration of expectation. For example, figure250 show for compared with the higher nail of thin tissue. Referring now to Figure 25 1,, when tissue thickness's compensationWhen part such as tissue thickness's compensating part 10020 for example uses together with thin tissue, for example larger nail canBe configured as the percussion configuration of expectation.

Due to the compression ratio of tissue thickness's compensating part, tissue thickness's compensating part can be to being captured in each nailThe thickness of tissue compensate. More specifically, referring now to Figure 24 5 and Figure 24 6, tissue thicknessCompensating part such as tissue thickness's compensating part 10020, for example, can be held back in region 10039 and hold according to nailThe thickness of tissue and/or the type nail that occupies each nail 10030 hold back the large of region 10039 and/Or less part. For example, be trapped in the situation in nail 10030 compared to thicker tissue T,If thinner tissue T is trapped in nail 10030, tissue thickness's compensating part 10020 can occupyNail is held back the major part in region 10039. Correspondingly, be trapped in nail compared to thinner tissue TSituation in 10030, if thicker tissue T is trapped in nail 10030, tissue thickness is mendedRepaying part 10020 can occupy nail and hold back the smaller portions in region 10039. Like this, tissue thickness's compensating partCan compensate for slower thin tissue and/or thicker tissue, and guarantee that compression stress is applied to tissue, no matter and or extremelySubstantially be trapped in tissue thickness in nail no matter few how. Except mentioned above, organize thickDegree compensating part 10020 can be to being trapped in dissimilar or different compression ratios in different nails 10030Tissue compensates. Referring now to Figure 24 6,, tissue thickness's compensating part 10020 can apply compression stressTo the T of vascular tissue that can comprise blood vessel V, and therefore limit blood flows through not too compressible blood vesselV, but still the compression stress of expectation is applied to tissue T around. In all cases, to upperLiterary composition is described further, and tissue thickness's compensating part 10020 also can compensate strained nail. Referring to figure247, the distortion of various nails 10030 can cause the larger nail being limited in this type of nail to hold back region10039. Due to the screen resilience of tissue thickness's compensating part 10020, referring now to Figure 24 8, even if limitFix on be out of shape the nail of nail in 10030 hold back region 10039 can be extended, be positioned at this and be out of shape nailTissue thickness's compensating part 10020 in 10030 still can be applied to tissue T by enough compression stresses.In all cases, being positioned at adjacent nail 10030 middle tissue thickness's compensating parts 10020 can be becomeThe nail 10030 of staple 10030 suitable shaping is around setovered against tissue T, and therefore by compression stressFor example be applied to around and/or be trapped in the tissue being out of shape in nail 10030. In all cases,Tissue thickness's compensating part can compensate different tissue densities, described different tissue density can be for example due toClassification, zone of fiber and/or the tissue previously having sewed up or processed and produce.

In various embodiments, fix or unmodifiable tissue space can be limited at support sectionAnd between anvil block. Why all can make nail be deformed in advance no matter be therefore trapped in the thickness of the tissue in nailFixed height. In the time that tissue thickness's compensating part uses together with these embodiment, tissue thickness's compensating partCan adapt to be trapped in the tissue between anvil block and support section nail bin, and due to tissue thickness's compensationThe screen resilience of part, tissue thickness's compensating part can be applied to tissue by additional compression stress. Referring now to figure,252-257, nail 10030 has been configured as predetermined height H. With reference to Figure 25 2, tissue thickness's compensating partDo not used, and tissue T occupies whole nail and has held back region 10039. With reference to Figure 25 9, groupA part of knitting thickness compensation part 10020 has been trapped in nail 10030, by tissue T compression,And occupy nail and held back at least a portion in region 10039. Referring now to Figure 25 4,, thin tissue TBe trapped in nail 10030. In this embodiment, compressed tissue T has about 2/9H'sHighly, and compressed tissue thickness compensating part 10020 for example there is the approximately height of 7/9H. ExistingReferring to Figure 25 5, the tissue T with interior thickness has been trapped in nail 10030. In this enforcementIn example, compressed tissue T has the height of about 4/9H, and compressed tissue thickness is mendedRepay part 10020 and for example there is the approximately height of 5/9H. Referring now to Figure 25 6,, there is interior thicknessTissue T has been trapped in nail 10030. In this embodiment, compressed tissue T has approximatelyThe height of 2/3H, and compressed tissue thickness compensating part 10020 has for example about 1/3H'sHighly. Referring now to Figure 25 5,, thick tissue T has been trapped in nail 10030. At this embodimentIn, compressed tissue T has the height of about 8/9H, and the compensation of compressed tissue thicknessPart 10020 for example has the approximately height of 1/9H. In all cases, tissue thickness's compensating part can wrapDraw together compression height, this compression height comprises: about 10% nail is for example held back height, about 20%Nail holds back that height, about 30% nail are held back height, about 40% nail is held back height, about 50%Nail hold back height, about 60% nail and hold back height, about 70% nail and hold back height, approximately80% nail is held back the nail of height and/or about 90% and is held back height.

In various embodiments, nail 10030 can comprise any suitable unshaped height. Real at someExecute in example, nail 10030 can comprise for example unshaped between about 2mm and about 4.8mmHighly. Nail 10030 for example can comprise approximately 2.0mm, about 2.5mm, about 3.0mm, about3.4mm, about 3.5mm, about 3.8mm, about 4.0mm, about 4.1mm and/or aboutThe unshaped height of 4.8mm. In various embodiments, following closely deformable height H can be by support sectionDistance between 10010 platform surface 10011 and relative anvil block decides. Real at least oneExecute in example, the distance between platform surface 10011 and the tissue contacting surface of anvil block can be for example about0.097 ". Height H also can be determined by the degree of depth that is limited to the shaping pit in anvil block. At at least oneIn embodiment, shaping pit for example can have the degree of depth of measuring from tissue contacting surface. In various enforcementIn example, as described in more detail below, nail bin 10000 also can comprise staple drivers. This staple drivers canNail 10030 is lifted towards anvil block, and at least one embodiment nail is lifted or " excessively driving "To platform surface 10011 tops. In this type of embodiment, nail 10030 forming height H also can be byNail 10030 distances that are overdriven decide. In at least one this type of embodiment, nail 10030For example can be overdriven approximately .028 ", and can cause following closely 10030 be shaped as for example about0.189 " height. In various embodiments, nail 10030 for example can be shaped as approximately 0.8mm,Approximately 1.0mm, about 1.5mm, about 1.8mm, about 2.0mm and/or about 2.25mmHeight. In certain embodiments, nail for example can be shaped as approximately 2.25mm and approximately 3.0mmHeight. To being above described further, the nail of nail is held back the height in region can be high by the shaping of following closelySpend and comprise that width and the diameter of the wire rod of nail determine. In various embodiments, nail 10030It is wide that the height that nail is held back region 10039 can comprise that the forming height H of nail deducts two diameters of wire rodDegree. In certain embodiments, nail wire rod for example can comprise about 0.0089 " diameter. In various enforcementIn example, nail row can comprise for example diameter between about 0.0069 " and about 0.0119 ". At least oneIn individual exemplary embodiment, the forming height H of nail 10030 can be about 0.189 ", and nail wire rodThe nail that diameter can be about 0.0089 ", thereby for example produce about 0.171 " is held back height.

In various embodiments, to being above described further, tissue thickness's compensating part can comprise notThe height of disposing compression or pre-, and can be deformed in multiple compression heights. At someIn embodiment, tissue thickness's compensating part for example can comprise about 0.125 " not compression height. VariousIn embodiment, the compensating part of tissue thickness can comprise and is for example more than or equal to about 0.080 " not compression highDegree. In at least one embodiment, tissue thickness's compensating part can comprise the height of unpressed or pre-deploymentDegree, this is highly greater than the not percussion height of nail. In at least one embodiment, tissue thickness's compensating partThe not percussion of the comparable nail of height of unpressed or pre-deployment highly for example high about 10%, approximately high20%, high about 30%, high about 40%, high about 50%, high about 60%, approximately high70%, high by about 80%, high about 90% and/or high about 100%. At at least one embodimentIn, the highly high example of not percussion of the comparable nail of height of the unpressed or pre-deployment of tissue thickness's compensating partAs at the most about 100%. In certain embodiments, the unpressed or pre-portion of tissue thickness's compensating partThe not percussion of the comparable nail of height of administration is highly high for example exceedes 100%. In at least one embodiment,Tissue thickness's compensating part can comprise the not compression height of the not percussion height that equals nail. Real at least oneExecute in example, tissue thickness's compensating part can comprise the not compression height of the not percussion height that is less than nail. ExtremelyIn a few embodiment, the comparable nail of height of the unpressed or pre-deployment of tissue thickness's compensating part is notPercussion is highly for example low about 10%, low about 20%, low about 30%, low about 40%, low largeApproximately 50%, low by about 60%, low about 70%, low about 80% and/or low by about 90%. ?In various embodiment, compressible Part II can comprise not compression height, this not compression height higher thanThe not compression height of the tissue T being just sewn. In certain embodiments, tissue thickness's compensating part can wrapDraw together not compression height, the not compression height of this tissue T that compression height does not equal be just sewn. RespectivelyIn kind of embodiment, tissue thickness's compensating part can comprise not compression height, this not compression height lower than just byThe not compression height of the tissue T of sewing up.

As mentioned above, no matter be that thick tissue or thin tissue are trapped in nail, tissue thickness's compensating partAll can be compressed in multiple one-tenth staples. In at least one exemplary embodiment, can make nail row or nailThe distortion of nail in row, makes the nail of each nail hold back region and for example comprises the approximately height of 2.0mm, itsMiddle tissue T and tissue thickness's compensating part can be compressed in this height. In some cases, tissueT can be included in and follow closely the compression height of holding back the about 1.75mm in region, and tissue thickness's compensating partCan be included in nail and hold back the compression height of the about 0.25mm in region, thereby obtain for example adding up toApproximately the nail of 2.0mm is held back region height. In some cases, tissue T can be included in nail and hold back districtThe compression height of about 1.50mm in territory, and tissue thickness's compensating part can be included in nail and holds back regionThe compression height of interior about 0.50mm, holds back thereby obtain adding up to for example nail of about 2.0mmRegion height. In some cases, tissue T can be included in nail and hold back the about 1.25mm in regionCompression height, and tissue thickness's compensating part can be included in nail and holds back about 0.75mm's in regionCompression height, holds back region height thereby obtain adding up to for example nail of about 2.0mm. In some feelingsUnder condition, tissue T can be included in nail and hold back the compression height of the about 1.0mm in region, and organizes thickDegree compensating part can be included in nail and hold back the compression height of the about 1.0mm in region, thereby is amounted toFor for example nail of about 2.0mm is held back region height. In some cases, tissue T can be included in nailHold back the compression height of the about 0.75mm in region, and tissue thickness's compensating part can be included in nail sectionStay the compression height of the about 1.25mm in region, thereby obtain adding up to for example about 2.0mm'sNail is held back region height. In some cases, tissue T can be included in nail hold back in region approximatelyThe compression height of 1.50mm, and tissue thickness's compensating part can be included in nail hold back in region approximatelyThe compression height of 0.50mm, thereby for example obtain adding up to approximately the nail of 2.0mm, to hold back region highDegree. In some cases, tissue T can be included in the compression that nail is held back the about 0.25mm in regionHighly, and tissue thickness's compensating part can be included in nail to hold back the compression of the about 1.75mm in region highDegree, holds back region height thereby obtain adding up to for example nail of about 2.0mm.

In various embodiments, to being above described further, tissue thickness's compensating part can comprise littleIn the not compression height of the percussion height of following closely. In certain embodiments, tissue thickness's compensating part can compriseEqual the not compression height of the percussion height of nail. In some other embodiment, tissue thickness's compensating partCan comprise the not compression height higher than the percussion height of nail. In at least one this type of embodiment, tissueThe not compression height of thickness compensation part can comprise for example following thickness: this thickness is the large of shaping staple heightApproximately 110%, about 120%, the shaping staple height of shaping staple height about 130%, become staple highAbout 150%, the shaping staple height of about 140%, the shaping staple height of degree about 160%, becomeAbout 180%, the shaping staple height of about 170%, the shaping staple height of staple height approximately190% and/or shaping staple height about 200%. In certain embodiments, tissue thickness's compensating partCan comprise not compression height, this is highly more than the twice of percussion height of nail. At various embodimentIn, tissue thickness can comprise compression height, this height is the staple height that is for example shaped about 85% to greatlyApproximately 150%. In various embodiments, as mentioned above, tissue thickness's compensating part can be compressed betweenNot between compressed thickness and compressed thickness. In certain embodiments, the compression of tissue thickness's compensating part is thickDegree can be for example for its not compressed thickness about 10%, its not compressed thickness about 20%, it does not pressContracting thickness about 30%, its not compressed thickness about 40%, its not compressed thickness approximately50%, its not compressed thickness about 60%, its not compressed thickness about 70%, it does not compress thickDegree about 80% and/or its not compressed thickness about 90%. In various embodiments, organize thickThe not compressed thickness of degree compensating part can be for example than the thick about twice of its compressed thickness, about ten times, approximately50 times and/or about 100 times. In at least one embodiment, the compression of tissue thickness's compensating partThickness can between its not compressed thickness about 60% to about 99%. In at least one embodiment,Comparable its compressed thickness thick at least 50% of not compressed thickness of tissue thickness's compensating part. Real at least oneExecute in example thick 100 times at the most of comparable its compressed thickness of not compressed thickness of tissue thickness's compensating part. ?In various embodiment, compressible Part II can be flexible, or flexible at least partly, andCan the distortion leg biasing against nail by tissue T. In at least one this type of embodiment, compressibleTwo parts can be between tissue T and the base portion of nail elastic stretch, to promote tissue against the leg of nailT. In certain embodiments, as below will further discussed in detail, tissue thickness's compensating part can be by fixedPosition is in the middle of the nail leg of tissue T and distortion. In all cases, due to mentioned above, tissue thicknessCompensating part can be eliminated nail and hold back any gap in region.

In various embodiments, tissue thickness's compensating part can comprise polymer composition. Combination of polymersThing can comprise one or more synthetic polymers and/or one or more non-synthetic polymers. Synthesized polymerThing can comprise synthetic absorbable polymer and/or synthetic non-absorbable polymer. At various embodimentIn, polymer composition can comprise for example biocompatible foam. Biocompatible foam can comprise exampleAs the closed-cell foam of the open celled foam of porous and/or porous. Biocompatible foam can have uniform holeForm maybe can have gradient pore form (that is, and on the whole depth of foam of a direction, orifice sizeIncrease and become macropore gradually). In various embodiments, polymer composition can comprise porous support,Porous matrix, gel-type vehicle, hydrogel matrix, solution matrix, thread matrix, tubulose matrix, multipleClose a kind of or many in matrix, membrane matrix, Biostatic polymer and biodegradable polymerKind and their combination. For example, tissue thickness's compensating part can comprise by thread matrix enhancementFoam, maybe can comprise the foam with additional hydrogel layer, and this additional hydrogel layer is deposited at body fluidIn lower expansion, so that compression to be further provided organizationally. In various embodiments, tissue thickness's compensationPart also can be made up of the coating on material and/or the second layer or the 3rd layer, and this coating expands under body fluid existsExhibition, further to provide organizationally compression. This type of layer can be hydrogel, and this hydrogel can be syntheticAnd/or natural source material, and for example can be biological durable and/or biodegradable. At certainIn a little embodiment, can use the fiber non-woven of additional flexibility, rigidity and/or intensity material can be providedMaterial or fiber mesh type element strengthen tissue thickness's compensating part. In various embodiments, organize thickDegree compensating part has porous form, and this porous form shows gradient-structure, for example, on a surfaceAperture and in another lip-deep larger hole. This type of form is for tissue growth or hemostasis rowFor even more ideal. In addition, gradient also can be combined with the bio-absorbable section changing. Short-term is inhaledReceive section and can be preferably, to solve hemostasis problem, and long-term absorption profile can solve ne-leakage situationUnder make to organize the problem of better healing.

The example of non-synthetic polymer include but not limited to freeze-drying polysaccharide, glycoprotein, elastin laminin,Proteoglycans, gelatin, collagen and oxidized regenerated cellulose (ORC). Synthetic absorbable polymerExample include but not limited to gather (lactic acid) (PLA), PLLA (PLLA), polycaprolactone(PCL), polyglycolic acid (PGA), PTMC (TMC), poly terephthalic acid second twoCopolymer, the second of ester (PET), polyhydroxy-alkanoates (PHA), glycolide and 6-caprolactone (PGCL)The copolymer of lactide and trimethylene carbonate, poly-(decanedioic acid glyceride) (PGS), poly-to dioxy hexamethyleneKetone, poly-(ortho esters), poly-acid anhydrides, polysaccharide, poly-(ester-acid amide), tyrosine-based polyarylate, tyrosineBase gathers imido-carbonic ester, tyrosine-based polycarbonate, poly-(D, L-lactide-carbamate), poly-(B-Hydroxybutyric acid), poly-(E-caprolactone), polyethylene glycol (PEG), poly-[two (carboxyphenoxy) phosphonitrile], poly-(amino acid), plan poly-(amino acid), absorbable polyurethane and their combination. At various embodimentIn, polymer composition for example can comprise gathering of about 50% to about 90% PLLA by weightCompound composition, and the polymer composition of about 50% to about 10% PCL by weight.In at least one embodiment, polymer composition for example can comprise by weight about 70%PLLA, and about 30% PCL by weight. In various embodiments, polymer compositionFor example can comprise the polymer composition of about 55% to about 85% PGA by weight, andThe polymer composition of 15% to 45% PCL by weight. In at least one embodiment, polymerizationCompositions for example can comprise about 65% PGA by weight, and by weight about 35%PCL. In various embodiments, polymer composition for example can comprise that by weight about 90% to largeThe polymer composition of approximately 95% PGA, and about 5% to about 10% PLA by weightPolymer composition.

In various embodiments, synthetic absorbable polymer can comprise can bio-absorbable, biofaciesCapacitive elastomer copolymer. Suitable can bio-absorbable, biocompatible flexible precursor copolymer comprisesBut be not limited to copolymer (the preferably mol ratio of 6-caprolactone and glycolide of 6-caprolactone and glycolideFor about 30:70 is to about 70:30, preferably 35:65 is to about 65:35, and also more preferably 45:55 is extremely35:65), 6-caprolactone and lactide (comprise that its L-lactide, D-lactide blend or lactic acid are altogetherPolymers) elastomer copolymer (preferably the mol ratio of 6-caprolactone and lactide be about 35:65 extremelyAbout 65:35, also 45:55 to 30:70 more preferably), to dioxanone (Isosorbide-5-Nitrae-dioxa hexamethyleneAlkane-2-ketone) and the elastomer copolymer of lactide (comprising L-lactide, D-lactide and lactic acid)(being preferably that about 40:60 is to about 60:40 to the mol ratio of dioxanone and lactide), ε-oneselfLactone and the elastomer copolymer to dioxanone (preferably 6-caprolactone with to dioxa hexamethyleneThe mol ratio of ketone is about 30:70 to about 70:30), to dioxanone and trimethylene carbonateElastomer copolymer (preferably to the mol ratio of dioxanone and trimethylene carbonate for approximately30:70 is to about 70:30), the elastomer copolymer of trimethylene carbonate and glycolide (preferably threeThe mol ratio of mesomethylene carbon acid esters and glycolide is about 30:70 to about 70:30), trimethylene carbonateAnd the elastomer of lactide (comprising its L-lactide, D-lactide blend or lactic acid copolymer) altogetherPolymers (preferably the mol ratio of trimethylene carbonate and lactide is about 30:70 to about 70:30) andIts blend. In one embodiment, elastomer copolymer is the copolymerization of glycolide and 6-caprolactoneThing. In another embodiment, elastomer copolymer is the copolymer of lactide and 6-caprolactone.

The name that is published in November 21 nineteen ninety-five is called " ELASTOMERICMEDICALDEVICE " United States Patent (USP) 5,468,253 and be published in December 4 calendar year 2001 name be called" FOAMBUTTRESSFORSTAPLINGAPPARATUS " for United States Patent (USP)6,325,810 disclosure is incorporated to herein separately in full by reference.

In various embodiments, can comprise for example can brand name for synthetic absorbable polymerVICRYL (polyglactic910) is from Ethicon, 90/10 poly-(glycolide-L-third that Inc. is commercially availableLactide) copolymer, can brand name DEXON commercially available from AmericanCyanamidCo.PGA, can brand name PDS from Ethicon, commercially available poly-to dioxy hexamethylene of Inc.Ketone, can brand name MAXON from commercially available poly-of AmericanCyanamidCo., (second is handed overEster-trimethylene carbonate) statistic copolymer, can brand name MONOCRYL from treasuring75/25 poly-(glycolide-E-caprolactone-poliglecaprolactone25) copolymerization that Kanggong department is commercially availableOne or more in thing.

Synthetic non-absorbable polymer includes but not limited to polyurethane foam plastics, polypropylene(PP), polyethylene (PE), Merlon, polyamide, for example nylon, polyvinyl chloride(PVC), polymethyl methacrylate (PMMA), polystyrene (PS), polyester, polyethersEther ketone (PEEK), polytetrafluoroethylene (PTFE), polytrifluorochloroethylene (PTFCE), poly-fluorineEthene (PVF), PEP (FEP), polyacetals, polysulfones and their groupClose. Synthetic non-absorbable polymer can include but not limited to elastomer foam plastics and poroelasticityBody, for example siloxanes, polyisoprene and rubber. In various embodiments, synthetic polymer can wrapDraw together expanded PTFE (ePTFE) (can brand name GORE-TEXSoftTissuePatch fromGe Er company (W.L.Gore&Associates, Inc.) is commercially available) and copolyether ester polyurethane foam(can brand name NASOPORE commercially available from Polyganics).

The polymer composition of tissue thickness's compensating part is characterised in that for example percentage porosity, hole chiVery little and/or hardness. In various embodiments, polymer composition can have for example about by volume30% to about 99% percentage porosity. In certain embodiments, polymer composition can have exampleAs about 60% to about 98% percentage porosity by volume. In various embodiments, polymerComposition for example can have about 85% to about 97% percentage porosity by volume. At least oneIn individual embodiment, polymer composition for example can comprise by weight about 70% PLLA and by heavyThe PCL of amount meter about 30%, and for example can comprise about 90% porosity by volume. ExtremelyIn few this type of embodiment, therefore, polymer composition will comprise about 10% be total to by volumePolymers. In at least one embodiment, polymer composition for example can comprise by weight about 65%PGA and about 35% PCL by weight, and for example can have by volume about 93%Arrive about 95% percentage porosity by volume. In various embodiments, polymer composition can wrapDraw together the porosity that is greater than by volume 85%. Polymer composition can have for example about 5 microns to largeThe hole dimension of approximately 2000 microns. In various embodiments, polymer composition for example can have between greatlyHole dimension between approximately 10 microns to about 100 microns. In at least one this type of embodiment, polymerizationCompositions can for example comprise the copolymer of PGA and PCL. In certain embodiments, polymer groupCompound can have for example hole dimension between about 100 microns to about 1000 microns. At leastIn this type of embodiment, polymer composition can comprise the copolymer of for example PLLA and PCL. RootAccording to some aspect, the hardness of polymer composition can Shore hardness represent. This Shore hardness can be by fixedJustice is the tolerance such as the permanent indenture to material of being measured by sclerometer. For assess toThe durometer value of determining material, is called " StandardTestMethodforRubberProperty-according to nameDurometerHardness " ASTM of (standard method of test of rubber property-durometer hardness)Program D2240-00, is applied to material by pressure with penetrator pin, and it in full by referenceBe incorporated to herein. Penetrator pin can be administered to material and continue enough a period of times, such as 15Second, for example, wherein reading reads from suitable scale. According to scale type used, when pressure head pinWhen complete penetrable material, can obtain reading 0, and in the time that material is not penetrated, can obtain reading100. This reading dimensionless. In various embodiments, can be for example according to ASTMD2240-00 basisAny suitable scale decides hardometer such as category-A and/or OO class scale. At various embodimentIn, the polymer composition of tissue thickness's compensating part can have the Shore A of about 4A to about 16AHardness number, this Xiao A hardness value is the Shore OO model to about 65OO at about 45OO for exampleEnclose. In at least one this type of embodiment, polymer composition can comprise for example PLLA/PCL copolymerizationThing or PGA/PCL copolymer. In various embodiments, the combination of polymers of tissue thickness's compensating partThing can have the Xiao A hardness value that is less than 15A. In various embodiments, tissue thickness compensating partPolymer composition can have the Xiao A hardness value that is less than 10A. In various embodiments, organize thickThe polymer composition of degree compensating part can have the Xiao A hardness value that is less than 5A. At some embodimentIn, polymeric material for example can have approximately 35OO to the Shore OO composition of about 75OOValue.

In various embodiments, polymer composition can have at least two in the above-mentioned characteristic identifyingKind. In various embodiments, polymer composition can have at least three in the above-mentioned characteristic identifyingKind. Polymer composition for example can have by volume 85% to 97% porosity, 5 microns and arriveThe hole dimension of 2000 microns and 4A are to the Xiao A hardness value of 16A and 45OO to 65OO'sShore OO hardness number. In at least one embodiment, polymer composition can comprise 70 % by weightThe polymer composition of the PCL of the polymer composition of PLLA and 30 % by weight; Described polymerComposition for example have 90% porosity by volume, 100 microns to 1000 microns hole dimension,With the Shore OO hardness number of 4A to the Xiao A hardness value of 16A and 45OO to 65OO. ?In at least one embodiment, polymer composition can comprise the combination of polymers of the PGA of 65 % by weightThe polymer composition of the PCL of thing and 35 % by weight; Described polymer composition for example have byThe porosity of stereometer 93% to 95%, the hole dimension of 10 microns to 100 microns and 4A are to 16AXiao A hardness value and 45OO to the Shore OO hardness number of 65OO.

In various embodiments, polymer composition can comprise pharmaceutically active agents. Polymer composition canDischarge the pharmaceutically active agents for the treatment of effective dose. In various embodiments, when polymer composition is desorbedOr absorb time pharmaceutically active agents can be released. In various embodiments, pharmaceutically active agents can be released toFluid is such as on the polymer composition of flowing through or through in the blood of polymer composition. Pharmaceutically activeThe example of agent can include but not limited to styptic and medicine, and for example fibrin, fibrin ferment and oxidation are againRaw cellulose (ORC); Anti-inflammatory agent, for example Diclofenac, aspirin, naproxen, sulindac andHydrocortisone; Antibiotic and antimicrobial agents or reagent, for example triclosan, ionic silver, ammonia benzylPenicillin, gentamicin, PB, chloramphenicol; And anticancer, for example cis-platinum, silk splitMycin, adriamycin.

In various embodiments, referring now to Figure 21 6, nail bin such as nail bin 10000 for example can compriseSupport section 10010 and compressible tissue thickness compensating part 10020. Referring now to Figure 21 8-220,,Support section 10010 can comprise platform surface 10011 and be limited to multiple in support section 10010Nail chamber 10012. The size in each nail chamber 10012 for example can be set for and can be removedly thereinStore nail such as nail 10030. Nail bin 10000 also can comprise multiple staple drivers 10040. Work as nail10030 and staple drivers 10040 in it not when firing position, each staple drivers can support nailOne or more nails 10030 in chamber 10012. In at least one this type of embodiment, first referring toFigure 22 4 and Figure 22 5, each staple drivers 10040 can comprise for example one or more supports or groove10041, this support or groove can also limit the phase between nail 10030 and staple drivers 10040 by support nailTo motion. In various embodiments, refer again to Figure 21 8, nail bin 10000 also can comprise nail percussionSliding part 10050; This nail percussion sliding part can move to from the near-end of nail bin 10001 far-end of nail bin10002, so as successively by staple drivers 10040 and nail 10030 from its not firing position towards being positionedAnvil block on nail bin 10000 opposites lifts. In certain embodiments, first referring to Figure 21 8 and figure220, one or more legs that each nail 10030 can comprise base portion 10031 and extend from base portion 1003110032, wherein each nail for example can be at least one in basic U-shaped and basic V-arrangement. At leastIn an embodiment, nail 10030 can be configured to make when nail 10030 is in its firing position notTime, the end of nail leg 10032 caves in respect to the platform surface 10011 of support section 10010. ?In at least one embodiment, nail 10030 can be configured to make do not pull the trigger position when nail 10030 in itWhile putting, the end of nail leg 10032 flushes with respect to the platform surface 10011 of support section 10010.In at least one embodiment, nail 10030 can be configured to make do not pull the trigger in it when nail 10030, at least certain part of the end of nail leg 10032 or nail leg 10032 extends to support section when the position10010 platform surface 10011 tops. In this type of embodiment, when nail 10030 does not hit in itWhile sending out position, nail leg 10032 may extend into and is embedded in tissue thickness's compensating part 10020. ?In at least one this type of embodiment, it is large that nail leg 10032 can for example extend to platform surface 10011 topsApproximately 0.075 ". In various embodiments, nail leg 10032 can for example extend on platform surface 10011Distance between Fang great Yue 0.025 " and about 0.125 ". In certain embodiments, to above enteringOne step is described, and tissue thickness's compensating part 10020 can comprise for example between about 0.08 " and about 0.125 "Not compressed thickness.

In use, to being above described further and first referring to Figure 23 3, anvil block is such as anvil block10060 are for example moveable to the closing position relative with nail bin 10000. As described in more detail below,Anvil block 10060 can be located tissue against tissue thickness's compensating part 10020, and at various embodimentIn, for example tissue thickness's compensating part 10020 is pressed to the platform surface of support section 1001010011. Once anvil block 10060 is appropriately located, can dispose nail 10030, same as Figure 23 3Shown in. In various embodiments, as mentioned above, nail percussion sliding part 10050 can be from nail bin 10000Near-end 10001 move towards far-end 10002, as shown in Figure 23 4. When sliding part 10050 is pushed awayWhile entering, sliding part 10050 can contact stud driver 10040 interior by staple drivers in nail chamber 1001210040 upwards lift. In at least one embodiment, sliding part 10050 and staple drivers 10040Can comprise separately one or more slopes or inclined-plane, these one or more slopes or inclined-plane can cooperate so thatStaple drivers 10040 from its not firing position move upward. In at least one this type of embodiment, ginsengSee Figure 22 1-225, each staple drivers 10040 can comprise at least one inclined-plane 10042, and slidesPart 10050 can comprise one or more inclined-planes 10052, and it can be configured to make when sliding part 10050While being pushed into towards distally in nail bin, inclined-plane 10052 is in inclined-plane 10042 lower slider. Work as staple drivers10040 its nail chamber 10012 is separately interior while upwards being lifted, and staple drivers 10040 can be by nail10030 upwards lift, and make to follow closely 10030 and can follow closely chamber from it by the opening in nail platform 10011In 10012, expose. During exemplary percussion sequence, first referring to Figure 22 7-229, sliding part10050 contact stud 10030a and start nail 10030a upwards to lift first. Work as sliding part10050 when be further promoted towards distally, and sliding part 10050 can start nail 10030b, 10030c,10030d, 10030e and 10030f and any other follow-up nail order are lifted. As shown in Figure 22 9,Sliding part 10050 can upwards drive nail 10030, makes the leg of the nail contacting with relative anvil block10032 are deformed into the shape of expectation, and are penetrated from support section 10010. In various situationsUnder, as a part for percussion sequence, sliding part 10030 can move upward multiple nails simultaneously. GinsengAccording to the percussion sequence shown in Figure 22 9, nail 10030a and 10030b have moved to its complete firing positionAnd penetrated from support section 10010, in nail 10030c and the process of 10030d in being pulled the triggerAnd be at least partly accommodated in support section 10010, and nail 10030e and 10030f are stillSo in its firing position not.

As mentioned above and referring to Figure 23 5, when nail 10030 is in it not when firing position, nail 10030Nail leg 10032 may extend into platform surface 10011 tops of support section 10010. Further ginsengAccording to the percussion sequence shown in Figure 22 9, nail 10030e and 10030f are depicted as in it and do not pull the trigger positionPut, and its nail leg 10032 extends to platform surface 10011 tops and extends to tissue thickness's benefitRepay in part 10020. In various embodiments, when nail 10030 is in it not when firing position, nail legAny other part of 10032 end or nail leg 10032 may Bu Tuchuan tissue thickness compensating part10020 top tissue contacting surface 10021. As shown in Figure 22 9, when nail 10030 is not pulled the trigger from itWhen position moves to its firing position, the end of nail leg can protrudingly be worn tissue contacting surface 10032. RespectivelyIn kind of embodiment, the end of nail leg 10032 can comprise and can cut and penetrate tissue thickness compensation part10020 sharp distal end. In certain embodiments, tissue thickness's compensating part 10020 can comprise multipleHole, the plurality of hole can hold nail leg 10032 and make to follow closely leg 10032 and compensate with respect to tissue thicknessPart 10020 slides. In certain embodiments, support section 10010 also can comprise from platform surfaceThe 10011 multiple guiders 10013 that extend. Guider 10013 can be oriented to contiguous platform tableThe nail chamber opening of face 10011, making to follow closely leg 10032 can be at least in part by 10013 of guiderSupport. In certain embodiments, guider 10013 can be positioned in the near-end of nail chamber opening and/or far awayEnd place. In various embodiments, the first guider 10013 can be positioned in each nail chamber openingFirst end, and the second guider 10013 can be positioned in the second end of each nail chamber openingPortion, makes the first nail leg 10032 that each the first guider 10013 can support nail 10030, andAnd each the second guider 10013 can support nail the second nail leg 10032. In at least one enforcementIn example, referring to Figure 23 5, each guider 10013 can comprise groove or slit, for example groove10016; Nail leg 10032 for example can be slidingly received in this groove. In various embodiments, everyIndividual guider 10013 can comprise extending and may extend into tissue thickness from platform surface 10011 to be mendedRepay clamping plate, projection and/or spike in part 10020. In at least one embodiment, as below moreIn detail, clamping plate, projection and/or spike can reduce tissue thickness's compensating part 10020 and support portionDivide the relative motion between 10010. In certain embodiments, the end of nail leg 10032 can be positionedIn guider 10013, and can not extend to and lead when firing position in it when nail 10030To the top surface top of device 10013. In this type of embodiment at least, guider 10013 canLimit guiding height, and can not extend to this guiding when firing position in it when following closely 10030Elevation-over.

In various embodiments, tissue thickness's compensating part for example, such as tissue thickness's compensating part 10020,Can be formed by single material piece. In at least one embodiment, tissue thickness's compensating part can comprise continuouslyMaterial piece, this continuous material sheet can cover the whole top platform surface of support section 1001010011, or covering is less than whole platform surface 10011. In certain embodiments, material piece can be coveredThe nail chamber opening of lid in support section 10010, and in other embodiments, material piece can comprise can be withOpening nail chamber register or that align at least partly. In various embodiments, tissue thickness's compensationPart can be made up of multilayer material. In certain embodiments, referring now to Figure 21 7, tissue thickness's compensationPart can comprise compressible core and the wrappage around compressible core. In certain embodiments, wrappage10022 can remain to support section 10010 releasedly by compressible core. At at least one, this type of is realExecute in example, support section 10010 can comprise for example one or more protuberances from its extension, such asProtuberance 10014(Figure 22 0), this protuberance can be contained in one or more holes and/or slit,For example be limited in the hole 10024 in wrappage 10022. Protuberance 10014 and hole 10024 can quiltsBe arranged so that protuberance 10014 can remain to support section 10010 by wrappage 10022. ExtremelyIn a few embodiment, the end of protuberance 10014 can for example be processed and is out of shape by hot melt, so thatExpand the end of protuberance 10014, and therefore limit wrappage 10022 and support section 10010 itBetween relative motion. In at least one embodiment, wrappage 10022 can comprise one or more wearingHole 10025, it can be conducive to wrappage 10022 to discharge from support section 10010, as Figure 21 7Shown in. Referring now to Figure 22 6,, tissue thickness's compensating part can comprise wrappage 10222, this wrappageComprise multiple holes 10223, its mesopore 10223 can with support section 10010 in nail chamber registerOr alignment at least partly. In certain embodiments, the core of tissue thickness's compensating part also can comprise and parcelThe hole of aliging or align at least partly in hole 10223 in thing 10222. In other embodiments, tissueThe core of thickness compensation part can comprise continuous main body and may extend into below hole 10223, make continuous masterBody covers the nail chamber opening in platform surface 10011.

In various embodiments, as mentioned above, tissue thickness's compensating part can comprise for by compressible coreRemain to releasedly the wrappage of support section 10010. In at least one this type of embodiment, ginsengSee Figure 21 8, nail bin also can comprise retainer fixture 10026, and this retainer fixture can suppress parcelThing separates with support section 10010 prematurely with compressible core. In various embodiments, each maintenanceDevice fixture 10026 can comprise the hole that can hold the protuberance 10014 extending from support section 1001010028, make retainer fixture 10026 can be held support section 10010. At some embodimentIn, retainer fixture 10026 can comprise at least one disc portion 10027 separately, this disc portion can prolongReach below support section 10010 and staple drivers 10040 can be supported and remain on support sectionIn 10010. In certain embodiments, as mentioned above, tissue thickness's compensating part can be by nail 10030Be attached to removedly support section 10010. More specifically, also as mentioned above, when nail 10030 placesIn it, not when firing position, the leg of nail 10030 may extend in tissue thickness's compensating part 10020, andTherefore tissue thickness's compensating part 10020 is remained to support section 10010 releasedly. At least oneIn individual embodiment, the sidewall contact that nail 10030 leg can its corresponding nail chamber 10012, wherein,Due to the friction between nail leg 10032 and sidewall, nail 10030 and tissue thickness's compensating part 10020 canBe held in place, until nail 10030 is deployed from nail bin 10000. After nail 10030 is deployed,Tissue thickness's compensating part 10020 can be trapped in nail 10030 and against the tissue T of sewing up and be protectedHold. In the time that anvil block moves to open position subsequently with release tissue T, support section 10010 is movableAway from the tissue thickness's compensating part 10020 that is fixed to tissue. In certain embodiments, can use stickyMixture is to remain to removedly support section 10010 by tissue thickness's compensating part 10020. At leastIn an embodiment, can use two-part adhesive, wherein at least one embodiment, adhesivePart I can be placed on platform surface 10011, and the Part II of adhesive can be putPut on tissue thickness's compensating part 10020, make to be close to platform table when tissue thickness's compensating part 10020When face 10011 is placed, Part I can contact Part II to enable adhesive and tissue thickness is mendedRepay part 10020 and be bonded to separably support section 10010. In various embodiments, can use and appointWhat his suitable method remains to tissue thickness's compensating part the support section of nail bin separably.

In various embodiments, to being above described further, sliding part 10050 can be from near-end10001 are advanced to far-end 10002 to dispose all nails that are accommodated in nail bin 10000 completely10030. In at least one embodiment, referring now to Figure 25 8-262, sliding part 10050 can prop upThe knife bar by firing member or surgical stapling device is divided in 10010 inherent longitudinally cavitys 10016 in support part10052 advance towards distally. In use, nail bin 10000 can be inserted in the jaw of surgical stapling deviceNail bin passage in, for example, in nail bin path 10 070, and firing member 10052 can be advanced toContact with sliding part 10050, as shown in Figure 25 8. When sliding part 10050 is by firing member 10052While propelling towards distally, sliding part 10050 can contact staple drivers or the driver 10040 of recent side,And will follow closely 10030 and pull the trigger or penetrate from warehouse 10010, as mentioned above. As shown in Figure 25 8, hitSend out member 10052 and also can comprise cutting blade 10053, in the time that nail 10030 is pulled the trigger, this cutting blade can pass throughCutter slit in support section 10010 is pushed into towards distally. In various embodiments, corresponding cutter is narrowThe extensible anvil block through being positioned in nail bin 10000 opposites of groove, makes at least one embodimentIn, cutting blade 10053 can extend and cut and is positioned in therebetween between anvil block and support section 10010Tissue and tissue thickness's compensating part. In all cases, sliding part 10050 can be by firing member10052 advance towards distally, until sliding part 10050 arrives the far-end 10002 of nail bin 10000, as figureShown in 260. Now, firing member 10052 can bounce back towards nearside. In certain embodiments, slidePart 10050 can, with firing member 10052 towards nearside retraction, still in various embodiments, be joined nowSee Figure 26 1, in the time that firing member 10052 bounces back, sliding part 10050 can be left on nail bin 10000Far-end 10002 in. Once firing member 10052 fully bounces back, anvil block can be opened again,Tissue thickness's compensating part 10020 can separate with support section 10010, and has exhausted nail bin 10000Remaining non-implant part, comprise support section 10010, can from nail bin path 10 070, be movedRemove.

After exhausting nail bin 10000 and being removed from nail bin passage, to above further retouchingState, new nail bin 10000 or any other suitable nail bin can be inserted in nail bin path 10 070.In various embodiments, to being above described further, nail bin path 10 070, firing member10052 and/or nail bin 10000 can comprise cooperative structures, this cooperative structures can be at new not percussion nailStorehouse 10000 while not being positioned in nail bin path 10 070, prevent firing member 10052 again or afterBe pushed into towards distally for continuous time. More specifically, refer again to Figure 25 8, when firing member 10052 is pushed awayEnter while contact with sliding part 10050, and when sliding part 10050 is in not firing position of its nearsideTime, the support nose 10055 of firing member 10052 can be positioned in the support on sliding part 10050On flange 10056 and/or on, make firing member 10052 be maintained at enough positions upwards,Fall into and be limited in nail bin passage with the lock that prevents from extending from firing member 10052 or crossbeam 10054Lock groove in. Can not fall into lock groove due to lock 10054 time, in such cases, when percussion structureWhen part 10052 is pushed into, lock 10054 can be in abutting connection with the distally sidewall 10057 of locking groove. Work as percussionMember 10052 promotes sliding part 10050 during towards distally, firing member 10052 can prop up owing to leaning againstSupport the support nose 10055 on flange 10056 and be supported on its upwards firing position. When percussion structureWhen part 10052 bounces back with respect to sliding part 10050, as mentioned above and as shown in Figure 26 1, work as supportWhen nose 10055 does not rely on the support lugn 10056 of sliding part 10050, firing member10052 can upwards fall position from it. In at least one this type of embodiment, surgical staples can comprise energyEnough firing member 10052 is biased to it suitable to the spring 10058 of upper/lower positions and/or any otherBiasing element. Once firing member 10052 bounces back completely, as shown in Figure 26 2, firing member10052 can not be pushed into towards distally through the nail bin 10000 of using up again. More specifically, when nowWhen sliding part 10050 in operating sequence has been left on far-end 10002 place of nail bin 10000, hitSend out member 10052 and can not be remained on its upper position by sliding part 10050. Therefore, as mentioned above,If firing member 10052 is again advanced in the situation that not replacing nail bin, lock crossbeam10054 by the sidewall 10057 of contact lock groove, and this will prevent that firing member 10052 is again towards distally quiltBe advanced in nail bin 10000. In other words, once the nail bin 10000 of using up replaced by new nail binChange, new nail bin will have the sliding part 10050 of nearside location, the sliding part of this nearside location can be byFiring member 10052 remains on its upwards position, and makes firing member 10052 again towards distally quiltAdvance.

As mentioned above, sliding part 10050 can by staple drivers 10040 first not firing position andBetween the second firing position, move, penetrate from support section 10010 to will follow closely 10030. RespectivelyPlant in embodiment, in the time that nail 10030 is penetrated from support section 10010, staple drivers 10040Can be accommodated in nail chamber 10012. In certain embodiments, can comprise can for support section 10010The one or more holding structures that stop staple drivers 10040 to penetrate or drop out from nail chamber 10012.In various other embodiment, sliding part 10050 can be by staple drivers 10040 from having nailIn 10030 support section 10010, penetrate. In at least one this type of embodiment, staple drivers10040 can by for example can bio-absorbable and/or biocompatible materials form, such as polyetherimideAmine. In certain embodiments, staple drivers can be attached to nail 10030. In at least one this type of enforcementIn example, staple drivers can be molded on the base portion of each nail 10030 and/or around, make to driveDevice is one-body molded with nail. The name of submitting on September 29th, 2006 is called " SURGICALSTAPLESHAVINGCOMPRESSIBLEORCRUSHABLEMEMBERSFORSECURING TISSUETHEREINANDSTAPLINGINSTRUMENTSFORDEPLOYINGTHESAME " U.S. Patent Application Serial Number 11/541,123 is incorporated herein by reference in full.

In various embodiments, to being above described further, compressible tissue thickness compensating partCan be with respect to rigid support componental movement, distortion and/or the deflection below nail bin. In various enforcementIn example, any other suitable part of support section and/or nail bin can comprise can limit tissue thicknessOne or more structures of relative motion between compensating part and support section. As mentioned above, nail 10030At least a portion may extend into platform surface 10011 tops of support section 10010, wherein,In some situation, referring now to Figure 26 3 and Figure 26 4, be applied to tissue thickness's compensating part 10120Nail 10030 and/or clamping plate 10013 that side force for example can be extended from support section 10010 are kept out.In all cases, nail 10030 can be in the time keeping out the lateral movement of tissue thickness's compensating part 10120Nail chamber 10012 is tilted and/or bending, wherein in various embodiments, and nail chamber 10012 and nail10030 size can be set for and can keep following closely 10030 leg 10032 and relative anvil blockAlignment relative between shaping pit 10062 in 10060, makes to follow closely 10000 in nail forming processCorrectly be shaped during this time. In various embodiments, nail 10030 and/or clamping plate 10013 can prevent or extremelyThe side direction distortion in thickness compensation part 10020 is organized in few restriction, as shown in Figure 26 4. At at least oneIn this type of embodiment, nail 10030 and/or clamping plate 10013 for example can be strengthened or limit tissue thickness and mendFirst or the tissue contacting surface 10021 of repaying part with respect to second or the side direction of lower surface 10029 and/Or lengthwise movement. In various embodiments, nail bin and/or the nail bin passage that is wherein positioned with nail bin can wrapDraw together at least one distortion and minimize member, this distortion minimize member can upwards extend to limit organize thickSide direction and/or lengthwise movement or the distortion of degree compensating part. As mentioned above, thick around organizing at least in partThe wrappage of degree compensating part also can prevent or at least limit and organize the side direction of thickness compensation part and/or longitudinally transportMove or distortion.

In various embodiments, refer again to Figure 26 3 and 264, tissue thickness's compensating part is such as tissueThickness compensation part 10120 for example can comprise core 10128 and crust 10122. Crust 10122 and can pressingContracting core 10128 can be made up of different materials or same material. In any situation, crust 10122Can there is the density higher than core 10128. Comprise tissue thickness's compensating part 10120 at crust 10122The situation at top under, the end of nail leg 10032 can embed in crust 10122. Suitcase is drawn together group outsideKnit in the embodiment of bottom of thickness compensation part 10120, nail leg 10032 is extensible goes forward side by side through crustEnter in core. In any situation, the outer micromicro of tissue thickness's compensating part contributes to keep nail leg10032 align with the shaping pit 10062 of anvil block 10060. In various embodiments, crust 10122Can comprise as lower density: this density for example than the density of core 10128 larger about 10%, than core 10128Density larger about 20%, than the density of core 10128 larger about 30%, larger than the density of core 10128About 40%, than the density of core 10128 larger about 50%, than the density of core 10128 larger about60%, than the density of core 10128 larger about 70%, than the density of core 10128 larger about 80%, ratioThe density of core 10128 larger about 90%, than the density of core 10128 larger about 100%. In various realitiesExecute in example, crust 10122 can comprise as lower density, and the density that this density is for example greater than core 10128 alsoAnd be less than the twice of the density of core 10128. In various embodiments, crust 10122 can comprise as followsDensity, this density is for example greater than the twice of the density of core 10128. In various embodiments, to aboveBe described further, crust 10122 and core 10128 can be formed simultaneously or manufacture. At least oneIn individual this type of embodiment, the fluid that comprises any suitable material disclosed herein can be introduced in dish orBe molded, and in the time that fluid solidifies, fluid can form to be had than the more highdensity crust of surplus materialOr layer. In various embodiments, the multiple layer in material can form with the following method by making: at thisIn method, one or more succeeding layers of material are poured on the layer of prior cured. In some enforcementIn example, two or more layers can be for example bonded to each other by adhesive. In certain embodiments, twoIndividual or more layers can be for example mechanical interlocked by one or more securing member and/or one or moreStructure is attached to each other. In at least one this type of embodiment, adjacent layer can be for example by one or moreMultiple dovetail joint link together. In certain embodiments, outer micromicro comprise can prevent or at least limitFluid processed is through wherein mobile sealing surfaces. In some other embodiment, outer micromicro for example comprisesThe loose structure of perforate.

In various embodiments, to being above described further, can cut from tissue thickness's compensating partCrust. In at least one embodiment, tissue thickness's compensating part can, from larger material block excision, makeObtain tissue thickness's compensating part and do not comprise crust. In at least one this type of embodiment, tissue thickness's compensationPart can by for example comprise the homogeneity of macropore or at least substantially the material of homogeneity form.

In various embodiments, nail bin can comprise multiple nails chamber, and each nail chamber holds and is positioned at whereinNail, wherein follows closely chamber and can be arranged to multirow, and the anvil block that is wherein positioned in nail bin opposite can compriseThe multiple shaping pits corresponding with nail chamber in nail bin. In other words, anvil block can comprise that multiple shapings are recessedHole row, wherein each shaping pit can be positioned in the opposite in the nail chamber in nail bin. At various embodimentIn, each shaping pit can comprise two cups that are shaped of the nail leg 10032 that can hold nail 10030,Wherein each shaping cup can hold nail leg 10032, and makes to follow closely leg 10032 for example towards other nailsLeg 10032 is shaped or is curling. In all cases, leg 10032 may lack shaping cup or just not haveReally enter the cup that is shaped, therefore following closely leg 10032 may deform during percussion sequence. HereinIn described various embodiment, anvil block can comprise shaping pit array or grid, and it can hold separatelyAnd formation nail leg. In at least one this type of embodiment, shaping pit array can comprise that some shapings are recessedHole, the quantity of this shaping pit exceedes the quantity of the nail holding in nail bin. At at least one embodimentIn, nail bin can comprise for example six nail chambeies of longitudinally going, wherein anvil block can comprise that following closely chambeies with six row alignsSix row shaping pits, and the pit that is shaped is in addition positioned in the centre of shaping pit row. For example,In a side of anvil block, anvil block can comprise that the first row that can be positioned on the first nail chamber is shaped recessedHole, can be positioned in second row shaping pit on the second nail chamber in contiguous the first nail chamber, withAnd be positioned in addition one in the middle of first row shaping pit and second row shaping pit and line up shape pit.In various embodiments, referring now to Figure 27 6-279, anvil block 10260 can comprise that six line up shape pit10261, it can be placed on the corresponding six nail chambeies in nail bin 10200. At at least oneIn this type of embodiment, in the middle of many rows, shaping pit 10262 can be positioned in and line up shape pit 10261 moreMiddle and/or the contiguous shape pit 10261 of lining up more. In certain embodiments, referring now to Figure 27 7,Figure 27 8 and Figure 28 0, each shaping pit 10261 and 10262 can comprise two cups that are shaped, whereinEach cup that is shaped comprise can make to follow closely leg 10032 towards nearside be shaped or curling distal part 10263 withAnd can make to follow closely leg 10032 towards distally shaping or curling portions of proximal 10264. In various other feelingsUnder condition, nail 10030 can be shaped by multiple other modes. For example, nail 10030 can be shaped so thatLeg 10032 be outwards shaped and another leg 10032 to internal shaping (Figure 28 1), orTwo legs 10032 are all outwards shaped (Figure 28 2), and this for example depends on 1) nail leg 10032 enters thatIndividual shaping cup, and/or 2) whether leg 10032 enter the portions of proximal 10263 of each cup that is shaped or far awaySide part 10064.

In various embodiments, to being above described further, each shaping pit 10261 and/orShaping pit 10262 can comprise for example triangle or diamond shape. In at least one embodiment, becomeEach distal part 10263 and/or each portions of proximal 10264 of shape pit can comprise triangle shapeShape, wherein at least one this type of embodiment, distal part 10263 and portions of proximal 10264Triangular shapedly be arranged such that it has the summit of relative direction of sensing. At some embodimentIn, anvil block can comprise for example a series of foursquare shaping pits substantially. At at least one, this type of is realExecute in example, the profiled surface of each foursquare shaping pit can be included between foursquare side and prolongThe arcuate surfaces of stretching. In certain embodiments, anvil block can comprise for example a series of circles or spherical femaleHole. In various embodiments, to being above described further, shaping pit 10261 can be along oneOr multiple row are positioned, and similarly, shaping pit 10262 also can be along one or more row by fixedPosition. In various other embodiment, shaping pit 10261 and/or shaping pit 10262 can be arrangedBecome one or more circular row. In at least one this type of embodiment, shaping pit 10261 can be along masterCircumference is arranged, and parallel shaping pit 10262 can be arranged along different circumference. At various embodimentIn, main circumference and different circumference can be concentric or substantially concentric. In certain embodiments,Shaping pit 10262 can for example be arranged along inner periphery and/or excircle; Described inner periphery is with respect to masterCircumference is radially inwardly located, and described excircle is radially outward located with respect to main circumference. In various enforcementIn example, main circumference can be limited by full diameter, and inner periphery can be limited by interior diameter, and excircle can be byOverall diameter limits. In at least one this type of embodiment, interior diameter can be shorter than full diameter, and straight outwardFull diameter can be longer than in footpath.

In various embodiments, as mentioned above, anvil block for example can move to closed position from open positionPut, so that against tissue thickness's compensating part such as tissue thickness's compensating part 10020 compression groups of nail binKnit. In all cases, before tissue thickness's compensating part is with respect to tissue location, tissue thickness is mendedRepay part and can be close to the support section location of nail bin. In certain embodiments, tissue thickness's compensating part10020 can be in as upper/lower positions: in this position, and before anvil block moves to its closing position, tissueThickness compensation part is in abutting connection with support section 10018. In some other embodiment, tissue thickness's compensating part10020 can be in as upper/lower positions: in this position, gap is present in tissue thickness's compensating part 10020 HesBetween support section 10018. In at least one this type of embodiment, anvil block can make tissue and tissue thicknessCompensating part 10020 is to bottom offset, until tissue thickness's compensating part 10020 is in abutting connection with support section10018, wherein, anvil block is now moveable to its closing position and in tissue, produces compression. AsFruit feels dissatisfied to the location of the tissue between anvil block and nail bin, and surgeon can open anvil block,Adjust the position of anvil block and nail bin, and closed anvil block again. Due to nail bin with respect to tissue this type ofLocation and reorientating, in all cases, the far-end of tissue thickness's compensating part 10020 can be for example withSupport section 10010 separates. In some these type of situations, the far-end of tissue thickness's compensating part 10020Can contact tissue, and peel off or roll with respect to support section 10010 from support section 10010. ?In various embodiment, as further discussed below, nail bin can comprise can by tissue thickness's compensating partDischarge the one or more structures that remain to the support section below nail bin.

In various embodiments, referring now to Figure 26 5, nail bin 10300 can comprise support section10310, the tissue thickness's compensating part 10320 being supported by support section 10310 and comprise nose10303 far-end 10302, this nose can by the far-end of tissue thickness's compensating part 10,320 10325Discharge and be held in place. In at least one embodiment, nose 10303 can comprise and can hold tissueThe slit 10305 of the far-end 10325 of thickness compensation part 10320. In various embodiments, far-end10325 can be compressed or be wedged in slit 10305, make when nail bin 10300 fixed with respect to tissue, far-end 10325 can be held in place when the position. In at least one this type of embodiment, slit 10305Can get along the direction being parallel to or be at least basically parallel to the platform surface 10311 of support section 10310To. In various embodiments, slit 10305 can be level with respect to platform surface 10311. ?In various other embodiment, referring now to Figure 26 6, nail bin 10400 can comprise support section, byTissue thickness's compensating part 10420 of support part sub-support and comprise the far-end 10402 of nose 10403,This nose can be held in place the far-end of tissue thickness's compensating part 10,420 10425 releasedly. ?In at least one embodiment, far-end 10425 can comprise the protuberance from its extension, and nose10403 can comprise the vertical slit 10405 of the protuberance that can hold far-end 10425. In various enforcementIn example, far-end 10425 and/or can be compressed or be wedged in slit 10405 from the protuberance of its extensionIn, making in the time that nail bin 10400 is located with respect to tissue, far-end 10425 can be held in place. ?In some embodiment, tissue thickness's compensating part 10420 for example can comprise slit such as slit 10429,This slit can hold at least a portion of nose 10403 therein. In at least one embodiment,Slit 10405 can along perpendicular to or be at least basically perpendicular to the side of the platform surface 10411 of support sectionTo orientation. In various embodiments, referring now to Figure 26 7, nail bin 10500 can comprise support portionPoint, the tissue thickness's compensating part 10520 being supported by support section and the far-end that comprises nose10502, this nose can keep the far-end of tissue thickness's compensating part 10,520 10525 just releasedlyPosition. In at least one embodiment, nose can comprise and can hold tissue thickness's compensating part 10520The vertical slit 10505 of far-end 10525. In various embodiments, far-end 10525 can be compressed orBe wedged in slit 10505, make in the time that nail bin 10500 is located with respect to tissue far-end 10525Can be held in place.

In various embodiments, refer again to Figure 26 5, tissue thickness's compensating part 10320 can comprise topPortion surface 10324, this top surface can be positioned on the top surface 10304 of nose 10303Side. Figure 23 8 shows another exemplary embodiment, in this exemplary embodiment, and tissue thicknessThe top surface of compensating part is positioned in the nose top of nail bin, wherein tissue thickness's compensating part 10720Top surface 10721 be for example positioned in top surface 10004 tops of nose 10003. MakeWith in, refer again to Figure 26 5, tissue can be slided on the top surface of nose 10,303 10304The far-end moving, and in some cases, tissue can contact tissue thickness compensation part 1032010325, and power can be applied to tissue thickness's compensating part 10320, thus make tissue thickness's compensating part10320 peel off from support section 10310. In embodiment as herein described, this peeling force can be by noseThe part of the far-end 10325 of portion's 10303 interior wedgings is resisted. Under any circumstance, once organizeAppropriately locate with respect to nail bin 13000, anvil block can be rotated to closing position with against support section10310 compress tissues and tissue thickness's compensating part 10320. In at least one this type of embodiment, anvil blockCan be rotated to as upper/lower positions: in this position, the top surface of anvil block contact nose 1030310304, therefore can prevent that anvil block is further rotated. In all cases, due to tissue thickness's compensationThe top surface 10324 of part 10320 is positioned in top surface 10304 tops of nose 10303,In the time that anvil block is just closed, top surface 10324 can be pushed down towards support section 10310, andAnd in some cases, top surface 10324 for example can be pushed to the top surface of nose 1030310304 belows. As described herein, when the nail being contained in nail bin 10300 has been deployed and has organizedAfter thickness compensation part 10320 is cut, support section 10310 and nose 10303 movable away fromTissue thickness's compensating part 10320, can skid off the far-end 10325 of tissue thickness's compensating part 10320Slit 10305.

As mentioned above, anvil block such as anvil block 10060 for example can be rotated to closing position, in this closurePosition, anvil block 10060 contacts the nose surface, top 10004 of nail bin such as nail bin 10000. OnceAnvil block has arrived its closing position, and tissue thickness's compensating part is such as tissue thickness's compensating part 10020 quiltsCompression amount inter alia by depend on tissue thickness's compensating part not compressed thickness or height andThe thickness of tissue. Referring now to Figure 23 6 and Figure 23 7,, tissue thickness's compensating part 10920 can comprise withThe top surface that the top surface 10004 of nose 10003 flushes or at least substantially flushes. Real at this type ofExecute in example, the top surface of tissue thickness's compensating part 10920 can be pushed to the top of nose 1000310004 belows, surface. Referring now to Figure 24 1 and Figure 24 2,, tissue thickness's compensating part is thick such as organizingDegree compensating part 10820 for example can comprise top surface 10821. At tissue thickness's compensating part 10820 quiltsBefore tissue T and anvil block 10060 compressions, this top surface is positioned in nose surface, top 10004Below. As shown in Figure 23 9 and Figure 24 0, in the situation that tissue T is relatively thin, tissue thickness is mendedRepay part 10920 and may stand relatively little compression. Referring now to Figure 24 1 and Figure 24 2,, work as tissueWhen T is relatively thick, tissue thickness's compensating part 10820 may stand larger compression. As Figure 24 3 HesShown in Figure 24 4, there is thin layer and compared with thick-layer in the situation that in tissue T, tissue thickness's compensating part simultaneously10820 can work as that it is compressed relatively large while being positioned in below thicker tissue T, and are positioned when itCompressed less amount below thin tissue time. As mentioned above, by this way, tissue thickness is mendedRepay part and can compensate different tissue thicknesses.

In various embodiments, referring now to Figure 26 8-270, surgery suturing appliance can comprise 1) canHold the storehouse passage 16670 of nail bin 16600, and 2) be attached to storehouse passage in mode that can pivotable16670 anvil block 16660. Nail bin 16600 can comprise support section 16610 and tissue thickness's compensating part16620, wherein the far-end 16625 of tissue thickness's compensating part 16620 can be by the far-end of nail bin 16600The nose 16603 at 16602 places remains to support section 16610 releasedly. At at least one embodimentIn, nose 16603 can comprise slit 16605 and can be made up of flexible material. In use, headFirst, referring to Figure 26 9, nose 16603 deflection downwards, to expand the opening of slit 16605. ?In some embodiment, nose 16603 can comprise recess or otch 16606, and this recess or otch canMake the downward deflection of nose 16603. Under any circumstance, in all cases, the expansion of slit 16605Large opening can be conducive to the far-end of tissue thickness's compensating part 16,620 16625 to insert slit 16605In. Once tissue thickness's compensating part 16620 is appropriately located, nose 16603 can be released, andDue to the screen resilience of material of composition nose 16603, nose 16603 can return or at least substantially returnTo its deflected not, and on platform surface 16611 capture tissue thickness compensation part 16620 far awayEnd 16625, as shown in Figure 27 0. In use, be similar to mentioned above, when support section 16610Motion away from sew up organize time, far-end 16625 can be pulled out slit 16605. In various situationsUnder, in the time that tissue thickness's compensating part 16620 separates with support section 16610, flexible nose 16603Can deflection. In various embodiments, refer again to Figure 27 0, tissue thickness's compensating part 16620 canComprise the top surface that aligns or at least substantially align with the top surface 16604 of nose 1660316621。

In various embodiments, referring to Figure 27 1, surgery suturing appliance can comprise 1) can hold nailThe path 10 770 in storehouse 10700, and 2) be rotatably attached to the anvil block of path 10 77010760. Nail bin 10700 can comprise support section 10710 and tissue thickness's compensating part 10720. RespectivelyPlant in embodiment, tissue thickness's compensating part 10720 can overlap 10703 by nose and be held in place, this noseCover can slide on support section 10710. In at least one embodiment, first referring to figure272, nose cover 10703 can comprise one or more side slits 10707, these one or more side slitsCan hold removedly the one or more attachments that for example extend along support section 10710. RespectivelyPlant in embodiment, tissue thickness's compensating part 10720 can be positioned in the middle of side slit 10707. At certainIn a little embodiment, nose cover 10703 also can comprise far-end 10702 and be limited in far-end 10702Cavity 10706, wherein cavity 10706 for example can also hold support section 10710 extremely thereinA few part. In use, nose cover 10703 can be from distally to nearside on support section 10710Direction slide. In various embodiments, tissue thickness's compensating part 10720 can be installed removedlyTo nose cover 10703, make, after nail has been pulled the trigger through tissue thickness's compensating part 10720, to work as supportWhen part 10710 and nose cover 10703 move away from tissue thickness's compensating part 10720, tissue thicknessCompensating part 10720 can overlap 10703 with nose and separate. In various embodiments, tissue thickness's compensating part10720 top surface 10721 can be positioned in top surface 10704 belows of nose 10703.

In various embodiments, referring now to Figure 27 3 and Figure 27 4, surgery suturing appliance can comprise1) can hold the nail bin passage 11070 of nail bin 11000, and 2) be rotatably attached to passage11070 anvil block 11060. Nail bin 11000 can comprise support section 11010 and tissue thickness's compensating part11020. In various embodiments, tissue thickness's compensating part 11020 can be by from support section 11010One or more longitudinal rails 11019 that platform 11011 extends are held in place. In at least one enforcementIn example, longitudinal rail 11019 can be embedded in tissue thickness's compensating part 11020. In some enforcementIn example, first referring to Figure 27 4, tissue thickness's compensating part 11020 can comprise can hold longitudinal rail11019 longitudinal fluting 11029. In at least one this type of embodiment, the size of groove 11029 canSet for and can hold for example guide rail 11019 of press-fit structure. To above further retouchingState, this class formation can prevent or at least limit and organize thickness compensation part 11020 and support sectionRelative lateral movement between 11010, and in addition, restriction is for example organized thickness compensation part 11020Discharged from support section 11010 prematurely. In various embodiments, referring now to Figure 27 5, outerSection's suture instruments can comprise 1) can hold the nail bin passage 11170 of nail bin 11100, and 2) canBe attached to rotatably the anvil block 11160 of passage 11170. Nail bin 11100 can comprise support section 11110With tissue thickness compensating part 11120. In various embodiments, tissue thickness's compensating part 11120 can be byThe spike extending from the platform 11111 of support section 11110 or tusk 11119 one or moreLongitudinally row is held in place. In at least one embodiment, longitudinal row 11119 of spike can be embedded inIn tissue thickness's compensating part 11120.

With reference to the embodiment shown in Figure 27 3. To being above described further, when nail is from being limited to itIn nail chamber 10012 while being penetrated, tissue thickness's compensating part 11020 of nail bin 11000 can be from supportingPart 11010 is discharged gradually. More specifically, to being described further, be positioned at nail chamber aboveNail in 10012 can the far-end of the near-end of nail bin 11,000 11001 and nail bin 11,000 11002 itBetween penetrated successively, make when nail by penetrate time, nail by bias force be upwards applied to tissue thickness mendRepay part 11020, this bias force is done in order to tissue thickness's compensating part 11020 is pushed away to guide rail 11019. ?In this type of situation, in the time that nail is penetrated from recent side nail chamber 10012, tissue thickness's compensating part 11020Near-end 11006 can be released from support section 11010. When nail is from the near-end of nail bin 1100011001 and far-end 11002 between support section 11010 while being penetrated gradually, tissue thickness's compensationPart 11020 can be discharged gradually from support section 11010 subsequently. When being positioned at farthest side nail chamberWhen nail in 10012 is penetrated from support section 11010, the far-end of tissue thickness's compensating part 1102011007 can be released from support section 11010. With reference to the embodiment shown in Figure 27 5, when nail is from pointWhen nail bin between end 11101 and far-end 11102 is penetrated gradually, tissue thickness's compensating part 11120The spike 1119 that can extend from self-supporting part 11110 is discharged gradually.

As mentioned above, when nail is penetrated and when contact tissue thickness compensation part gradually from support section, groupKnitting thickness compensation part can be discharged gradually from the support section of nail bin. In various embodiments, for example existThe absence that tissue thickness's compensating part is discharged from support section, the leg of nail is such as nail leg 10032Can pass tissue thickness's compensating part. In this type of embodiment, tissue thickness's compensating part can keep and prop upJoint is divided in support part, until nail base portion such as base portion 10031 contact tissue thickness compensation parts and by its toUpper promotion. But in various embodiments, clamping plate and/or other holding structures that extend from support sectionFor example can hinder the release of tissue thickness's compensating part from support section. In certain embodiments, as belowDescribed in more detail, support section can comprise holding structure, in the time that nail is pulled the trigger gradually from nail bin, and this guarantorHolding structure can discharge tissue thickness's compensating part gradually from support section. Referring now to Figure 28 3,, nailStorehouse such as nail bin 11200 for example can comprise support section 11210, and this support section comprises can be by groupKnit thickness compensation part 11220(Figure 28 4) remain to releasedly the holding structure of support section 1121011213. In various embodiments, holding structure 11213 can be positioned in for example each nail chamber 11212End, wherein each holding structure 11213 can comprise the guide groove being limited to wherein11216, this guide groove can be held the nail leg 10032 of nail 10030 slidably. In this type of enforcementIn example, nail leg 10032 and holding structure 11213 can discharge tissue thickness's compensating part 11220Remain to support section 11210. In use, referring now to Figure 28 4, be contained in support sectionStaple drivers 10040 in 11210 can upwards be driven by sliding part 10050, as mentioned above, and whereinStaple drivers 10040 can contact holding structure 11213, makes holding structure 11213 and support section11210 outwards separate, and make holding structure 11213 and at least in part away from nail 10030 and nailChamber 11212 displacements. When holding structure 11213 separates with support section 11210 and/or to outer displacementTime, as shown in Figure 28 4, holding structure 11213 can no longer can be by tissue thickness's compensating part 11220Remain to support section 11210, therefore, tissue thickness's compensating part 11220 can be from support section 11210Be released. Be similar to mentioned above, when nail 10030 for example from nail bin towards anvil block such as anvil block 11260While ejaculation gradually, tissue thickness's compensating part 11220 can be discharged gradually from support section 11210.In various embodiments, when the top surface of staple drivers 10040 for example with support section 11210When platform surface 11211 coplines or at least substantially copline, staple drivers 10040 can contact guarantorHold structure 11213. In this type of embodiment, be formed it at nail 10030 and be shaped completely or completelyPercussion when configuration and/or nail 10030 be formed its be shaped completely or pull the trigger completely configuration itBefore, tissue thickness's compensating part 11220 can discharge from support section 11210. At at least one, this type of is realExecute in example, first referring to Figure 28 5, driver 10040 can be overdriven, and it is pushed toPlatform surface 11211 tops so that nail 10030 be shaped completely, and process phase being overdrivenBetween, holding structure 11213 and support section 11210 are departed from. In various embodiments, again joinSee Figure 28 4, holding structure 11213 is separating or to may extend into or dangle nail chamber before outer displacementOn 11212 and enter into nail chamber, just make to arrive platform surface 11211 when driver 10040Time, driver 10040 can contact holding structure 11213. Under any circumstance, once tissue thicknessCompensating part 11220 is released from support section 11210, referring now to Figure 28 5, support section11210 movable tissue thickness's compensating parts 11220 away from implanting.

As mentioned above, in the time that nail is pulled the trigger or disposed from nail bin, the compressible tissue thickness of nail bin is mendedRepaying part can be discharged gradually from the support section of nail bin or warehouse. In all cases, this type of release canComprise tissue thickness's compensating part is unclamped gradually from support section, wherein in some cases, until anvilSeat is opened and support section moves away from tissue thickness's compensating part of implanting, tissue thickness's compensating partJust may separate completely with support section. In various embodiments, referring now to Figure 28 9, nail bin is allAs nail bin 11300 for example can comprise the tissue thickness's compensation that remains to releasedly support section 11310Part 11320. In at least one embodiment, support section 11310 can comprise multiple from its extensionRetaining member 11313, the plurality of retaining member can be by tissue thickness's compensating part 11320 releasedlyCompress and remain to support section 11310. In at least one this type of embodiment, each retaining member11313 can comprise can hold therein tissue thickness's compensating part 11320 longitudinal side towards interiorPassage or slit 11316. In all cases, multiple retaining members 11313 can be along support sectionFirst longitudinal side of 11310 is extended, and multiple retaining member 11313 can be along support section 11310The second longitudinal side extend. Wherein, in some cases, retaining member 11313 can prevent or extremelyRelative lateral movement between thickness compensation part 11320 and support section 11310 is organized in few restriction, andAnd prevent in addition or at least limit and organize thickness compensation part 11320 to release from support section 11310 prematurelyPut. In various embodiments, retaining member 11313 can be one-body molded with support section 11310, andAnd at least one embodiment, referring to Figure 29 0, retaining member 11313 can with support section11310 separate or separate at least partly, to make tissue thickness's compensating part 11320 and support section11310 separate, for example, as shown in Figure 29 1. In certain embodiments, anvil block such as anvil block 11360For example can compress tissue thickness compensation part 11320, and in response to tissue thickness's compensating part 11320The pressure of middle generation, tissue thickness's compensating part 11320 can lateral extension to make retaining member 11313 withTissue thickness's compensating part 11320 separates at least in part or departs from. In various embodiments, as above instituteState, advance cutter member can dispose through anvil block 11360 and nail bin 11300 nail being accommodated in wherein,And push anvil block 11360 and nail bin 11300 simultaneously and make it more each other close, this can be by the pressure increasingContracting power is applied to tissue thickness's compensating part 11320, thereby in the time that cutter member passes nail bin 11300, makes to protectHolding member 11313 separates successively.

In various embodiments, referring now to Figure 29 2-294, nail bin such as nail bin 11400 for example canComprise the tissue thickness's compensating part 11420 that is attached to removedly support section 11410. At least oneIn individual embodiment, nail bin 11400 can comprise and longitudinal side of tissue thickness's compensating part 11420 can be protectedHold one or more retainer bars 11413 of platform surface 11411. In at least one this type of enforcementIn example, each retainer bar 11413 can comprise relative arm 11418, and this relative arm limits therebetween logicalRoad 11416. In this type of embodiment, one in arm 11418 can extend to tissue thickness's compensationOn part 11420, and another arm 11418 can extend to and extends from support section 11410Below antelabium 11419. First referring to Figure 29 2, the passage 11416 of each retainer bar 11413Size can be set for and can nail bin 11400 is front is applied to tissue thickness compensation by compression stress usingLongitudinal side of part 11420. During use, first referring to Figure 29 3, nail bin 11400 can be positionedIn nail bin passage, once and nail bin 11400 appropriately locate, anvil block such as anvil block 11460 examplesAs be moveable in the position of its compressible tissue thickness compensating part 11420. Be similar to mentioned above,When compressed, tissue thickness's compensating part 11420 can side direction or is outwards stretched, and therefore makes retainerBar 11413 separates with nail bin 11400. In some other embodiment, the closure of anvil block 11460 canMake retainer bar 11413 not separate with nail bin or not separate completely with nail bin. At at least one, this type of is realExecute in example, as mentioned above, advance trigger shaft can dispose from support section 11410 through nail bin 11400Nail 10030, and push anvil block 11460 and nail bin 11400 makes it more each other close simultaneously, so thatCompression stress is applied to tissue thickness's compensating part 11420, and this compression stress is enough to make tissue thickness's compensating part11420 lateral extension, and retainer bar 11413 is separated with nail bin 11400. Once retainerBar 11413 separates with nail bin 11400, referring to Figure 29 4, support section 11410 movable away fromTissue thickness's compensating part 11420 of implanting also removes from operative site. In some alternative enforcementIn example, referring now to Figure 29 5, nail bin 11400 ' can comprise retainer bar 11413 ', this retainer barBe similar to the arm 11418 ' comprising from its extension mentioned above. In at least one this type of embodiment,Each in arm 11418 ' can comprise and retainer bar 11413 ' can be latchable to nail bin releasedlyWedge-lock inclined-plane 11417 ' of 11400 '. More specifically, at least one embodiment, nail bin 11400 'Support section 11410 ' can comprise undercutting 11419 ', this undercutting cooperates with wedge-lock inclined-plane 11417 ',Retainer bar 11413 ' can be remained to nail bin 11400 releasedly, and suppress tissue thickness's compensationPart 11420 separates with support section 11410 ' prematurely. Use therebetween, be similar to mentioned above,In the time that enough compression stresses are applied to tissue thickness's compensating part 11420, retainer bar 11413 ' can be withNail bin 11400 ' separates.

In all cases, as mentioned above and refer again to Figure 25 9 and Figure 26 0, nail bin 10000The firing member 10052 of sliding part 10050 and surgery suturing appliance can be from the near-end of nail bin 1000010001 move to far-end 10002(Figure 21 9 of nail bin 10000) so that from support section 10010Dispose nail 10030. In at least one this type of situation, each nail 10030 is firing position fortune neverMove firing position, and penetrate to be positioned anvil block 10060 and nail bin from support section 10010Tissue between 10000 is caught whole tissue thickness compensating part 10020. In some cases, surgeryDoctor may not need to pull the trigger all nails 10030 from nail bin 10000, and surgeon may makeAdvancing of sliding part 10050 and trigger shaft 10052 is barred from the near-end that is positioned at nail bin 1000010001 and far-end 10002 in the middle of some place. In such cases, tissue thickness's compensating part 10020Can be only by part implanting tissue T, so as the not implant part that makes tissue thickness's compensating part 10020 withSupport section 10010 separates. Surgeon can implant support section 10010 tissue away from partThickness compensation part 10020 tractives, make not implant part peel off or come off from support section 10010.Although this type of embodiment is suitable for various situations, Figure 30 0-302 shows improvement, and wherein tissue thickness is mendedTissue thickness's compensating part 11520 of repaying part such as nail bin 11500 for example can comprise can be separated from one anotherMultiple junction fragments. In at least one this type of embodiment, tissue thickness's compensating part 11520 can compriseFirst or recent side fragment 11520a, be connected to removedly the second fragment of the first fragment 11520a11520b, be connected to the 3rd fragment 11520c of the second fragment 11520b, removedly removedlyBe connected to the 4th fragment 11520d of the 3rd fragment 11520c and be connected to removedly the 4th fragmentThe 5th fragment 11520e of 11520d. In various embodiments, tissue thickness's compensating part 11520 can wrapDraw together to be positioned at and can limit predetermined breakdown point in the middle of any two adjacent segment 11520a-11520eOr at least one thin layer 11529 of burble point, tissue thickness's compensating part fragment can or be divided at this breakdown pointSeparated from one another from point. In certain embodiments, tissue thickness's compensating part can comprise any suitable wearingHole, thin layer and/or for produce any other device of burble point in tissue thickness's compensating part. FirstFirst, referring to Figure 30 1, anvil block 11560 is shown in the close position, and firing member 10052 is shownBy part advance through nail bin 11500, make the first fragment 11520a, the second fragment 11520b andNail 10030 below the 3rd fragment 11520c is pulled the trigger with capture tissue thickness compensation part in tissue T11520. In this position, firing member 10052 is not also pushed into dispose for example the 4th fragmentNail 10030 below 11520d and the 5th fragment 11520e. Referring now to Figure 30 2,, anvil block 11560Have been moved to open position, and the support section 11510 of nail bin 11500 moves thick away from organizingThe implant part of degree compensating part 11520. As shown in Figure 30 2, be positioned at the 3rd fragment 11520c and the 4thThin layer 11529(Figure 30 0 in the middle of fragment 11520d) Yi Shi tissue thickness compensating part 11520 is notImplant part separates with implant part.

In various embodiments, to being above described further, nail bin can comprise multiple securing members,The plurality of securing member can remain to tissue thickness's compensating part the support section of nail bin releasedly. ?In some embodiment, support section can comprise the multiple holes that are for example limited in platform surface, wherein tightFirmware is extensible to be passed tissue thickness's compensating part and can be remained on releasedly in support section hole.In use, in the time that nail is penetrated gradually from support section, securing member can be released gradually from support sectionPut. In at least one this type of embodiment, securing member can be implanted with tissue thickness's compensating part,And at least one embodiment, securing member can be for example can bio-absorbable by least one material structureBecome. In certain embodiments, after tissue thickness's compensating part is implanted at least partly, and work asSupport section motion away from implant tissue thickness compensating part time, securing member can separate with support section.In various embodiments, referring now to Figure 32 3-325, nail bin such as nail bin 11600 for example can compriseThe tissue thickness that is installed to releasedly support section 11610 by multiple securing members 11613 compensatesPart 11620. Each securing member 11613 can comprise embed in tissue thickness compensating part 11620 and/or withFirst end 11618 that tissue thickness's compensating part 11620 engages, engage with support section 11610The second end 11618 and first end 11618 is connected to the connector of the second end 1161811616. In each middle embodiment, securing member 11613 is extensible through being limited to support section 11610In cutter slit 11615. In use, as mentioned above, firing member 10052 can make blade motionThrough the cutter slit 11615 in support section 11610 and cutting securing member 11613, so that from propping up11610 release tissue thickness compensating parts 11620 are divided in support part. In at least one this type of embodiment, hitSend out the far-end that bar 10052 can be advanced to from the near-end of nail bin 11,600 11601 nail bin 1160011602, so that 1) as mentioned above sliding part 10050 advanced towards distally and pull the trigger and follow closely gradually10030, and 2) cut gradually securing member 11613 and/or securing member 11613 is ruptured with from supportingPart 11610 discharges tissue thickness's compensating part 11620 gradually. In certain embodiments, be similar toDescribed in literary composition, tissue thickness's compensating part 11620 can comprise multiple separable fragment 11620a-11620e, shouldMultiple separable fragments for example can remain to support section by one or more securing members 11613 separately11610. As shown in Figure 32 4, if firing member 10052 is barred from the near-end of nail bin 1160011601 and far-end 11602 in the middle of, be opened and support section 11610 moves at anvil block 11660After tissue T, as shown in Figure 32 5, securing member 11613 can contribute to tissue thickness to compensateThe not implant part of part 11620 remains to support section 11610. In various embodiments, to aboveBe described further, the cutting blade 10053 of firing member 10052 can cut securing member 11613 and/Or securing member 11613 is ruptured. In some alternative embodiment, referring now to Figure 32 7 HesFigure 32 8, nail is disposed sliding part such as sliding part 11650 for example can comprise blade 11653, works as sliding part11650 while traversing nail bin 11600, and this blade can cut the connector 11616 of securing member 11613.In at least one this type of embodiment, each connector 11616 can be included in the T of securing member 11613The cylindrical member extending between shape end 11618, wherein blade 11653 can comprise concave profile11653, this concave profile for example can hold cylinder shape connector 11616.

As mentioned above, nail bin can be loaded onto in the nail bin passage of surgery suturing appliance. In various situationsUnder, surgeon or other clinicians can insert nail bin by downward power being applied on nail binEnter in nail bin passage with by nail bin locks in place. In some this type of situation, clinician can be for example byIts thumb is placed on the top surface of nail bin and applies this type of downward power. In various embodiments,The top surface of nail bin can comprise the top surface of tissue thickness's compensating part, wherein, as mentioned above, groupKnit thickness compensation part and can be compressiblely, and in certain embodiments, be applied to tissue thickness's compensationThe downward power of part can make tissue thickness's compensating part be compressed to following point: this point, clinician'sThumb contacts with the end that is stored in the nail in support section. In various embodiments, can utilize nail binApplication device inserts nail bin in nail bin passage, and this nail bin application device can prevent or at least limit and faceBed doctor touches the possibility of the nail in nail bin. Be properly oriented in nail bin passage it at nail binAfter, as described in more detail below, application device can separate with nail bin.

In certain embodiments, referring now to Figure 30 5 and Figure 30 6, nail bin application device can for example wrapDraw together the rigid cap that can be attached to nail bin 10000 such as lid 10080. To being above described further,In the time that nail bin 10000 is inserted in nail bin passage, lid 10080 can for example prevent from or at least suppress facingBed doctor's thumb contact is positioned at the end of the nail 10030 in nail bin 10000. Referring now to figure,307 and Figure 30 8, lid 10080 may extend into the top surface 10021 of tissue thickness's compensating part 10020Or at least a portion of top surface 10021, and can comprise 1) may extend into tissue thicknessOn compensating part 10020 and/or the lower surface 10081 of subjacent tissue's thickness compensation part 10020, withAnd 2) can be clinician provide press surface to apply the top surface of downward power to it10082. In use, clinician can grasp the shank part 10084 of covering 10080, by nail bin10000 support section 10010 aligns with nail bin passage, and at least in part nail bin 10000 is insertedEnter in nail bin passage. Then, clinician can be by applying to the top surface 10082 of lid 10880Downward power makes nail bin 10000 completely sit and put in nail bin passage. In various embodiments, this toUnder power can be directly transferred to support section 10010. In at least one this type of embodiment, lid10080 can comprise proximal supports 10087, and this support member can and contact the flat of support section to downward-extensionPlatform surface 10011. In certain embodiments, also can comprise can be in abutting connection with nose 10003 for lid 10080Distally support section 10083. In the time applying downward power to lid 10080, the Li Ketong that this is downwardCross proximal supports 10087 and/or distally support section 10083 is passed, and not can or at least basicOn this downward power can be delivered to support section 10010 by tissue thickness's compensating part 10020.In all cases, due to mentioned above, clinician can not direct contact tissue thickness compensation part10020. Also, due to mentioned above, in the time that nail bin 10000 is inserted in nail bin passage, lid 10080 canDo not compress or compress tissue thickness compensation part 10020 not at least substantially. In various embodiments, lidCan comprise the support member of any suitable quantity, this support member can be delivered to support portion by downward powerPoint, and can or at least substantially can not transmit this downward power by tissue thickness's compensating part. At certainIn a little embodiment, support member may extend into near-end, far-end and/or longitudinal side of tissue thickness's compensating partAround. In certain embodiments, support member is extensible through tissue thickness's compensating part. At least oneIn individual this type of embodiment, support member is extensible through the hole in tissue thickness's compensating part and in abutting connection with support portionThe platform dividing. In certain embodiments, at least some support members can be applied to and cover it in downward powerBefore do not contact platform; But in various embodiments, lid can deflection, or move downward untilThe platform of support member contact support section. Now, can stop or at least substantially stop downward the scratching of lidSong or the further deflection of moving.

As mentioned above, lid 10080 can be attached to nail bin 10000 and can be used for regulating and controlling nail bin 10000Position. In various embodiments, lid 10080 can comprise the clamping components of any suitable quantity, this folderHold the support section that member for example can remain to lid 10080 nail bin 10000 releasedly10010. In at least one this type of embodiment, lid 10080 for example also can comprise one or more maintenancesMember, such as hammerlock 10088 and/or 10089. In various embodiments, hammerlock 10089 can prolongReach the side periphery of nose 10003 and engage the lower surface 10009(figure of nose 10003306). Similarly, hammerlock 10088 may extend into the side periphery of lock protuberance 10008, and this lock is prominentGo out lock protuberance 10008 extends and engage in portion lower surface from support section 10010. In various realitiesExecute in example, these hammerlocks can be positioned at lid 10080 as on inferior segment or region: Gai Quhuo districtIn territory, nail is stored in support section 10010. Under any circumstance, once nail bin 10000Be properly oriented, lid 10080 can separate with nail bin 10000. In at least one embodiment, clinicalDoctor can apply lifting force upwards to shank 10084, so that by far-end and the nail bin of lid 1008010000 far-end 10002 separates. In at least one this type of embodiment, shank 10084 byOn while lifting, hammerlock 10088 and 10089 outwards deflections, make the hammerlock 10088 and 10089 canRespectively around lock protuberance 10008 and nose 10003 deflections. Then, the near-end of lid 10080 can quiltLift from the near-end 10001 of nail bin, and lid 10080 is movable away from nail bin 10000.

In certain embodiments, referring now to Figure 30 9 and Figure 31 0, except by nail bin such as nail bin10600 be for example positioned in nail bin passage outside, nail bin application device is such as nail bin application device 10680For example top can also be organized thickness compensation part such as tissue thickness's compensating part 10690 for example with respect toAnvil block location. Be similar to mentioned above, application device 10680 can comprise can with lock protuberance10608 hammerlocks 10688 that engage releasedly, this lock protuberance is from the support section of nail bin 1060010610 extend, and make application device can be maintained at tissue thickness's compensating part 10620 of nail bin 10600On position. In various embodiments, top organizes the thickness compensation part 10690 can be removableBe attached to nail bin application device 10680, for example make anvil block such as the anvil block 10060 of surgical instrumentsCan be closed on application device 10680, joining tissue thickness compensation part 10690, and make tissue thicknessCompensating part 10690 separates with application device 10680. In various embodiments, tissue thickness's compensating part10690 and/or anvil block 10060 can comprise one or more holding structures, this holding structure can be by groupKnit thickness compensation part 10690 and remain to releasedly anvil block 10060. At at least one this type of embodimentIn, tissue thickness's compensating part 10690 can comprise for example top table from tissue thickness's compensating part 10690The longitudinal rail 10695 that face 10691 extends, this longitudinal rail can be housed inside and be limited to anvil block 10060In interior longitudinal knife slit 10065. In various embodiments, tissue thickness's compensating part 10690 and verticalDirection guiding rail 10695 can for example be made up of any suitable compressible material, such as being described in this patent ShenPlease in those, wherein longitudinal rail 10695 for example can be compressed and/or be wedged in cutter slit 10065In. Once anvil block 10060 engages with tissue thickness compensating part 10690, anvil block 10060 can returnGet back to open position, and in such cases, tissue thickness's compensating part 10690 can with application device10680 separate. Then, application device 10680 can separate with nail bin 10600, makes anvil block 10060With nail bin 10600 can be with respect to by the tissue location that is sewn and/or cuts. In use, nail is disposedSliding part is such as sliding part 10050(Figure 23 6) for example can be by firing member 10052(Figure 23 6) courtDistally advances through nail bin 10600, for example, to nail is penetrated from nail bin 10060, as mentioned above.Due to nail distortion, therefore each nail can be at the top surface capture tissue thickness compensation part 10690 of tissueA part, and in the part of lower surface capture tissue thickness compensation part 10620 of tissue.Meanwhile, firing member 10052 can advance blade 10053(Figure 23 6) through tissue thickness's compensating part10620 and/or tissue thickness's compensating part 10690. Wherein at least one embodiment, blade10053 can be pushed into by longitudinal rail 10695, to cut guide rail 10695 and make to organize thickDegree compensating part 10690 separates gradually with anvil block 10060. After nail has been deployed, anvil block 10060Can again be opened and be moved away from tissue thickness's compensating part 10690 of implanting, and similarly, nailThe movable tissue thickness's compensating part 10620 away from implanting of support section 10610 in storehouse 10600. ?In various embodiment, to being above described further, tissue thickness's compensating part 10620 and/or tissueThickness compensation part 10690 can comprise multiple separable fragments. If only tissue thickness's compensating part 10620While being passed nail implantation with 10690 part, separable fragment can be separated from one another.

In various embodiments, to being above described further, application device 10680 can comprise energyEnough tissue thickness's compensating part 10690 is remained to the one or more of application device 10680 releasedlyHolding structure. In at least one this type of embodiment, first referring to Figure 31 0, application device 10680Can comprise longitudinal maintenance guide rail 10685 that can be accommodated in longitudinal maintenance slit 10694, this is verticalTo keeping slit to be limited at the lower surface 10692 of tissue thickness's compensating part 10690 with press-fitIn. In all cases, keep guide rail 10685 and keep slit 10694 tissue thickness can be mendedRepay part 10690 and remain to application device 10680, until compensate to tissue thickness by anvil block 10060Part 10690 applies enough lifting forces upwards, as mentioned above. At at least one this type of embodimentIn, the maintenance guide rail 10685 extending from application device 10680 also can comprise and is positioned at maintenance guide rail10685 near-end and the end stop of far-end 10686, this end stop can prevent or at leastThe relative longitudinal motion between thickness compensation part 10690 and application device 10680 is organized in restriction. At certainIn a little embodiment, refer again to Figure 31 0, one or more adhesives are such as longitudinal adhesive tape 10693For example can be placed on the contact surface 10691 of tissue thickness's compensating part 10690, make to work as anvil blockWhen 10060 contact tissue thickness compensation part 10690, as mentioned above, adhesive can be by tissue thicknessCompensating part 10690 is attached to anvil block 10060 releasedly. In various embodiments, except above-mentioned canThe holding structure of compression is outer or replace above-mentioned compressible holding structure, for example, can use one or moreAdhesive. In certain embodiments, can use one or more adhesives can by tissue thickness's compensating partDischarge and remain to nail bin application device. In at least one embodiment, referring now to Figure 31 0A,Lid 10080 for example can comprise one or more adhesive pads 12185, and these one or more adhesive pads canOrganize thickness compensation part such as tissue thickness's compensating part 12190 for example to remain to releasedly lid on top10080 top surface 10082. In at least one this type of embodiment, be similar to above-described embodiment,Anvil block can be closed with joining tissue thickness compensation part 12190 on tissue thickness's compensating part 12190Longitudinally keep guide rail 12195. In certain embodiments, relieving mechanism can be positioned in tissue thickness's benefitRepay in the middle of part 12190 and lid 10080. This relieving mechanism can be used for breaking the compensating part by tissue thickness12190 remain to the bonding of covering 10080, and make tissue thickness's compensating part 12190 and lid 10080Separate. In at least one embodiment, relieving mechanism can comprise pull tab 12196 and the collar 12197,Wherein the collar 12197 can comprise the first end and the second end that are attached to pull tab 12196. The collar12197 can for example comprise suture, and this suture can limit the periphery that defines adhesive pad 12185, makesWhen proper pull tab 12196 is pulled towards distally, suture can be at tissue thickness's compensating part 12190 and lidBetween 10080, slide and contact tissue pad 12185. In such cases, suture for example can complete withAt least one in lower function: adhesive pad 12185 is separated with tissue thickness compensating part 12190; MakeAdhesive pad 12185 separates with lid 10080; And/or cut-out adhesive pad 12185.

In various embodiments, referring now to Figure 31 1, nail bin can for example comprise support section10710. Be similar to mentioned abovely, this support section can comprise the longitudinal knife slit that runs through extension10715. In at least one this type of embodiment, nail bin application device such as application device 10780 for exampleCan comprise longitudinal maintenance and alignment member 10786, this longitudinally keeps and alignment member extends to support portionDivide in the cutter slit 10715 in 10710. In certain embodiments, retaining member 10786 for example canEnough sidewalls that engages cutter slit 10715 with press-fit, can be able to be released application device 10780Put and remain to support section 10710. In various embodiments, although not shown, tissue thickness is mendedThe Part I of repaying part can be positioned in the first side of retaining member 10786, and tissue thickness is mendedThe Part II of repaying part can be positioned in relative or second side of retaining member 10786. Be similar toMentioned above, the Part I of tissue thickness's compensating part and Part II for example can pass through retaining member10013 are installed to the support section 10710 of nail bin. Also be similar to mentioned above, top tissue thicknessLongitudinal guarantor that compensating part 10790 can extend by the loading surface 10782 from application device 10780Hold member 10785 and be installed to removedly application device 10780. Wherein retaining member 10785For example can be press fitted into releasedly the lower surface that is limited to tissue thickness's compensating part 10790In longitudinal slit 10794 in 10792. In various embodiments, be also similar to mentioned above, groupKnit thickness compensation part 10790 and also can comprise the top surface 10791 from tissue thickness's compensating part 10790The longitudinal retaining member 10795 extending, this longitudinal retaining member can be remained on restriction releasedlyIn longitudinal knife slit 10065 in anvil block 10060. In at least one this type of embodiment, longitudinallyRetaining member 10795 can comprise wedge-shaped cross-section, and this wedge-shaped cross-section comprises the top that is greater than bottom,Wherein bottom for example can be attached to tissue thickness's compensating part 10790 by retaining member 10795.

In various embodiments, referring now to Figure 31 2 and Figure 31 3, comprise support section 10810 HesThe nail bin 10800 of tissue thickness's compensating part 10820 for example can be loaded with nail bin application device 10880In nail bin passage. Be similar to mentioned abovely, nail bin application device 10880 for example can also be by topTissue thickness's compensating part 10890 is located with respect to anvil block such as anvil block 10060, makes to work as anvil blockWhen 10060 closure, anvil block 10060 can contact and joining tissue thickness compensation part 10890. At least oneIn individual embodiment, tissue thickness's compensating part 10890 can comprise from the top of tissue thickness's compensating part 10890Multiple maintenance legs 10895 that extend on portion surface 10891, this maintenance leg can engage anvil block 10060 alsoTissue thickness's compensating part 10890 is remained to anvil block 10060 releasedly. At at least one, this type of is realExecute in example, leg 10895 can be arranged to longitudinal row, and wherein each leg 10895 can comprise at least onePin, this pin can enter and engage the cutter slit 10065 being limited in anvil block 10060. At someIn embodiment, some pin of leg 10895 can extend along a direction, and other pin can be along another sideTo extension. In at least one embodiment, some pin can extend along relative direction. In any situationUnder, once anvil block 10060 engage with tissue thickness compensating part 10890, referring now to Figure 31 3 HesFigure 31 4, anvil block 10060 can be opened again, and clinician can be by nail bin application device 10880Move apart tissue thickness's compensating part 10820 and 10890. Then, referring to Figure 31 4A, top tissue thicknessCompensating part 10890 can be positioned in the first side of target tissue, and can comprise that bottom organizes thickness compensationTissue thickness's compensating part 10820 of part can be positioned in the second side of tissue. When tissue thickness's compensationAfter part 10820 and 10890 has been properly oriented, referring now to Figure 31 4B, the blade of firing member is allAs blade 10053 for example can be pushed into through tissue and tissue thickness's compensating part. At various embodimentIn, referring now to Figure 31 8, nail bin application device such as application device 12280 for example can comprise and can divideThe liftoff tissue thickness's compensating part 12290 that is installed to it. As shown in Figure 31 9, when anvil block 10060 is transportedWhile moving closing position, this tissue thickness's compensating part can be similar to mentioned above being inserted in nail bin passageAnd engaged by anvil block 10060. In at least one this type of embodiment, tissue thickness's compensating part 12290Can comprise the upwardly extending multiple maintenance structures of top surface 12291 from tissue thickness's compensating part 12290Part 12295. Wherein each retaining member 12295 can comprise multiple flexible legs 12296, the plurality of flexibilityLeg can insert in the cutter slit 10065 in anvil block 10060. First referring to Figure 32 1 and Figure 32 2,The flexible leg 12296 of each retaining member 12295 can be separated by gap 12298, makes to work as legIn 12296 insertion cutter slits 10065 time, inwardly deflection of leg 12296, once and flexible legThe pin of 12296 expansion has passed cutter slit 10065, leg 12296 outwards resilience subsequently. VariousIn embodiment, the pin of the expansion of flexible leg 12296 can be being defined to relative in anvil block 10060Keep antelabium 12297 deflections below, and due to the interaction of leg 12296 and antelabium 12297,Tissue thickness's compensating part 12290 can be held anvil block 10060. Then, nail bin application device 12280Movable away from tissue thickness's compensating part 12290, as shown in Figure 32 0. In use, once tissueThickness compensation part 12290 is for example implanted to tissue by the nail of disposing from nail bin 10000, anvilSeat 10060 can be opened again, and compensates away from the tissue thickness implanting when anvil block 10060 movesPart 12290, the inwardly deflection of leg 12296 of retaining member 12995, makes it can be from cutter slit10065 are pulled out.

In various embodiments, referring now to Figure 31 5 and Figure 31 6, tissue thickness's compensating part is such as groupKnitting thickness compensation part 11990 for example can be by longitudinal load in anvil block such as anvil block 11960. More specificallyGround, at least one embodiment, tissue thickness's compensating part 11990 can comprise one or more longitudinalGuide rail 11995, these one or more longitudinal rails can insert in the cutter slit 11965 of anvil block 11960Distal openings in, and subsequently towards distally promote, until tissue thickness's compensating part 11990 is rightlySeat is put in anvil block 11960. In at least one this type of embodiment, each guide rail 11995 can compriseCan be positioned in longitudinal maintenance antelabium 11997 longitudinal maintenance pin 11996 below, this longitudinally keeps lipEdge for example limits cutter slit 11965 at least partly. As shown in Figure 31 6, pin 11996 can be along relativeDirection extend so that be positioned in keep antelabium 11997 after, this maintenance antelabium is positioned in cutterOn the opposite side of slit 11965. In various embodiments, axial clearance 11998 can be limited at and leadBetween rail 11995, in the time that tissue thickness's compensating part 11990 separates with anvil block 11960, between this is longitudinalGap can make guide rail 11995 inwardly deflection toward each other. In certain embodiments, referring now to figure317, tissue thickness's compensating part such as tissue thickness's compensating part 12090 for example can comprise that to extend to anvil block allAs one or more hammerlocks 12098 of the side periphery of anvil block 12060. In use, hammerlock 12098Can engage anvil block 12060 and tissue thickness's compensating part 12090 is remained to anvil block releasedly12060. In at least one this type of embodiment, anvil block 12060 for example can comprise one or more recessesOr lock shoulder 12097, these one or more recesses or lock shoulder can hold from hammerlock 12098 and extend separatelyPin. In use, after tissue thickness's compensating part 12090 is at least partly implanted, at arm12098 outwards deflections, and in the time that anvil block 12060 moves away from tissue thickness's compensating part 12090Separate with anvil block 12060.

As mentioned above, surgery suturing appliance can comprise and can hold the nail bin passage of nail bin, rotatablyBe connected to the anvil block of nail bin passage and comprise the firing member of blade, this firing member can be with respect to anvilSeat and the motion of nail bin passage. In use, nail bin can be positioned in nail bin passage, and works as nail binAfter consuming at least in part, nail bin can remove and be replaced by new nail bin from nail bin passage. At someIn this type of embodiment, nail bin passage, anvil block and/or the firing member of surgery suturing appliance can with replacementNail bin is reused together. In some other embodiment, nail bin can comprise the disposable loading of partUnit block, this disposable loading unit assembly for example can comprise nail bin passage, anvil block and/or percussionMember, these can be replaced with nail bin, one of disposable loading unit assembly as an alternativePoint. Some disposable loading unit assembly is disclosed in the name of submitting on February 15th, 2008 and is called“ENDEFECTORCOUPLINGARRANGMENTSFORASURGICALCUTTINGANDSTAPLINGINSTRUMENT " U.S. Patent Application Serial NumberIn 12/031,817, whole disclosures of this patent application are incorporated herein by reference. Ginseng nowSee Figure 37 0, disposable loading unit for example can comprise support portion such as disposable loading unit 12500Points 12510, be rotatably connected to the anvil block 12560 of support section 12510 and from support section12510 slender axles 12570 that extend. Be similar to nail bin as herein described, support section 12510 can wrapDraw together multiple nails chamber 10012 and nail, for example, be positioned at the nail 10030 in each nail chamber 10012. OnceProperty loading unit 12500 also can comprise firing member 12552, and this firing member can be pushed into towards distallyTo anvil block 12560 is moved to closing position from open position, as shown in Figure 37 0. In various realitiesExecute in example, disposable loading unit 12500 also can comprise and being positioned on support section 12510 and/or attachedReceive tissue thickness's compensating part 12520 of support section 12510. Wherein, when anvil block 12560 inWhen its closing position, anvil block 12560 can be positioned in the opposite of tissue thickness's compensating part 12520, andAnd in certain embodiments,, when anvil block 12560 is during in its closing position, anvil block 12560 can be at leastPartly compress tissue thickness compensation part 12520. In any situation, firing member 12552 canBe further promoted, to nail is penetrated from support section 12510. After nail is penetrated, nail can lead toCross anvil block 12560 and be out of shape, and catch at least a portion of tissue thickness's compensating part 12520 wherein.Then, firing member 12552 can bounce back towards nearside, and anvil block 12560 can be opened again, and12510 movable tissue thickness's compensating parts 12520 away from implanting are divided in support part.

In various embodiments, can quilt to being described further tissue thickness's compensating part 12520 aboveBe installed to separably support section 12510. In at least one this type of embodiment, support section12510 can comprise the longitudinal maintenance guide rail 12526 that is installed to its each side, wherein each guide rail 12526Can comprise one or more holes 12528, these one or more holes can hold therein tissue thickness and mendRepay at least a portion of part 12520. Once tissue thickness's compensating part 12520 is at least partly plantedEnter, can be by tissue thickness's compensating part 12520 from hole 12528 in the time that support section 12510 is moved apartMiddle tractive goes out. In various embodiment, referring now to Figure 37 1-373, disposable loading unit 12600Can comprise support section 12610, be installed to separably the tissue thickness compensation of support section 12610Part 12620 and one or more maintenance guide rail 12626, these one or more maintenance guide rails can prolongReach below tissue thickness's compensating part 12620, and tissue thickness's compensating part 12620 is installed to and is propped upSupport part divides 12610. Each maintenance guide rail 12626 for example can comprise multiple maintenance hooks 12628, the plurality ofKeep hook to join support to by the maintenance slit 12614 being for example limited in support section 12610Part 12610. In use, at least one this type of embodiment, when tissue thickness's compensating part12620 are at least partly implanted and support section 12610 moves away from tissue thickness's compensating part 12620Afterwards, tissue thickness's compensating part 12620 can separate with keeping guide rail 12626. At various embodimentIn, referring now to Figure 37 4-376, disposable loading unit 12700 can comprise one or more maintenancesGuide rail 12726, these one or more maintenance guide rails can comprise separately and may extend into tissue thickness's compensating part12720 bottom bars 12725 below and extend to the top surface of tissue thickness's compensating part 12620Push rod 12727 on 12621. In certain embodiments, tissue thickness's compensating part 12620 can be on topBetween bar 12727 and bottom bar 12725, be at least partially compressed, make to keep the guide rail 12726 can be relativeKeep tissue thickness's compensating part 12620 in support section 12610. At at least one this type of embodimentIn, each maintenance guide rail 12726 can comprise one or more maintenance hooks 12728, these are one or moreKeep hook to engage that maintenance guide rail 12726 is remained to support section with support section 1261012610。

In various embodiments, referring now to Figure 37 7 and Figure 37 8, disposable loading unit 12800Can comprise retaining member 12822, this retaining member can be installed to tissue thickness's compensating part 12620Support section 12610. In at least one this type of embodiment, retaining member 12822 can comprise locationMaterial piece on the platform surface 12611 of support section, wherein tissue thickness's compensating part 12620 examplesAs being attached to material piece by least one adhesive. Retaining member 12822 also can comprise longitudinal guarantorHold guide rail 12825, this longitudinally keeps guide rail to extend downwardly into being limited in support section 12610Cutter slit 12615 in. In at least one this type of embodiment, the size of maintenance guide rail 12825 canSet for and be configured to make it compressed between the sidewall of cutter slit 12615. UsingIn, firing member 12552 can comprise blade, is pushed into and longitudinally at firing member 12552 towards distallyWhen transecting patient tissue thickness compensation part 12620 and maintenance guide rail 12825, this blade can pass cutter slit12615. In addition, in use, the penetrable retaining member of nail penetrating from support section 1261012822, tissue thickness's compensating part 12820 and be positioned at tissue thickness's compensating part 12820 and anvil blockTissue between 12560. In various embodiments, retaining member 12822 can by biocompatibility and/Or material that can bio-absorbable forms. In certain embodiments, retaining member 12822 can be by can be abundantThe material of compression forms, to comprise tissue thickness's compensating part 12620 tissue thickness's compensating part below.In various embodiments, referring now to Figure 37 9-381, disposable loading unit 12900 can comprise and addingCarry assembly, this charging assembly comprises the bottom that can be attached to removedly support section 1261012922, can be attached to removedly the top 12990 of anvil block 12560 and connect bottom12922 and the flexible joint 12991 at top 12990. Be similar to mentioned abovely, longitudinally keep guide rail12825 can extend downwardly into from bottom 12922 the cutter slit 12615 being limited to support section 12610In, make bottom 12922 to be remained to releasedly support section 12610. Similarly, longitudinalKeep guide rail 12995 can extend up to from top 12990 the cutter slit being limited to anvil block 12560In, make top 12990 to be remained to releasedly anvil block 12560. As Figure 38 0 and Figure 38 1Shown in, tissue thickness's compensating part 12620 can be installed to the bottom 12922 of charging assembly, wherein,For with respect to support section 12610 position tissue thickness compensation parts 12620, clinician can make topPortion 12990 and bottom 12922, towards flex relative to each other, be positioned at charging assembly anvil block 12560 and supportBetween part 12610, and discharge the charging assembly of deflection, make the charging assembly can be against anvil block12560 come elastic stretch and biasing top 12990, and against support section 12610 come elastic stretch andBiasing bottom 12922. In at least one embodiment, referring now to Figure 38 2-384, charging assembly alsoCan comprise for example one or more latch hooks such as the latch hook 12994 from its extension, this latch hook can be by topPortion 12990 is connected to anvil block 12560 releasedly, and/or bottom 12922 is connected to releasedlySupport section 12610.

In various embodiments, referring now to Figure 38 5, disposable loading unit 15900 for example can wrapDraw together anvil block 15960 and nail bin passage 15970, wherein nail bin passage 15970 can be with respect to anvil block 15960Rotation. In at least one this type of embodiment, anvil block 15960 may not rotate. Real at someExecute in example, tissue can be positioned between anvil block 15960 and nail bin passage 15970, and follows closely subsequentlyStorehouse passage 15970 can be towards tissue rotation with against anvil block grasping tissue. At at least one this type of embodimentIn, disposable loading unit 15900 also can comprise tissue thickness's compensating part that can contact tissue15920。

As mentioned above and referring to Figure 33 2, nail bin such as nail bin 10000 for example can comprise support section10010 and tissue thickness's compensating part 10020, wherein multiple nails 10030 can be at least partly stored inSupport part is divided in 10010, and not may extend into tissue thickness when firing position in it when nail 10030In compensating part 10020. In various embodiments, when nail 10030 is in it not when firing position, nail10030 end is not from tissue thickness's compensating part 10020 projections. When nail 10030 is by staple drivers10040 when from it, firing position does not move to its firing position, as mentioned above, and the end of nail 10030Can be through tissue thickness's compensating part 10020 and/or through upper strata or crust 10022. Can be for choosing at someIn the embodiment selecting, when nail 10030 is in it not when firing position, the end of nail 10030 can protrudingly be wornThe top surface of tissue thickness's compensating part 10020 and/or crust 10022. In any situation, whenNail 10030 is while extending upward support section 10010 before being deployed, and nail 10030 can be with respect toSupport section tilts and/or deflection, similarly, as described above. In various embodiments, referring now to figure329, nail bin such as nail bin 13000 for example can comprise multiple ways or retainer, the plurality of guidingMember or retainer can limit the support section 13010 of nail bin 13000 and be positioned at nail whereinRelative motion between end. First referring to Figure 33 0, nail bin 13000 can comprise and is installed to support portionDivide tissue thickness's compensating part 13020 of 13010, and be attached in addition tissue thickness's compensating part 13020Multiple absorbent cotton 13022 of top surface 13021. In various embodiments, each absorbent cotton13022 can comprise the multiple holes 13029 that are limited to wherein, and the plurality of hole can hold therein slidablyReceive and/or guide the leg 13022 of nail 13030. Except hole or replace hole, absorbent cotton for example can wrapDraw together any suitable opening, such as slit, guider and/or groove, it can hold slidablyReceive and/or lead leg 13022. In certain embodiments, as shown in Figure 33 0, when nail 13030 inIt is not when firing position, and the end of nail leg 13032 can be positioned in hole 13029. At at least oneIn this type of embodiment, when nail is in it not when firing position, the end of nail leg 13032 can project into de-Cotton 13022 tops of fat. In some other embodiment, when nail 13030 is in its firing position notTime, the end of nail leg 13032 can be positioned in the immediately below of absorbent cotton 13022, makes when nail13030 while being moved upward through tissue thickness's compensating part 13020, and nail leg 13032 can enter degreasingIn cotton 13022 hole 13029 and slide through this hole. Under any circumstance, when following closely 13030 leg13032 while being positioned in absorbent cotton, can limit side direction and/or the lengthwise movement of nail leg 13032, andIn the time that being deployed, nail 13030 do not stop moving upward of nail leg 13032. When nail 13030 is deployedTime, referring now to Figure 33 1, nail leg 13032 can pass absorbent cotton 13022 by upward sliding, to penetrate groupKnit T, contact is positioned at the anvil block on nail bin 13030 opposites, and distortion is downwards to catch tissue whereinT and tissue thickness's compensating part 13030.

In various embodiments, to being above described further, absorbent cotton 13022 for example can useAt least one biocompatibility and/or adhesive that can bio-absorbable are attached to tissue thickness's compensating part13020. In certain embodiments, absorbent cotton 13022 and/or the maintenance structure from each absorbent cotton extensionPart can embed in tissue thickness's compensating part 13020 at least partly. In at least one this type of embodiment,Tissue thickness's compensating part 13020 can comprise be limited to wherein can hold at least partly absorbent cotton13022 pit. In certain embodiments, in molded manufacture process, tissue thickness's compensating part13020 can be integrally molded or form around absorbent cotton 13022. In various embodiments, degreasingCotton 13022 can comprise the discrete retainer that can move independently of one another. In at least one embodiment,First referring to Figure 33 0, each absorbent cotton 13022 can comprise interlocking and/or bonding structure, this interlocking and/Or bonding structure can allow and limit to a certain extent side direction relative between absorbent cotton 13022 and verticalTo motion. In at least one this type of embodiment, each absorbent cotton 13022 for example can comprise protuberance13026 and one or more groove 13027, wherein the protuberance 13026 of the first absorbent cotton 13022 canBe positioned in the groove 13027 of the second adjacent absorbent cotton and the 3rd absorbent cotton 13022, and/or phaseGroove 13027 for the second adjacent absorbent cotton and the 3rd absorbent cotton 13022 aligns. In various realitiesExecute in example, gap can be present between adjacent absorbent cotton 13022, and this gap can make absorbent cotton13022 relative to each other motion or slips, until it contacts adjacent absorbent cotton 13022. Real at someExecute in example, absorbent cotton 13022 can loosely interconnection. In various embodiments, absorbent cotton 13022 energyEnough being connected to separably each other. In at least one this type of embodiment, absorbent cotton 13022 can be madeMake the absorbent cotton for a slice interconnection. Wherein, in the time applying enough power to this sheet, absorbent cotton 13022In one or more can the disengaging with other absorbent cotton. In certain embodiments, refer again to figure329, first 13024 absorbent cotton 13022 can be positioned in the first side of longitudinal slit 13025,And second 13024 absorbent cotton 13022 can be positioned in the second side of slit 13025. ExtremelyIn a few embodiment, to being described further, extend through tissue thickness's compensating part aboveLongitudinal slit 13025 of 13020 can be conducive to the blade of firing member through tissue thickness's compensating part13020, and when firing member is through out-of-date, firing member can apply compression stress to described 13024,And make in absorbent cotton 13022 at least some separately or separate.

In various embodiments, absorbent cotton 13022 for example can be by biocompatibility and/or can bio-absorbablePlastics form. In certain embodiments, absorbent cotton 13022 for example can be by solid material, semisolidMaterial and/or flexible material form. In certain embodiments, absorbent cotton 13022 can embed organize thickIn degree compensating part, make absorbent cotton 13022 with tissue thickness's compensating part motion. At at least one this type ofIn embodiment, absorbent cotton 13022 can be enough flexibilities, makes that it can be with tissue thickness compensating partTop surface deflection. In certain embodiments, absorbent cotton 13022 can keep being embedded in organize thickIn degree compensating part, and in some other embodiment, absorbent cotton 13022 can compensate from tissue thicknessPart ejects or separates with tissue thickness compensating part. In various embodiments, absorbent cotton 13022 can compriseThe top surface flushing with the top surface of tissue thickness compensating part. In certain embodiments, absorbent cotton13022 top surface can be positioned in top surface top and/or the below of tissue thickness's compensating part.In various embodiments, the top surface of absorbent cotton 13022 can be positioned such that to work as from tissue thicknessWhen the top surface of compensating part is observed, it is visible, and in other embodiments, absorbent cotton 13022Top surface for example can be positioned in tissue thickness's compensating part layer below. At some embodimentIn, guide frame for example can be molded in the top surface of tissue thickness's compensating part. At at least oneIn this type of embodiment, tissue thickness's compensating part can not comprise composite, and for example can comprise oneThe material of entirety.

In various embodiments, referring now to Figure 33 8, nail bin for example can comprise tissue thickness's compensating part13620 and crust or top layer 13621. In at least one this type of embodiment, one or more degreasingsCotton or retainer 13622 for example can embed crust 13621. In certain embodiments, each retainer13622 can comprise the one or more holes 13629 that wherein limit, when nail 13030 is not pulled the trigger position in itWhile putting, these one or more holes can hold the nail leg 13032 of nail 13030 therein, as Figure 33 8Shown in. In use, to being above described further, when nail 13030 is from its firing position fortune notWhile moving its firing position, nail leg 10032 is slidably through hole 13629, until the base of nail 13030Portion's 13031 contact tissue thickness compensation parts 13620, and for example against the bottom of absorbent cotton 13622At least a portion of compress tissue thickness compensation part 13620 is carried out on surface. In various embodiments, presentReferring to Figure 33 3, nail bin for example can comprise tissue thickness's compensating part 13120 and crust or top layer13122. In at least one this type of embodiment, tissue thickness's compensating part 13120 for example can comprise can be fromThe upwardly extending taper lug of top surface 13121 of tissue thickness's compensating part 13120, protuberance,And/or jut 13128. When nail 13030 is in it not when firing position, protuberance 13128 canHold and seal the end of the nail leg 13032 of nail 13030, as shown in Figure 33 3. Top layer 13122 alsoCan comprise align with protuberance 13128 or at least substantial alignment taper lug, protuberance and/orJut 13129. In use, the penetrable protuberance 13128 and 13129 of nail leg 10032, and fromTissue thickness's compensating part 13120 exposes. In various embodiments, referring now to Figure 33 7, nail bin exampleAs comprised tissue thickness's compensating part 13520 and crust or top layer 13522. At at least one this type ofIn embodiment, crust 13522 for example can comprise can be from the top surface of tissue thickness's compensating part 1352013521 upwardly extending taper lugs, protuberance and/or jut 13529. Be similar to institute aboveState, when nail 13030 is in it not when firing position, protuberance 13529 can hold and seal nailThe end of 13030 nail leg 13032, as shown in Figure 33 7. In use, nail leg 10032 can be wornSaturating protuberance 13529 also exposes from crust 13522.

In various embodiments, referring now to Figure 33 4, nail bin for example can comprise tissue thickness's compensating part13220 and crust or top layer 13222. In at least one this type of embodiment, tissue thickness's compensating part13220 for example can comprise the top surface 13221 that can extend downwardly into tissue thickness's compensating part 13220In pyramidal pits and/or groove 13128. In various embodiments, when nail 13030 does not hit in itWhile sending out position, the end of nail leg 13032 is extensible through groove 13128, as shown in Figure 33 4. ?In at least one embodiment, top layer 13222 also can comprise and can align with groove 13228 or at least basicThe pyramidal pits of upper alignment and/or groove 13229. In various embodiments, referring now to Figure 33 5,Nail bin for example can comprise tissue thickness's compensating part 13320 and crust or top layer 13322. At least oneIn individual this type of embodiment, crust 13320 can comprise can extend downwardly into tissue thickness's compensating part 13320Top surface 13321 in thick part 13329. In various embodiments, when nail 13030 placesIn it, not when firing position, thick part 13329 can be held the nail leg of nail 13030 thereinAt least a portion of 13032, as shown in Figure 33 5. In this type of embodiment, thick part 13329Nail leg 13032 can be held in place, make leg 13032 and be positioned at tissue thickness's compensating part 13320The nail shaping pit alignment of the anvil block on opposite or at least substantial alignment. In various embodiments, presentReferring to Figure 33 6, nail bin for example can comprise tissue thickness's compensating part 13420 and crust or top layer13422. In at least one this type of embodiment, crust 13422 can comprise can be from tissue thickness's compensating part13420 the upwardly extending thick part 13429 of top surface 13421. In various embodiments, whenNail 13030 is not in it when firing position, and thick part 13429 can be held nail 13030 thereinAt least a portion of nail leg 13032, as shown in Figure 33 6. In this type of embodiment, thick part13429 can be held in place nail leg 13032, make leg 13032 and are positioned at tissue thickness's compensating partThe nail shaping pit alignment of the anvil block on 13420 opposites or at least substantial alignment.

In various embodiments, referring now to Figure 33 9 and Figure 34 0, nail bin for example can comprise organize thickDegree compensating part 13720 and crust or top layer 13721. In at least one this type of embodiment, tissueThickness compensation part 13720 for example can comprise can be from the top surface of tissue thickness's compensating part 1372013721 upwardly extending tapers and/or staged lug, protuberance and/or jut 13728. WhenNail 13030 is in it not when firing position, and protuberance 13728 can hold and seal nail 13030The end of nail leg 13032, as shown in Figure 34 0. Similarly, can comprise can be with outstanding for top layer 13721Portion 13728 align or at least the taper of substantial alignment and/or staged lug, protuberance and/orJut 13729. In various embodiments, crust 13721 also can comprise from protuberance 13729 toOne or more tusks 13727 of upper extension, it is fixed that this tusk can engage against top layer 13721The tissue of position, and the end that prevents or at least limit tissue, top layer 13721 and/or nail leg 13032Relative side direction and/or lengthwise movement between end. In use, when nail 13030 is from its firing position notWhile moving to its firing position, nail the penetrable protuberance 13728 of leg 13032 and 13729 and from tissueThickness compensation part 13720 exposes. In various embodiments, referring now to Figure 34 1 and Figure 34 2, nailStorehouse for example can comprise tissue thickness's compensating part 13820 and crust or top layer 13821. At at least oneIn this type of embodiment, tissue thickness's compensating part 13820 for example can comprise can be from tissue thickness's compensating part13820 the upwardly extending taper of top surface 13821 and/or staged lug, protuberance and/orJut 13828. When nail 13030 is in it not when firing position, protuberance 13828 can holdAnd seal the end of nail 13030 nail leg 13032, as shown in Figure 34 2. Similarly, top layer13821 can comprise and can align with protuberance 13828 or at least taper and/or the staged of substantial alignmentLug, protuberance and/or jut 13829. In various embodiments, top layer 13821 also can wrapDraw together the one or more tusks 13827 that extend downwardly in tissue thickness's compensating part 13820, this toothShape thing for example can prevent or at least limit phase between top layer 13821 and tissue thickness's compensating part 13820Right side direction and/or lengthwise movement. In use, when nail 13030 from its not firing position move to itWhen firing position, the nail penetrable protuberance 13828 of leg 10032 and 13829 and compensate from tissue thicknessPart 13820 exposes.

In various embodiments, referring now to Figure 34 3, nail bin can comprise tissue thickness's compensating part such asTissue thickness's compensating part 13920, this tissue thickness's compensating part for example can comprise the ridge being limited to wherein13923 and paddy 13924. In at least one embodiment, paddy 13924 can be limited at ridge 13923 itBetween. In various embodiments, each ridge 13923 can comprise identical height, substantially the same heightDegree or different height. Similarly, each paddy 13924 can comprise the identical degree of depth, phase substantiallyThe same degree of depth or the different degree of depth. In various embodiments, multiple nails 13030 can store up at least partlyExist in tissue thickness's compensating part 13920, make to follow closely 13030 end and can be positioned in ridge 13923In. In at least one this type of embodiment, when nail 13030 is stored in it not when firing position, nail13030 nail leg 13032 for example can and/or be attached to not from tissue thickness's compensating part 13920 organize thickCrust or top layer 13921 projections of degree compensating part 13920. In various embodiments, ridge 13923 and/Or paddy 13924 can extend laterally across nail bin. In at least one this type of embodiment, nail bin can compriseLongitudinal knife slit, its median ridge 13923 and paddy 13924 can along transverse to and/or perpendicular to the side of cutter slitTo extension. In all cases, ridge 13923 can be held in place the end of nail leg 13032, straightTo nail 13030 from its not firing position move to its firing position. In various embodiments, join nowSee Figure 34 4, the outer micromicro of tissue thickness's compensating part and/or covering tissue thickness compensating part comprises longitudinal ridgeAnd/or paddy. In at least one this type of embodiment, tissue thickness's compensating part can comprise by ridge 14023 HesThe top surface that paddy 14024 limits, its two-story valley 14024 for example can be limited between ridge 14023.In various embodiments, tissue thickness's compensating part can comprise crust 14021, and this outer micromicro comprises restrictionMultiple holes 14029 therein, each hole can hold nail leg 13032 separately. At some embodimentIn, hole 14029 can be limited in ridge 14023, and the end of wherein following closely leg 13032 can be positioned in14028 belows, summit of ridge 14029, be oriented to flush and/or be positioned in summit 1402814028 tops, summit. In certain embodiments, except mentioned above or replace mentioned above,Hole 14029 for example can be limited in paddy 14024. In certain embodiments, each hole for example can quiltEmbossing around or can strengthen around the crust in hole and/or tissue thickness's compensation around, this embossing at least partlyPart. Under any circumstance, to being above described further, crust 14021 can be any suitableMode is attached to tissue thickness's compensating part, for example, comprise and use at least one adhesive.

As mentioned above and refer again to Figure 23 3, surgery suturing appliance for example can comprise that anvil block is such as anvil block10060, this anvil block can move between open position and closing position, so that for example against nail binTissue thickness's compensating part 10020 compress tissue T of 10000. In all cases, anvil block 10060 canRotate towards nail bin 10000, until it moves downward by certain part of nail bin 10000 and/or is positioned with nailCertain part of the passage in storehouse 10000 stops. In at least one this type of embodiment, anvil block 10060Can be rotated down, until it moves downward by the nose 10003 of nail bin 10000 and/or is positioned at nose10003 and nail bin 10000 in the middle of tissue T resist. In some cases, anvil block 10060 canFully compress tissue thickness compensation part 10020, so that the end of tissue T contact stud 10030. At certainIn a little situations, according to the thickness of tissue T, anvil block 10060 is compress tissue thickness compensation part fully10020, make to wait until when anvil block 10060 has arrived its complete closing position anvil block 10060 and nail10030 contacts. In other words, in such cases, be advanced to nail bin at firing member 10052In 10000, with before percussion nail 10030, anvil block 10060 can make to follow closely 10030 distortion. This type of situationAcceptable in certain embodiments; But referring now to Figure 35 8 and Figure 35 9, other are imaginedEmbodiment. In described other embodiment, for example, can use gap, distally setting member such as element10059 limit following distance: before trigger shaft 10052 is advanced in nail bin 10000, and anvilSeat 10060 can be closed in this distance. In various embodiments, element 10059 can be thick from organizingThe top surface 10021 of degree compensating part 10020 upwards extends, and makes when tissue T rest element10059 is compressed and while producing drag therebetween, moving downward of anvil block 10060 can be prevented from. ?In use, as mentioned above, firing member 10052 can be towards distally towards the far-end of nail bin 1000010002 are advanced in nail bin 10000, penetrate from support section 10010 to will follow closely 10030.Meanwhile, firing member 10052 can engage anvil block 10060, and anvil block 10060 is just positioned atOn the nail 10030 of shape, apart from platform surface 10011(Figure 21 8 of support section 10010) expect distanceFrom. Like this, firing member 10052 can be controlled the tissue contacting surface of anvil block 10060 and in concrete positionPut distance or gap between the platform surface 10011 at place. Wherein, when firing member 10052 is towards farWhen side is pushed into, this particular location can be pushed into towards distally. In all cases, this clearance distance canBe shorter than the gap between anvil block 10060 and platform surface 10011, this gap is by tissue thickness's compensating partGap, the distally setting member 10059 of 10020 far-end is controlled or determines. At various embodimentIn, referring now to Figure 35 9, when firing member 10052 arrives the far away of tissue thickness's compensating part 10020When end, the blade 10053 of firing member 10052 can gap, crosscut distally setting member 10059,Make after element 10059 has been crosscut, firing member 10052 can be by anvil block 10060 towards propping up10010 downward tractives are divided in support part, and when in the time that the far-end percussion of nail bin 10000 follows closely 10030,Clearance height by gap-closing to expectation. In some alternative embodiment, work as firing memberWhile approaching the far-end of nail bin, gap, distally setting member can close up. At at least one this type of embodimentIn, gap, distally setting member can comprise pillars, this pillars can provide as mentioned above for anvil blockResistance, once and reach the fastening of gap setting member in the time that firing member approaches the far-end of nail binIntensity, then fastening suddenly of this pillars. In at least one embodiment, this tightening force for example canFor about 10lbf. In certain embodiments, for example exceed scheduled volume when applying to gap setting memberWhen power, gap setting member can be to falling in the platform of support section. At some other embodimentIn, gap, distally can be controlled by the nose of nail bin. In at least one this type of embodiment, anvil block10060 move downward can be limited by nose, until firing member has arrived the far-end in storehouse. Wherein,The compression stress that is applied to nose now can make nose collapse. In certain embodiments, nose can comprise byThe cavity that chamber wall limits. Exceed predetermined power once be applied to the compression stress of cavity, can make cavity collapseContracting. In at least one this type of embodiment, cavity can be limited by the wall of can collapsing.

In various embodiments, as mentioned above, anvil block such as anvil block 10060 for example can be at open positionAnd move between closing position, so that compress tissue thickness is mended between anvil block and the support section of nail binRepay part. In some cases, referring now to Figure 36 0 and Figure 36 1, when tissue thickness's compensating part 14120When compressed against the support section 14110 of nail bin 14100, tissue thickness's compensating part of nail bin such asTissue thickness's compensating part 14120 of nail bin 14100 for example can side direction and/or extending longitudinally. Real at someExecute in example, the end of tissue thickness's compensating part 14120 and/or side can be not supported part 14110 and/Or anvil block 10060 retrains. Therefore, in tissue thickness's compensating part 14120, do not produce compression pressure orIn the situation of at least unexpected compression pressure, tissue thickness's compensating part 14120 can be stretched along those directionsExhibition. In this type of embodiment, firing member is such as the percussion structure through tissue thickness's compensating part 14120Part 10052(Figure 23 6) for example can not can be organized compression stress unexpected in thickness compensation part 14120Improper prevention. In some other embodiment, refer again to Figure 36 0, tissue thickness's compensating part14120 far-end 14125 for example can be retrained by the nose of nail bin 14,100 14103. Specifically real at thisExecute in example, be similar to mentioned abovely, the far-end 14125 of tissue thickness's compensating part 14120 can be by nose14103 constraints, to reduce tissue thickness's compensating part 14120 and support section 14110 premature disengagementPossibility. Under any circumstance, due to mentioned above, large internal pressure can result from far-endIn 14125, this internal pressure can stop the propelling of firing member 10052, especially works as firing memberWhen 10052 arrival far-end 14125. More specifically, in some cases, when firing member 10052When transecting patient tissue thickness compensation part 14120, firing member can promote towards distally, plough except and/or shiftTissue thickness's compensating part 14120. Therefore, even larger internal pressure can result from tissue thickness's benefitRepay in the far-end 14125 of part 14120. In order to eliminate at least partly in tissue thickness's compensating part 14120This pressure, nose 14103 can be made up of flexible material. This flexible material can make nose 14103 examplesAs towards distally deflection, and produce additional space for tissue thickness's compensating part 14120. In some enforcementIn example, referring now to Figure 36 2 and Figure 36 3, the nose of nail bin can comprise the portion that can slide towards distallyPoint. More specifically, the nose 14203 of nail bin 14200 can comprise slidably part 14204, and this canSlipper can be connected to nose 14203 slidably, make to be closed when anvil block 10060 and/orWhen firing member 10052 is advanced in the far-end of nail bin 14200, slidably part 14204 can courtSliding and be that tissue thickness's compensating part 14200 produces additional space in distally, and alleviates at least partlyInternal pressure wherein. In at least one embodiment, nose 14203 and slidably part 14204In one can comprise one or more guide rails, and nose 14203 and slidably in part 14204Another one can comprise one or more passages that can hold slidably therein guide rail. At least oneIn individual this type of embodiment, passage and guide rail for example can cooperate and limit slidably part 14204 to longitudinallyThe motion of distal channel.

In all cases, to being above described further, for example following closely such as farthest side in nail binCan capture tissue thickness compensation part compared to the nearside nail in nail bin and the part of Yan Geng great. At this type ofIn situation, therefore, compared to nearside nail, the tissue of catching in can distad following closely applies largeClamping pressure. As mentioned above, although tissue thickness's compensating part can be by the base with substantial constant thicknessIn basis, the material of homogeneity forms, but be transferred to when at least a portion of tissue thickness's compensating part and/orWhile gathering during use the far-end of nail bin, can there are these situations. In all cases, the phaseHope some nail apply larger clamping pressure to tissue compared with other nails. Wherein, at various embodimentIn, support section and/or tissue thickness's compensating part can be configured to and be arranged to control which nail can be toTissue applies larger clamping force and which nail can apply less clamping force to tissue. Referring now toFigure 36 4, nail bin 14300 can comprise support section 14310, and is in addition positioned at support sectionTissue thickness's compensating part 14320 on 14310 platform surface 14311. Public with institute in present patent applicationThere is comprising of opening its of support section 14310 smooth or smooth platform surface at least substantiallyHe embodiment compares, and platform surface 14311 can be at the far-end of support section 14,310 14305 and near-endBetween 14306, tilt and/or decline. In at least one embodiment, the platform of support section 14310Surface 14311 can comprise the podium level at its far-end 14305 places, and this podium level is lower than its near-endThe podium level at 14306 places. In at least one this type of embodiment, the far-end of nail bin 14300Nail 10030 may extend into the larger distance in platform surface 14311 tops than the nail 10030 of proximal endFrom. In various alternative embodiment, the platform surface of support section can comprise its far-endHighly, this height is higher than the height of its proximal end. Refer again to Figure 36 4, tissue thickness's compensating part14320 can comprise the thickness different along its longitudinal length. In various embodiments, tissue thickness's compensationPart 14320 for example can comprise the thickness at its far-end 14325 places, and this thickness is thicker than its near-end 14326.In at least one this type of embodiment, tissue thickness's compensating part 14322 can comprise lower surface14322, this lower surface tiltable or decline, to mate or at least substantially to mate support section14310 inclination or the platform surface of decline 14311. Therefore, the top of tissue thickness's compensating part 14320Portion or tissue contacting surface 14321 can comprise can be positioned with above the smooth or at least basic of tissue TUpper smooth surface. Under any circumstance, because tissue thickness's compensating part 14320 is at its far-end14325 places are thicker, and therefore distally nail 10030 is than nearside nail 10030 tissues that can catch whereinThe major part of thickness compensation part 14320. Therefore, distally nail 10030 can apply to tissue T largerCompression stress, especially when the clearance distance between anvil block 10060 and platform surface 14311 is at nail binNear-end and far-end be constant or substantial constant time. But in some cases, anvil block10060 can arrive complete closing position, therefore between anvil block 10060 and platform surface 14311 betweenStand-off distance is from larger than proximal end at the far-end of nail bin 14300. In all cases, distally nail10030 may not be shaped completely, should this distally nail 10030 may be not apply expectation to tissue TClamping pressure. At tissue thickness's compensating part in the thicker embodiment of the far-end of nail bin, tissue thicknessCompensating part can compensate unshaped nail and apply enough pressure to tissue T.

In various embodiments, referring now to Figure 36 5, nail bin such as nail bin 14400 for example can compriseSupport section 14410 and be in addition positioned in the platform surface 14411 of support section 14410On tissue thickness's compensating part 14420. Be similar to mentioned above, platform surface 14411 tiltables and/Or decline, making at least one embodiment, the far-end 14405 of support section 14410 for example canThere is the podium level lower than the podium level at near-end 14406 places. In certain embodiments, organize thickDegree compensating part 14420 can comprise the constant or thickness of substantial constant at least along its length. Therefore,The top of tissue thickness's compensating part 14420 or tissue contacting surface 14421 can be parallel to or be at least basicOn be parallel to the profile of platform surface 14411. In various embodiments, when following closely 10030 in it notWhen firing position, the nail 10030 of nail bin 14400 can embed tissue thickness's compensating part 14420 Hes completelyIn support section 14410. In certain embodiments, when nail 10030 is in it not when firing position,The nail 10030 that is positioned in the proximal end of nail bin 14400 can embed tissue thickness's compensating part completely14420 and support section 14410 in; And due to the decline of platform 14411 and top surface 14421Slope, when nail 10030 is in it not when firing position, some nail 10030, comprises and is positioned in nailThe nail 10030 of the far-end in storehouse 14400, top surface that can Tu Chuan tissue thickness compensating part 1442014421。

In various embodiments, as mentioned above, tissue thickness's compensating part can be made up of single material, itsIn whole tissue thickness compensating part can there is from start to finish identical or at least substantially the same material spyProperty, such as density, rigidity, flexible ratio, hardness and/or elasticity. At various other embodimentIn, referring now to Figure 36 8, tissue thickness's compensating part for example can such as tissue thickness's compensating part 14520Comprise multiple material or material layer. In at least one embodiment, tissue thickness's compensating part 14520 canComprise first or central stratum 14520a, on its opposite side, be attached to ground floor 14520a second orIntermediate layer 14520b and be attached in second layer 14520b each the 3rd or outer14520c. In certain embodiments, can utilize at least one adhesive that intermediate layer 14520b is attached toCentral stratum 14520a, and similarly, can use at least one adhesive by attached outer 14520cTo the second layer 14520. Except adhesive or replace adhesive, for example can be by one or moreInterlocking structure and/or securing member keep together layer 14520a-14520c. Under any circumstance, inLayer 14520a for example can be made up of first material with first group of material behavior; Intermediate layer 14520bCan be formed by second material with second group of material behavior; And outer 14520c can be by having the 3rdThe 3rd material of group material behavior forms. These several groups of material behaviors for example can comprise density, rigidity, bulletSex rate, hardness and/or elasticity. In certain embodiments, nail bin for example can comprise six nails10030, wherein a nail 10030 for example can be at least partly positioned at each in outer 14520cIn each in person and in internal layer 14520b, and wherein two nails 10030 can be at least by partBe positioned in internal layer 14520a. In use, be similar to mentioned abovely, nail 10030 can be penetrated from nail binGo out, make the top surface of the nail leg 10032 penetrate tissue thickness compensation parts 14520 of following closely 1003014521, penetrate by anvil block against top surface 14521 and the tissue of location, and contact subsequently anvil block,Make leg 10032 be out of shape to catch tissue thickness's compensating part 14520 and the tissue in nail 10030. AlsoBe similar to mentioned above, in the time that firing member is pushed into through nail bin, tissue thickness's compensating part 14520Can be by firing member crosscut. In at least one this type of embodiment, firing member for example can be along by axis14529 passage crosscut internal layer 14520a and the tissues that limit.

In various embodiments, to being above described further, be positioned in internal layer 14520aMany nails 10030 can comprise the nail row at the edge of the most approaching tissue being crosscut. Correspondingly, be positioned atThe edge that many nails 10030 in outer 14520c can comprise the tissue that distance is crosscut nail farthestRow. In certain embodiments, the first material that comprises internal layer 14520a for example can comprise as lower density:This density is higher than the density of the second material that comprises intermediate layer 14520b; And similarly, the second materialDensity can be higher than the density of the 3rd material that comprises outer 14520c. In all cases, therefore,Compared to the compression that is positioned in the nail 10030 interior generations in intermediate layer 14520b and outer 14520cPower, larger compression stress can be in the interior generation of nail 10030 being located in internal layer 14520a. PhaseLike, compared to the compression stress that is positioned in the nail 10030 interior generations in outer 14520c, moreLarge compression stress can be in the interior generation of nail 10030 being located in the 14520b of intermediate layer. Supply variousIn the embodiment selecting, comprise that the first material of internal layer 14520a for example can comprise as lower density: this is closeDegree is lower than the density of the second material that comprises intermediate layer 14520b; And similarly, the second material is closeDegree can be lower than the density of the 3rd material that comprises outer 14520c. In all cases, therefore, compareThe compression stress of the nail 10030 interior generations in being positioned in intermediate layer 14520b and internal layer 14520a andSpeech, larger compression stress can be in the interior generation of nail 10030 being located in outer 14520c. SimilarGround is compared to the compression stress that is positioned in the nail 10030 interior generations in internal layer 14520a, largerCompression stress can be in the interior generation of nail 10030 being located in the 14520b of intermediate layer. In various other realitiesExecute in example, can use layer, material and/or the material behavior of any other suitable constructions. In any feelingsUnder condition, in various embodiments, the layer 14520a-14520c of tissue thickness's compensating part 14520 canBe attached to one another in its implanted rear maintenance. In some other embodiment, tissue thickness's compensating part14520 layer 14520a-14520c can be separated from one another in its implanted rear maintenance. At at least one thisIn class embodiment, layer 14520a-14520c can utilize the adhesive knot that one or more can bio-absorbableBe combined together, these one or more can bio-absorbable adhesive can first layer be remained to together, soAfter in time pass make layer from each other discharge.

As mentioned above, tissue thickness's compensating part of nail bin for example can such as tissue thickness's compensating part 14520Comprise multiple longitudinal layers. In various other embodiment, referring now to Figure 36 9, nail bin can comprise groupKnit thickness compensation part such as tissue thickness's compensating part 14620, this tissue thickness's compensating part for example can compriseMultiple level courses. In at least one this type of embodiment, tissue thickness's compensating part 14620 can compriseOne or bottom 14620a, be attached to second or the intermediate layer 14620b and attached of bottom 14620aTo the 3rd or the top layer 14620c of intermediate layer 14620b. In various embodiments, ground floor 14620aFor example can comprise smooth or smooth lower surface 14626a and the top of triangle or taper substantiallyThe surface 14625a of portion. In at least one this type of embodiment, second layer 14620b can comprise triangleOr the lower surface 14626b of taper, this lower surface can be parallel to and in abutting connection with ground floor 14620a'sTop surface 14625a. Be similar to mentioned abovely, second layer 14620b can comprise triangle or taperTop surface 14625b, this top surface for example can be parallel to and in abutting connection with the end of the 3rd layer of 14620cThe lower surface 14626c of portion's triangle or taper. In various embodiments, the 3rd layer of 14626cTop surface can comprise smooth or smooth tissue contacting surface 14621 at least substantially. Also similarIn mentioned above, tissue thickness's compensating part 14620 for example can store six rows therein at least in partNail is such as nail 10030, and wherein firing member for example can be along the passage crosscut that extends through axis 14629Two tissue thickness's compensating parts 14620 between the nail row of inner side. Be similar to mentioned above, eachLayer 14620a, 14620b, and 14620c can be made up of the different materials that comprises dissimilar material properties, andAnd due to triangle or the conical configuration of layer 14620a-14620c, tissue thickness's compensating part 14620 canEach position has different overall characteristic therein. For example, outermost many nails 10030 canMore the 3rd layer of 14620c of capture ratio ground floor 14620a therein, and the most nails of inner side10030 can capture ratio ground floor 14620a the 3rd layer of 14620c still less. Therefore, although tissue thicknessCompensating part 14620 can have the identical or at least substantially the same general thickness across it, stillTissue thickness's compensating part 14620 for example can be trapped in inner side nail 10030 to be different from compressionThe mode of tissue compress the tissue being trapped in outermost nail 10030.

In various embodiments, referring now to Figure 28 6, tissue thickness's compensating part of nail bin, such as nailTissue thickness's compensating part 14720 in storehouse 14700, for example can comprise be limited to wherein make organize thickSpace, pit, passage and/or groove that the thickness of degree compensating part 14720 changes. At leastIn this type of embodiment, tissue thickness's compensating part 14720 can be against the support section of nail bin 1470014710 platform surface 14711 is located, and makes to be limited to the bottom of tissue thickness's compensating part 14720Space 14723 in surface 14722 can overlay on some nail chamber 10012 above instead of other nail chambeiesOn. In various embodiments, space 14723 can be transverse to the cutter slit to support section 1471014715, perpendicular to cutter slit 14715 and/or be parallel to cutter slit 14715 and extend. Real at someExecute in example, space 14723 can limit in the lower surface of tissue thickness's compensating part 14,720 14722Bearing-surface pattern. Under any circumstance, when nail is such as following closely 10030 for example from support section 14710 quiltsWhen deployment, referring now to Figure 28 7 and 288, some nail 10030 can be in the district that comprises space 14723Territory IT tissue thickness compensating part 14720; And other nails 10030 can be located in space 14723Middle region IT tissue thickness compensating part 14720. Except mentioned above or replace aboveDescribed, tissue thickness's compensating part 14720 for example can comprise and is limited to top or tissue contacting surfaceSpace, pit, passage and/or groove in 14721. In certain embodiments, referring now to figure366 and Figure 36 7, nail bin 14800 can comprise tissue thickness's compensating part 14820, this tissue thickness's compensationPart can comprise multiple bearing-surfaces 14823, and the plurality of bearing-surface is for example at least one in following situationKind: from the top surface 14821 of tissue thickness's compensating part 14820 upwards extend, towards central groove14825 extend internally and/or extend towards distally towards the far-end of nail bin 14800. At at least one this type ofIn embodiment, bearing-surface 14823 for example can be by passage, slit and/or groove such as passage 14824Separately. In all cases, due to mentioned above, the general thickness of tissue thickness's compensating part can be at nailBetween row, between variation and/or the nail in nail row, change. In some cases, bearing-surface or thick portionDivide and can be constructed to and be arranged so that in the time that tissue thickness's compensating part is compressed, bearing-surface or thick portionDividing can be along the direction of expecting such as inwardly flowing.

In various embodiments, referring now to Figure 30 3, nail bin such as nail bin 14900 for example can compriseSupport section 14910 and the tissue thickness's compensation being in addition positioned against support section 14910Part 14920. Be similar to mentioned above, support section 14910 can comprise can by nail dispose sliding part toOn the staple drivers that lifts, to lift nail such as nail 10030, this nail is for example towards anvil block, such asBe positioned in the anvil block 10060 on nail bin 14900 opposites and be at least partly positioned at support sectionIn 14910. In certain embodiments, support section 14910 can comprise six row nail chambeies, such as outsideTwo nail chambeies of side, two nail chambeies of inner side and be positioned at inboard row and outboard row in the middle of centreTwo nail chambeies. Wherein anvil block 10060 can comprise and aliging with nail chamber or six lining up of substantial alignment at leastShape pit 10062. In various embodiments, inner side nail chamber row can comprise that the nail being positioned at wherein drivesDevice 14940a; Middle nail chamber row can comprise the staple drivers 14940b being positioned at wherein; And outside nailChamber row can comprise the staple drivers 14940c being positioned at wherein. Wherein every in staple drivers 14940aOne can comprise can support nail 10030 support 14949a; Wherein in staple drivers 14940bEach can comprise support 14949b that can support nail 10030; And wherein staple drivers 14940cIn each can comprise can support nail 10030 support 14949c. At its firing position place not,, when staple drivers 14940a-14940c is placed in the driving extending to below support section 14910On device support member 14926 time, than support 14949b and the staple drivers of staple drivers 14940bThe support 14949c of 14940c, the support 14949a of staple drivers 14940a can more close anvil block10060 location. In this type of position, first is shaped apart from can being limited at support 14949a and being positioned atBetween shaping pit 10062 on support 14949a; Second is shaped apart from being limited at support14949b and being positioned between the shaping pit 10062 on support 14949b; And the 3rd is shapedDistance can be limited at support 14949c and be positioned at the shaping pit 10062 on support 14949cBetween. Wherein, in various embodiments, for example first is shaped apart from being shorter than the second shaping distance,And second is shaped apart from being shorter than the 3rd moulding distance. When staple drivers 14940a-14940c is from itWhen firing position (Figure 30 3) does not move to its firing position, each staple drivers 14940a-14940cCan be disposed sliding part towards the anvil block 10060 equal or equal distance at least substantially that moves upward by nailFrom, make the first driver 14940a that its nail 10030 is separately driven to the first forming height; SecondIts nail 10030 is separately driven the second forming height by driver 14940b; And the 3rd driverIts nail 10030 is separately driven the 3rd forming height by 14940c. Wherein, for example the first forming heightCan be shorter than the second forming height, and the second forming height can be shorter than the 3rd forming height. Imagine eachPlant other embodiment, wherein the first staple drivers 14940a is by upward displacement the first distance; The second nail drivesMoving device 14940b is by upward displacement second distance, and the 3rd staple drivers 14940c is by upward displacementThe 3rd distance. Wherein, one or more in the first distance, second distance, the 3rd distance can be notWith.

In various embodiments, refer again to Figure 30 3, with respect to the tissue contact table of anvil block 10060Face 10061, the platform surface 14911 of support section 14910 can in height change to some extent. At certainIn a little embodiment, this height change can produce in side direction, and at least one embodiment, exampleAs the height of the platform surface 14911 around nail chamber, inner side row can be higher than the platform around nail chamber, outside rowThe height on surface 14911. In various embodiments, the lower surface of tissue thickness's compensating part 1492014922 can be parallel to or at least substantially parallel to the platform surface 14911 of support section 14910. RightAbove be described further, tissue thickness's compensating part 14920 also can change to some extent on thickness. ItsIn, at least one embodiment, the top of tissue thickness's compensating part 14920 or tissue contacting surface14921 can slope inwardly from its outward flange or lateral edge. In at least one this type of embodiment, byIn mentioned above, tissue thickness's compensating part 14920 can be in the region being located on the row of nail chamber, inner sideInside thinner, and thicker in the region on the row of nail chamber outside being located in. At various embodimentIn, referring now to Figure 30 4, the platform surface of support section 15010 for example can comprise staged platformSurface, wherein the highest step on staged surface can be arranged around nail chamber, inner side, and staged surfaceMinimum step can be arranged around nail chamber, outside. In at least one this type of embodiment, there is intermediate altitudeStep can be arranged around nail chamber, centre. In certain embodiments, tissue thickness's compensating part is such as tissue thicknessCompensating part 15020 for example can comprise lower surface, and this lower surface is parallel to and in abutting connection with support section15010 platform surface. In at least one embodiment, the top of tissue thickness's compensating part or tissueContact surface 15021 for example can comprise arc, parabolical and/or curved surface, at leastIn this type of embodiment, this surface can be extended from the first cross side of tissue thickness's compensating part 15020To the second cross side of tissue thickness's compensating part 15020, the wherein center pair of summit and nail bin 15000Together or at least substantial alignment. In various embodiments, referring now to Figure 29 9, nail bin 15300 examplesAs comprised support section 15310, be positioned at the nail being defined in support section 15310 movinglyMultiple staple drivers 15340 in chamber and be positioned at the platform surface 15311 of support section 15310Tissue thickness's compensating part 15320 of top. Nail bin 15300 also can comprise one or more bottom plate portionDivide 15326, this bottom plate part can be attached to support section 15310 and extend to support section 15310Bottom periphery, and supporting driver 15340 and in its nail 15330 of firing position not. Work as nailWhen deployment sliding part is pushed into through nail bin, along with sliding part is by staple drivers 15340 and nail 15330Upwards lift through tissue thickness's compensating part 15320, sliding part also can be by 15326 of bottom plate partsSupport. In at least one embodiment, tissue thickness's compensating part 15320 can comprise that being positioned at inner side follows closely chamberOn row first or inner 15322a, be positioned in the middle of second or mid portion on nail chamber row15322b and be positioned at the 3rd or outside 15322c on a nail chamber. Wherein, for example inner15322a can be thicker than mid portion 15322b, and mid portion 15322b can be thicker than outside15322c. In at least one embodiment, tissue thickness's compensating part 15320 for example can comprise and being limited toVertical passage wherein, this vertical passage can produce the thinner part of tissue thickness's compensating part 1532015322b and 15322c. In various alternative embodiment, vertical passage can be limited at tissueIn the top surface and/or lower surface of thickness compensation part. In at least one embodiment, tissue thicknessThe top surface 15321 of compensating part 15320 for example can comprise smooth or smooth table at least substantiallyFace.

In various embodiments, referring now to Figure 29 6, nail bin for example can comprise tissue thickness's compensating partSuch as tissue thickness's compensating part 15120, this tissue thickness's compensating part can comprise having the many of different-thicknessIndividual part. In at least one embodiment, tissue thickness's compensating part 15120 can comprise have first thickFirst or inner 15122a of degree, extend from Part I 15122a there is the of the second thicknessTwo or mid portion 15122b and extend from Part II 15122b there is the 3rd thicknessThe 3rd or outside 15122c. In at least one this type of embodiment, for example the 3rd thickness can be thicker than secondThickness, and the second thickness can be thicker than the first thickness, but in various other embodiment, can use anySuitable thickness. In various embodiments, the part 15122a-of tissue thickness's compensating part 1512015122c can comprise the step with different-thickness. In at least one embodiment, be similar to institute aboveState, nail bin can comprise many nails 10030 and have multiple staple drivers of differing heights, this nail drivingDevice can make to follow closely 10030 and be deformed into different forming heights. Also be similar to mentioned abovely, nail bin can compriseThe first staple drivers 15140a, its can drive nail 10030 to first forming heights thereon of support,The second staple drivers 15140b, its can drive nail 10030 to second forming heights thereon of support,And the 3rd staple drivers, it can drive support nail 10030 thereon to the 3rd forming height. ItsIn, for example the first forming height can be shorter than the second forming height, and the second forming height can be shorter thanThree forming heights. In various embodiments, as shown in Figure 29 6, each nail 10030 can comprise identicalOr substantially the same unshaped or percussion height. In some other embodiment, referring now toFigure 29 6A, the first driver 15140a, the second driver 15140b and/or the 3rd driver15140c can support the nail with different unshaped height. In at least one this type of embodiment, firstStaple drivers 15140a can support the nail 15130a with the first unshaped height, the second staple drivers15140b can support the nail 15130b with the second unshaped height, and the 3rd staple drivers15140c can support the nail 15130c with the 3rd unshaped height. Wherein, for example the first unshaped is highDegree can be shorter than the second unshaped height, and the second unshaped height can be shorter than the 3rd unshaped height.In various embodiments, refer again to Figure 29 6A, nail 15130a, the end of 15130b and/or 15130cEnd can be arranged in or at least be located substantially on identical plane, and in other embodiments, nail 15130a,The end of 15130b and/or 15130c can not be arranged in identical plane. In certain embodiments, existingReferring to Figure 29 7, nail bin can comprise tissue thickness's compensating part 15220 with multiple parts, and these are manyIndividual part has different thickness, this tissue thickness's compensating part can by nail 15130a, 15130b and15130c is implanted against tissue T, as mentioned above. In at least one embodiment, referring now toFigure 29 8, nail 15130a, 15130b and/or 15130c can be deformed to different forming heights. WhereinOne nail 15130a can be deformed to the first forming height, and it is high that the second nail 15130b can be deformed to the second shapingDegree, and the 3rd nail 15130c can be deformed to the 3rd forming height, and the first forming height example whereinAs being shorter than the second forming height, and the second forming height can be shorter than the 3rd forming height. ImagineOther embodiment, wherein follow closely 15130a, and it is high that 15130b and 15130c can be configured as any suitable shapingDegree and/or any relative forming height.

In various embodiments, as mentioned above, the anvil block of surgery suturing appliance can and close at open positionCo-bit is moved between putting. In such cases, in the time that anvil block moves to its closing position, the group of anvil blockKnit contact surface and be moveable to its final or shaping position. Once anvil block is in its closing position,In some embodiment, tissue contacting surface can be no longer adjustable. In some other embodiment,Referring now to Figure 35 1,, surgical stapling device such as surgical stapling device 15500 for example can comprise anvil channel15560 and be positioned at adjustable tissue in anvil channel 15560 contact anvil block adjustable plate 15561.In this type of embodiment, anvil block plate 15561 can be raised and/or reduce in anvil channel 15560,To regulate the tissue of anvil block plate 15561 to connect with respect to the nail bin that is positioned at anvil block plate 15561 oppositesTouch surperficial position. In various embodiments, surgical stapling device 15500 can comprise adjusting slider15564. Referring to Figure 35 6 and Figure 35 7, this adjusting slider can be at anvil channel 15560 and anvil block plateIn the middle of 15561, slide, to control the distance between anvil block plate 15561 and nail bin. In some enforcementIn example, refer again to Figure 35 1 and Figure 35 2, surgical stapling device 15500 also can comprise and be attached to adjustingThe actuator 15562 of slide block 15564, this actuator can slide to make adjusting slider 15564 towards nearsideSlide and/or slide to adjusting slider 15564 is slided towards distally towards distally towards nearside. VariousIn embodiment, refer again to Figure 35 6 and Figure 35 7, actuator 15562 can be pre-at two or moreBetween allocation, slide, to regulate respectively anvil block plate 15561 between two or more positions.In at least one embodiment, this type of precalculated position for example can be divided on surgical stapling device 15500For line of demarcation 15563(Figure 35 1). In certain embodiments, referring to Figure 35 7, adjusting slider15564 for example can comprise multiple stayed surfaces, support table such as the first stayed surface 15565a, secondFace 15565b and the 3rd stayed surface 15565c, the plurality of stayed surface can be respectively and anvil block plate 15561The back side on the alignment of multiple plate locating surfaces, such as the first locating surface 15569a, the second navigation watchFace 15569b and the 3rd locating surface 15569c, to be positioned at first by anvil block plate 15561Put. For anvil block plate 15561 is positioned in the second place, actuator 15562 and slide block 15564For example can slide towards nearside, so as by the stayed surface 15565a-15565c of slide block 15564 with respect toThe locating surface 15569a-15569c of anvil block plate 15561 aligns again. More specifically, referring to figure356, slide block 15564 can slide towards distally, makes the first stayed surface 15565a of slide block 15564Can be positioned in after the second locating surface 15569b of anvil block plate 15561, and make slide blockThe second stayed surface 15565b of 15564 can be positioned in the 3rd locating surface of anvil block plate 15561After 15569c, to anvil block plate 15561 is moved to more close nail bin. When anvil block plate 15561 fromWhen its primary importance moves to its second place, in such cases, adjustable anvil block plate 15561 canThe further tissue T of compression set between anvil block plate 15561 and nail bin. Except mentioned above itOutward, the shaping pit that is conditioned and is limited in anvil block plate 15561 when anvil block plate 15561 will moveTo more close and/or during further from nail bin, the forming height of nail can be by anvil block plate 15561 with respect to nail binPosition control. Although only described two positions above, slide block 15564 is slidably to closingIn the position of suitable quantity, more close and/or further from nail bin so that anvil block plate 15561 is moved to. In officeIn what situation, once anvil block plate 15561 has been properly oriented, nail is disposed sliding part 15550 can be at nailSlide in Nei Chao distally, storehouse, to staple drivers 15540 and nail 15530 are lifted towards anvil block plate 15561Rise and suture tissue T, as shown in Figure 35 4. Similar surgical stapling device is disclosed in February 28 in 2011The name of submitting to day is called the United States Patent (USP) Shen of " SURGICALSTAPLINGINSTRUMENT "Please sequence number 13/036,647, its whole disclosures are incorporated herein by reference.

In various embodiments, referring now to Figure 35 3, nail bin can be positioned in surgical stapling deviceIn 15500 nail bin passage 15570, this nail bin passage for example can comprise tissue thickness's compensating part, allAs tissue thickness's compensating part 15520. In the time that anvil block plate 15561 moves towards nail bin, as mentioned above, anvilThe compressible tissue thickness of seat board 15561 compensating part 15520 and/or be positioned at anvil block plate 15561 and tissueTissue T in the middle of thickness compensation part 15520. In the time that nail 15530 is deployed from nail bin, referring to figure355, nail 15530 can be against tissue T compression implanting tissue thickness compensation part 15520. In various realitiesExecute in example, locate and organize against slide block 15564 when anvil block plate 15561 and be not also placed in anvil block plate15561 and tissue thickness's compensating part 15520 between time, can work as anvil block plate 15561 in its firstWhile putting, between anvil block plate 15561 and the top surface 15521 of tissue thickness's compensating part 15520, limitGap. In the time that anvil block plate 15561 moves to the second place, anvil block plate 15561 can contact tissue thicknessCompensating part 15520. In various alternative embodiment, when anvil block plate 15561 is against slide block15564 location and organizing be not also placed in anvil block plate 15561 and tissue thickness's compensating part 15520 itBetween time, can work as anvil block plate 15561 in the time of its primary importance and/or the second place at anvil block plate 15561And limit gap between the top surface 15521 of tissue thickness's compensating part 15520. At at least one thisIn class embodiment, anvil block plate 15561 can be not contact with tissue thickness compensating part 15520. OtherIn alternative embodiment, when anvil block plate 15561 is located and organizes also not against slide block 15564While being placed between anvil block plate 15561 and tissue thickness's compensating part 15520, anvil block plate 15561 for exampleCan contact with the top surface 15521 of tissue thickness compensating part 15520, no matter and anvil block plate 15561Whether in primary importance and/or the second place. Although two of only having described anvil block plate 15611 hereinPosition, anvil block plate 15611 can be positioned or index in the position of any suitable quantity.

In various embodiments, due to mentioned above, surgery suturing appliance can comprise for regulating nailThe device of forming height, this device can compensate different tissue thicknesses in all cases. In addition, outerSection's suture instruments for example can comprise for compensating different tissue thicknesses and/or in-house varied in thicknessDevice. In at least one this type of embodiment, anvil block plate 15561 can upwards be regulated or is adjusted to farFrom relative nail bin, to increase shaping or the percussion height of nail. Correspondingly, anvil block plate 15561 can quiltRegulate downwards or towards relative nail bin, to reduce shaping or the percussion height of nail. At various embodimentIn, to for example adjustable shaping pit being limited in anvil block plate 15561 of the adjusting of anvil block plate 15561Between gap and the percussion height of staple drivers or for example staple drivers support more specificallyPercussion height. Even have regulating nail forming height this type of ability be for example responsible for process thicker and/Or thinner tissue, tissue thickness's compensating part also can the thick and/or thinner tissue of compensate for slower, and/or mendsRepay in-house varied in thickness, as mentioned above. In this type of embodiment, can be at same surgical staplingIn apparatus for surgeon provides multiple compensation arrangements.

As mentioned above and as shown in multiple embodiment, surgery suturing appliance can use nail bin, this nail bin toolHave nail chamber and the nail of linear arrangement, wherein firing member can be pushed into towards distally through nail bin with from nail chamberDispose nail. In certain embodiments, nail bin can comprise bending nail chamber and nail row. Real at least oneExecute in example, referring now to Figure 34 5 and Figure 34 6, surgery suturing appliance such as stitching unstrument 15600 for exampleCan comprise the one or more circles or the ring-shaped staple chamber that are limited in circle or annular brace part 15610Row. This type of circular staple row for example can comprise 15612 row and circular nail chambeies, outside, circular nail chamber, inner side15613 rows. In at least one this type of embodiment, circular nail chamber row can be around being limited to stitching unstrumentCircle in 15600 or looping pit 15615, this hole can hold be positioned at removedly wherein circular orEndless knife. In use, tissue can be located against the platform surface of support section 15,610 15611,And anvil block (not shown) can be by extending through and/or be positioned at the actuator assembling in hole 15615To surgical stapling device 15600, make in the time that actuator activated, anvil block can be towards support section 15610Clamped, and against platform surface 15611 compress tissues. Fully compressed once organize, fixedThe nail of position in nail chamber 15612 and 15613 can penetrate and pass tissue from support section 15610, makesMust follow closely and can contact anvil block and fully be out of shape to catch tissue wherein. When nail is just being pulled the trigger and/or working as nailAfter percussion, circular knife can be pushed into transecting patient tissue. Then, anvil block is movable away from support portionPoints 15610 and/or separate with surgical stapling device 15600, make anvil block and the surgical stapling device 15600 canBe removed from operative site. This type of surgical stapling device 15600 and this type of surgical technic are at various embodimentIn can be utilized, for example to connect two parts of large intestine. In all cases, circular staple row can beIn the situation of organization healing, multiple parts of large intestine are kept together, and meanwhile make the many of large intestineIndividual part elastic stretch. Similar surgery suturing appliance and surgical technic are disclosed in February 15 in 1994The name of submitting to day is called " SURGICALANASTOMOSISSTAPLINGINSTRUMENT " United States Patent (USP) 5,285,945 in, its whole disclosures are with way of reference alsoEnter herein.

In various embodiments, to being above described further, tissue thickness's compensating part for example can supportSurgical stapling device 15600 is located and/or be attached to support section 15610 by surgical stapling device 15600Support section 15610. In at least one embodiment, tissue thickness's compensating part can be by circle ringShape rings of material forms, and this rings of material for example comprises inside radius and outer radius. In some cases, tissueCan locate against this rings of material, and in the time that anvil block is used for tissue to move towards support section 15610,Tissue thickness's compensating part can be compressed between tissue and platform surface 15611. During use, nailCan be by percussion through tissue thickness's compensating part and tissue, make nail joint touch anvil block and be deformed into its percussion positionPut, so that the part of tissue and tissue thickness's compensating part is captured in nail. In all cases, to upperLiterary composition is described further, and comprises that the rings of material of tissue thickness's compensating part must be enough with resilience, withMake around multiple parts stretching, extensions of the large intestine of nail row. In various embodiments, refer again to Figure 34 5 HesFigure 34 6, flexible tissue thickness's compensating part 15620 for example can comprise the interior ring of the flexibility of circle or annular15624, this interior ring can limit circle or looping pit 15625 at least one embodiment. Real at someExecute in example, interior ring 15624 can be constructed to make it not to be trapped in from surgical stapling device 15600 to disposeNail in; On the contrary, at least one embodiment, interior ring 15624 can be with respect to nail chamber, inner side15612 rows radially inwardly locate. In at least one this type of embodiment, tissue thickness's compensating part 15620Can comprise for example multiple attachments from its extension, such as interior attachment 15622 and outer attachment15623, attachment in the time of nail distortion can be at least partly captured in nail. More specifically, headFirst, referring to Figure 34 5, each interior attachment 15622 can comprise as head portion: this head is positioned in limitOn nail chamber 15612 in surgical stapling device 15600, wherein head for example can pass through neck15626 are attached to interior ring 15624; And similarly each outer attachment 15623 can comprise as followingPortion: this head is positioned on the nail chamber 15613 being defined in surgical stapling device 15600, whereinHead for example can be attached to interior ring 15624 by neck 15627. In various embodiments, interior attachedThe head of part 15622 and outer attachment 15623 for example can comprise any suitable shape, such as circleShape, avette and/or oval. Neck 15626 and/or 15627 also can comprise any suitable shape,Wherein at least one embodiment, the head of outer attachment 15623 is connected to interior ring 15624Neck 15627 can extend between the adjacent nail chamber, inner side 15612 in support section 15610,Neck 15627 is not trapped in the nail of disposing from nail chamber, inner side 15612.

In various embodiments, referring now to Figure 34 7 and Figure 34 8, flexible tissue thickness's compensating part15720 for example can comprise flexible outer shroud 15724 circular or annular. In certain embodiments, outer shroud15724 can be constructed to make it not to be trapped in the nail of disposing from surgical stapling device 15600; AndThat at least one embodiment, outer shroud 15724 can be arranged radially with respect to nail chamber, outside 15613To outside fix. In at least one this type of embodiment, tissue thickness's compensating part 15720 for example can compriseFrom multiple attachments of its extension, such as interior attachment 15622 and outer attachment 15623, make to work asWhen nail distortion, attachment can be at least partly captured in nail. More specifically, first referring to Figure 34 7,Each interior attachment 15622 can comprise as head portion: this head is positioned in and is defined in surgical stapling deviceOn nail chamber 15612 in 15600, wherein head for example can be attached to outer shroud by neck 1572615724; And similarly each outer attachment 15623 can comprise as head portion: this head is positioned inBe defined on the nail chamber 15613 in surgical stapling device 15600, wherein head for example can pass through neck15727 are attached to outer shroud 15724. In various embodiments, interior attachment 15622 and outer attachment15623 head for example can comprise any suitable shape, such as circular, avette and/or oval.Neck 15726 and/or 15727 also can comprise any suitable shape, wherein at least one embodimentIn, the neck 15727 that the head of interior attachment 15622 is connected to outer shroud 15724 can be adjacentNail chamber, outside 15613 between extend, neck 15726 is not trapped in from nail chamber, outsideIn 15613 nails of disposing. In some alternative embodiment, tissue thickness's compensating part can compriseRing in circular or annular flexibility, circular or annular flexible outer shroud and in addition can be connected toMultiple attachments of interior ring and/or outer shroud. In at least one embodiment, some attachment can be connected toInterior ring, and some other attachment can be connected to outer shroud. In certain embodiments, in attachmentAt least some can be connected to interior ring and outer shroud. Under any circumstance, to above further retouchingState the interior ring 15624 of tissue thickness's compensating part 15620, the outer shroud of tissue thickness's compensating part 1572015724 and/or any other suitable tissue thickness's compensating part can elastic stretch and/or contraction, withJust adapt to stretching, extension and/or the contraction of tissue, this tissue thickness's compensating part is implanted against this tissue. ThisAlthough various embodiment is described to comprise circle or annular brace ring herein, organize thick outward,Degree compensating part can comprise the supporting construction for attachment being connected to its any suitable shape. RespectivelyIn kind of embodiment, to being above described further, advanced with to being trapped in anvil by surgical stapling deviceThe circular knife that tissue between seat and support section cuts also can be cut backing material. At least oneIn individual this type of embodiment, the neck that cutter can for example can pass through cutting attachment is by inside support ring and attachmentSeparately.

In various embodiments, to being above described further, tissue thickness's compensating part can comprise canThat separate and/or relatively movable position, this position can make tissue thickness compensating part stretch and/orShrink, to adapt to the motion of tissue, this tissue thickness's compensating part is implanted against this tissue. ExistingReferring to Figure 34 9 and Figure 35 0, when tissue thickness's compensating part 15820 is just against organizing when implanted,Circular or annular tissue thickness's compensating part 15820 can be against being maintained at not extended position (figure349) platform surface 15611 of surgical stapling device 15600 is located, and/or by being maintained at notThe platform surface 15611 of the surgical stapling device 15600 of extended position supports; When tissue thickness's compensating part15820 implanted after, tissue thickness's compensating part 15820 can outwards stretch, as 0 of Figure 35Show. In various embodiments, tissue thickness's compensating part 15820 can comprise multiple arcuate sections15822, the plurality of arcuate section for example can be joined together by interior ring 15824. At at least oneIn embodiment, arcuate section 15822 can be separated from each other by seam 15828. At at least one, other are realExecute in example, arcuate section 15822 can be connected to each other, wherein at least one this type of embodiment, and holeStructure can make arcuate section 15822 be separated from each other. In either case, at various embodimentIn, arcuate section 15822 for example can comprise interlocking structure, such as protuberance 15826 and recess15823, this interlocking structure can cooperate arc to limit before tissue thickness's compensating part 15820 is implantedRelative motion between part 15822. To being above described further, each arcuate section15822 for example can be connected to interior ring 15824 by one or more connectors 15827, this one or manyIndividual connector can be held in place arcuate section 15822 releasedly. When using nail for example to storeNail 10030 in support section 15610 is against organizing implanting tissue thickness compensation part 15620After, first referring to Figure 35 0, connector 15827 can separate with interior ring 15824, and makes tissue thicknessCompensating part 15820 stretches at least partly to adapt to in-house motion below. In all cases,All arcuate sections 15822 can separate with interior ring 15824, and in other cases, arcuate sectionMore only can separate with interior ring 15824 in 15822. In some alternative embodiment, bowShape part 15822 can be connected by flexible portion, this flexible portion can make arcuate section 15822 with respect toEach other motion but not separated from one another. In at least one this type of embodiment, flexible portion can be not thereinHold nail, and can stretch and/or shrink the relative motion to adapt to arcuate section 15822. At figure349 and Figure 35 0 shown in embodiment in, tissue thickness's compensating part 15820 for example can comprise eight bowsShape part 15822. In some other embodiment, tissue thickness's compensating part for example can comprise any closingThe arcuate section of suitable quantity, such as two or more arcuate sections.

To being above described further, tissue thickness's compensating part 15620,15720 and/or 15820 examplesIf compensation is trapped in thicker between anvil block and the support section 15610 of surgical instruments 15600And/or thinner tissue. In various embodiments, be similar to mentioned above, can by towards and/orCome shaping or the percussion height of regulating nail away from support section 15610 motion anvil blocks. More specifically, anvilSeat is moveable to more close support section 15610 to reduce the forming height of nail, and correspondingly, anvil blockCan further be moved to away from support section 15610 to increase the forming height of nail. In this type of enforcementIn example, therefore, surgeon can be adjusted to anvil block away from support section 15610 thick to be responsible for processingTissue, and be adjusted to towards support section 15610 to be responsible for processing thin tissue. In various other realitiesExecute in example, surgeon can determine not regulate anvil block, and relies on tissue thickness's compensating part to be responsible for processingThinner and/or thicker tissue. In various embodiments, therefore, surgical instruments 15600 can comprise toFew two devices change for compensating different tissue thicknesses and/or tissue thickness.

In various embodiments, as mentioned above, tissue thickness's compensating part can be attached to the support portion of nail binPoint. In certain embodiments, the lower surface of tissue thickness's compensating part can comprise in hook layer or cover circular layerOne, and the platform surface of support section can comprise hook layer and the another one of cover in circular layer. At leastIn this type of embodiment, hook and the collar can be engaged with each other and by tissue thickness's compensating part releasedlyRemain to support section. In various embodiments, each hook for example can comprise the expansion of extending from neckHead. In certain embodiments, the multiple pads that comprise the collar for example can be adhered to tissue thickness's compensationThe lower surface of part, and comprise that multiple pads of hook can be adhered to the platform surface of support section. At leastIn an embodiment, support section for example can comprise one or more holes and/or groove, this one or manyIndividual hole and/or groove can hold the insert that comprises hook and/or the collar therein. Except mentioned aboveOutside or replace mentioned abovely, tissue thickness's compensating part for example can use this type of hook and the collar to be movedRemove and be installed to anvil block. In various embodiments, hook and the collar for example can comprise fiber surface.

In various embodiments, as mentioned above, nail bin can comprise support section and be attached to support sectionTissue thickness's compensating part. In certain embodiments, also as mentioned above, support section can comprise canHold therein longitudinal slit of cutting element, and tissue thickness's compensating part can comprise and can be maintained atThe longitudinally retaining member in slit. In at least one embodiment, referring now to Figure 38 6, nail bin16000 can comprise support section 16010, and this support section comprises platform surface 16011 and longitudinal slit16015. Nail bin 16000 also can comprise the tissue thickness's compensating part that is positioned at platform surface 16011 tops16020. In various embodiments, tissue thickness's compensating part 16020 can comprise extend downwardly into longitudinally narrowLongitudinal retaining member 16025 in groove 16015. In at least one this type of embodiment, retaining member16025 can be pressed down in slit 16015, make between retaining member 16025 and slit 16015Interaction can resist the relative fortune between support section 16010 and tissue thickness's compensating part 16020Moving. In various embodiments, the main body of tissue thickness's compensating part 16020 can be made up of the first material,And retaining member 16025 can by second or different materials form. In certain embodiments, organize thickThe main body of degree compensating part 16020 can be made up of the material with the first hardness, and retaining member16025 can be made up of the material with the second hardness, and wherein the second hardness for example can be hard higher than firstDegree. In use, at least one embodiment, nail 10030 can be by staple drivers 10040 upwardsPromote, making to follow closely 10030 end can be through the main body of tissue thickness's compensating part 16020 and from tissueContact surface 16021 exposes, and at least one against target tissue capture tissue thickness compensation part 16020Part. In various embodiments, in the time that nail 10030 is just being deployed, through the cutting of slit 16015Member can crosscut retaining member 16025. Once tissue thickness's compensating part 16020 is implanted, respectivelyPlant in embodiment, retaining member 16025 is pulled out slit 16015. At some other embodimentIn, the main body of tissue thickness's compensating part 16020 can separate with retaining member 16025.

Referring now to Figure 38 7 and Figure 38 9,, nail bin 17000 can comprise support section 17010, thisSupport part is divided and is comprised platform surface 17011 and longitudinal slit 17015. Nail bin 17000 also can comprise locationTissue thickness's compensating part 17020 above platform surface 17011. In various embodiments, tissueThickness compensation part 17020 can comprise the longitudinal retaining member extending downwardly in longitudinal slit 1701517025. In at least one this type of embodiment, retaining member 17025 can be pressed down to slit 17015In, make the interaction between retaining member 17025 and slit 17015 can resist support section17010 and tissue thickness's compensating part 17020 between relative motion. In various embodiments, keepMember 17025 extensible through whole tissue thickness compensating part 17020 to its top surface 17021,Wherein the main part 17024 of tissue thickness's compensating part 17020 can be attached to retaining member 17025Opposite side. In at least one this type of embodiment, retaining member 17025 can also for example resist tissueThe lateral deflection of thickness compensation part 17020. In various embodiments, main part 17024 can be byOne material form, and retaining member 17025 can by second or different materials form. In some enforcementIn example, main part 17024 can be made up of the material with the first hardness, and retaining member17025 can be made up of the material with the second hardness, and wherein the second hardness for example can be hard higher than firstDegree. In various embodiments, to being above described further, in the time that nail 10030 is just being deployed,Cutting element through slit 17015 can crosscut retaining member 17025. Once tissue thickness's compensating part17020 is implanted, and in various embodiments, retaining member 17025 is pulled out slit 17015.In some other embodiment, main part 17024 can separate with retaining member 17025.

Referring now to Figure 38 8,, nail bin 18000 can comprise support section 18010, this support portion subpackageDraw together platform surface 18011 and longitudinal slit 18015. Nail bin 18000 also can comprise and is positioned at platform tableTissue thickness's compensating part 18020 of face 18011 tops. In various embodiments, tissue thickness's compensationPart 18020 can comprise the longitudinal retaining member 18025 extending downwardly in longitudinal slit 18015. ?In at least one this type of embodiment, retaining member 18025 can be pressed down in slit 18015, makesInteraction between retaining member 18025 and slit 18015 can be resisted support section 18010 and groupKnit the relative motion between thickness compensation part 18020. In various embodiments, retaining member 18025The extensible whole tissue thickness compensating part 18020 that passes, to its top surface 18021, is wherein organized thickThe main part 18024 of degree compensating part 18020 can be attached to the opposite side of retaining member 18025. ?In at least one embodiment, retaining member 18025 can comprise amplifier section 18026, this amplifier sectionCan be contained in the cavity 18016 being defined in slit 18015. At at least one this type of embodimentIn, amplifier section 18026 can resist retaining member 18025 and withdraw from from slit 18015.

Device disclosed in this invention can be designed to after single uses process, or can be by itBe designed to repeatedly to use. But in any situation, described device all can be repaired,To reuse after using at least one times. Again repair any combination that can comprise the steps: tear openUnload this device, then clean or replace some part and subsequently assembling. Particularly, described device canWith dismounting, and can be combined and optionally replace or remove specific zero of this device arbitrary numberPart or part. Clean and/or replace after specific part, this device can re-assembly at restoration facilities placeTo use subsequently, or carry out being re-assemblied by surgical team before operation being about to. AbilityThe technical staff in territory will know, the reparation of device can utilize multiple for dismounting, clean/displacement and heavyThe technology of new assembling. The use of these technology and the prosthetic device of gained are all in scope of the present inventionIn.

Preferably, at pre-operative treatment device as herein described. First, obtain new or with crossingDevice, and where necessary device is cleaned. Then device is carried out disinfection. In one sterilization skillIn art, this device is placed in to container closed and sealing, for example, in plastics or TYVEK bag. SoAfter container and device are placed in to the radiation area that can penetrate this container, for example γ radiation, x-ray or heightCan electronics. By device, the bacterium above and in container kills in radiation. Then the device after sterilizing is kept atIn disinfecting container. Sealing container keeps aseptic by apparatus, until open this appearance in Medical DevicesDevice.

With way of reference in full or be partly incorporated to any patent, announcement or other open materials hereinAll only be incorporated to material not with existing definition of the present invention, statement or other open material phasesIn the scope of conflict, be incorporated to herein. Thus, under necessary degree, that clearly sets forth herein disclosesAny afoul material that content is incorporated herein by reference replacement. If according to stating the side of quotingFormula is incorporated to herein but is afoul any with existing definition as herein described, statement or other open materialsMaterial or its part only do not produce the journey of conflict between be incorporated to material and existing open materialUnder degree, be incorporated to herein.

Although the present invention is described as exemplary design, can also be of the present disclosureIn essence and scope, the present invention is modified. Therefore present patent application is intended to contain employing the present invention oneAs any modification pattern, purposes or the remodeling of principle. In addition, present patent application is intended to contain the present inventionUnder come from field known or be used to have the disengaging pattern of the present disclosure in practical framework.

Claims

1. the assembly using together with surgical stapling device, described assembly comprises:

Storehouse passage;

Be positioned at the warehouse in the passage of described storehouse, described warehouse comprises:

Support section;

Be limited to the multiple nails chamber in described support section, wherein each described nail chamber comprisesBe arranged in the opening of described support section;

At least one of at least one extension from described storehouse passage and described support sectionDistortion minimizes member; And

Implanted compressible portion, wherein said distortion minimizes member and described compressiblePart engages, and wherein said compressible portion comprises:

The first surface of contiguous described support section location;

Tissue contacting surface; And

The porous master who extends between described first surface and described tissue contacting surfaceBody, the deflection fully of wherein said porous bodies, to allow described tissue to connectTouch surface with respect to described first surface lateral movement, wherein said at least one turn roundSong minimizes the described flexure unber lateral that member can suppress described porous bodies; And

Multiple nails, wherein at least a portion of each described nail is stored in described in one removedlyIn nail chamber, wherein each described nail can not move between firing position and firing position, itsIn in the time that each described nail moves between described not firing position and described firing position, eachDescribed nail can not pulled the trigger configuration and pull the trigger between configuration and be out of shape, and wherein said compressiblePart can be captured in described nail, and when described nail described do not pull the trigger configuration and described in hitSend out while distortion between configuration, described compressible portion is taked different pressures in different described nailsContracting height.

2. assembly according to claim 1, wherein said first surface comprises in described porous bodiesCrust, and wherein said crust has the density higher than the density of described porous bodies.

3. assembly according to claim 1, wherein said tissue contacting surface comprises described porous masterCrust on body, and wherein said crust has close higher than the density of described porous bodiesDegree.

4. assembly according to claim 1, wherein said implanted compressible portion is by homogeneous materialForm.

5. assembly according to claim 1, wherein said at least one distortion minimizes member and comprisesEmbed removedly the multiple clamping plate in described porous bodies.

6. assembly according to claim 1, wherein said at least one distortion minimizes member and comprisesAt least one sidewall extending from described passage.