CN103648410B

CN103648410B - Compressible nail bin groupware

Info

Publication number: CN103648410B
Application number: CN201280032819.5A
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: 2012-04-11
Publication date: 2016-10-26
Anticipated expiration: 2032-04-11
Also published as: AU2012250107B2; BR112013027776A2; JP2014518679A; CA2834557A1; JP6374040B2; BR112013027776B1; RU2600201C2; JP6359447B2; AU2012250107A1; CA2834557C; RU2013152964A; JP2017074494A; CN103648410A

Abstract

Fastener cartridge can include support section, the tissue thickness's compensating part positioned relative to described support section and be positioned at the multiple securing members that can be used for fastening tissue in described support section and/or described tissue thickness compensating part.In use, fastener cartridge can be positioned in the first jaw of surgical fastening device, and wherein the second jaw or anvil block can be positioned in the opposite of described first jaw.For disposing securing member, nail is disposed component and is advanced through described fastener cartridge so that securing member moves towards anvil block.When securing member is deployed, described securing member can capture at least some of of tissue thickness therein compensating part, at least some of together with the tissue just fastened.

Description

Compressible nail bin groupware

Cross-Reference to Related Applications

The patent application of this non-transitory is the entitled of JIUYUE in 2010 submission on the 30th according to 35U.S.C. § 120 The U.S. of " Surgical Stapling Instrument With a Variable Staple Forming System " is special The part continuation application of profit patent application serial numbers 12/894,360, the entire disclosure is hereby incorporated herein by accordingly.

Background technology

The present invention relates to a kind of surgical instruments, and relate in various embodiments being designed to cutting and stitching group The surgical cutting knitted and suture instruments and nail bin thereof.

Accompanying drawing explanation

By combining the accompanying drawing following description with reference to the embodiment of the present invention, inventive feature and advantage and acquisition side thereof Method will become more apparent, and is better understood invention itself, wherein:

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

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

Figure 1B-1E shows the some with the clamping of implanted nail bin and the end effector sewing up tissue；

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

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

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

Fig. 5 is that another local when knife bar is partly advanced through wherein of the end effector shown in Fig. 2 to Fig. 4 is horizontal Side cross-sectional view；

The perspective view of alternative nail bin embodiment that Fig. 6 is mounted in surgical cutting and stitching devices；

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

The top view of another surgery nail bin embodiment that Fig. 8 is mounted in the elongated passageway of end effector；

Fig. 9 is the bottom view of anvil block；

Figure 10 is the fragmentary, perspective view of the multiple nails of the part forming nail row；

Figure 11 is another fragmentary, perspective view of the nail row of Figure 10, and its nail is at the anvil block by surgical cutting and stitching devices After contact shapes；

Figure 12 is the fragmentary, perspective view of the alternative nail of the part forming another nail row；

Figure 13 is the fragmentary, perspective view of the alternative nail of the part forming another nail row；

Figure 14 is the fragmentary, perspective view of the alternative nail of the part forming another nail row embodiment；

Figure 15 is the sectional view of the end effector supporting nail bin；

Figure 16 is that the elongated passageway portion of end effector shown in Figure 15 is removing implanted cartridge body part and nail from it Sectional view afterwards；

Figure 17 is the sectional view of the end effector supporting another nail bin；

Figure 18 A-18D describes to be positioned at the deformation of the surgical staples can collapsed in staple cartridge body according at least one embodiment；

Figure 19 A is to illustrate that be positioned at can the schematic diagram of nail in conquassation staple cartridge body；

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

Figure 19 C be illustrate shown in Figure 19 A can conquassation staple cartridge body by the schematic diagram of the further conquassation of anvil block；

Figure 19 D is to illustrate that the nail shown in Figure 19 A is in be fully formed can be in by conquassation nail bin shown in configuration and Figure 19 A The schematic diagram of conquassation state completely；

Figure 20 be illustrate the nail positioned against nail bin stayed surface and illustrate follow closely with nail bin stayed surface between potential The schematic diagram of relative motion；

Figure 21 is the sectional view of nail bin stayed surface, and described nail bin stayed surface includes slit or groove, with stable Figure 20 institute The base portion of the nail shown；

Figure 22 is the sectional view of the nail according at least one alternative embodiment, and described nail includes the hat of overmolding Portion and the slit of a part or the groove of described bizet can be accommodated；

Figure 23 is the top view of the nail bin according at least one embodiment, and described nail bin includes that embedding can be collapsed in staple cartridge body Nail；

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

Figure 25 is the front view of the nail bin according at least one embodiment, and described nail bin includes around being positioned at nail of can collapsing The protective layer of the nail in warehouse；

Figure 26 is the sectional view of nail bin shown in Figure 25 that the line 26-26 along Figure 25 intercepts；

Figure 27 is the front view of the nail bin according at least one embodiment, and described nail bin includes extending at least in part can Collapse the nail outside staple cartridge body and the protective layer around described staple cartridge body；

Figure 28 is the sectional view of nail bin shown in Figure 27 that the line 28-28 along Figure 27 intercepts；

Figure 29 is the partial cutaway view of the nail bin according at least one embodiment, and described nail bin includes the most embedding Entering the nail can collapsed in staple cartridge body, described nail is at least partially situated in the nail lacuna in described staple cartridge body；

Figure 30 is the sectional view of nail bin shown in Figure 29 that the line 30-30 along Figure 29 intercepts；

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

Figure 32 is the partial cutaway view of the nail bin according at least one embodiment, and described nail bin includes the most embedding Enter the nail can collapsed in staple cartridge body and connect described nail the alignment matrix making described nail relative to each other align；

Figure 33 is the sectional view of nail bin shown in Figure 32 that the line 33-33 along Figure 32 intercepts；

Figure 34 is the partial cutaway view of the internal layer of compressible staple cartridge body；

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

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

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

Figure 38 is the schematic diagram illustrating the sub-component including internal layer shown in Figure 34 and the shown nail of the Figure 36 being inserted in outer layer；

Figure 39 is to illustrate that outer layer shown in Figure 38 is sealed to form the schematic diagram sealing nail bin；

Figure 40 is the sectional view sealing nail bin shown in Figure 39；

Figure 41 is the sectional view of the nail bin according at least one embodiment and staple cartridge channel；

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

Figure 43 is the front view of the end effector of surgical stapling device, and described end effector includes in an open position Anvil block and the nail bin being positioned in staple cartridge channel；

Figure 44 is the front view of end effector shown in Figure 43, and it illustrates anvil block in the close position and is compressed in anvil Nail bin between seat and staple cartridge channel；

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 positioned at nail with alternative In the passage of storehouse；

Figure 46 is the sectional view of the end effector of surgical stapling device, and described end effector includes being positioned at staple cartridge channel Compressible nail bin and be attached to one piece of backing material of anvil block；

Figure 47 is the sectional view of end effector shown in Figure 46, and it illustrates anvil block in the close position；

Figure 48 is the sectional view of alternative embodiment of the end effector of surgical stapling device, described end effector Including the nail bin with impermeable stratum；

Figure 49 is the sectional view of another alternative embodiment of the end effector of surgical stapling device；

Figure 50 is the sectional view of alternative embodiment of the end effector of surgical stapling device, described end effector Including staged anvil block and the nail bin with staged warehouse；

Figure 51 is the sectional view of another alternative embodiment of the end effector of surgical stapling device；

Figure 52 is the sectional view of alternative embodiment of the end effector of surgical stapling device, described end effector Including the tissue contacting surface tilted；

Figure 53 is the sectional view of another alternative embodiment of the end effector of surgical stapling device, and described end is held Row device includes the tissue contacting surface tilted；

Figure 54 is the sectional view of alternative embodiment of the end effector of surgical stapling device, described end effector Including the support insert that can support nail bin；

Figure 55 is the sectional view of alternative embodiment of the end effector of surgical stapling device, described end effector Including the nail bin with multiple compressible stratum；

Figure 56 is the sectional view of alternative embodiment of the end effector of surgical stapling device, described end effector Including the nail bin with the compressible warehouse of staged；

Figure 57 is the sectional view of another alternative embodiment of the end effector of surgical stapling device, and described end is held Row device includes the nail bin with the compressible warehouse of staged；

Figure 58 is the sectional view of alternative embodiment of the end effector of surgical stapling device, described end effector Nail bin including the tissue contacting surface with bending；

Figure 59 is the sectional view of alternative embodiment of the end effector of surgical stapling device, described end effector Nail bin including the tissue contacting surface with inclination；

Figure 60 is the sectional view of compressible nail bin, and described compressible nail bin includes following closely and wherein storing have at least one medicine Agent；

Figure 61 be illustrate the compressible nail bin shown in Figure 60 compressed and accommodated in it nail deformation after schematic diagram；

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

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

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

Figure 65 is the sectional view of implanted nail bin shown in Figure 64；

Figure 66 is the perspective view of alternative embodiment of nail bin, described nail bin include from the outer layer of nail bin extend can Deformation element；

Figure 67 is the perspective view of alternative embodiment of nail bin, and described nail bin includes being assembled to outside the nail bin of internal layer Layer；

Figure 68 is the sectional view of alternative embodiment of nail bin, and described nail bin includes multiple nail, compressible stratum and takes off Fat cotton layer；

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

Figure 70 is the absorbent cotton being partitioned into from the degreasing cotton layer shown in Figure 68 and the nail alignd with the groove absorbent cotton Perspective view；

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

Figure 72 is the perspective that the absorbent cotton support frame of degreasing cotton layer shown in Figure 68 is removed from the absorbent cotton being partitioned into Figure；

Figure 73 is the decomposition diagram of alternative embodiment of compressible nail bin, and described compressible nail bin includes nail With the system for driving 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 sectional view of nail bin shown in Figure 73；

Figure 75 is the front view that can traverse the nail bin shown in Figure 73 the sliding part that makes nail advance towards anvil block；

Figure 76 is the schematic diagram illustrating staple drivers, and described staple drivers can be carried towards anvil block by the sliding part shown in Figure 75 Rise；

Figure 77 is the excision view of the nail bin according at least one alternative embodiment, and described nail bin includes being positioned at nail Nail in driver；

Figure 78 is sectional view when being positioned at staple cartridge channel of the nail bin shown in Figure 77；

Figure 79 is the sectional view of nail bin shown in Figure 77, and it is illustrated and moves to the anvil block of make position and deformed by anvil block The nail being contained in nail bin；

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

Figure 81 is the perspective view of alternative embodiment of nail bin, and described nail bin includes each flexible sides of connection nail bin Band；

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

Figure 83 is to be shown with the sliding part shown in Figure 82 and cutting element assembly to promote the nail of nail bin shown in Figure 77 Schematic diagram；

Figure 84 is to illustrate the ability to jointing nail and promote the sliding part of nail towards anvil block and can optionally make sliding part to far The schematic diagram of the locking system of lateral movement；

Figure 85 A-85C illustrates and nail is inserted the process in crown portion；

Figure 86 is the sectional view of the nail bin including a support plate or keeper；

Figure 87 is the partial sectional view of the compressible nail bin according at least one alternative embodiment；

Figure 88 is to illustrate the schematic diagram when nail bin shown in Figure 87 is in implanting state；

Figure 89 is the partial cutaway view of the compressible nail bin according at least one alternative embodiment；

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

Figure 91 is to illustrate the schematic diagram when nail bin shown in Figure 89 is in implanting state；

Figure 92 be according at least one alternative embodiment can the partial sectional view of conquassation nail bin；

Figure 93 is that the local excision of the collapsed nail bin including multiple crushable member according at least one embodiment regards Figure；

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

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

Figure 96 A is the partial sectional view of the end effector of surgery suturing appliance, described end effector include jaw and Staple cartridge channel that described jaw relatively positions and be positioned at the nail bin of described staple cartridge channel, wherein said jaw includes attached Receive the holding matrix of jaw；

Figure 96 B is the partial sectional view of end effector shown in Figure 96 A, and it illustrates the jaw towards staple cartridge channel traveling, quilt Anvil block and the nail bin and the nail that keep matrix compression, described nail extends through at least in part and is positioned in holding matrix and nail bin Between tissue；

Figure 96 C is the partial sectional view of end effector shown in Figure 96 A, its illustrate be in final position jaw and with figure The holding matrix that nail joint shown in 96B is closed；

Figure 96 D is the partial sectional view of end effector shown in Figure 96 A, and it illustrates that jaw and staple cartridge channel are away from implantation Nail bin and holding matrix motion；

Figure 97 is the perspective view of the retaining hole keeping matrix according at least one alternative embodiment, described holding Hole includes multiple holding component, for engaging the fastener leg extending through described retaining hole；

Figure 98 is the perspective view of the retaining hole keeping matrix according at least one alternative embodiment, described holding Hole includes that six keep component；

Figure 99 is the perspective view of the retaining hole keeping matrix according at least one alternative embodiment, described holding Hole includes that eight keep component；

Figure 100 is the perspective view of the retaining hole keeping matrix according at least one alternative embodiment, described guarantor Hold hole and include multiple holding component, for engaging the fastener leg extending through described retaining hole；

Figure 101 is the perspective view of the retaining hole keeping matrix according at least one alternative embodiment, described guarantor Hold hole and include that six keep component；

Figure 102 is the perspective view of the retaining hole keeping matrix according at least one alternative embodiment, described guarantor Hold hole and include that eight keep component；

Figure 103 is the perspective view of the retaining hole keeping matrix according at least one alternative embodiment, described guarantor Hold multiple holding components that hole includes being stamped to form by sheet metal；

Figure 104 is the perspective view of the retaining hole keeping matrix according at least one alternative embodiment, described guarantor Hold multiple holes that matrix includes extending along the periphery of described retaining hole；

Figure 105 is the top view of the retaining hole keeping matrix according at least one alternative embodiment；

Figure 106 is the top view of the retaining hole keeping matrix according at least one alternative embodiment；

Figure 107 is the top view of the retaining hole keeping matrix according at least one alternative embodiment；

Figure 108 is the top view of the retaining hole keeping matrix according at least one alternative embodiment；

Figure 109 is the top view of the retaining hole keeping matrix according at least one alternative embodiment；

Figure 110 is the top view of the retaining hole keeping matrix according at least one embodiment, and described retaining hole includes prolonging Extend the holding inserted sheet in described retaining hole；

Figure 111 is the top view of the retaining hole keeping matrix according at least one alternative embodiment, described guarantor Hold the holding inserted sheet that hole includes extending in described retaining hole；

Figure 112 is the perspective view of fastening system, and described fastening system includes the holding square that multiple nail and described nail joint are closed Battle array and the alignment matrix of the described nail that can align；

Figure 113 is the perspective view keeping matrix shown in Figure 112；

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

Figure 115 is partial top view when keeping matrix to close with the nail joint shown in Figure 112 shown in Figure 112；

Figure 116 is partial bottom view when keeping matrix to close with the nail joint shown in Figure 112 shown in Figure 112；

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 partial sectional view when keeping matrix to close with the nail joint shown in Figure 112 shown in Figure 112；

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 includes the protection being assembled to follow closely lower limb Cap；

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

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

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

Figure 125 is the front view of the end effector according at least one embodiment, and described end effector includes being in The jaw of open position, the holding matrix being positioned in jaw and multiple protective cap and the nail bin being positioned in staple cartridge channel；

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

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

Figure 128 is front view when keeping matrix and protective cap to be assembled to the nail bin shown in Figure 125 shown in Figure 125；

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 jaw in an open position and is positioned at holding Relatively thin tissue between matrix and nail bin；

Figure 131 is the front view of end effector shown in Figure 125, and it illustrates locates against the relatively thin tissue shown in Figure 130 Jaw in make position；

Figure 132 is the front view of end effector shown in Figure 125, and it illustrates and is in firing position to keep matrix and nail The jaw of relatively thin tissue shown in Figure 130 is captured between storehouse；

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

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

Figure 135 is the sectional view of the protective cap being positioned on nail lower limb end according at least one alternative embodiment；

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

Figure 137 is the perspective view of jaw, and described jaw includes that multiple depressed part is contained in it for by multiple protective caps In；

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

Figure 139 is the sectional view of the protective cap being positioned on nail lower limb end according at least one alternative embodiment, Wherein said protective cap includes internal profiled surface；

Figure 140 is another sectional view of protective cap shown in Figure 139, and it illustrates the nail lower limb deformed against profiled surface；

Figure 141 is to maintain the top view of alternative embodiment of matrix, and described holding matrix includes multiple connected Matrix element；

Figure 142 is to maintain the top view of alternative embodiment of matrix, and described holding matrix includes multiple connected Matrix element；

Figure 143 is to maintain the top view of alternative embodiment of matrix, and described holding matrix includes multiple connected Matrix element；

Figure 144 is to maintain the top view of alternative embodiment of matrix array, and described holding matrix array includes many Individual connected matrix element；

Figure 145 is to maintain the top view of alternative embodiment of matrix, and described holding matrix includes multiple connected Matrix element；

Figure 146 is the exploded partial view including keeping the jaw of matrix, and described holding matrix includes compressible lid；

Figure 147 is the detail drawing keeping matrix shown in Figure 146；

Figure 148 is the partial sectional view of fastening system including keeping matrix, described holding matrix include compressible stratum and Encapsulate multiple unit of one or more medicines；

Figure 149 is to illustrate the schematic diagram that nail lower limb pierces through unit shown in Figure 148 with holding matrix when engaging；

Figure 150 is the partial sectional view including keeping the fastening system of matrix, and described holding matrix includes compressible stratum；

Figure 151 is the front view of fastener cartridge plug-in package, and described fastener cartridge plug-in package includes clamper, first tight Firmware storehouse and the second fastener cartridge；

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

Figure 153 is the front view of end effector shown in Figure 152, and it illustrates the second jaw and the use being in closed configuration In loading the first storehouse for the first jaw and being that the second jaw loads the fastener cartridge plug-in package shown in the Figure 151 in the second storehouse；

Figure 154 is the front view of end effector shown in the Figure 153 loaded, and it illustrates the storehouse removed from end effector Plug-in package, it is again at the second jaw of open configuration and is positioned at the tissue in the middle of the first jaw and the second jaw；

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

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

Figure 157 is the front view of end effector shown in Figure 152, and it illustrates according at least one embodiment and still clamps with first The part in the first storehouse that mouth engages；

Figure 158 is the front view of alternative embodiment of fastener cartridge plug-in package, described fastener cartridge insertion group Part includes clamper, the first fastener cartridge and the second fastener cartridge；

Figure 159 is used to the first jaw of end effector and loads the first storehouse and be the second jaw figure of loading the second storehouse The front view of fastener cartridge plug-in package shown in 158；

Figure 160 is the sectional view having loaded end effector shown in Figure 159；

Figure 161 is the perspective of the surgical stapling device including bottom jaw and top jaw according at least one embodiment Figure, wherein some part of surgical stapling device is removed；

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

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

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

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

Figure 166 is to illustrate the schematic diagram that the slidably anvil block system shown in Figure 163 is in non-cock；

Figure 167 be illustrate shown in Figure 163 slidably the first of anvil block system slidably anvil block be in non-firing position and position Nail in the jaw of bottom is in the schematic diagram of non-deployed position；

Figure 168 is that the nail being shown in the jaw of bottom is in and disposes shown in configuration and Figure 167 the first slidably anvil block Be pulled to nearside so that first group nail nail lower limb deformation schematic diagram；

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

Figure 170 be illustrate shown in Figure 163 slidably the second of anvil block system slidably anvil block be pushed to distally so that second The schematic diagram of group nail lower limb deformation；

Figure 171 is the fragmentary, perspective view of the anvil block including multiple shaping pit according at least one embodiment；

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

Figure 173 is the schematic diagram illustrating and manufacturing the first step shaping pit shown in Figure 171；

Figure 174 is the schematic diagram illustrating and manufacturing the second step shaping pit shown in Figure 171；

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

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

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

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

Figure 179 is surgical stapling and the front, left perspective view cutting off apparatus, and wherein to include that connecting rod triggers automatic for handle portions Cam mechanism and ratchet manual retrieving mechanism；

Figure 180 is surgical stapling and the right rear view of cut-out apparatus of Figure 179, and wherein a part for slender axles is cut And the right half-shell of shank shell is removed show automatic firing end traveling cam mechanism and manually fire cam mechanism；

Figure 181 is the surgical stapling of Figure 179 and cuts off perspective disassembled view behind the handle portions of apparatus and the right side of slender axles；

Figure 182 is surgical stapling and the right rear view of cut-out apparatus of Figure 31, outside the rightest half-shell and tool portion Portion is removed Guan Bi and the firing lock being in original state with display；

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

Figure 184 is surgical stapling and the right rear view of cut-out apparatus of the decomposed of Figure 182, and wherein close mechanism closes Close and clamping, and gemmule pawl firing lock completes the first stroke, and wherein manual retrieving mechanism is removed to show connecting rod The distal link of formula tooth bar, this distal link triggers the automatic retracted of firing lock；

Figure 185 is surgical stapling and the right rear view of cut-out apparatus of the decomposed of Figure 183, wherein gemmule pawl percussion Mechanism departs from and distal link is close to automatic retracted；

The left side elevational of surgical stapling and cut-out apparatus that Figure 186 is in the decomposed of Figure 183 of original state regards Figure, when this original state, end effector is opened and Anti-backup mechanism is engaged；

Figure 187 is right half-shell and the left side detail drawing of anti-retrogression trip lever of the handle portions of Figure 186；

Figure 188 is surgical stapling and thin portion, the left side elevational view of cut-out apparatus of the decomposition of Figure 179, wherein closes triggering Device is clamped, percussion trigger performs last stroke and distal link is oriented to trigger automatic retracted；

Figure 189 is that distal link activates towards anti-retrogression trip lever and locks, so that after link-type tooth bar retraction Figure 188 decomposition surgical stapling and cut off apparatus thin portion, left side elevational view；

Figure 190 be Figure 179 surgical stapling and cut off the idler gear of manual retrieving mechanism of apparatus and backgear and The right resolution perspective view of 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 partly cut away connecing Close the ratchet gear exposing small diameter on the backgear of ratchet pawl；

Figure 192 is the surgical stapling left side elevational view with the decomposed cutting off apparatus of Figure 179, wherein anti-retrogression machine Structure is joined to the link-type tooth bar fired completely, before the manual retrieving lever of Figure 190 is braked, and this link-type tooth bar and combination Tension force/compression spring depart from；

Figure 193 is the surgical stapling left side elevational view with the decomposed cutting off apparatus of Figure 192, and wherein anti-retrogression is released The hidden parts putting lever, backgear and manual percussion trip lever is shown in phantom；

Figure 194 is the surgery of the Figure 193 after the actuating manually firing trip lever has made link-type tooth bar manual retrieving Sew up and cut off the left side elevational view of the decomposed of apparatus；

Figure 195 is the surgical stapling left side elevational view with the decomposed cutting off apparatus of Figure 194, wherein link-type tooth Bar is omitted, it is shown that manually percussion trip lever departs from Anti-backup mechanism；

Figure 196 is the surgical stapling for Figure 179 and alternative anti-retrogression trip lever and the shank cutting off apparatus The left side detail drawing of shell；

Figure 197 is alternative anti-retrogression release thick stick, backgear axle and the left perspective of automatic retracted cam of Figure 196 Decomposition view；

Figure 198 is the right side elevational view of alternative anti-retrogression relieving mechanism of Figure 196, wherein at link-type tooth bar In advanced position, and anti-retrogression trip lever is proximally positioned in the anti-backup plate being joined to fire connecting rod；

Figure 198 A is thin portion, the right side elevational view of the backgear of Figure 198, automatic retracted cam and farthest side connecting rod；

Figure 199 is the right side elevational view of the anti-retrogression relieving mechanism of the Figure 198 after the first firing stroke；

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

Figure 200 is the right side elevational view of the anti-retrogression relieving mechanism of the Figure 199 after the second firing stroke；

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

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

Figure 20 1A is that thin portion, the right side facade of the backgear of Figure 20 1, automatic retracted cam and recent side fourth link regards Figure；

Figure 20 2 is to make automatic retracted cam slide towards distally at another firing stroke and lock anti-retrogression trip lever, Thus the right side elevational view of the automatic releasing mechanism shown in Figure 20 1 after separating with anti-retrogression relieving mechanism；

Figure 20 3 is the front, left perspective view that assembly used by the nail opened, and the right half part of the most replaceable nail bin is included in In nail groove；

Figure 20 4 is that group used by the nail of the axle configuration with complete replaceable nail bin and non-joint motions shown in Figure 20 3 The decomposition diagram of part；

Figure 20 5 is split type cutter and the perspective view of trigger shaft (E type crossbeam) that assembly used by the nail shown in Figure 20 3；

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

Figure 20 7 is to use, along the nail shown in Figure 20 3, the left side that the centrage 207-207 of assembly intercepts in longitudinal cross-section Elevational view；

Figure 20 8 is the perspective view that assembly used by the nail opened shown in Figure 20 3, without replaceable nail bin, neighbouring spelling A part for the nail groove of the intermediate pin of box-like cutter and trigger shaft, and do not follow closely the distal part of groove；

Figure 20 9 is to use, along the nail shown in Figure 20 3, the front facade that the centrage 209-209 of assembly intercepts in cross-section to regard Figure, it is shown that the inside staple drivers of nail bin and split type cutter and each several part of trigger shaft；

Figure 21 0 is that the left side of the longitudinal axis 207-207 intercepting that assembly used by the nail approximately along the Guan Bi shown in Figure 20 3 is stood Face view, to include the center contact point between split type cutter and wedge-shaped slides, but also Strategic Lateral Offset is to illustrate nail bin Interior nail and staple drivers；

Figure 21 1 is thin portion, the left side elevational view that assembly used by the nail shown in Figure 21 0, and wherein split type cutter retraction is the most, This is typical situation for nail bin is replaced；

Figure 21 2 is thin portion, the left side elevational view that assembly used by the nail shown in Figure 21 1, and wherein split type cutter starts percussion, Corresponding to the configuration shown in Figure 21 0；

Figure 21 3 is that assembly used by the nail of the Guan Bi shown in the Figure 21 0 after split type cutter and trigger shaft fire towards distally Left cross sectional elevational view；

Figure 21 4 is that group used by the nail of the Guan Bi shown in the Figure 21 3 after the percussion of nail bin and the retraction of split type cutter The left cross sectional elevational view of part；

Figure 21 5 is the left cross sectional elevational view that assembly used by the nail shown in Figure 21 4, and wherein split type cutter is allowed to fall Enter in latched position；

Figure 21 6 is the perspective view of the nail bin of at least one embodiment according to the present invention, and nail bin includes and surgical stapling device Rigid support part that tool is used together and compressible tissue thickness compensating part；

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

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

Figure 21 9 is another exploded view of the nail bin shown in Figure 21 6, and this nail bin is not covered with the bag of tissue thickness's compensating part Wrap up in thing；

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

Figure 22 1 is the top perspective of sliding part, and this sliding part can move, with from nail in the nail bin shown in Figure 21 6 Nail is disposed in storehouse；

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

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

Figure 22 4 is the top perspective of driver, and this driver can support one or more nail and by shown in Figure 22 1 Sliding part be lifted up with will nail from nail bin penetrate；

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

Figure 22 6 is the wrappage of the compressible tissue thickness compensating part that can at least partly surround nail bin；

Figure 22 7 is the partial sectional view of nail bin, and nail bin includes rigid support part and compressible tissue thickness compensating part, Show that nail never firing position during First ray moves to firing position；

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

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

Figure 23 3 is nail bin and the longitudinal sectional view of anvil block in the close position, and nail bin includes rigid support part and can Tissue thickness's compensating part of compression, it is shown that nail never firing position during First ray moves to firing position；

Figure 23 4 is another sectional view of the anvil block shown in Figure 23 3 and nail bin, it is shown that locate after percussion sequence completes Anvil block in open position；

Figure 23 5 is the local detail drawing of the nail bin shown in Figure 23 3, it is shown that be in the nail of non-firing position；

Figure 23 6 is the cross-sectional elevational view of nail bin, and this nail bin includes that rigid support part and compressible tissue thickness are mended Repay part, it is shown that be in the nail of non-firing position；

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

Figure 23 8 is nail bin and the front view of anvil block in an open position, and nail bin includes rigid support part and compressible Tissue thickness's compensating part, it is shown that be in the nail of non-firing position；

Figure 23 9 is nail bin and the front view of anvil block in the close position, and nail bin includes rigid support part and compressible Tissue thickness's compensating part, it is shown that be in the nail of non-firing position and be trapped between anvil block and tissue thickness's compensating part Tissue；

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

Figure 24 1 is nail bin and the front view of anvil block in the close position, and nail bin includes rigid support part and compressible Tissue thickness's compensating part, it is shown that be in the nail of non-firing position, it is shown that be positioned between anvil block and nail bin is thicker Tissue；

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

Figure 24 3 is the front view of the anvil block shown in Figure 24 1 and nail bin, it is shown that the tool being positioned between anvil block and nail bin There is the tissue of different-thickness；

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

Figure 24 5 shows tissue thickness's compensating part that the different tissues thickness captured in difference is followed closely compensates Schematic diagram；

Figure 24 6 shows tissue thickness's compensating part and applies compression pressure to one or more blood vessel crosscutting by nail row Schematic diagram；

Figure 24 7 shows the schematic diagram of the imappropriate situation about shaping of wherein one or more nails；

Figure 24 8 shows the schematic diagram of the tissue thickness's compensating part that can compensate for the most appropriately becoming staple；

Figure 24 9 shows the signal of the tissue thickness's compensating part being positioned in the tissue regions that multiple nail row intersects Figure；

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

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

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

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

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

Figure 25 5 shows the tissue thickness's compensating part captured in nail and has the signal of tissue of interior thickness Figure；

Figure 25 6 shows the tissue thickness's compensating part captured in nail and has the showing of tissue of another interior thickness It is intended to；

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

Figure 25 8 is the partial sectional view of the end effector of surgery suturing appliance, it is shown that be in retraction, non-firing position Trigger shaft and nail percussion sliding part；

Figure 25 9 is another partial sectional view of the end effector shown in Figure 25 8, it is shown that is in local and advances position Trigger shaft and nail percussion sliding part；

Figure 26 0 is the cross-sectional schematic of the end effector shown in Figure 25 8, it is shown that is in and is fully advanced or firing position Trigger shaft；

Figure 26 1 is the sectional view of the end effector shown in Figure 25 8, it is shown that be in hitting of advanced position after being fired Send out bar and stay the nail percussion sliding part of its complete firing position；

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

Figure 26 3 is the partial sectional view of the end effector of the surgery suturing appliance including nail bin, and this nail bin includes tissue Thickness compensation part and be at least partially positioned at nail therein；

Figure 26 4 is another partial sectional view of the end effector shown in Figure 26 3, it is shown that relative to being positioned in nail The nail that the anvil block on opposite, storehouse at least partly moves and/or rotates；

Figure 26 5 is the partial sectional view of the end effector of the surgery suturing appliance according at least one embodiment；

Figure 26 6 is the partial sectional view of the end effector according at least one alternative embodiment；

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

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

Figure 26 9 is the partial sectional view of the end effector shown in Figure 26 8 being illustrated at deflected；

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

Figure 27 1 is the perspective view of the end effector including tissue thickness's compensating part set；

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

Figure 27 3 is the perspective view of the end effector including multiple guide rail, and the plurality of guide rail is from support section and has The tissue thickness's compensating part being defined in longitudinal cavity therein extends；

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

Figure 27 5 is the perspective view of end effector, and this end effector includes from supporting part and the tissue that engages Multiple tusks that thickness compensation part extends；

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

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

Figure 27 8 is the partial lengthwise sectional view of the anvil block shown in Figure 27 6；

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

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

Figure 28 1 is the front view of the percussion nail of the lower limb including a lower limb and the outwards deformation being deformed inward；

Figure 28 2 is to include the front view that the percussion of two lower limbs outwards shaped is followed closely；

Figure 28 3 is the fragmentary, perspective view of the support section of nail bin, and this nail bin includes that detachable and/or interchangeable nail lower limb is led To device；

Figure 28 4 is the partial sectional view of the nail bin shown in Figure 28 3, it is shown that the nail disposed from nail bin；

Figure 28 5 is by the detail drawing of the sectional view shown in Figure 28 4 after firing at nail bin；

Figure 28 6 is the exploded view of the nail bin including tissue thickness's compensating part, and this tissue thickness's compensating part includes being defined in it In space；

Figure 28 7 shows against the schematic diagram organizing the tissue thickness's compensating part shown in implanted Figure 28 6；

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

Figure 28 9 is the perspective cross-sectional view including laterally keeping the nail bin of component, and this laterally keeps component from its supporting part Divide and extend, it is possible to tissue thickness's compensating part is held in place；

Figure 29 0 is the sectional view for sewing up the nail bin shown in Figure 28 9 of tissue；

Figure 29 1 is another sectional view of the nail bin shown in Figure 28 9, it is shown that positive motion is mended away from the tissue thickness implanted Repay the support section of part；

Figure 29 2 is the perspective cross-sectional view of nail bin, and this nail bin includes tissue thickness's compensating part being remained to supporting part That divides laterally keeps component；

Figure 29 3 is the sectional view for sewing up the nail bin shown in Figure 29 2 of tissue；

Figure 29 4 is another sectional view of the nail bin shown in Figure 29 2, it is shown that positive motion is mended away from the tissue thickness implanted Repay the support section of part；

Figure 29 5 is the holding of the support section that tissue thickness's compensating part remains to nail bin according at least one embodiment The cross section detail drawing of device；

Figure 29 6 is the broken section of the nail bin of the staple drivers including having differing heights according at least one embodiment Figure；

Figure 29 6A show the staple drivers shown in Figure 29 6 and be supported on thereon have difference do not fire height The schematic diagram of nail；

Figure 29 7 show include variable thickness tissue thickness's compensating part, have differing heights staple drivers and There is the schematic diagram of the nail of different unshaped height；

Figure 29 8 shows the nail shown in Figure 29 7 of implanted tissue and the schematic diagram of tissue thickness's compensating part；

Figure 29 9 is the office of the nail bin of the tissue thickness's compensating part including having variable thickness according at least one embodiment Portion's sectional view；

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

Figure 30 1 is the sectional view of the end effector shown in Figure 30 0 being illustrated at part percussion configuration；

Figure 30 2 is the sectional view of the end effector shown in Figure 30 0 being illustrated at being again turned on configuration；

Figure 30 3 is the sectional view of the end effector of the surgery suturing appliance according at least one embodiment, and this surgery stitches Clutch tool includes having differing heights and the staple drivers of wavy platform surface；

Figure 30 4 is the sectional view of the end effector of the surgery suturing appliance according at least one embodiment, and this surgery stitches Clutch tool includes having differing heights and the staple drivers of staged platform surface；

Figure 30 5 is the perspective view of the nail bin using nail bin application device to be loaded in the executor of surgery suturing appliance；

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

Figure 30 7 is the side view of the nail bin application device shown in Figure 30 5 being assembled into nail bin；

Figure 30 8 is the sectional view of the assembly shown in Figure 30 7；

Figure 30 9 is the perspective view of the nail bin application device assembly according at least one embodiment, this nail bin application device group Part also includes the top tissue thickness compensation part being positioned on the top surface of nail bin application device；

Figure 31 0 is the top tissue thickness compensation part shown in Figure 30 9 and the exploded view of nail bin application device；

Figure 31 0A is the exploded view of the nail bin application device assembly including tractive component, and this tractive component can make to be attached to The top tissue thickness compensation part of nail bin application device separates；

Figure 31 1 is the decomposed figure of the nail bin application device assembly according at least one alternative embodiment；

Figure 31 2 is the perspective view of nail bin application device assembly, and this nail bin application device assembly includes that top tissue thickness is mended Repaying part and nail bin, top tissue thickness compensation part includes that the multiple holding structures extended from it and nail bin include that bottom tissue is thick Degree compensating part；

Figure 31 3 is the front view of the nail bin application device assembly shown in Figure 31 2, and this nail bin application device assembly is positioned in Staple cartridge channel and on nail bin application device assembly Guan Bi anvil block in；

Figure 31 4 is in the figure being again turned on the anvil block shown in Figure 31 3 of position and being just removed from end effector The front view of the nail bin application device shown in 312；

Figure 31 4A is to be positioned in the middle of the top tissue thickness compensation part shown in Figure 31 2 and bottom tissue thickness compensating part The sectional view of tissue；

Figure 31 4B show by cutting element be seamed to tissue cut-off top tissue thickness compensation part and The sectional view of bottom tissue thickness compensating part；

Figure 31 5 is, according to showing of at least one embodiment, tissue thickness's compensating part is inserted the schematic diagram in anvil block；

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

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

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

Figure 31 9 is the front view of the nail bin application device assembly shown in Figure 31 8, and this nail bin application device assembly is positioned in Staple cartridge channel and just towards top tissue thickness compensation part motion anvil block in；

Figure 32 0 shows after top tissue thickness compensation part engages with anvil block, is just removing from end effector Nail bin application device shown in Figure 31 8；

Figure 32 1 is directed towards the cross sectional end view of the anvil block of the top tissue thickness compensation part motion shown in Figure 31 8；

Figure 32 2 is the cross sectional end view of the anvil block engaged with top tissue thickness compensation part；

Figure 32 3 is the sectional view of the end effector of the surgery suturing appliance including nail bin, and this nail bin includes by multiple Securing member is attached to tissue thickness's compensating part of the sectional of the support section of nail bin；

Figure 32 4 is the sectional view of the end effector shown in Figure 32 3, it is shown that be in the percussion structure of part firing position Part；

Figure 32 5 is the sectional view of the end effector shown in Figure 32 3, it is shown that the tissue that positive motion is implanted away from part is thick The support section of degree compensating part；

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

Figure 32 7 is the perspective view that sliding part disposed by the nail according at least one embodiment；

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

Figure 32 9 is the perspective view of the end effector of the surgery suturing appliance including nail bin, and this nail bin includes tissue thickness Compensating part and the multiple nail guiders being positioned on tissue thickness's compensating part；

Figure 33 0 is in not firing the tissue thickness's compensating part shown in Figure 32 9 of configuration and the partial cutaway of nail guider View；

Figure 33 1 is in firing the tissue thickness's compensating part shown in Figure 32 9 of configuration and the broken section of nail guider Figure；

Figure 33 2 is the section view of the nail bin including tissue thickness's compensating part and support section according at least one embodiment Figure；

Figure 33 3 is the partial sectional view of tissue thickness's compensating part, nail guide layer and the nail being in non-firing position；

Figure 33 4 is the tissue thickness's compensating part according at least one alternative embodiment, nail guide layer and is in The partial sectional view of the nail of non-firing position；

Figure 33 5 is the tissue thickness's compensating part according at least one alternative embodiment, nail guide layer and is in The partial sectional view of the nail of non-firing position；

Figure 33 6 is the tissue thickness's compensating part according at least one alternative embodiment, nail guide layer and is in The partial sectional view of the nail of non-firing position；

Figure 33 7 is the tissue thickness's compensating part according at least one alternative embodiment, nail guide layer and is in The partial sectional view of the nail of non-firing position；

Figure 33 8 is the tissue thickness's compensating part according at least one alternative embodiment, nail guide layer and is in The partial sectional view of the nail of non-firing position；

Figure 33 9 is the tissue thickness's compensating part according at least one alternative embodiment, nail guide layer and is in The partial sectional view of the nail of non-firing position；

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

Figure 34 1 is the tissue thickness's compensating part according at least one alternative embodiment, nail guide layer and is in The partial sectional view of the nail of non-firing position；

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

Figure 34 3 is the tissue thickness's compensating part according at least one alternative embodiment, nail guide layer and is in The partial sectional view of the nail of non-firing position；

Figure 34 4 is the nail guide layer according at least one alternative embodiment and the multiple nails being in non-firing position Perspective view；

Figure 34 5 is the end-view of the tissue thickness's compensating part can being used together with circular surgical staplers；

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

Figure 34 7 is the tissue can being used together with circular surgical staplers according at least one alternative embodiment The end-view of thickness compensation part；

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

Figure 34 9 is the end-view of the tissue thickness's compensating part can being used together with circular surgical staplers；

Figure 35 0 is in the end-view of the tissue thickness's compensating part shown in Figure 34 9 of local extended configuration；

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

Figure 35 2 is the end-view relative to the surgery suturing appliance shown in Figure 35 1 of tissue positioned；

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

Figure 35 4 is that the surgery suturing appliance shown in Figure 35 1 never with tissue thickness's compensating part is deployed in tissue The fragmentary, perspective view of nail；

Figure 35 5 is the nail being deployed to tissue from the surgery suturing appliance shown in the Figure 35 1 with tissue thickness's compensating part Fragmentary, perspective view；

Figure 35 6 is the partial sectional view of the end effector of the surgery suturing appliance shown in Figure 35 1, including being in first The anvil plate put；

Figure 35 7 is the partial sectional view of the end effector of the surgery suturing appliance shown in Figure 35 1, it is shown that be in second The anvil plate shown in Figure 35 6 of position；

Figure 35 8 is the sectional view of the end effector of the surgery suturing appliance including nail bin, and this nail bin includes that gap sets Element；

Figure 35 9 shows the perspective view of firing member, and this firing member is cut at the end of the firing stroke of firing member Cut the gap shown in Figure 35 8 and set element；

Figure 36 0 is the sectional view of the end effector of the surgery suturing appliance including nail bin, and this nail bin includes flexible nose；

Figure 36 1 is the sectional view of the end effector shown in Figure 36 0, it is shown that be in the nose of flexure configuration；

Figure 36 2 is the sectional view of the end effector of the surgery suturing appliance including nail bin, and this nail bin includes slidably portion Point；

Figure 36 3 is the sectional view of the end effector shown in Figure 36 2, it is shown that the slidably part slided towards distally；

Figure 36 4 is the section view of the end effector of the surgery suturing appliance including support section and tissue thickness's compensating part Figure, this support section includes that the platform surface tilted and this tissue thickness's compensating part include the thickness of change；

Figure 36 5 is the section view of the end effector of the surgery suturing appliance including support section and tissue thickness's compensating part Figure, this support section includes that the platform surface tilted and this tissue thickness's compensating part include consistent thickness；

Figure 36 6 is the perspective view of the nail bin of the tissue thickness's compensating part including having variable thickness；

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

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

Figure 36 9 is the transversal of the tissue thickness's compensating part including multiple layers according at least one alternative embodiment Face perspective view；

Figure 37 0 is the perspective view of disposable loading unit, and this disposable loading unit includes tissue thickness being compensated Part releasably holds its holding component；

Figure 37 1 is the perspective view of tissue thickness's compensating part, and this tissue thickness's compensating part includes tissue thickness being compensated Part releasably holds the holding component of disposable loading unit；

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

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

Figure 37 4 is the perspective view of tissue thickness's compensating part, and this tissue thickness's compensating part includes tissue thickness being compensated Part releasably holds the holding component of disposable loading unit；

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

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

Figure 37 7 is the perspective view of tissue thickness's compensating part, and this tissue thickness's compensating part includes tissue thickness being compensated Part releasably holds the holding component of disposable loading unit；

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

The perspective of tissue thickness's compensating part application device that Figure 37 9 is located in the executor of disposable loading unit Figure；

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 to be positioned at the group in the executor of disposable loading unit according at least one alternative embodiment Knit the perspective view of thickness compensation part application device；

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

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

Figure 38 5 is the front view of disposable loading unit, and what this disposable loading unit included supporting nail bin can pivot Turn jaw；

Figure 38 6 is the sectional view of the nail bin according at least one embodiment, and this nail bin includes the supporting part being attached to nail bin The tissue thickness's compensating part divided；

Figure 38 7 is the sectional view of the nail bin according at least one embodiment, and this nail bin includes the supporting part being attached to nail bin The tissue thickness's compensating part divided；

Figure 38 8 is the sectional view of the nail bin according at least one embodiment, and this nail bin includes the supporting part being attached to nail bin The tissue thickness's compensating part divided；And

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

Run through multiple view, the parts that corresponding reference marks instruction is corresponding.Example shown herein as shows in one form Certain embodiments of the present invention, and the scope this type of example should not being construed as in any way limiting the present invention are gone out.

Detailed description of the invention

Present applicant also has following U.S. Patent application, and these patent applications are submitted in JIUYUE in 2010 on the 30th, And the most each it is entirely incorporated into herein:

Entitled " Surgical Stapling Instrument With a Variable Staple Forming System " U.S. Patent Application Serial Number 12/894,360；

Entitled " Surgical Stapling Instrument With Interchangeable Staple Cartridge Arrangements " U.S. Patent Application Serial Number 12/894,322；

Entitled " Surgical Cutting and Fastening Instruments With Separate and Distinct Fastener Deployment and Tissue Cutting Systems " U.S. Patent Application Serial Number 12/894,351；

Entitled " Surgical Stapling Instrument With Compact Articulation Control Arrangement " U.S. Patent Application Serial Number 12/894,339；

The United States Patent (USP) Shen of entitled " Jaw Closure Arrangements For Surgical Instruments " Please serial number 12/894,327；

The U.S. of entitled " Surgical Instruments With Reconfigurable Shaft Segments " Patent application serial number 12/894,311；

Entitled " Surgical Staple Cartridges Supporting Non-Linearly Arranged Staples and Surgical Stapling Instruments With Common Staple-Forming Pockets” U.S. Patent Application Serial Number 12/894,340；

Entitled " Surgical Staple Cartridges With Detachable Support Structures and Surgical Stapling Instruments With Systems For Preventing Actuation Motions When a Cartridge is Not Present " U.S. Patent Application Serial Number 12/894,350；

Entitled " Implantable Fastener Cartridge Having a Non-Uniform Arrangement " U.S. Patent Application Serial Number 12/894,338；

The U.S. of entitled " Implantable Fastener Cartridge Comprising Multiple Layers " State's patent application serial number 12/894,312；

The U.S. of entitled " Selectively Orientable Implantable Fastener Cartridge " is special Profit patent application serial numbers 12/894,377；

Entitled " Implantable Fastener Cartridge Comprising Bioabsorbable Layers " U.S. Patent Application Serial Number 12/894,383；

The U.S. Patent Application Serial Number 12/894 of entitled " Compressible Fastener Cartridge ", 389；

The United States Patent (USP) of entitled " Fasteners Supported By a Fastener Cartridge Support " Patent application serial numbers 12/894,345；

The U.S. Patent Application Serial Number 12/894,306 of entitled " Collapsible Fastener Cartridge "；

Entitled " Fastener System Comprising a Plurality of Connected Retention Matrix Elements " U.S. Patent Application Serial Number 12/894,318；

Entitled " Fastener System Comprising a Retention Matrix and an Alignment Matrix " U.S. Patent Application Serial Number 12/894,330；

The U.S. Patent application sequence of entitled " Fastener System Comprising a Retention Matrix " Row number 12/894,361；

Entitled " Fastening Instrument For Deploying a Fastener System Comprising a Retention Matrix " U.S. Patent Application Serial Number 12/894,367；

The U.S. of entitled " Fastener System Comprising a Retention Matrix and a Cover " State's patent application serial number 12/894,388；

Entitled " Fastener System Comprising a Plurality of Fastener Cartridges " U.S. Patent Application Serial Number 12/894,376；And

Entitled " Implantable Fastener Cartridge Comprising a Support Retainer " U.S. Patent Application Serial Number 12/894,369.

Present applicant also has following U.S. Patent application, and these patent applications are submitted on the same day with the application, And each each it is entirely incorporated into herein with way of reference:

Entitled " Tissue Thickness Compensator Comprising Portions Having Different Properties " U.S. Patent Application Serial Number _ _ _ _ _ _ _, attorney is END6849USCIP1/ 100534CIP1；

The U.S. of entitled " Staple Cartridge Comprising an Adjustable Distal Portion " State's patent application serial number _ _ _ _ _ _ _, attorney is END6847USCIP1/100532CIP1；

The United States Patent (USP) of entitled " Tissue Thickness Compensator For a Surgical Stapler " Patent application serial numbers _ _ _ _ _ _ _, attorney is END6736USCIP1/100060CIP1；

Entitled " Surgical Stapler Anvil Comprising a Plurality of Forming Pockets " U.S. Patent Application Serial Number _ _ _, attorney is END6735USCIP1/100059CIP1；

The U.S. Patent Application Serial Number of entitled " Staple Cartridge Loading Assembly " _ _ _ _ _ _ _, Attorney is END6855USCIP1/100540CIP1；

Entitled " Staple Cartridge Comprising a Variable Thickness Compressible Portion " U.S. Patent Application Serial Number _ _ _ _ _ _ _, attorney is END6840USCIP1/100525CIP1；

Entitled " Tissue Thickness Compensator Comprising Detachable Portions's " U.S. Patent Application Serial Number _ _, attorney is END6842USCIP1/100527CIP1；

Entitled " Tissue Thickness Compensator For a Surgical Stapler Comprising An Adjustable Anvil " U.S. Patent Application Serial Number _ _ _ _ _ _ _, attorney is END6843USCIP1/ 100528CIP1；

Entitled " Compressible Staple Cartridge Comprising Alignment Members's " U.S. Patent Application Serial Number _, attorney is END6856USCIP1/100541CIP1；

The United States Patent (USP) Shen of entitled " Staple Cartridge Comprising a Releasable Portion " Please serial number _ _ _ _ _ _ _, attorney is END6857USCIP1/100542CIP1；

Entitled " Staple Cartridge Comprising Compressible Distortion Resistant Components " U.S. Patent Application Serial Number _ _ _ _ _ _ _, attorney is END6858USCIP1/ 100543CIP1；

Entitled " Staple Cartridge Comprising a Tissue Thickness Compensator's " U.S. Patent Application Serial Number _ _ _ _ _ _ _, attorney is END6859USCIP1/100544CIP1；

Entitled " Staple Cartridge Comprising Staples Positioned Within a Compressible Portion Thereof " U.S. Patent Application Serial Number _ _ _ _ _ _ _, attorney is END6841USCIP1/100526CIP1。

Some exemplary embodiment be will now be described, to understand the knot of apparatus as disclosed herein and method on the whole Structure, function, manufacture and purposes.One or more examples of these embodiments are shown in the drawings.The ordinary skill people of this area Member it will be appreciated that apparatus and method specifically described herein and illustrated in the accompanying drawings are nonrestrictive exemplary embodiment, and And the scope of various embodiments of the invention is limited only by the appended claims.One exemplary embodiment is carried out graphic extension or retouched The feature stated, can be combined with the feature of other embodiments.This modification and version are intended to be included in the present invention Within the scope of.

" the various embodiment ", " some embodiments ", " embodiment " or " embodiment " that this specification is quoted in the whole text etc., Refer to that the specific features, structure or the characteristic that combine the description of described embodiment include at least one embodiment.Therefore, this explanation Phrase " in many embodiment " that book occurs in the whole text, " in certain embodiments ", " in one embodiment " or " in embodiment In " etc. be not necessarily all referring to identical embodiment.Additionally, in one or more embodiments, specific features, structure or characteristic can Combine in any suitable way.Therefore, without limitation, illustrate in conjunction with an embodiment or describe concrete special Levy, structure or characteristic can be combined with feature, structure or the characteristic of other embodiments one or more whole or in part.This repair Within reshaping formula and version are intended to be included in the scope of the present invention.

Terms used herein " nearside " and " distally " are for the clinician of manipulation of surgical apparatus handle portions 's.Term " nearside " refers to that the part near clinician, term " distally " refer to the part of clinician.Also should Understand, for succinct and clear for the sake of, this paper can in conjunction with accompanying drawing use such as " vertically ", " level ", "up" and "down" etc Spatial terminology.But, surgical instruments uses in many directions and position, and these terms nonrestrictive and/or exhausted To.

Provide various exemplary means and method to perform abdominal cavity mirror and micro-wound surgical operation operation.But, ability Those of ordinary skill in territory will readily appreciate that, various method and devices disclosed herein can be used for many surgical procedures And in application (including such as operating, with open surgery, the application combined).With continued reference to this detailed description of the invention, this Those of ordinary skill in field it will be appreciated that various apparatus disclosed herein can insert internal by any way, example As by nature tract, by the otch being formed in tissue or puncturing hole etc..The working portion of apparatus or end effector portion Divide to be plugged directly into and the most maybe can insert by having the entrance device of service aisle, the end effector of surgical instruments And slender axles can be advanced by described service aisle.

Seeing accompanying drawing, wherein in multiple views, the element that similar digitized representation is similar, Fig. 1 shows and can put into practice The surgical instruments 10 of multiple beneficial effect specific to the present invention.Surgery suturing appliance 10 is designed to handle and/or cause Move and be operably attached to the various forms of surgery suturing appliance 10 and the end effector 12 of size.In the reality shown in Fig. 1-1E Executing in example, such as end effector 12 includes elongated passageway 14, and this elongated passageway forms the lower jaw 13 of end effector 12.Carefully Long-channel 14 can support " implanted " nail bin 30 and also support the anvil of the upper jaw 15 being used as end effector 12 actively Seat 20.

In various embodiments, elongated passageway 14 can be made by such as 300 and 400 series, 17-4 and 17-7 rustless steel, titanium etc. Become, and formed together with spaced-apart sidewalls 16.Anvil block 20 can be by such as 300 and 400 series, 17-4 and 17-7 rustless steel, titanium etc. Making, and have nail shaped lower face, be generally designated as 22, described nail shaped lower face has and multiple is formed at nail therein Shape pit 23.See Figure 1B-1E.It addition, anvil block 20 has and is divided into two-part slide assemblies 24 from its proximad projection. Anvil block pin 26 from each cross side projection of slide assemblies 24, be contained in the respective slots in the sidewall 16 of elongated passageway 14 or In opening 18, thus be conducive to movable for anvil block pin or be pivotably attached to described respective slots or opening.

Various forms of implanted nail bins can be used together with the various embodiments of surgical instruments disclosed herein.Below Specific nail bin configuration and structure be will be discussed in more detail.But, in the embodiment shown in Figure 1A, it is shown that implanted nail bin 30.In at least one embodiment, nail bin 30 has main part 31, and supporting in this main part has multiple rows of unfashioned metal Nail 32, main part is by compressible hemostatic material (such as oxidized regenerated cellulose (ORC) or bioabsorbable foam) group Become.In at least certain embodiments, impacted for anti-non-magnetic shim and prevent hemostatic material introduce and position fixing process during be activated, Whole storehouse can be coated with or be enclosed with biodegradable film 38, such as with trade markThe six cyclic ketones films or sweet to gather sold Oil sebacate (PGS) film or with by PGA(polyglycolic acid, sells with trade mark Vicryl), PCL(polycaprolactone), PLA or PLLA(polylactic acid), PHA(polyhydroxyalkanoatefrom), PGCL(poliglecaprone 25, with trade mark Monocryl sell) or by PGA, Other biodegradable films that the complex of PCL, PLA, PDS is formed, described film is only the most permeable when rupturing.Nail bin 30 Main body 31 be sized to be supported on removedly in elongated passageway 14 as depicted so that when anvil block 20 is driven to During with nail bin 30 shaping contact, the nail that each nail 32 therein is all corresponding with anvil block shapes pit 23 and aligns.

In use, once end effector 12 positions adjacent to target tissue, and end effector 12 is just manipulated to target Tissue captures or is clamped between the top surface 36 of nail bin 30 and the nail profiled surface 22 of anvil block 20.Nail 32 is in the following way Shape: motion anvil block 20 in the path being arranged essentially parallel to elongated passageway 14, so that nail profiled surface 22 is the most therein Nail shapes pit 23 and substantially simultaneously contacts the top surface 36 of nail bin 30.When anvil block 20 continues to move in nail bin 30, nail The lower limb 34 of 32 contacts the nail of correspondence in anvil block 20 and shapes pit 23, and this nail shapes pit and is used for making nail lower limb 34 bend so that following closely 32 It is configured to " B shape ".Anvil block 20 will compress nail 32 further towards the motion further of elongated passageway 14, and makes nail 32 shape by a definite date The final forming height " FF " hoped.

Above-mentioned nail forming process is substantially illustrated in Figure 1B-1E.Such as, Figure 1B illustrates end effector 12, its group that hits Knit " T " between the top surface 36 of anvil block 20 and implanted nail bin 30.Fig. 1 C illustrates the initial clamped position of anvil block 20, its Middle anvil block 20 has been closed up to target tissue " T ", with target tissue " T " is clamped in anvil block 20 and nail bin 30 top surface 36 it Between.Fig. 1 D illustrates and initially follows closely shaping, and wherein anvil block 20 has started to compress nail bin 30 so that the lower limb 34 of nail 32 begins through anvil block 20 In nail shape pit 23 and shape.Fig. 1 E illustrates and is in the nail 32 of final shaped state through target tissue " T ", rises for clear See and remove anvil block 20.Once nail 32 shapes and is fastened to target tissue " T ", surgeon's just motion anvil block 20 to open position, To make warehouse 31 and nail 32 can remain attached to target tissue when withdrawing from end effector 12 from patient.When two jaws 13, 15 when jointly clamping, and end effector 12 makes all of nail shape simultaneously.Remaining " by conquassation " material of main part 31 is used as hemostasis Agent (ORC) and nail row strengthening agent (other film compositions 38 of PGA, PDS or any of above).Additionally, due to nail 32 is during shaping Warehouse 31 need not be left, therefore follow closely 32 probabilities becoming deformity during shaping and be minimized.As used herein, term " is planted Enter formula " refer to that the warehouse material for support nail also would be held in the patient and can be finally by patient body in addition to nail Absorb.This type of implanted nail bin is different from previous nail bin structure, this previous nail bin structure after it is by percussion still Intactly it is positioned in end effector.

In various being embodied as, end effector 12 can be connected to from the prominent slender axles assembly of shank assembly 100 40.End effector 12(is when Guan Bi) and slender axles assembly 40 can have a similar shape of cross section, and its size sets Become operationally through trocar tube or the service aisle in another access instruments form.As used herein, term is " operationally Pass " refer to can inserting by passage or tube opening or may pass through passage at least partially of end effector and slender axles assembly Or tube opening, and if necessary in passage or tube opening, it can be handled surgery stitching operation.Implement at some In example, when in the closed position, the jaw 13 and 15 of end effector 12 can be the horizontal stroke that end effector provides circular Cross sectional shape is beneficial to it through circular passage/opening.It is contemplated, however, that the end effector of various embodiments of the present invention And slender axles Assemblies Example has other shape of cross sections, thus may pass through and there is the entrance of non-circular transverse cross-section lead to Road and opening.Therefore, the overall dimension of the cross section of the end effector of Guan Bi by with end effector by the passage passed or The size of opening is correlated with.Therefore, an end effector is such as referred to alternatively as " 5mm " end effector, and this refers to that it can The opening of about 5mm operatively it is at least through diameter.

In many embodiment, slender axles assembly 40 can have and the external diameter of end effector in the closed position 12 Of substantially equal external diameter.Such as, 5mm end effector can be connected to the slender axles assembly 40 with 5mm cross-sectional diameter.So And, with continued reference to this detailed description of the invention, it will be apparent that, various embodiments of the present invention can be effectively combined different chi Very little end effector uses.Such as, 10mm end effector could attach to the slender axles with 5mm cross-sectional diameter.On the contrary, For the application entering opening or passage wherein providing 10mm or bigger, slender axles assembly 40 can have 10mm(or more Cross-sectional diameter greatly), but also be able to activate 5mm or 10mm end effector.Therefore, the external diameter of outer shaft 40 can be attached to it The external diameter of end effector 12 of Guan Bi identical or different.

As it can be seen, slender axles assembly 40 is distally extending substantially along straight line from shank assembly 100, to limit longitudinal axis A-A.In various embodiments, such as slender axles assembly 40 may be about 9-16 inch (229-406mm) length.But, slender axles Assembly 40 may be configured as other length, and in other embodiments, can have joint or in other words can in slender axles assembly Enough be conducive to end effector 12 to carry out hinged relative to other parts of axle or shank assembly, below will be discussed in more detail. In various embodiments, slender axles assembly 40 includes ridge component 50, and this ridge component extends to end effector from shank assembly 100 12.The near-end of the elongated passageway 14 of end effector 12 has a pair holding lug 17 from its projection, and this is to keeping lug It is sized to be contained in the corresponding lug opening provided in the far-end of ridge component 50 or support 52, so that end performs Device 12 can couple slender axles assembly 40 removedly.Ridge component 50 can be made by such as 6061 or 7075 aluminum, rustless steel, titanium etc. Become.

In various embodiments, shank assembly 100 includes that pistol grasps shell body, and described pistol grasps shell body and can be added Work becomes two or more parts for assembling.Such as, shank assembly 100 as depicted includes by polymer or plasticity material Material molding or be in other words processed into and be designed to right hand housing member 102 and the left hand housing member being combined together (not shown).Can by the snap arrangement, bolt and the pod that mould wherein or in other words formed and/or by binding agent, Screw etc. and this type of housing member is attached together.Ridge component 50 has near-end 54, is formed with flange 56 on this near-end.Convex Edge 56 can be rotationally supported in groove 106, and this groove is by from housing member 102, each the joining to inner process in 104 Close rib 108 to be formed.This structure beneficially ridge component 50 is attached to shank assembly 100, makes the ridge component 50 can be relative to simultaneously Shank assembly 100 rotates along 360 ° of paths around longitudinal axis A-A.

As in FIG it can further be shown that ridge component 50 is through installing axle bush 60 and being supported by installing axle bush 60, this installation Axle bush is pivotally attached to shank assembly 100.Axle bush 60 is installed there is proximal flange 62 and distal lip 64, this proximal flange Limiting rotated trench 65 with distal lip, the leading edge portion 101 of shank assembly 100 can rotatably be accommodated by this rotated trench Betwixt.This structure makes installation axle bush 60 can rotate around longitudinal axis A-A relative to shank assembly 100.Ridge component 50 By ridge pin 66 non-rotatably pin joint to installing axle bush 60.It addition, rotary knob 70 is attached to install axle bush 60.A reality Executing in example, rotary knob 70 has hollow mounting flange portion 72, and being sized to of this hollow mounting flange portion will install axle bush The part of 60 is contained therein.In various embodiments, rotary knob 70 can be by such as glass or carbon filled nylon, poly-carbonic acid Ester,Etc. processing, and it is attached to axle bush 60 is installed also by ridge pin 66.It addition, to the holding flange of inner process 74 are formed in mounting flange portion 72 and can extend to be formed in the radial groove 68 installed in axle bush 60.Therefore, surgery Doctor can be by promptly rotary knob 70 and make it rotate relative to shank assembly 100 and make ridge component 50(and be attached to ridge structure The end effector 12 of part 50) rotate around longitudinal axis A-A along 360 ° of paths.

In various embodiments, anvil block 20 is maintained at open position by anvil block spring 21 and/or another biased configuration.Anvil Seat 20 can optionally move to various Guan Bi or clamped position and firing position by trigger system from open position, described Trigger system is generally indicated at 109.Trigger system 109 includes " firing member " 110, in various embodiments, " should fire structure Part " include hollow firing tube 110.Hollow firing tube 110 can axially-movable on ridge component 50, therefore formation slender axles assembly 40 Outside.Firing tube 110 can be formed by polymer or other suitable materials processing, and have and be attached to trigger system 109 The near-end of percussion yoke 114.The most in various embodiments, the percussion moldable near-end to firing tube 110 of yoke 114.But, it is possible to Use other fastener constructions.

As can be seen in Figure 1, percussion yoke 114 can be pivotally supported in support lining ring 120, this support lining ring energy Enough axially-movables in shank assembly 100.In various embodiments, support lining ring 120 and there is a pair the fin extended laterally, should It is sized to fin be slidably received within the fin slit being formed in left hand housing member and right hand housing member In.Therefore, supporting lining ring 120 can slide axially in shank housing 100, makes percussion yoke 114 and the firing tube 110 can phase simultaneously Rotate around longitudinal axis A-A for supporting lining ring 120.In various embodiments, it is provided with the narrowest through firing tube 110 Groove, so that ridge pin 66 can extend in ridge component 50 through longitudinal slit, the most beneficially firing tube 110 is on ridge component 50 Axially advance.

Trigger system 109 also includes firing trigger 130, and this percussion trigger is used for controlling firing tube 110 at ridge component Axial traveling on 50.See Fig. 1.The axially-movable generation in a distal direction of this type of firing tube 110 and the percussion of anvil block 20 Interaction is referred to herein as " percussion motion ".As can be seen in Figure 1, percussion trigger 130 can be transported by pivot pin 132 Move or be pivotally coupled to shank assembly 100.Use torsionspring 135 to bias percussion trigger 130 and make it away from shank " opening " or the original position that the pistol grip portion 107 of assembly 100 and arriving does not activates.As can be seen in Figure 1, percussion is touched Sending out device 130 and have top 134, this top is attached (pin joint) movingly and arrives percussion chain link 136, and this percussion chain link is the most attached Connect (pin joint) to supporting lining ring 120.Therefore, trigger 130 is fired from original position (Fig. 1) to the hands of adjacent hub parts 100 The end position motion of pistol grip 107 will make percussion yoke 114 and firing tube 110 move along distal direction " DD ".Percussion is touched Send out device 130 will make away from the motion (under the bias of torsionspring 135) of the pistol grip portion 107 of shank assembly 100 Percussion yoke 114 and firing tube 110 move along proximal direction " PD " on ridge component 50.

Various embodiments of the present invention can be used together with the implanted nail bin of different size and configuration.Such as, when with One percussion adapter 140 is when being used in combination, and surgical instruments 10 can be with about 20mm length (or the tool for supporting implanted nail bin 30 Have other length) 5mm end effector 12 be used together.This end effector size can be particularly well-suited in the most real The dissection of existing opposite fine and management of blood vessels.But, as hereafter institute is described in more detail, the most also can be by by the first percussion linking Son 140 is replaced by the second percussion adapter and surgical instruments 10 is used in combination with end effector and the nail bin of other sizes. In further embodiments, slender axles assembly 40 can be attached to the end effector of a kind of form or size.

To explain a kind of method for end effector 12 is removably coupled to ridge component 50 now.By by thin Holding lug 17 on long-channel 14 inserts in the lug support 52 in ridge component 50 and starts connection process.Subsequently, surgery doctor Percussion trigger 130 is advanced by life towards the pistol grip 107 of casing assembly 100, with by firing tube 110 and the first percussion linking Son 140 is advanced on the proximal part 47 of elongated passageway 14 towards distally, thus lug 17 is maintained at its respective support 52 In.First percussion adapter 140 this type of position on lug 17 is referred to herein as " coupled position ".The present invention's is various Embodiment also can have end effector locked component, will fire for after being attached to ridge component 50 at end effector 12 Trigger 130 locks in place.

More specifically, end effector locked component 160 embodiment includes retaining pin 162, this retaining pin can be transported It is supported in the top 134 of percussion trigger 130 dynamicly.As it has been described above, first firing tube 110 must be advanced connection towards distally Connecing position, wherein, the lug 17 that keeps of end effector 12 is maintained at the lug in ridge component 50 by the first percussion adapter 140 In support 52.Surgeon will be by firing adapter from original position towards pistol grip 107 tractive percussion trigger 130 140 distally advance to coupled position.When firing trigger 130 and first activating, retaining pin 162 is towards distal movement, until hitting Sending out pipe 110 and first percussion adapter 140 is advanced to coupled position, now retaining pin 162 is biased to be formed at housing member In latch well 164 in.In various embodiments, when retaining pin 162 enters in latch well 164, pin 162 can send audible " clicker " sound or other sound, and can provide what end effector 12 had been " locked " on ridge component 50 to touch for surgeon Feel and indicate.As long as it addition, the most wittingly retaining pin 162 is biased out latch well 164, surgeon just will not activate unintentionally and hit Send out trigger 130 to start to make the nail 32 in end effector 12 shape.Similarly, if surgeon's release is in connection position The percussion trigger 130 put, then retaining pin 162 can make percussion trigger 130 be maintained at this position, to prevent from firing trigger 130 are back to original position and therefore discharge end effector 12 from ridge component 50.

Various embodiments of the present invention may also include trigger system locking press button 137, and this trigger system locking press button is with energy Enough pivotably it is attached to shank assembly 100.In one form, trigger system locking press button 137 has on its distal end The breech lock 138 formed, this breech lock is oriented to the breech lock 138 when percussion release button is in the first position latching and engages percussion yoke 114.As can be seen in Figure 1, late spring 139 is for being biased to the first position latching by trigger system locking press button 137.? In the case of various, breech lock 138 is for engaging percussion yoke 114 at following point: at this point, the percussion yoke 114 on ridge component 50 Position corresponding to wherein first percussion adapter 140 will towards be distally advanced on anvil block 20 clamping slideway 28 on point. Should be appreciated that anvil block 20 will move along path, and make along with the first percussion adapter 140 axially advances on clamping slideway 28 Forming surface portion 22 must be followed closely and be arranged essentially parallel to the top surface 36 of nail bin 30.

After end effector 12 is connected to ridge component 50, open by first depressing trigger system locking press button 137 Begin nail forming process so that percussion yoke 114 can on ridge component 50 further distal motion and the most at last anvil block 20 compress To nail bin 30.After pressure trigger system locking press button 137, surgeon continues to activate percussion towards pistol grip 107 Trigger 130, thus the nail that the first nail lining ring 140 is driven into correspondence shapes on slideway 29, to force anvil block 20 and nail bin 30 In nail 32 shaping contact.Trigger system locking press button 137 prevents from being ready to start to make before following closely forming process surgeon Nail 32 is unexpected to be shaped.In this type of embodiment, surgeon can must depress before being further actuated at percussion trigger 130 Trigger system locking press button 137 is to start to follow closely forming process.

Surgical instruments 10 optionally can be used only as tissue apposition device.But, various embodiments of the present invention also can be wrapped Including tissue diced system, this tissue diced system is generally indicated at 170.In at least one form, organize diced system 170 Including cutter component 172, can be by activating cutter traveling trigger 200 by this cutter component optionally from adjacent end executor's 12 The unactuated position of near-end is advanced to actuated position.Cutter component 172 is movably supported in ridge component 50 and is attached to knife bar 180 or in other words from knife bar 180 projection.Cutter component 172 can be by such as having more than 38HRC(RHC) hardness 420 or 440 rustless steels process, and can have the tissue cutting edge 176 being formed on its far-end 174, and can Slidably extend through the slit in anvil block 20 and the slit 33 being centrally located in nail bin 30, be clamped in end hold to cut through Tissue in row device 12.In various embodiments, knife bar 180 extends through ridge component 50 and has and cutter transporter transmission friendship The proximal part connect, this cutter transporter is operably attached to cutter traveling trigger 200.In various embodiments, cutter is advanced Trigger 200 is attached to pivot pin 132 so that cutter traveling trigger 200 can be in the case of without activating percussion trigger 130 It is pivoted or in other words activated.In various embodiments, the first cutter tooth wheel 192 is also attached to pivot pin 132 so that cutter The actuating of traveling trigger 200 also makes the first cutter tooth wheel 192 pivot.It is attached with between first cutter tooth wheel 192 and shank housing 100 Percussion return spring 202, is biased to original position or unactuated position with trigger 200 of being advanced by cutter.

The various embodiments of cutter transporter also include the second cutter tooth wheel 194, and this second cutter tooth wheel is pivotally supported at Engage on second gear shaft and with the first cutter tooth wheel 192.Second cutter tooth wheel 194 and the 3rd cutter tooth being supported on the 3rd gear shaft Wheel 196 engagement.4th cutter tooth wheel 198 is also supported on the 3rd gear shaft 195.4th cutter tooth wheel 198 can be positioned at by transmission joint A series of gear teeth on the near-end of knife bar 180 or ring.Therefore, this structure makes the 4th cutter tooth wheel 198 can be along distally Direction " DD " or proximal direction " PD " axially drive knife bar 180, make trigger shaft 180 enclose relative to the 4th cutter tooth wheel 198 simultaneously Rotate around longitudinal axis A-A.Therefore, surgeon can touch by advancing towards the pistol grip 107 tractive cutter of shank assembly 100 Send out device 200 and make trigger shaft 180 axially advance and all morning distally promotion cutter component 172.

Various embodiments of the present invention also include cutter locking system 210, and this cutter locking system prevents pushing away of cutter component 172 Enter, unless percussion trigger 130 has been pulled to complete firing position.Therefore, this structure will prevent cutter propulsion system 170 Activate, unless first nail is fired or form in tissue.As can be seen in Figure 1, cutter locking system 210 various specifically Implementing to include cutter securing rod 211, this cutter securing rod is by can pivotably be supported on the pistol grip of shank assembly 100 In portion 107.Cutter securing rod 211 has activated end 212, when firing trigger 130 and being in complete firing position, and activated end 212 Can be engaged by percussion trigger 130.It addition, cutter securing rod 211 has holding suspension hook 214 on the other end thereof, this holding is hung Hook can engage the latch bar 216 on the first cutting gear 192 in suspension hook mode.Cutter locking spring 218 is used to be locked by cutter Bar 211 is biased to " locking " position.In this " locks " position, suspension hook 214 is kept to keep engaging with latch bar 216, thus anti- The only actuating of cutter traveling trigger 200, unless percussion trigger 130 is in complete firing position.

Nail be " fired " (shaping) to after in target tissue, surgeon can depress percussion trigger release button 167, So that percussion trigger 130 can be back to original position, so that anvil block 20 can under the bias of torsionspring 135 Bias at spring 21 biases downwards into open position.When in open position, surgeon can withdraw from end effector 12 and leave implanted nail bin 30 and nail 32.During end effector passes the application that passage, service aisle etc. insert wherein, outward Section doctor will make anvil block 20 be back to make position, so that end effector 12 can lead to by activating percussion trigger 130 Cross described passage or service aisle is withdrawn by.But, if surgeon wants to cut target tissue, then surgery after percussion nail Doctor activates cutter traveling trigger 200 in the above described manner, to drive knife bar 172 to arrive the end of end effector through target tissue Portion.Subsequently, surgeon's releasable cutter traveling trigger 200, so that percussion return spring 202 can make percussion transporter incite somebody to action Knife bar 172 is back to initiate (actuating) position.Once knife bar 172 is back to original position, and surgeon just can open end Executor's jaw 13,15, to be released to implanted storehouse 30 in the patient and subsequently from withdrawing from end effector 12 in the patient. Therefore, this type of surgical instruments is conducive to using the little implanted nail that can be inserted by relatively small service aisle and path Storehouse, provides selection as follows for surgeon: after percussion is followed closely or followed closely if necessary in percussion in the case of not cutting tissue simultaneously Also cut tissue.

The various uniquenesses of the present invention and new embodiment use compressible nail bin, and described compressible nail bin supports and is in Substantially fixed position is for the nail by anvil block shaping contact.In various embodiments, during anvil block is driven to unshaped nail. Wherein, at least one this type of embodiment, the degree that the nail reached shapes depends on how far anvil block is driven in nail.This Class formation allows a surgeon to regulation and applies shaping or the size of percussion pressure to nail, thus changes the final shaping of nail Highly.In other various embodiments of the present invention, surgical stapling structure can use nail to drive element, and this nail drives the element can be by Nail lifts towards anvil block.Hereafter this type of embodiment is described in more detail.

In various embodiments, with reference to the embodiment of foregoing detailed description, be applied to movable anvil block fires the big of motion The little degree depending on firing the actuating of trigger.Such as, if surgeon goes for the nail that only part shapes, the most only need Percussion trigger is partially inwardly depressed towards pistol grip 107.Wanting to obtain and more follow closely shaping, surgeon only needs into one Step compresses percussion trigger so that anvil block is driven to contact to form with nail further.As used herein, term " shapes Contact " refer to follow closely profiled surface or the end of nail shaping pit contact stud lower limb and have started to be shaped by lower limb or bend to becoming morpheme Put.The degree that nail shapes refers to follow closely the degree that lower limb is folded and the forming height finally referring to nail referred to above.This area In those of ordinary skill it will be appreciated that because to anvil block 20 apply percussion motion time, anvil block 20 be with nail bin base Relation parallel in basis is moved, so nail substantially simultaneously shapes and has substantially the same forming height.

Fig. 2 and Fig. 3 shows alternative end effector 12 ", divided by the lower difference that can accommodate knife bar 172 ' Outside, end effector 12 " it is similar to above-mentioned end effector 12 '.Knife bar 172 ' is connected to knife bar 180 or dashes forward from knife bar 180 Rise, and in addition operate in the way of above in connection with described in knife bar 172.But, in this embodiment, knife bar 172 ' long enoughs are to traverse end effector 12 " whole length, therefore end effector 12 " in be provided without single distal blade Component.Be formed on knife bar 172 ' crosscutting component 173 ' and under crosscutting component 175 '.Upper crosscutting component 173 ' is oriented to can The most crosscutting anvil block 20 " in corresponding elongated slot 250, and under crosscutting component 175 ' be oriented to crosscut end executor 12 " elongated passageway 14 " in elongated slot 252.Also at anvil block 20 " middle offer disengaging slit (not shown) so that work as knife bar 172 ' are driven to end effector 12 " in end position time, upper crosscutting component 173 ' is fallen by corresponding slit, makes anvil Seat 20 " open position can be moved to, depart from the tissue being sewn and cutting.Anvil block 20 " can in addition with above-mentioned anvil block 20 Identical, and elongated passageway 14 " can be in addition identical with above-mentioned elongated passageway 14.

In these embodiments, anvil block 20 " it is biased to fully open position by spring or other Unclosing structure (not shown) (Fig. 2).Anvil block 20 " by percussion adapter 150 axially advance in the above described manner open position and fully clamped position it Between move.Once percussion adapter 150 is advanced into fully clamped position (Fig. 3), and surgeon the most just can court in the above described manner Distally makes knife bar 172 " advance.If surgeon wants that end effector is used as grasp device carrys out manipulating tissue, then can be by Percussion adapter proximally moves, to allow anvil block 20 " away from elongated passageway 14 " motion, as shown in phantom in figure 4.At this In embodiment, when knife bar 172 " towards distal movement time, upper crosscutting component 173 ' and under crosscutting component 175 ' tractive anvil block 20 simultaneously " And elongated passageway 14 ", with at knife bar 172 " through end effector 12 " obtain desired nail shaping when advancing towards distally.See Fig. 5.Therefore, in this embodiment, nail shapes and occurs with tissue cutting simultaneously, but nail itself can be at knife bar 172 " driven towards distally Sequentially shape time dynamic.

The various surgery nail bins of the present invention and the uniqueness of surgical instruments and novel structure enable the nail in described nail bin It is arranged in one or more row linearly or nonlinearly.This type of nail row multiple can be provided with on each side of elongated slot, described Elongated slot is centrally positioned in nail bin, accommodates tissue cutting element for through described elongated slot.Arrange in one In mode, such as the nail in one row can be substantially parallel to be positioned at the adjacent nail followed closely in row but offset from it.Real at other Executing in example, one or more nail row can be essentially nonlinear.In other words, the base portion of at least one nail in nail row can edge Substantially crosscutting with the base portion of other nails in same nail row axis extends.Such as, as hereafter will be discussed in more detail, can In selective embodiment, the nail row on each side of elongated slot can have sawtooth appearance.With in the nail bin of prior art The various linear nail arrangement mode used is compared, and this type of nonlinear nail arrangement mode can use less nail to obtain preferably Tissue tightening results.

Fig. 6 shows the use of end effector embodiment 612 ' Chinese and foreign department nail bin embodiment 900.As in figure 6 and figure 7 Can be seen that, the embodiment of surgery nail bin 900 has warehouse 902, and this warehouse has the elongated slot 904 being centrally located, and this is elongated Slit extends to the region adjacent with far-end 905 through near-end 903.Elongated slot 904 can carry out group in the above described manner Allow during knitting cutting operation that cutter main body is through elongated slot 904 axially-movable.In at least one embodiment, warehouse 902 by Such as oxidized regenerated cellulose (ORC) or such as by PGA(polyglycolic acid, sells with trade mark Vicryl), PCL(polycaprolactone), PLA or PLLA(polylactic acid), PDS(PPDO), PHA(polyhydroxyalkanoatefrom), PGCL(poliglecaprone 25, with Trade mark Monocryl sells) or the bioabsorbable foam that processes of the complex of PGA, PCL, PLA and PDS etc. compressible Hemostatic material composition, in described compressible hemostatic material support have unshaped nail 922 formation row 920,930.But, Warehouse 902 also can be processed by other materials, and this material is for being supported on unshaped nail 922 in expectation orientation so that when When anvil block 910 ' contacts with unshaped nail 922, unshaped nail 922 can be compressed.As above-mentioned other embodiments various, nail bin 900 is implanted, and completes the tissue remaining attached to afterwards be sewn at suture operation.In at least certain embodiments, And hemostatic material impacted for anti-non-magnetic shim 922 is introducing and is being activated during position fixing process, and whole storehouse 900 can be coated with or wrap It is wrapped in biodegradable film 906, such as with trade markThe six cyclic ketones films sold or polyglycerol sebacate (PGS) Film or such as by PGA(polyglycolic acid, sells with trade mark Vicryl), PCL(polycaprolactone), PLA or PLLA(polylactic acid), PHA (polyhydroxyalkanoatefrom), PGCL(poliglecaprone 25, sell with trade mark Monocryl) or the complex of PGA, PCL, PLA, PDS The film formed, described film is only the most permeable when rupturing.Being sized to of the warehouse 902 of nail bin 900 supports removedly In the elongated passageway of end effector 612 '.

In the embodiment shown in Fig. 6, Figure 10 and Figure 11, surgery nail bin 900 is operationally in the one of elongated slot 904 The first row 920 that on individual cross side 907, support nail 922 is formed, and support nail on another cross side 909 of elongated slot 904 The 2nd 930 of 922 formation.In various embodiments, nail 922 can be by such as titanium, titanium alloy (such as 6Al-4V titanium, 3al-2.5V Titanium), stainless steel and other metal materials process and have nail base portion 924 and from nail base portion 924 projection two upright nails Lower limb 926.Tissue-piercing tips 928 can be formed with on each nail lower limb 926.In the first row 920 of nail 922 formation, at least one The nail base portion 924 of nail 922 is overlapping with the nail base portion of another nail 922.In a preferred embodiment, except being positioned at the first nail row Outside the base portion 924 of the last nail 922 on 920 each ends, nail all adjacent with two nail 922 of base portion 924 of each nail 922 Nail base portion 924 is overlapping.See Figure 10.Therefore, the first nail row 920 has the most nonlinear shape.More specifically, when from upper When side is observed, the first nail row 920 has the most zigzag outward appearance.

As can be seen that in fig .9, anvil block 90 has the longitudinal direction nail of two orders and shapes pit 912, follows closely shaping longitudinally in each Pit 912 has the most zigzag shape corresponding with the shape of the first row 920 of nail 922 formation so that when anvil block 910 With nail 922 form contact time, the lower limb 926 of nail shapes as shown in figure 11.Therefore, the far leg of a nail is with in the vertical The near leg of next nail shares same pit.This structure can form more dense pit pattern, even up to follows closely and self enters The degree of row interaction (such as stride across and fold each other).In the nail bowl configurations of prior art, in general, one group recessed Metal/the space between 0.005 inch to 0.015 inch must be had between hole and next group pit.But, the such as present invention This type of embodiment there is the interference/section gap structure of 0 to 0.02 inch (substantially, a-0.020 "), this is because one Follow closely and coordinate with next nail.This structure makes it possible to include having more the nail of 15% to 30% in identical space.Additionally, when each During nail interlocking, the demand of multiple lateral staples is reduced.Existing structure generally uses three on each side of tissue cut line Nail, to prevent from there is the open approach that blood can flow through.The probability in the path that pinning row formation blood can flow through is less mutually. Another clear advantage that the various interlocking pin structures of the present invention are provided relates to and tears the size phase of power needed for nail row opening " rupture strength " of the improvement closed.

Another nail shapes the nail shaping pit that pocket configuration can include sharing.As used herein, " shared nail becomes term Shape pit " refer to, with the anvil block that wherein each lower limb for each preformation staple arranges the prior art being individually formed pit Design difference, one shapes pit and all nails in single nail row can be made to shape.

Figure 12 illustrates that another follows closely embodiment 922 ', and wherein base portion 924 ' has offset part 929, is beneficial to each base portion 924 ' and enters Row is overlapping more closely.As it has been described above, nail bin 900 has the nail 922 on the second cross side 909 being supported on elongated slot 904 The second row 930.Second row 930 of nail 922 is substantially the same with the first row 920 of nail 922.Therefore, anvil block 910 has correspondence Share nail in the second of the second nail row 930 and shape pit 912, to follow closely row 930 shaping contact with second.But, available Embodiment in, the second row 930 of nail 922 can in shape and may be different from the first nail row 920 following closely on number.

Fig. 8 illustrates surgery nail bin 900 ', in addition to being supported on the row 920 ', 930 ' that nail 922 therein is formed, and surgery nail bin 900 ' is substantially the same with above-mentioned nail bin 900.Such as, in this embodiment, the line 920 ' of nail 922 is relative to each other set to and makes Obtain the nail base portion 924 of base portion axis S-S at least one another adjacent nail 922 substantially transverse of at least one nail base portion 924 Base portion axis S-S.When viewed from above, this type of predetermined nail pattern includes the most zigzag arrangement.Shown in Figure 13 Embodiment in, nail 922 each base portion 924 on additionally can have base support member 927, as shown in the figure by overmolding.Various In embodiment, base support member 927 can be by the plastics (such as polyether-ether-ketone " PEEK ") or absorbable of such as nonabsorable Plastics (such as polyglycolic acid " PGA ", polylactic acid " PLA " or " PLLA ", PPDO " PDS ", PCL(polycaprolactone), PHA(polyhydroxyalkanoatefrom), PGCL(poliglecaprone 25, with trade mark Monocryl sell) or PGS, PDS, PLA, PGA and The various compound mixtures of PCL) process.Base support member 927 is conducive to making in the case of not making nail self overlap Interlock between each nail.Therefore, this class formation can make in the case of not making the lower limb overlap of nail self nail be configured to " B " shape or " W " shape.But, owing to bizet is connected by base support member, therefore bizet works as overlapping nail.This type of structure Make and make combination pit have two discreet paths for each lower limb.

Embodiment shown in Figure 14 uses nail row 920 ", at nail row 920 " in, the lower limb 926 of neighbouring nail 922 is by with molding Or other modes are attached to the coupling part 929 of lower limb 926 and are linked together.Each coupling part 929 can be by such as polyethers Ether ketone " PEEK " or absorbable plastics (such as polyglycolic acid " PGA ", polylactic acid " PLA " or " PLLA ", PPDO " PDS ", PCL(polycaprolactone), PHA(polyhydroxyalkanoatefrom), PGCL(poliglecaprone 25, with trade mark Monocryl sell) or The various compound mixtures of PGS, PDS, PLA, PGA and PCL) process.When viewed from above, this type of nail row 920 " tool There is the most zigzag outward appearance.Although having combined making for explaining various surgery nail bin embodiment of end effector 612 ' 900,900 ', it being understood, however, that nail bin 900,900 ' can effectively with other end effectors various mentioned above and outer Section's apparatus is used together.The anvil block of these apparatuses is wherein provided with suitably nail and shapes bowl configurations, in order to move at anvil block Desired nail shaping amount is reached to during with nail shaping contact.

Figure 15 and Figure 16 shows that another surgery nail bin 940 in the elongated passageway 14 being supported on surgical instruments 10 is real Execute example.In at least one embodiment, surgery nail bin 940 includes warehouse 942, and this warehouse has the elongated slot being centrally located 944, this elongated slot extends at least partially through warehouse 942.Elongated slot 944 can be cut carrying out tissue in the above described manner Allow during cutting operation that the cutter main body of surgical instruments 10 is axially movable through elongated slot 944.In various embodiments, warehouse 942 by compressible hemostasis such as the bioabsorbable foams of the above-mentioned or following type of such as oxidized regenerated cellulose (ORC) Material form, in described hemostatic material support have unshaped nail 922 formation row 946,948,950, and 952.At least some of In embodiment, and hemostatic material impacted for anti-non-magnetic shim 922 is introducing and is being activated during position fixing process, and whole storehouse 940 can It is coated with or is wrapped in biodegradable film 954, such as with trade markThe six cyclic ketones films sold or polyglycereol last of the ten Heavenly stems two Acid esters (PGS) film or such as by PGA(polyglycolic acid, sells with trade mark Vicryl), PCL(polycaprolactone), PLA or PLLA(gather Lactic acid), PHA(polyhydroxyalkanoatefrom), PGCL(poliglecaprone 25, with trade mark Monocryl sell) or PGA, PCL, PLA, The film that the complex of PDS is formed, described film is only the most permeable when rupturing.

In the embodiment shown in fig. 15, storehouse 940 also includes the storehouse supporting member 960 being connected to warehouse 942.In various realities Executing in example, storehouse supporting member 960 can be by rigid metal processing such as any alloys that such as titanium, rustless steel, aluminum, above-mentioned material are formed Form, and can be partially embedded in warehouse 942.In various embodiments, storehouse supporting member 960 just can be kept by such as film 954 Position.In other embodiments needing restricted combination, can sporadically use cyanoacrylate adhesive by two units Part " glued " is together.In further embodiments, warehouse 942 can be heated also " welding " or " melting " to storehouse supporting member 960.In various embodiments, storehouse supporting member 960 formed warehouse 942 lower surface at least some of with elongated passageway 14 coordinate.In at least one embodiment, storehouse supporting member 960 has the one or more snap arrangement 962 from its projection, uses In storehouse supporting member 960 is releasably attached to elongated passageway 14.Snap arrangement/the fastener constructions of other forms can be used Storehouse supporting member 960 is releasably attached to elongated passageway 14.

In various embodiments, storehouse supporting member 960 is formed with a series of support ridge 964,966,968,970,972, 974,976, with to nail row 946, the base portion 924 of the nail 922 in 948,950,952 provides some lateral support, as shown in figure 15. Therefore, at least certain embodiments, support ridge is the most coextensive with nail row.Figure 17 illustrates alternative basic with storehouse 940 The most identical upper nail bin embodiment 940 ', difference is, nail bin embodiment 940 ' includes respectively from support ridge 964,966, 968,970,972,976 projections with to nail 922 offer extra lateral support upstanding fins parts 978,979,980,981, 982,983.In various embodiments, finless parts can form as one with storehouse supporting member 960, and it highly may be about 1/2 or less than storehouse height.Therefore, in various embodiments, any rising structure being such as used for supporting foam all cannot extend More than the solid height of foam.Therefore, if storehouse is designed to such as be compressed to its original height when firing 1/3, then 66% on the way down between the 10% of uncompressed height by uncompressed height of fin.

In use, once nail 922 is shaped by contact anvil block 20 in the above described manner, then open and anvil block 20 by end Portion executor 12 is pulled away from sutured tissue.When end effector 12 is pulled away from sutured tissue, warehouse 942 keeps fastening To sutured tissue and separate with the storehouse supporting member 960 remaining coupled to elongated passageway 14 subsequently.In various embodiments, The color of storehouse supporting member 960 is different from color and the color of elongated passageway 14 of the material including warehouse 942.This type of is arranged The instruction that can easily identify that there is not nail bin in end effector is provided for surgeon.Therefore, surgeon will not be not intended to Ground attempts in the case of not installing new nail bin in end effector again insertable into/use end effector.To this end, surgery Doctor only needs the snap arrangement making storehouse supporting member 960 to depart from from elongated passageway 14, so that the storehouse supporting member of new nail bin 940 960 can be placed in elongated passageway 14.Although explaining nail bin 940 in conjunction with surgical instruments 10,940 ', it being understood, however, that Under conditions of without departing substantially from the spirit and scope of the invention, these storehouses can effectively with other surgery devices of many disclosed herein Tool embodiment is used together.

In various embodiments, nail bin can include warehouse and the multiple nails being stored in warehouse.In use, can be by nail bin Introduce in operative site and be located on the side of handled tissue.It addition, nail can be shaped anvil block to be positioned at tissue On opposite side.In various embodiments, anvil block wherein first can be clamped by the second jaw carrying by the first jaw carrying and nail bin Mouth and/or the second jaw can move towards another jaw.Once nail bin and anvil block are relative to tissue positioned, then can penetrate from staple cartridge body Go out nail so that the pierceable tissue of nail contact stud shape anvil block.From staple cartridge body, once dispose nail, then can remove from operative site Staple cartridge body.In various embodiments disclosed herein, nail bin or nail bin at least some of in implantable have nail.At least one In this type of embodiment individual, as being hereafter more fully described, nail bin can include warehouse, when anvil block moves to Guan Bi from open position During position, described warehouse can be compressed by described anvil block, conquassation and/or collapse.When warehouse compressed, conquassation and/or when collapsing, position Nail in warehouse can be deformed by anvil block.Alternatively, the jaw being used for supporting nail bin can move towards anvil block To make position.In any one of two kinds of situations, in various embodiments, when nail is at least partially situated in warehouse, nail Deformable.In certain embodiments, nail can not be shot up from nail bin, and in certain embodiments, nail can be with the one of warehouse Divide and be shot up from nail bin together.

Referring now to Figure 18 A-18D, compressible nail bin (such as nail bin 1000) such as can include compressible, implanted warehouse 1010, and it is positioned at the multiple nails 1020 in compressible warehouse 1010 in addition, but Figure 18 A-18D only illustrates a nail 1020.Figure 18A illustrates the nail bin 1000 supported by nail bin support member or staple cartridge channel 1030, and wherein nail bin 1000 is shown at uncompressed State.In this type of uncompressed state, anvil block 1040 can contact or not contact tissue T.In use, anvil block 1040 can be from opening Position moves to contact tissue T, as shown in figure 18b, and tissue T is positioned against warehouse 1010.Even if anvil block 1040 can be by Tissue T is located against the tissue contacting surface 1019 of staple cartridge body 1010, but refers again to Figure 18 B, and staple cartridge body 1010 is now By few (if any) compression stress or pressure, and 1020 can be followed closely it is positively retained at unshaped or non-cock.As Shown in Figure 18 A and Figure 18 B, staple cartridge body 1010 can include one or more layer, and follow closely the nail lower limb 1021 of 1020 and may pass through these Layer upwardly extends.In various embodiments, warehouse 1010 can include ground floor 1011, the second layer 1012, third layer 1013 and Four layer 1014, wherein the second layer 1012 can be positioned between ground floor 1011 and third layer 1013, and wherein third layer 1013 can It is positioned between the second layer 1012 and the 4th layer 1014.In at least one embodiment, the base portion 1022 of such as nail 1020 can It is positioned in the chamber 1015 in the 4th layer 1014, and follows closely lower limb 1021 and can upwardly extend and pass the 4th layer from base portion 1022 1014, third layer 1013 and the second layer 1012.In various embodiments, each deformable lower limb 1021 can include end, such as cutting edge of a knife or a sword The end 1023 of profit, such as, when nail bin 1000 is in uncompressed state, sharp end 1023 such as can be positioned in second In layer 1012.In at least one this type of embodiment, end 1023 can be not extend to and/or through ground floor 1011, Qi Zhong In at least one embodiment, when nail bin 1000 is in uncompressed state, end 1023 can be not projecting through tissue contacting surface 1019.In certain embodiments, when nail bin is in uncompressed state, sharp end 1023 can be positioned in third layer 1013 And/or in any other suitable layer.In various alternative embodiments, the warehouse of nail bin can have any suitable number Layer, such as less than four layers or more than four layers.

In various embodiments, as being hereafter more fully described, ground floor 1011 can be by backing material and/or plasticity material Material (such as PPDO (PDS) and/or polyglycolic acid (PGA)) is constituted, and the second layer 1012 can be by can biological inhale The foamed materials received and/or compressible hemostatic material (such as oxidized regenerated cellulose (ORC)) are constituted.In various embodiments In, in ground floor 1011, the second layer 1012, third layer 1013 and the 4th layer 1014 one or more can will nail 1020 holding In staple cartridge body 1010, and nail 1020 additionally can be made to keep being mutually aligned.In various embodiments, third layer 1013 can comprise Backing material or the most incompressible or non-elastic material, described material can by the nail lower limb 1021 of nail 1020 relative to each other It is held in place.Additionally, the second layer 1012 being positioned in the opposite sides of third layer 1013 and the 4th layer 1014 can be stablized or reduce The motion of nail 1020, even if the second layer 1012 and the 4th layer 1014 can comprise compressible foam or elastomeric material.Real at some Executing in example, the nail end 1023 of nail lower limb 1021 can be at least partially embedded in ground floor 1011.In at least one this type of embodiment In, ground floor 1011 and third layer 1013 can be held in place collaboratively and firmly by nail lower limb 1021.Real at least one Executing in example, ground floor 1011 and third layer 1013 can comprise bioabsorbable material respectively and (such as sell with trade name Vicryl Polyglycolic acid (PGA), polylactic acid (PLA, PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), with business The poliglecaprone 25(PGCL that name of an article Monocryl sells), polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL, And/or the complex of PCL) thin slice that formed, and the second layer 1012 and the 4th layer 1014 can comprise at least one hemostasis respectively Material or hemorrhage.

Although ground floor 1011 can be compressible, but the second layer 1012 can substantially more can be pressed than ground floor 1011 Contracting.Such as, the compressibility of the second layer 1012 can be ground floor 1011 approximately twice as, about three times, about four times, about five Times and/or about ten times.In other words, for given power, the compression degree of the second layer 1012 can be the big of 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 1012 can Compressibility can ground floor 1011 approximately twice as about ten times between.In at least one embodiment, in the second layer 1012 Can define multiple air gap, wherein amount and/or the size of the air gap in the second layer 1012 can be controlled to provide the second layer 1012 Expectation compression.With similar to the above, although third layer 1013 can be compressible, but the 4th layer 1014 can be compared third layer 1013 the most more compressibilities.Such as, the compressibility of the 4th layer 1014 can be third layer 1013 approximately twice as, about Three times, about four times, about five times and/or about ten times.In other words, for given power, the compression journey of the 4th layer 1014 Degree can be third layer 1013 approximately twice as, about three times, about four times, about five times and/or about ten times.Real at some Execute in example, the compressibility of the 4th layer 1014 can third layer 1013 approximately twice as about ten times between.At at least one In embodiment, can define multiple air gap in the 4th layer 1014, wherein amount and/or the size of the air gap in the 4th layer 1014 can quilt Control to provide the expectation compression of the 4th layer 1014.In all cases, (that is, layer is for sizing can to pass through compression ratio The distance compressed of power) express warehouse or the compressibility of warehouse layer.Such as, compared with the layer with relatively little compressible, The layer with high compression rate will compress bigger distance for apply to this layer to the compression stress of sizing.For Ru Ci, the Than ground floor 1011, there is higher compression ratio for two layer 1012；Similarly, the 4th layer 1014 has more than third layer 1013 High compression ratio.In various embodiments, the second layer 1012 and the 4th layer 1014 can comprise identical material and can have identical Compression ratio.In various embodiments, the second layer 1012 and the 4th layer 1014 can comprise the material with different compression ratio.Similar Ground, ground floor 1011 and third layer 1013 can comprise identical material and can have identical compression ratio.In certain embodiments, Ground floor 1011 and third layer 1013 can comprise the material with different compression ratio.

When anvil block 1040 is advanced towards its make position, anvil block 1040 can contact tissue T execute tissue T and nail bin 1000 Compressive forces, as shown in figure 18 c.In this case, anvil block 1040 can push down on warehouse 1010 towards nail bin support member 1030 Top surface or tissue contacting surface 1019.In various embodiments, nail bin support member 1030 can include storehouse stayed surface 1031, the described storehouse when nail bin 1000 is compressed between the tissue contacting surface 1041 of storehouse stayed surface 1031 and anvil block 1040 Stayed surface 1031 can support nail bin 1000.Due to anvil block 1040 pressure applied, warehouse 1010 can be compressed and anvil block 1040 can contact stud 1020.More specifically, in various embodiments, compression and the tissue contacting surface 1019 of warehouse 1010 are downward Motion the end 1023 of nail lower limb 1021 can be made to pierce through the ground floor 1011 of warehouse 1010, pierce through tissue T and enter anvil block 1040 In shaping pit 1042 in.When warehouse 1010 is compressed further by anvil block 1040, end 1023 can contact restriction and shape recessed The wall in hole 1042, and the most such as lower limb 1021 can be deformed inward or crimp, as shown in figure 18 c.When following closely lower limb 1021 and deforming, with As shown in figure 18 c, the base portion 1022 of nail 1020 can contact nail bin support member 1030 or be supported by nail bin support member 1030 sample.Respectively Planting in embodiment, as described in more detail below, nail bin support member 1030 can include that multiple supporting construction, such as nail support ditch Groove, slit or groove 1032, the plurality of supporting construction can work as nail 1020 deformation time support nail 1020 or at least nail 1020 base Portion 1022.The most as shown in figure 18 c, apply to the compression stress of staple cartridge body 1010 to make the chamber 1015 in the 4th layer 1014 collapse. In addition to chamber 1015, staple cartridge body 1010 may also include one or more space (such as space 1016), such as one or many Can position in individual space or no-fix has the part of nail, the one or more space can allow for warehouse 1010 and collapses. In various embodiments, can collapse in chamber 1015 and/or space 1016, so that the wall limiting chamber and/or space bends downwards also Contact storehouse stayed surface 1031 and/or contact warehouse 1010 be positioned at the layer below chamber and/or space.

When comparison diagram 18B and Figure 18 C, it is clear that the second layer 1012 and the 4th layer of 1014 pressure applied by anvil block 1040 Compression pressure substantially compresses.It may also be noted that ground floor 1011 and third layer 1013 are also compressed.Close when anvil block 1040 moves to it When closing position, anvil block 1040 can continue pressure further by pushing down on tissue contacting surface 1019 towards nail bin support member 1030 Contracting warehouse 1010.When warehouse 1010 is further compressed, anvil block 1040 can make nail 1020 be deformed into it and be fully formed shape, as Shown in Figure 18 D.Seeing Figure 18 D, the lower limb 1021 of each nail 1020 can deform downwards towards the base portion 1022 of each nail 1020, in order to will Capturing at deformable lower limb at least partially of tissue T, ground floor 1011, the second layer 1012, third layer 1013 and the 4th layer 1014 Between 1021 and base portion 1022.When comparison diagram 18C and Figure 18 D, more obviously, the second layer 1012 and the 4th layer 1014 further by The compression pressure that anvil block 1040 is applied is significantly compression.When comparison diagram 18C and Figure 18 D it may also be noted that ground floor 1011 and Also it is further compressed for three layer 1013.After nail 1020 completely or is shaped the most fully, anvil block 1040 can be away from tissue T And be lifted, and nail bin support member 1030 can away from and/or depart from nail bin 1000 move.As shown in Figure 18 D and due to above Described, warehouse 1010 is implantable nail 1020.In various embodiments, implanted warehouse 1010 can be along nail row supporting tissue. In some cases, the hemorrhage and/or any other the suitable medicine that accommodate in implanted warehouse 1010 can be at any time Between process tissue.It is hemorrhage, in combination with agent or group that hemorrhage as above can reduce the tissue sewed up and/or cut Knit binding agent and As time goes on can provide intensity for tissue.The warehouse 1010 implanted can comprise such as ORC(oxidation regeneration Cellulose), albumen substrate, the polyglycolic acid (PGA) sold with trade name Vicryl, polylactic acid (PLA or PLLA), poly-to dioxy Ketohexamethylene (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25(PGCL that sells with trade name Monocryl), poly-in oneself The materials such as the complex of ester (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL.In some cases, warehouse 1010 can include anti-biotic material and/or the antimicrobial material that can reduce the probability of surgical site infection, such as collargol And/or triclosan.

In various embodiments, each layer of warehouse 1010 can be connected with each other.In at least one embodiment, may utilize at least The second layer 1012 is adhered to ground floor 1011, by third layer by a kind of binding agent (such as fibrin and/or protein hydrogel) 1013 adhere to the second layer 1012, and adhere to third layer 1013 by the 4th layer 1014.In certain embodiments, although not showing Go out, but each layer of warehouse 1010 can be linked together by interlocked mechanical structure.In at least one this type of embodiment, first Layer 1011 and the second layer 1012 can each include the interlocking structure of correspondence, such as tenon groove structure and/or dovetail structure.Similar Ground, the second layer 1012 and third layer 1013 can each include the interlocking structure of correspondence, simultaneously third layer 1013 and the 4th layer 1014 Can each include the interlocking structure of correspondence.In certain embodiments, although not shown, but nail bin 1000 can such as include one Or multiple rivet, the one or more rivet can extend across one or more layers of warehouse 1010.At at least one this type of In embodiment, each rivet can include first end that adjacent first layer 1011 positions or head and neighbouring 4th layer 1014 and Second head of location, described 4th layer can be assembled into the second end of rivet or be formed by the second end of rivet.Due to The compressible character of warehouse 1010, at least one embodiment, the compressible warehouse of such as rivet 1010, so that the head of rivet Can cave in relative to the tissue contacting surface 1019 of warehouse 1010 and/or lower surface 1018.In at least one this type of embodiment In, each rivet can comprise the polyglycolic acid (PGA), polylactic acid (PLA or PLLA), poly-to two such as sold with trade name Vicryl Oxygen Ketohexamethylene (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25(PGCL that sells with trade name Monocryl), poly-oneself The bioabsorbable materials such as the complex of lactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL.At some In embodiment, in addition to by the nail 1020 accommodated in warehouse 1010, each layer of warehouse 1010 can not be connected to each other.At least In one this type of embodiment, each layer of warehouse 1010 such as can be maintained at by the frictional engagement between nail lower limb 1021 and warehouse 1010 Together, and once following closely shaping, the most each layer can be trapped in nail 1020.In certain embodiments, at least the one of lower limb 1021 is followed closely Part can include roughened surface or the rough coatings that can increase the frictional force between nail 1020 and warehouse 1010.

As it has been described above, surgical instruments can include the first jaw and the second jaw, the first jaw includes nail bin support member 1030, Second jaw includes anvil block 1040.In various embodiments, described in greater detail below, nail bin 1000 can include one or many Individual holding structure, the one or more keeps structure can engage nail bin support member 1030 and therefore by releasable for nail bin 1000 Remain to nail bin support member 1030.In certain embodiments, can pass through at least one binding agent (such as, fibrin and/or Protein hydrogel) nail bin 1000 is adhered to nail bin support member 1030.In use, at least one situation, especially exist In abdominal cavity mirror and/or endoscopic procedure, the such as second jaw is moveable to the make position relative with the first jaw so that First jaw and the second jaw can be inserted in operative site by the trocar.In at least one this type of embodiment, sleeve pipe Pin can limit the hole of about 5mm or intubate, and the first jaw and the second jaw can be by described holes or intubate and be inserted into.At some In embodiment, the second jaw is moveable to the partial closed position between in an open position and make position, and described part is closed Close position tolerable the first jaw and the second jaw to be inserted into through the trocar, and without making the nail accommodated in staple cartridge body 1010 1020 deformation.In at least one this type of embodiment, when the second jaw is in the centre position of its part Guan Bi, anvil block 1040 Staple cartridge body 1010 can not be applied compression stress, and in some other embodiment, in the second jaw is in its part Guan Bi Between position time, the compressible staple cartridge body of anvil block 1,040 1010.Although the compressible nail bin when anvil block 1040 is in this type of centre position Body 1010, but anvil block 1040 can compress staple cartridge body 1010 by halves, so that anvil block 1040 contact stud 1020 and/or make nail 1020 are deformed by anvil block 1040.Once the first jaw and the second jaw are inserted into by the trocar in operative site, then and second Jaw can be opened again, and anvil block 1040 and nail bin 1000 can position relative to target tissue as mentioned above.

Referring now to Figure 19 A-19D, in various embodiments, the end effector of surgical stapling device can include being positioned at anvil block Implanted nail bin 1100 between 1140 and nail bin support member 1130.With similar to the above, anvil block 1140 can include contact tissue table Face 1141, nail bin 1100 can include tissue contacting surface 1119, and nail bin support member 1130 can include supporting nail bin The stayed surface 1131 of 1100.Seeing Figure 19 A, tissue T is positioned to the group against nail bin 1100 by available anvil block 1140 Knit contact surface 1119 and do not make nail bin 1100 deform, and when anvil block 1140 is in this type of position, tissue contacting surface 1141 can be positioned so that and nail bin stayed surface 1131 distance 1101a, and tissue contacting surface 1119 can be positioned so that With nail bin stayed surface 1131 distance 1102a.Subsequently, when anvil block 1140 moves towards nail bin support member 1130, join now See that Figure 19 B, anvil block 1140 can push down on the top surface of nail bin 1100 or tissue contacting surface 1119 and compress warehouse 1110 Ground floor 1111 and the second layer 1112.When layer 1111 and layer 1112 are compressed, referring again to Figure 19 B, the second layer 1112 can By conquassation, and follow closely the lower limb 1121 of 1120 and can be pierced ground floor 1111 and enter tissue T.In at least one this type of embodiment, Follow closely in the 1120 nail chambeies can being positioned at least partially in the second layer 1112 or space 1115, and when the second layer 1112 is compressed Time, can collapse and therefore allow that the second layer 1112 is collapsed around nail 1120 in nail chamber 1115.In various embodiments, the second layer 1112 can include covering part 1116, this covering part extensible in nail chamber 1115 on and around or at least partly surround nail Chamber 1115.Figure 19 B shows and is pressed downward the covering part 1116 burst to nail chamber 1115.In certain embodiments, the second layer 1112 can include one or more weakening part, and the one or more weakening part can be conducive to collapsing of the second layer 1112. In various embodiments, this type of weakening part can include such as can being conducive to warehouse 1110 carry out controlled collapse cut, wear Hole and/or thin cross section.In at least one embodiment, ground floor 1111 can include that can beneficially follow closely lower limb 1121 penetrates One or more weakening parts of ground floor 1111.In various embodiments, can include such as can be with nail for this type of weakening part Cut, perforation and/or the thin cross section that lower limb 1121 aligns or at least substantially aligns.

Referring again to Figure 19 A, when anvil block 1140 is in the non-firing position of part Guan Bi, anvil block 1140 can be positioned so that With storehouse stayed surface 1131 distance 1101a so that define gap therebetween.This gap can be by having nail bin height 1102a Nail bin 1100 and tissue T fill.When anvil block 1140 moves downward to compress nail bin 1100, referring again to Figure 19 B, tissue connects The distance touched between surface 1141 and storehouse stayed surface 1131 can be limited by distance 1101b being shorter than distance 1101a.In various feelings Under condition, the gap limited by distance 1101b between tissue contacting surface 1141 and the storehouse stayed surface 1131 of anvil block 1140 can More than original undeformed nail bin height 1102a.Referring now to Figure 19 C, when anvil block 1140 moves to closer to storehouse support table During face 1131, the second layer 1112 can continue to collapse and follow closely lower limb 1121 and the distance shaped between pit 1142 can reduce.Similarly, Distance between tissue contacting surface 1141 and storehouse stayed surface 1131 can be decreased to distance 1101c, in various embodiments, away from From 1101c can greater than, equal to or less than original not deformed storehouse height 1102a.Referring now to Figure 19 D, anvil block 1140 is movable To final firing position, in final firing position, nail 1120 is fully formed or is at least shaped to Desired Height.At this type of In position, the tissue contacting surface 1141 of anvil block 1140 can be with storehouse stayed surface 1131 distance 1101d, wherein distance 1101d can be shorter than original not deformed storehouse height 1102a.Same as shown in Figure 19 D, nail chamber 1115 can completely or at least substantially Collapse, and follow closely 1120 second layers 1112 that can be collapsed completely or at least substantially around.In all cases, anvil block 1140 Can move away from nail bin 1100 subsequently.Once anvil block 1140 departs from nail bin 1100, then warehouse 1110 can partly Again it is stretched in various position (that is, the adjacent position between nail 1120).In at least one embodiment, the warehouse of conquassation 1110 may not stretch again with elastic type.In various embodiments, the nail 1120 of shaping and be additionally disposed in adjacent nail Warehouse 1110 between 1120 can apply pressure or compression stress to tissue T, and this can provide various useful therapeutic effect.

As it has been described above, refer again to the embodiment shown in Figure 19 A, each nail 1120 can include the nail lower limb extended from it 1121.Although nail 1120 is shown as including two nail lower limbs 1121, but is possible with to include a nail lower limb or as another Selection includes the various nails more than two nail lower limbs (such as three nail lower limbs or four nail lower limbs).As shown in Figure 19 A, each nail lower limb 1121 All can embed in the second layer 1112 of warehouse 1110 so that nail 1120 is fixed in the second layer 1112.In various embodiments, nail 1120 can be inserted in the nail chamber 1115 of warehouse 1110 so that the end 1123 of nail lower limb 1121 advances into chamber at base portion 1122 In 1115.In various embodiments, after end 1123 is inserted into chamber 1115, end 1123 can be pressed into covering part In 1116 and cut the second layer 1112.In various embodiments, enough degree of depth that nail 1120 can be sealed in the second layer 1112 Place so that follow closely 1120 and do not move relative to the second layer 1112 or do not move.In certain embodiments, nail 1120 can The enough depths being sealed in the second layer 1112 so that base portion 1122 is positioned or embeds in nail chamber 1115.Various its In his embodiment, base portion 1122 can not be positioned or embed in the second layer 1112.Refer again to Figure 19 A, in certain embodiments, Base portion 1122 can extend below the lower surface 1118 of warehouse 1110.In certain embodiments, base portion 1122 can be bearing on storehouse On stayed surface 1130 or directly abut storehouse stayed surface 1130 and position.In various embodiments, storehouse stayed surface 1130 can wrap Include and extend from it and/or be limited to supporting construction therein, wherein at least one this type of embodiment, the base portion of nail 1120 In 1122 one or more support trenches, slit or the grooves 1132 can being positioned in such as nail bin support member 1130 or by institute State one or more support trenches, slit or groove 1132 to support, as described in more detail below.

To being described further above, referring now to Figure 20, the base portion 1122 of nail 1120 can directly abut nail bin and support The stayed surface 1131 of part 1130 and position.In various embodiments, including below embodiment: wherein nail base portion 1122 includes circle Shape or arcuate shaped bottom surface 1124, such as nail base portion 1122 can move along nail bin stayed surface 1131 or slide.When anvil block 1140 It is compressed against during the end 1123 following closely lower limb 1121 occurring this type of to slide during following closely forming process.In certain embodiments, as above Described and referring now to Figure 21, nail bin support member 1130 can include one or more support slit 1132, one or many Individual support slit can eliminate or at least reduce the relative motion between nail base portion 1122 and storehouse stayed surface 1131.At least one In this type of embodiment individual, each support slit 1132 all can be limited by surface profile, described surface profile be positioned at support slit The profile of the nail lower surface in 1132 matches or at least substantially matches.Such as, the end of the base portion 1122 shown in Figure 21 Surface, portion 1124 can include circular or at least substantially circular surface, and support slit 1132 and may also comprise circle or at least Substantially circular surface.In at least one this type of embodiment, can be by being more than or equal to for limiting the surface of slit 1132 The radius of curvature of the radius of curvature limiting lower surface 1124 limits.Although slit 1132 can help to prevent or reduce nail 1120 And the sliding relative movement between nail bin support member 1130, but slit 1132 also is able to prevent or reduce nail 1120 and props up with nail bin Relative rotary motion between support member 1130.More specifically, at least one embodiment, slit 1132 can be closely received Base portion 1122, in order to prevent or reduce the nail 1120 rotation around axis 1129, such as so that nail 1120 will not revolve when deformation Turn or distortion.

In various embodiments, to being described further above, each nail 1120 all can by circle or at least substantially The wire rod of circle is formed.In certain embodiments, lower limb and the base portion of each nail all can be by having non-circular cross sections (such as rectangle horizontal stroke Cross section) wire rod formed.In at least one this type of embodiment, nail bin support member 1130 can include the non-circular slit of correspondence (such as rectangular slot), described non-circular slit can accommodate the base portion of this type of nail.Referring now to Figure 22, in various embodiments In, each nail 1120 may each comprise overmolding bizet such as bizet 1125 to base portion 1122, the most each bizet 1125 All can be positioned in the support slit in nail bin support member 1130.In at least one this type of embodiment, each bizet 1125 May each comprise such as square and/or the cross section of rectangle, described cross section can be contained in such as nail bin support member 1130 Square and/or rectangle slit 1134 in.In various embodiments, bizet 1125 can comprise bioabsorbable plastics (such as with trade name Vicryl sell polyglycolic acid (PGA), polylactic acid (PLA or PLLA), PPDO (PDS), Polyhydroxyalkanoatefrom (PHA), with trade name Monocryl sell poliglecaprone 25(PGCL), polycaprolactone (PCL) and/ Or the complex of PGA, PLA, PDS, PHA, PGCL and/or PCL), and can be by such as injection moulding process around the base portion following closely 1120 1122 are formed.It is entitled that various bizets and the method for forming various bizet are disclosed in that JIUYUE in 2006 submits on the 29th “SURGICAL STAPLES HAVING COMPRESSIBLE OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME " U.S. Patent application In serial number 11/541,123.Referring again to Figure 22, slit 1134 may also include introduction part or oblique angle 1135, this introduction part or oblique Angle can be conducive to inserting in slit 1134 bizet 1125.In various embodiments, prop up when nail bin 1100 is assembled to nail bin During support member 1130, base portion and/or the bizet of nail 1120 can be positioned in slit 1134.In certain embodiments, nail bin is worked as 1100 when being assembled to nail bin support member 1130, and the bizet 1125 of nail 1120 can align with slit 1134.At at least one this type of In embodiment, bizet 1125 can not enter in slit 1134, until to nail lower limb 1121 apply compression stress and nail 1120 base portion and/ Or bizet is pushed down in slit 1134.

Referring now to Figure 23 and Figure 24, in various embodiments, nail bin such as nail bin 1200 such as can include compressible planting Entering formula warehouse 1210, this warehouse includes outer layer 1211 and internal layer 1212.With similar to the above, nail bin 1200 can include being positioned at warehouse Multiple nails 1220 in 1210.In various embodiments, each nail 1220 may each comprise base portion 1222 and from base portion extension One or more nail lower limbs 1221.In at least one this type of embodiment, nail lower limb 1221 can be inserted in internal layer 1212 and is sealed to The lower surface 1218 such as making the adjacent and/or neighbouring internal layer 1212 of base portion 1222 of nail 1220 positions.In Figure 23 and Figure 24 institute In the embodiment shown, internal layer 1212 does not include accommodating the nail chamber of a part for nail 1220, and in other embodiments, internal layer 1212 can include that this type of follows closely chamber.In various embodiments, to being described further above, internal layer 1212 can comprise can allow (the most bioabsorbable foam and/or oxidation are again for the compressible material that warehouse 1210 is collapsed when it is applied compressive load Raw cellulose (ORC)).In various embodiments, internal layer 1212 can comprise and such as comprise polylactic acid (PLA) and/or polyglycolic acid (PGA) freeze dried foam.ORC can be commercially available with trade name Surgicel and can include that (similar surgery is used for loose weaven goods Sponge), staple in bulk (similar cotton balls) and/or foam.In at least one embodiment, internal layer 1212 can by wherein comprising and/or Applied atop has the material of medicine (the most cryodesiccated thrombin and/or fibrin) to constitute, and described medicine such as can quilt Fluid water activation in the patient and/or activation.In at least one this type of embodiment, cryodesiccated thrombin and/or fibre Fibrillarin is positively retained at such as Vicryl(PGA) in substrate.But, in some cases, such as, insert patient when nail bin 1200 Time in internal operative site, activable medicine can by mistake be activated.Refer again to Figure 23 and Figure 24, in various embodiments In, outer layer 1211 can be made up of water impervious or the most water impervious material so that liquid does not contacts or The most do not contact internal layer 1212, until warehouse 1210 is compressed and follows closely after lower limb penetrates outer layer 1211 and/or outer layer After 1211 are cut open in some way.In various embodiments, outer layer 1211 can comprise backing material and/or plastic material (such as PPDO (PDS) and/or polyglycolic acid (PGA)).In certain embodiments, outer layer 1211 can include cincture Internal layer 1212 and the wrappage of nail 1220.More specifically, at least one embodiment, nail 1220 can be inserted into internal layer 1212 and In outer layer 1211 and around including that internal layer 1212 and the sub-component of nail 1220 are wrapped and are subsequently sealed.

Referring now to Figure 25 and Figure 26, in various embodiments, nail bin such as nail bin 1300 such as can include compressible planting Entering formula warehouse 1310, this warehouse includes outer layer 1311 and internal layer 1312.With similar to the above, nail bin 1300 may also include and is positioned at warehouse Nail 1320 in 1310, the most each nail 1320 may each comprise base portion 1322 and the one or more lower limbs extended from base portion 1322 1321.Being similar to nail bin 1200, the base portion 1322 of nail 1320 can extend below the lower surface 1318 of internal layer 1312, and outward Layer 1311 can be around base portion 1322.In at least one this type of embodiment, outer layer 1311 can have enough flexibilities and surround often Individual nail base portion 1322 so that outer layer 1311 conforms to the profile of base portion 1322.Refer again to Figure 24, available at least one Embodiment in, outer layer 1211 can have enough rigidity so that it extends around base portion 1222 and does not conform to each base portion 1222.In any case, in various embodiments, outer layer 1311 can be positioned in nail 1320 base portion 1322 with for supporting Between the nail bin stayed surface (such as stayed surface 1031 or 1131) of nail bin 1300.In at least one this type of embodiment, outward Layer 1311 can be positioned in base portion 1322 and the support slit (such as slit 1032 or 1132) being limited in nail bin stayed surface Between.In at least one this type of embodiment, to being described further above, outer layer 1311 can limit the fortune of base portion 1322 Move and/or increase the coefficient of friction between base portion 1322 with nail bin stayed surface and/or support slit to reduce phase therebetween To motion.Referring now to Figure 27 and Figure 28, in various alternative embodiments, the outer layer of nail bin such as nail bin 1400 can not Completely about the nail being located therein.In at least one this type of embodiment, the nail lower limb 1421 at nail 1420 inserts warehouse 1410 Before in, the outer layer 1411 of compressible implanted warehouse 1410 can be assembled to internal layer 1412.Due to mentioned above, nail 1420 Base portion 1422 is extensible in the outside of outer layer 1411, and at least one this type of embodiment, such as base portion 1422 can be direct It is positioned in the support slit 1032 or 1132 in nail bin stayed surface 1031 or 1131.In various embodiments, when nail lower limb 1421 when being inserted through outer layer 1411, and nail lower limb 1421 can cut outer layer 1411.In all cases, nail lower limb 1421 hole formed Can be closely around nail lower limb 1421 so that the fluid of leakage few (if present) between nail lower limb 1421 and outer layer 1411, This can reduce or prevent the medicine accommodated in staple cartridge body 1410 from being activated and/or leaking out the possibility of warehouse 1410 prematurely Property.

As it has been described above, refer again to Figure 23 and Figure 24, the lower limb 1221 of nail 1220 can embed in warehouse 1210, and follows closely 1220 Base portion 1222 can stretch out from the lower surface 1218 of internal layer 1212.In various embodiments, to carrying out above further Describing, internal layer 1212 may not include the nail chamber that can accommodate nail 1220.Referring now to Figure 29 and Figure 30, in other embodiments various In, nail bin such as nail bin 1500 such as can include compressible implanted warehouse 1510, and this warehouse includes can accommodating nail wherein At least one of nail chamber 1515 of 1520.In at least one this type of embodiment, the top of the nail lower limb 1521 of nail 1520 can be embedding Enter in internal layer 1512, and follow closely the bottom of lower limb 1521 and base portion 1522 can be positioned in nail chamber 1515.In certain embodiments, base Portion 1522 can be fully located in nail chamber 1515, and in certain embodiments, base portion 1522 can be at least in part at internal layer 1512 Lower surface 1518 below extend.With similar to the above, outer layer 1511 can be around internal layer 1512 and the nail being positioned in internal layer 1512 1520.Referring now to Figure 31, in some other embodiment, nail bin 1600 can include being positioned in compressible implanted warehouse 1610 Nail chamber 1615 in nail 1620, wherein at least some of of nail 1620 is not surrounded by outer layer 1611.At at least one, this type of is real Execute in example, each nail 1620 may each comprise the nail lower limb 1621 being at least partially embedded in internal layer 1612 and around outer layer 1611 to The base portion 1622 of outer extension.

Referring now to Figure 32 and Figure 33, in various embodiments, nail bin such as nail bin 1700 such as can include compressible planting Enter formula warehouse 1710 and the multiple nails 1720 being at least partially situated in warehouse 1710.Warehouse 1710 can include outer layer 1711, Internal layer 1712 and alignment matrix 1740, this alignment matrix by nail 1720 alignment and/or can be held in place in warehouse 1710. In at least one embodiment, internal layer 1712 can include the depressed part 1741 that can accommodate alignment matrix 1740 wherein.Respectively In kind of embodiment, in alignment matrix 1140 can be press-fitted in depressed part 1741 and/or in other words utilize at least one binding agent (example As, fibrin and/or protein hydrogel) it is fixed to internal layer 1712 rightly.In at least one embodiment, depressed part 1741 The lower surface 1718 of the lower surface 1742 and internal layer 1712 that enable to alignment matrix 1740 is alignd or the most right Together.In certain embodiments, the lower surface 1742 of alignment matrix can cave in relative to the lower surface 1718 of the second layer 1712 And/or extend from lower surface 1718.In various embodiments, each nail 1720 may each comprise base portion 1722 and from base portion The 1722 one or more lower limbs 1721 extended, that wherein follows closely lower limb 1721 can extend across alignment matrix 1740 at least partially.Right Neat matrix 1740 may also include such as extend through multiple hole therein and/or slit, the plurality of hole and/or slit can be Wherein accommodate nail lower limb 1721.In at least one this type of embodiment, each hole all can be closely received nail lower limb 1721 so that nail The least (if any) relative motion is there is between lower limb 1721 and the sidewall in hole.In certain embodiments, alignment matrix hole Alignment matrix 1740 can not extended completely through, and when following closely lower limb 1721 and being pushed through alignment matrix 1740, follow closely lower limb 1721 Can need to cut alignment matrix 1740.

In certain embodiments, alignment matrix 1740 can be made up of the plastic body moulded, at least one embodiment, The plastic body of described molding is than internal layer 1712 and/or outer layer 1711 is harder or compressibility is lower.At at least one this type of In embodiment, alignment matrix 1740 can comprise plastic material and/or any other suitable material (such as PPDO (PDS) and/or polyglycolic acid (PGA)).In certain embodiments, alignment matrix 1740 can be assembled to internal layer 1712, and subsequently Nail lower limb 1721 is insertable through alignment matrix 1740 and embeds in internal layer 1712.In various embodiments, alignment matrix 1740 Lower surface 1742 can include accommodating at least in part one or more grooves of base portion 1722 of nail 1720, slit or Groove.With similar to the above, outer layer 1711 can be placed in the week of the sub-component including internal layer 1712, alignment matrix 1740 and nail 1720 Enclose.Alternatively, outer layer 1711 can be placed in around the sub-component including internal layer 1712 and alignment matrix 1740, Wherein nail 1720 can be then inserted through outer layer 1711, alignment matrix 1740 and internal layer 1712.In any case, due to upper Literary composition is described, and nail 1720 can be held in place by internal layer 1712, alignment matrix 1740 and/or outer layer 1711, until anvil block as above institute State and make nail 1720 deform, and/or anvil block make as mentioned above nail 1720 deformation after, internal layer 1712, alignment matrix 1740 and/ Or nail 1720 can be held in place by outer layer 1711.In at least one this type of embodiment, alignment matrix 1740 can be used at nail Storehouse 1700 is implanted to be held in place nail 1720 in the patient before, and fixes group at the tailing edge nail row that nail bin 1700 is implanted Knit.In at least one embodiment, such as do not embed in nail 1720 can be fixed on alignment matrix 1740 internal layer 1712 and/or In outer layer 1711.

Referring now to Figure 34-40, in various embodiments, can be by compression internal layer 1812, by nail such as nail 1820 insertion Nail bin such as nail bin 1800 are assembled in internal layer 1812 and by outer layer 1811 wrapping inner layer 1812.Referring first to Figure 34, compressible Internal layer 1812 be shown as including and be limited to multiple nail chamber 1815 therein, but it can also be envisaged that go out wherein internal layer 1812 do not include other embodiments following closely chamber.Referring now to Figure 35, compressible internal layer 1812 can be positioned in transfer plate 1850 And between gripper shoe 1860 and be compressed in the compressive surfaces 1852 of transfer plate 1850 and the compressive surfaces of gripper shoe 1860 respectively Between 1862.As shown in figure 35, the top surface of internal layer 1812 and lower surface can be compressed toward each other, and in response to this, Internal layer 1812 can expand laterally outward.In certain embodiments, internal layer 1812 can be compressed into the big of such as its original height At the height of about 1/3rd, and can have the height between the most about 0.06 " to about 0.08 " in its compressive state Or thickness.The most as shown in figure 35, transfer plate 1850 may also include and is such as positioned at multiple nails of multiple nail well 1853 and such as follows closely 1820.It addition, transfer plate 1850 may also include multiple driver 1851, nail 1820 can upwards be released by the plurality of driver Outside nail well 1853.Referring now to Figure 36, the nail lower limb 1821 of nail 1820 is pushed the internal layer 1812 of compression by available driver 1851 In and pass through the internal layer 1812 of compression.In various embodiments, driver 1851 enables to when nail 1820 is from transfer plate When being fully deployed in the nail well 1853 of 1850, the top surface of driver 1851 is oriented to and the compaction table of transfer plate 1850 Face 1852 flushes or the most almost flushes.In certain embodiments, the most as shown in figure 36, gripper shoe 1860 can include multiple appearance Receiving bore 1861, the plurality of receiving hole 1861 can nail lower limb 1821 be pushed through after internal layer 1812 accommodate follow closely lower limb 1821 or At least follow closely the end of lower limb 1821.Internal layer 1812 has been compressed in the embodiment at the height being shorter than nail 1820 height wherein, Receiving hole 1861 or similar structures can be required, therefore when following closely 1820 and being penetrated completely from nail well 1853, follow closely lower limb 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 higher than nail At the height of 1820 height, therefore need not the receiving hole 1861 in gripper shoe 1860.

Referring now to Figure 37, after nail 1820 is inserted in internal layer 1812, gripper shoe 1860 can be away from transfer plate 1850 Motion, in order to allow that internal layer 1812 reduces pressure.In this case, can again extend to it with elastic type original for internal layer 1812 Uncompressed height or at least close to original uncompressed height.When internal layer 1812 stretches again, the height of internal layer 1812 can increase Greatly to exceeding the nail lower limb 1821 of the height following closely 1820 and nail 1820 no longer from the top surface projection of internal layer 1812.In various situations Under, nail lower limb 1821 can be held in place by receiving hole 1861, has moved to enough remote at least up to gripper shoe 1860 and makes lower limb 1821 are no longer in receiving hole 1861.In this case, receiving hole 1861 can contribute to when internal layer 1812 stretches again Nail 1820 in internal layer 1812 keeps alignment relative.In all cases, internal layer 1812 and the nail 1820 that is located therein can include Sub-component 1801, referring now to Figure 38, sub-component 1801 can such as be inserted in outer layer 1811.In at least one this type of embodiment In, outer layer 1811 can include being limited to cavity 1802 therein, and described cavity can accommodate sub-component 1801 wherein.Various In the case of, available instrument such as tweezers 1855 are by outer layer 1811 tractive to sub-component 1801.Referring now to Figure 39, once son Assembly 1801 is fully located in outer layer 1811, then outer layer 1811 can be sealed.In various embodiments, available outer layers 1811 A part apply heat energy carry out sealable outer 1811.More specifically, at least one embodiment, outer layer 1811 can comprise plasticity Material, the opening of its ectomesoderm 1811 can be by one or more heated elements or ferrum 1856 hot melt, in order to by outer layer The periphery of the opening of 1811 combines and/or is sealed.Referring now to Figure 40, at least one this type of embodiment, outward The redundance 1857 of layer 1811 can be removed, and as described herein can use nail bin 1800 subsequently.

As it has been described above, nail bin can be located in nail bin attachment and/or is fixed to nail bin attachment.Referring now to Figure 41 and Tu, 42, in various embodiments, nail bin attachment can include staple cartridge channel such as staple cartridge channel 1930, and this staple cartridge channel such as can Accommodate at least some of of nail bin such as nail bin 1900 wherein.In at least one embodiment, staple cartridge channel 1930 can include Bottom support surface the 1931, first lateral support wall 1940 and the second lateral support wall 1941.In use, nail bin 1900 can quilt Be positioned in staple cartridge channel 1930 so that nail bin 1900 against and/or adjacent bottom stayed surface 1931 position, and be positioned at first Between lateral support wall 1940 and the second lateral support wall 1941.In certain embodiments, the first lateral support wall 1940 and Sideshake can be defined between two lateral support walls 1941.In at least one this type of embodiment, nail bin 1900 can include side Width to the sideshake limited between width 1903, this lateral width and supporting walls 1940 and 1941 is identical and/or wide The sideshake limited between supporting walls 1940 and 1941 so that the compressible implanted warehouse 1910 of nail bin 1900 can jail Admittedly be matched with between wall 1940 and 1941.In some other embodiment, the lateral width 1903 of nail bin 1900 can be shorter than The gap limited between one sidewall 1940 and the second sidewall 1941.In various embodiments, wall 1940 and 1941 and bottom Can being limited by the metal passage of punching press at least partially of stayed surface 1931, and at least one embodiment, lateral support Wall 1940 and/or lateral support wall 1941 can comprise flexible material (such as elastomeric material) at least partially.Referring first to Figure 41, the first side wall 1940 of staple cartridge channel 1930 and the second sidewall 1941 all can be upwardly extended by from bottom support surface 1931 Rigid element 1933 and constitute from the upwardly extending flexible portion of rigid element 1,933 1934.

In various embodiments, to being described further above, the warehouse 1910 of nail bin 1900 can be by one or more Compressible layer such as ground floor 1911 and the second layer 1912 are constituted.When warehouse 1910 is compressed the end of against in the above described manner by anvil block During portion's stayed surface 1931, the sidepiece of warehouse 1910 can laterally stretch.The reality that nail bin 1930 is made up of rigid sidewalls wherein Executing in example, rigid sidewalls can prevent or at least limit the lateral extension of warehouse 1910, therefore can produce significant quantity in warehouse 1910 Internal pressure or stress.In at least some of embodiment being made up of flexible sidewall of nail bin 1930, flexible sidewall can Laterally bend and allow the sidepiece lateral extension of warehouse 1910, thus produced internal pressure or should in reducing warehouse 1910 Power.Not including that sidewall or included sidewall are relatively shorter than in the embodiment of nail bin at storehouse passage, the sidepiece of nail bin can not be subject to Suppress ground or laterally stretch with being at least substantially not inhibited.Referring now to Figure 42, in any case, staple cartridge channel 2030 Can include sidewall 2040 and 2041, this sidewall can completely include flexible material, such as elastomeric material.Staple cartridge channel 2030 also may be used The lateral slit 2033 extended including the limit of the bottom support surface 2031 along staple cartridge channel 2030, this lateral slit can be at it Middle receiving fixed sidewall 2040 and 2041 at least some of.In certain embodiments, sidewall 2040 and 2041 can be via taking Snap fit close and/or press-fit structure and be fixed in slit 2033, and at least some embodiments, sidewall 2040 and 2041 can lead to Cross one or more binding agents to be fixed in slit 2033.In at least one embodiment, sidewall 2040 and 2041 can use Period separates with bottom support surface 2031.In any case, when warehouse 2010 is implanted with following closely 2020, compressible implantation Formula warehouse 2010 can separate with sidewall 2040 and 2041 and/or depart from.

Referring now to Figure 43, in various embodiments, surgical instruments can include that axle 2150 and the far-end from axle 2150 prolong The end effector stretched.With similar to the above, end effector can include staple cartridge channel 2130, can be in open position and make position Between the anvil block 2140 of motion and nail bin 2100 between staple cartridge channel 2130 and anvil block 2140.It is also similarly to Literary composition, nail bin 2100 can include compressible implanted warehouse 2110 and the multiple nails 2120 being positioned in warehouse 2110.In various realities Executing in example, staple cartridge channel 2130 can include bottom support surface 2131, far-end 2135 and near-end 2136, and nail bin 2100 can be the end of against Portion's stayed surface 2131 and position.In at least one embodiment, as shown in figure 43, nail bin 2100 can include first end 2105 With the second end 2106, described first end 2105 can be positioned in the far-end 2135 of staple cartridge channel 2130, described second end Portion 2106 can be positioned in the near-end 2136 of staple cartridge channel 2130.In various embodiments, the far-end of staple cartridge channel 2130 2135 can include that at least one distally keeps structure (such as keeping wall 2137)；Similarly, near-end 2136 can include at least one Nearside keeps structure (such as keeping wall 2138).In at least one this type of embodiment, distally keeps wall 2137 to keep with nearside Can define gap between wall 2138, described gap can be equal to or less than the length of nail bin 2100 so that when nail bin 2100 is inserted When entering in staple cartridge channel 2130, nail bin 2100 can be securely fitted in staple cartridge channel 2130.

Referring again to Figure 23 and Figure 24, in various embodiments, nail bin such as nail bin 1200 such as can include flat or extremely The most flat few tissue contacting surface 1219.In at least one this type of embodiment, the staple cartridge body 1210 of nail bin 1200 can wrap Including first end 1205 and the second end 1206, described first end can be limited by the first height or thickness 1207, and described second End 1206 can be limited by the second height or thickness, and wherein the first height 1207 can be equal to or the substantially equal at least second height 1208.In certain embodiments, warehouse 1210 can include constant or extremely between first end 1205 and the second end 1206 The height of few substantial constant or thickness.In at least one this type of embodiment, tissue contacting surface 1219 can be parallel or at least It is arranged essentially parallel to the lower surface 1218 of warehouse 1210.Refer again to Figure 43, in various embodiments, the warehouse of nail bin 2100 The first end 2105 of 2110 2107 can be limited by the first height, and this first is highly different from the second of the second end 2106 highly 2108.In the embodiment shown, the first height 2107 is more than the second height 2108, but in alternative embodiment, the Two height 2108 can be more than the first height 2107.In various embodiments, the height of warehouse 2110 can first end 2105 with Reduce linearly and/or geometrically between the second end 2106.In at least one this type of embodiment, first end 2105 with The tissue contacting surface 2119 extended between the second end 2106 can limit along between first end 2105 and the second end 2106 Angle be orientated.In at least one this type of embodiment, tissue contacting surface 2119 can be not parallel to the end of warehouse 2110 Surface, portion 2118 and/or be not parallel to the stayed surface 2131 of staple cartridge channel 2130.

Referring again to Figure 43 and Figure 44, in various embodiments, anvil block 2140 can include tissue contacting surface 2141, works as anvil When seat 2140 is in the close position, tissue contacting surface 2141 can be parallel to or at least substantially parallel to staple cartridge channel 2130 Stayed surface 2131, as shown in figure 44.When anvil block 2140 is in the close position, the anvil block 2140 first end to nail bin 2100 The compression degree of 2105 can be more than the second end 2106, this is because the height of first end 2105 is higher, and the second end The height of 2106 is relatively low.In some cases, have including wherein tissue T between tissue contacting surface 2119 and 2141 The situation of constant or the most constant thickness, tissue T and storehouse 2100 are produced at the far-end of end effector Pressure can be more than at pressure produced by the proximal end of end effector.More specifically, when anvil block 2140 and nail bin 2100 it Between tissue T time there is the thickness of substantial constant, be positioned at the far-end 2145 of anvil block 2140 and the first end of nail bin 2100 The degree that tissue T between 2105 is compressed can be more than the second end of the near-end 2146 with nail bin 2100 being positioned at anvil block 2140 Tissue T between 2106.In various embodiments, the tissue T between near-end and the far-end of end effector can produce pressure Gradient.More specifically, at least one embodiment, the tissue T between anvil block 2140 and nail bin 2100 has substantially permanent The height of fixed thickness and nail bin 2100 is when end effector distal-to-proximal reduces linearly, and the pressure in tissue T can Reduce linearly from the near-end of the far-end of end effector to end effector.Similarly, at least one embodiment, anvil is worked as Tissue T between seat 2140 and nail bin 2100 has the thickness of substantial constant and the height of nail bin 2100 from end effector Distal-to-proximal when geometrically reducing, the pressure in tissue T can be several from the near-end of the far-end of end effector to end effector Where reduce.

Referring again to Figure 43, in various embodiments, the tissue T between nail bin 2100 and anvil block 2140 can not have The most constant thickness.In at least one this situation, it is positioned at the of the near-end 2146 of anvil block 2140 and nail bin 2100 Tissue T between two ends 2106 can be thicker than between the far-end 2145 and the first end 2105 of nail bin 2100 of anvil block 2140 Tissue T.Therefore, in this case, thicker tissue T can be usually located at above the relatively low near-end 2106 of nail bin 2100, And relatively thin tissue T can be usually located at above higher far-end 2105.In use, the percussion lining ring 2152 of axle 2150 can edge Axle ridge 2151 advances towards distally so that percussion lining ring 2152 engages the cam portion 2143 of anvil block 2140, and makes anvil block 2140 court Nail bin 2100 rotates, as shown in figure 44.Once anvil block 2140 rotates to of completely closed position, then tissue T can be compressed in group Knit between contact surface 2119 and 2141, although and the height of nail bin 2100 can be between the near-end of end effector and far-end Non-constant, but applying to the pressure of tissue T or compression stress can be constant or the most constant in tissue T.More Specifically, when relatively thin tissue T can be with the higher height correlation of nail bin 2100, and thicker tissue T can be with nail bin 2100 Relatively low height correlation time, tissue T and the cumulative height of nail bin 2100 or height sum can the near-end of end effector with Being constant or the most constant between far-end, therefore this cumulative height is compressed in cumulative height by anvil block 2140 Can be constant or the most constant.

Referring again to Figure 43 and Figure 44, in various embodiments, nail bin 2100 can include asymmetric configuration.At at least one In this type of embodiment, the such as nail bin 2100 height at its first end 2105 can be higher than nail bin 2100 at its second end Height at 2106.In certain embodiments, nail bin 2100 and/or staple cartridge channel 2130 can include one or more alignment and/ Or holding structure, the one or more alignment and/or keep structure be able to ensure that nail bin 2100 the most in one direction (that is, its Middle first end 2105 is positioned in the far-end 2135 of staple cartridge channel 2130 and direction in the second end 2106 proximally-located 2136) It is positioned in staple cartridge channel 2130.In various alternative embodiments, nail bin 2100 and/or staple cartridge channel 2130 can include One or more alignment and/or holding structure, the one or more alignment and/or holding structure can allow nail bin 2100 edge More than one direction is positioned in staple cartridge channel 2130.Referring now to Figure 45, such as nail bin 2100 can be positioned in staple cartridge channel In 2130, so that the first end 2105 of nail bin 2100 can be positioned in the near-end 2136 of staple cartridge channel 2130 and the second end 2106 can be positioned in far-end 2135.Therefore, in various embodiments, the nail bin 2100 of lower height can keep in neighbouring distally Wall 2137 positions, and the nail bin 2100 of high height can keep wall 2138 to position by neighbouring nearside.In at least one this type of embodiment In, nail bin 2100 can be set appropriately with to having thicker portion in the far-end of end effector and at end effector The tissue T in near-end with thinner part applies constant or the most constant clamping pressure.In various embodiments, Nail bin 2100 such as optionally can be orientated in staple cartridge channel 2130.In at least one this type of embodiment, nail bin 2100 Alignment and/or holding structure can be symmetrical, and surgeon can be led to along the such as direction shown in Figure 43 and Figure 45 at nail bin In road 2130, nail bin 2100 is carried out selectivity orientation.

To being described further above, implanted warehouse 2110 can include longitudinal axis 2109, when nail bin 2100 is determined When position is in staple cartridge channel 2130, longitudinal axis 2109 can extend between the near-end of end effector and far-end.In various realities Executing in example, the thickness of warehouse 2110 substantially can reduce along longitudinal axis 2109 between first end 2105 and the second end 2106 And/or substantially increase.In at least one this type of embodiment, the distance between lower surface 2118 and tissue contacting surface 2119 Or height can substantially reduce between first end 2105 and the second end 2106 and/or substantially increase.In certain embodiments, The thickness of warehouse 2110 both can increase along longitudinal axis 2109 and also can reduce.In at least one this type of embodiment, warehouse 2110 Thickness may be included in the one or more parts and the one or more parts that can reduce on thickness increased on thickness.? In various embodiments, nail bin 2100 can include the multiple nails 2120 being positioned in.In use, as it has been described above, work as anvil block 2140 when moving to make position, follows closely 2120 deformables.In certain embodiments, each nail 2120 can have identical or at least Substantially the same height.In at least one this type of embodiment, can be such as from following closely the bottom of base portion to the top following closely the highest lower limb Or end measures the height of nail.

In various embodiments, the nail in nail bin can have different staple heights.In at least one this type of embodiment, nail Storehouse can include first group of nail with the first staple height and have second group of nail of the second staple height, and described first group of nail is positioned at In the Part I of compressible warehouse, and second group of nail is positioned in the Part II of compressible warehouse.At at least one In embodiment, the first staple height can be higher than the second staple height, and first group is followed closely the first end that can be positioned in nail bin 2100 In 2105, and second group of nail can be positioned in the second end 2106.Alternatively, first group of higher nail can quilt It is positioned in the second end 2106 of nail bin 2100, and relatively low second group of nail can be positioned in first end 2105.At certain In a little embodiments, available multiple nail groups, the most each group each has different staple heights.In at least one this type of embodiment In, having the 3rd group of middle staple height can be positioned in warehouse 2110 between first group of nail with second group of nail.Various In embodiment, each nail in the staple in nail bin can each include different staple heights.In at least one embodiment, staple Interior Gao Ding can be positioned on the first end of staple, and minimum nail can be positioned on the opposite end of this staple.Extremely In few this type of embodiment, the nail between the highest nail and minimum nail may be arranged such that staple height such as the highest nail with Decline between minimum nail.

Referring now to Figure 46, in various embodiments, the end effector of surgical stapling device can include anvil block 2240, nail bin Passage 2230 and the nail bin 2200 supported by staple cartridge channel 2230.Nail bin 2200 can include compressible implanted warehouse 2210 And the multiple nails being positioned in warehouse 2210, such as nail 2220a and nail 2220b.In various embodiments, staple cartridge channel 2230 can include that storehouse stayed surface 2231 and the multiple nails being limited in storehouse stayed surface 2231 support slit, such as support narrow Groove 2232a and 2232b.In at least one this type of embodiment, nail bin 2200 can include that two outside nail 2220a arrange and in two Side nail 2220b row, wherein support slit 2232a can support nail 2220a, and support slit 2232b can support nail 2220b.Seeing Figure 46 and Figure 47, anvil block 2240 can include that being limited to multiple nail therein shapes pit 2242, when anvil block 2240 Towards nail bin 2200 move time, the plurality of nail shapes pit 2242 can accommodate nail 2220a and 2220b make it deform.Extremely In few this type of embodiment, the lower surface supporting slit 2232a can shape the top surface of pit 2242 at a distance of the with nail One distance 2201a, and the lower surface supporting slit 2232b can be with the top surface second distance of nail shaping pit 2242 2201b.In at least one this type of embodiment, have owing to wherein defining in the stayed surface 2231 supporting slit 2232b The step raised, therefore supports slit 2232b and positions closer to anvil block 2240.Due to have different distances 2201a and 2201b, the most in various embodiments, outside nail 2220a row and inner side nail 2220b row can be deformed to different forming heights. In all cases, the nail being deformed into differing formed height can apply different clamping pressures or clamping to the tissue T sewed up Power.Over and above what is described above, nail can have different unshaped staple heights originally.Refer again to Figure 46, at least one this In class embodiment, the initial unshaped height of outer layer nail 2220a can be more than the initial unshaped height of inner side nail 2220b.Such as figure Shown in 46 and Figure 47, the unshaped height inner side nail 2220b less than outside nail 2220a also can have less than outside nail 2220b's Forming height.In various alternative embodiments, it is high that inner side nail 2220b can have the unshaped higher than outside nail 2220a Spend and there is the deformation staple height lower than outside nail 2220a.

In various embodiments, to being described further above, anvil block 2240 is moveable in make position, such as Figure 47 Shown in, in order to compression warehouse 2210 also makes nail 2220a and 2220b deform.In certain embodiments, including shown in Figure 46 and Figure 47 The surgical stapling device of end effector such as may also include cutting element, described cutting element can crosscutting be positioned at anvil block 2240 with Tissue T between nail bin 2200.In at least one this type of embodiment, anvil block 2240, staple cartridge channel 2230 and/or nail bin 2200 Can limit slit, described slit can accommodate cutting element slidably therein.More specifically, anvil block 2240 can include slit Part 2249, staple cartridge channel 2230 can include slotted portion 2239, and nail bin 2200 can include slotted portion 2203, works as anvil block 2240 in the close position or at least substantially close position time, slotted portion 2249, slotted portion 2239 and slotted portion 2203 can be mutually aligned or at least substantially align.In various embodiments, it is closed at anvil block 2240 and follows closely 2220a, 2220b After deformation, cutting element can be from the near-end of end effector towards the distal movement of end effector.In at least one embodiment In, cutting element can be to move with the nail incoherent mode of deformation process.In certain embodiments, cutting element can become at nail It is pushed into while shape.In any case, at least one embodiment, cutting element can be along being positioned at inner side nail 2220b Path incised tissue between row.

In various embodiments, as shown in figure 47, inner side nail 2220b can be shaped to the height less than outside nail 2220a, its Middle inner side nail 2220b can apply bigger clamping pressure or clamping to the tissue adjacent with the line of cut that cutting element is formed Power.In at least one this type of embodiment, bigger clamping pressure or clamping force that inner side nail 2220b is formed can provide various and have The therapeutic effect of benefit, such as, make to be cut open tissue T and reduce hemorrhage, and the less clamping pressure that outside nail 2220a is formed can Motility is provided in the tissue sewed up.Referring again to Figure 46 and Figure 47, in various embodiments, anvil block 2240 may also include attached Receive at least one piece of backing material of anvil block 2240, such as backing material 2260.In at least one this type of embodiment, nail The lower limb of 2220a, 2220b can work as the nail shaping pit that nail bin 2200 is compressed by anvil block 2240 and contacts in anvil block 2240 subsequently When 2242, the lower limb of nail 2220a, 2220b cuts backing material 2260 and/or through the hole in backing material 2260.Work as nail When the lower limb of 2220a, 2220b deforms, described lower limb can contact and/or cut backing material 2260 again.In various embodiments, prop up Timbering material 2260 can improve to be sewed up the hemostatic capability of tissue and/or is provided intensity by sewing up tissue.

Referring again to Figure 46 and Figure 47, in various embodiments, the lower surface of warehouse 2210 can include stepped profile, Described stepped profile is mated with the stepped profile of storehouse stayed surface 2231 or is at least substantially mated.In some embodiment In, the lower surface deformable of warehouse 2210 is to mate or at least substantially to mate the profile of storehouse stayed surface 2231.Ginseng now Seeing Figure 48, in various embodiments, the end effector being similar to end effector shown in Figure 46 such as can include being positioned at it In nail bin 2300.Nail bin 2300 can include the compressible implanted main body 2310 with internal layer 2312 and outer layer 2311.Wherein To being described further above, at least one embodiment, outer layer 2311 can comprise water impervious material.Various In embodiment, outer layer 2311 can extend around nail 2220a, 2220b and can lay respectively at nail 2220a, 2220b and support slit Between 2232a, 2232b.Referring now to Figure 49, the end, in various embodiments, being similar to end effector shown in Figure 46 is held Row device such as can include the nail bin 2400 being positioned in.It is similar to nail bin 2300, the compressible implanted warehouse of nail bin 2400 2410 can include internal layer 2412 and outer layer 2411；But, at least one embodiment, warehouse 2410 can not include therein Cutting element slit.In at least one this type of embodiment, cutting element can need such as when it is pushed into through nail bin Cut internal layer 2412 and/or outer layer 2411.

Referring now to Figure 50, in various embodiments, the end effector of surgical stapling device can include anvil block 2540, nail bin Passage 2530 and the nail bin 2500 being positioned in staple cartridge channel 2530.With similar to the above, nail bin 2500 can include compressible planting Enter formula warehouse 2510, outside nail 2220a row and inner side nail 2220b row.Staple cartridge channel 2530 can include flat or the most basic Upper flat storehouse stayed surface 2531 and the nail being limited in storehouse stayed surface 2531 support slit 2532.Anvil block 2540 can include rank Ladder type surface 2541 and be limited in stepped surface 2541 multiple nail shape pits, such as shape pit 2542a and 2542b.With similar to the above, shaping and can define distance between pit 2542a and support slit 2532, described distance is more than shaping Pit 2452b and the distance supported between slit 2532.In various embodiments, anvil block 2540 may also include and is attached to anvil block One piece of backing material 2560 of the stepped surface 2541 of 2540.In at least one this type of embodiment, backing material 2560 can Conform to or at least substantially conform to stepped surface 2541.In various embodiments, backing material 2560 can be by least A kind of binding agent (such as, fibrin and/or protein hydrogel) is removably attached to surface 2541.In some embodiment In, warehouse 2510 may also include staged profile, and at least one embodiment, described staged profile is parallel to or at least base The stepped surface 2541 of anvil block 2540 it is parallel in basis.More specifically, at least one embodiment, anvil block 2540 can include The step 2548 extended towards nail bin 2500, wherein step 2548 can include shoulder height, described shoulder height equal to or at least base Equal to the shoulder height of the step 2508 extended from warehouse 2510 in basis.In at least one this type of embodiment, due to institute above Stating, the amount that the most compressible warehouse 2510 can be trapped in the first nail 2220a may differ from compressible warehouse 2510 and can be caught Obtain the amount in the second nail 2220b.

Referring now to Figure 51, in various embodiments, end effector can include anvil block 2640, staple cartridge channel 2530, with And the nail bin 2600 between anvil block 2640 and staple cartridge channel 2530.Nail bin 2600 can include compressible implanted warehouse 2610, warehouse 2610 include internal layer 2612, outer layer 2611 and be positioned in warehouse 2610 multiple nails (such as nail 2220a and 2200b).In various embodiments, anvil block 2640 can include on surface 2641 that multiple nail shapes pit 2642, and nail bin leads to Road 2530 can include the multiple nail formed slots 2532 being limited in stayed surface 2531.As shown in figure 51, anvil faces 2641 Can be parallel to or at least substantially parallel to storehouse stayed surface 2531, the most each shaping pit 2642 can be positioned so that with relative And corresponding nail support slit 2532 at a distance of equal or the most equal distance.In various embodiments, nail bin Nail included by 2600 can have identical or the most identical initial unshaped staple height and identical or the most basic Upper identical shaping staple height.In some other embodiment, outside staple can include following closely 2220a and inner side staple can include nail 2220b, wherein as it has been described above, nail 2220a and 2220b can have different unshaped staple heights.When anvil block 2640 is towards nail bin 2600 when moving to make position, and nail 2220a and 2220b can be shaped as that to make nail 2220a and 2220b have identical or at least Substantially the same shaping staple height.In at least one this type of embodiment, due to mentioned above, outside shaping follow closely 2220a and Inner side nail 2220b can have identical, or the compressible warehouse 2610 being contained therein of at least substantially equal number；So And, such as follow closely 2220b higher unshaped staple height owing to outside nail 2220a has than inner side, but can have identical shaping Staple height, can generate the clamping pressure bigger than inner side nail 2220b in the nail 2220a of outside.

Referring now to Figure 52, in various embodiments, the end effector of surgical stapling device can include anvil block 2740, nail bin Passage 2530 and the nail bin 2700 being positioned in staple cartridge channel 2530.With similar to the above, nail bin 2700 can include compressible planting Entering formula warehouse 2710, this warehouse includes that internal layer 2712, outer layer 2711 and the multiple nails being positioned in warehouse 2710 (are such as followed closely 2220a and 2220b).In at least one embodiment, the thickness of warehouse 2710 can change on its whole width.Extremely In few this type of embodiment, warehouse 2710 can include central part 2708 and sidepiece 2709, and wherein the thickness of central part 2708 can Thickness more than sidepiece 2709.In various embodiments, the thickest part of warehouse 2710 can be located at central part 2708, and storehouse The thinnest part of body 2710 can be located at sidepiece 2709.In at least one this type of embodiment, the thickness of warehouse 2710 can be It is gradually reduced between central part 2708 and sidepiece 2709.In certain embodiments, the thickness of warehouse 2710 can be at central part 2708 And reduce linearly and/or geometrically between sidepiece 2709.In at least one this type of embodiment, the contact tissue of warehouse 2710 Surface 2719 can include from central part 2708 towards sidepiece 2709 downward-sloping two inclination or angled surfaces.Various In embodiment, anvil block 2740 can include two that tilt or angled surfaces, that said two tilts or angled surface It is parallel to or at least substantially parallel to the tissue contacting surface 2719 tilted.In at least one embodiment, anvil block 2740 is also At least one piece of backing material 2760 being attached to the inclined surface of anvil block 2740 can be included.

In various embodiments, to being described further above, the inner side staple in nail bin 2700 can include higher Follow closely 2220a, and outside staple can include relatively low nail 2220b.In at least one embodiment, higher nail 2220a can quilt It is positioned in thicker central part 2708 and/or adjacent with central part 2708, and follows closely 2220b and can be positioned in sidepiece 2709 And/or it is adjacent with sidepiece 2709.In at least one this type of embodiment, due to mentioned above, higher nail 2220a is than relatively low Nail 2220b capture more implanted warehouse 2710 material.This situation can make nail 2220a execute tissue T than nail 2220b Add bigger clamping pressure.In certain embodiments, although higher nail 2220a captures more than relatively low nail 2220b The material of warehouse 2710, shape pit 2742a and 2742b yet with nail and there is the structure of inclination, the highest nail 2220a has higher shaping staple height than relatively low nail 2220b.This type of Consideration can be utilized at nail 2220a and 2220b The tissue captured obtains desired clamping pressure, the most such as the clamping pressure in nail 2220a can be more than, be less than or etc. In the clamping pressure that tissue is applied by nail 2220b.In various alternative embodiment of end effector shown in Figure 52, relatively Low nail 2220b can be positioned in the thicker central part 2708 of warehouse 2710 and/or neighbouring central part 2708, and higher Nail 2220a can be positioned in relatively thin sidepiece 2709 and/or adjacent side portion 2709.Although additionally, nail bin 2700 is shown Become to include inner side and outside staple, but nail bin 2700 can include the staple added, such as, be positioned at inner side staple and outside staple Between staple.In at least one this type of embodiment, the unshaped staple height of such as middle staple can between nail 2220a not Shape between the unshaped staple height of staple height and nail 2220b, and the staple height that shapes of middle staple can be between nail 2220a's Shape between the shaping staple height of staple height and nail 2220b.

Referring now to Figure 53, in various embodiments, the end effector of surgical stapling device can include anvil block 2840, nail bin Passage 2530 and the nail bin 2800 being positioned in staple cartridge channel 2530.With similar to the above, nail bin 2800 can include compressible planting Entering formula warehouse 2810, this warehouse includes that internal layer 2812, outer layer 2811 and the multiple nails being positioned in warehouse 2810 (are such as followed closely 2220a and 2220b).In at least one embodiment, the thickness of warehouse 2810 can change on its whole width.Extremely In few this type of embodiment, warehouse 2810 can include central part 2808 and sidepiece 2809, and wherein the thickness of central part 2808 can Thickness less than sidepiece 2809.In various embodiments, the thinnest part of warehouse 2810 can be located at central part 2808, and storehouse The thickest part of body 2810 can be located at sidepiece 2809.In at least one this type of embodiment, the thickness of warehouse 2810 can be It is gradually increased between central part 2808 and sidepiece 2809.In certain embodiments, the thickness of warehouse 2810 can be at central part 2808 And increase linearly and/or geometrically between sidepiece 2809.In at least one this type of embodiment, the contact tissue of warehouse 2810 Surface 2819 can include from central part 2808 towards acclivitous two that tilt or the angled surfaces of sidepiece 2809.Various In embodiment, anvil block 2840 can include two that tilt or angled surfaces, that said two tilts or angled surface It is parallel to or at least substantially parallel to the tissue contacting surface 2819 tilted.In at least one embodiment, anvil block 2840 is also At least one piece of backing material 2860 being attached to the inclined surface of anvil block 2840 can be included.In various embodiments, to entering above Row further describes, and the outside staple in nail bin 2800 can include higher nail 2220a, and inner side staple can include relatively low Nail 2220b.In at least one embodiment, higher nail 2220a can be positioned in thicker sidepiece 2809 and/or and sidepiece 2809 is adjacent, and follow closely 2220b and can be positioned in central part 2808 and/or adjacent with central part 2808.At at least one this type of In embodiment, due to mentioned above, higher nail 2220a captures more implanted warehouse 2810 than relatively low nail 2220b Material.

As discussed above concerning described in the embodiment of Figure 46, such as, staple cartridge channel 2230 can include stepped support surface 2231, Nail 2220a and 2220b can be supported at differing heights by this stepped support surface relative to anvil block 2240.In various enforcements In example, staple cartridge channel 2230 can be made up of metal, and the step in stayed surface 2231 can by such as grinding operation shape Become in stayed surface 2231.Referring now to Figure 54, in various embodiments, the end effector of surgical instruments can include nail bin Passage 2930, this staple cartridge channel includes the support insert 2935 being positioned in.More specifically, at least one embodiment In, staple cartridge channel 2930 can be formed to make it have the most flat or the most flat stayed surface 2931, this support Surface can support insert 2935, and this support insert includes for being supported on not by nail 2220a and 2220b of nail bin 2200 With the stepped surface at height.In at least one this type of embodiment, insert 2935 can include flat or at least substantially Flat lower surface, described lower surface can position against stayed surface 2931.Insert 2935 may also include the narrow trough of support Groove or groove 2932a and 2932b, supporting slit, groove or groove 2932a and 2932b can prop up respectively by nail 2220a and 2220b Support is at differing heights.With similar to the above, insert 2935 can include being limited to cutter slit 2939 therein, and this cutter slit can Allow that cutting element passes through.In various embodiments, staple cartridge channel 2930 can be by being same or different from support insert The material of 2935 is constituted.In at least one this type of embodiment, staple cartridge channel 2930 and support insert 2935 both of which can examples As being made up of metal, and in other embodiments, staple cartridge channel 2930 can be such as made up of metal, and supports insert 2935 Can be such as made up of plastics.In various embodiments, support insert 2935 and can be fastened and/or be welded to staple cartridge channel 2930 In.In certain embodiments, supporting insert 2935 can be snap-fitted and/or be press-fitted in staple cartridge channel 2930.At least one In individual embodiment, binding agent can be used to be fixed in staple cartridge channel 2930 by support insert 2935.

Referring now to Figure 55, in various embodiments, the end effector of surgical stapling device can include anvil block 3040, nail bin Passage 3030 and the compressible implanted nail bin 3000 being positioned in staple cartridge channel 3030.With similar to the above, anvil block 3040 can wrap Include and be limited to multiple nail shaping pit 3042 therein and cutting element can be slidably received within cutter slit therein 3049.Being also similarly to above, staple cartridge channel 3030 can include that being limited to multiple nail therein supports slit 3032 and also can Enough cutting element is slidably received within cutter slit 3039 therein.In various embodiments, nail bin 3000 can include first Layer 3011, the second layer 3012 and the multiple nails (such as nail 3020a and 3020b) being positioned in nail bin 3000.At at least one In embodiment, the unshaped staple height of nail 3020a can be higher than the unshaped staple height of nail 3020b.In various embodiments, first Layer 3011 can comprise the first compressible material, and the second layer 3012 can comprise the second compressible material.In certain embodiments, The compression ratio of the first compressible material can be higher than the second compressible material, and in some other embodiment, the first compressible material The compression ratio of material can be less than the second compressible material.In at least one embodiment, the first compressible material can be by comprising The elastomeric material of one flexible ratio is constituted, and the second compressible material can be by the elastomeric material structure that can comprise the second flexible ratio Becoming, described second flexible ratio is different from described first flexible ratio.In various embodiments, the elasticity of the first compressible material Ratio can be more than the flexible ratio of the second compressible material.In some other embodiment, the elasticity ratio of the first compressible material Rate is smaller than the flexible ratio of the second compressible material.In various embodiments, the first compressible stratum can comprise the first rigidity, and And second compressible stratum can comprise the second rigidity, wherein the first rigidity is different from the second rigidity.In various embodiments, first can The rigidity of compression layer can be more than the rigidity of the second compressible stratum.In some other embodiment, the rigidity of the first compressible stratum can Rigidity less than the second compressible stratum.

Referring again to Figure 55, in various embodiments, the second layer 3012 of nail bin 3000 can include on its whole width Constant or the most constant thickness.In at least one embodiment, the thickness of ground floor 3011 can be at its whole width Change on degree.In at least one this type of embodiment, ground floor 3011 can include one or more step 3008, this step The thickness of warehouse 3010 can be increased in some part (such as central part) of warehouse 3010.Refer again to Figure 55, relatively low nail 3020b can be positioned in the step 3008(i.e. thicker portion of warehouse 3010) in or align with step 3008, and higher nail 3020a can be positioned in the thinner part of warehouse 3010 or align with described thinner part.In various embodiments, due to storehouse The thicker portion of body 3010 and thinner part, warehouse 3010 can be more than along outside nail 3020a row's along the rigidity that inner side 3020b arranges Rigidity.In various embodiments, ground floor 3011 may be connected to the second layer 3012.In at least one this type of embodiment, first Layer 3011 and the second layer 3012 can include interlocking structure, and layer 3011 and 3012 can be kept together by described interlocking structure.At certain In a little embodiments, ground floor 3011 can include that ground floor compound and the second layer 3012 can include second layer compound, wherein first Laminates can adhere to second layer compound by one or more binding agents.In various embodiments, nail bin 3000 can include cutter Slit 3003, this cutter slit can accommodate cutting element slidably therein.

Referring now to Figure 56, in various embodiments, nail bin 3100 can include compressible implanted warehouse 3110, this warehouse Including monolayer compressible material and multiple nails (such as, nail 3020b) of being positioned in warehouse 3110.In at least one embodiment In, the thickness of warehouse 3110 can change on its whole width.In at least one this type of embodiment, warehouse 3110 can include edge The step 3108 that its sidepiece extends.Referring now to Figure 57, in various embodiments, nail bin 3200 can include compressible implanted storehouse Body 3210, this warehouse includes monolayer compressible material and the multiple nails (such as, nail 3020b) being positioned in warehouse 3210.? In at least one embodiment, the thickness of warehouse 3210 can change on its whole width.In at least one this type of embodiment, storehouse Body 3210 can include the step 3208 extended along the center portion thereof.Referring now to Figure 58, in various embodiments, nail bin 3300 can wrap Including compressible implanted warehouse 3310, wherein with similar to the above, the thickness of warehouse 3310 can change on its whole width.Extremely In a few embodiment, the thickness of warehouse 3310 geometrically can increase between the sidepiece of warehouse 3310 and central part.At least In one this type of embodiment, the thickness of warehouse 3310 can be limited and can include the group of arch or bending by the profile of arch or bending Knit contact surface 3319.In certain embodiments, the thickness of warehouse 3310 and the profile of tissue contacting surface 3319 can be by such as One radius of curvature or alternately limited by multiple radius of curvature.Referring now to Figure 59, in various embodiments, nail bin 3400 can include compressible implanted warehouse 3410, wherein the thickness of warehouse 3410 can the sidepiece of warehouse 3410 and central part it Linearly ground or at least substantially linearly increase.

Referring now to Figure 60, in various embodiments, nail bin 3500 can include compressible implanted warehouse 3510 and determine Position multiple nails 3520 wherein.Implanted warehouse 3510 can include first internal layer the 3512, second internal layer 3513 and outer layer 3511.In at least one embodiment, the first internal layer 3512 can comprise the first thickness and the second internal layer 3513 can comprise second Thickness, wherein the second internal layer 3513 can be thicker than the first internal layer 3512.In at least one alternative embodiment, the first internal layer 3512 can be thicker than the second internal layer 3513.In another alternative embodiment, the first internal layer 3512 and the second internal layer 3513 can There is identical or the most identical thickness.In certain embodiments, each nail 3520 can include base portion 3522 and from One or more deformable lower limbs 3521 that base portion 3522 extends.In various embodiments, each lower limb 3521 can include embedding first End 3523 in internal layer 3511, it addition, each base portion 3522 of nail 3520 can embed in the second internal layer 3512.At at least one In embodiment, the first internal layer 3512 and/or the second internal layer 3513 can include at least one medicine being stored therein, and respectively Planting in embodiment, outer layer 3511 can encapsulate and seal the first internal layer 3512 and the second internal layer 3513 so that only when outer layer 3511 After being pierced through by nail 3520, medicine just can flow out staple cartridge body 3510.More specifically, to being described further above, can abut against The tissue positioned against the tissue contacting surface 3519 of nail bin 3500 pushes down on anvil block so that warehouse 3510 is compressed and table Face 3519 moves downward towards nail end 3523 and at least in part at nail end 3523 moved beneath so that end 3523 makes outer layer 3511 rupture or pierce through outer layer 3511.After lower limb 3521 makes outer layer 3511 rupture with nail, at least one medicine M can from flow out around The warehouse 3510 of nail lower limb 3521 flows out.In all cases, additional medicine M can be extruded warehouse by the additional compression of warehouse 3510 3510, as shown in Figure 61.

Referring again to Figure 60, in various embodiments, outer layer 3511 can include water impervious or the most not Permeable wrappage, described wrappage can 1) prevent medicine from flowing out nail bin 3500 prematurely；And 2) prevent from such as performing the operation Fluid in position enters in nail bin 3500 prematurely.In certain embodiments, the first internal layer 3512 can include storage or absorb In the first medicine therein, and the second internal layer 3513 can include storage or be absorbed in the second medicine therein, wherein the second medicine Thing may differ from the first medicine.In at least one embodiment, the initial compression making outer layer 3511 rupture of warehouse 3510 is usual The first internal layer 3512 can be made to discharge the first medicine, and the subsequent compression of warehouse 3510 generally can make the second internal layer 3513 discharge Go out the second medicine.But, in this type of embodiment, some part of the first medicine and the second medicine can be released simultaneously, but The major part of the medicine being just released can be made up of the first medicine, and the major part of the medicine being subsequently released can be by the second medicine Thing is constituted.In certain embodiments, to being described further above, the first internal layer 3512 can be had by than the second internal layer 3513 The biggest compressible material is constituted so that can be less than subsequent compression power or the initial compression force of pressure or pressure can be in first Layer 3512 produces the initial deflection amount bigger than in the second internal layer 3513.This type of bigger initially scratching in first internal layer 3512 What bent amount can make the first medicine discharged from the first internal layer 3512 is partially larger than the discharged from the second internal layer 3513 Two medicines.In at least one embodiment, the first internal layer 3512 is than the second internal layer 3513 more porous and/or more flexible. In at least one this type of embodiment, the first internal layer 3512 can include being limited to multiple hole therein or space 3508, and Two internal layers 3513 can include being limited to multiple hole therein or space 3509, and the most in various embodiments, hole 3508 can be by First medicament storage is in the first internal layer 3512, and hole 3509 can be by the second medicament storage in the second internal layer 3513.? In some embodiment, the hole 3508 in the first internal layer 3512 and the size in the hole 3509 in the second internal layer 3513 and density can be selected It is selected to provide results needed as herein described.

Refer again to Figure 60 and Figure 61, in various embodiments, outer layer the 3511, first internal layer 3512 and/or the second internal layer 3513 can be made up of bioabsorbable material.In at least one embodiment, the first internal layer 3512 can comprise first can be biological The material absorbed, the second internal layer 3513 can comprise the second bioabsorbable material, and outer layer 3511 can be biological by the 3rd The material absorbed is constituted, and wherein the first bioabsorbable material, the second bioabsorbable material and/or the 3rd can be biological The material absorbed can be made up of different materials.In certain embodiments, the first bioabsorbable material can be with first rate By bio-absorbable, the second bioabsorbable material can the second speed by bio-absorbable, and the 3rd bioabsorbable material Material can be with third speed by bio-absorbable, and wherein first rate, the second speed and/or third speed can be different.At at least one In this type of embodiment, when material with specific speed by bio-absorbable time, this type of speed can be defined as quilt within the unit interval The amount of the quality of materials that patient body absorbs.It is known that the health of different patients can be different speed absorb different materials Material, therefore this type of speed can be expressed as Mean Speed to explain this type of transmutability.In any case, with slower speed phase Ratio, speed can be the more absorbed speed of quality within the unit interval faster.Refer again to Figure 60 and Figure 61, various In embodiment, the constituent material of the first internal layer 3512 and/or the second internal layer 3513 than outer layer 3511 constituent material quickly By bio-absorbable.In at least one this type of embodiment, the first internal layer 3512 and/or the second internal layer 3513 can be by bioabsorbable Foam, tissue seal and/or hemostatic material (such as oxidized regenerated cellulose (ORC)) constitute, and outer layer 3511 can be by Backing material and/or plastic material (polyglycolic acid (PGA) such as sold with trade name Vicryl, polylactic acid (PLA, PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), with trade name Monocryl sell poliglecaprone 25 (PGCL), polycaprolactone (PCL) and/or the complex of PGA, PLA, PDS, PHA, PGCL and/or PCL) constitute.Real at this type of Executing in example, the first internal layer 3512 and/or the second internal layer 3513 such as can directly process tissue and can to reduce tissue hemorrhage, its China and foreign countries Layer 3514 long-term structure can be provided to support and can be slower speed by bio-absorbable.

To being described further above, owing to the bioabsorbable speed of outer layer 3511 is relatively slow, therefore outer layer 3511 Can when the organization healing in nail row supporting tissue or structurally strengthen tissue.In certain embodiments, the first internal layer 3512 With one of them constituent material of the second internal layer 3513 than the constituent material of another one quickly by bio-absorbable.At least one In individual embodiment, therein one layer can provide treatment material initial release, and another layer can provide identical treatment material and/ Or the slow release of difference treatment material.In at least one this type of embodiment, the speed that treatment material can be released from layer 3512,3513 Rate can be depending on the absorbability of the bottom wherein absorbing or being dispersed with medicine.Such as, at least one embodiment, including The substrate of the first internal layer 3512 than include the substrate of the second internal layer 3513 quickly by bio-absorbable, the most such as medicine is from the The speed of one internal layer 3512 release can be faster than the speed of the release from the second internal layer 3513.In various embodiments, such as this paper institute State, one or more by least one binding agent (such as, fiber egg in the layer 3511,3512 and 3513 of warehouse 3510 White and/or protein hydrogel) adhere to each other.In certain embodiments, binding agent can be water soluble and can work as nail bin 3500 The connection between each layer is discharged time implanted and/or after implanted certain period.In at least one this type of embodiment, bonding Agent can be than outer layer the 3511, first internal layer 3512 and/or the second internal layer 3513 quickly by bio-absorbable.

Referring now to Figure 62 and Figure 63, in various embodiments, nail bin (such as, nail bin 3600) such as can include warehouse 3610, this warehouse includes compressible ground floor 3611, the second layer 3612 being attached to ground floor 3611 and is attached to second The removable compressible stratum 3613 of layer 3612.In at least one this type of embodiment, such as ground floor 3611 can be by compressible Foamed materials constitute, the second layer 3612 can include the lamination material utilizing one or more binding agents to adhere to ground floor 3611 Material, and third layer 3613 can include the compressible foam that utilizes one or more binding agents to be removably adhered to the second layer 3612 Foam material.In various embodiments, nail bin 3600 may also include the multiple nails (such as following closely 3620) being positioned in warehouse 3610.Extremely In few this type of embodiment, the most each nail 3620 can include the base portion 3622 being positioned in third layer 3613 and from base portion 3622 extend upwardly to the one or more deformable lower limbs 3621 in ground floor 3611 through the second layer 3612.In use, To being described further above, the top surface 3619 of staple cartridge body 3610 can be pushed down on by anvil block, until nail lower limb 3621 is worn Top surface 3619 and target tissue also contact anvil block.After nail lower limb 3621 is badly deformed, anvil block can be transported away from nail bin 3600 Dynamic so that the compressible stratum of nail bin 3600 can stretch the most again.In all cases, when nail inserts through tissue Tissue can be made hemorrhage.In at least one embodiment, third layer 3613 can be made up of absorbing material (such as protein hydrogel), institute State absorbing material and can absorb blood from the tissue being sewn.In addition to above or as replacement above, third layer 3613 can be by Hemostatic material and/or tissue seal (the most freeze-dried thrombin and/or fibrin) are constituted, described hemostatic material And/or tissue seal can to reduce tissue hemorrhage.In certain embodiments, third layer 3613 can be to ground floor 3611 and second Layer 3612 provides structure to support, and wherein third layer 3613 can be by bioabsorbable material and/or the most bioabsorbable material Constitute.In any case, in various embodiments, after nail bin 3610 is implanted, third layer 3613 can be with the second layer 3612 separate.Third layer 3613 includes having in the embodiment of the material of implanted characteristic wherein, and surgeon is optional is The no third layer 3613 removing warehouse 3610.In at least one embodiment, third layer 3613 can be with integral form from second Layer 3612 removes.

In various embodiments, ground floor 3611 can be made up of the first foamed materials, and third layer 3613 can be by second Foamed materials is constituted, and the second foamed materials may differ from the first foamed materials.In at least one embodiment, the first foamed materials Can have the first density and the second foamed materials can have the second density, wherein the first density may differ from the second density.? In at least one this type of embodiment, the second density can be higher than the first density, therefore third layer 3613 than ground floor 3611 can Compressibility is less or has lower compression ratio.In at least one alternative embodiment, the first density can be higher than second Density, therefore ground floor 3611 is less than the compressibility of third layer 3613 or has lower compression ratio.Referring now to figure, 64 and Figure 65, in various embodiments, it is similar to nail bin 3600, nail bin 3700 can include warehouse 3710, and this warehouse includes first Compressible froth bed 3711, it is attached to the second layer 3712 of ground floor 3711 and is removably attached to the second layer 3712 Dismountable 3rd compressible foam foam layer 3713.In at least one this type of embodiment, third layer 3713 can include multiple nail Accommodating slit or otch 3709, the plurality of nail accommodates slit or otch can be able to accommodate at least the one of nail 3620 wherein Partly (such as nail base portion 3622).In certain embodiments, nail 3620 can slide in nail accommodates slit 3709, or in other words Say, such as, when nail bin 3700 positions against target tissue and compressed by anvil block, third layer 3713 can be sliding relative to nail 3620 Dynamic.In at least one embodiment, accommodate slit 3709 and can make to exist between nail 3620 and the sidewall accommodating slit 3709 sky Gap.In at least one this type of embodiment, due to mentioned above, when following closely 3620 deformation, nail 3620 can not be by third layer 3713 A part capture wherein, as shown in Figure 64 and Figure 65.In some other embodiment, nail accommodates neighbouring the of slit 3709 The end of two layer 3712 can be by the part Guan Bi of third layer 3713, and therefore when following closely 3620 deformation, third layer 3713 is at least A part can be trapped in nail 3620.In any case, third layer 3713 such as can include one or more perforation and/or Cut 3708, the one or more perforation and/or cut can allow that third layer 3713 is with two parts or more part It is removed from the second layer 3712, as shown in Figure 64.In Figure 64, a portion of third layer 3713 is shown to pass through instrument 3755 remove.In various embodiments, perforation 3708 can be arranged along the line being positioned at the first nail middle with the second nail.

Referring again to Figure 64 and Figure 65, in various embodiments, the base portion 3622 of nail 3620 can be located at receiving slit 3709 In, the most at least one embodiment, the sidewall accommodating slit 3709 can contact stud lower limb 3621 can being released by nail lower limb 3621 It is held in place with putting.In certain embodiments, although not shown, but third layer 3713 can include all nails in nail row Elongated slot.In at least one this type of embodiment, including the nail bin of four staples such as can include with nail bin bottom every The elongated slot of individual staple alignment.To being described further above, at least partially may be used of nail bin 3600 and/or nail bin 3700 Implanted in the patient, and nail bin at least partially can be from removing in the patient.Refer again to Figure 64 and Figure 65, at least In one embodiment, ground floor 3711 and the second layer 3712 can be trapped in following closely 3620 and can be implanted together with nail 3620, And third layer 3713 is optionally removed from nail bin 3700 or separates.In all cases, remove and implanted the one of nail bin Part can reduce the amount of the material that patient body must absorb, and this can provide various useful therapeutic effect.Such as passing through abdomen In the situation that a part for nail bin is separated and removes by chamber mirror instrument 3755, the nail bin part separated can pass through the trocar (such as having the trocar in 5mm hole) is removed from operative site.In certain embodiments, warehouse can include more than one can The layer being removed.Such as, warehouse 3710 can include the 4th layer, and wherein the third layer 3713 of warehouse 3710 can be by hemostatic material structure Become, and the 4th layer can be made up of supporting layer.In at least one this type of embodiment, the most removable supporting layer of surgeon is also Choose whether subsequently to remove hemostatic layer.

Referring now to Figure 66, in various embodiments, nail bin (such as, nail bin 3800) such as can include warehouse 3810, should Warehouse includes outer layer 3811 and internal layer 3812.Internal layer 3812 can be made up of compressible foamed materials, and outer layer 3811 can be extremely Partially wrap up around internal layer 3812.In at least one embodiment, outer layer 3811 can include Part I 3811a and Part II 3811b, this Part I can be positioned on the first side of internal layer 3812, and this Part II can be positioned at internal layer On second side of 3812, wherein Part I 3811a and Part II 3811b can pass through flexible hinge (such as hinge 3809) even Connect.In at least one this type of embodiment, the first side of internal layer 3812 and/or the second side can be coated at least one binding agent (such as, fibrin and/or protein hydrogel) is to be fixed to the first side and/or the second side by some part of outer layer 3811. In various embodiments, outer layer 3811 can include the one or more fastening members extended from it.At at least one, this type of is implemented In example, outer layer 3811 can include from the side of outer layer 3811 extend and can be placed in compressible internal layer 3812 multiple variable Shape lower limb 3821.In at least one this type of embodiment, lower limb 3821 can not be from the second lateral process of internal layer 3812, and at least one In alternative embodiment, lower limb 3821 can be at least in part from internal layer 3812 projection.When compressible warehouse 3810 is compressed, In use, lower limb 3821 can pierce through the Part II 3811b of internal layer 3812 and outer layer 3811.In certain embodiments, outer layer The Part II 3811b of 3811 can include being limited to hole therein (such as hole 3808), and described hole can accommodate nail lower limb 3821.? In some embodiment, at least some included cutter slit 3803 of nail bin 3800, this cutter slit can the most slidably Ground accommodates cutting element.In at least one this type of embodiment, cutter slit 3803 can be not entirely through the thickness of warehouse 3810 Extending, therefore when cutting element moves relative to warehouse 3810, cutting element can cut warehouse 3810.

Referring now to Figure 67, in various embodiments, similar to nail bin 3800, nail bin 3900 can include warehouse 3910, should Warehouse includes internal layer 3812 and outer layer 3811, its ectomesoderm 3811 can include the first side of neighbouring internal layer 3812 and position first Part 3811a and the Part II 3811b positioned adjacent to the second side of internal layer 3812.In at least one embodiment, with Similar to the above, outer layer 3811 can include the one or more fastening members extended from it.In at least one this type of embodiment, outward Layer 3811 can include the multiple deformable lower limbs extending from the side of outer layer 3811 and can being placed in compressible internal layer 3812 3921.In certain embodiments, each deformable lower limb 3921 can include at least one suspension hook from its projection or barb 3923, institute State at least one suspension hook or barb can engage the Part II 3811b of outer layer 3811 and therefore outer layer 3811 be remained to internal layer 3812.In at least one this type of embodiment, barb 3923 can be from the second lateral process of internal layer 3812 and extend through outer layer Hole 3808 in the Part II 3811b of 3811 so that the outer surface of the engageable outer layer of barb 3,923 3811 by outer layer 3811 Lock onto internal layer 3812.For structure nail bin 3900, internal layer 3812 can be at least partially compressed, so that barb is dashed forward from internal layer 3812 Rise and in access aperture 3808.In at least one this type of embodiment, such as when nail bin 3900 is inserted in nail bin, nail bin 3900 Can be by precommpression at least in part.In certain embodiments, to being described further above, at least partially may be used of lower limb 3921 Embedding in the Part I 3811a of outer layer 3811, the most at least one embodiment, outer layer 3811 can be by plastic material (example Such as PPDO (PDS) and/or polyglycolic acid (PGA)) constitute, and described plastic material can around lower limb 3921 extremely Few a part of overmolding.

Referring now to Figure 68-72, in various embodiments, nail bin (such as, nail bin 4000) can include warehouse 4010, this storehouse Body includes compressible ground floor 4011, the second layer 4012 and the multiple nails 4020 being positioned in warehouse 4010.See figure 70, in certain embodiments, each nail 4020 can include base portion 4022 and at least one deformable extended from base portion 4022 Lower limb 4023.Seeing Figure 68, at least one embodiment, nail bin 4000 can be positioned in staple cartridge channel 4030 and surgical stapling device End effector anvil block 4040 between, wherein warehouse 4010 the second layer 4012 and/or nail 4020 base portion 4022 can support Position by staple cartridge channel 4030.Referring now to Figure 69, in various embodiments, the second layer 4012 can include one layer of absorbent cotton 4060, described one layer of absorbent cotton is interconnected amongst one another by absorbent cotton support frame 4061.In at least one this type of embodiment, defat Cotton 4060 and absorbent cotton support frame 4061 can be made up of the plastic material (such as polyglycolic acid (PGA)) moulded.Each defat Cotton 4060 can include that one or more hole or slit 4062, the one or more hole or slit can accommodate extends through wherein Nail lower limb 4021, as shown in Figure 70 and Figure 71.Each absorbent cotton 4060 may also include and is limited to receiving slit 4063 therein, should Accommodate slit and can accommodate the 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 include multiple cut, perforation or similar structures, the plurality of cut, perforation or similar structures energy Enough allow that absorbent cotton 4060 separates with absorbent cotton support frame 4061 at desired location.Similarly, see Figure 71, one or many Individual absorbent cotton 4060 such as can be connected to each other along the line including perforation and/or cut 4064.In use, compressible froth bed 4011 can position against target tissue T, and warehouse 4010 can be compressed by anvil block 4040 so that anvil block 4040 can make nail 4020 Deformation.When following closely 4020 deformation, the nail lower limb 4021 of each nail 4020 can be by tissue T, a part for ground floor 4011 and defat Cotton 4060 captures are in the nail of deformation.When staple cartridge channel 4030 moves away from the nail bin 4060 implanted, such as absorbent cotton props up Support frame frame 4061 can separate with absorbent cotton 4060 and/or each absorbent cotton 4060 can be separated from one another.In some cases, when nail 4020 When being deformed in the above described manner by anvil block 4040, absorbent cotton 4060 can be with framework 4061 and/or separated from one another.

In various embodiments described herein, when anvil block moves to make position, the nail of nail bin can be complete by anvil block Shape.Referring now to Figure 73-76, in other embodiments various, the nail of nail bin (such as nail bin 4100) such as can be by motion To make position anvil block and make nail towards Guan Bi anvil block motion staple drivers system and deform.Nail bin 4100 can include can Compression warehouse 4110, this compressible warehouse can be such as by foamed materials and be at least partially situated in compressible warehouse 4110 Multiple nails 4120 are constituted.In various embodiments, staple drivers system can include driver clamper 4160, be positioned at driver folder Multiple staple drivers 4162 in holder 4160 and cartridge tray 4180, staple drivers 4162 can be maintained at by this cartridge tray In driver clamper 4160.In at least one this type of embodiment, staple drivers 4162 can be positioned in driver clamper In one or more slits 4163 in 4160, wherein the sidewall of slit 4163 can help to boot up staple drivers towards anvil block 4162.In various embodiments, nail 4120 can be supported in slit 4163 by staple drivers 4162, wherein implements at least one In example, when following closely 4120 and staple drivers 4162 is in its non-firing position, nail 4120 can be fully located in slit 4163.At certain In other embodiments a little, when following closely 4120 and staple drivers 4162 is in its non-firing position, at least partially may be used of nail 4120 Opening 4161 through slit 4163 upwardly extends.Now referring first to Figure 74, at least one this type of embodiment, nail The base portion of 4120 can be positioned in driver clamper 4160, and follow closely the end of 4120 and can embed compressible warehouse 4110 In.In certain embodiments, the height of about 1/3rd of nail 4120 can be positioned in driver clamper 4160, and The height of about 2/3rds of nail 4120 can be positioned in warehouse 4110.See Figure 73 A, at least one embodiment, Such as nail bin 4100 may also include around warehouse 4110 and the water impervious wrappage of driver clamper 4160 or film 4111。

In use, such as, nail bin 4100 can be located in staple cartridge channel, and anvil block can move to Guan Bi towards nail bin 4100 Position.In various embodiments, when anvil block moves to its make position, anvil block can contact and compress compressible warehouse 4110. In certain embodiments, when anvil block is in its make position, anvil block can not contact stud 4120.In some other embodiment, When anvil block moves to its make position, anvil block can the lower limb of contact stud 4120 make nail 4120 deform at least in part.Arbitrary In situation, nail bin 4100 may also include one or more sliding part 4170, and the one or more sliding part can be at nail bin 4100 Interior edge is longitudinally propelling so that sliding part 4170 can jointing nail driver 4162 make staple drivers 4162 and nail 4120 towards anvil subsequently Seat motion.In various embodiments, sliding part 4170 can slide between cartridge tray 4180 and staple drivers 4162.Anvil wherein The Guan Bi of seat has made in the embodiment that the forming process of nail 4120 starts, and nail 4120 moves upward towards anvil block and can complete forming process And make nail 4120 be deformed into its height being fully formed or the most desired height.The Guan Bi of anvil block does not makes nail 4120 become wherein In the embodiment of shape, nail 4120 moves upward towards anvil block and can start and complete forming process and to make nail 4120 be deformed into it to become completely The height of shape or the most desired height.In various embodiments, sliding part 4170 can be advanced to nail from the near-end of nail bin 4100 The far-end in storehouse 4100 so that before the nail 4120 in the far-end being positioned at nail bin 4100 is fully formed, be positioned at the near of nail bin 4100 Nail 4120 in end is fully formed.Seeing Figure 75, at least one embodiment, sliding part 4170 can each include at least one Angularly or the surface 4711 that tilts, it can be in staple drivers 4162 slid underneath and promote staple drivers as shown in Figure 76 4162。

In various embodiments, to being described further above, nail 4120 can be formed, in order to by tissue T at least At least some of capture of the compressible warehouse 4110 of a part and nail bin 4100 is wherein.After nail 4120 shaping, surgery The anvil block of stiching instrument and staple cartridge channel 4130 can move away from the nail bin 4100 implanted.In all cases, storehouse dish 4180 can Engage staple cartridge channel 4130, therefore when staple cartridge channel 4130 is pulled away from the warehouse 4110 implanted, storehouse dish in a position-stable manner 4180 can separate with compressible warehouse 4110.Referring again to Figure 73, in various embodiments, storehouse dish 4180 can include relative side Wall 4181, this warehouse 4110 can be removably positioned between relative sidewall 4181.In at least one this type of embodiment, Compressible warehouse 4110 can be compressed between sidewall 4181 so that warehouse 4110 can be removably retained in during use Between sidewall 4181, and when storehouse dish 4180 is pulled away from, warehouse 4110 departs from releasedly from storehouse dish 4180.At at least one this In class embodiment, driver clamper 4160 may be connected to storehouse dish 4180 so that when storehouse dish 4180 is removed from operative site, Driver holder 4160, driver 4162 and/or sliding part 4170 are positively retained in storehouse dish 4180.At some, other are implemented In example, driver 4162 can be shot up from driver clamper 4160 and stay in operative site.At at least one, this type of is real Execute in example, each driver 4162 can by such as with trade name Vicryl sell polyglycolic acid (PGA), polylactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), with trade name Monocryl sell poliglecaprone 25(PGCL), the complex of polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL etc. are bioabsorbable Material constitute.In various embodiments, driver 4162 could attach to follow closely 4120 so that driver 4162 is deployed with nail 4120.In at least one this type of embodiment, each driver 4162 can include the groove that such as can accommodate the base portion of nail 4120, The most at least one embodiment, described groove can accommodate nail base portion with press-fit and/or snap fit.

In certain embodiments, to being described further above, driver clamper 4160 and/or sliding part 4170 can It is shot up from storehouse dish 4180.In at least one this type of embodiment, sliding part 4170 can clamp with driver at storehouse dish 4180 Slide between device 4160 so that when sliding part 4170 advances to drive up staple drivers 4162 and nail 4120, sliding part 4170 also can make driver clamper 4160 move upward to outside storehouse dish 4180.In at least one this type of embodiment, drive Device clamper 4160 and/or sliding part 4170 can be by such as with polyglycolic acid (PGA), the polylactic acid of the sale of trade name Vicryl (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), gathering with the sale of trade name Monocryl Caprone 25(PGCL), the complex etc. of polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL can give birth to The material that thing absorbs is constituted.In various embodiments, sliding part 4170 can be integrally formed and/or be attached to driving rod or cutting Component, described driving rod or cutting element promote sliding part 4170 through nail bin 4100.In this type of embodiment, sliding part 4170 can not be shot up from storehouse dish 4180 and can keep together with surgical stapling device, and are not attached to drive at sliding part 4170 In other embodiments of dynamic rod, sliding part 4170 can be stayed in operative site.In any case, to retouching the most further Stating, the compressibility tolerable of warehouse 4110 uses thicker nail bin in the end effector of surgical stapling device, this is because When the anvil block of stiching instrument closes, warehouse 4110 is compressible or collapses.In certain embodiments, owing to following closely quilt when anvil block closes Deform at least in part, therefore can use higher nail (such as have about 0.18 " nail of staple height), the most about 0.12 " staple height can be positioned in compressible stratum 4110, and wherein compressible stratum 4110 may have about 0.14 " not Compression height.

Referring now to Figure 77-80, in various embodiments, nail bin (such as, nail bin 4200) such as can include compressible storehouse Body 4210, the multiple nails 4220 being positioned in compressible warehouse 4210 and the lateral supports 4234 of multiple flexibility.Ginseng now Seeing Figure 78, in various embodiments, it is middle with staple cartridge channel 4230 that nail bin 4200 can be positioned in anvil block 4240, wherein at least In one embodiment, lateral support component 4234 could attach to staple cartridge channel 4230.When anvil block 4240 moves downward with compression bin Body 4210 when making nail 4220 deform at least in part, as shown in Figure 79, the sidepiece of warehouse 4210 can laterally expand and outwards Promote lateral support component 4234.In at least one this type of embodiment, lateral support component 4234 could attach to warehouse 4210, And when warehouse 4210 laterally expands as mentioned above, lateral support component 4234 can separate with warehouse 4210, such as Figure 79 institute Show.In at least one embodiment, lateral support component 4234 can utilize at least one binding agent (such as, fibrin and/or Protein hydrogel) adhere to warehouse 4210.With similar to the above, nail 4220 when anvil block 4240 closes, can be only partially made to deform, its In can be by advance one or more sliding part 4270 to complete to follow closely the shaping of 4220 through nail bin 4200 as shown in Figure 80.Now Seeing Figure 82 and Figure 83, in various embodiments, sliding part 4270 can be cut component 4280 and advance from the near-end of nail bin 4200 Far-end to nail bin 4200.In at least one this type of embodiment, cutting element 4280 can include cutting element or cutter 4283, institute State cutting element or cutter 4283 may pass through tissue T and/or compressible warehouse 4210 and advances.In certain embodiments, cutting structure Part 4280 can include cam member 4282, and this cam member can advance and by described jaw along the outer surface of jaw 4230 and 4240 Move or be held in place.In various embodiments, due to mentioned above, nail 4220 can while tissue T is cut open or at least Substantially simultaneously it is shaped to its net shape.In at least one this type of embodiment, sliding part 4270 can be relative to cutter 4283 It is positioned in distally so that when only the propulsive units at tissue is sewed up completely, tissue T is just cut open.

Referring again to Figure 82 and Figure 83, in various embodiments, sliding part 4270 can include single slidable member, institute State slidable member to be advanced by cutting element 4280 together.In at least one this type of embodiment, sliding part 4270 can be received In nail bin 4200, and cutting element 4280 can be advanced in nail bin 4200 by trigger shaft 4281 so that cutting element 4280 Engaging slide part 4270 also advances sliding part 4270 towards distally.In certain embodiments, each sliding part 4270 can be connected to each other.? In any one situation, each sliding part 4270 can include angled surface or cam 4271, this angled surface or cam The nail 4220 of alignment can be lifted in staple.In certain embodiments, angled surface 4271 can be with cutting element 4280 Be formed as overall.Referring again to Figure 82 and Figure 83, at least one embodiment, each nail 4200 can include base portion and bizet 4229, at least one deformable member extends from base portion, and bizet 4229 overmolding is to following closely the base portion of 4200 and/or variable At least some of of shape component above and/or positions at least partially around described.In various embodiments, such as this type of hat Portion 4229 directly can be driven by sliding part 4270.More specifically, at least one embodiment, bizet 4229 energy of nail 4220 Enough make in the case of no-fix has staple drivers between the angled surface 4271 and bizet 4229 of sliding part 4270, become The surface 4271 of angle can bizet 4229 slid underneath and directly contact bizet 4229.In this type of embodiment, each bizet 4229 all include at least one angled or surface of inclination cooperated, angled or table of inclination of at least one cooperation described Face can be engaged by the angled surface 4271 of sliding part 4270 so that when sliding part 4270 is when following closely 4220 slid underneath, association The angled surface made can drive up nail 4220.

Referring now to Figure 81, in various embodiments, nail bin (such as, nail bin 4300) such as can include compressible main body 4310 and be positioned at the multiple nails 4320 in compressible main body 4310.With similar to the above, nail bin 4300 can include flexibility Lateral supports 4334, the lateral supports of this flexibility could attach to staple cartridge channel and/or adheres to compressible main body 4310. In addition to person mentioned above, flexible lateral supports 4334 can be connected to one by one or more pillars or connecting elements 4335 Rising, lateral supports 4334 can be kept together by the one or more pillar or connecting elements 4335.In use, even Connection member 4335 is prevented from or at least suppression lateral supports 4334 separates with warehouse 4310 prematurely.In some embodiment In, connecting elements 4335 can be after nail bin 4300 be compressed by anvil block, and lateral supports 4334 is maintained at by this connecting elements Together.In this type of embodiment, lateral supports 4334 can resist lateral expansion or the displacement of the sidepiece of warehouse 4310.At some In embodiment, cutting element (such as cutting element 4280) can work as cutting element 4280 in warehouse 4310 towards distal movement Time, cutting element can crosscutting connecting elements 4335.In at least one this type of embodiment, cutting element 4280 can push away towards distally Dynamic one or more sliding parts (such as sliding part 4270), in order to make nail 4320 shape against anvil block.Sliding part 4270 can draw Lead cutting blade 4283 so that cutting element 4280 will not crosscutting connecting elements 4335, until the nail 4320 of neighbouring connecting elements 4335 It is fully formed or is at least shaped to Desired Height.In all cases, cooperate with lateral supports 4334 can for connecting elements 4335 Prevent or at least reduce the lateral movement of compressible warehouse 4310, and prevent simultaneously or at least reduce the nail being positioned at warehouse 4310 The lateral movement of 4320.In this case, nail 4320 can be held in place by connecting elements 4335, until nail 4320 deformation, and And connecting elements 4335 can be then cut out discharging the sidepiece of warehouse 4310.As it has been described above, lateral supports 4334 may be connected to Staple cartridge channel, therefore after nail bin 4300 is implanted, lateral supports 4334 can be from operative site quilt together with staple cartridge channel Remove.In certain embodiments, lateral supports 4334 can be made up of implanted material and can be left in operative site.Extremely In a few embodiment, connecting elements 4335 can be positioned in the middle of warehouse 4310 and tissue T, and connecting elements 4335 with After lateral supports 4334 separates, connecting elements 4335 can keep implantation within a patient.In at least one this type of embodiment, Connecting elements 4335 can be made up of implanted material, and in certain embodiments, connecting elements 4335 can such as by with laterally The material that supporting member 4334 is identical is constituted.In various embodiments, connecting elements 4335 and/or lateral supports 4334 can be by Such as with trade name Vicryl sell polyglycolic acid (PGA), polylactic acid (PLA or PLLA), PPDO (PDS), Polyhydroxyalkanoatefrom (PHA), with trade name Monocryl sell poliglecaprone 25(PGCL), polycaprolactone (PCL) and/ Or the flexible bioabsorbable material such as the complex of PGA, PLA, PDS, PHA, PGCL and/or PCL is constituted.In various realities Executing in example, connecting elements can include the material piece for connecting each lateral supports 4334.In certain embodiments, nail bin can wrap The connecting elements including the top surface extending through warehouse 4310 and the connection extended around the lower surface of warehouse 4310 Component.

Referring now to Figure 84, in various embodiments, nail bin can include nail (such as, follow closely 4420), and described nail such as can wrap Include the wire rod portion being inserted in bizet.In at least one embodiment, wire rod portion can be by metal (such as titanium and/or rustless steel) And/or plastics (such as PPDO (PDS) and/or polyglycolic acid (PGA)) are constituted.In at least one embodiment, Bizet can be by metal (such as titanium and/or rustless steel) and/or plastics (such as PPDO (PDS) and/or polyglycolic acid (PGA)) constitute.In certain embodiments, the wire rod portion of each nail 4420 can include base portion 4422 and extend from base portion 4422 Deformable lower limb 4421, the bizet of the most each nail 4420 can include bizet 4429, and this bizet can accommodate base portion wherein 4422 at least some of.Referring now to Figure 85 A-85C, for assembling each several part of each nail 4420, can be by the leg in wire rod portion 4421 insert in the opening 4426 in bizet 4429, and lower limb 4421 can be guided to base portion chamber 4427 by its split shed 4426. Wire rod portion also can be inserted in bizet 4429 so that lower limb 4421 leaves the base portion 4422 in base portion chamber 4427 and wire rod portion and enters base In portion's chamber 4427.In at least one this type of embodiment, base portion chamber 4427 enables to when base portion 4422 enters base compartment During room 4427, wire rod portion rotates in bizet 4429 so that nail lower limb 4421 point to upwards or at least substantially upwardly direction. Referring again to Figure 84, in various embodiments, bizet 4429 can include outlet opening 4425, and this outlet opening can accommodate nail wherein Lower limb 4421.

In various embodiments, to being described further above, surgical stapling device can include sliding part 4470, this slip The nail 4420 that part is accommodated in can traversing nail bin 4400 and staple cartridge channel 4430 and making warehouse 4410 moves towards anvil block.Various In the case of, sliding part 4470 can be from the proximal movement of staple cartridge channel 4430 to the far-end of storehouse passage 4430, to implant warehouse 4410 With nail 4420.In some cases, sliding part 4470 regracting or return to the near-end of storehouse passage 4430, and another nail bin 4400 can be inserted in storehouse passage 4430.The newest nail bin 4400 is positioned in storehouse passage 4430, then sliding part 4470 can Again advance towards distally.In various embodiments, surgical stapling device can include one or more latch-up structure, one or many Individual latch-up structure no-fix can prevent sliding part 4470 again towards far in the case of having new nail bin 4400 in storehouse passage 4430 Side advances.Referring again to Figure 84, at least one this type of embodiment, staple cartridge channel 4430 can include locking shoulder 4439, should Locking shoulder is prevented from or at least limit slippage part 4470 is towards distal movement.More specifically, unless sliding part 4470 is by promoting Structure 4428 is lifted up exceeding shoulder 4439 at least in part, and otherwise sliding part 4470 can adjoin shoulder 4439, promotes knot Extend between the structure 4428 such as recent side in nail bin 4400 nail 4420.In other words, when new nail bin 4400 does not exists When recent side follows closely 4420, sliding part 4470 cannot advance.Therefore, when storehouse passage 4430 exists used nail bin 4400 or When there is not any nail bin 4400 in storehouse passage 4430, sliding part 4470 cannot advance in storehouse passage 4430.

Referring now to Figure 86, to being described further above, nail bin (such as, nail bin 4500) such as can be positioned in nail In storehouse passage 4530 and compressible warehouse 4510, the multiple nails 4520 being positioned in warehouse 4510 and storehouse dish or guarantor can be included Holder 4580.In various embodiments, compressible warehouse 4510 can include outer layer 4511 and internal layer 4512, wherein at least one In embodiment, outer layer 4511 can surround internal layer 4512 in a sealing fashion.In at least one this type of embodiment, outer layer 4511 can be Extend between internal layer 4512 and storehouse dish 4580.In some other embodiment, outer layer 4511 can only partially about internal layer 4512, And at least one this type of embodiment, outer layer 4511 and storehouse dish 4580 can cooperate with surrounding or at least substantially surround internal layer 4512.In various embodiments, to being described further above, nail 4520 can be supported by storehouse dish 4580, wherein storehouse dish 4580 Can include the one or more of support nail 4520 can following closely support passages.In certain embodiments, storehouse dish 4580 could attach to storehouse Body 4510, wherein at least one this type of embodiment, warehouse 4510 can be by laterally between the relative sidewall of storehouse dish 4580 Ground compression.In various embodiments, the sidewall of storehouse dish 4580 can laterally support warehouse 4510, at least one this type of embodiment In, storehouse dish 4580 can include one or more walls or the fin extending upwardly to warehouse 4510 from bottom support 4583 4582.In at least one this type of embodiment, warehouse 4510 can include one or more slit or passage, one or many Individual slit or passage can accommodate wall 4582 and/or interlock with wall 4582.In various embodiments, wall 4582 can partly or several Extend through warehouse 4510 fully.In at least one this type of embodiment, wall 4582 can be in the first nail 4520 and second Nail bin 4500 is extended longitudinally through between nail 4520.

In various embodiments, warehouse 4510 and/or storehouse dish 4580 can include that cooperation keeps structure, and described cooperation keeps knot Structure can provide snap-fitted between storehouse dish 4580 and warehouse 4510.In certain embodiments, nail bin 4500 can be positioned in storehouse In passage 4530 so that storehouse dish 4580 positions against storehouse passage 4530 and/or is attached to storehouse passage 4530.Real at least one Executing in example, storehouse dish 4580 can be detachably coupled to storehouse passage 4530 so that is compressed by anvil block 4540 at nail bin 4500 and follows closely After 4520 deformation, storehouse dish 4580 can separate with storehouse passage 4530 and can be implanted together with warehouse 4510.At at least one this In class embodiment, storehouse dish 4580 can by such as with trade name Vicryl sell polyglycolic acid (PGA), polylactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), with trade name Monocryl sell poliglecaprone 25(PGCL), the complex of polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL etc. are bioabsorbable Material constitute.In certain embodiments, surgical stapling device may also include firing lock and/or driver, described firing lock And/or driver can be at staple cartridge channel 4530 and driving surface, bottom middle slip on storehouse dish 4580, described bottom drives table Face can promote from storehouse passage 4530 or penetrate storehouse dish 4580.In certain embodiments, warehouse 4510 can join separably Receive storehouse dish 4580 so that after nail bin 4500 is compressed by anvil block 4540 and follows closely 4520 deformation, warehouse 4510 can be from storehouse dish 4580 separate.In at least one this type of embodiment, storehouse dish 4580 can keep engaging storehouse passage 4530 in a position-stable manner so that storehouse Dish 4580 is removed from operative site together with storehouse passage 4530.In certain embodiments, surgical stapling device may also include percussion Mechanism and/or driver, described firing lock and/or driver can drive table at cartridge tray 4580 with bottom on warehouse 4510 Face middle slip, driving surface, described bottom can promote from storehouse dish 4580 or penetrate warehouse 4510.At at least one this type of In embodiment, nail bin 4500 may also include and is positioned at storehouse dish 4580 and the middle staple drivers of nail 4520 so that when firing lock court Time slip in distally, staple drivers and nail 4520 can be driven upwardly towards anvil block.In at least one this type of embodiment, staple drivers Can be at least partially embedded in compressible warehouse 4510.

In various embodiments, with similar to the above, nail bin 4500 can include that latch-up structure, described latch-up structure are prevented from Or at least restriction cutting element is towards distal movement, unless positioned the nail bin 4500 not fired in staple cartridge channel 4530.At certain In a little embodiments, cartridge tray 4580 can include such as being lifted up cutting element in staple cartridge channel 4530 and making it exceed The surface of locking surface.Wherein storehouse passage 4530 does not exist in the situation of the nail bin 4500 including storehouse dish 4580, cut structure Part cannot advance.In at least one embodiment, the nail of the recent side in nail bin 4500 and/or any other suitably nail can include Promoting surface, cutting element can be lifted beyond locking surface by described lifting surface completely.Over and above what is described above or substitute on Literary composition is described, and each several part of nail bin 4500 can be made up of the material with different colours.In this type of embodiment, surgeon can Visually identify and when staple cartridge channel 4530 exists the nail bin not firing and/or firing.In at least one this type of embodiment In, the outer layer 4511 of warehouse 4510 can have the first color, and storehouse dish 4580 can have the second color, and staple cartridge channel 4530 can There is the 3rd color.In surgeon sees the situation of the first color, surgeon may know that the storehouse 4500 not fired exists In staple cartridge channel 4530；In surgeon sees the situation of the second color, surgeon may know that the storehouse 4500 of percussion is deposited It is in staple cartridge channel 4530, and remaining storehouse dish 4580 needs to remove；And the feelings of the 3rd color are seen surgeon In shape, surgeon may know that any part of nail bin 4500 is all not kept in staple cartridge channel 4530.

Referring now to Figure 87, in various embodiments, nail bin (such as, nail bin 4600) such as can include compressible implanted Warehouse 4610 and the multiple nails 4620 being positioned in warehouse 4610.Warehouse 4610 can include outer layer 4611 and internal layer 4612.? In some embodiment, internal layer 4612 can include being limited to multiple pit therein (such as pit or chamber 4615), the plurality of recessed Hole can be conducive to collapsing of warehouse 4610.In at least one this type of embodiment, internal layer 4612 can include corrugated or honeycomb structure The dot matrix of type, described dot matrix can bear compression stress or pressure, as long as this compression stress or pressure are less than specific threshold value. When not less than threshold value, internal layer 4612 can be relative to the compression stress applied or pressure with linear or the most linear Rate deformation.After compression stress or pressure exceed threshold value, internal layer 4612 can be yielded to suddenly due to compressive load scratch greatly Song is also collapsed or bends.In various embodiments, the dot matrix of internal layer 4612 can be by multiple sublayers 4612a being connectable to together Constitute.In at least one embodiment, each sublayer 4612a can include multiple ditch alternately and ridge or ripple, the plurality of alternately Ditch and ridge or ripple can align with ridge with the ditch alternately of adjacent sublayers 4612a.In at least one this type of embodiment, the first son The ditch of layer 4612a can be positioned so that adjacent with the ridge of the second sublayer 4612a；Similarly, the ridge of the first sublayer 4612a can be positioned Become adjacent with the ditch of the second sublayer 4612a.In various embodiments, adjacent sublayer 4612a can pass through at least one binding agent (such as, fibrin and/or protein hydrogel) adheres to each other and/or adheres to outer layer 4611.Figure 88 shows at warehouse 4610 have collapsed and followed closely 4620 has deformed capture against warehouse 4610 and keep the nail bin 4600 after tissue T.

Referring now to Figure 89-91, in various embodiments, nail bin (such as, nail bin 4700) such as can include compressible planting Enter formula warehouse 4710 and the multiple nails 4720 being positioned in warehouse 4710.With similar to the above, warehouse 4710 can include outer layer 4711 and internal layer 4712, wherein internal layer 4712 can include multiple sublayer 4712a.Same with similar to the above, each sublayer 4712a can Including ditch 4717 alternately and ridge 4718, described zastrugi alternately can be mutually aligned to limit pit or chamber 4715 betwixt. In at least one this type of embodiment, ditch 4717 and/or ridge 4718 can be along that be parallel to each other and/or be parallel to longitudinal axis 4709 Axis extend.In various embodiments, nail 4720 can align in multiple staples, and the plurality of staple can be along being parallel to each other And/or the axis being parallel to longitudinal axis 4709 extends.Refer again to Figure 87 and Figure 88, in various alternative embodiments In, the nail 4620 accommodated in warehouse 4600 can extend along axis, described axis across or be perpendicular to by the ditch of sublayer 4612a and The axis that ridge is limited.Referring again to Figure 89-91, nail 4720 can extend across ditch 4717 and ridge 4718, wherein nail 4720 and son Nail 4720 can be maintained in warehouse 4710 by the frictional force between layer 4712a.In certain embodiments, the plurality of sublayer 4712a can be by backing material and/or plastic material (such as PPDO (PDS) and/or polyglycolic acid (PGA)) structure Becoming, nail 4720 such as can be maintained at upright orientation and/or will follow closely 4720 by described backing material and/or plastic material It is kept into and relative to each other aligns, as shown in Figure 89 and Figure 90.Figure 91 is shown in warehouse 4710 and has collapsed and followed closely 4720 and deform To capture against warehouse 4710 and to keep the nail bin 4700 after tissue T.

Referring again to Figure 89-91, in various embodiments, when warehouse 4710 is compressed, warehouse 4710 can be with resilience Ground or collapse with elastic type.In at least one this type of embodiment, when warehouse 4710 is compressed, ditch 4717 and ridge 4718 exist Ripple formed in each sublayer 4712a can be by graduation or at least substantially by graduation, and this can make between ditch 4717 and ridge 4718 The cavity 4715 limited is collapsed or is at least substantially collapsed.In all cases, when removing compression stress or pressure from warehouse 4710 After power, at least some of warehouse 4710 or warehouse 4710 can with resilience ground or again stretch with elastic type.Extremely In few this type of embodiment, the connection when warehouse 4710 is compressed, between ditch 4717 and the ridge 4718 of adjacent sublayers 4712a Can keep intact or the most intact so that after removing compression stress on warehouse 4710, sublayer 4712a can be inclined Put ditch 4717 itself to make it away from each other with ridge 4718, and therefore make warehouse 4710 the most again stretch.Real at some Executing in example, when warehouse 4710 is compressed, it can deform or in plastic manner by conquassation, is therefore removing pressure on warehouse 4710 After contracting power or pressure, warehouse 4710 can not stretch again.Referring now to Figure 92, in certain embodiments, nail bin (such as nail bin 4800) such as can include can the warehouse 4810 of conquassation, this warehouse of conquassation can include outer layer 4811 and internal layer 4812, wherein internal layer 4812 can include corrugated, the dot matrix of honeycomb configuration, and described dot matrix has the multiple pits or chamber 4815 limited wherein.? In various embodiments, the wall of the dot matrix limiting internal layer 4812 can include one or more reduction or thin cross section 4819, institute State one or more reduction or thin cross section 4819 can the wall of tolerance bound fixed point battle array be ruptured when warehouse 4810 compresses. In this case, when nail bin 4800 is implanted, warehouse 4810 can be by conquassation.

Referring now to Figure 93-95, in various embodiments, nail bin (such as, nail bin 4900) such as can include warehouse 4910, This warehouse include outer layer 4911 and be positioned at outer layer 4911 top and bottom between multiple crushable members 4912.First Seeing Figure 93 and Figure 94, nail bin 4900 may also include multiple nail 4920, and the most each nail 4920 can be positioned in crushable member In 4912.More specifically, each crushable member 4912 can include Part I 4912a, Part II 4012b and the 3rd Dividing 4012c, described Part I 4912a, Part II 4012b and Part III 4012c can limit cavity the most wherein 4915, described cavity can accommodate nail 4920.In use, to being described further above, nail bin 4900 can be positioned in In staple cartridge channel and tissue contacting surface 4919 can be applied compression stress to compress warehouse 4910.When tissue contacting surface 4919 to During lower motion, crushable member 4912 can be collapsed.In this case, the Part II 4912b of each crushable member 4912 Can be collapsed in the Part I 4912a of correspondence；Similarly, the Part III 4912c of each crushable member 4912 can collapse To corresponding Part II 4912b.When warehouse 4910 is compressed and crushable member 4912 is collapsed, it is positioned at crushable member Nail 4920 deformable in 4912, as shown in Figure 95.In various embodiments, the Part II of each crushable member 4912 4912b can be frictionally engaged correspondence Part I 4912a and/or be press-fitted in correspondence Part I 4912a in so that the most right The compression stress that crushable member 4912 applies exceedes for Part I 4912a and Part II 4912b is maintained at its extension Retentivity in position (Figure 94), then Part I 4912a and Part II 4912b can start relative to each other to slide.Similar Ground, the Part III 4912c of each crushable member 4912 can be frictionally engaged correspondence Part II 4912b and/or be press-fitted in In corresponding Part II 4912b so that the compression stress once applied crushable member 4912 exceedes for by Part II 4912b and Part III 4912c is maintained at the retentivity in its extended position (Figure 94), then Part II 4912b and the 3rd Divide 4912c can start relative to each other to slide.

In many embodiments as herein described, nail bin can include multiple nail.In various embodiments, this type of nail can be by It is deformed into substantially U-shaped configuration and there is the metal wire rod composition of two nail lower limbs.It is contemplated that wherein nail can include various configuration Other embodiments of (being such as joined together and have two or more wire rods of three or more nail lower limbs).Various In embodiment, circle or at least substantially round cross section can be included for forming one or more wire rods of nail.At least one In individual embodiment, staple line material can include any other suitable cross section, such as square and/or the cross section of rectangle.At certain In a little embodiments, nail can be made up of plastic wire.In at least one embodiment, nail can be by the metal wire rod structure being coated with plastics Become.In various embodiments, except nail in addition to or as follow closely replacement, storehouse can include the securing member of any suitable type.At least In one this type of embodiment, this type of securing member can include that pivotable arm, described arm can be folded when being engaged by anvil block.At certain In a little embodiments, may utilize and be divided into two-part securing member.In at least one this type of embodiment, nail bin can include multiple first Fastener portion, and anvil block can include multiple second fastener portion；When anvil block is compressed against nail bin, the second fastening Part is attached partially to the first fastener portion.In certain embodiments, as it has been described above, sliding part or driving can be advanced in nail bin Device is to complete the forming process of nail.In certain embodiments, sliding part or driver can be advanced in anvil block, in order to make one Or multiple formed parts moves downwardly to and engages with relative nail bin and nail or the securing member that is positioned in nail bin.

In various embodiments described herein, nail bin can include being stored in four staples therein.Real at least one Executing in example, described four staples can be configured to two inner side staples and two outside staples.In at least one this type of embodiment In, inner side staple and outside staple can be positioned on the first side of the cutting element in nail bin or cutter slit；Similarly, inner side Staple and outside staple can be positioned on the second side of cutting element or cutter slit.In certain embodiments, nail bin can not Including cutting element slit；But, this type of nail bin can include that the specific part that can be cut component incision is narrow to substitute nail bin Groove.In various embodiments, each inner side staple can be arranged in nail bin so that it is with cutting element slit equidistantly or at least Substantially it is equally spaced.Similarly, each outside staple can be arranged in nail bin so that it is equidistant with cutting element slit Ground or be at least substantially equally spaced.In various embodiments, nail bin can include being stored in more or less than four staples In nail bin.In at least one embodiment, nail bin can include six staples.In at least one this type of embodiment, nail bin can be Include three staples on first side of cutting element slit, and on the second side of cutting element slit, include three staples. In certain embodiments, nail bin can include odd number staple.Such as, nail bin can include two on the first side of cutting element slit Individual staple, and on the second side of cutting element slit, include three staples.In various embodiments, staple can include having The nail of identical or the most identical unshaped staple height.In some other embodiment, one or more staples can be wrapped Include the nail from other nails with different unshaped staple heights.In at least one this type of embodiment, such as cutting element slit The first side on nail can have the first unshaped height, and the nail on the second side of cutting element slit can have second not Forming height, described second unshaped height is different from described first height.

Referring now to Figure 96 A-96D, in various embodiments, the end effector of surgical stapling device comprises the steps that storehouse is attached Portion (such as, staple cartridge channel 5030)；The fastener cartridge (such as, nail bin 5000) being removeably positioned in staple cartridge channel 5030；With And the jaw 5040 relatively positioned with nail bin 5000 and staple cartridge channel 5030.Nail bin 5000 can include compressible body 5010 and Multiple nails 5020 and/or any other the suitable securing member being at least partially situated in compressible body 5010.At least one In this type of embodiment individual, each nail 5020 can include base portion 5022 and from the upwardly extending lower limb of base portion 5,022 5021, wherein lower limb 5021 can be embedded at least partially in warehouse 5010.In various embodiments, compressible body 5010 can include top table Face or tissue contacting surface 5019 and lower surface 5018, wherein lower surface 5018 can be against the support table of staple cartridge channel 5030 Face 5031 and position and supported by stayed surface 5031.With similar to the above, stayed surface 5031 such as can include being limited to wherein Multiple support slit 5032(Figure 96 D), the plurality of support slit 5032 can accommodate and the base portion 5022 of support nail 5020. In various embodiments, the end effector of surgical stapling device may also include holding matrix (such as keeping matrix 5050), described Keep matrix can jointing nail 5020, and tissue capture is being kept matrix and is following closely between 5020.At at least one, this type of is implemented In example, keep matrix 5050 can be removably attached to jaw 5040.In use, once nail bin 5000 is positioned in nail bin In passage 5030, then jaw 5040 and be attached to the holding matrix 5050 of jaw 5040 can be towards nail bin 5000 and staple cartridge channel 5030 Motion.In at least one embodiment, jaw 5040 can move downward along axis 5099 so that when jaw 5040 closes, pincers Mouth 5040 and staple cartridge channel 5030 remain parallel to each other or the most parallel.More specifically, this type of is implemented at least one In example, jaw 5040 can be closed, so that when jaw 5040 moves towards nail bin 5000, keeping the contact tissue table of matrix 5050 Face 5051 is parallel to or at least substantially parallel to the tissue contacting surface 5019 of nail bin 5000.

Referring now to Figure 96 A, in various embodiments, keep matrix 5050 can be detachably secured to jaw 5040, Make when keeping matrix 5050 to be attached to jaw 5040, keep existing between matrix 5050 and jaw 5040 the least (if If having) relative motion.In at least one embodiment, jaw 5040 can include one or more holding structure, one Or multiple holding structure can be held in place keeping matrix 5050.In at least one this type of embodiment, keep matrix 5050 Can be snap-fitted and/or be press-fitted in jaw 5040.In certain embodiments, at least one binding agent can be utilized will to keep matrix 5050 adhere to jaw 5040.In any case, jaw 5040 is moveable in following location: wherein keep matrix 5050 to connect Touch tissue T and tissue T positions against the tissue contacting surface 5019 of nail bin 5000.When tissue T by jaw 5040 be positioned to During by nail bin 5000, the compressible body 5010 of described nail bin 5000 can be compressed by jaw 5040 or can not be compressed by it.In office In a kind of situation, in various embodiments, the lower limb 5021 of nail 5200 can be not passed through the tissue contacting surface 5019 of nail bin 5000 and dashes forward Rise, as shown in Figure 96 A.Additionally, same as shown in Figure 96 A, in the case of retaining matrix 5050 not jointing nail 5020, jaw 5040 can keep tissue T against compressible body 5010.This type of embodiment tolerable surgeon repeatedly open and close Jaw 5040, in order to such as obtain end effector expected location in operative site in the case of not damaging tissue T.So And, it is contemplated to other embodiments, wherein nail end 5023 can be from contact tissue before warehouse 5010 is compressed by anvil block 5040 Surface 5019 projection.Referring now to Figure 96 B, once end effector is properly positioned, then jaw 5040 can be towards staple cartridge channel 5030 move downward so that compressible body 5010 is compressed by anvil block 5040, and make tissue contacting surface 5019 relative to nail 5020 are pushed down.When tissue contacting surface 5019 is pushed down, the end 5023 of nail lower limb 5021 can be pierced tissue and connects Touch surface 5019 and pierce through at least some of of tissue T.In this case, matrix 5050 is kept can be positioned on nail 5020 Side so that keep the retaining hole 5052 of matrix 5050 to align with the end 5023 of nail lower limb 5021 or at least substantially align.

Referring now to Figure 96 C, when pushing down on holding matrix 5050 along axis 5099, the nail lower limb 5021 of nail 5020 can enter Enter in retaining hole 5052.In various embodiments, the sidewall of the engageable retaining hole of lower limb 5,021 5052 is followed closely.In certain embodiments, Described in greater detail below, matrix 5050 is kept can to include extending in retaining hole 5052 and/or around retaining hole 5052 One or more holding components, the one or more holding component can jointing nail lower limb 5021.In any one situation, follow closely lower limb 5021 can be maintained in retaining hole 5052.In all cases, the end 5023 of nail lower limb 5021 can enter in retaining hole 5052 And can be frictionally engaged holding component and/or the sidewall in hole 5052.Promoted when keeping the matrix 5050 base portion 5022 towards nail 5020 Time, nail lower limb 5021 can be relative to sidewall and/or holding member slide.Due to mentioned above, nail lower limb 5021 and holding matrix 5050 Between can produce force of sliding friction, wherein this type of force of sliding friction can be resisted holding matrix 5050 and is inserted on nail 5020.Respectively In kind of embodiment, when keeping matrix 5050 along nail lower limb 5021 slide downward of nail 5020, keep matrix 5050 and nail 5020 it Between force of sliding friction can be constant or the most constant.In certain embodiments, owing to such as following closely lower limb 5021, protecting Hold hole 5052 and/or extend in retaining hole 5052 and/or keep component change in size and geometry around retaining hole 5052 Change；When keeping matrix 5050 along nail lower limb 5021 slide downward, force of sliding friction can increase and/or reduce.In various embodiments In, the compressible body 5010 of nail bin 5000 also can be resisted holding matrix 5050 and be inserted in nail 5020.More specifically, compressible master Body 5010 can be such as made up of elastomeric material, and described elastomeric material can apply drag to keeping matrix 5050；Work as compressible body When the distance that 5010 are compressed increases, described drag increases.In at least one this type of embodiment, by resisting that warehouse 5010 produces The increase of power can be the most proportional to the distance that warehouse 5010 is compressed or the most proportional.Real at some Execute in example, warehouse 5010 increase of the drag produced can be proportional to the geometric distance ground that warehouse 5010 is compressed.

In various embodiments, to being described further above, jaw 5040 and holding matrix 5050 can be applied foot Enough percussion forces, to overcome above-mentioned drag and frictional force.In use, matrix 5050 is kept can be seated to relative to nail 5020 Any suitable depth.In at least one embodiment, matrix 5050 is kept can be pacified relative to the base portion 5022 of nail 5020 Put to a depth, in order to two-layer or more layers tissue are secured together and in tissue, produce compression stress or pressure.Respectively In the case of Zhong, including keeping the system tolerable surgeon of matrix 5050 and nail 5020 by selecting holding matrix 5050 to be pacified The degree of depth put selects compression stress or the size of pressure applying tissue.Such as, holding matrix 5050 can be towards the nail of nail 5020 Base portion 5022 is pushed down, until keeping matrix 5050 to be seated to and supporting the bottom of slit 5032 at a distance of certain depth 5011, the most shallow degree of depth 5011 can produce and apply to the highest compression stress of tissue T or pressure, and the deepest degree of depth 5011 The lowest compression stress or pressure applied to tissue T can be produced.In various embodiments, compression stress or the pressure of tissue T it are applied to Power can be the most proportional or the most proportional to the degree of depth 5011 keeping matrix 5050 to be placed.Various In the case of, the compression stress or the pressure that are applied to tissue T can be depending on and keeping the tissue T between matrix 5050 and nail bin 5020 Thickness.More specifically, for given distance 5011, the existence of thicker tissue T may compare the existence of thin tissue T and produces higher Compression stress or pressure.

In all cases, to being described further above, surgeon's adjustable keeps matrix 5050 to be placed The degree of depth is to cause the thicker and/or relatively thin tissue being positioned at end effector, and to group in the way of unrelated with tissue thickness Knit T and apply specific or predetermined pressure.Such as, when fastening relatively thin tissue T, surgeon can pacify keeping matrix 5050 Put to the shallower degree of depth 5011, or be seated to the deeper degree of depth 5011 when the tissue T of fastening thicker, in order in tissue Reach identical or the most identical compression stress.In certain embodiments, to being described further above, surgeon Optionally determine the size being pointed to keep the compression stress of the tissue T applying between matrix 5050 and nail bin 5010.Respectively In the case of Zhong, surgeon can engage keeping matrix 5050 with nail 5020, and is positioned to by holding matrix 5050 and nail 5020 Base portion 5022 first distance, in order to tissue apply the first compression pressure.Alternatively, surgeon can Being positioned to by holding matrix 5050 and base portion 5022 second distance, described second distance is shorter than described first distance, in order to Tissue is applied more than the second compression pressure of the first pressure.Alternatively, surgeon can will keep matrix 5050 are positioned to base portion 5022 at a distance of the 3rd distance, and described 3rd distance is shorter than described second distance, in order to apply tissue The 3rd compression pressure more than the second pressure.In various embodiments, including keeping matrix 5050 and the fastening system of nail 5020 Can allow that target tissue is executed the compression pressure of widening range by surgeon.

Referring now to Figure 96 D, in various embodiments, nail lower limb 5021 may pass through holding matrix 5050 and is inserted into so that Nail lower limb end 5023 extends to keep above the top surface of matrix 5050.Refer again to Figure 96 C, at least one embodiment In, jaw 5040 may also include and is limited to mesopore 5042 therein, when nail lower limb end 5023 is through keeping in matrix 5050 During retaining hole 5052, this mesopore can accommodate nail lower limb end 5023.In at least one this type of embodiment, mesopore 5042 can Align with retaining hole 5052 so that lower limb 5021 not contact jaw 5040.In various embodiments, mesopore 5042 can have enough The degree of depth so that no matter why keeping the distance that is placed of matrix 5050, follow closely lower limb 5021 the most not contact jaw 5040.Referring now to Figure 96 D, after keeping matrix 5050 to engage with nail 5020 and be placed to desired location, staple cartridge channel 5030 and jaw 5040 Can move away from tissue T.More specifically, staple cartridge channel 5030 can separate with the nail bin 5000 implanted, and anvil block 5040 can Separate with the holding matrix 5050 implanted.When jaw 5040 away from keep matrix 5050 and advance and nail support member 5032 away from When nail base portion 5022 moves, although jaw 5040 and staple cartridge channel 5030 are no longer to keeping matrix 5050 and base portion 5022 offer Support, but still can keep the distance 5011 between the bottom of matrix 5050 and base portion 5022.In various embodiments, although The warehouse 5010 compressed and/or the tissue T compressed are to keeping matrix 5050 to apply bias force, but follow closely lower limb 5021 and keep Stiction between matrix 5050 can be enough to be held in place holding matrix 5050.In at least one this type of embodiment, storehouse Body 5010 can be made up of elastomeric material, and described elastomeric material when compressed can be to keeping matrix 5050 and nail 5020 applying elasticity Bias force so that described elastic bias force is propulsive holding matrix 5050 and nail 5020 so that it separates, but this motion By resisting of the frictional engagement between nail lower limb 5021 and holding matrix 5050.

In various embodiments, as it has been described above, keep matrix can include multiple retaining hole, the most each retaining hole can be Wherein accommodate the lower limb of securing member.In at least one embodiment, referring now to Figure 97, there is shown keep matrix 5150 one Point, this part can include the retaining hole 5152 limited by periphery 5156.In various embodiments, the periphery 5156 in hole 5152 can wrap Include circular or at least substantially circular profile and/or any other suitable profile.In certain embodiments, matrix is kept 5150 can include one or more holding component (such as keeping component 5153), and the one or more keeps component to extend to hole In 5152 and when can work as in fastener leg insertion hole 5152, described hole 5152 engages this fastener leg.At at least one In this type of embodiment, each holding component 5153 can include towards central axis 5159(i.e., towards the center in hole 5152) extend internally Cantilever.In various embodiments, each cantilever can include that first end and the second end, described first end are attached to keep Matrix main body 5158, described the second end forms the periphery 5156 of retaining hole 5152.In certain embodiments, retaining hole 5152 Periphery 5156 can be limited by the first diameter or width, and fastener leg can be limited by Second bobbin diameter or width, wherein said Second bobbin diameter can be more than described first diameter.In at least one this type of embodiment, fastener leg can contact holding component One or more in 5153 also make it bend, in order to make retaining hole 5152 when fastener leg is inserted in retaining hole 5152 Diameter increases.In certain embodiments, to being described further above, the periphery that fastener leg is limited can be more than keeping The periphery 5156 in hole 5152 so that when fastener leg is inserted in periphery 5156, fastener leg can make periphery 5156 extend.

Referring again to Figure 97, in various embodiments, hole 5152 can be limited by deformable member 5153, the most each variable Shape component 5153 can relative to or bend independent of other deformable members 5153.In at least one this type of embodiment, phase Adjacent deformable member 5153 can be separated by slit 5154, and this slit can allow that each deformable member 5153 is relative to other Deformable member 5153 bends.In certain embodiments, each slit 5154 can include being positioned in holding matrix main body 5158 First end 5155, the second end leading to retaining hole 5152 and extension between first end 5155 and the second end Constant or the most constant width.In other embodiments various, the width of each slit 5154 can be inconsistent, and And the width that each slit 5154 is between its first end and the second end can increase and/or reduce.In certain embodiments, The first end 5155 of slit 5154 can include amplifier section (such as circular portion), and described amplifier section both can be to be attached to protect The base portion of the deformable member 5153 holding matrix main body 5158 provides release of tension, it is possible to increase the soft of deformable member 5153 Property.In various embodiments, the geometry of deformable member 5153 and/or slit 5154 can be selected to deformable member 5153 provide desired flexibility.In certain embodiments, such as slit 5154 can be lengthened out, to form longer deformable member 5153, this longer deformable member is the most flexible than the deformable member 5153 with short length.Real at least one Executing in example, the width of each deformable member 5153 can be selected to it and provide desired flexibility.More specifically, have relatively thin The deformable member of width is the most flexible than the deformable member with thicker width.Refer again to Figure 97, implement at some In example, second end being attached to keep the first end of matrix main body 5158 can be wider than cantilever of the cantilever of deformable member 5153 Portion.In at least one this type of embodiment, cantilever can be with linearly or at least substantially between its first end and the second end Linear mode is tapered.

Refer again to Figure 97, in various embodiments, keep matrix main body 5158 can include having tissue contacting surface 5151 and the flat or the most flat material piece of top surface 5157.In at least one this type of embodiment, tissue connects Touch surface 5151 to be parallel to each other or be at least substantially parallel to each other with top surface 5157.In various embodiments, Mei Geke Deformation element 5153 can include Part I 5153a and Part II 5153b, and wherein Part I 5153a can be in the first direction Extend, and Part II 5153b can extend along different directions or second direction.In at least one this type of embodiment, keep Matrix main body 5158 can limit plane, and the Part I 5153a of deformable member 5153 can be located in this plane.Various In embodiment, the Part II 5153b of deformable member 5153 angularly can extend relative to Part I 5153a.Extremely In few this type of embodiment, Part II 5153b can be along the direction away from the top surface 5157 keeping matrix main body 5158 Extend, and in certain embodiments, Part II 5153b can assemble towards the central axis 5159 of retaining hole 5152.Any In situation, in various embodiments, when fastener leg is inserted into through Part II 5153b, Part II 5153b energy Enough bend away from central axis 5159.The nail lower limb 5021 of nail 5020 inserts in the embodiment in retaining hole 5152 wherein, variable Shape component 5153 can be along the Direction distortion of the base portion 5122 generally away from nail 5120.Therefore, in certain embodiments, deformable structure Part 5153 can be along the general direction flexure identical or the most identical with the direction that nail lower limb 5021 is inserted into.

Referring again to figure BD, in various embodiments, the Part II 5153b of deformable member 5153 such as can each wrap Including sharp end, described sharp end can work as nail lower limb 5021 when being inserted, and described end slides against nail lower limb 5021. If nail lower limb 5021 (that is, the direction removed from retaining hole 5052 by nail lower limb 5021) in opposite direction is pulled, then Part II The sharp tips of 5153b also is able to occlusion to following closely in lower limb 5021.In some cases, Part II 5153b can be relative to nail lower limb The limit of 5021 is tilted more than the angle of 90 degree, is therefore withdrawn from nail lower limb 5021 when nail lower limb 5021 from retaining hole 5052 by tending to During power, Part II 5153b can dig or be dug in the limit of nail lower limb 5021.In certain embodiments, nail lower limb 5021 can be at its table Face includes that impression and/or concavity (such as micro-indentations), described impression and/or concavity can accommodate deformable structure the most wherein The end of part 5053.In at least one this type of embodiment, when nail lower limb 5021 is applied to withdraw from power, deformable member 5053 End can be confined in or be dug in the impression of nail lower limb 5021.In various embodiments, it is dug into nail lower limb due to Part II 5153b In 5021, Part II 5153b can be only seated to follow closely lower limb by the power acted on for removing nail lower limb 5021 from retaining hole 5022 Deeper inside increase in 5021 remove the nail desired power of lower limb 5021.Additionally, due to Part II 5153b is inclined upwardly, therefore In at least one embodiment, Part II 5153b can more allow that nail lower limb 5021 inserts in retaining hole 5152 and more resistant to nail lower limb 5021 withdraw from.Therefore, at least one embodiment, desired power in retaining hole 5022 of nail lower limb 5021 being inserted be smaller than from Retaining hole 5022 removes the nail desired power of lower limb 5021.In various embodiments, from retaining hole 5022, nail lower limb is such as removed 5021 desired power are than nail lower limb 5021 inserts desired power about 50% in retaining hole 5022.In other embodiments various, Such as remove the nail desired power of lower limb 5021 than inserting between the nail desired power of lower limb 5021 about 10% to about 100%.At some In embodiment, such as remove nail the desired power of lower limb 5021 can be insert follow closely about the 100% of the desired power of lower limb 5021, about 150%, About 200% and/or than insert nail the desired power of lower limb 5021 about 200%.

Referring again to Figure 97, in certain embodiments, Part II 5153b can circumferentially arrange around hole 5152 and can be Pit is limited between Part II 5153b and hole 5152.More specifically, Part II 5153b can limit pit 5160, this pit Can work as fastener leg when being inserted in retaining hole 5152, pit 5160 accommodates the end of fastener leg.In various enforcements In example, the Part II 5153b of deformable member 5153 can include annular or at least substantially annular profile, described profile Such as can limit the annular or at least substantially annular profile of pit 1560 collaboratively.In at least one this type of embodiment In, Part II 5153b can limit taper or truncated cone shape pit.In various embodiments, pit can be by suitable number of Deformable member limit, such as four deformable member 5153(Figure 97), six deformable member 5153(Figure 98) or eight can Deformation element 5153(Figure 99).Referring now to Figure 100, in certain embodiments, keep matrix (such as keeping matrix 5250) Deformable member such as can form cone shape or at least substantially for the shape of cone.In various embodiments, matrix is kept 5250 such as can include multiple retaining hole (such as retaining hole 5252), and the plurality of retaining hole can be limited by periphery 5256.Respectively In kind of embodiment, periphery 5256 can include polygonal or at least substantially for polygonal profile and/or other suitably outside Shape.In certain embodiments, keep matrix 5250 can include one or more holding component (such as keeping component 5253), described When one or more holding components extend in hole 5252 and can work as in fastener leg insertion hole 5252, described hole 5252 connects Close this fastener leg.In at least one this type of embodiment, each holding component 5253 can include towards central axis 5259 The cantilever that (that is, towards the center in hole 5252) extends internally.In various embodiments, each cantilever can include first end and second End, described first end is attached to keep matrix main body 5258, and described the second end forms the periphery 5256 of retaining hole 5252. In certain embodiments, the periphery 5256 of retaining hole 5252 can be limited by the first diameter or width, and fastener leg can be by Second bobbin diameter or width limit, and wherein said Second bobbin diameter can be more than described first diameter.In at least one this type of embodiment, Fastener leg can contact and keeps one or more in component 5253 and make it bend, in order to inserts in fastener leg and protects The diameter making retaining hole 5252 when holding in hole 5252 increases.In certain embodiments, to being described further above, securing member The periphery that supporting leg is limited can be more than the periphery 5256 of retaining hole 5252 so that when fastener leg is inserted in periphery 5256, Fastener leg can make periphery 5256 extend.

Referring again to Figure 100, in various embodiments, hole 5252 can be limited by deformable member 5253, the most each can Deformation element 5253 can relative to or bend independent of other deformable members 5253.In at least one this type of embodiment, Adjacent deformable member 5253 can be separated by slit 5254, slit 5254 can allow each deformable member 5253 relative to Other deformable members 5253 bend.In various embodiments, matrix main body 5258 is kept can to include having tissue contacting surface 5251 and the flat or the most flat material piece of top surface 5257.In at least one this type of embodiment, tissue connects Touch surface 5251 to be parallel to each other or be at least substantially parallel to each other with top surface 5257.In various embodiments, Mei Geke Deformation element 5253 can include Part I 5253a and Part II 5253b, and wherein Part I 5253a can be in the first direction Extend, and Part II 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 5253 can be located in this plane.Various In embodiment, the Part II 5253b of deformable member 5253 angularly can extend relative to Part I 5253a.Extremely In few this type of embodiment, Part II 5253b can be along the direction away from the top surface 5257 keeping matrix main body 5258 Extend, and in certain embodiments, Part II 5253b can assemble towards the central axis 5259 of retaining hole 5252.Any In situation, in various embodiments, Part II 5253b can work as fastener leg through Part II 5253b and be inserted into Time, Part II 5253b can bend away from central axis 5259.Refer again to Figure 100, in certain embodiments, Part II 5253b can circumferentially arrange around hole 5252 and can limit pit between Part II and hole.More specifically, Part II 5253b can limit pit, and when fastener leg is inserted in retaining hole 5252, described pit can accommodate fastener leg End.In various embodiments, the Part II 5253b of deformable member 5253 such as can limit polygon or at least substantially For polygonal pit.In various embodiments, pit can be limited by suitable number of deformable member, such as, can limit pros Four deformable member 5253(Figure 100 of shape), hexagonal six deformable member 5253(Figure 101 can be limited), maybe can limit Fixed octagonal eight deformable member 5253(Figure 102).

Referring now to Figure 103, in various embodiments, holding matrix (such as, keeping matrix 5350) such as can be by flat Or the most flat material (such as, titanium and/or rustless steel) thin slice is formed.In at least one this type of embodiment, can lead to Cross one or more punching course and form multiple hole 5352 in the main body 5358 keeping matrix 5350.Material piece can be positioned in In diel, some part of material can be stamped out by described mould when activating, in order to forms such as slit 5354, slit The hole 5355 of 5354 and/or the periphery 5356 of retaining hole 5352.Diel also is able to bend to deformable member 5353 close Suitable configuration.In at least one this type of embodiment, diel can make Part II 5353b along broken line 5353c relative to A part of 5353a is upwardly-deformed.Referring now to Figure 104, in various embodiments, keep matrix (such as, keeping matrix 5450) Such as can include multiple retaining hole 5452.With similar to the above, the periphery 5456 of each retaining hole 5452 can be by by slit or slit 5454 spaced apart multiple deformable members 5453 limit.In at least one this type of embodiment, each deformable member 5453 Entirety all can be bent upwards, the free end including the cantilever of deformable member 5453 can limit periphery 5456.Respectively In kind of embodiment, keep matrix 5450 can include around or at least substantially about multiple holes 5455 of retaining hole 5452.Extremely In few this type of embodiment, hole 5455 can around or surround the periphery limited by the fixing end of the cantilever of deformable member 5453 And it is arranged to circular array.In certain embodiments, each hole 5455 can include circular or at least substantially circular periphery And/or any other suitable periphery.In use, hole 5455 both can be the deformable structure being attached to keep matrix main body 5458 The base portion of part 5453 provides release of tension, can increase again the flexibility of deformable member 5453.In various embodiments, bigger hole 5455 can make deformable member 5453 the most flexible compared with less hole 5455.Additionally, closer to deformable member 5453 Hole 5455 can provide bigger flexibility compared with farther hole 5455.

Referring now to Figure 105, in various embodiments, keep matrix (such as, keeping matrix 5550) such as can include many Individual retaining hole 5552.Each retaining hole 5552 may each comprise elongated slot 5554, and this elongated slot has the circle or extremely of amplification Few substantially circular end 5555.In at least one this type of embodiment, end 5555 can be by the diameter being wider than slit 5554 Limit.In certain embodiments, elongated slot 5554 and end 5555 can position along longitudinal axis 5559 and/or between two parties.Respectively Planting in embodiment, slit 5554 and end 5555 can limit two relative inserted sheets 5553, the inserted sheet 5553 that said two is relative Can the lower limb of jointing fastener, and when fastener leg is inserted into through inserted sheet 5553, the inserted sheet that said two is relative 5553 can bend.In at least one embodiment, the end 5555 with the biggest girth or diameter can limit the longest inserting Sheet 5553, described inserted sheet 5553 is the most flexible than the inserted sheet 5553 that the end 5555 with less girth or diameter is limited. In various embodiments, end 5555 can have identical girth and diameter, and at least one this type of embodiment, each Inserted sheet 5553 can be about the axisymmetrical vertical or the most vertical with longitudinal axis 5559.Alternatively, End 5555 can have different girths and/or diameter, and the most at least one embodiment, each inserted sheet 5553 can be not in relation to Its axisymmetrical.At at least one in this type of alternative embodiment, when fastener leg is inserted through retaining hole 5552 Fashionable, inserted sheet 5553 can distort around its axis.Referring now to Figure 106, in various embodiments, keep matrix (such as, to keep square Battle array 5650) such as can include multiple retaining hole 5652.Each retaining hole 5652 may each comprise elongated slot 5654, this elongated slot Including circular or at least substantially circular end 5655.In at least one this type of embodiment, elongated slot 5654 and end 5655 can position along longitudinal axis 5659 and/or between two parties.In various embodiments, each end 5655 all can by with slit 5654 The identical or the most identical diameter of width limit.

Referring now to Figure 107, in various embodiments, keep matrix (such as, keeping matrix 5750) such as can include many Individual retaining hole 5752.Each retaining hole 5752 can include multiple slits (such as slit 5754) with enlarged distal end 5755.? In at least one this type of embodiment, slit 5754 and end 5755 can position along longitudinal axis 5759 and/or between two parties.In various realities Executing in example, axis 5759 can extend along perpendicular or transverse to direction each other.In certain embodiments, slit 5754 and end 5755 can such as limit four inserted sheets 5753, described four inserted sheets 5753 can jointing fastener supporting leg, and prop up when securing member When lower limb is inserted into through retaining hole 5752, described four inserted sheets 5753 bend.In at least one embodiment, each slotting Configuration (such as equilateral triangle) that is that sheet 5753 can include triangle or that be at least substantially triangle.Referring now to Figure 108, In other embodiments various, keep matrix (such as keeping matrix 5850) such as can include multiple retaining hole 5852.Each guarantor Holding hole 5852 and can include having multiple slits (such as slit 5854) of end 5855, wherein slit 5854 and end 5855 can edges Longitudinal axis 5859 positions and/or between two parties.In various embodiments, axis 5859 prolongs perpendicular or transverse to direction each other Stretch.In certain embodiments, slit 5854 and end 5855 can limit inserted sheet 5853, and inserted sheet 5853 can prop up by jointing fastener Lower limb, and when fastener leg is inserted into through retaining hole 5852, inserted sheet 5853 bends.In at least one embodiment In, each inserted sheet 5853 can include the profile of arch.More specifically, different from the end of the point shown in Figure 105, each inserted sheet 5853 ends that can include bending, described end can contact fastener leg.

Referring now to Figure 109, in various embodiments, keep matrix (such as, keeping matrix 5950) such as can include many Individual retaining hole 5952.Each retaining hole 5952 can include multiple slit (such as slit 5954), and the most each slit 5954 can edge Axis 5959 extends and/or between two parties.In various embodiments, axis 5959 can transversely to one another, and at least one this type of In embodiment, axis 5959 can be disposed so that all axis 5959 extend through the center of retaining hole 5952 and equally spaced from each other Ground or be at least substantially equally spaced.In at least one embodiment, each slit 5954 can include towards retaining hole The opening at the center of 5952 and be positioned at second or the Guan Bi end 5955 of opposed ends of slit 5954.With phase above Seemingly, slit 5954 and end 5955 can such as limit three inserted sheets 5953, and described three inserted sheets 5953 can prop up by jointing fastener Lower limb, and when fastener leg is inserted into through retaining hole 5952, described three inserted sheets 5953 bend.In various realities Executing in example, each inserted sheet 5953 may be included in the arcuate configuration extended between the adjacent end 5955 of slit 5954.Referring now to Figure 110, in various embodiments, keeps matrix (such as, keeping matrix 6050) such as can include multiple retaining hole 6052.Each Retaining hole 6052 can include inserted sheet 6053, described inserted sheet can jointing fastener supporting leg, and be inserted into guarantor when fastener leg When holding in hole 6052, inserted sheet 6053 bends.In at least one this type of embodiment, inserted sheet 6053 can include being fixed to keep The base portion of matrix main body 6058 and include arch or the free end of curved profile 6056, described free end can contact securing member Supporting leg.In certain embodiments, fastener leg can be the nail lower limb being made up of circular wire rod, and the profile 6056 wherein bent can Mate with the crooked outer surface of circular wire rod or at least substantially mate.

Refer again to Figure 110, in various embodiments, keep matrix main body 6058 can include multiple slit 6054 and hole 6055, the plurality of slit 6054 and hole 6055 can limit inserted sheet 6053 and the various piece of retaining hole 6052.At least one In individual embodiment, inserted sheet 6053 can include that rectangular configuration, described rectangular configuration include parallel or the most parallel limit. Referring now to Figure 111, in certain embodiments, keep matrix (such as keeping matrix 6150) such as can include multiple retaining hole 6152.Each retaining hole 6152 can include inserted sheet 6153, this inserted sheet can jointing fastener supporting leg, and when fastener leg quilt When inserting in retaining hole 6152, this inserted sheet bends.In at least one this type of embodiment, inserted sheet 6153 can include being fixed to Keeping the base portion of matrix main body 6158 and include arch or the free end of curved profile 6156, described free end can contact tightly Firmware supporting leg.In various embodiments, keep matrix main body 6158 can include multiple slit 6154 and hole 6155, the plurality of narrow Groove 6154 and hole 6155 can limit inserted sheet 6153 and the various piece of retaining hole 6152.In at least one embodiment, inserted sheet 6153 can include that tapered configuration, described tapered configuration include the limit of arch.In at least one this type of embodiment In, inserted sheet 6153 can geometrically be tapered, such as, make base portion be wider than free end.

In various embodiments, as it has been described above, fastening system can include that multiple nail, the plurality of nail include through keeping square Multiple retaining holes in Zhen and the nail lower limb that is inserted into.In certain embodiments, as being hereafter more fully described, nail can be kept In the first jaw, and keep matrix can be maintained in the second jaw, wherein in the first jaw and the second jaw at least One can be moved towards another one.In all cases, it is positioned at the nail in the first jaw can be fixed on wherein so that when keeping square When battle array engages with nail lower limb, nail lower limb aligns with retaining hole.Seeing Figure 112 and Figure 113, in certain embodiments, closure system can Including the nail bin 6200 in the first jaw being such as positioned at surgical stapling device and the second jaw of being such as positioned at surgical stapling device In holding matrix 6250.Referring now to Figure 119 and Figure 120, to being described further above, keep matrix 6250 to include Multiple retaining holes 6252, the most each retaining hole 6252 can include the periphery limited by one or more deflection components 6253 6256.In at least one this type of embodiment, to being described further above, for limiting the deflection structure in each hole 6252 Part 6253 can limit pit 6201.In various embodiments, each pit 6201 can include such as bending and/or concave surface, Described bending and/or concave surface such as can be unjustified with retaining hole 6252 and first contact deflection component 6253 at nail lower limb And/or the end of nail lower limb is guided to hole 6252 by the situation of tissue contacting surface 6251.

In various embodiments, to being described further above, fastening system may also include multiple nail 6220, described many Individual nail 6220 includes may pass through the nail lower limb 6221 keeping retaining hole 6252 in matrix 6250 and be inserted into.At at least one this type of In embodiment, each nail 6220 can include that the most substantially U-shaped cross section configuration, described configuration include base portion 6222, described nail lower limb 6221 can upwardly extend from base portion 6222.Referring now to Figure 115 and Figure 116, in various embodiments, keep in matrix 6250 Retaining hole 6252 can be arranged to such as two parallel or the most parallel stringers, and described stringer can be along keeping matrix Longitudinal axis or be parallel to described longitudinal axis extend.In certain embodiments, the retaining hole 6252 in first row can be relative Retaining hole 6252 in second row biases or stagger arrangement.In at least one this type of embodiment, each nail 6220 can include being positioned at The first nail lower limb 6221 in the retaining hole 6252 of first row and the second nail lower limb 6221 in being positioned at the retaining hole 6252 of second row, Therefore base portion 6222 can extend along the direction across the longitudinal axis keeping matrix 6250.In at least one this type of embodiment, Nail 6220 can be parallel to each other or be at least substantially parallel to each other.More specifically, the base portion 6222a such as following closely 6220a can be parallel to Or the base portion 6222b, the base portion 6222b of described nail 6220b at least substantially parallel to nail 6220b can be parallel to or the most basic On be parallel to follow closely 6220c base portion 6222c.In at least one embodiment, the nail lower limb 6221a of such as nail 6220a is limited The plane that plane can be parallel to or be limited at least substantially parallel to the nail lower limb 6221b following closely 6220b, and follow closely the nail of 6220b The plane that the plane that lower limb 6221b is limited can be parallel to or be limited at least substantially parallel to the nail lower limb 6221 following closely 6220c.

Referring now to Figure 112 and Figure 114, in various embodiments, nail bin 6200 can include multiple nail 6220 and include The alignment matrix 6260 of multiple alignment guide (such as, slit, groove and/or hole), the plurality of alignment guide can be right Neat nail 6220.In all cases, alignment matrix 6260 enables to before keeping matrix 6250 jointing nail lower limb 6221, nail The nail lower limb 6221 of 6220 aligns with keeping the retaining hole 6252 in matrix 6250.Referring now to Figure 117 and Figure 118, in various realities Executing in example, alignment matrix 6260 can include that multiple alignment hole 6262, the plurality of alignment hole can be closely received nail 6220 Nail lower limb 6221.In at least one this type of embodiment, each nail 6220 can include base portion 6222 and from base portion 6222 extension Two nail lower limbs 6221, wherein the base portion 6222 of nail 6220 can extend around the lower surface 6264 keeping matrix 6260, and follows closely Lower limb 6221 may pass through alignment hole 6262 and upwardly extends.In certain embodiments, each alignment hole 6262 can be circular or extremely Few substantially circular, and the nail lower limb 6221 that the diameter limiting alignment hole 6262 can extend equal to or slightly greater than passing through Diameter.In various embodiments, alignment matrix 6260 may also include the component 6263 of multiple projection, the structure of the plurality of projection Part can upwardly extend from the top surface 6261 of alignment matrix 6260 and around or at least partly surround alignment hole 6262.At certain In a little embodiments, protruding component 6263 can provide longer alignment hole 6262, the most in all cases, longer hole 6262 Comparable short hole 6262 better controls over the alignment of nail lower limb 6221.

In use, in various embodiments, the first jaw supporting nail bin 6200 can be located at the tissue that is sewn On side, and the second jaw supporting holding matrix 6250 can be positioned on the opposite side of tissue.In certain embodiments, Once jaw is properly positioned relative to tissue, then the second jaw and holding matrix 6250 can move towards nail bin 6200.Respectively Plant in embodiment, when following closely lower limb 6221 and being inserted into through the retaining hole 6252 keeping matrix 6250, keep the group of matrix 6250 Knit contact surface or lower surface 6251 can contact tissue and tissue is pressed against alignment matrix 6260 tissue contacting surface or On top surface 6261.In other embodiments various, as described in more detail below, nail bin 6200 also can such as include position Above the top surface 6261 of alignment matrix 6260 and can the compressible warehouse of contact tissue.Refer again to Figure 114 and Tu 118, in certain embodiments, alignment matrix 6260 may also include and is limited to one or more hole 6203；When alignment square When battle array 6260 positions against tissue, the one or more hole can accommodate a part for tissue wherein.Can press wherein Contracting warehouse is positioned at above alignment matrix 6260 and/or against in the embodiment of alignment matrix 6260, when warehouse is compressed, can press A part for contracting warehouse can be in access aperture 6203.Similarly, keep matrix 6250 can include multiple hole 6202, when keeping matrix 6250 when positioning against tissue, and the plurality of hole 6202 can accommodate at least some of of tissue wherein.

To being described further above, when nail 6220 nail lower limb 6221 through keep matrix 6250 retaining hole 6252 and When being inserted into, the end of nail lower limb 6221 can be from keeping the top surface 6257 of matrix 6250 upwardly.In all cases, as Upper described, the end of nail lower limb 6221 can be inserted into keep afterwards not bending through retaining hole 6252.Referring now to Figure 121- 124, in certain embodiments, the fastening system including nail bin 6200 and holding matrix 6250 can include multiple protective cap or lid (such as cap 6270), the plurality of protective cap or lid can mount to be projected on the nail lower limb 6221 kept above matrix 6250.Respectively In kind of embodiment, each cap 6270 can the sharp tips of completely or at least partially covering nail lower limb 6221 so that described sharp-pointed end End will not contact the tissue being adjacent.Referring now to Figure 124, at least one embodiment, each cap 6270 can include limit Being scheduled on hole 6271 therein, this hole can be closely received the end of nail lower limb 6221 wherein.In various embodiments, cap 6270 Can be made up of elastomeric material (such as siloxanes, polyisoprene, Sanoprene and/or natural rubber).Real at least one Executing in example, the girth in hole 6271 or diameter are smaller than the girth following closely lower limb 6221 or the diameter being inserted.At at least one this type of In embodiment, the hole 6271 in protective cap 6270 is expansible to accommodate nail lower limb 6221 wherein.In various alternative enforcements In example, cap 6270 may not include hole, and when lower limb 6221 inserts cap 6270, the end of nail lower limb 6221 can cut cap 6270. In any case, in various embodiments, each cap 6270 all can be seated to follow closely on lower limb 6221, until the base portion of cap 6270 6272 adjoin or position adjacent to the top surfaces 6257 keeping matrixes 6250.In all cases, cap 6270 enables to it Closely it is seated to follow closely on the end of lower limb 6221, so as not to be removed from described end easily.Implement at some In example, each cap 6270 can such as include taper or the outer surface of at least substantially taper.In various embodiments, cap 6270 Any suitable shape can be included, such as, include the shape of parabola shaped or the most parabola shaped outer surface.

In various embodiments, such as can use the surgical stapling device shown in Figure 125-127 dispose the most above-mentioned tightly Fixer system.In various embodiments, end effector can include the first jaw or staple cartridge channel 6230 and the second jaw 6240, Nail bin 6200 can be supported on wherein by the first jaw or staple cartridge channel 6230, and the second jaw 6240 can support holding square Battle array 6250 and the plurality of protective cap 6270.Referring first to Figure 125, it illustrates and is in the second jaw 6240 opening configuration, pincers Relative to tissue T, mouth 6230 and 6240 can be positioned such that tissue T is keeping between matrix 6250 and nail bin 6200.Respectively Plant in embodiment, as it has been described above, nail bin 6200 may also include compressible warehouse (such as warehouse 6210), in described compressible warehouse Nail 6220 and alignment matrix 6260 can have been positioned.In at least one this type of embodiment, tissue T can be against the top of warehouse 6210 Surface and position.In certain embodiments, the second jaw 6240 can include multiple depressed part or hole 6245 and one or more Keep structure or keeper, the plurality of depressed part or hole 6245 can accommodate multiple protective cap 6270, and one or Holding matrix 6250 can be held in place by multiple holding structures or keeper relative to cap 6270.At at least one, this type of is implemented In example, matrix 6250 is kept to be maintained in hole 6245 by cap 6270.Referring now to Figure 137, in various embodiments, each Hole 6245 all can be by contained therein for part or all of cap 6270.In certain embodiments, the size in hole 6245 is by foot Enough being set to and can be for instance such that can be by being press-fitted and/or cap 6270 is fixed on by least one in snap fit features In hole 6245.In certain embodiments, at least one binding agent can be utilized to be fixed in hole 6245 by cap 6270.At least one In this type of embodiment individual, this type of binding agent may be chosen such that cap 6270 jointing nail lower limb 6221 and the second jaw 6240 away from After the fastener assembly motion implanted, cap 6270 can separate with the second jaw 6240.Referring now to Figure 138, real at some Executing in example, the second jaw 6240 may also include at least one emulsion sheet 6246, and at least one emulsion sheet described can be assembled to second Jaw 6240 also can extend above at cap 6270 and is maintained in hole 6245 by cap 6270.In at least one this type of embodiment, Such as can utilize at least one binding agent that emulsion sheet 6246 is fixed to jaw 6240 at least partially.In use, extremely In a few embodiment, before end effector is inserted into operative site, emulsion sheet 6246 can at least in part with jaw 6240 separate.In certain embodiments, emulsion sheet 6246 can be made up of implanted material (such as PDS and/or PGA), when nail lower limb 6221 in time keeping matrix 6250 to show, described implanted material can be cut by nail lower limb 6221.In at least one this type of embodiment In, emulsion sheet 6246 can be fixed in fastening system between lid 6270 and holding matrix 6250.

Referring now to Figure 126, to being described further above, jaw 6240 can move to close position from open position Putting, in make position, tissue T positions against holding matrix 6250 and warehouse 6210.In this type of position, keep matrix 6250 can not jointing nail 6220.In various embodiments, jaw 6240 can by actuator 6235 its open position and its Move between make position.In at least one this type of embodiment, jaw 6240 can include distal pin 6243 He extended from it Proximal pin 6244, wherein distal pin 6243 can in the distally slit 6233 in being limited to storehouse passage 6230 vertically or at least base Vertically slide in basis, and wherein proximal pin 6244 can be in the proximal slot 6234 in being limited to staple cartridge channel 6230 equally Vertically or at least substantially vertically slide.In use, actuator 6235 can proximally be retracted, with by pin 6243 and 6244 Drive to the upper end of its corresponding slit 6233 and 6234, as shown in Figure 126.In at least one this type of embodiment, activate Device 6235 can include that distally drives slit 6236 and nearside to drive slit 6237, wherein drives the sidewall energy of slit 6236 and 6237 Enough contact distal pin 6243 and proximal pin 6244 respectively, and pin 6243 He is driven up when actuator 6235 proximally moves 6244.More specifically, when actuator 6235 proximally moves, distal pin 6243 can make the inclination of distally driving slit 6236 Part I 6236a upward sliding is in mid portion or Part II 6236b；Similarly, proximal pin 6244 can make distally drive The Part I 6237a upward sliding of the inclination of dynamic slit 6237 is in mid portion or Part II 6237b.When pin 6243 He When 6244 both of which move upward, jaw 6240 can rotate down to make position towards tissue T.

Referring now to Figure 127, to being described further above, actuator 6235 can the most proximally be pulled, with Push down on the second jaw 6240, compression warehouse 6210 towards the first jaw 6230 and make holding matrix 6250 and multiple protective cap 6270 engage with the nail lower limb of nail 6220.In at least one this type of embodiment, the additional proximal movement of actuator 6235 can make Drive the sidewall of slit 6236 and 6237 respectively contact plug 6243 and 6244 and downward towards the bottom of slit 6233 and 6234 respectively Drive pin 6243 and 6244.In this case, actuator 6235 can proximally be pulled so that distal pin 6243 leaves driving The Part II 6236b of slit 6236 also enters the Part III 6236c of inclination, and similarly, proximal pin 6244 is left and driven Move the Part II 6237b of slit 6237 and enter the Part III 6237c of inclination.When pin 6243 and 6244 both of which is transported downwards Time dynamic, the second jaw 6240 can move downwardly to firing position towards the first jaw 6230.In at least one this type of embodiment, the Two jaws 6240 can move downward so that keeps matrix 6250 to remain parallel to or at least substantially parallel to the top of warehouse 6210 Surface, portion and/or be parallel to or at least substantially parallel to alignment matrix 6260.In any case, matrix 6250 is once kept And the nail lower limb 6221 of protective cap 6270 jointing nail 6220, as shown in Figure 129, then the second jaw 6240 may return to open or extremely Few substantially open position.In at least one this type of embodiment, actuator 6235 can be promoted towards distally, with by pin 6243 Drive the end to slit 6233 and 6234 with 6244 respectively, and the most once sell through corresponding driving slit 6236 He Mid portion 6236b and 6237b of 6237, then actuator 6235 is driven downwards towards the bottom of slit 6233 and 6234.Once Second jaw 6240 is opened, then the first jaw 6230 can separate with the nail bin 6200 implanted, and the first jaw 6230 He Second jaw 6240 can remove from the fastener assembly implanted, as shown in Figure 128.

Refer again to Figure 127, reader will note that, although keeping matrix 6250 and cap 6270 jointing nail lower limb 6221, but Pin 6243 and 6244 is not shown as being placed in the bottommost of its respective slots 6233 and 6234 by figure.When thick tissue T When keeping between matrix 6250 and warehouse 6210, this situation can occur.Referring now to Figure 130, the most relatively thin tissue T In keeping the situation between matrix 6250 and warehouse 6210, pin 6243 and 6244 can be driven downwards to it corresponding further Slit 6233 and 6234 in, as shown in Figure 132.In general, at least one this type of embodiment, actuator 6235 can court Nearside is pulled, in order to come upwardly or downwardly drive pin 6243 and 6244 by above-mentioned with the process shown in Figure 130-132, and Owing to tissue T is relatively thin, keep matrix 6250 and protective cap 6270 can be driven to further follow closely on the nail lower limb 6221 of 6220, such as figure Shown in 133 and Figure 134.In various embodiments, due to the adjustable keeping matrix 6250 to be provided, no matter capture in end Tissue in executor is thick or thin, all can obtain identical or the most identical in the tissue fastened Compression pressure.In certain embodiments, the adjustable tolerable surgeon keeping matrix 6250 to be provided is protected by selection Hold the degree of depth that matrix 6250 is placed to select tissue is applied the compression pressure that bigger compression pressure is the least.At least In one this type of embodiment, the scope keeping matrix 6250 can be seated to follow closely on lower limb 6221 such as can pass through slit 6233 He Length or the scope of 6234 determine.

In various embodiments, as it has been described above, protective cap 6270 can be by end soft that such as can promptly follow closely lower limb 6221 Soft or flexibility material is constituted.In certain embodiments, protective cap 6270 can be by bioabsorbable plastics (such as with commodity The polyglycolic acid (PGA) of name Vicryl sale, polylactic acid (PLA or PLLA), PPDO (PDS), poly-hydroxyalkanoate Acid esters (PHA), the poliglecaprone 25(PGCL sold with trade name Monocryl), polycaprolactone (PCL) and/or PGA, PLA, The complex of PDS, PHA, PGCL and/or PCL) and/or biocompatibility metal (such as titanium and/or rustless steel) composition.Such as figure Shown in 124, at least one embodiment, each cap 6270 can be not attached to other caps 6270.In some other embodiment, One or more caps 6270 can be mounted to keep matrix 6250.In at least one this type of embodiment, cap 6270 can be the most logical Crossing at least one binding agent and be connected to keep matrix 6250, wherein the hole 6271 in cap 6270 can be with the guarantor kept in matrix 6270 Hold hole 6252 to align or at least substantially align.Referring now to Figure 135, in various embodiments, protective cap (such as cap 6370) Such as can limit inner chamber or fornix 6374, inner chamber or fornix 6374 such as can be by contained therein for the end of nail lower limb 6221.? In at least one this type of embodiment, cap 6370 can include bottom 6372 and extend through the hole 6371 of bottom 6372.In various realities Executing in example, hole 6371 can be limited by the component 6373 of one or more deflections, when following closely lower limb 6221 and pass through and being inserted into, The component 6373 of the one or more deflection can bend.In certain embodiments, such as two or more caps 6370 can be connected together to be formed the array of cap 6370.Referring now to Figure 136, at least one this type of embodiment, multiple Cap 6370 can be linked together by material piece 6375.In certain embodiments, sheet 6375 can have enough rigidity so that Keep desired arrangement and/or the alignment thereof of cap 6370.In at least one embodiment, cap 6370 can be by biocompatibility gold Belong to (such as titanium and/or rustless steel) to constitute, and sheet 6375 (such as can be gone out with trade name Vicryl by bioabsorbable plastics The polyglycolic acid (PGA) sold, polylactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), The poliglecaprone 25(PGCL sold with trade name Monocryl), polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, The complex of PGCL and/or PCL) constitute.In various embodiments, sheet 6375 by wherein storing and/or can be dispersed with antibacterial The bioabsorbable material of (such as collargol and/or triclosan) is constituted, such as when sheet 6375 is by bio-absorbable, described anti- Microbial inoculum can be released.

In various embodiments, to being described further above, such as may utilize injection moulding process sheet 6375 is molded in Around cap 6370 so that cap 6370 is embedded in sheet 6375.In some other embodiment, such as, may utilize injection moulding process and carry out mould Film-making 6375, the most such as, during injection moulding process and/or after injection moulding process, available process for stamping is formed in sheet 6375 Hole 6376.In any one situation, cap 6370 can be inserted in hole 6376 and utilization is press-fitted and/or snap-fitted interconnecting method And/or at least one binding agent is fixed in hole 6376.In certain embodiments, each cap 6370 can include around or extremely Partially around the ring-shaped groove of cap 6370 periphery, described ring-shaped groove can be by contained therein for the periphery in hole 6376.? In some embodiment, sheet 6375 can be by allowing that the flexibility carrying out relative motion between cap 6370 and/or pliable material are constituted. In at least one this type of embodiment, flexible sheets 6375 can be made up of such as rubber, plastics and/or silicone compositions, and cap 6370 can be made up of rigid material (such as metal).In at least one this type of embodiment, with similar to the above, can be by flexible material It is overmolded to around cap 6370.In certain embodiments, such as cap 6370 can be pressed in the sheet 6375 moulded in advance.Various In embodiment, can be chosen to the hardness of flexible material provide the desired rigidity of sheet 6375.In certain embodiments, sheet 6375 can It is configurable to include the band of flexibility.In any case, sheet 6375 can be conducive to being assembled in end effector cap 6370, this It is because multiple caps 6370 to be positioned and/or being aligned in end effector simultaneously.Additionally, for the sheet of attachment cap 6370 6375 is the most implanted, then such as can strengthen along nail row or support nail.In addition to the thin slice for attachment cap 6370 or conduct The replacement of described thin slice, cap 6370 can be linked together by multiple chain links.In at least one this type of embodiment, this type of chain link Can be flexible and between tolerable cap 6370, carry out relative motion.

Referring now to Figure 139 and Figure 140, in various embodiments, protective cap (such as, cap 6470) can include shaping table Face, described profiled surface can make the end of nail lower limb deform.In at least one this type of embodiment, cap 6470 can include base portion 6472, this base portion can include extending through hole 6471 therein.In various embodiments, nail lower limb can (such as be followed closely by hole 6471 Lower limb 6221) it is closely received wherein.In at least one this type of embodiment, limit the diameter in hole 6471 or girth can equal to or Diameter or girth more than nail lower limb 6221.In various embodiments, cap 6470 may also include chamber or fornix 6474, this chamber or fornix The end accommodating nail lower limb 6221 when nail lower limb 6221 is inserted in cap 6470 can be worked as.Referring first to Figure 140, cap 6470 may also include Anvil block or profiled surface 6473, this anvil block or profiled surface can make nail lower limb 6221 bend and deform.In some cases, shape Surface 6473 can be such as bending and/or spill, and nail lower limb 6221 can be worked as make nail lower limb volume 6221 when being inserted into cap 6470 Bent.In certain embodiments, nail lower limb 6221 can be deformed sufficiently so that it cannot be withdrawn by, therefore cap through hole 6471 6470 can be locked to follow closely lower limb 6221.In at least one this type of embodiment, the base portion 6472 of cap 6470 can limit around hole 6471 and the antelabium that extends, described antelabium can prevent strained nail lower limb 6221 to be removed from chamber 6474.In all cases, Due to mentioned above, one or more caps 6470 can prevent from or suppress keeping matrix (such as keeping matrix 6250) to fall from nail 6220 Move back or depart from.In various embodiments, although not shown, but cap 6470 can be asymmetrically formed symmetrically or at least substantially, And hole 6471 can position along the central axis 6479 extended through cap 6470.Refer again to Figure 139, various alternative In embodiment, hole 6471 can bias relative to central axis 6479.In at least one this type of embodiment, the hole 6471 of biasing can Allow that nail lower limb 6221 contacts the side of profiled surface 6473 and is crimped onto opposite side rather than the contact shaping of profiled surface 6473 The center on surface 6473, as contingent in the embodiment in the above-mentioned hole 6471 including and being centrally located.

In various embodiments, as it has been described above, holding matrix (such as, keeping matrix 6250) can be by material piece and through institute The multiple retaining holes 6252 stating material piece and extend are constituted.In at least certain embodiments, the material of holding matrix 6250 is constituted Sheet can be rigidity or the most not deflection.In some other embodiment, holding matrix can be by keeping matrix element Array and multiple flexible connecting members or chain link for connecting described holding matrix element are constituted.Referring now to Figure 141, respectively Plant in embodiment, keep matrix or keep a part for matrix 6550 can include multiple element body 6505, the plurality of element Main body can be linked together by one or more connection chain links 6507.In at least one embodiment, each element body 6505 May each comprise multiple deformable member 6553, the plurality of deformable member can limit retaining hole 6552 wherein.Real at some Execute in example, keep the element body 6505 of matrix 6550 and connection chain link 6507 are formed as one and integral type material can be included Block.In various embodiments, holding matrix 6550 can be such as by metal material (such as titanium and/or rustless steel) punching press or casting Become.In at least one embodiment, matrix 6550 is kept can be made up of plastics, such as polyether-ether-ketone (PEEK), general with trade name Polypropylene that reason spirit (Prolene) is sold, polyester, the poly terephthalic acid sold with trade name Ethibond and Mersilene Glycol ester, polyvinylidene fluoride, polyvinylidene fluoride-co-hexafluoropropene, with trade name Pronova sell poly-hexafluoro third Alkene-VDF and/or the long-chain fat race polymer nylon 6 sold with trade name Ethilon and Nurolon and nylon 6,6, and Can be formed by such as injection moulding process.In certain embodiments, element body 6505 can not form one with being connected chain link 6507. In various embodiments, multiple single element body 6505 can be produced, the plurality of single element body 6505 subsequently by Link together and be embedded in holding matrix.In at least one this type of embodiment, element body 6505 can be by metal material (such as titanium and/or rustless steel) is stamped to form and is placed in plastic injection mould, wherein plastic material can be injected mould In with formed around or at least partly surround element body 6505 edge 6506 and from edge 6506 extend connection chain Joint 6507.In some other embodiment, one or more connector dot matrix can be formed to include being limited to multiple edge Hole in 6506, this pores the most each all can be by contained therein for element body 6505.In at least one embodiment, often Neighboring that is that individual element body 6505 can include circle or that be at least substantially circle；Similarly, can in each edge 6506 Hole that is that define circle or that be at least substantially circle, the diameter in wherein said hole can be equal to or less than element body 6505 Diameter.In at least one this type of embodiment, element body 6505 can be press-fitted or in hole in built-in edge 6505.Real at some Execute in example, at least one binding agent can be utilized to be fixed in hole by element body 6505.

In certain embodiments, to being described further above, keep matrix can include multiple element body 6505 with And multiple connection chain link 6507, the plurality of connection chain link 6507 can be with any suitable array (such as, shown in Figure 142-145 Those) carry out connecting element main body 6505.No matter the pattern of array why, in various embodiments, connecting chain link 6507 can Allow that element body 6505 relative to each other moves with retaining hole 6552.In at least one this type of embodiment, constitute and protect The element body 6505 holding matrix 6550 and the dot matrix connecting chain link 6507 once engage with tissue and just can stretch, distort, collapse Contracting and/or in other words bend, in order to allow the motion of in-house at least some and simultaneously resisted organize carry out bigger fortune Dynamic.In various embodiments, each connection chain link 6507 can include flexible member, described flexible member can stretch, distort, And/or collapse, in order to such as allow that holding matrix 6550 is keeping flexure between matrix element 6505.Refer again to Figure 141, limit The width of the fixed each chain link 6507 extended from edge 6506 can be narrower than element body 6505 and/or the width at edge 6506.Ginseng Seeing Figure 142-145, in certain embodiments, one or more chain links 6507 can include straight part, and described straight part is such as Extend along the line between adjacent element body 6506.In at least one this type of embodiment, each chain link 6507 can include attached Receive the first end at the first edge 6506 and be attached to the second end at the second edge 6506.Refer again to Figure 141, at some In embodiment, two or more chain links 6507 can be connected to each other.In at least one this type of embodiment, such as two or more Individual chain link 6507 can be connected at middle hinge 6509.In various embodiments, the tranverse sectional thickness of such as hinge 6509 with The tranverse sectional thickness of chain link 6507 is compared and can be reduced along one or more directions, and the chain link 6507 that this tolerable is connected is relative to that This motion.In certain embodiments, keeping matrix 6550 to may also include hinge 6508, chain link 6507 can be connected to by hinge 6508 Relative motion between chain link 6507 and edge 6506 is also allowed in edge 6506.Similar to hinge 6509, the such as horizontal stroke of hinge 6508 Section thickness can reduce along one or more directions compared with the tranverse sectional thickness of chain link 6507.

In various embodiments, to being described further above, the chain link 6507 being connected can extend in different directions. In at least one this type of embodiment, the first chain link 6507 can extend in a first direction, and the second chain link 6507 can be along second Direction extends, and wherein said first direction may differ from described second direction.In certain embodiments, the first chain link 6507 can edge The first row extends, and the second chain link 6507 can extend along the second row, and wherein said the first row can be at an angle of with described second row (the most about 30 degree, about 45 degree, about 60 degree and/or about 90 degree) intersect.In various embodiments, hinge 6508 And/or hinge 6509 can include hinges, described hinges tolerable chain link 6507 the most repeatedly move and not Can rupture.In certain embodiments, hinge 6508 and/or hinge 6509 can include the frangible or part of easy fracture, described frangible Or the part of easy fracture ruptures when in excessive deflection and/or too much can bend number of times.In at least one this type of embodiment, this Class frangible portion tolerable keeps one or more parts of matrix 6550 to disconnect with the another part keeping matrix 6550.Respectively Planting in embodiment, hinge 6508 and/or hinge 6509 such as can include that the ratio of holding matrix 6550 keeps other of matrix 6550 Part is easier to the section of cutting.More specifically, keep matrix and the tissue by the holding matrix fastening implanted implanted can It is cut component the most for various reasons to cut, and this crosscutting in order to be conducive to carrying out, hinge 6508 and/or hinge 6509 such as can provide approach or thin layer, and cutting element may pass through described approach or thin layer more readily passes through holding matrix 6550.In various embodiments, to being described further above, connect chain link 6507 and can include such as being limited to therein one Individual or multiple cast structure or material upsetting, the one or more cast structure or material upsetting can beneficially connect chain link Bending, fracture and/or the cutting of 6507.

In various embodiments, keep matrix can include multiple holding matrix element (such as, matrix element main body 6505), The plurality of holding matrix element can embed in piece of flexible material or material band.In at least one embodiment, piece of flexible material Can be formed by bioabsorbable elastomeric material (such as siloxanes), wherein said flexible flake can produce and be limited to wherein Multiple holes.In at least one this type of embodiment, moldable go out solid flexible flake in described flexible flake middle punch Form multiple hole.In various alternative embodiments, moldable flexible flake and in molding process formed be limited to it In hole.In any one situation, keep matrix element 6505 such as can be inserted into and be maintained in flexible flake.At some its In his embodiment, with similar to the above, flexible flake can be formed at around matrix element 6505.In at least one embodiment, soft Property thin slice can be such as made up of woven net and/or any other suitable material.To being described further above, this woven Net can be easy to crosscutting.

Referring now to Figure 146 and Figure 147, in various embodiments, including keeping matrix (such as, keeping matrix 6250) Closure system may also include lid (such as, cover 6670), when the end of nail lower limb 6221 extends to keep the top table of matrix 6250 Time above face 6257, described lid can cover described end.In various embodiments, lid 6670 could attach to keep matrix 6250. In certain embodiments, lid 6670 and/or holding matrix 6250 can include keeping structure, and described holding structure can will cover 6670 Remain to keep matrix 6250.In at least one embodiment, at least one binding agent can be utilized to adhere to lid 6670 keep Matrix 6250.In at least one embodiment, lid 6670 can be made up of single layer, but lid 6670 is shown as including two Layer, as being hereafter more fully described.In various embodiments, referring first to Figure 147, the end of nail lower limb 6221 can extend across The lower surface 6673 of lid 6670；But, lid 6670 can include enough thickness so that nail end does not extends across lid 6670 Top surface 6675.Therefore, at least one this type of embodiment, the end of nail lower limb 6221 can not be from covering 6670 projections.Respectively Planting in embodiment, lid 6670 can include multiple layer.In at least one this type of embodiment, lid 6670 can include ground floor 6671 He The second layer 6672.In at least one embodiment, ground floor 6671 and the second layer 6672 can be attached to each other, wherein at least one In embodiment, the second layer 6672 can include the lower surface 6676 being attached to ground floor 6671.In various embodiments, ground floor 6671 and the second layer 6672 can include different thickness, and in certain embodiments, it can include identical thickness.At least one In individual embodiment, ground floor 6671 and the second layer 6672 can include substantially the same width and/or length.Alternative In embodiment, layer 6671 and 6672 can include different width and/or length.

In various embodiments, to being described further above, ground floor 6671 can be by being cut by nail lower limb 6211 Compressible foam, Web materials and/or hydrogel constitute.In at least one embodiment, the second layer 6672 can be by more tough and tensile Material or skin (such as PGA and/or PDS) and/or any suitable backing material constitute.In at least one this type of embodiment In, nail lower limb 6221 can penetrate ground floor 6671；But, in various embodiments, nail lower limb 6221 possibly cannot penetrate the second layer 6672.In certain embodiments, the second layer 6672 can be made up of the material with sufficiently resilient and/or toughness, and described material can Allow that the second layer 6672 is contacted by nail lower limb 6221 and shifts, but do not cut by the nail end of nail lower limb 6221 or only marginally cut Cut.Although not shown in, but lid can include many more than two layer, and wherein one or more in these layers pierce through for anti- 's.In at least one this type of embodiment, in use, holding matrix 6250 can be against tissue positioned to be fastened and towards distally Promote so that the nail lower limb 6221 of nail 6220 is promoted through the retaining hole 6252 in tissue T and holding matrix 6250, and enters In the ground floor 6271 of lid 6270.In various embodiments, the end of nail lower limb 6221 can not enter or do not enter In the second layer 6272 of lid 6270.After keeping matrix 6250 to be properly positioned, jaw 6240 can be opened, and covers 6670 and keep matrix 6250 can separate with jaw 6240, as shown in Figure 146.As shown in Figure 146, jaw 6640 can keep not Only one keeps matrix 6250 and lid 6670.In at least one this type of embodiment, jaw 6640 can include two passages 6679, Said two passage 6679 can be able to accommodate lid 6670 and the holding matrix 6250 relative to lid 6670 location wherein, The tissue contacting surface 6251 making each holding matrix 6250 is downwardly depending from the bottom of jaw 6240.At at least one this type of In embodiment, keep matrix 6250 and lid 6270 can be contained in jaw 6640 on each side of cutter slit 6678.Using In, keep both matrix 6250 and lid 6670 can be deployed and/or relative to the relative nail bin (example positioned through it simultaneously Such as storehouse 6200) it is deployed in identical depth.Subsequently, in various embodiments, can be by the cutting structure traversing cutter slit 6678 Part cuts the tissue fastened along line of cut, and wherein jaw 6640 can be opened again subsequently.In certain embodiments, lid 6670 Can be not attached to keep matrix 6250.In at least one this type of embodiment, lid 6670 can be positioned in passage 6679 and can It is maintained in passage 6679 by the holding matrix 6250 of jaw 6640 can be fixed to.In various embodiments, often Individual holding matrix 6250 can be wider than and/or be longer than its accordingly lid 6670 so that keep matrix 6250 can be covered 6670 whole Body is held in place.In certain embodiments, each holding matrix 6250 can include identical width by the most its corresponding lid 6670 Degree and/or length.

In various embodiments, as it has been described above, closure system can include can being attached to keep matrix (such as, to keep Matrix 6250) material layer.Referring now to Figure 150, at least one embodiment, material layer 6870 could attach to keep matrix The lower surface 6251 of 6250.In certain embodiments, layer 6870 and/or holding matrix 6250 can include keeping structure, described Keep structure can remain to layer 6870 keep matrix 6250.In at least one embodiment, at least one can be utilized to bond Layer 6870 is adhered to keep matrix 6250 by agent.In any case, layer 6870 can include lower surface or tissue contacting surface 6873, lower surface or tissue contacting surface 6873 can be worked as holding matrix 6250 and move downward so that retaining hole towards nail 6220 6252 with nail lower limb 6221 engage time, lower surface or tissue contacting surface 6873 contact tissue T.In at least one this type of embodiment In, layer 6870 can be made up of compressible material (the most bioabsorbable foam), and described compressible material can be compressed in guarantor Hold between lower surface 6251 and the tissue T of matrix 6250.In various embodiments, layer 6870 may also include storage and/or inhales Closing at least one medicine therein, at least one medicine described can be discharged from layer 6870 when layer 6870 compresses.Extremely In a few embodiment, described medicine can include at least one tissue seal, hemorrhage and/or anti-biotic material (such as ion Silver and/or triclosan).In various embodiments, the compression of layer 6870 can extrude medicine from layer 6870 so that the table of tissue T Whole or at least a big chunk in face is coated with medicine.Additionally, penetrated tissue T and layer when layer 6870 compresses and follows closely lower limb 6221 When 6870, medicine such as can flow down and treat, along nail lower limb 6221, the tissue cut by nail lower limb 6221.In various embodiments, protect Hold the ground floor that the main body of matrix 6250 can include being made up of, and the end biocompatible materials (such as titanium and/or rustless steel) Layer 6870 can include by bioabsorbable material (such as oxidized regenerated cellulose (ORC), such as (liquid or be frozen dry) The bioactivator such as fibrin and/or thrombin, glycerol, it is in the fluffy or absorbable pig gelatin of foam configuration and/or example Such as the antibacterial such as ionic silver and/or triclosan) second layer that constitutes.Other bioabsorbable material can include such as Surgicel Nu-Knit, Surgicel Fibrillar, with trade name Promogran sell collagen/ORC(its for glue The mixture of original matrix form construction), with trade name Vicryl sell polyglycolic acid (PGA), polylactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), with trade name Monocryl sell poliglecaprone 25(PGCL), polycaprolactone (PCL) and/or the complex of PGA, PLA, PDS, PHA, PGCL and/or PCL.Although in Figure 150 One layer 6870 is only shown, but any suitable number of layer can be used.In at least one embodiment, including the first medicine Ground floor could attach to keep matrix 6250, and includes that the second layer of the second medicine or different pharmaceutical could attach to ground floor. In at least one this type of embodiment, can use multiple layer, the most each layer can include different pharmaceutical contained therein and/or Different drug regimens.

Referring now to Figure 148, in various embodiments, closure system can include the bottom being attached to keep matrix 6250 The material layer 6770 on surface 6251.In certain embodiments, layer 6770 and/or holding matrix 6250 can include keeping structure, institute State holding structure to remain to layer 6770 keep matrix 6250.In at least one embodiment, at least one can be utilized to glue Layer 6770 is adhered to keep matrix 6250 by mixture.In any case, layer 6770 can include lower surface or contact tissue table Face 6773, lower surface or tissue contacting surface 6773 can be worked as holding matrix 6250 and move downward so that retaining hole towards nail 6220 6252 with nail lower limb 6221 engage time, lower surface or tissue contacting surface 6773 contact tissue T.In at least one this type of embodiment In, layer 6770 can be made up of compressible material (the most bioabsorbable foam), and described compressible material can be compressed in guarantor Hold between surface 6251 and the tissue T of matrix 6250.In various embodiments, layer 6770 may also include one or more capsule or born of the same parents 6774, the one or more capsule or born of the same parents 6774 can store at least one medicine wherein.See Figure 149, implement at some In example, capsule 6774 can align with retaining hole 6252 or at least substantially align so that when nail lower limb 6221 is through tissue T and layer 6770 And when being promoted, nail lower limb 6221 can be pierced capsule 6774 and/or in other words makes capsule 6774 rupture.After capsule 6774 ruptures, deposit The storage at least one medicine M in capsule 6774 can flow out in tissue T.In at least one this type of embodiment, medicine M can include Fluid, the tissue T that described fluid can be flowed down along nail lower limb 6221 or just cut by nail lower limb by nail lower limb drain treatment.Due to above Described, it is stored in the medicine in capsule 6774 and tissue can be provided local treatment.In certain embodiments, the capsule in thin slice 6770 Different medicines can be stored in 6774.Such as, first group of capsule 6774 can store the first medicine or the first drug regimen, and And second group of capsule can store different medicines or different drug regimens.In various embodiments, layer 6770 can be by flexibility Siloxanes thin slice constitute, and capsule 6774 can represent the space in siloxanes thin slice.In at least one this type of embodiment, silicon Oxygen alkane thin slice can include two layers that can be attached to each other, and wherein capsule 6774 can be limited between said two layer.Various In embodiment, layer 6770 can include one or more thin layer or weakening part (such as local perforations), and the one or more is thin Layer or weakening part can be conducive to lower limb 6221 cut layer 6770 and make capsule 6774 rupture.In certain embodiments, capsule 6774 is extremely A few part can be positioned in fornix 6777, and wherein fornix 6777 can upwardly extend from thin slice 6770.At at least one this type of In embodiment, can being positioned at least partially of fornix 6777 and/or capsule 6774 keeps the pit formed in matrix 6250 In 6201.In certain embodiments, capsule 6774 can include the independent born of the same parents not being connected to each other.In some other embodiment, capsule One or more in 6774 mutually can flow via one or more paths, conduit and/or the passage extending through layer 6770 Body connects.The U.S. being published on August 24th, 2010 and entitled " ADHESIVE AND MECHANICAL FASTENER " is special The disclosure of profit 7,780,685 is incorporated by reference in its entirety herein accordingly.

In various embodiments, to being described further above, including the nail of warehouse, nail and/or alignment matrix Storehouse can be loaded in the first jaw of end effector, and similarly, keeps matrix and/or one or more lid to be added It is loaded onto in the second jaw of end effector.Referring now to Figure 151, (such as storehouse loads, in certain embodiments, can to use apparatus Device 6990) two or more fastener cartridge are inserted simultaneously in end effector.In at least one embodiment, such as storehouse adds Carrying device 6990 and can include shank 6991 and storehouse carrier 6992, wherein storehouse carrier 6992 can include that the first maintaining part and second keeps Portion, the warehouse 6210 of nail bin 6200 can be remained to storehouse carrier 6992, and described second maintaining part by described first maintaining part Can keep warehouse 6980, this warehouse 6980 supports multiple protective cap 6270 wherein and the lower surface along warehouse 6980 supports Keep matrix 6250.In various embodiments, the first maintaining part and the second maintaining part can each include one or more holding structure Part, the one or more keeps component can be releasably engaged warehouse 6210 and 6980.Referring now to Figure 152 and Figure 153, In use, end effector can include the first jaw or bottom jaw 6230 and the 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.Various In the case of, top jaw 6940 can rotate to make position (Figure 153) by actuator 6235 from open position (Figure 152), Wherein the operation of actuator 6235 is as it has been described above, here is omitted for simplicity's sake.Referring now to Figure 153, once top pincers Mouth 6940 is in its make position, then the far-end 6993 of storehouse carrier 6992 can be inserted in end effector so that nail bin 6200 Slide in the first attachment in the first jaw 6230 or passage 6939 through the far-end 6938 of the first jaw 6930.Similar Ground, the far-end 6993 of storehouse carrier 6992 can be inserted in end effector so that warehouse 6980 is remote through the second jaw 6940 6948 are held to slide in the second attachment in the second jaw 6940 or passage 6949.The shank of hand-held storehouse loader 6990 The surgeon of 6991 or other clinicians can be each passed through passage 6939 and 6949 and promote nail bin 6200 and warehouse 6980, Until nail bin 6200 and warehouse 6980 are placed in passage 6939 and 6949 completely.

When nail bin 6200 and warehouse 6980 are placed, nail bin 6200 and warehouse 6980 can engage its corresponding jaw respectively One or more maintaining parts in 6230 and 6940, as being hereafter more fully described.Referring now to Figure 154, in any situation In, once nail bin 6200 and warehouse 6980 are placed, then storehouse loader 6990 can separate with nail bin 6200 and warehouse 6980 and from Remove on end effector.In at least one this type of embodiment, for nail bin 6200 is maintained in the first jaw 6230 Retentivity can be more than the retentivity for nail bin 6200 remains to storehouse carrier 6992 so that when storehouse carrier 6992 is pushed away towards distally When going out end effector, nail bin 6200 is positively retained at the first jaw 6230 rear.Similarly, for warehouse 6980 being maintained at the Retentivity in two jaws 6940 can be more than the retentivity for warehouse 6940 remains to storehouse carrier 6992 so that when storehouse carrier 6992 when being pushed out end effector towards distally, and warehouse 6940 is positively retained at the second jaw 6940 rear.Once storehouse loader 6990 are removed from end effector, then the first jaw 6230 loaded and the second jaw 6940 loaded can be relative to inciting somebody to action The tissue T being sewn positions.Referring now to Figure 155, the second jaw 6940 can move to percussion from open position (Figure 154) Position (Figure 155), in order to make holding matrix 6250 that warehouse 6980 carried and the plurality of protective cap 6270 and be positioned at nail bin Nail 6220 in 6200 engages.

Referring now to Figure 156 and Figure 157, the second jaw 6940 can be opened again, and the plurality of protective cap 6270 And keeping matrix 6250 can separate with warehouse 6980 so that cap 6270 and holding matrix 6250 can keep and tissue T and nail bin 6200 engage.In at least one embodiment, warehouse 6980 can include multiple pit and one or more holding slit, described many Individual cap 6270 can be removably positioned in the plurality of pit, and the one or more keeps slit will keep Matrix 6250 remains to warehouse 6980 removedly.In various embodiments, after the second jaw 6940 is opened, the second jaw Warehouse 6980 can be maintained in the second jaw 6940 by the holding component engaged with warehouse 6980 of 6940.In some embodiment In, warehouse 6980 can work as tear when the second jaw 6940 is opened so that a part for warehouse 6980 and cap 6270 and holding square Battle array 6250 is the most implanted, and a part for warehouse 6980 is retained in the second jaw 6940.Similarly, figure is referred again to 156 and Figure 157, after the second jaw 6940 is opened, the holding component engaged with warehouse 6210 of the first jaw 6230 can be by Warehouse 6210 is maintained in the first jaw 6230.In certain embodiments, warehouse 6210 can work as the first jaw 6230 away from The tear when storehouse 6200 implanted is pulled a so that part for warehouse 6210 is planted together with nail 6220 and alignment matrix 6260 Enter, and a part for warehouse 6210 remaines in the first jaw 6230.Referring now to Figure 158-160, in various embodiments, Nail bin (such as nail bin 6900) such as can include the one or more longitudinally holding slits 6913 extended along the length of warehouse 6910, Such as when nail bin 6900 is inserted in jaw 6930, the one or more longitudinally keeps slit 6913 to accommodate wherein The one or more longitudinally holding guide rails 6916 extended from jaw 6930.In use, at least one embodiment, such as exist Before nail bin 6900 slides through the far-end 6938 of holding passage 6939, the end keeping slit 6913 can be with holding guide rail The far-end alignment of 6916.

Referring again to Figure 160, in various embodiments, jaw 6940 can include that two keep passage 6949, the most each Keep passage 6949 to accommodate wherein include multiple cap 6270 and keep the warehouse 6980 of matrix 6250.In some embodiment In, each warehouse 6980 can include one or more longitudinally holding shoulder 6917, and the one or more longitudinally keeps shoulder energy Enough when its during warehouse 6980 is inserted into jaw 6940 keeps in passage 6949 accordingly, the one or more longitudinally keeps Shoulder 6917 longitudinally keeps guide rail 6918 to slide along the one or more of the second jaw 6940.In various embodiments, warehouse is worked as 6980, with when separating on the cap 6270 being stored therein and holding matrix 6250, keep guide rail 6918 and keep shoulder 6917 to assist Make ground to be maintained in the second jaw 6940 by warehouse 6980.Referring now to Figure 159, in various embodiments, the second jaw 6940 May also include the one or more distally projection extended from it or keep component 6915, the one or more distally projection or guarantor Hold component can be locked in removedly by warehouse 6980 in its corresponding holding passage.In at least one this type of embodiment, Second jaw 6940 can include distally projection 6915, and distally projection 6915 is configured relative to each holding passage 6949 and positions Becoming to make when warehouse 6980 is inserted in passage 6949, each warehouse 6980 can bend around projection 6915, wherein, just in storehouse When body 6915 is placed in passage 6949 completely, the far-end of warehouse 6980 can cross projection 6915 and by being buckled on projection 6915 Side.Remove it afterwards for being previously used at warehouse 6980, as it has been described above, warehouse 6980 can be withdrawn into above projection 6915 and incite somebody to action It removes from holding passage 6949.With similar to the above, the first jaw 6930 can include the one or more distally extended from it Keeping projection 6914, when nail bin 6900 is laid completely, the one or more distally keeps projection can be contained in warehouse One or more holding grooves in 6910 or slit 6912(Figure 158) in.

In various embodiments, to being described further above, wherein there is the first tight of multiple first securing member location Firmware storehouse can be positioned in the first jaw of surgical fastening device, and wherein there is the second tight of multiple second securing member location Firmware storehouse can be positioned in the second jaw of surgical fastening device.In use, in the first jaw and/or the second jaw Person can move towards another one, in order to makes the first securing member and the second securing member engage and be fixed on therebetween by tissue.Real at some Executing in example, when the first securing member and the second securing member engage, the first fastener cartridge can engage with the second fastener cartridge.At least In one embodiment, the main body of the first fastener cartridge can be made up of the first compressible material, and the main body of the second fastener cartridge Can be made up of the second compressible material, wherein the first main body and/or the second main body can be compressed against the tissue fastened.? Organizing by after fastening, the first jaw can move away from the first fastener cartridge implanted, and the second jaw can be away from planting The the second fastener cartridge motion entered.Subsequently, the first jaw can be again loaded with another the first fastener cartridge or like, and And second jaw can again load another the second fastener cartridge or like, and surgical fasteners tool can be reused.To the greatest extent Pipe can use nail in certain embodiments, but it can also be envisaged that goes out to include that other kinds of securing member is (such as when being bonded with each other Lock together is divided into two-part securing member) other embodiments.In at least one this type of embodiment, the first securing member Storehouse can include the first storage part for storing the first fastener portion, and the second fastener cartridge can include for storage second Second storage part of fastener portion.In various embodiments, fastening system as herein described is available includes any suitable class The material of type and/or the securing member of form.In certain embodiments, securing member can include penetrating component.This type of penetrates component can Such as it is made up of polymer, complex and/or multiple field substrate.The example of multiple field substrate can be to have elastomer or polymerization The wire rod of thing coating or sheet substrate.It can be thin thin slice, and is formed so that penetrating component is oriented to be perpendicular to Or it is at least substantially orthogonal to connecting elements.Penetrate component and can include the profile of rectangle, semicircular profile and/or any horizontal stroke Beam profile.In various embodiments, available any suitable method (such as wire rod extrusion method) manufactures as herein described Securing member.Further possibility is to use precision machining method to penetrate component to form hollow.These penetrate component can be by not It is same as wire rod extrusion method and uses the method for combination of materials to process.

As it has been described above, the end through holding matrix projection of nail lower limb can be by one or more caps and/or blanketing lid.At certain In a little embodiments, the deformable after being inserted through holding matrix of the end of nail lower limb.In at least one embodiment, it is used for keeping The jaw keeping matrix may also include and is positioned at the anvil block pit alignd above retaining hole and/or with retaining hole, described anvil block pit Nail lower limb can be made to deform when following closely lower limb and being projected on above holding matrix.In various embodiments, the nail lower limb of each nail can such as court Each other and/or towards nail center inward curl.In some other embodiment, nail nail lower limb in one or more can be away from it He follows closely lower limb and/or outwards crimps away from the center of nail.In various embodiments, no matter nail lower limb crimps along which direction, lower limb is followed closely End all can contact and keep the main body of matrix and can not be again introduced into being clenched in solid tissue.In at least one embodiment In, nail lower limb can be locked in keeping matrix in location in the deformation after holding matrix.

Referring now to Figure 161 and Figure 162, in various embodiments, surgery suturing appliance (such as, surgical stapling device 7000) Can include the first jaw 7030 and the second jaw 7040, wherein the second jaw 7040 can by the motion of actuator 6235 towards Move with away from the first jaw 7030.The operation of actuator 6235 is as it has been described above, here is omitted for simplicity's sake.Various In embodiment, the first jaw 7030 can include far-end 7031 and near-end 7032, and wherein the first jaw 7030 can be limited to far-end The passage extended between 7031 and near-end 7032, described passage can accommodate nail bin.For ease of diagram, Figure 161 does not shows The warehouse of this type of nail bin, but this type of nail bin can include warehouse, the nail 6220 being positioned at warehouse and be positioned at below nail 6220 Staple drivers 7012.In certain embodiments, although the most not shown in Figure 161, but the second jaw 7040 energy Matrix (such as keeping matrix 6250) enough will be kept to be maintained on nail 6220 and/or holding matrix will be moved to by described above shifting Engage with the lower limb of nail 6220.In at least one embodiment, surgical stapling device 7000 may also include and is such as positioned at the first jaw Sliding part 7010 in 7030, sliding part 7010 can slide and towards second towards near-end 7032 from the far-end 7031 of the first jaw 7030 The matrix that keeps of jaw 7040 promotes staple drivers 7012 and the nail 6220 being supported on staple drivers 7012.In other realities various Executing in example, such as sliding part 7010 can proximally 7032 move towards far-end 7031, in order to disposes nail 6020.Implement at least one In example, sliding part 7010 can include slope or the cam 7011 of one or more inclination, the one or more slope tilted Or cam can be in staple drivers 7012 slid underneath and be lifted up staple drivers 7012.In various embodiments, surgery seam Clutch 7000 may also include pull bar or the push rod being such as operably linked to sliding part 7010, described pull bar or push rod and can pass through It is positioned at the actuator on the shank of surgical stapling device 7000 and/or axle and proximally and/or towards distal movement.

Referring again to Figure 161, in various embodiments, the second jaw 7040 of surgical stapling device 7000 can include framework 7041, far-end 7048 and the near-end 7049 with far-end 7048 relative localization.In certain embodiments, the second jaw 7040 also may be used Including guidance system, described guidance system includes that the one or more guide rails extended along the longitudinal axis of framework 7041 (are such as led Rail 7045 and 7046), as being hereafter more fully described, the one or more guide rail can guide can be at the nail of nail 6220 Lower limb 6221 passes the nail lower limb of jointing nail 6220 after keeping matrix and makes its one or more anvil blocks deformed or cam.At least In one this type of embodiment, guide rail 7045 and 7046 can include leading line or cable, and described leading line or cable are such as along framework The top of 7041 or surface, extend around distally post 7047 returning along top or the surface of framework 7041.As it has been described above, And now referring first to Figure 163 and Figure 165, in various embodiments, the second jaw 7040 may also include one or more anvil Seat or cam (such as first anvil block 7050 and the second anvil block 7060), the one or more anvil block or cam can be along the second jaws 7040 longitudinally move, in order to the lower limb at nail 6220 makes described lower limb deform after keeping matrix.In at least one embodiment In, surgical stapling device 7000 may also include the first anvil block driving being connected to and/or being operably linked to the first anvil block 7050 Device or actuator 7051, this first anvil block driver or actuator can proximally tractive the first anvil blocks 7050 and/or towards distally Promote the first anvil block 7050.Similarly, at least one embodiment, surgical stapling device 7000 may also include be connected to and/or It is operably linked to the second anvil block driver or actuator of the second anvil block 7060, described second anvil block driver or actuator The second anvil block 7060 and/or proximally tractive the second anvil block 7060 can be promoted towards distally.In various embodiments, the first anvil block 7050 can include guide groove 7052, and the second anvil block 7060 can include guide groove 7062, and this guide groove 7052 and guide groove 7062 can be distinguished Guide rail 7045 or guide rail 7046 can be slidably received within wherein.In at least one this type of embodiment, guide rail 7045 and 7046 can be closely received in guide groove 7052 and 7062 so that can prevent or at least limit guide rail 7045 and 7046 and guide groove Relative lateral movement or side-to-side movement is there is between 7052 and 7062.

In certain embodiments, to being described further above, can proximally pull the first anvil block 7050 can be towards far Layback moves the second anvil block 7060.Seeing Figure 161, at least one embodiment, guide rail 7045 and 7046 and distally post 7047 can Including pulley system, described pulley system can be towards distally tractive the second anvil block 7060 and/or proximally tractive the second anvil block 7060.In at least one this type of embodiment, guide rail 7045 and guide rail 7046 can include the company extended around distally post 7047 Continuous wire rod or cable, a part for wherein said continuous wire can be pulled so that wire rod around distally post 7047 round.? In various embodiments, guide rail 7046 such as can be mounted to the second anvil block 7060 so that when continuous cable round in the first direction Time, the second anvil block 7060 can be pulled to distally towards the far-end 7048 of jaw 7040, and when continuous cable in a second direction or During rightabout round, the second anvil block 7060 can be pulled to nearside towards near-end 7049.Referring now to Figure 163, at least one In embodiment, guide rail 7046 can be fixed in guide groove 7062 so that can transmit pulling force betwixt.At at least one, this type of is implemented In example, guide rail 7045 can slide in another guide groove 7062.In various embodiments, the first anvil block 7050 can be with second The unrelated mode of anvil block 7060 works, and pulley system and the guide groove 7052 that is limited in the first anvil block 7050 can be slidably Ground accommodates guide rail 7045 and 7046 so that allows and carries out relative fortune between pulley system and guide groove 7052 with guide rail 7045 and 7046 Dynamic.In various embodiments, the continuous cable constituting guide rail 7045 and 7046 can have enough flexibilities, in order to adapts to top pincers Opening and closing of mouth 7040.Cable also can have enough flexibilities to adapt to the second jaw 7060 end of toward and away from continuously The vertical movement of portion's jaw 7030, is described in more detail.

Referring again to Figure 163 and Figure 165, in various embodiments, the first anvil block 7050 can include the cam extended from it Driven member 7055, described cam follower 7055 can ride in the framework 7041 being limited to the second jaw 7040 or Multiple cam slot or guide groove such as cam slot 7070(Figure 166) in.More specifically, at least one embodiment, framework 7041 the first cam slot 7070 that can include the first side longitudinal extension along framework 7041 and the second side along framework 7041 Or the second cam 7070 of opposite side longitudinal extension, the cam follower 7055 wherein extended from the first side of the first anvil block 7050 Can ride in the first cam slot 7070, and the cam follower 7055 extended from the second side of the first anvil block 7050 can be ridden In the second cam slot 7070.In at least one this type of embodiment, the profile of each cam slot 7070 can be identical Or the most identical, and can be mutually aligned or at least substantially align.Similarly, in various embodiments, second Anvil block 7060 can include the cam follower 7065 extended from it, and described cam follower 7065 can ride in being limited to second Cam slot 7070(Figure 166 in the framework 7041 of jaw 7040) in.More specifically, at least one embodiment, from The cam follower 7065 that first side of two anvil blocks 7060 extends can ride in the first cam slot 7070, and from the second anvil The cam follower 7065 that second side of seat 7060 extends can ride in the second cam slot 7070.In use, the first anvil The seat cam follower 7055 of 7050 and the cam follower 7065 of the second anvil block 7060 can slide in cam slot 7070, make When proper first anvil block 7050 and the second anvil block 7060 are pulled to nearside and/or are pushed to distally, the first anvil block 7050 and second Anvil block 7060 advances along the profile of cam slot 7070.In various embodiments, each cam slot 7070 can include multiple stopping Have a rest portion or top 7071 and multiple driver portion or bottom 7072, the plurality of portion or the top 7071 and the plurality of of resting Driver portion or bottom 7072 can be on anvil block 7050 and 7060 edge longitudinally (that is, at far-end 7048 and the near-end of framework 7041 Between 7049) the vertically motion anvil block 7050 and 7060 (that is, toward and away from bottom jaw 7030) while motion, as hereafter It is more fully described.

When surgical stapling device 7000 is in non-cock, seeing Figure 166, the first anvil block 7050 can be positioned on framework The far-end 7048 of 7041, and the second anvil block 7060 can be positioned on the near-end 7049 of framework 7041；Additionally, referring now to Figure 167, When surgical stapling device 7000 is in non-cock, be positioned at the nail 6220 of the first jaw 7030 may be not inserted into tissue T and/ Or it is positioned holding matrix thereon.Referring now to Figure 168, in use, staple drivers 7012 can be in the nail chamber 7033 of nail bin Inside drive up nail 6220；It addition, the first anvil block 7050 can from the far-end 7048 of framework 7041 towards far-end 7049 proximal motion, So as the nail lower limb 6221 of jointing nail 6220.In at least one embodiment, at the nail lower limb 6221 of the first anvil block 7050 with nail 6220 Nail 6220 can be driven up before joint.In various embodiments, before the first anvil block 7050 is advanced into contact stud lower limb 6221, Sliding part 7010 can upwards dispose all of nail 6220, or alternatively, sliding part 7010 can be at the first anvil block 7050 proximally motion while proximally move, but sliding part 7010 can guide fully the first anvil block 7050 with will nail 6220 are deployed in the first anvil block 7050 front.In various embodiments, as shown in Figure 168, cam slot 7070 can or by cloth It is set to so that, such as when the first cam 7050 passes and rests portion or top, the profiled surface of the first cam 7050 (such as shapes Surface or cam face 7053 and 7054) can at least some in contact stud lower limb 6221.In all cases, the first anvil block 7050 Cam follower 7055 can be respectively positioned in the portion of resting 7071 of cam slot 7070 so that profiled surface 7053 and 7054 are in the position raised, and make when during anvil block 7050 is there through rest position, and nail lower limb 6221 only partially deforms. When the first cam 7050 moves further along cam slot 7070, as shown in Figure 169, the cam follower of the first anvil block 7050 In 7055 drive divisions that can be driven to cam slot 7070 or bottom 7072 so that profiled surface 7053 and 7054 is towards nail lower limb 6021 move downward vertically, in order to driven to its configuration finally shaped by nail lower limb 6021.Subsequently, enter when the first anvil block 7050 One step along cam slot 7070 advance time, the first anvil block 7050 can be stopped by another group of upwards vertical drive to cam slot 7070 Have a rest in portion 7071.As shown in Figure 168 and Figure 169, reader will note that, the first anvil block 7050 can only engage some nail lower limb and not engage Other follow closely lower limb.In at least one this type of embodiment, the first anvil block 7050 can the most only make to include following closely the distally nail lower limb of 6220 One group of nail lower limb deformation of 6221.In at least one this type of embodiment, the first anvil block 7050 can make distally nail lower limb 6221 towards nail The center deformation of 6220.In various embodiments, each nearside nail lower limb 6221 all can twice by the first anvil block 7050(i.e., by the One profiled surface 7053 and the second profiled surface 7054 alignd with the first profiled surface 7053) contact.At at least one this type of In embodiment, when the first anvil block 7050 is in the portion of resting or top, the first profiled surface 7053 can make distally follow closely lower limb 6221 It is deformed into part deformed configuration, and when the first anvil block 7050 moves in drive division or bottom, the second profiled surface 7054 Distally nail lower limb 6221 can be made to be deformed into and to be fully formed configuration.Referring now to Figure 163 and Figure 164, in various embodiments, the first anvil Seat 7050 can include multiple first profiled surface 7053 and multiple second profiled surface 7054, in order to is arranged at nail lower limb 6221 The distally nail lower limb 6221 making nail 6220 when a more than row or a row deforms.In various embodiments, as hereafter in more detail Describing, the such as second anvil block 7060 can make the nearside nail lower limb 6221 of nail 6020 deform.

In various embodiments, to being described further above, the first anvil block 7050 can be from the far-end of framework 7041 7048 move to near-end 7049, in order to make all distally nail lower limb 6221 of nail 6220 deform.Reader will note that, the first anvil block 7050 Upwardly or downwardly can move relative to undeformed nearside nail lower limb 6221, and for adapting to this type of relative motion, in various enforcements In example, the first anvil block 7050 can include one or more clearance slot 7057(Figure 165), the one or more clearance slot 7057 can work as the first anvil block 7050 makes distally nail lower limb 6221 accommodate unbent nearside nail lower limb 6221 when bending.Similarly, then Secondary seeing Figure 163, the second anvil block 7060 can include clearance slot 7067, and this clearance slot can work as the first anvil block 7050 as above institute State the vertical movement of the first cam actuator 7051 adapting to up and down motion when it rests motion between portion and drive division.Institute After having a distally nail lower limb 6221 being bent, at least one embodiment, anvil block actuator 7061 can make the second anvil block 7060 from The near-end 7049 of framework 7041 moves to far-end 7048.With similar to the above, referring now to Figure 170, the such as second anvil block 7060 Cam follower 7065 can slide in cam slot 7070 so that the second anvil block 7060 at the portion of resting or top and drive division or Move between bottom, in order to make nearside nail lower limb 6221 be deformed inward towards the center of nail 6220.With similar to the above, the second anvil block 7060 Can include that multiple first shaping or cam face 7063 and multiple second shape or cam face 7064, the plurality of the first one-tenth Shape or cam face 7063 and the plurality of second shape or cam face 7064 can be able to make in nearside nail lower limb 6021 One or more deform at least in part and/or be badly deformed.Referring again to Figure 164, the second anvil block 7060 can include multiple First profiled surface 7063 and multiple second profiled surface 7064, the plurality of first profiled surface 7063 and the plurality of second Profiled surface 7064 can make the nearside nail lower limb 6221 being arranged in the nail 6220 of multiple row or multiple row deform.Same such as Figure 164 Shown in, the first profiled surface 7063 of the second anvil block 7060 and the second profiled surface 7064 can not be with the first of the first anvil block 7050 Profiled surface 7053 and the second profiled surface 7054 align, and therefore the near leg 6221 of nail 6220 can be with the far leg of nail 6220 6221 are positioned in different rows or row.Reader it shall yet further be noted that the second anvil block 7060 can when the second anvil block 7060 is towards distal movement Promote the first anvil block 7050.In at least one this type of embodiment, the first anvil block 7050 can be pushed back to frame by the second anvil block 7060 In the far-end 7048 of frame 7041 so that the first anvil block 7050 may return to its initial position or non-firing position.At nail 6220 After all nearsides nail lower limb 6221 all deforms, the second anvil block 7060 can proximally be retracted and is back to its initial position or do not fires Position.Consequently, it is possible to surgical stapling device 7000 can reset to so that positioning new nail bin in the first jaw 7030, and can be Second jaw 7040 positions new holding matrix, in order to reuse surgical stapling device 7000.

In various embodiments, as it has been described above, surgical stapling device can include two or more anvil blocks, said two or more Multiple anvil blocks can longitudinally be advanced transversely to engage the lower limb of multiple nail.In certain embodiments, surgical stapling device can include The anvil block proximally moved, such as so that first group of nail lower limb deforms and such as make second group of nail lower limb deformation.At at least one this type of In embodiment, this type of anvil block can include the such as profiled surface towards nearside and the profiled surface towards distally.

Referring now to Figure 171, in various embodiments, anvil block such as anvil block 7140 can include lower surface or contact tissue Surface 7141 and the multiple shaping pits 7142 being limited in lower surface or tissue contacting surface 7141.Real at least one Executing in example, anvil block 7140 can include the more than one plate can being welded in framework 7144, such as crater plate 7143.At least one In this type of embodiment individual, each crater plate 7143 all can be positioned in the plate passage 7145 in framework 7144 and by extending through Cross the welding slit 7146 of framework 7144 and be soldered to framework 7144 to form longitudinal measure part 7147.In various embodiments In, longitudinal measure part 7147 such as can include the sequential welding fitting extended along the whole length of welding slit 7146 or narrow along welding The a series of the most spaced apart pad that the length of groove 7146 extends.In various embodiments, each crater plate 7143 May each comprise two or more plate parts being soldered together.In at least one this type of embodiment, each crater plate 7143 may each comprise can be along seam 7,148 first plate part 7143a welded together and the second plate part 7143b.Various In embodiment, in the plate passage 7145 in plate 7143 is soldered to framework 7144 before, the first plate part of each plate 7143 7143a and the second plate part 7143b can be soldered together.In at least one this type of embodiment, the first plate part 7143a and Second plate part 7143b can include the cooperation profile that can fit together to be formed impervious seam 7148, such as institute in Figure 171 The tooth profile shown.In at least one embodiment, each plate 7143 can include the most about .02 " height, described height can The degree of depth higher than plate passage 7145 so that the tissue contacting surface 7141 of plate 7143 extends from the framework 7044 of anvil block 7040.Existing Seeing Figure 172, in certain embodiments, plate 7143 can be such as by being positioned at least one weldment of the far-end of plate 7143 7149 and connect together.

As shown in Figure 171 and Figure 172, each crater plate 7143 may each comprise and is limited at multiple shaping pit therein 7142.In various embodiments, can be existed by any suitable manufacture method (such as Ginding process and/or electrode combustion method) Plate 7143 is formed and shapes pit 7142.Referring now to Figure 173 and Figure 174, at least one this type of embodiment, such as, can lead to Cross following methods to manufacture each shaping pit 7142: be initially formed deep-well 7150, form arch then around deep-well 7150 Or curved surface 7151, in curved surface 7151, then form nail lower limb guiding groove 7152.In other embodiments various In, these steps can be performed in any suitable order.Referring now to Figure 175, in various embodiments, nail shapes pit 7142 can be formed the inner edge 7153 making shaping pit spaced apart by consistent or the most consistent gap 7154.? In at least one this type of embodiment, gap 7154 can the most about .008 ".Additionally, at least one this type of embodiment, become Shape pit 7142 can position along two or more row or line, and the centrage shaping pit 7142 can be by consistent or the most basic Upper consistent spacing 7155 is spaced apart.In at least one this type of embodiment, the spacing 7155 between centrage can be the biggest About .035 ".Referring again to Figure 175, in various embodiments, each shaping pit 7142 can be at narrow width 7156 and wide width It is tapered between degree 7157.In at least one this type of embodiment, the narrowest width 7156 may be about .045 ", and Wide width 7157 may be about .075 ".In various embodiments, plate 7143 can be made up of the material identical with framework 7144. In at least one this type of embodiment, plate 7143 and framework 7144 both of which can be such as by rustless steel (such as 300 series or 400 The rustless steel of series) and/or titanium composition.In other embodiments various, plate 7143 and framework 7144 can be by different material structures Become.In at least one this type of embodiment, plate 7143 can be such as made up of ceramic material, and framework 7144 can be such as by stainless Steel and/or titanium are constituted.In all cases, according to the material used, such as in addition to above-mentioned welding method or as above-mentioned The replacement of welding method, it be also possible to use at least one solder brazing method and is fixed in framework 7144 by plate 7143.

Referring now to Figure 176-178, in various embodiments, anvil block 7240 can include framework 7244 and can be inserted into frame Multiple crater plate 7243 in frame 7244.With similar to the above, each crater plate 7243 can include being limited to multiple shaping therein Pit 7242.In at least one embodiment, anvil block framework 7244 can include being limited to holding slit 7246 therein, this holding Slit can accommodate the holding guide rail 7247 extended from crater plate 7243.For crater plate 7243 is assembled into anvil block framework 7244, The sidewall 7245 of this anvil block framework 7244 can flex outward or launch (as shown in Figure 177) so that keep slit 7246 broaden, from And make each holding slit 7246 can accommodate the holding guide rail 7247 of crater plate 7243 wherein.Guide rail 7247 is once kept to be determined Position is in keeping slit 7246, and sidewall 7245 can be released (as shown in Figure 178), thus allows that framework 7244 is with elastic type Retract and/or be back to its non-deflected.In this case, keep slit 7246 regracting and therefore will keep guide rail 7247 captures are wherein.In certain embodiments, keep guide rail 7247 and/or keep slit 7246 can include one or more association The conical surface made；After the holding slit 7246 of flexure is released, the one or more conical surface coordinated can shape One-tenth can keep the taper lock in slit 7246 to engage by keeping guide rail 7247 to be maintained at.With similar to the above, crater plate 7243 can It is made up of the material identical or different with framework 7244.In at least one this type of embodiment, plate 7243 can be such as by pottery material Material is constituted, and framework 7244 can be such as made up of rustless steel and/or titanium.In all cases, according to the material used, example As at least one solder brazing method and/or at least one welding method can be used to be fixed in framework 7244 by plate 7243.

In Figure 179 and 180, surgical stapling and cut-out apparatus 8010 can include anvil block 8014, and this anvil block can arrive around it The pivotal attachment of elongated nail groove 8016 and be repeatedly opened and closed.Nail is used assembly 8012 and can be included anvil block 8014 and groove 8016, wherein assembly 8012 can proximally be attached to be formed the slender axles 8018 of tool portion 8022.When assembly 8012 used by nail During Guan Bi, or when at least substantially closing, tool portion 8022 can present sufficiently small cross section, and this cross section is suitable to make nail execute Inserted by the trocar with assembly 8012.In various embodiments, assembly 8012 can be grasped by the shank 8020 being connected to axle 8018 Vertical.Shank 8020 can include user control such as rotary knob 8030, and this rotary knob makes slender axles 8018 and nail use assembly 8012 around axle 8018 longitudinal axis rotate.Closure trigger 8026 can be depressed to close nail and use assembly 8012, and this closes Closing trigger can be in pistol grip 8036 front wall around the closure trigger pin 8152(figure laterally engaged across shank shell 8154 181) pivot.In various embodiments, when closure trigger 8026 is clamped, Guan Bi release button 8038 can outwards be present in On shank 8020 so that release button 8038 can be depressed to unclamp closure trigger 8026 and open nail to use assembly 8012, As described in more detail below.It is same that the percussion trigger 8034 that can pivot before closure trigger 8026 can make nail use assembly 8012 Time cut off and stitching be clamped in tissue therein.In all cases, as described in more detail below, percussion trigger can be used 8034 use multiple firing stroke to need the size of the power applied by surgical hands to reduce every stroke.Implement at some In example, shank 8020 can include rotatable right indicator wheel 8040 and/or the left indicator wheel 8041 that may indicate that percussion progress (Figure 181).Such as, percussion stroke completely may need to fire three complete firing stroke of trigger 8034, thus indicate that device Wheel 8040,8041 each can rotate at most 1/3rd turns at every stroke of percussion trigger 8034.As described in more detail below, If it is required, manually percussion trip lever 8042 can allow trigger system firing retraction before stroke completes completely, and this Outward, if trigger system is blocked and/or lost efficacy, percussion trip lever 8042 can allow surgeon or other clinicians to make to hit The system of sending out retraction.

In conjunction with Figure 179 and Figure 181, slender axles 8018 can include external structure, and this external structure includes the most reciprocal The Guan Bi pipe 8024 of motion, this Guan Bi pipe makes anvil block 8014 in response to pressing under the nearside of the closure trigger 8026 of shank 8020 Pivot towards its make position.Elongated slot 8018 can be by the framework 8028(Figure 181 within Guan Bi pipe 8024) it is connected to shank 8020.Framework 8028 is rotatably engaged to shank 8020 so that rotary knob 8030(Figure 179) rotation can make tool part 8022 rotate.Referring specifically to Figure 181, rotary knob 8030 can be made up of two half-shell, and these two half-shell can include one or many Individual inward projection 8031, this protuberance can extend across the one or more elongated side opening 8070 in Guan Bi pipe 8024 also Engage framework 8028.Therefore, rotary knob 8030 and framework 8028 can together with or rotated simultaneously so that the rotation of knob 8030 Position determines the position of rotation of tool portion 8022.In various embodiments, the longitudinal length long enough of longer opening 8070, with Allow longitudinal closing motion of Guan Bi pipe 8024 and open motion.About producing the closing motion closing pipe 8024, referring first to Figure 181 and Figure 183, the top 8160 of closure trigger 8026 can promote forward closed yoke 8162 by Guan Bi connecting rod 8164.Close Close connecting rod 8164 at its far-end by Guan Bi yoke pin 8166 can pivotably be attached to closed yoke 8162, and at it Proximal end is by closing link pin 8168 can pivotably be attached.In various embodiments, closure trigger 8026 can Being closed trigger stretching spring 8246 and be advanced into open position, this stretching spring is proximally connected to closure trigger 8026 Top 8160 and the shank shell 8154 formed by right half-shell 8156 and left shell half 8158.By opening that stretching spring 8246 applies Power can be applied to the closing force of closure trigger 8026 and overcome, in order to towards distally advance yoke 8162, Guan Bi connecting rod 8164 and Guan Bi pipe 8024.

As it has been described above, when closure trigger 8026 activated or depresses, if it is desired, Guan Bi release button 8038 can quilt It is located so that surgeon or other clinicians can press Guan Bi release button 8038, and makes closure trigger 8026 And the remainder of surgical instruments is back to non-actuating state.In various embodiments, Guan Bi release button 8038 can pass through The lateral pivot 8173 of central authorities is connected to pivoting latch arm 8172 so that can transmit between release button 8038 and lock arm 8172 Motion.Referring again to Figure 181, Guan Bi release button 8038 can proximally be biased by compression spring 8174, i.e. as seen from the right side Examine, bias clockwise around the lateral pivot of central authorities 8173, and the top 8160 of closure trigger 8026 can include having after the most recessed The nearside tooth top 8170 of mouth 8171.When closure trigger 8026 is depressed, pivoting latch arm 8172 can straddle nearside tooth top On 8170, and when closure trigger 8026 arrives its fully depressed position, it will be appreciated that rear recess 8171 is present in pivot Below lock arm 8172, this pivoting latch arm compression spring 8174 force fall into and lock after recess 8171.Now, close The manual depression closing release button 8038 makes pivoting latch arm 8172 upwards and rotates from rear recess 8171, thus will Guan Bi Trigger 8026 unlocks and makes closure trigger 8026 to be back to its unclamped position.

Once closure trigger 8026 is proximally clamped, as it has been described above, then percussion trigger 8034 can be pulled to pistol Formula handle 8036, in order to from shank 8020 towards distally propelling percussion connecting rod 8032.In various embodiments, percussion trigger 8034 Can pivot around percussion trigger pin 8202, this percussion trigger pin is horizontally through right half-shell 8156 and the left shell half of shank 8020 8158 and engage.When activated, percussion trigger 8034 can advance link-type transmission firing lock 8150.Link-type passes Dynamic firing lock 8150 can be forced to retraction, non-firing position by spring 8184.This spring: 1) it is attached to the hands of shank 8020 Gun-type handle 8036；And 2) it is attached to one of them connecting rod of such as link-type transmission firing lock 8150, as the most detailed Thin described.Spring 8184 can include the non-athletic end 8186 being connected to shell 8154 and be connected to the near-end 8190 of steel band 8192 Motion end 8188.The end 8194 being arranged at distally of steel band 8192 can be attached in multiple connecting rod 8196a-8196d Attachment structure 8195 on front rod 8196a, the plurality of connecting rod forms link-type tooth bar 8200.Link-type tooth bar 8200 can be Flexible so that it can easily be retracted into pistol grip 8036 and minimize the length of shank 8020, but is formed straight The tooth bar assembly of rigidity, significant percussion force can be transferred to and/or through percussion connecting rod 8032 by this tooth bar assembly.As the most more Being described in detail, percussion trigger 8034 can engage with first connecting rod 8196a during the first actuating of percussion trigger 8034, Engage with second connecting rod 8196b, at the 3rd period of energization of percussion trigger 8034 during second actuating of percussion trigger 8034 Between engage with third connecting rod 8196c, and percussion trigger 8034 the 4th actuating during engage with fourth link 8196d, Wherein link-type tooth bar 8200 can be advanced the amount being incremented by by every time activating of percussion trigger 8034 towards distally.In various embodiments In, to being described further above, multiple strokes of percussion trigger 1034 can make right indicator wheel 1040 and left indicator Wheel 1041 rotation, with the distance indicating link-type tooth bar 8200 to advance.

Referring now to Figure 181 and Figure 183, Anti-backup mechanism 8250 can prevent combining stretching/compressing spring 8184 and make connecting rod Formula tooth bar 8200 bounces back between firing stroke.In various embodiments, couple sliding tube 8131 and adjoin first connecting rod 8196a also It is connected to fire connecting rod 8032 with transmission percussion motion.Percussion connecting rod 8032 proximally extends the near-end of framework 8028 and extends Through hole 8408 through anti-backup plate 8266.Being sized to when sliding with when firing connecting rod 8032 vertical alignment of through hole 8408 Ground accommodates percussion connecting rod 8032, and it is the most motionless to make percussion connecting rod roll in through-holes when inclined.Bottom inserted sheet attachment 8271 from The lower lip of the near-end of framework 8028 proximally extends, and extends through the hole 8269 on the lower limb of anti-backup plate 8266.Under this The bottom of anti-backup plate 8266 is drawn to neighbouring framework 8028 by portion's inserted sheet attachment 8271 so that when percussion connecting rod 8032 is towards far When side is pushed into, anti-backup plate 8266 is for vertical, and anti-backup plate 8266 can make when firing connecting rod 8032 and attempting retraction Top tilts backwards to bound state.Anti-retrogression compression spring 8264 is retrained towards distally by the near-end of framework 8028, and towards closely Side adjoins the top of anti-backup plate 8266, thus anti-backup plate 8266 is biased to lock-out state.Anti-retrogression cam tube 8268 is supported Anti-spring biases and cincture slidably couples sliding tube 8131 and adjacent anti-backup plate 8266.It is attached to anti-retrogression cam tube The proximally prominent anti-retrogression yoke 8256 of 8268 extends beyond closed yoke 8162.

Seeing Figure 181, the automatic retracted mechanism 8289 that connecting rod triggers is attached to surgical stapling and cuts off in apparatus 8010, with Cutter is made to bounce back at the end of firing stroke completely.To this end, distal link 8196d includes tang 8290, when distal link 8196d quilt Be advanced into the rach slot 8291(Figure 181 being formed in closed yoke 8162) in time tang upwardly.Align this tang 8290 with Start anti-retrogression trip lever 8248(Figure 186) on bottom proximal cam 8292.Referring specifically to Figure 186 and Figure 187, it is formed at The motion of the structural constraint anti-retrogression trip lever 8248 in right half-shell 8156 and left shell half 8158.It is respectively formed in right half-shell Pin socket 8296 and circular pegs 8293 between 8156 and left shell half 8158 are received through longitudinally elongated hole 8294, this hole shape Bottom Cheng Yu in the anti-retrogression trip lever 8248 in proximal cam 8292 distally, thus allow longitudinal translation and around circular pegs 8293 rotate.In right half-shell 8156, the groove 8295 proximally opened includes and the angled part up and towards distally The nearside horizontal component 8295a of 8295b connection, this is up and angled part 8295b accommodates anti-retrogression release towards distally Rear pin 8297(Figure 187 to the right of the near proximal ends of lever 8248), thus when anti-retrogression trip lever 8248 arrives its translation Farthest side part time, angled part 8295b gives rotation upwards up and towards distally for this.Once anti-retrogression release Lever 8248 is assembled, and the barrier structure being formed in the right half-shell 8156 of neighbouring anti-retrogression trip lever 8248 prevents anti-retrogression Trip lever 8248 proximally moves, so that rear pin 8297 to the right is maintained in the groove 8295 proximally opened.

To being described further above, as shown in Figure 187 and Figure 188, the far-end 8254 of anti-retrogression trip lever 8248 Thus towards distally and be forced to downwards, make front pin 8298 to the right fall into the rank opened towards distally being formed in right half-shell 8156 In ladder structure 8299, this is engaged through compression spring 8300(Figure 188) it is fixed to be positioned at front pin 8298 to the right and the thinnest The long hook 8301 to the left on the anti-retrogression trip lever 8248 between hole 8294 and realize.The other end of compression spring 8300 Be attached to be formed in right half-shell 8156 closed yoke 8266 immediately above closer to and hook 8302(Figure 186 of lower position, Figure 188, Figure 189).Compression spring 8300 thus by the far-end 8254 downwardly and rearwardly tractive of anti-retrogression trip lever 8248, make Front pin 8298 to the right locks onto when being pushed into towards distally in the hierarchic structure 8299 opened towards distally.Therefore, the most loose Opening, see Figure 189, anti-retrogression trip lever 8248 keeps forward, is held vertically throughout anti-backup plate 8266, so that link-type tooth Bar 8200 bounces back.When in the case of free end executor 8012, closed yoke 8266 bounces back subsequently, on closed yoke 8266 Reset tang 8303 upwardly contacts the bottom distal cam 8305 of anti-retrogression trip lever 8248, by front pin to the right 8298 lift from the hierarchic structure 8299 opened towards distally so that anti-retrogression compression spring 8264 can be by anti-retrogression cam tube 8268 and anti-retrogression trip lever 8248 be proximally pushed to its advanced position (Figure 186).

In various embodiments, seeing Figure 179 and Figure 189, percussion trigger 8034 can in any suitable manner may be used It is operatively engaged to link-type tooth bar 8200.Referring specifically to Figure 180 and Figure 185, percussion trigger 8034 is around being connected to shell The percussion trigger pin 8202 of 8154 pivots.When firing trigger 8034 and depressing towards pistol grip 8036, fire trigger The top 8204 of 8034 is around percussion trigger pin 8202 towards distal movement, thus the percussion trigger stretching that will proximally place Spring 8206(Figure 181) stretching, this stretching spring is proximally connected to fire top 8204 and the shell 8154 of trigger 8034 Between.Under percussion trigger every time during pressure, the side pawl that the top 8204 of percussion trigger 8034 biases via spring Mechanism 8210 engagement link formula tooth bar 8200.When firing trigger and being released, side pawl mechanism and link-type tooth bar 8200 Separate, and fire trigger and may return to non-depressed or non-firing position.In use, every by connecting rod 8196a-8196d The right rail of the inclination formed towards nearside and inclined-plane to the right 8284 in individual is engaged by side pawl assembly 8285.Specifically Ground, pawl slide block 8270(Figure 181 and Figure 183) there is lower left quarter guide rail and right lower quadrant guide rail 8272, this lower left quarter guide rail and Right lower quadrant guide rail left track 8274(Figure 181 in the closed yoke 8266 being formed at below rach slot 8291 respectively) in and Right track 8275 in closed yoke guide rail 8276 slides.Closed yoke guide rail 8276 is parallel to rach slot 8291 and is attached to tooth bar Groove lid 8277, what this rach slot lid closed the rach slot 8291 in closed yoke 8266 opens to the right part, described opens to the right portion Divide the distally of the traveling being positioned at pawl slide block 8270.In Figure 181, Figure 182 and Figure 185, compression spring 8278 is attached at The hook 8279 in the proximal position of top on closed yoke guide rail 8276 and the hook on the Distal Right of pawl slide block 8270 Between 8280, this makes pawl slide block 8270 proximally contact with the top 8204 firing trigger 8034 downwards.

Referring specifically to Figure 181, pawl block 8318 is positioned on pawl slide block 8270, around vertical rear pin 8320 pivot Turning, this rear pin is through the left proximal turning of pawl block 8318 and pawl slide block 8270.Kick out of block groove 8322 to be formed at In the distal part of the top surface of block 8318, to accommodate by normal pin 8326 can pivotably be fixed on therein playing Going out block 8324, the bottom end of this normal pin extends to the pawl spring groove on the top surface of pawl slide block 8270 In 8328.Pawl spring 8330 in pawl spring groove 8328 extends to the right side of vertical front pin 8326, forces system Bull stick block 8318 rotates counterclockwise to engage with the right rail 8282 tilted time viewed from above.Kick out of in block groove 8322 Little wind spring 8332 force and kick out of block 8324 and turn clockwise time viewed from above so that it is near-end is forced and is formed at tooth bar The wavy antelabium 8334 in closed yoke 8266 above groove 8291 contacts.As shown in Figure 184, pawl spring 8330 is compared to little Wind spring 8332 for the higher mechanical dominance that had mean that pawl block 8318 is prone to and kicking out of of turning clockwise Block 8324 engages.In Figure 185, when firing trigger 8034 and being fully depressed and start to be released, kick out of block 8324 in system Bull stick slide block 8270 runs into the ridge 8336 of wavy antelabium 8334 when bouncing back, force that to kick out of block 8324 clockwise time viewed from above Rotate, thus pawl block 8318 is kicked out of and the joint of link-type tooth bar 8200.The shape kicking out of block groove 8322 makes to kick out of The stopping that turning clockwise of block 8324 so that it is be in the direction being perpendicular to wavy antelabium 8334, should being fully retracted period holding Depart from thus eliminate ratcheting noise.

In Figure 181, Figure 183, Figure 190 and Figure 195, surgical stapling and cut-out apparatus 8010 can include manual retrieving mechanism 8500, this manual retrieving mechanism provides the manual release of firing lock, manual retrieving, and a kind of pattern (Figure 196-202) In at the end of firing stroke completely, also perform automatic retracted.Referring now to Figure 181, Figure 190 and Figure 191, specifically, front idle running Gear 8220 engages with the surface, dentation upper left 8222 of link-type tooth bar 8200, and wherein front idler gear 8220 also engages and has relatively The rear idler gear 8230 of little right-side ratchet gear 8231.Front idler gear 8220 and rear idler gear 8230 are rotatably attached To the shank shell 8154 laid respectively on front idler axle 8232 and rear idler wheel axle 8234.The often end of rear idler wheel axle 8232 Extend through corresponding right half-shell 8156 and left shell half 8158, and be attached to left indicator wheel 8040 and right indicator wheel 8041, and owing to hind axle 8234 rotates freely in shank shell 8154 and is bonded to backgear 8230 with bonding pattern, Thereby indicate that device wheel 8040,8041 rotates together with backgear 8230.Link-type tooth bar 8200, idler gear can be advantageously selected Gear relation between 8220 and backgear 8230 so that dentation upper surface 8222 has the teeth size that intensity is suitable, and makes Must be during the stroke of percussion completely of link-type transmission firing lock 8150, the rotation of backgear 8230 is less than a circle.Gear Mechanism 8502 is in addition to indicating percussion stroke or progress intuitively, and gear mechanism 8502 can be additionally used in and makes cutter manual retrieving.? In various embodiments, the less right-side ratchet gear 8231 of rear idler gear 8230 extends to the wheel of manual retrieving lever 8042 In hub 8506, specifically with by wheel hub 8506 to point vertical longitudinally-aligned slit 8508(Figure 190) align.Wheel hub 8506 Lateral through hole 8510 connects with upper grooves 8512.Anterior 8514 are shaped as the locking pawl that receiving proximally guides 8516, this locking pawl pivots around the lateral pin 8518 to the right in the far-end being formed at upper grooves 8512.Rear portion 8520 are shaped as receiving L-type spring tab 8522, and this spring tab forces locking pawl 8516, and downwards and right side is less Ratchet gear 8231 engages.Barrier structure 8524(Figure 186 and Figure 193) project into upper grooves 8512 from right half-shell 8156； When manual retrieving lever 8042 is downward (Figure 193), this barrier structure stops locking pawl 8516 to engage less right side spine Wheel gear 8231.Wind spring 8525(Figure 181) force manual retrieving lever 8042 downward.

In use, as shown in Figure 192 and Figure 193, combination stretching/compressing spring 8184 can be with the connecting rod being positioned at distally Formula tooth bar departs from.In Figure 194 and Figure 195, when manual retrieving lever 8042 lifts, locking pawl 8516 turns clockwise And be no longer blocked structure 8524 and stop, and engage less right-side ratchet gear 8231, so that rear idler gear 8230 exists Turn clockwise when left sides.Therefore, front idler gear 8220 responds counterclockwise, makes link-type tooth bar 8200 bounce back.This Outward, curved ridges 8510 to the right highlights from wheel hub 8506, and it is sized to contact and discharges towards distal movement anti-retrogression Lever 8248, with when manual retrieving lever 8042 rotates, this anti-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 can fire row completely It is attached to automatic retracted at the end of journey to have in the front idler gear 8220a of tooth 8602；This front idler gear is at cam 8606 In circular groove 8604 in motion, until rotating, corresponding to the nearly omnidistance of three firing stroke, the thing that meets with obstruction 8608.In such cases, ridge 8610 to the right is rotated upwardly to contact bottom cam groove 8612, with anti-down towards distal movement Move back trip lever 8248a.The far-end operated as described in the preceding is included referring specifically to Figure 197, anti-retrogression trip lever 8248a 8254.It is respectively formed in the circular pegs 8293 between right half-shell 8156 and left shell half 8158 and pin socket 8296 was formed through the end of in Substantially rectangular hole 8294a in portion's cam 8192 anti-retrogression trip lever 8248a below is received, thus allows the most flat The downward lock motion of the far-end 8254 of shifting and anti-retrogression trip lever 8248a.In right half-shell 8156, level is proximally The groove 8295a opened accommodates the rear pin 8297 to the right of the near proximal ends of anti-retrogression trip lever 8248a.

In operation, before the percussion in Figure 198,198A, at link-type tooth bar 8200 and anti-retrogression cam tube 8268 In advanced position, thus when anti-retrogression compression spring 8264 makes anti-backup plate 8266 proximally tilt, Anti-backup mechanism 8250 Locked.Automatic retracted mechanism 8600 is in original state, wherein anti-retrogression trip lever 8248a retraction, and connecting rod 8196a is with front Idler gear 8220a contacts.Tooth 8602 is in the position of six o'clock sharps, and wherein the total travel of circular groove 8604 is carried out counterclockwise, Ridge 8610 just adjacent teeth 8602 to the right.In Figure 199, Figure 199 A, there is a firing stroke, by a distal link 8196b moves upward to contact with front idler gear 8220a.Before tooth 8602 circular groove 8604 by fixing cam 8606 1/3rd turns are entered.In Figure 200, Figure 200 A, there is second firing stroke, another connecting rod 8196c has upwards been transported Move and contact with front idler gear 8220a.Tooth 8602 by the circular groove 8604 of fixing cam 8606 advanced three/ Two turns.In Figure 20 1, Figure 20 1A, there is the 3rd firing stroke, a distal link 8196d has been moved upward to front Idler gear 8220a contacts.Tooth 8602 proceeds to contact with hindering thing 8608 around circular groove 8604 whole process, thus starts The rotation (when observing from right side) counterclockwise of cam 8606, so that ridge 8608 to the right and anti-retrogression trip lever 8248a Contact.In Figure 20 2, anti-retrogression trip lever 8248a is as responding towards distal movement, thus is locked by front pin 8298 to the right Determine in the hierarchic structure 8299 opened towards distally and discharge Anti-backup mechanism 8250.Similar surgery suturing appliance is disclosed in The United States Patent (USP) 7 that on August 1st, 2006 announces, in 083,075, the complete disclosure of this patent is incorporated by reference herein.

Seeing Figure 20 3, the nail of surgery suturing appliance 9010 is used assembly 9012 and is implemented function such as: clamping organizationally, By driving nail along axle 9016 relative to two kinds of different motion of the longitudinal going down of pedestal 9070 and cut off tissue.Pedestal 9070 shanks being proximally attached to surgery suturing appliance are coupled to it, to be rotated about longitudinal axes.For surgical stapling With cut off illustrative many strokes shank of apparatus at CO-PENDING and entitled " the SURGICAL STAPLING that owns together INSTRUMENT INCORPORATING A MULTISTROKE FIRING POSITION INDICATOR AND RETRACTION MECHANISM " U.S. Patent Application Serial Number 10/374, described in more detail in 026, this is special The disclosure of profit application is incorporated by reference in its entirety.Other application meeting the present invention can be in conjunction with single firing stroke, such as At CO-PENDING and entitled " the SURGICAL STAPLING INSTRUMENT HAVING SEPARATE that owns together DISTINCT CLOSING AND FIRING SYSTEMS " that described in U.S. Patent Application Serial Number 10/441,632 Sample, the disclosure of this patent application is incorporated by reference in its entirety.

Referring specifically to Figure 20 4, the distal attachment of pedestal 9070 is to nail groove 9018.Anvil block 9022 has nearside hub switch side 9072, this nearside hub switch side, can pivotably be contained in the near-end 9074 of nail groove 9018, is placed exactly in itself and pedestal Distally at 9070 attachments.When anvil block 9022 pivots downwards, anvil block 9022 makes tissue contacting surface 9028 and shapes pit 9026 towards relative nail bin motion, as the most described in more detail.The hub switch side 9072 of anvil block 9022 includes closing structure 9076, this closing structure distally at itself and the attachment of nail groove 9018 but at itself and nail groove attachment.Therefore, Guan Bi pipe Its far-end of 9078(includes the shape of a hoof hole 9080 engaging this closing structure 9076) optionally will during nearside lengthwise movement Open motion and give anvil block 9022, and give anvil block by closing motion during the distally lengthwise movement of Guan Bi pipe 9078 9022, this Guan Bi pipe 9078 slides on pedestal 9070 in response to closure trigger, similarly as described above.Pedestal 9070 promotees Make and guide percussion motion from shank through the split type cutter of longitudinally reciprocating motion and trigger shaft 9090.Specifically, pedestal 9070 Including longitudinal trigger shaft slit 9092, this longitudinal direction trigger shaft slit accommodates split type cutter and the portions of proximal of trigger shaft 9090, tool It it is lamination tapered trigger shaft 9094 body.Should be appreciated that the tapered trigger shaft 9094 of lamination can by solid trigger shaft and/or Any other suitable material replaces.

E type crossbeam 9102 is the distal part of split type cutter and trigger shaft 9090, and it is conducive to individually Guan Bi and percussion, with And by spaced apart to anvil block 9022 and elongated nail groove 9018 during firing.Referring specifically to Figure 20 4 and Figure 20 5, except any attachment Processing outside such as solder brazing and binding agent, spill that cutter is also formed from E type crossbeam 9102 with trigger shaft 9090 is vertical to be attached Hole 9104 is formed, and this hole accommodates the correspondingly convex attachment members 9106 presented by the trigger shaft 9094 that lamination is tapered in distally, So that each part is formed by the selected material and method being suitable to its difference in functionality (such as intensity, pliability, frictional force). E type crossbeam 9102 can advantageously be formed by the material with desired material properties, to form a pair top pin 9110, a pair centre Pin 9112 and base pins or leg 9114, and it is obtained in that sharp knife edges 9116.Hang down additionally, hold each of blade 9116 One-body molded and the proximally prominent top guide device 9118 of straight end and intermediate guide 9120 also define set of organizations Tie region 9122, contributes to guiding to sharp knife edges 9116 before cutting off tissue.Intermediate guide 9120 is additionally operable to By adjacent wedge-shaped slides 9126(Figure 20 6) staged central member 9124 engage and fire nail application equipment 9012, Thus use assembly 9012 by nail and realize the formation of nail, as described in more detail below.Group is carried out compared to by multiple parts For dress, it is integrally formed these structures (such as, top pin 9110, intermediate pin 9112 and bottom supports with E type crossbeam 9102 9114) be conducive to manufacturing under the tolerance limit of the most more compactness, ensure that in percussion and/or use with nail Desired operation is carried out during the effective interaction of the various latch-up structures of assembly 9012.

In Figure 20 7 and Figure 20 8, nail uses what assembly 9012 was illustrated as opening, and wherein E type crossbeam 9102 is fully retracted. During assembly, the lower leg 9114 of E type crossbeam 9102 falls in nail groove 9018 through expanded hole 9130, and E type crossbeam 9102 are pushed into subsequently so that E type crossbeam 9102 slides along the lower railway 9132 being formed in nail groove 9018 towards distally.Specifically Ground, lower railway 9132 includes slit 9133, and it is opened as expanding slit 9134 on the lower surface of nail groove 9018, with laterally Cross section forms the T-shaped of reversion, as specifically shown in Figure 20 8 and Figure 20 9；This slit 9133 connects with expanded hole 9130. The most assembled, the parts being attached to the tapered trigger shaft of lamination 9094 at nearside do not allow lower leg 9114 the most proximally March to expanded hole 9130 to allow to depart from.Seeing Figure 21 0, the tapered trigger shaft of lamination 9094 is conducive to nail is used assembly 9012 insert through the trocar.Specifically, when E type crossbeam 9102 is fully retracted, the downward protuberance 9136 of farther side is lifted Play E type crossbeam 9102.This is subjected to displacement in certain point by downward protuberance 9136 and realizes；At this point, this protuberance Upwards cam in the proximal of the expanded hole 9130 in nail groove 9018.Referring now to Figure 21 1, the trigger shaft that lamination is tapered 9094 operations also strengthening some latch-up structure, described latch-up structure can by including the protuberance 9138 upwards closer to side and It is attached to follow closely in groove 9018；Described protuberance is ordered about downwards by pedestal 9070 during the initial part of percussion stroke.Specifically, Lateral rod 9140 is limited at pedestal 9070(Figure 20 4) in a square holes 9142 between.Surround downwards lateral rod 9140 Clip springs 9144 forces a part for the tapered trigger shaft 9094 of lamination prominent towards distally from longitudinal trigger shaft slit 9092, The latch-up structure that the when of guaranteeing suitable, some is favourable is engaged.When protuberance 9138 contacts clip spring 9144 upwards, This motive force becomes apparent from or is limited only to firing the part of stroke.

In Figure 20 7 and Figure 20 8, E type crossbeam 9102 bounces back, and the pivot near-end that its top pin 9110 is positioned at anvil block 9022 is attached In near anvil block pit 9150.The vertical anvil slot 9152(Figure 20 3 opened downwards) anvil block 9022 is laterally expanded into anvil block Inner tracks 9154, when the top pin 9110 of E type crossbeam 9102 advances towards distally during firing, anvil block inner tracks captures The top pin 9110 of E type crossbeam 9102, as shown in Figure 21 0 and Figure 21 1, anvil block 9022 is the most spaced apart with nail groove 9018.Cause This, after E type crossbeam 9102 bounces back, surgeon can be repeatedly opened and close nail and use assembly 9012, until to being trapped in Placement and orientation with the tissue cut off the most to be stapled pleases oneself, and E type crossbeam 9102 is even for having minimizing Diameter and correspondingly reduce the appropriate location also contributing to tissue for assembly 9012 used by the nail of rigidity.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 shown as having and includes the replaceable of wedge-shaped slides 9126 Nail bin 9020.Longitudinally-aligned and parallel multiple wedge slot 9202(Figure 20 9 opened downwards) accommodate wedge-shaped slides 9126 Required corresponding wedge 9204.In Figure 20 9-211, the multiple staple drivers of wedge-shaped slides 9126 the most upwards cam 9206, the plurality of staple drivers can vertical sliding motion in staple drivers groove 9208.In this illustrative pattern, each nail drives Dynamic device 9206 includes that two vertical contact pins, each vertical contact pin translate up in corresponding nail 9210 or cavity 9024, with Will rest against nail profiled surface 9214(Figure 21 1 of anvil block 9022) on nail 9023 upwards extrude and make it deform.It is limited to neighbouring Nail groove 9018 nail bin 9020 in central authorities percussion groove 9216(Figure 20 4) allow wedge-shaped slides 9126 bottom horizontal portion 9218(Figure 20 6) and the intermediate pin 9112 of E type crossbeam 9102 pass through.Specifically, nail bin pallet 9220(Figure 20 4, Figure 20 9) attached It is connected to polymer staple cartridge body 9222 and is positioned under；This polymer staple cartridge body has and is formed at staple drivers groove therein 9208, nail 9210 and central authorities' percussion groove 9216.When following closely 9023 and therefore shaping at either side, sharp knife edges 9116 enters hangs down Direct through groove 9230, in addition to the only distalmost end of this vertical through slot, this vertical through slot is through the longitudinal axis of nail bin 9020.

As shown in Figure 21 1, when by split type cutter and trigger shaft 9090 proximally tractive until downward protuberance 9136 is by E During intermediate guide 9120 upwardly and rearwardly cam on type crossbeam 9102, start to fire nail and use assembly 9012, thus work as When anvil block 9022 such as Figure 20 3 and 207 is opened, new nail bin 9020 is made to insert in nail groove 9018.In Figure 21 2, split type cutter and Trigger shaft 9090 is pushed into a small distance towards distally, so that when clip springs 9144 acts on the percussion that lamination is tapered During the protuberance 9138 upwards of bar 9094, downward protuberance 9136 falls in the expanded hole 9130 of lower railway 9132.Middle Guider 9120 prevents owing to being resisted against produce in the staged central member 9124 of wedge-shaped slides 9126 further Be rotated down, thus the intermediate pin 9112 of E type crossbeam is maintained at central authorities percussion groove 9216 in.In Figure 21 3, split type Cutter and trigger shaft 9090 are fired towards distally, thus advance wedge-shaped slides 9126, with when being clamped in anvil block 9022 and tool The tissue 9242 between the nail bin 9020 of sharp knife edges 9116 is had to make nail 9023 shape when cutting off.Subsequently, in Figure 21 4, split Formula cutter and trigger shaft 9090 bounce back, and make wedge-shaped slides 9126 position in distally.In Figure 21 5, intermediate pin 9112 be allowed to Under move to be formed at nail groove 9018(referring also to Figure 20 8, Figure 21 1) in latch recess 9240 in.Therefore, slide when wedge shape Part 9126(is not shown in Figure 21 5) not when proximally-oriented (such as, nail bin 9020 lacks or nail bin 9020 exhausts), if Intermediate pin 9112 runs into the distal side edge of latch recess 9240, then operator will receive haptic indication.Similar surgery seam The United States Patent (USP) 7 that clutch tool was announced on June 3rd, 2008, has disclosed in 380,696, the complete disclosure of this patent with Way of reference is expressly incorporated herein.

In various embodiments, as it has been described above, nail bin can include warehouse, this warehouse includes multiple nail limited wherein Chamber.Warehouse can include that platform and top platform surface, the most each nail chamber can limit the opening in platform surface.The most as above institute Stating, nail can be positioned in each nail intracavity so that until it is shot up from warehouse in nail is stored in warehouse.In various embodiments In, before being shot up from warehouse, nail can be accommodated in warehouse so that nail does not protrudes into above platform surface.Real at this type of Execute in example, when nail is positioned in below platform surface, the damaged and/or probability of premature contact target tissue of nail can be reduced. In all cases, nail can move between non-firing position and firing position.When non-firing position, it is not dashed forward from warehouse Going out, when firing position, it has exposed from warehouse and can contact the anvil block being positioned in nail bin opposite.In various embodiments, Anvil block and/or the nail being defined in anvil block shape pit and can be positioned so that anomaly platform surface one preset distance so that work as nail When warehouse is deployed, nail is deformed into a predetermined forming height.In some cases, it is trapped between anvil block and nail bin The thickness variable of tissue, therefore, in thicker tissue can be trapped in some nail, relatively thin tissue can be trapped in some In other nails.In either case, nail it is applied to the clamping pressure of tissue or compaction forces such as can be different because of nail, or at nail Change between nail on one end of row and the nail on the other end of staple.In some cases, anvil block and nail bin platform can be controlled Between gap so that nail applies the clamping pressure of a certain minimum in each nail.But in some such cases, in difference Nail in the notable change of clamping pressure may possibly still be present.

In various embodiments described herein, nail bin can include following device: this device is for being disposed from nail bin The thickness of tissue of nail capture compensate.In various embodiments, seeing Figure 21 6, nail bin such as nail bin 10000 such as may be used Including Part I such as support section 10010 of rigidity, and compressible Part II such as thickness compensation part 10020. In at least one embodiment, referring first to Figure 21 8, support section 10010 can include warehouse, top platform surface 10011 and Multiple nail chambeies 10012.Wherein, similarly as described above, each nail chamber 10012 can limit the opening in platform surface 10011.Nail 10030 such as can be removably positioned in each nail chamber 10012.In at least one this type of embodiment, referring first to figure 245 and as described in more detail below, each nail 10030 can include base portion 10031 and one or many extended from base portion 10031 Individual lower limb 10032.Before nail 10030 is deployed, the most as described in more detail below, the base portion 10031 of nail 10030 can be by being positioned at Staple drivers in support section 10010 supports, and simultaneously, the lower limb 10032 of nail 10030 can at least be partly accommodated in nail chamber In 10012.In various embodiments, nail 10030 can be deployed between non-firing position and firing position so that lower limb 10032 Move across tissue thickness's compensating part 10020, penetrate the top surface of tissue thickness's compensating part 10020, penetrate tissue T, and Contact is positioned in the anvil block on nail bin 10000 opposite.When lower limb 10032 is against deflection, the lower limb 10032 of each nail 10030 Can the part of tissue T in the part of capture tissue thickness compensation part 10020 and each nail 10030, and will compression Power is applied to tissue.To being described further above, the lower limb 10032 base portion 10031 downwardly toward nail of each nail 10030 can be made Deformation, retains region 10039 forming nail, and retaining region, tissue T and tissue thickness's compensating part 10020 at this nail can be captured. In all cases, nail retains region 10039 and can be limited at the inner surface of strained lower limb 10032 and the interior of base portion 10031 Between surface.Nail retains the size in region and can be depending on some questions, the length of such as lower limb, the diameter of lower limb, the width of base portion, And/or the degree of such as lower limb deformation.

In embodiment previously, the organizational choice that surgeon is usually required for just being sewn has suitable staple height Suitable nail.Such as, surgeon may select high nail and is used together and selects low nail and thin tissue one with thick tissue Rise and use.But in some cases, the tissue being just sewn does not has consistent thickness, and therefore, some nails cannot realize the phase The percussion configuration hoped.Such as, Figure 25 0 shows the higher nail in relatively thin tissue.Referring now to Figure 25 1, when tissue thickness Degree compensating part is time such as tissue thickness's compensating part 10020 is such as used together with thin tissue, and the biggest nail can shape by a definite date The percussion configuration hoped.

Due to the compression ratio of tissue thickness's compensating part, tissue thickness's compensating part can be to the thickness of capture tissue in each nail Degree compensates.More specifically, referring now to Figure 24 5 and Figure 24 6, tissue thickness's compensating part such as tissue thickness's compensating part 10020, thickness and/or the type of the tissue that such as can accommodate in retaining region 10039 according to nail occupy each nail 10030 Nail retains the bigger and/or less part in region 10039.Such as, it is trapped in nail 10030 compared to thicker tissue T Situation, if relatively thin tissue T be trapped in nail 10030 in, then tissue thickness's compensating part 10020 can occupy nail and retain region The major part of 10039.Correspondingly, it is trapped in the situation in nail 10030 compared to relatively thin tissue T, if thicker group Knit T to be trapped in nail 10030, then tissue thickness's compensating part 10020 can occupy nail and retain the smaller portions in region 10039.This Sample, tissue thickness's compensating part can compensate for relatively thin tissue and/or thicker tissue, and guarantees that compression stress is applied to tissue, regardless of whether No matter or being at least substantially trapped in the tissue thickness in nail.In addition to the above, tissue thickness's compensating part The tissue of the dissimilar or different compression ratio being trapped in different nail 10030 can be compensated by 10020.Referring now to figure, 246, tissue thickness's compensating part 10020 can apply compressive force to include the vascular tissue T of blood vessel V, and therefore limit blood Flow through the most compressible blood vessel V, but still desired compression stress is applied to the tissue T of surrounding.In all cases, right Being described further above, tissue thickness's compensating part 10020 can also compensate for strained nail.See Figure 24 7, various nails The deformation of 10030 may result in the bigger nail being limited in this type of nail and retains region 10039.Due to tissue thickness's compensating part The resilience force of 10020, referring now to Figure 24 8, even if be limited at the nail deformed in nail 10030 retain region 10039 can quilt Expand, be positioned at this tissue thickness's compensating part 10020 deformed in nail 10030 and still enough compression stresses can be applied to group Knit T.In all cases, it is positioned at the tissue thickness's compensating part 10020 in the middle of adjacent nail 10030 and can be deformed nail 10030 weeks The nail 10030 suitably shaped enclosed biases against tissue T, and therefore apply compressive force to such as around and/or be trapped in Deform the tissue in nail 10030.In all cases, tissue thickness's compensating part can compensate for different tissue densities, described not Same tissue density can such as produce due to classification, zone of fiber and/or the tissue previously sewed up or processed.

In various embodiments, fixing or unmodifiable interstice can be limited at support section and anvil block it Between.No matter the thickness of the tissue being therefore trapped in nail the most all can make nail be deformed into predetermined height.When tissue thickness is mended Repaying part and these embodiments when being used together, tissue thickness's compensating part is suitable for being trapped between anvil block and support section nail bin Tissue, and due to the resilience force of tissue thickness's compensating part, additional compression stress can be applied to group by tissue thickness's compensating part Knit.Referring now to Figure 25 2-257, nail 10030 is formed for predetermined height H.With reference to Figure 25 2, tissue thickness's compensating part does not has Used, and tissue T is occupied whole nail and retains region 10039.With reference to Figure 25 9, of tissue thickness's compensating part 10020 Point it is trapped in nail 10030, tissue T has been compressed, and occupied nail and retain at least some of of region 10039.Existing Seeing Figure 25 4, thin tissue T has been trapped in nail 10030.In this embodiment, the tissue T compressed has about 2/9H Height, and the tissue thickness's compensating part 10020 compressed has the height of the most about 7/9H.Referring now to Figure 25 5, tool, The tissue T having interior thickness has been trapped in nail 10030.In this embodiment, the tissue T compressed has about 4/9H's Highly, and tissue thickness's compensating part 10020 of being compressed has the height of the most about 5/9H.Referring now to Figure 25 6, have The tissue T of interior thickness has been trapped in nail 10030.In this embodiment, the tissue T compressed has the height of about 2/3H Spend, and the tissue thickness's compensating part 10020 compressed has the height of the most about 1/3H.Referring now to Figure 25 5, thick tissue T has been trapped in nail 10030.In this embodiment, the tissue T compressed has the height of about 8/9H, and is compressed Tissue thickness's compensating part 10020 there is the height of the most about 1/9H.In all cases, tissue thickness's compensating part can include Compression height, this compression height includes: the nail of the most about 10% retains height, the nail of about 20% retains height, about 30% Nail retains height, the nail of about 40% retains height, the nail of about 50% retains height, the nail of about 60% retains height, about The nail of 70% retains height, the nail of about 80% retains height and/or the nail of about 90% retains height.

In various embodiments, nail 10030 can include any suitable unshaped height.In certain embodiments, nail 10030 can include such as unshaped height between about 2mm and about 4.8mm.Nail 10030 can include the most about 2.0mm, about 2.5mm, about 3.0mm, about 3.4mm, about 3.5mm, about 3.8mm, about 4.0mm, about 4.1mm, And/or the unshaped height of about 4.8mm.In various embodiments, following closely deformable height H can be by support section 10010 Distance between platform surface 10011 and relative anvil block determines.In at least one embodiment, platform surface 10011 He Distance between the tissue contacting surface of anvil block can the most about 0.097 ".Highly H also can be by the shaping being limited in anvil block The degree of depth of pit determines.In at least one embodiment, shape pit and such as can have the degree of depth measured from tissue contacting surface. In various embodiments, as described in more detail below, nail bin 10000 may also include staple drivers.This staple drivers can will be followed closely 10030 lift towards anvil block, and are lifted by nail at least one embodiment or " excessively drive " is to above platform surface 10011. In this type of embodiment, the distance that the forming height H of nail 10030 also can be overdriven by nail 10030 determines.At least one In this type of embodiment individual, nail 10030 can be overdriven the most about .028 ", and may result in nail 10030 and be shaped as such as About 0.189 " height.In various embodiments, nail 10030 can be shaped as the most about 0.8mm, about 1.0mm, about The height of 1.5mm, about 1.8mm, about 2.0mm and/or about 2.25mm.In certain embodiments, as a example by nail can be formed Such as about 2.25mm and the height of about 3.0mm.To being described further above, the nail of nail retains the height in region can be by following closely Forming height and include that the width of wire rod of nail and diameter are determined.In various embodiments, the nail of nail 10030 retains district The height in territory 10039 can include that the forming height H of nail deducts two diameter widths of wire rod.In certain embodiments, staple line material The most about 0.0089 can be included " diameter.In various embodiments, nail row can include such as between about 0.0069 " and big About 0.0119 " diameter.In at least one exemplary embodiment, the forming height H of nail 10030 may be about 0.189 ", and And nail gauge or diameter of wire may be about 0.0089, and the nail of ", thus such as produce about 0.171 " retains height.

In various embodiments, to being described further above, tissue thickness's compensating part can include unpressed or pre- The height disposed, and can be deformed in multiple compression height.In certain embodiments, tissue thickness's compensating part can Including the most about 0.125 " uncompressed height.In various embodiments, the compensating part of tissue thickness can include being greater than Equal to about 0.080 " uncompressed height.In at least one embodiment, tissue thickness's compensating part can include unpressed or The pre-height disposed, not this height not firing highly more than nail.In at least one embodiment, not the pressing of tissue thickness's compensating part Contracting or the pre-height disposed is the highest by about 10% than not firing of nail, height about 20%, height about 30%, height about 40%, height about 50%, height about 60%, height about 70%, height about 80%, height about 90% and/or height about 100%.At least In one embodiment, the height of the unpressed or pre-deployment of tissue thickness's compensating part is the highest the most extremely than not firing of nail Many about 100%.In certain embodiments, not the height of the unpressed or pre-deployment of tissue thickness's compensating part not hitting than nail Send out the highest such as more than 100%.In at least one embodiment, tissue thickness's compensating part can include not firing height equal to follow closely The uncompressed height of degree.In at least one embodiment, tissue thickness's compensating part can include not firing the most not less than nail Compression height.In at least one embodiment, the height of the unpressed or pre-deployment of tissue thickness's compensating part is than nail not Fire the lowest by about 10%, low by about 20%, low by about 30%, low by about 40%, low by about 50%, low by about 60%, low greatly About 70%, low about 80% and/or low by about 90%.In various embodiments, compressible Part II can include uncompressed height Degree, this uncompressed height is higher than the uncompressed height of the tissue T being just sewn.In certain embodiments, tissue thickness's compensating part Can include uncompressed height, this uncompressed height is equal to the uncompressed height of the tissue T being just sewn.In various embodiments, Tissue thickness's compensating part can include uncompressed height, and this uncompressed height is less than the uncompressed height of the tissue T being just sewn.

As it has been described above, whether thickness is organized or thin tissue is trapped in nail, tissue thickness's compensating part all can be multiple Compressed in becoming staple.In at least one exemplary embodiment, the nail in nail row or staple can be made to deform so that each nail Nail retains the height that region includes the most about 2.0mm, wherein tissue T and tissue thickness's compensating part can be compressed to this height with In.In some cases, tissue T may be included in nail and retains the compression height of the about 1.75mm in region, and tissue thickness is mended Repay part and may be included in the compression height following closely the about 0.25mm retained in region, thus obtain adding up to the most about 2.0mm's Nail retains region height.In some cases, tissue T may be included in nail and retains the compression height of the about 1.50mm in region, And tissue thickness's compensating part may be included in nail and retains the compression height of the about 0.50mm in region, thus obtain adding up to such as The nail of about 2.0mm retains region height.In some cases, tissue T may be included in the about 1.25mm that nail retains in region Compression height, and tissue thickness's compensating part may be included in nail and retains the compression height of about 0.75mm in region, thus Region height is retained to the nail adding up to the most about 2.0mm.In some cases, tissue T may be included in nail and retains in region The compression height of about 1.0mm, and tissue thickness's compensating part may be included in nail, and to retain the compression of about 1.0mm in region high Degree, thus the nail obtaining adding up to the most about 2.0mm retains region height.In some cases, tissue T may be included in nail section Stay the compression height of about 0.75mm in region, and tissue thickness's compensating part may be included in nail and retains in region about The compression height of 1.25mm, thus the nail obtaining adding up to the most about 2.0mm retains region height.In some cases, group Knit T and may be included in the compression height following closely the about 1.50mm retained in region, and tissue thickness's compensating part may be included in nail and retains The compression height of the about 0.50mm in region, thus the nail obtaining adding up to the most about 2.0mm retains region height.At certain In the case of Xie, tissue T may be included in nail and retains the compression height of the about 0.25mm in region, and tissue thickness's compensating part can wrap Include the compression height retaining about 1.75mm in region at nail, thus the nail obtaining adding up to the most about 2.0mm retains district Territory height.

In various embodiments, to being described further above, tissue thickness's compensating part can include the percussion less than nail The uncompressed height of height.In certain embodiments, tissue thickness's compensating part can include the uncompressed of the percussion height equal to nail Highly.In some other embodiment, tissue thickness's compensating part can include the uncompressed height of the percussion height higher than nail.Extremely In few this type of embodiment, the uncompressed height of tissue thickness's compensating part can include such as following thickness: this thickness is for shaping Staple height about 110%, shape staple height about 120%, shape staple height about 130%, shape staple height about 140%, shape staple height about 150%, shape staple height about 160%, shape about the 170% of staple height, become staple high About the 180% of degree, about the 190% of shaping staple height and/or about the 200% of shaping staple height.In certain embodiments, group Knit thickness compensation part and can include uncompressed height, be more than the twice of the percussion height that this height is nail.In various embodiments, group Knitting thickness and can include compression height, this height is such as to shape about the 85% to about 150% of staple height.In various embodiments In, as it has been described above, tissue thickness's compensating part can be compressed between uncompressed thickness and compressed thickness.In some embodiment In, the compressed thickness of tissue thickness's compensating part can for example, about the 10% of its uncompressed thickness, its uncompressed thickness about 20%, about the 30% of its uncompressed thickness, about the 40% of its uncompressed thickness, about the 50% of its uncompressed thickness, it is not pressed About the 60% of contracting thickness, about the 70% of its uncompressed thickness, about the 80% of its uncompressed thickness and/or its uncompressed thickness About 90%.In various embodiments, the uncompressed thickness of tissue thickness's compensating part can such as thick than its compressed thickness about two Again, about ten times, about 50 times and/or about 100 times.In at least one embodiment, the pressure of tissue thickness's compensating part Contracting thickness can be between about the 60% of its uncompressed thickness to about 99%.In at least one embodiment, tissue thickness's compensating part Uncompressed thickness than its compressed thickness thickness at least 50%.In at least one embodiment, tissue thickness's compensating part is uncompressed Thickness is than its compressed thickness thickness at most 100 times.In various embodiments, compressible Part II can be elastic, or extremely Small part elasticity, and tissue T can be biased against the deformation lower limb of nail.In at least one this type of embodiment, compressible Part II can between tissue T and the base portion of nail elastic stretch, in order to against nail lower limb promote tissue T.In some embodiment In, discussing in detail as discussed further below, tissue thickness's compensating part can be positioned in the middle of the nail lower limb of tissue T and deformation.Respectively In the case of Zhong, due to mentioned above, tissue thickness's compensating part can eliminate any gap that nail retains in region.

In various embodiments, tissue thickness's compensating part can include polymer composition.Polymer composition can include one Kind or multiple synthetic polymer and/or one or more non-synthetic polymer.Synthetic polymer can include the absorbable poly-of synthesis Compound and/or the non-absorbable polymer of synthesis.In various embodiments, polymer composition can include such as biocompatibility Foam.Biocompatible foam can include the open celled foam of such as porous and/or the closed-cell foam of porous.Biocompatible foam Can have uniform pore morphology maybe can have gradient pore form (that is, on the whole depth of foam in a direction, orifice size by Cumulative adding, becomes macropore).In various embodiments, polymer composition can include porous support, porous matrix, gel-type vehicle, Hydrogel matrix, solution substrate, thread substrate, tubulose substrate, composite interstitial substance, membrane matrix, Biostatic polymer and can be biological One or more in the polymer of degraded and combinations thereof.Such as, tissue thickness's compensating part can include by thread base The foam that matter strengthens, maybe can include the foam with additional hydrogel layer, and this additional hydrogel layer expands in the presence of body fluid Exhibition, to further provide for compression organizationally.In various embodiments, tissue thickness's compensating part also can be by material and/or second Coating on layer or third layer is constituted, and this coating extends in the presence of body fluid, to further provide for compression organizationally.This type of layer Can be hydrogel, this hydrogel can be synthesis and/or natural source material, and can be such as that biology is durable and/or can give birth to Thing degraded.In certain embodiments, can use and be provided that the fibrous nonwoven material of additional flexibility, rigidity and/or intensity Or fiber mesh type element strengthens tissue thickness's compensating part.In various embodiments, tissue thickness's compensating part has porous Form, this porous form shows gradient-structure, aperture the most on a surface and on the other surface bigger Hole.This type of form is even more ideal for tissue growth or hemostasis behavior.Additionally, gradient also can be with the bio-absorbable of change Section is combined.Short-term absorption profile can be that preferably to solve hemostasis problem, and Long-term absorption section can solve ne-leakage feelings The problem that tissue more preferably heals is made under condition.

The example of non-synthetic polymer includes but not limited to lyophilizing polysaccharide, glycoprotein, elastin laminin, Dan Baiduotang proteoglycan PG, bright Glue, collagen and oxidized regenerated cellulose (ORC).The example of the absorbable polymer of synthesis includes but not limited to poly-(lactic acid) (PLA), PLLA (PLLA), polycaprolactone (PCL), polyglycolic acid (PGA), PTMC (TMC), poly- PETP (PET), polyhydroxy-alkanoates (PHA), Acetic acid, hydroxy-, bimol. cyclic ester and the copolymer of 6-caprolactone (PGCL), second are handed over Ester and the copolymer of trimethylene carbonate, poly-(decanedioic acid glyceride) (PGS), PPDO, poly-(ortho esters), poly- Anhydride, polysaccharide, poly-(ester-acid amide), tyrosine-based polyarylate, the poly-imido-carbonic ester of tyrosine-based, tyrosine-based polycarbonate, poly- (D, L-lactide-carbamate), poly-(B-hydroxybutyric acid), poly-(E-caprolactone), Polyethylene Glycol (PEG), poly-[two (carboxyls Phenoxy group) phosphonitrile], poly-(aminoacid), intend poly-(aminoacid), absorbable polyurethane and combinations thereof.In various enforcements In example, polymer composition can include the polymer composition of the PLLA of the most about 50% to about 90%, and The polymer composition of the PCL of the most about 50% to about 10%.In at least one embodiment, polymer composition can Including the PLLA of the most about 70%, and the PCL of the most about 30%.In various embodiments, polymer Compositions can include the polymer composition of the PGA of the most about 55% to about 85%, and by weight 15% arrives The polymer composition of the PCL of 45%.In at least one embodiment, polymer composition can include the most about The PGA of 65%, and the PCL of the most about 35%.In various embodiments, polymer composition can include the most by weight The polymer composition of the PGA of meter about 90% to about 95%, and the polymerization of the PLA of the most about 5% to about 10% Compositions.

In various embodiments, the absorbable polymer of synthesis can include bioabsorbable, biocompatible elastomers Copolymer.The most bioabsorbable, biocompatible elastomers copolymer includes but not limited to 6-caprolactone and Acetic acid, hydroxy-, bimol. cyclic ester Copolymer (the preferably mol ratio of 6-caprolactone and Acetic acid, hydroxy-, bimol. cyclic ester is about 30:70 to about 70:30, preferably 35:65 to about 65: 35, still more preferably 45:55 to 35:65), 6-caprolactone and lactide (include its L-lactide, D-lactide blend or breast Acid copolymer) elastomer copolymer (the preferably mol ratio of 6-caprolactone and lactide is about 35:65 to about 65:35, the most more Preferably 45:55 to 30:70), dioxanone (1,4-dioxane-2-ketone) and lactide (are included that L-third hands over Ester, D-lactide and lactic acid) elastomer copolymer (the preferably mol ratio to dioxanone Yu lactide is about 40: 60 to about 60:40), 6-caprolactone and to the elastomer copolymer of dioxanone (preferably 6-caprolactone with to dioxa The mol ratio of Ketohexamethylene is about 30:70 to about 70:30), elastomer copolymerization to dioxanone and trimethylene carbonate Thing (the preferably mol ratio to dioxanone Yu trimethylene carbonate is about 30:70 to about 70:30), trimethylene carbon (preferably trimethylene carbonate is about 30:70 to about with the mol ratio of Acetic acid, hydroxy-, bimol. cyclic ester to the elastomer copolymer of acid esters and Acetic acid, hydroxy-, bimol. cyclic ester 70:30), trimethylene carbonate and the bullet of lactide (including its L-lactide, D-lactide blend or lactic acid copolymer) Gonosome copolymer (preferably trimethylene carbonate is about 30:70 to about 70:30 with the mol ratio of lactide) and blend thereof. In one embodiment, elastomer copolymer is the copolymer of Acetic acid, hydroxy-, bimol. cyclic ester and 6-caprolactone.In another embodiment, elastomer Copolymer is the copolymer of lactide and 6-caprolactone.

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

In various embodiments, can include such as can be with brand name VICRYL for the absorbable polymer of synthesis (polyglactic910) from Ethicon, commercially available for Inc. 90/10 poly-(Acetic acid, hydroxy-, bimol. cyclic ester-L-lactide) copolymer, can be with business Entitling claim DEXON from PGA commercially available for American Cyanamid Co., can with brand name PDS from The commercially available PPDO of Ethicon, Inc., can be with brand name MAXON from American Cyanamid Co. Commercially available poly-(glycolide-trimethylene carbonate) statistic copolymer, can be with brand name MONOCRYL from treasuring One in 75/25 poly-(Acetic acid, hydroxy-, bimol. cyclic ester-E-caprolactone-poliglecaprolactone25) copolymer that Kanggong department is commercially available Or it is multiple.

Synthesis non-absorbable polymer include but not limited to polyurethane foam plastics, polypropylene (PP), polyethylene (PE), Merlon, polyamide, such as nylon, polrvinyl chloride (PVC), polymethyl methacrylate (PMMA), polystyrene (PS), poly- Ester, polyether-ether-ketone (PEEK), polytetrafluoroethylene (PTFE), polytrifluorochloroethylene (PTFCE), polyvinyl fluoride (PVF), ethylene fluoride Propylene (FEP), polyacetals, polysulfones and combinations thereof.The non-absorbable polymer of synthesis may include but be not limited to elastomer Foam plastics and porous elastomers, such as siloxanes, polyisoprene and rubber.In various embodiments, synthetic polymer can (can be with brand name GORE-TEX Soft Tissue Patch from Ge Er company including expanded PTFE (ePTFE) (W.L.Gore&Associates, Inc.) is commercially available) and copolyether ester polyurethane foam (can be with brand name NASOPORE Commercially available from Polyganics).

The polymer composition of tissue thickness's compensating part is characterised by such as percent porosity, hole dimension and/or hard Degree.In various embodiments, polymer composition can have the percent porosity of the most about 30% to about 99%. In certain embodiments, polymer composition can have the percent porosity of the most about 60% to about 98%.? In various embodiments, polymer composition can have the percent porosity of the most about 85% to about 97%.Extremely In a few embodiment, polymer composition can include the PLLA's and the most about 30% of the most about 70% PCL, and the porosity of the most about 90% can be included.In at least one this type of embodiment, therefore, polymer Compositions will include the copolymer of the most about 10%.In at least one embodiment, polymer composition can include such as The PGA and the PCL of the most about 35% of the most about 65%, and can have the most about 93% to by The percent porosity of stereometer about 95%.In various embodiments, polymer composition can include being more than by volume 85% Porosity.Polymer composition can have the hole dimension of the most about 5 microns to about 2000 microns.In various embodiments, Polymer composition can have such as hole dimension between about 10 microns to about 100 microns.At at least one this type of In embodiment, polymer composition can such as include the copolymer of PGA and PCL.In certain embodiments, polymer composition can There is the hole dimension such as between about 100 microns to about 1000 microns.In at least one this type of embodiment, polymerization Compositions can include the copolymer of such as PLLA and PCL.According to some aspect, the hardness of polymer composition can be hard with Shore Degree represents.This Shore hardness can be defined as the toleration of the permanent indenture to material such as measured by sclerometer. In order to assess the durometer value of given material, according to entitled " Standard Test Method for Rubber Property-Durometer Hardness " the ASTM program of (standard method of test of rubber property-durometer hardness) D2240-00, applies pressure to material with penetrator foot, and it is hereby incorporated herein by full.Can be by durometer Pressure head foot is administered to material and continues enough a period of times, and such as 15 seconds, such as, wherein reading read from suitable scale. According to scale type used, when pressure head foot completely penetrates through material, reading 0 can be obtained, and when material is not pierced, can Obtain reading 100.This reading dimensionless.In various embodiments, can such as according to ASTM D2240-00 according to any suitably Scale such as A class and/or OO class scale determine durometer.In various embodiments, the polymer group of tissue thickness's compensating part Compound may have about the 4A Shore A Hardness value to about 16A, and this Shore A Hardness value is such as at about 45OO to about 65OO Shore OO scope.In at least one this type of embodiment, polymer composition can include such as PLLA/PCL copolymer or PGA/PCL copolymer.In various embodiments, the polymer composition of tissue thickness's compensating part can have the Shore A less than 15A Hardness number.In various embodiments, the polymer composition of tissue thickness's compensating part can have the Shore A Hardness value less than 10A. In various embodiments, the polymer composition of tissue thickness's compensating part can have the Shore A Hardness value less than 5A.Real at some Executing in example, polymeric material can have the Shore OO compositions value of the most about 35OO to about 75OO.

In various embodiments, at least two during polymer composition can have the above-mentioned characteristic identified.Various In embodiment, polymer composition can have at least three kinds in the above-mentioned characteristic identified.Polymer composition can have example As by volume 85% to 97% porosity, the hole dimension of 5 microns to 2000 microns and the Shore A Hardness value of 4A to 16A and The Shore OO hardness value of 45OO to 65OO.In at least one embodiment, polymer composition can include the PLLA's of 70 weight % The polymer composition of the PCL of polymer composition and 30 weight %；Described polymer composition has the most by volume The porosity of 90%, the hole dimension of 100 microns to 1000 microns and the Shore A Hardness value of 4A to 16A and 45OO to 65OO's Shore OO hardness value.In at least one embodiment, polymer composition can include the polymer composition of PGA of 65 weight % And 35 polymer compositions of PCL of weight %；Described polymer composition has the hole of the most by volume 93% to 95% Rate, the hole dimension of 10 microns to 100 microns and the Shore A Hardness value of 4A to 16A and the Shore OO hardness of 45OO to 65OO Value.

In various embodiments, polymer composition can include pharmaceutically active agents.Polymer composition has releasably been treated The pharmaceutically active agents of effect amount.In various embodiments, when polymer composition is desorbed or absorbs, pharmaceutically active agents can be released Put.In various embodiments, pharmaceutically active agents can be released to fluid and such as flows through on polymer composition or through polymerization In the blood of compositions.The example of pharmaceutically active agents may include but be not limited to hemorrhage and medicine, such as fibrin, blood coagulation Enzyme and oxidized regenerated cellulose (ORC)；Anti-inflammatory agent, such as diclofenac, aspirin, naproxen, sulindac and hydrogenation can Pine；Antibiotic and antimicrobial agents or reagent, such as triclosan, ionic silver, ampicillin, gentamycin, polymyxin B, chloromycetin；And anticarcinogen, such as cisplatin, mitomycin, amycin.

In various embodiments, referring now to Figure 21 6, nail bin such as nail bin 10000 such as can include support section 10010 With compressible tissue thickness compensating part 10020.Referring now to Figure 21 8-220, support section 10010 can include platform surface 10011 and multiple nail chambeies 10012 of being limited in support section 10010.The size in each nail chamber 10012 such as can be set to also Nail can be stored the most removedly and such as follow closely 10030.Nail bin 10000 may also include multiple staple drivers 10040.Work as nail 10030 and staple drivers 10040 when being in its non-firing position, each staple drivers can in support nail chamber 10012 one Or multiple nail 10030.In at least one this type of embodiment, referring first to Figure 22 4 and Figure 22 5, each staple drivers 10040 can Can support nail limit nail 10030 and staple drivers including the most one or more supports or groove 10041, this support or groove Relative motion between 10040.In various embodiments, referring again to Figure 21 8, nail bin 10000 may also include nail percussion and slides Part 10050；This nail percussion sliding part can move to the far-end 10002 of nail bin from the near-end 10001 of nail bin, in order to is driven by nail successively Dynamic device 10040 and nail 10030 lift towards the anvil block being positioned in nail bin 10000 opposite from its non-firing position.Real at some Execute in example, referring first to Figure 21 8 and Figure 22 0, each nail 10030 can include base portion 10031 and from base portion 10031 extend one Or multiple lower limb 10032, the most each nail can be such as at least one in substantially U-shaped and basic V-arrangement.In at least one embodiment In, nail 10030 may be configured such that, when following closely 10030 and being in its non-firing position, the end of nail lower limb 10032 is relative to support The platform surface 10011 of part 10010 caves in.In at least one embodiment, nail 10030 may be configured such that when nail 10030 when being in its non-firing position, and the end of nail lower limb 10032 is neat relative to the platform surface 10011 of support section 10010 Flat.In at least one embodiment, nail 10030 may be configured such that when following closely 10030 and being in its non-firing position, follows closely lower limb The end of 10032 or at least certain part of nail lower limb 10032 extend to above the platform surface 10011 of support section 10010.At this In class embodiment, when following closely 10030 and being in its non-firing position, nail lower limb 10032 may extend into and is embedded in tissue thickness and mends Repay in part 10020.In at least one this type of embodiment, nail lower limb 10032 can such as extend to above platform surface 10011 about 0.075".In various embodiments, nail lower limb 10032 can such as extend to above platform surface 10011 about 0.025 " and about 0.125 " distance between.In certain embodiments, to being described further above, tissue thickness's compensating part 10020 can wrap Include the uncompressed thickness between the most about 0.08 " and about 0.125 ".

In use, to being described further above and referring first to Figure 23 3, anvil block such as anvil block 10060 such as may be used Move to the make position relative with nail bin 10000.As described in more detail below, anvil block 10060 can be by tissue against tissue thickness Degree compensating part 10020 positions, and in various embodiments, such as, tissue thickness's compensating part 10020 is pressed to support section The platform surface 10011 of 10010.Once anvil block 10060 is appropriately positioned, then can dispose nail 10030, same such as Figure 23 3 institute Show.In various embodiments, as it has been described above, nail percussion sliding part 10050 can be from the near-end 10001 of nail bin 10000 towards far-end 10002 motions, as shown in Figure 23 4.When sliding part 10050 is pushed into, sliding part 10050 can contact stud driver 10040 also In nail chamber 10012, staple drivers 10040 is lifted up.In at least one embodiment, sliding part 10050 and staple drivers 10040 can each include one or more slope or inclined-plane, this one or more slopes or inclined-plane can cooperate so that staple drivers 10040 move upward from its non-firing position.In at least one this type of embodiment, see Figure 22 1-225, each staple drivers 10040 can include at least one inclined-plane 10042, and sliding part 10050 can include one or more inclined-plane 10052, and it can quilt It is arranged so that, when sliding part 10050 is pushed into towards distally in nail bin, inclined-plane 10052 is in inclined-plane 10042 lower slider.Work as nail When driver 10040 is lifted up in its respective nail chamber 10012, nail 10030 can upwards be lifted by staple drivers 10040 Rise so that nail 10030 can be exposed from its nail chamber 10012 by the opening in nail platform 10011.In the exemplary percussion sequence phase Between, referring first to Figure 22 7-229, sliding part 10050 can first contact stud 10030a and start to be lifted up nail 10030a. When sliding part 10050 is further promoted towards distally, sliding part 10050 can start will to follow closely 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 by nail 10030 to Upper driving so that the lower limb 10032 of the nail contacted with relative anvil block is deformed into desired shape, and from support section 10010 It is shot up.In all cases, as a part for percussion sequence, multiple nails can be moved upward by sliding part 10030 simultaneously.Ginseng According to the percussion sequence shown in Figure 22 9, nail 10030a and 10030b has moved to its complete firing position and from support section 10010 are shot up, and nail 10030c and 10030d is in during being fired and is at least partly accommodated in support section In 10010, and follow closely 10030e and 10030f and be still within its non-firing position.

As mentioned above and see Figure 23 5, when following closely 10030 and being in its non-firing position, the nail lower limb 10032 of nail 10030 can Extend to above the platform surface 10011 of support section 10010.With further reference to the percussion sequence shown in Figure 22 9, follow closely 10030e It is illustrated at its non-firing position with 10030f, and its nail lower limb 10032 extends to above platform surface 10011 and extends In tissue thickness's compensating part 10020.In various embodiments, when following closely 10030 and being in its non-firing position, lower limb 10032 is followed closely End or any other part of nail lower limb 10032 may the top contact tissue table of Bu Tuchuan tissue thickness compensating part 10020 Face 10021.As shown in Figure 22 9, when following closely 10030 and moving to its firing position from its non-firing position, the end of nail lower limb can be convex Wear tissue contacting surface 10032.In various embodiments, the end of nail lower limb 10032 can include cutting and to penetrate tissue thickness The sharp distal end of degree compensating part 10020.In certain embodiments, tissue thickness's compensating part 10020 can include multiple hole, the plurality of Hole can accommodate nail lower limb 10032 and make nail lower limb 10032 slide relative to tissue thickness's compensating part 10020.In some embodiment In, support section 10010 may also include the multiple guiders 10013 extended from platform surface 10011.Guider 10013 Can be positioned so that the nail chamber opening of neighbouring platform surface 10011 so that nail lower limb 10032 can be at least in part by guider 10013 support.In certain embodiments, guider 10013 can be positioned in near-end and/or the far-end of nail chamber opening.? In various embodiments, the first guider 10013 can be positioned in the first end of each nail chamber opening, and second guides dress Put 10013 the second ends that can be positioned in each nail chamber opening so that each first sustainable nail of guider 10013 The first nail lower limb 10032 of 10030, and the second nail lower limb 10032 of each second sustainable nail of guider 10013.At least In one embodiment, seeing Figure 23 5, each guider 10013 can include groove or slit, such as groove 10016；Nail lower limb 10032 such as can be slidingly received in this groove.In various embodiments, can include can be from for each guider 10013 Platform surface 10011 extends and may extend into the clamping plate in tissue thickness's compensating part 10020, projection and/or spike.At least In one embodiment, as described in more detail below, clamping plate, projection and/or spike can reduce tissue thickness's compensating part 10020 and Relative motion between support section 10010.In certain embodiments, the end of nail lower limb 10032 can be positioned in guider In 10013, and can not extend to above the top surface of guider 10013 when following closely 10030 and being in its non-firing position. In at least this type of embodiment, guider 10013 can limit guiding height, and does not fires position when nail 10030 is not at it This guiding elevation-over can not extended to when putting.

In various embodiments, tissue thickness's compensating part such as tissue thickness's compensating part 10020, such as can be by single material Sheet is constituted.In at least one embodiment, tissue thickness's compensating part can include continuous sheet, and this continuous sheet can cover props up The whole top platform surface 10011 of 10010 is divided in support part, or covers less than whole platform surface 10011.In some embodiment In, material piece can cover the nail chamber opening in support section 10010, and in other embodiments, material piece can include can be with nail Chamber register or at least part of opening alignd.In various embodiments, tissue thickness's compensating part can be by multilayer material structure Become.In certain embodiments, referring now to Figure 21 7, tissue thickness's compensating part can include compressible core and around compressible core Wrappage.In certain embodiments, compressible core can be releasably held support section 10010 by wrappage 10022.? In at least one this type of embodiment, support section 10010 can include the one or more protuberances such as extended from it, such as dashes forward Go out portion 10014(Figure 22 0), this protuberance may be housed in one or more hole and/or slit, such as, be limited to wrappage In hole 10024 in 10022.Protuberance 10014 and hole 10024 may be configured such that protuberance 10014 can be by wrappage 10022 remain to support section 10010.In at least one embodiment, the end of protuberance 10014 can be such as by hot melt Manage and deform, in order to expand the end of protuberance 10014, and therefore limit between wrappage 10022 and support section 10010 Relative motion.In at least one embodiment, wrappage 10022 can include one or more perforation 10025, its can beneficially by Wrappage 10022 discharges from support section 10010, as shown in Figure 21 7.Referring now to Figure 22 6, tissue thickness's compensating part can include Wrappage 10222, this wrappage includes multiple hole 10223, and its mesopore 10223 can be with the nail chamber opening in support section 10010 Align or at least partly align.In certain embodiments, the core of tissue thickness's compensating part may also include with in wrappage 10222 The hole alignd or at least partly align in hole 10223.In other embodiments, the core of tissue thickness's compensating part can include continuous main body And may extend into below hole 10223 so that the nail chamber opening during main body covers platform surface 10011 continuously.

In various embodiments, as it has been described above, tissue thickness's compensating part can include for compressible core being protected releasedly Hold the wrappage of support section 10010.In at least one this type of embodiment, seeing Figure 21 8, nail bin may also include keeper Fixture 10026, this keeper fixture can suppress wrappage and compressible core to separate with support section 10010 prematurely.Respectively Planting in embodiment, each keeper fixture 10026 can include accommodating the protuberance 10014 extended from support section 10010 Hole 10028 so that keeper fixture 10026 can be held support section 10010.In certain embodiments, keeper folder Tool 10026 can each include at least one disc portion 10027, and this disc portion may extend into below support section 10010 and can Staple drivers 10040 is supported and is maintained in support section 10010.In certain embodiments, as it has been described above, tissue thickness is mended Repay part and can be removably attachable to support section 10010 by nail 10030.More specifically, as also described above, when following closely at 10030 When its non-firing position, the lower limb of nail 10030 may extend in tissue thickness's compensating part 10020, and therefore tissue thickness is mended Repay part 10020 and releasably hold support section 10010.In at least one embodiment, the lower limb of nail 10030 can be corresponding to it Nail chamber 10012 sidewall contact, wherein, due to nail lower limb 10032 and sidewall between friction, nail 10030 and tissue thickness mend Repay part 10020 can be held in place, until nail 10030 is deployed from nail bin 10000.After nail 10030 is deployed, tissue thickness It is kept in compensating part 10020 can be trapped in nail 10030 and against the tissue T sewed up.Open when anvil block is subsequently moved into When position is with release tissue T, support section 10010 is movable away from the tissue thickness's compensating part 10020 having been secured to tissue.? In some embodiment, binding agent can be used so that tissue thickness's compensating part 10020 is remained to support section 10010 removedly. In at least one embodiment, two-part adhesive, the most at least one embodiment, the Part I of binding agent can be used Can be placed on platform surface 10011, and the Part II of binding agent can be placed to tissue thickness's compensating part 10020 On so that when tissue thickness's compensating part 10020 be close to platform surface 10011 place time, Part I can contact Part II with Enable binding agent and tissue thickness's compensating part 10020 is bonded to support section 10010 separably.In various embodiments, Can use any other suitable method that tissue thickness's compensating part remains to the support section of nail bin separably.

In various embodiments, to being described further above, sliding part 10050 can proximally 10001 be advanced to Far-end 10002 is to dispose all nails 10030 being accommodated in nail bin 10000 completely.In at least one embodiment, join now Seeing Figure 25 8-262, sliding part 10050 can be stitched by firing member or surgery in support section 10010 in longitudinal cavity 10016 The knife bar 10052 of clutch advances towards distally.In use, nail bin 10000 can be inserted into the nail bin in the jaw of surgical stapling device In passage, such as in staple cartridge channel 10070, and firing member 10052 can be advanced to contact with sliding part 10050, such as figure Shown in 258.When sliding part 10050 is advanced towards distally by firing member 10052, sliding part 10050 can contact the nail of recent side Driver or driver 10040, and nail 10030 is fired from warehouse 10010 or penetrates, as mentioned above.As shown in Figure 25 8, Firing member 10052 may also include cutting blade 10053, and when following closely 10030 and being fired, this cutting blade can be by support section 10010 Cutter slit be pushed into towards distally.In various embodiments, corresponding cutter slit can extend across that to be positioned in nail bin 10000 right The anvil block in face so that at least one embodiment, cutting blade 10053 can extend between anvil block and support section 10010 and cut Cut the tissue being positioned in therebetween and tissue thickness's compensating part.In all cases, sliding part 10050 can be by firing member 10052 advance towards distally, until sliding part 10050 arrives the far-end 10002 of nail bin 10000, as shown in Figure 26 0.Now, percussion Component 10052 can proximally bounce back.In certain embodiments, sliding part 10050 proximally can bounce back with firing member 10052, But in various embodiments, referring now to Figure 26 1, when firing member 10052 bounces back, sliding part 10050 can be left on nail In the far-end 10002 in storehouse 10000.Once firing member 10052 the most fully bounces back, and anvil block can be opened again, and tissue thickness is mended Repay part 10020 to separate with support section 10010, and exhausted the remaining non-implanted portion of nail bin 10000, including supporting Part 10010, can be removed from staple cartridge channel 10070.

When exhausting after nail bin 10000 is removed from staple cartridge channel, to being described further above, new nail bin 10000 or any other suitable nail bin can be inserted in staple cartridge channel 10070.In various embodiments, to entering above One step describes, and staple cartridge channel 10070, firing member 10052 and/or nail bin 10000 can include cooperative structures, this cooperative structures Can new not firing prevent firing member 10052 again when nail bin 10000 is not located in staple cartridge channel 10070 or after It is pushed into towards distally for continuous time.More specifically, refer again to Figure 25 8, when firing member 10052 is advanced to and sliding part 10050 During contact, and when sliding part 10050 is in the non-firing position of its nearside, the support nose 10055 of firing member 10052 can Be positioned on the support lugn 10056 on sliding part 10050 and/or on so that firing member 10052 is maintained at enough Position upwards, to prevent the lock or the crossbeam 10054 that extend from firing member 10052 from falling into the lock being limited in staple cartridge channel In groove.When will not fall into lock groove due to lock 10054, in such cases, when firing member 10052 is pushed into, lock The 10054 distally sidewalls 10057 that can not adjoin lock groove.When sliding part 10050 is promoted by firing member 10052 towards distally, Firing member 10052 can be supported on it upwards fire position due to the support nose 10055 that leans against on support lugn 10056 Put.When firing member 10052 bounces back relative to sliding part 10050, as mentioned above and as shown in Figure 26 1, when supporting nose 10055 when not relying on the support lugn 10056 of sliding part 10050, and firing member 10052 upwards can fall position from it. In at least one this type of embodiment, surgical staples can include the spring that firing member 10052 can be biased to its down position 10058 and/or any other suitable biasing element.Once firing member 10052 is fully retracted, as shown in Figure 26 2, and percussion Component 10052 can not again pass through the nail bin 10000 used up and be pushed into towards distally.More specifically, when being now in operation order Sliding part 10050 when being left at the far-end 10002 of nail bin 10000, firing member 10052 can not be by sliding part 10050 It is maintained at its upper position.Therefore, if as it has been described above, firing member 10052 in the case of not replacing nail bin by again Advance, then lock crossbeam 10054 is by the sidewall 10057 of contact lock groove, and this will prevent firing member 10052 from again being pushed away towards distally Enter in nail bin 10000.In other words, the nail bin 10000 once used up is replaced by new nail bin, and new nail bin will have closely The sliding part 10050 of location, side, firing member 10052 can be maintained at its upwards position by this proximally-oriented sliding part, and Firing member 10052 is made again to be pushed into towards distally.

As it has been described above, sliding part 10050 can be by staple drivers 10040 at the first non-firing position and the second firing position Between move, in order to will nail 10030 from support section 10010 penetrate.In various embodiments, at nail 10030 from support When part 10010 is shot up, staple drivers 10040 can be accommodated in nail chamber 10012.In certain embodiments, support section 10010 can include one or more holding structures that staple drivers 10040 can be stoped to penetrate or drop out from nail chamber 10012. In other embodiments various, sliding part 10050 can be by staple drivers 10040 from the support section 10010 with nail 10030 Middle injection.In at least one this type of embodiment, staple drivers 10040 can be by the most bioabsorbable and/or bio-compatible Property material constitute, such as Polyetherimide.In certain embodiments, staple drivers could attach to follow closely 10030.At at least one this In class embodiment, staple drivers can be molded on the base portion of each nail 10030 and/or surrounding so that driver and nail one Body formed.Entitled " the SURGICAL STAPLES HAVING COMPRESSIBLE OR of JIUYUE in 2006 submission on the 29th CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME " U.S. Patent Application Serial Number 11/541,123 is incorporated by reference in its entirety herein.

In various embodiments, to being described further above, compressible tissue thickness compensating part can be relative to nail Rigid support componental movement, distortion and/or deflection below storehouse.In various embodiments, support section and/or nail bin Any other suitably part can include limiting relative motion between tissue thickness's compensating part and support section one or Multiple structures.As it has been described above, on the platform surface 10011 that may extend into support section 10010 at least partially of nail 10030 Side, wherein, in some cases, referring now to Figure 26 3 and Figure 26 4, is applied to the side force example of tissue thickness's compensating part 10120 Nail 10030 and/or clamping plate 10013 as extended from support section 10010 are kept out.In all cases, nail 10030 is supporting During the lateral movement of gear tissue thickness compensating part 10120 can the tilted and/or bending in nail chamber 10012, wherein in various enforcements In example, nail chamber 10012 can be set to the size of nail 10030 and can keep following closely the lower limb 10032 of 10030 and relative anvil block The alignment relative shaped between pit 10062 in 10060 so that nail 10000 correctly shapes during nail forming process.Respectively In kind of embodiment, nail 10030 and/or clamping plate 10013 are prevented from or at least limit in tissue thickness's compensating part 10020 lateral Distortion, as shown in Figure 26 4.In at least one this type of embodiment, nail 10030 and/or clamping plate 10013 such as can be strengthened or limit First or the tissue contacting surface 10021 of tissue thickness processed compensating part relative to second or lower surface 10029 lateral and/or Lengthwise movement.In various embodiments, nail bin and/or wherein location have the staple cartridge channel of nail bin can include at least one distortion Littleization component, this minimizing twisting component can upwardly extend to limit the lateral of tissue thickness's compensating part and/or lengthwise movement or Distortion.As it has been described above, at least partly surround the wrappage of tissue thickness's compensating part prevented also from or at least limit tissue thickness Lateral and/or the lengthwise movement of compensating part or distortion.

In various embodiments, Figure 26 3 and 264, tissue thickness's compensating part such as tissue thickness's compensating part are referred again to 10120 such as can include core 10128 and crust 10122.Crust 10122 can be by different materials or identical with compressible core 10128 Material is constituted.In either case, crust 10122 can have density more higher than core 10128.Group is included at crust 10122 In the case of knitting the top of thickness compensation part 10120, the end of nail lower limb 10032 can embed in crust 10122.Skin includes group outside In the embodiment of the bottom knitting thickness compensation part 10120, nail lower limb 10032 can extend across crust and enters in core.At any one In the case of, the crust of tissue thickness's compensating part can help to keep nail lower limb 10032 right with the shaping pit 10062 of anvil block 10060 Together.In various embodiments, crust 10122 can include such as lower density: this density such as than the density of core 10128 larger about 10%, Than the density of core 10128 larger about 20%, than the density of core 10128 larger about 30%, than the density of core 10128 larger about 40%, ratio The density of core 10128 larger about 50%, than the density of core 10128 larger about 60%, than the density of core 10128 larger about 70%, compare core The density of 10128 larger about 80%, than the density of core 10128 larger about 90%, than the density of core 10128 larger about 100%.Respectively Planting in embodiment, crust 10122 can include such as lower density, and this density is greater than the density of core 10128 and less than core 10128 The twice of density.In various embodiments, crust 10122 can include such as lower density, and this density is greater than the close of core 10128 The twice of degree.In various embodiments, to being described further above, crust 10122 and core 10128 can be formed simultaneously or Manufacture.In at least one this type of embodiment, the fluid comprising any suitable material disclosed herein can be introduced in dish or It is molded, and when fluid sets, fluid can be formed has crust more highdensity than surplus material or layer.In various enforcements In example, the multiple layers in material can be by making to be formed with the following method: in the method, one or more succeeding layer quilts of material It is poured on the layer of prior cured.In certain embodiments, two or more layers can be such as bonded to each other by binding agent.? In some embodiments, two or more layers can be such as by one or more securing member and/or one or more machinery Interlocking structure is attached to each other.In at least one this type of embodiment, adjacent layer can such as be connect by one or more dovetail Conjunction links together.In certain embodiments, outer micromicro includes that can prevent or at least limit fluid passes through the sealing of flowing Surface.In some other embodiment, outer micromicro includes the loose structure of such as perforate.

In various embodiments, to being described further above, crust can be cut from tissue thickness's compensating part.At least In one embodiment, tissue thickness's compensating part can be from bigger material block excision so that tissue thickness's compensating part does not include crust. In at least one this type of embodiment, tissue thickness's compensating part can be by homogeneity or at least substantially homogeneity such as including macropore Material is constituted.

In various embodiments, nail bin can include multiple nail chamber, and each nail chamber accommodates the nail being positioned in, and wherein follows closely chamber Multirow can be arranged to, and the anvil block being wherein positioned in nail bin opposite can include the multiple one-tenth corresponding with the nail chamber in nail bin Shape pit.In other words, anvil block can include that multiple shaping pit row, the most each shaping pit can be positioned in the nail in nail bin The opposite in chamber.In various embodiments, each shaping pit can include two one-tenth that can accommodate the nail lower limb 10032 of nail 10030 Shape cup, the most each shaping cup can accommodate nail lower limb 10032, and make nail lower limb 10032 such as shape towards other nail lower limbs 10032 Or curling.In all cases, lower limb 10032 may lack shaping cup or not properly enter shaping cup, therefore nail lower limb 10032 May deform during percussion sequence.In various embodiments described herein, anvil block can include shape pit array or Grid, it each can accommodate and be formed nail lower limb.In at least one this type of embodiment, shape pit array and can include that some become Shape pit, the quantity of the nail that the quantity of this shaping pit accommodates in exceeding nail bin.In at least one embodiment, nail bin can include The nail chamber of such as six lengthwise rows, wherein anvil block can include that six row alignd with six row nail chambeies shape pit, and shapes in addition Pit is positioned in the centre shaping pit row.Such as, on the side of anvil block, anvil block can include being positioned in the first nail First row on chamber shapes pit, can be positioned adjacent to the second row on the second nail chamber in the first nail chamber and shape recessed Cheat and be positioned in addition in the middle of first row shaping pit and second row shaping pit one and line up shape pit.In various realities Executing in example, referring now to Figure 27 6-279, anvil block 10260 can include that six line up shape pit 10261, and it can be placed on nail bin On corresponding six nail chambeies in 10200.In at least one this type of embodiment, multiple rows of middle shaping pit 10262 can quilt It is positioned in the middle of multiple rows of shaping pit 10261 and/or neighbouring multiple rows of shaping pit 10261.In certain embodiments, referring now to Figure 27 7, Figure 27 8 and Figure 28 0, each shaping pit 10261 and 10262 can include that two shape cup, the most each shaping cup bag Include the distal part 10263 that nail lower limb 10032 can be made proximally to shape or crimp and nail lower limb 10032 can be made to shape towards distally Or the portions of proximal 10264 of curling.Various in the case of other, nail 10030 can be shaped by other modes multiple.Such as, nail 10030 may be shaped so that a lower limb 10032 outwards shapes and another lower limb 10032 is to internal shaping (Figure 28 1), or two Individual lower limb 10032 the most outwards shapes (Figure 28 2), and this depends on such as 1) nail lower limb 10032 enter that shape cup, and/or 2) lower limb 10032 portions of proximal 10263 whether entering each shaping cup or distal part 10064.

In various embodiments, to being described further above, each shaping pit 10261 and/or shaping pit 10262 can include such as triangle or diamond shape.In at least one embodiment, each distal part of pit is shaped 10263 and/or each portions of proximal 10264 can include triangular shaped, wherein at least one this type of embodiment, extremity Points 10263 and the triangular shaped of portions of proximal 10264 may be arranged so that it has the summit pointing to relative direction.At certain In a little embodiments, anvil block can include the most foursquare the most a series of shaping pit.In at least one this type of embodiment, The profiled surface of each foursquare shaping pit may be included in the arcuate surfaces extended between foursquare side.Real at some Executing in example, anvil block can include the most a series of circle or spherical pit.In various embodiments, to retouching the most further Stating, shaping pit 10261 can be positioned along one or more row, and similarly, shaping pit 10262 also can be along one or many Individual row is positioned.In other embodiments various, shape pit 10261 and/or shape pit 10262 can be arranged to one or Multiple circular row.In at least one this type of embodiment, shaping pit 10261 can be arranged along main circumference, shapes pit parallel 10262 can be arranged along different circumference.In various embodiments, main circumference and different circumference can be concentric or substantially Concentric.In certain embodiments, shape pit 10262 can such as be arranged along inner periphery and/or excircle；Described inner periphery Radially-inwardly positioning relative to main circumference, described excircle is located radially outward relative to main circumference.In various embodiments, main Circumference can be limited by full diameter, and inner periphery can be limited by interior diameter, and excircle can be limited by overall diameter.At at least one this In class embodiment, interior diameter can be shorter than full diameter, and overall diameter can be longer than full diameter.

In various embodiments, as it has been described above, anvil block such as can move to make position from open position, in order to against nail Tissue thickness's compensating part in storehouse such as tissue thickness's compensating part 10020 compressed tissue.In all cases, compensate in tissue thickness Before part is relative to tissue positioned, tissue thickness's compensating part can be adjacent to the support section location of nail bin.In certain embodiments, group Knit thickness compensation part 10020 and can be at following location: in this position, before anvil block moves to its make position, tissue thickness Compensating part adjoins support section 10018.In some other embodiment, tissue thickness's compensating part 10020 can be at following location: In this position, gap is present between tissue thickness's compensating part 10020 and support section 10018.At least one this type of embodiment In, anvil block can make tissue and tissue thickness's compensating part 10020 to bottom offset, supports until tissue thickness's compensating part 10020 is adjacent Part 10018, wherein, anvil block is now moveable to its make position and produces compression in tissue.If to anvil block and nail The location of the tissue between storehouse feels dissatisfied, then surgeon can open anvil block, adjusts anvil block and the position of nail bin, and again Secondary Guan Bi anvil block.Owing to nail bin relative to this type of location of tissue and is reorientated, in all cases, tissue thickness's compensating part The far-end of 10020 can such as separate with support section 10010.In some such cases, tissue thickness's compensating part 10020 is remote End can contact tissue, and peel off from support section 10010 or roll relative to support section 10010.In various embodiments, as As further described below, nail bin can include tissue thickness's compensating part can releasably hold the supporting part below nail bin The one or more structures divided.

In various embodiments, referring now to Figure 26 5, nail bin 10300 can include support section 10310, by support section 10310 tissue thickness's compensating parts 10320 supported and include the far-end 10302 of nose 10303, this nose can will be organized The far-end 10325 of thickness compensation part 10320 releasably holds in place.In at least one embodiment, nose 10303 can include The slit 10305 of the far-end 10325 of tissue thickness's compensating part 10320 can be accommodated.In various embodiments, far-end 10325 can Compressed or be wedged in slit 10305 so that when nail bin 10300 is relative to tissue positioned, far-end 10325 just can be kept Position.In at least one this type of embodiment, slit 10305 along being parallel to or can be at least substantially parallel to support section 10310 The direction orientation of platform surface 10311.In various embodiments, slit 10305 can be level relative to platform surface 10311 's.In other embodiments various, referring now to Figure 26 6, nail bin 10400 can include support section, be supported by support section Tissue thickness's compensating part 10420 and include the far-end 10402 of nose 10403, this nose can be by tissue thickness's compensating part The far-end 10425 of 10420 releasably holds in place.In at least one embodiment, far-end 10425 can include extending from it Protuberance, and nose 10403 can include the vertical slit 10405 that can accommodate the protuberance of far-end 10425.In various enforcements In example, far-end 10425 and/or can be compressed or be wedged in slit 10405 from its protuberance extended so that work as nail bin 10400 relative to tissue positioned time, far-end 10425 can be held in place.In certain embodiments, tissue thickness's compensating part 10420 such as can include slit such as slit 10429, and this slit can accommodate at least some of of nose 10403 wherein.? In at least one embodiment, slit 10405 can be along the platform surface 10411 being perpendicular to or being at least substantially perpendicular to support section Direction is orientated.In various embodiments, referring now to Figure 26 7, nail bin 10500 can include support section, be supported by support section Tissue thickness's compensating part 10520 and include the far-end 10502 of nose, this nose can be by tissue thickness's compensating part 10520 Far-end 10525 releasably hold in place.In at least one embodiment, nose can include that can accommodate tissue thickness compensates The vertical slit 10505 of the far-end 10525 of part 10520.In various embodiments, far-end 10525 can be compressed or is wedged in narrow In groove 10505 so that when nail bin 10500 is relative to tissue positioned, far-end 10525 can be held in place.

In various embodiments, referring again to Figure 26 5, tissue thickness's compensating part 10320 can include top surface 10324, This top surface can be positioned in above the top surface 10304 of nose 10303.Figure 23 8 shows another exemplary enforcement Example, in this exemplary embodiment, the top surface of tissue thickness's compensating part is positioned in above the nose of nail bin, wherein organizes The top surface 10721 of thickness compensation part 10720 is such as positioned in above the top surface 10004 of nose 10003.Using In, referring again to Figure 26 5, tissue can slide on the top surface 10304 of nose 10303, and in some cases, group Knit can the far-end 10325 of contact tissue thickness compensation part 10320, and tissue thickness's compensating part 10320 can be exerted a force to, from And make tissue thickness's compensating part 10320 peel off from support section 10310.In the embodiments described herein, this peeling force can quilt In nose 10303, the part of the far-end 10325 of wedging is resisted.Under any circumstance, once organize relative to nail bin 13000 Appropriate location, anvil block can be rotated to make position with against support section 10310 compression tissue and tissue thickness's compensating part 10320.In at least one this type of embodiment, anvil block can be rotated to following location: in this position, anvil block contact nose The top surface 10304 of 10303, therefore can prevent anvil block from further rotating.In all cases, due to tissue thickness's compensating part The top surface 10324 of 10320 is positioned in above the top surface 10304 of nose 10303, when anvil block is just closed, and top Surface, portion 10324 can be pushed down towards support section 10310, and in some cases, top surface 10324 such as can quilt It is pushed to below the top surface 10304 of nose 10303.As described herein, the nail in being contained in nail bin 10300 is deployed And after tissue thickness's compensating part 10320 is cut, support section 10310 and nose 10303 are movable away from tissue thickness Compensating part 10320 so that the far-end 10325 of tissue thickness's compensating part 10320 can skid off slit 10305.

As it has been described above, anvil block such as anvil block 10060 such as can be rotated to make position, at this make position, anvil block The top nose surface 10004 of 10060 contact nail bin such as nail bins 10000.Once anvil block has arrived its make position, then organize The thickness compensation part amount that such as tissue thickness's compensating part 10020 is compressed will depend upon which tissue thickness's compensating part inter alia Uncompressed thickness or height and tissue thickness.Referring now to Figure 23 6 and Figure 23 7, tissue thickness's compensating part 10920 can wrap Include the top surface that the top surface 10004 with nose 10003 flushes or is at least substantially flush.In this type of embodiment, tissue The top surface of thickness compensation part 10920 can be pushed to below the top surface 10004 of nose 10003.Referring now to Figure 24 1, With Figure 24 2, tissue thickness's compensating part such as tissue thickness's compensating part 10820 such as can include top surface 10821.In tissue thickness Before degree compensating part 10820 is compressed by tissue T and anvil block 10060, this top surface is positioned in top nose surface 10004 times Side.As shown in Figure 23 9 and Figure 24 0, in the case of tissue T is relatively thin, tissue thickness's compensating part 10920 can suffer from relatively Less compression.Referring now to Figure 24 1 and Figure 24 2, when tissue T is relatively thick, tissue thickness's compensating part 10820 can suffer from Bigger compression.As shown in Figure 24 3 and Figure 24 4, in the case of tissue T has thin layer and relatively thick-layer simultaneously, tissue thickness is mended Repay part 10820 can work as compressed when it is positioned in below thicker tissue T relatively large, and when it is positioned under relatively thin tissue Less amount is compressed during face.As it has been described above, by this way, tissue thickness's compensating part can compensate for different tissue thicknesses.

In various embodiments, referring now to Figure 26 8-270, surgery suturing appliance can include 1) nail bin can be accommodated The storehouse passage 16670 of 16600, and 2) can pivotably be attached to the anvil block 16660 of storehouse passage 16670.Nail bin 16600 can include support section 16610 and tissue thickness's compensating part 16620, the wherein far-end of tissue thickness's compensating part 16620 16625 can be releasably held support section 16610 by the nose 16603 of the far-end 16602 of nail bin 16600.At least In one embodiment, nose 16603 can include slit 16605 and can be made up of flexible material.In use, referring first to figure 269, nose 16603 can bend downwards, in order to expands the opening of slit 16605.In certain embodiments, nose 16603 can wrap Including notch or cut out 16606, this notch or cut out can make nose 16603 bend downwards.Under any circumstance, in various situations Under, the opening of the expansion of slit 16605 can be conducive to the far-end 16625 of tissue thickness's compensating part 16620 is inserted slit 16605 In.Once tissue thickness's compensating part 16620 the most appropriately positions, and nose 16603 can be released, and due to composition nose 16603 The resilience force of material, nose 16603 can return to or be the most substantially back to its non-deflected, and at platform surface 16611 The far-end 16625 of upper capture tissue thickness compensation part 16620, as shown in graph 270.In use, similarly as described above, when propping up When support part divides 16610 to move away from the tissue sewed up, far-end 16625 can be pulled out slit 16605.In all cases, when When tissue thickness's compensating part 16620 separates with support section 16610, flexible nose 16603 can deflect.In various embodiments In, referring again to Figure 27 0, tissue thickness's compensating part 16620 can include that the top surface 16604 with nose 16603 aligns or extremely Few substantially aligned top surface 16621.

In various embodiments, seeing Figure 27 1, surgery suturing appliance can include 1) passage of nail bin 10700 can be accommodated 10770, and 2) anvil block 10760 of passage 10770 it is rotatably coupled to.Nail bin 10700 can include support section 10710 He Tissue thickness's compensating part 10720.In various embodiments, tissue thickness's compensating part 10720 can by nose set 10703 holding just Position, this nose set can slide on support section 10710.In at least one embodiment, referring first to Figure 27 2, nose set 10703 can include one or more sides slit 10707, and this one or more sides slit can accommodate removedly such as along supporting One or more attachments that part 10710 extends.In various embodiments, tissue thickness's compensating part 10720 can be positioned in In the middle of side slit 10707.In certain embodiments, nose set 10703 may also include far-end 10702 and is limited to far-end 10702 In cavity 10706, wherein cavity 10706 can also accommodate at least some of of such as support section 10710 wherein.Make In with, nose set 10703 can be distally to the direction slip of nearside on support section 10710.In various embodiments, tissue Thickness compensation part 10720 can be removably mountable to nose set 10703 so that has fired through tissue thickness's compensating part at nail After 10720, when support section 10710 and nose set 10703 move away from tissue thickness's compensating part 10720, tissue thickness is mended Repay part 10720 to separate with nose set 10703.In various embodiments, the top surface of tissue thickness's compensating part 10720 10721 can be positioned in below the top surface 10704 of nose 10703.

In various embodiments, referring now to Figure 27 3 and Figure 27 4, surgery suturing appliance can include 1) nail bin can be accommodated The staple cartridge channel 11070 of 11000, and 2) it is rotatably coupled to the anvil block 11060 of passage 11070.Nail bin 11000 can include Support section 11010 and tissue thickness's compensating part 11020.In various embodiments, tissue thickness's compensating part 11020 can be by from propping up One or more longitudinal rails 11019 that support part divides the platform 11011 of 11010 to extend are held in place.In at least one embodiment In, longitudinal rail 11019 can be embedded in tissue thickness's compensating part 11020.In certain embodiments, referring first to Figure 27 4, Tissue thickness's compensating part 11020 can include the longitudinal fluting 11029 that can accommodate longitudinal rail 11019.At at least one this type of In embodiment, the size of groove 11029 can be set to and can accommodate the guide rail 11019 of such as press-fit structure.To above Be described further, this class formation be prevented from or at least limit tissue thickness compensating part 11020 and support section 11010 it Between relative to lateral movement, and additionally, limit tissue thickness compensating part 11020 such as by prematurely from support section 11010 Release.In various embodiments, referring now to Figure 27 5, surgery suturing appliance can include 1) nail bin of nail bin 11100 can be accommodated Passage 11170, and 2) it is rotatably coupled to the anvil block 11160 of passage 11170.Nail bin 11100 can include support section 11110 and tissue thickness's compensating part 11120.In various embodiments, tissue thickness's compensating part 11120 can be by from support section Spike or one or more lengthwise rows of tusk 11119 that the platform 11111 of 11110 extends are held in place.At at least one In embodiment, the lengthwise rows 11119 of spike can be embedded in tissue thickness's compensating part 11120.

With reference to the embodiment shown in Figure 27 3.To being described further above, when nail is from being limited to nail chamber therein 10012 when being shot up, and tissue thickness's compensating part 11020 of nail bin 11000 gradually can be discharged from support section 11010.More Body ground, to being described further above, the nail being positioned in nail chamber 10012 can be at the near-end 11001 of nail bin 11000 and nail bin Being penetrated successively between the far-end 11002 of 11000 so that when nail is shot up, it is thick that bias force upwards is applied to tissue by nail Degree compensating part 11020, this bias force effect is to push away guide rail 11019 by tissue thickness's compensating part 11020.In such cases, When nail is shot up from recent side nail chamber 10012, the near-end 11006 of tissue thickness's compensating part 11020 can be from support section 11010 It is released.When nail is gradually penetrated from the support section 11010 between the near-end 11001 and far-end 11002 of nail bin 11000, Tissue thickness's compensating part 11020 gradually can be discharged from support section 11010 subsequently.In being positioned at farthest side nail chamber 10012 Nail when support section 11010 is shot up, the far-end 11007 of tissue thickness's compensating part 11020 can be from support section 11010 quilt Release.With reference to the embodiment shown in Figure 27 5, when nail is gradually penetrated from the nail bin between most advanced and sophisticated 11101 and far-end 11102, Tissue thickness's compensating part 11120 gradually can be discharged from the spike 1119 that self-supporting part 11110 extends.

As it has been described above, when nail is gradually penetrated also contact tissue thickness compensation part from support section, tissue thickness compensates Part gradually can be discharged from the support section of nail bin.In various embodiments, such as not by tissue thickness's compensating part from In the case of support part subrelease is put, the lower limb of nail such as follows closely lower limb 10032 can pass tissue thickness's compensating part.In this type of embodiment, Tissue thickness's compensating part can keep engaging with support section, until the base portion such as base portion 10031 contact tissue thickness compensation of nail Part by it upwardly.But in various embodiments, clamping plate and/or from support section extend other keep structures such as The release from support section of tissue thickness's compensating part can be hindered.In certain embodiments, as described in more detail below, support section Can include keep structure, when nail gradually fired from nail bin time, this holding structure can gradually by tissue thickness's compensating part from Support part subrelease is put.Referring now to Figure 28 3, nail bin such as nail bin 11200 such as can include support section 11210, this support section Including can be by tissue thickness compensating part 11220(Figure 28 4) releasably hold the holding structure of support section 11210 11213.In various embodiments, structure 11213 is kept can be positioned in the end in the most each nail chamber 11212, the most often Individual holding structure 11213 can include being limited to guide groove 11216 therein, and this guide groove can slidably receive nail The nail lower limb 10032 of 10030.In this type of embodiment, nail lower limb 10032 and holding structure 11213 can be by tissue thickness's compensating parts 11220 releasably hold support section 11210.In use, referring now to Figure 28 4, it is contained in support section 11210 Staple drivers 10040 can be driven up by sliding part 10050, as it has been described above, wherein staple drivers 10040 can contact holding Structure 11213, makes holding structure 11213 be at least partially separated with support section 11210, and make holding structure 11213 to Outer and away from nail 10030 and nail chamber 11212 displacement.When keeping structure 11213 to separate with support section 11210 and/or outside position During shifting, as shown in Figure 28 4, keep structure 11213 can be no longer able to tissue thickness's compensating part 11220 is remained to support section 11210, therefore, tissue thickness's compensating part 11220 can be released from support section 11210.Similarly as described above, work as nail 10030 such as from nail bin towards anvil block such as anvil block 11260 is gradually penetrated time, tissue thickness's compensating part 11220 can be from supporting part 11210 are divided gradually to be discharged.In various embodiments, when staple drivers 10040 top surface such as with support section 11210 Platform surface 11211 copline or at least substantially copline time, staple drivers 10040 can contact holding structure 11213.? In this type of embodiment, it is formed while it is fully formed or fires configuration completely and/or at nail 10030 quilts at nail 10030 Be formed as its be fully formed or completely percussion configuration before, tissue thickness's compensating part 11220 can discharge from support section 11210. In at least one this type of embodiment, referring first to Figure 28 5, driver 10040 can be overdriven so that it is pushed to put down So that nail 10030 is fully formed above platform surface 11211, and during the process being overdriven, make holding structure 11213 Depart from support section 11210.In various embodiments, refer again to Figure 28 4, keep structure 11213 separating or outside position May extend into before shifting or dangling to follows closely on chamber 11212 and enters in nail chamber so that just arrive flat when driver 10040 During platform surface 11211, driver 10040 can contact holding structure 11213.Under any circumstance, once tissue thickness's compensating part 11220 are released from support section 11210, and referring now to Figure 28 5, then support section 11210 is movable away from the group implanted Knit thickness compensation part 11220.

As it has been described above, when nail is fired from nail bin or disposes, the compressible tissue thickness compensating part of nail bin can be from nail Support section or the warehouse in storehouse are gradually discharged.In all cases, this type of release can include making tissue thickness's compensating part from propping up Support part is divided and is gradually unclamped, the most in some cases, until anvil block is opened and support section moves away from the tissue implanted Thickness compensation part, tissue thickness's compensating part is only possible to be kept completely separate with support section.In various embodiments, referring now to figure 289, nail bin such as nail bin 11300 such as can include the tissue thickness's compensating part releasably holding support section 11310 11320.In at least one embodiment, support section 11310 can include the multiple holding components 11313 extended from it, and these are many Tissue thickness's compensating part 11320 can be compressed and remain to support section 11310 by individual holding component releasedly.At least one In this type of embodiment individual, each holding component 11313 can include the longitudinal direction that can accommodate tissue thickness's compensating part 11320 wherein Side towards interior passage or slit 11316.In all cases, multiple holding components 11313 can be along support section 11310 First longitudinal side extends, and multiple holding component 11313 can extend along the longitudinal side of the second of support section 11310.Wherein, exist In some cases, keep component 11313 to be prevented from or at least limit tissue thickness's compensating part 11320 and support section 11310 Between relative to lateral movement, and prevent in addition or at least limit tissue thickness compensating part 11320 prematurely from support section 11310 releases.In various embodiments, holding component 11313 can be one-body molded with support section 11310, and at least one In individual embodiment, see Figure 29 0, keep component 11313 can separate with support section 11310 or be at least partially separate, in order to Tissue thickness's compensating part 11320 is made to separate with support section 11310, such as shown in Figure 29 1.In certain embodiments, anvil block Such as anvil block 11360 such as can compress tissue thickness's compensating part 11320, and in response in tissue thickness's compensating part 11320 The pressure produced, tissue thickness's compensating part 11320 can lateral extension to making holding component 11313 and tissue thickness's compensating part 11320 are at least partially separated or depart from.In various embodiments, as it has been described above, advance cutter component through anvil block 11360 and nail Storehouse 11300 can be disposed and be accommodated in nail therein, and extruding anvil block 11360 and nail bin 11300 make it closer to each other simultaneously, The compression stress of increase can be applied to tissue thickness's compensating part 11320 by this, thus makes holding when cutter component is through nail bin 11300 Component 11313 separates successively.

In various embodiments, referring now to Figure 29 2-294, nail bin such as nail bin 11400 such as can include removedly It is attached to tissue thickness's compensating part 11420 of support section 11410.In at least one embodiment, nail bin 11400 can include energy Enough one or more keeper bars 11413 that longitudinal side of tissue thickness's compensating part 11420 is remained to platform surface 11411. In at least one this type of embodiment, each keeper bar 11413 can include opposing arms 11418, and this opposing arms limits therebetween Passage 11416.In this type of embodiment, one in arm 11418 can extend on tissue thickness's compensating part 11420, and And another arm 11418 can extend to below the antelabium 11419 that support section 11410 extends.Referring first to Figure 29 2, often The size of the passage 11416 of individual keeper bar 11413 can be set to and compression stress can be applied before using nail bin 11400 Longitudinal side to tissue thickness's compensating part 11420.During use, referring first to Figure 29 3, nail bin 11400 can be positioned in nail In the passage of storehouse, and once nail bin 11400 the most appropriately positions, and anvil block such as anvil block 11460 is such as moveable to its compressible group Knit in the position of thickness compensation part 11420.Similarly as described above, when pressurised, tissue thickness's compensating part 11420 can be lateral Or flex outward, and keeper bar 11413 is therefore made to separate with nail bin 11400.In some other embodiment, anvil block 11460 Guan Bi keeper bar 11413 can be made not separate with nail bin or not be kept completely separate with nail bin.In at least one this type of embodiment, As it has been described above, advance trigger shaft can dispose nail 10030 from support section 11410 through nail bin 11400, and extrude anvil block simultaneously 11460 and nail bin 11400 make it closer to each other, in order to apply compressive force to tissue thickness's compensating part 11420, this compression stress Be enough to make tissue thickness's compensating part 11420 lateral extension, and make keeper bar 11413 separate with nail bin 11400.Once keep Device bar 11413 separates with nail bin 11400, sees Figure 29 4, and support section 11410 is movable to be mended away from the tissue thickness implanted Repay part 11420 and remove from operative site.In some alternative embodiment, referring now to Figure 29 5, nail bin 11400 ' can Including keeper bar 11413 ', this keeper bar arm 11418 ' including extending from it similarly as described above.At least one In this type of embodiment individual, keeper bar 11413 ' can be latchable to nail bin by every each and every one can including in arm 11418 ' releasedly The wedge of 11400 '-lock inclined-plane 11417 '.More specifically, at least one embodiment, the support section of nail bin 11400 ' 11410 ' can include undercuting 11419 ', and this undercutting cooperates with wedge-lock inclined-plane 11417 ', it is possible to by releasable for keeper bar 11413 ' Remain to nail bin 11400, and suppress tissue thickness's compensating part 11420 to separate with support section 11410 ' prematurely.Using Therebetween, similarly as described above, when enough compression stresses are applied to tissue thickness's compensating part 11420, keeper bar 11413 ' can separate with nail bin 11400 '.

In all cases, as mentioned above and refer again to Figure 25 9 and Figure 26 0, sliding part 10050 He of nail bin 10000 The firing member 10052 of surgery suturing appliance can move to the far-end 10002 of nail bin 10000 from the near-end 10001 of nail bin 10000 (Figure 21 9), in order to dispose nail 10030 from support section 10010.At at least one in the case of this type of, each nail 10030 can be never Firing position moves to firing position, and from support section 10010 penetrate be positioned anvil block 10060 and nail bin 10000 it Between tissue capture whole tissue thickness compensating part 10020.In some cases, surgeon is perhaps without from nail bin Fire all nails 10030 in 10000, and surgeon may make the advance of sliding part 10050 and trigger shaft 10052 be blocked At point in the middle of the near-end 10001 being positioned at nail bin 10000 and far-end 10002.In such cases, tissue thickness's compensating part 10020 can be only by part implanting tissue T, in order to make non-implant part and the support section of tissue thickness's compensating part 10020 10010 separate.Tissue thickness's compensating part 10020 tractive that support section 10010 can be implanted by surgeon away from part so that Non-implant part is peeled off from support section 10010 or comes off.Although this type of embodiment is suitable to various situation, Figure 30 0-302 illustrates Improving, wherein such as can include can be each other for tissue thickness's compensating part 11520 of tissue thickness's compensating part such as nail bin 11500 The multiple junction fragments separated.In at least one this type of embodiment, tissue thickness's compensating part 11520 can include first or nearest Lateral plate section 11520a, it is removably connected to the second fragment 11520b of the first fragment 11520a, is removably connected to second 3rd fragment 11520c of fragment 11520b, it is removably connected to the 4th fragment 11520d of the 3rd fragment 11520c and can move It is connected to the 5th fragment 11520e of the 4th fragment 11520d with removing.In various embodiments, tissue thickness's compensating part 11520 can Predetermined breakdown point or burble point can be limited extremely in the middle of any two adjacent segment 11520a-11520e including being positioned at A few thin layer 11529, tissue thickness's compensating part fragment can be separated from one another at this breakdown point or burble point.In some embodiment In, tissue thickness's compensating part can include any suitable perforation, thin layer and/or divide for producing in tissue thickness's compensating part Any other device from point.Referring first to Figure 30 1, anvil block 11560 is shown in make position, and firing member 10052 It is shown as and is partly advanced through nail bin 11500 so that the first fragment 11520a, the second fragment 11520b and the 3rd fragment Nail 10030 below 11520c is fired to capture tissue thickness compensation part 11520 in tissue T.At this position, firing member 10052 are not also pushed into dispose the nail 10030 below the such as the 4th fragment 11520d and the 5th fragment 11520e.Referring now to Figure 30 2, anvil block 11560 has been moved to open position, and the support section 11510 of nail bin 11500 has moved away from tissue thickness The implant part of degree compensating part 11520.As shown in Figure 30 2, it is positioned in the middle of the 3rd fragment 11520c and the 4th fragment 11520d Thin layer 11529(Figure 30 0) the non-implant part of Yi Shi tissue thickness compensating part 11520 separates with implant part.

In various embodiments, to being described further above, nail bin can include multiple securing member, the plurality of securing member Tissue thickness's compensating part can be releasably held the support section of nail bin.In certain embodiments, support section can wrap Including the multiple holes being such as limited in platform surface, wherein securing member can extend across tissue thickness's compensating part and can be able to be released It is maintained at putting in support section hole.In use, when nail is gradually penetrated from support section, securing member can be from support section Gradually discharged.In at least one this type of embodiment, securing member can be implanted with tissue thickness's compensating part, and extremely In a few embodiment, securing member can be such as made up of at least one bioabsorbable material.In certain embodiments, in group Knit after thickness compensation part at least partly implanted, and when support section moves away from tissue thickness's compensating part of implanting 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 Such as can include the tissue thickness's compensating part being releasably attached to support section 11610 by multiple securing members 11613 11620.In each securing member 11613 can include embedding tissue thickness compensating part 11620 and/or with tissue thickness's compensating part The second end 11618 that engages with support section 11610 of first ends 11618 that 11620 engage and by first end 11618 adapters 11616 being connected to the second end 11618.In each middle embodiment, securing member 11613 can extend across limit The cutter slit 11615 being scheduled in support section 11610.In use, as it has been described above, firing member 10052 can make blade move Through the cutter slit 11615 in support section 11610 and cut securing member 11613, in order to from support section 11610 release group Knit thickness compensation part 11620.In at least one this type of embodiment, trigger shaft 10052 can be from the near-end 11601 of nail bin 11600 It is advanced to the far-end 11602 of nail bin 11600, in order to 1) as mentioned above sliding part 10050 is advanced towards distally and gradually fire Nail 10030, and 2) gradually cut securing member 11613 and/or make securing member 11613 rupture with from support section 11610 gradually Release tissue thickness compensating part 11620.In certain embodiments, similarly as described above, tissue thickness's compensating part 11620 can wrap Including multiple separable fragment 11620a-11620e, the plurality of separable fragment such as can be each via one or more securing members 11613 remain to support section 11610.As shown in Figure 32 4, if firing member 10052 is barred from the near-end of nail bin 11600 11601 and far-end 11602 in the middle of, after anvil block 11660 is opened and support section 11610 moves away from tissue T, as figure Shown in 325, securing member 11613 can help to the non-implant part of tissue thickness's compensating part 11620 is remained to support section 11610.In various embodiments, to being described further above, the cutting blade 10053 of firing member 10052 can cut tightly Firmware 11613 and/or make securing member 11613 rupture.In some alternative embodiment, referring now to Figure 32 7 and figure 328, sliding part such as sliding part 11650 disposed by nail such as can include blade 11653, when sliding part 11650 traverses nail bin 11600 Time, this blade can cut the adapter 11616 of securing member 11613.In at least one this type of embodiment, each adapter The cylindrical member extended between the 11616 T-shaped ends 11618 that may be included in securing member 11613, wherein blade 11653 can wrap Including concave profile 11653, this concave profile such as can accommodate cylinder shape connector 11616.

As it has been described above, nail bin can be loaded onto in the staple cartridge channel of surgery suturing appliance.In all cases, surgeon Or other clinicians can be by being applied to downward power on nail bin insert nail bin in staple cartridge channel lock nail bin In place.At some in the case of this type of, its thumb such as can be placed on the top surface of nail bin and apply this type of by clinician Downward power.In various embodiments, the top surface of nail bin can include the top surface of tissue thickness's compensating part, wherein, as Upper described, tissue thickness's compensating part can be compressible, and in certain embodiments, be applied to tissue thickness's compensating part to Under power tissue thickness's compensating part can be made to be compressed to following point: at this point, the thumb of clinician be stored in support section In nail end contact.In various embodiments, nail bin is inserted in staple cartridge channel by available nail bin application device, this nail bin Application device is prevented from or at least limits clinician touching the probability of the nail in nail bin.It is properly oriented at nail bin After in staple cartridge channel, 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 such as include could attach to nail The rigid cap in storehouse 10000 such as covers 10080.To being described further above, when nail bin 10000 is inserted in staple cartridge channel Time, lid 10080 can such as prevent or at least suppress the nail 10030 that the thumb contact of clinician is positioned in nail bin 10000 End.Referring now to Figure 30 7 and Figure 30 8, lid 10080 may extend into the top surface 10021 of tissue thickness's compensating part 10020 Or top surface 10021 at least some of on, and 1 can be included) may extend on tissue thickness's compensating part 10020 And/or the lower surface 10081 of subjacent tissue's thickness compensation part 10020, and 2) can be clinician provide pressing surface with The top surface 10082 of downward power is applied to it.In use, clinician can grasp the handle portions of lid 10080 10084, the support section 10010 of nail bin 10000 is alignd with staple cartridge channel, and at least in part nail bin 10000 is inserted nail In the passage of storehouse.Then, clinician can make nail bin 10000 by applying downward power to the top surface 10082 of lid 10880 Rest upon completely in staple cartridge channel.In various embodiments, this downward power can be directly transferred to support section 10010.? In at least one this type of embodiment, lid 10080 can include proximal supports 10087, and this support member can downwardly extend and contact and prop up The platform surface 10011 that support part is divided.In certain embodiments, lid 10080 may also include and can adjoin the distally of nose 10003 and prop up Support part divides 10083.When to lid 10080 applying downward power, this downward power can be by proximal supports 10087 and/or remote Side support section 10083 is passed, without or at least substantially will not be by this downward power by tissue thickness's compensating part 10020 are delivered to support section 10010.In all cases, due to mentioned above, it is thick that clinician can be not directly contacted with tissue Degree compensating part 10020.Due also to mentioned above, when nail bin 10000 is inserted in staple cartridge channel, lid 10080 can not compress or The most do not compress tissue thickness's compensating part 10020.In various embodiments, lid can include any appropriate number of support Part, downward power can be delivered to support section by this support member, without or at least substantially will not be mended by tissue thickness Repay part and transmit this downward power.In certain embodiments, support member may extend into the near-end of tissue thickness's compensating part, far-end and/ Or around longitudinal direction side.In certain embodiments, support member can extend across tissue thickness's compensating part.At at least one, this type of is real Executing in example, support member can extend across the hole in tissue thickness's compensating part the platform of adjacent support section.In some embodiment In, at least some support member can not contact platform before downward power is applied to lid；On the contrary, in various embodiments, lid Can bend, or move downward until support member contacts the platform of support section.Now, can stop or at least substantially stop lid Downward flexure or motion further flexure.

As it has been described above, lid 10080 could attach to nail bin 10000 and can be used for regulating and controlling the position of nail bin 10000.In various realities Executing in example, lid 10080 can include any appropriate number of clamping components, and this clamping components such as can be releasable by covering 10080 Remain to the support section 10010 of nail bin 10000.In at least one this type of embodiment, lid 10080 such as may also include one Individual or multiple holding components, such as hammerlock 10088 and/or 10089.In various embodiments, hammerlock 10089 can extend to nose The side periphery in portion 10003 also engages lower surface 10009(Figure 30 6 of nose 10003).Similarly, hammerlock 10088 is extensible To the side periphery of lock protuberance 10008, this lock protuberance extends from support section 10010 and engages lock protuberance 10008 Lower surface.In various embodiments, lid can 10080 be positioned on following district or region by these hammerlocks: in this district or In region, nail is stored in support section 10010.Under any circumstance, once nail bin 10000 is properly oriented, lid 10080 can separate with nail bin 10000.In at least one embodiment, clinician can apply lifting upwards to shank 10084 Power, in order to the far-end of lid 10080 is separated with the far-end 10002 of nail bin 10000.In at least one this type of embodiment, at handle When portion 10084 is lifted up, hammerlock 10088 and 10089 can flex outward so that hammerlock 10088 and 10089 can respectively around Lock protuberance 10008 and nose 10003 bend.Then, the near-end of lid 10080 can be subsequently lifted the near-end 10001 of nail bin, and covers 10080 is movable away from nail bin 10000.

In certain embodiments, referring now to Figure 30 9 and Figure 31 0, except nail bin such as nail bin 10600 is such as positioned at Outside in staple cartridge channel, thickness compensation such as can also be organized in top by nail bin application device such as nail bin application device 10680 Part such as tissue thickness's compensating part 10690 such as positions relative to anvil block.Similarly as described above, application device 10680 can wrap Including the hammerlock 10688 can being releasably engaged with lock protuberance 10608, this lock protuberance is from the support section of nail bin 10600 10610 extend so that application device can be maintained at the position on tissue thickness's compensating part 10620 of nail bin 10600.? In various embodiments, top tissue thickness compensation part 10690 can be removably attached to nail bin application device 10680 so that The anvil block of surgical instruments such as anvil block 10060 such as can close on application device 10680, engages tissue thickness's compensating part 10690, and make tissue thickness's compensating part 10690 separate with application device 10680.In various embodiments, tissue thickness compensates Part 10690 and/or anvil block 10060 can include one or more holding structure, and this holding structure can be by tissue thickness's compensating part 10690 releasably hold anvil block 10060.In at least one this type of embodiment, tissue thickness's compensating part 10690 can include The longitudinal rail 10695 such as extended from the top surface 10691 of tissue thickness's compensating part 10690, this longitudinal rail can be held It is contained in the longitudinal knife slit 10065 being limited in anvil block 10060.In various embodiments, tissue thickness's compensating part 10690 He Longitudinal rail 10695 can be such as made up of any suitable compressible material, is such as described in those in this patent application, its Middle longitudinal rail 10695 such as can be compressed and/or be wedged in cutter slit 10065.Once anvil block 10060 with tissue thickness Compensating part 10690 engages, then anvil block 10060 can return to open position, and in such cases, tissue thickness's compensating part 10690 can separate with application device 10680.Then, application device 10680 can separate with nail bin 10600 so that anvil block 10060 Can be relative to the tissue positioned that will be sewn and/or cut with nail bin 10600.In use, nail deployment sliding part such as slides Part 10050(Figure 23 6) such as can be by firing member 10052(Figure 23 6) it is advanced through nail bin 10600 towards distally, such as so that will Nail penetrates from nail bin 10060, as mentioned above.Due to nail deformation, the most each nail can be thick at the top surface capture tissue of tissue A part for degree compensating part 10690, and a part for the lower surface capture tissue thickness compensation part 10620 at tissue.With Time, firing member 10052 can advance blade 10053(Figure 23 6) mend through tissue thickness's compensating part 10620 and/or tissue thickness Repay part 10690.The most at least one embodiment, blade 10053 can be pushed into by longitudinal rail 10695, in order to cutting Guide rail 10695 and make tissue thickness's compensating part 10690 be gradually disengaged with anvil block 10060.After nail is deployed, anvil block The 10060 tissue thickness's compensating parts 10690 that can be opened again and move away from implantation, and similarly, propping up of nail bin 10600 10610 movable tissue thickness's compensating parts 10620 away from implantation are divided in support part.In various embodiments, to entering one above Step describes, and tissue thickness's compensating part 10620 and/or tissue thickness's compensating part 10690 can include multiple separable fragment.If only When the part of tissue thickness's compensating part 10620 and 10690 is implanted by nail, separable fragment can be separated from one another.

In various embodiments, to being described further above, application device 10680 can include can be by tissue thickness Compensating part 10690 releasably holds one or more holding structures of application device 10680.At at least one, this type of is implemented In example, referring first to Figure 31 0, application device 10680 can include being accommodated in the longitudinal direction guarantor longitudinally kept in slit 10694 Holding guide rail 10685, this longitudinal direction keeps slit to be limited at the lower surface of tissue thickness's compensating part 10690 with press-fit In 10692.In all cases, keep guide rail 10685 and keep slit 10694 to be protected by tissue thickness's compensating part 10690 Hold application device 10680, until applying enough liftings upwards by anvil block 10060 to tissue thickness's compensating part 10690 Power, as mentioned above.In at least one this type of embodiment, the holding guide rail 10685 extended from application device 10680 may also include Being positioned within the end stop 10686 proximally and distally of guide rail 10685, this end stop is prevented from or at least Limit the relative longitudinal motion between tissue thickness's compensating part 10690 and application device 10680.In certain embodiments, again Seeing Figure 31 0, one or more binding agents such as longitudinal adhesive tape 10693 such as can be placed in tissue thickness's compensating part 10690 Contact surface 10691 on so that when anvil block 10060 contact tissue thickness compensation part 10690, as it has been described above, binding agent energy Enough tissue thickness's compensating part 10690 is releasably attached to anvil block 10060.In various embodiments, except above-mentioned compressible Holding structure outer or replace above-mentioned compressible holding structure, such as can use one or more binding agents.Implement at some In example, can use one or more binding agents that tissue thickness's compensating part is releasably held nail bin application device.At least In one embodiment, referring now to Figure 31 0A, lid 10080 such as can include one or more adhesive pad 12185, this or many Top can be organized thickness compensation part such as tissue thickness's compensating part 12190 such as to releasably hold lid by individual adhesive pad The top surface 10082 of 10080.In at least one this type of embodiment, being similar to above-described embodiment, anvil block can be in tissue thickness The longitudinal direction being closed to engage tissue thickness's compensating part 12190 on compensating part 12190 keeps guide rail 12195.In some embodiment In, relieving mechanism can be positioned in the middle of tissue thickness's compensating part 12190 and lid 10080.This relieving mechanism can be used for breaking by Tissue thickness's compensating part 12190 remains to cover the bonding of 10080, and makes tissue thickness's compensating part 12190 and 10080 points of lid From.In at least one embodiment, relieving mechanism can include pull tab 12196 and the collar 12197, and wherein the collar 12197 can include It is attached to first end and the second end of pull tab 12196.The collar 12197 can such as include stitching thread, and this stitching thread can limit Defining the periphery of adhesive pad 12185 so that when pull tab 12196 is pulled towards distally, stitching thread can be at tissue thickness's compensating part Slide and contact tissue pad 12185 between 12190 and lid 10080.In such cases, stitching thread such as can complete following functions In at least one: make adhesive pad 12185 separate with tissue thickness compensating part 12190；Make adhesive pad 12185 and 10080 points of lid From；And/or cut off adhesive pad 12185.

In various embodiments, referring now to Figure 31 1, nail bin can such as include support section 10710.It is similar to institute above Stating, this support section can include the longitudinal knife slit 10715 running through extension.In at least one this type of embodiment, nail bin is used Device such as application device 10780 such as can include longitudinally keeping and alignment member 10786, and this longitudinal direction keeps and alignment member is prolonged Reach in the cutter slit 10715 in support section 10710.In certain embodiments, holding component 10786 such as can be to be press-fitted Mode engages the sidewall of cutter slit 10715 so that application device 10780 can be releasably retained support section 10710. In various embodiments, although not shown, the Part I of tissue thickness's compensating part can be positioned in and keep the of component 10786 On side, and the Part II of tissue thickness's compensating part can be positioned in and keep the relative of component 10786 or on the second side. Similarly as described above, the Part I of tissue thickness's compensating part and Part II such as can be pacified by keeping component 10013 Install to the support section 10710 of nail bin.Being also similar to mentioned above, top tissue thickness compensation part 10790 can be by from executing Component 10785 is kept to be removably attachable to application device by the longitudinal direction loading surface 10782 extension of device 10780 10780.Wherein keep component 10785 such as can be press-fitted into the end being limited to tissue thickness's compensating part 10790 releasedly In longitudinal slit 10794 in surface, portion 10792.In various embodiments, it is also similar to mentioned above, tissue thickness's compensating part 10790 may also include the longitudinal direction extended from the top surface 10791 of tissue thickness's compensating part 10790 keeps component 10795, and this is indulged In the longitudinal knife slit 10065 keeping component can be releasably retained in being defined in anvil block 10060.At at least one In this type of embodiment, longitudinally keeping component 10795 can include wedge-shaped cross-section, this wedge-shaped cross-section includes the top more than bottom Portion, wherein bottom such as can be attached to tissue thickness's compensating part 10790 by keeping component 10795.

In various embodiments, referring now to Figure 31 2 and Figure 31 3, including support section 10810 and tissue thickness's compensating part The nail bin 10800 of 10820 such as can be loaded onto in staple cartridge channel with nail bin application device 10880.Similarly as described above, nail Top such as can also be organized thickness compensation part 10890 fixed relative to anvil block such as anvil block 10060 by storehouse application device 10880 Position so that when anvil block 10060 closes, anvil block 10060 can contact and engage tissue thickness's compensating part 10890.At at least one In embodiment, tissue thickness's compensating part 10890 can include top surface 10891 extension from tissue thickness's compensating part 10890 Multiple holding lower limbs 10895, this holding lower limb can engage anvil block 10060 and be releasably held by tissue thickness's compensating part 10890 To anvil block 10060.In at least one this type of embodiment, lower limb 10895 can be arranged to longitudinal row, and the most each lower limb 10895 can Including at least one foot, this foot can enter and engage the cutter slit 10065 being limited in anvil block 10060.Implement at some In example, some feet of lower limb 10895 can extend in one direction, and other feet can extend along another direction.Real at least one Executing in example, some feet can extend along relative direction.Under any circumstance, once anvil block 10060 with tissue thickness's compensating part 10890 engage, and referring now to Figure 31 3 and Figure 31 4, anvil block 10060 can be opened again, and nail bin can be used by clinician Device 10880 moves apart tissue thickness's compensating part 10820 and 10890.Then, Figure 31 4A, top tissue thickness compensation part are seen 10890 the first sides that can be positioned in target tissue, and tissue thickness's compensating part of bottom tissue thickness compensating part can be included 10820 can be positioned on the second side of tissue.After tissue thickness's compensating part 10820 and 10890 is properly oriented, now Seeing Figure 31 4B, the blade of firing member such as blade 10053 such as can be advanced through tissue and tissue thickness's compensating part.? In various embodiments, referring now to Figure 31 8, nail bin application device such as application device 12280 such as can include pacifying separably Install to its tissue thickness's compensating part 12290.As shown in Figure 31 9, when anvil block 10060 moves to make position, this tissue is thick Degree compensating part can be similar to mentioned above be inserted in staple cartridge channel and engaged by anvil block 10060.At at least one, this type of is implemented In example, tissue thickness's compensating part 12290 can include from the top surface 12291 of tissue thickness's compensating part 12290 upwardly extending Multiple holding components 12295.The most each holding component 12295 can include multiple flexible leg 12296, and the plurality of flexible leg can Insert in the cutter slit 10065 in anvil block 10060.Referring first to Figure 32 1 and Figure 32 2, the flexible leg of each holding component 12295 12296 can be separated by gap 12298 so that when lower limb 12296 inserts in cutter slit 10065, lower limb 12296 can inward deflection, and And the foot of the once expansion of flexible leg 12296 is through cutter slit 10065, then lower limb 12296 springs back outward into subsequently.In various enforcements In example, the foot of the expansion of flexible leg 12296 can be scratched below at the relative holding antelabium 12297 in being defined to anvil block 10060 Song, and due to lower limb 12296 and the interaction of antelabium 12297, tissue thickness's compensating part 12290 can be held anvil block 10060.Then, nail bin application device 12280 is movable away from tissue thickness's compensating part 12290, as shown in Figure 32 0.Using In, once tissue thickness's compensating part 12290 is implanted to tissue by the nail disposed from nail bin 10000 the most, then anvil block 10060 can be opened again, and when anvil block 10060 moves away from tissue thickness's compensating part 12290 of implantation, keep component The lower limb 12296 of 12995 can inward deflection so that it can be pulled out from cutter slit 10065.

In various embodiments, referring now to Figure 31 5 and Figure 31 6, tissue thickness's compensating part such as tissue thickness's compensating part 11990 such as can be by longitudinal load to anvil block such as anvil block 11960.More specifically, at least one embodiment, tissue thickness Degree compensating part 11990 can include one or more longitudinal rail 11995, and these one or more longitudinal rails can be inserted into anvil block In distal openings in the cutter slit 11965 of 11960, and promote towards distally subsequently, until tissue thickness's compensating part 11990 is the most proper Locality rests upon in anvil block 11960.In at least one this type of embodiment, each guide rail 11995 can include being positioned in vertical Keeping foot 11996 to the longitudinal direction kept after antelabium 11997, this longitudinally keeps antelabium the most partially defined cutter slit 11965.As shown in Figure 31 6, foot 11996 can extend along relative direction, in order to is positioned in after holding antelabium 11997, This holding antelabium is positioned on the opposite side of cutter slit 11965.In various embodiments, axial clearance 11998 can be defined Between guide rail 11995, when tissue thickness's compensating part 11990 separates with anvil block 11960, this axial clearance can make guide rail 11995 inward deflection toward each other.In certain embodiments, referring now to Figure 31 7, tissue thickness's compensating part such as tissue thickness Compensating part 12090 such as can include the one or more hammerlocks 12098 extending to the side periphery of anvil block such as anvil block 12060. In use, the engageable anvil block of hammerlock 12,098 12060 tissue thickness's compensating part 12090 is releasably held anvil block 12060.In at least one this type of embodiment, anvil block 12060 such as can include one or more recess or lock shoulder 12097, should One or more recesses or lock shoulder each can accommodate the foot extended from hammerlock 12098.In use, when tissue thickness's compensating part After 12090 are at least partly implanted, arm 12098 can flex outward, and when anvil block 12060 move away from tissue thickness mend Separate with anvil block 12060 when repaying part 12090.

As it has been described above, surgery suturing appliance can include can accommodating the staple cartridge channel of nail bin, being rotationally coupled to nail bin The anvil block of passage and include the firing member of blade, this firing member can move relative to anvil block and staple cartridge channel.Using In, nail bin can be positioned in staple cartridge channel, and after nail bin is consumed at least in part, nail bin can remove from staple cartridge channel And replaced by new nail bin.In some these type of embodiments, the staple cartridge channel of surgery suturing appliance, anvil block and/or firing member Can be reused together with replacing nail bin.In some other embodiment, nail bin can include the disposable loading unit group of part Part, this disposable loading unit assembly such as can include staple cartridge channel, anvil block and/or firing member, and these can be with nail bin It is replaced, as the part replacing disposable loading unit assembly.Some disposable loading unit assembly is disclosed in 2008 2 Entitled " the END EFECTOR COUPLING ARRANGMENTS FOR A SURGICAL CUTTING that the moon 15 was submitted to AND STAPLING INSTRUMENT " U.S. Patent Application Serial Number 12/031, in 817, the entire disclosure of this patent application Content is incorporated by reference herein.Referring now to Figure 37 0, disposable loading unit such as disposable loading unit 12500 example As support section 12510 can be included, be rotationally coupled to the anvil block 12560 of support section 12510 and from support section 12510 slender axles 12570 extended.Being similar to nail bin as herein described, support section 12510 can include multiple nail chamber 10012 And nail, such as it is positioned at the nail 10030 in each nail chamber 10012.Disposable loading unit 12500 may also include firing member 12552, this firing member can be advanced to towards distally from open position, anvil block 12560 be moved to make position, such as Figure 37 0 Shown in.In various embodiments, disposable loading unit 12500 may also include and is positioned on support section 12510 and/or is attached Tissue thickness's compensating part 12520 to support section 12510.Wherein, when anvil block 12560 is in its make position, anvil block 12560 opposites that can be positioned in tissue thickness's compensating part 12520, and in certain embodiments, when anvil block 12560 is in it During make position, anvil block 12560 can compress tissue thickness's compensating part 12520 at least in part.In either case, percussion structure Part 12552 can be further promoted, in order to is penetrated from support section 12510 by nail.After nail is shot up, nail can pass through anvil block 12560 deformation, and capture at least some of of tissue thickness therein compensating part 12520.Then, firing member 12552 can court Proximal retraction, anvil block 12560 can be opened again, and support section 12510 is movable away from the tissue thickness's compensation implanted Part 12520.

In various embodiments, can be pacified separably being described further tissue thickness's compensating part 12520 above Install to support section 12510.In at least one this type of embodiment, support section 12510 can include being installed to each of which side Longitudinally keeping guide rail 12526, the most each guide rail 12526 can include one or more hole 12528, and these one or more holes can Accommodate at least some of of tissue thickness's compensating part 12520 wherein.Once tissue thickness's compensating part 12520 is the most at least by part Implant, then tissue thickness's compensating part 12520 can be drawn out from hole 12528 when support section 12510 is displaced from.Various realities Executing in example, referring now to Figure 37 1-373, disposable loading unit 12600 can include support section 12610, be separately mounted To tissue thickness's compensating part 12620 and one or more holding guide rail 12626 of support section 12610, these one or more guarantors Hold guide rail to can extend to below tissue thickness's compensating part 12620, and tissue thickness's compensating part 12620 is installed to supporting part Divide 12610.Each holding guide rail 12626 such as can include multiple retaining hook 12628, and the plurality of retaining hook can be by such as limiting Holding slit 12614 in support section 12610 is joined to support section 12610.In use, at least one, this type of is real Execute in example, when tissue thickness's compensating part 12620 at least partly implanted and support section 12610 move away from tissue thickness mend After repaying part 12620, tissue thickness's compensating part 12620 can separate with keeping guide rail 12626.In various embodiments, now Seeing Figure 37 4-376, disposable loading unit 12700 can include one or more holding guide rail 12726, these one or more guarantors Hold guide rail can each include the bottom bar 12725 that may extend into below tissue thickness's compensating part 12720 and extend to tissue thickness Push rod 12727 on the top surface 12621 of compensating part 12620.In certain embodiments, tissue thickness's compensating part 12620 At least can be partially compressed between push rod 12727 and bottom bar 12725 so that holding guide rail 12726 can be relative to support section 12610 keep tissue thickness's compensating part 12620.In at least one this type of embodiment, each holding guide rail 12726 can include one Individual or multiple retaining hooks 12728, these one or more retaining hooks can engage with support section 12610 to keep guide rail 12726 Remain to support section 12610.

In various embodiments, referring now to Figure 37 7 and Figure 37 8, disposable loading unit 12800 can include keeping component 12822, tissue thickness's compensating part 12620 can be installed to support section 12610 by this holding component.At at least one, this type of is real Execute in example, keep component 12822 can include the material piece being positioned on the platform surface 12611 of support section, wherein organize thickness Degree compensating part 12620 such as can be attached to material piece by least one binding agent.Component 12822 is kept to may also include longitudinal guarantor Holding guide rail 12825, this longitudinal direction keeps guide rail can extend downwardly in the cutter slit 12615 being limited in support section 12610. In at least one this type of embodiment, keep the size of guide rail 12825 can be set to and be configured so that it is at cutter slit Compressed between the sidewall of 12615.In use, firing member 12552 can include blade, at firing member 12552 towards distally Being pushed into and longitudinal cutting tissue thickness compensating part 12620 is with when keeping guide rail 12825, this blade may pass through cutter slit 12615. It addition, in use, from the nail of support section 12610 injection can penetrate holding component 12822, tissue thickness's compensating part 12820, And it is positioned at the tissue between tissue thickness's compensating part 12820 and anvil block 12560.In various embodiments, component is kept 12822 can be made up of biocompatibility and/or bioabsorbable material.In certain embodiments, keep the component 12822 can be by Can constitute, to include tissue thickness's compensating part 12620 tissue below thickness compensation part by compressed sufficiently material.In various enforcements In example, referring now to Figure 37 9-381, disposable loading unit 12900 can include charging assembly, and this charging assembly includes can Be attached to support section 12610 bottom 12922 with removing, the top 12990 that anvil block 12560 can be removably attached to, And bottom connecting 12922 and the flexible joint 12991 at top 12990.Similarly as described above, longitudinally keep guide rail 12825 Can extend downwardly in the cutter slit 12615 being limited to support section 12610 from bottom 12922 so that bottom 12922 can quilt Releasably hold support section 12610.Similarly, guide rail 12995 is longitudinally kept can to extend up to limit from top 12990 It is scheduled in the cutter slit in anvil block 12560 so that top 12990 can be releasably retained anvil block 12560.Such as Figure 38 0 He Shown in Figure 38 1, tissue thickness's compensating part 12620 can be installed to the bottom 12922 of charging assembly, wherein, in order to relative to propping up 12610 position tissue thickness compensation parts 12620 are divided in support part, and clinician can make top 12990 and bottom 12922 towards each other scratch Song, is positioned at charging assembly between anvil block 12560 and support section 12610, and discharges the charging assembly of flexure so that add Carry assembly and can come elastic stretch and biasing top 12990 against anvil block 12560, and carry out elastic stretch against support section 12610 With bottom biasing 12922.In at least one embodiment, referring now to Figure 38 2-384, charging assembly may also include such as from it One or more latch hooks such as latch hook 12994 extended, top 12990 can be releasably connected to anvil block by this latch hook 12560, and/or bottom 12922 is releasably connected to support section 12610.

In various embodiments, referring now to Figure 38 5, disposable loading unit 15900 such as can include anvil block 15960 He Staple cartridge channel 15970, wherein staple cartridge channel 15970 can rotate relative to anvil block 15960.In at least one this type of embodiment, Anvil block 15960 may not rotate.In certain embodiments, tissue can be positioned in anvil block 15960 and staple cartridge channel 15970 Between, and staple cartridge channel 15970 can rotate towards tissue with against anvil block clamping tissue subsequently.In at least one this type of embodiment In, disposable loading unit 15900 may also include can tissue thickness's compensating part 15920 of contact tissue.

As mentioned above and see Figure 33 2, nail bin such as nail bin 10000 such as can include support section 10010 and tissue thickness Degree compensating part 10020, plurality of nail 10030 can at least by section store in support section 10010, and when nail 10030 May extend into when being in its non-firing position in tissue thickness's compensating part 10020.In various embodiments, it is in when nail 10030 During its non-firing position, the end of nail 10030 is not from tissue thickness's compensating part 10020 projection.When nail 10030 is by staple drivers 10040 when its non-firing position moves to its firing position, mends as it has been described above, the end of nail 10030 may pass through tissue thickness Repay part 10020 and/or through upper strata or crust 10022.In some alternative embodiment, when nail 10030 is in it not During firing position, the end of nail 10030 can the top surface of Tu Chuan tissue thickness compensating part 10020 and/or crust 10022.? In the case of any one, when following closely 10030 and extending upward support section 10010 before being deployed, nail 10030 can be relative to propping up Support portions incline and/or deflection, similarly, as described above.In various embodiments, referring now to Figure 32 9, nail bin such as nail bin 13000 such as can include that multiple ways or keeper, the plurality of ways or keeper can limit nail bin 13000 Relative motion between support section 13010 and the end of nail being positioned in.Referring first to Figure 33 0, nail bin 13000 can wrap Include the tissue thickness's compensating part 13020 being installed to support section 13010, and be attached to tissue thickness's compensating part 13020 in addition Multiple absorbent cottons 13022 of top surface 13021.In various embodiments, each absorbent cotton 13022 can include being limited to it In multiple holes 13029, the plurality of hole can accommodate slidably therein and/or guide nail 13030 lower limb 13022.Except Outside hole or replacement hole, absorbent cotton such as can include any suitable opening, such as slit, guider and/or groove, its Can slidably receive and/or lead leg 13022.In certain embodiments, as shown in Figure 33 0, when nail 13030 is in it not During firing position, the end of nail lower limb 13032 can be positioned in hole 13029.In at least one this type of embodiment, when nail is in During its non-firing position, the end of nail lower limb 13032 can project into above absorbent cotton 13022.In some other embodiment, work as nail 13030 when being in its non-firing position, and the end of nail lower limb 13032 can be positioned in the immediately below of absorbent cotton 13022 so that works as nail 13030 when being moved upwardly through tissue thickness's compensating part 13020, and nail lower limb 13032 can enter the hole 13029 of absorbent cotton 13022 In and slide through this hole.Under any circumstance, when the lower limb 13032 following closely 13030 is positioned in absorbent cotton, nail lower limb can be limited Lateral and/or the lengthwise movement of 13032, and do not stop moving upward of nail lower limb 13032 when following closely 13030 and being deployed.Work as nail 13030 when being deployed, referring now to Figure 33 1, nail lower limb 13032 can upward sliding through absorbent cotton 13022, to penetrate tissue T, connect Touch the anvil block being positioned at nail bin 13030 opposite, and deform downwards to capture tissue T therein and tissue thickness's compensating part 13030.

In various embodiments, to being described further above, absorbent cotton 13022 such as can use at least one biological The compatibility and/or bioabsorbable binding agent are attached to tissue thickness's compensating part 13020.In certain embodiments, absorbent cotton 13022 and/or the holding component that extends from each absorbent cotton can be at least partially embedded tissue thickness compensating part 13020.Extremely In few this type of embodiment, tissue thickness's compensating part 13020 can include being limited to therein can at least partly accommodating defat The pit of cotton 13022.In certain embodiments, in molding manufacture process, tissue thickness's compensating part 13020 can be integrally molded Or formed around absorbent cotton 13022.In various embodiments, what absorbent cotton 13022 can include moving independently of one another is discrete Keeper.In at least one embodiment, referring first to Figure 33 0, each absorbent cotton 13022 can include interlocking and/or bonding Structure, this interlocking and/or bonding structure can allow for and limit to a certain extent between absorbent cotton 13022 relative to lateral and vertical To motion.In at least one this type of embodiment, each absorbent cotton 13022 such as can include protuberance 13026 and one or many Individual groove 13027, wherein the protuberance 13026 of the first absorbent cotton 13022 can be positioned in adjacent the second absorbent cotton and the 3rd In the groove 13027 of absorbent cotton 13022, and/or relative to the second adjacent absorbent cotton and the groove of the 3rd absorbent cotton 13022 13027 alignment.In various embodiments, gap may be present between adjacent absorbent cotton 13022, and this gap can make absorbent cotton 13022 are movable with respect to or slide, until the absorbent cotton 13022 that its contact is adjacent.In certain embodiments, absorbent cotton 13022 can loosely interconnect.In various embodiments, absorbent cotton 13022 can be detachably connected to each other.At at least one In this type of embodiment, absorbent cotton 13022 can be manufactured such that the absorbent cotton of a piece of interconnection.Wherein, when applying enough power to this sheet Time, one or more in absorbent cotton 13022 can depart from other absorbent cottons.In certain embodiments, refer again to Figure 32 9, First 13024 absorbent cotton 13022 can be positioned on the first side of longitudinal slit 13025, and second 13024 absorbent cotton 13022 can be positioned on the second side of slit 13025.In at least one embodiment, to being described further above, prolong The longitudinal slit 13025 extending through tissue thickness's compensating part 13020 can be conducive to the blade of firing member through tissue thickness Compensating part 13020, and when firing member is through out-of-date, firing member can apply compression stress to described 13024, and makes defat At least some in cotton 13022 separately or separates.

In various embodiments, absorbent cotton 13022 such as can be by biocompatibility and/or bioabsorbable plastics structure Become.In certain embodiments, absorbent cotton 13022 such as can be made up of solid material, semi-solid material and/or flexible material.? In some embodiment, absorbent cotton 13022 can embed in tissue thickness's compensating part so that absorbent cotton 13022 compensates with tissue thickness Part moves.In at least one this type of embodiment, absorbent cotton 13022 can be sufficiently flexible so that it can be mended with tissue thickness Repay the top surface flexure of part.In certain embodiments, absorbent cotton 13022 can keep being embedded in tissue thickness's compensating part In, and in some other embodiment, absorbent cotton 13022 can eject from tissue thickness's compensating part or with tissue thickness's compensating part Separate.In various embodiments, absorbent cotton 13022 can include the top table that the top surface with tissue thickness compensating part flushes Face.In certain embodiments, the top surface of absorbent cotton 13022 can be positioned in above the top surface of tissue thickness's compensating part And/or lower section.In various embodiments, the top surface of absorbent cotton 13022 can be oriented so that when compensating from tissue thickness When the top surface of part is observed, it is visible, and in other embodiments, the top surface of absorbent cotton 13022 such as can be determined Position is in the lower section of the layer of tissue thickness's compensating part.In certain embodiments, guide frame such as can be molded into tissue thickness's benefit Repay in the top surface of part.In at least one this type of embodiment, tissue thickness's compensating part may not include composite, and example As one block of overall material can be included.

In various embodiments, referring now to Figure 33 8, nail bin such as can include tissue thickness's compensating part 13620 and outer Skin or top layer 13621.In at least one this type of embodiment, one or more absorbent cottons or keeper 13622 such as can embed Crust 13621.In certain embodiments, each keeper 13622 can include the one or more holes 13629 wherein limited, when When nail 13030 is in its non-firing position, these one or more holes can accommodate the nail lower limb 13032 of nail 13030 wherein, such as figure Shown in 338.In use, to being described further above, when nail 13030 moves to its firing position from its non-firing position Time, nail lower limb 10032 can be slid through hole 13629, until the base portion 13031 contact tissue thickness compensation part 13620 of nail 13030, And such as the lower surface against absorbent cotton 13622 compresses at least some of of tissue thickness's compensating part 13620.Various In embodiment, referring now to Figure 33 3, nail bin such as can include tissue thickness's compensating part 13120 and crust or top layer 13122. In at least one this type of embodiment, tissue thickness's compensating part 13120 such as can include can be from tissue thickness's compensating part 13120 Top surface 13121 upwardly extending taper lug, protuberance and/or jut 13128.Do not fire when nail 13030 is in it During position, protuberance 13128 can accommodate and encapsulate the end of the nail lower limb 13032 of nail 13030, as shown in Figure 33 3.Top layer 13122 may also include taper lug, protuberance and/or the jut aliging with protuberance 13128 or at least substantially aliging 13129 in use, and nail lower limb 10032 can penetrate protuberance 13128 and 13129, and exposes from tissue thickness's compensating part 13120. In various embodiments, referring now to Figure 33 7, nail bin such as can include tissue thickness's compensating part 13520 and crust or top layer 13522.In at least one this type of embodiment, crust 13522 such as can include can be from the top of tissue thickness's compensating part 13520 The upwardly extending taper in surface 13521 lug, protuberance and/or jut 13529.Similarly as described above, when nail 13030 When being in its non-firing position, protuberance 13529 can accommodate and encapsulate the end of the nail lower limb 13032 of nail 13030, such as Figure 33 7 Shown in.In use, nail lower limb 10032 can penetrate protuberance 13529 and expose from crust 13522.

In various embodiments, referring now to Figure 33 4, nail bin such as can include tissue thickness's compensating part 13220 and outer Skin or top layer 13222.In at least one this type of embodiment, tissue thickness's compensating part 13220 such as can include downwardly extending Pyramidal pits in the top surface 13221 of tissue thickness's compensating part 13220 and/or groove 13128.In various embodiments In, when following closely 13030 and being in its non-firing position, the end of nail lower limb 13032 can extend across groove 13128, such as Figure 33 4 institute Show.In at least one embodiment, top layer 13222 may also include the cone that can align with groove 13228 or at least substantially align Shape pit and/or groove 13229.In various embodiments, referring now to Figure 33 5, nail bin such as can include that tissue thickness compensates Part 13320 and crust or top layer 13322.In at least one this type of embodiment, crust 13320 can include extending downwardly into Thick part 13329 in the top surface 13321 of tissue thickness's compensating part 13320.In various embodiments, when nail 13030 When being in its non-firing position, thick part 13329 can accommodate at least some of of the nail lower limb 13032 of nail 13030 wherein, As shown in Figure 33 5.In this type of embodiment, nail lower limb 13032 can be held in place by thick part 13329 so that lower limb 13032 is with fixed The nail of the position anvil block on tissue thickness's compensating part 13320 opposite shapes pit alignment or at least substantially aligns.In various enforcements In example, referring now to Figure 33 6, nail bin such as can include tissue thickness's compensating part 13420 and crust or top layer 13422.Extremely In few this type of embodiment, crust 13422 can include can from the top surface 13421 of tissue thickness's compensating part 13420 upwards The thick part 13429 extended.In various embodiments, when following closely 13030 and being in its non-firing position, thick part 13429 Can accommodate nail 13030 wherein follows closely at least some of, as shown in Figure 33 6 of lower limb 13032.In this type of embodiment, thick Nail lower limb 13032 can be held in place by part 13429 so that lower limb 13032 and the anvil being positioned at tissue thickness's compensating part 13420 opposite The nail of seat shapes pit alignment or at least substantially aligns.

In various embodiments, referring now to Figure 33 9 and Figure 34 0, nail bin such as can include tissue thickness's compensating part 13720 And crust or top layer 13721.In at least one this type of embodiment, tissue thickness's compensating part 13720 such as can include can be from The upwardly extending taper of top surface 13721 of tissue thickness's compensating part 13720 and/or staged lug, protuberance and/or Jut 13728.When following closely 13030 and being in its non-firing position, protuberance 13728 can accommodate and encapsulate the nail of nail 13030 The end of lower limb 13032, as shown in Figure 34 0.Similarly, top layer 13721 can include can aliging or the most basic with protuberance 13728 The taper of upper alignment and/or staged lug, protuberance and/or jut 13729.In various embodiments, crust 13721 May also include from the upwardly extending one or more tusks 13727 of protuberance 13729, this tusk can be engaged against top layer The tissue of 13721 location, and prevent or at least limit between the end of tissue, top layer 13721 and/or nail lower limb 13032 relative Lateral and/or lengthwise movement.In use, when following closely 13030 and moving to its firing position from its non-firing position, lower limb is followed closely 13032 can penetrate protuberance 13728 and 13729 and expose from tissue thickness's compensating part 13720.In various embodiments, now Seeing Figure 34 1 and Figure 34 2, nail bin such as can include tissue thickness's compensating part 13820 and crust or top layer 13821.At least In one this type of embodiment, tissue thickness's compensating part 13820 such as can include can be from the top table of tissue thickness's compensating part 13820 The upwardly extending taper in face 13821 and/or staged lug, protuberance and/or jut 13828.When nail 13030 is in it During non-firing position, protuberance 13828 can accommodate and encapsulate the end of the nail lower limb 13032 of nail 13030, as shown in Figure 34 2.Phase As, top layer 13821 can include the taper that can align with protuberance 13828 or at least substantially align and/or staged lug, Protuberance and/or jut 13829.In various embodiments, top layer 13821 may also include and extends downwardly into tissue thickness's benefit Repaying the one or more tusks 13827 in part 13820, this tusk is such as prevented from or at least limits top layer 13821 He Between tissue thickness's compensating part 13820 relative to lateral and/or lengthwise movement.In use, position is not fired when nail 13030 from it Putting when moving to its firing position, nail lower limb 10032 can penetrate protuberance 13828 and 13829 and from tissue thickness's compensating part 13820 Expose.

In various embodiments, referring now to Figure 34 3, nail bin can include that tissue thickness's compensating part such as tissue thickness compensates Part 13920, this tissue thickness's compensating part such as can include being limited to ridge 13923 therein and paddy 13924.Implement at least one In example, paddy 13924 can be limited between ridge 13923.In various embodiments, each ridge 13923 can include identical height, Substantially the same height or different height.Similarly, each paddy 13924 can include the identical degree of depth, substantially the same The degree of depth or the different degree of depth.In various embodiments, multiple nails 13030 can at least partly be stored in tissue thickness's compensating part In 13920 so that the end of nail 13030 can be positioned in ridge 13923.In at least one this type of embodiment, when nail 13030 When being stored in its non-firing position, the nail lower limb 13032 of nail 13030 such as can not be from tissue thickness's compensating part 13920 and/or attached Receive crust or top layer 13921 projection of tissue thickness's 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 include longitudinal knife slit, its median ridge 13923 and paddy 13924 can transverse to and/or be perpendicular to cutter slit direction extend.In all cases, ridge 13923 can The end of nail lower limb 13032 is held in place, until nail 13030 moves to its firing position from its non-firing position.In various realities Executing in example, referring now to Figure 34 4, the outer micromicro of tissue thickness's compensating part and/or covering tissue thickness compensating part includes longitudinal ridge And/or paddy.In at least one this type of embodiment, tissue thickness's compensating part can include the top limited by ridge 14023 and paddy 14024 Surface, portion, its two-story valley 14024 such as can be limited between ridge 14023.In various embodiments, tissue thickness's compensating part can wrap Including crust 14021, this outer micromicro includes being limited to multiple hole 14029 therein, and each hole each can accommodate nail lower limb 13032. In certain embodiments, hole 14029 can be limited in ridge 14023, and wherein the end of nail lower limb 13032 can be positioned in ridge Below the summit 14028 of 14029, be oriented to flush and/or be positioned in summit 14028 with summit 14028 above.At certain In a little embodiments, in addition to the above or replace mentioned above, hole 14029 such as can be limited in paddy 14024.At certain In a little embodiments, each hole such as can embossed around or at least partially surrounding, this embossing can strengthen around hole crust and/or Tissue thickness's compensating part.Under any circumstance, to being described further above, crust 14021 can be in any suitable manner It is attached to tissue thickness's compensating part, such as, includes using at least one binding agent.

As mentioned above and refer again to Figure 23 3, surgery suturing appliance such as can include anvil block such as anvil block 10060, this anvil Seat can move between the open and the closed positions, in order to the such as tissue thickness's compensating part 10020 against nail bin 10000 is pressed Contracting tissue T.In all cases, anvil block 10060 can rotate towards nail bin 10000, until it moves downward by certain of nail bin 10000 Part and/or location have certain part of the passage of nail bin 10000 to be stoped.In at least one this type of embodiment, anvil block 10060 Can be rotated down, until it moves downward by the nose 10003 of nail bin 10000 and/or is positioned at nose 10003 and nail bin Tissue T in the middle of 10000 is resisted.In some cases, anvil block 10060 can fully compress tissue thickness's compensating part 10020, with Make the end of tissue T contact stud 10030.In some cases, according to the thickness of tissue T, anvil block 10060 can fully compress tissue Thickness compensation part 10020 so that until anvil block 10060 has arrived its fully closed position, anvil block 10060 connects with nail 10030 Touch.In other words, in such cases, in firing member 10052 is advanced to nail bin 10000 before percussion nail 10030, Anvil block 10060 can make nail 10030 deform.This type of situation is acceptable in certain embodiments；But referring now to Figure 35 8 He Figure 35 9, it is contemplated to other embodiments.In other embodiments described, such as, distant gap can be used to set element such as element 10059 limit following distance: before trigger shaft 10052 is advanced in nail bin 10000, and anvil block 10060 can be in this distance Place is closed.In various embodiments, element 10059 upwards can prolong from the top surface 10021 of tissue thickness's compensating part 10020 Stretch so that when tissue T rest element 10059 is compressed and produces drag therebetween, moving downward of anvil block 10060 can be hindered Only.In use, as it has been described above, firing member 10052 can be advanced to nail towards distally towards the far-end 10002 of nail bin 10000 In storehouse 10000, in order to nail 10030 is penetrated from support section 10010.Meanwhile, the engageable anvil block of firing member 10,052 10060, And anvil block 10060 is positioned at the platform surface 10011(figure on the nail 10030 being just formed, away from support section 10010 218) desired distance.So, firing member 10052 can control the tissue contacting surface of anvil block 10060 and in particular locations Distance between platform surface 10011 or gap.Wherein, when firing member 10052 is pushed into towards distally, this particular location can It is pushed into towards distally.In all cases, this clearance distance can be shorter than the gap between anvil block 10060 and platform surface 10011, This gap is set element 10059 by the distant gap of the far-end of tissue thickness's compensating part 10020 and is controlled or determine.Various In embodiment, referring now to Figure 35 9, when firing member 10052 arrives the far-end of tissue thickness's compensating part 10020, fire structure The blade 10053 of part 10052 can set element 10059 by crosscutting distant gap so that after element 10059 is crosscut, Firing member 10052 by anvil block 10060 towards the downward tractive of support section 10010, and can work as the far-end at nail bin 10000 During percussion nail 10030, by gap-closing to desired clearance height.In some alternative embodiment, work as firing member During close to the far-end of nail bin, distant gap sets element and can close up.In at least one this type of embodiment, distant gap sets Element can include pillars, this pillars can the resistance for anvil block provided as described above, and when firing member close to nail bin Far-end time once reach gap set element fastening intensity, then this pillars buckles the most suddenly.Implement at least one In example, this tightening force such as may be about 10lbf.In certain embodiments, when such as exceeding pre-to gap setting element applying During quantitative power, gap sets in the platform that element can drop downward into support section.In some other embodiment, between distally Gap can be controlled by the nose of nail bin.In at least one this type of embodiment, moving downward of anvil block 10060 can be limited by nose, Until firing member has arrived the far-end in storehouse.Wherein, the compression stress being applied to nose now can make nose collapse.Implement at some In example, nose can include the cavity limited by cavity wall.The compression stress being once applied to cavity exceedes predetermined power, then can make cavity Collapse.In at least one this type of embodiment, cavity can be limited by wall of can collapsing.

In various embodiments, as it has been described above, anvil block such as anvil block 10060 such as can open position and make position it Between move, in order between anvil block and the support section of nail bin, compress tissue thickness compensating part.In some cases, referring now to Figure 36 0 and Figure 36 1, when tissue thickness's compensating part 14120 is compressed against the support section 14110 of nail bin 14100, nail bin Tissue thickness's compensating part 14120 of tissue thickness's compensating part such as nail bin 14100 such as can laterally and/or extending longitudinally.At certain In a little embodiments, the end of tissue thickness's compensating part 14120 and/or side supported portion can not divide 14110 and/or anvil block 10060 constraints.Therefore, in tissue thickness's compensating part 14120, do not produce compression pressure or the most unexpected compression pressure In the case of, tissue thickness's compensating part 14120 can stretch along those directions.In this type of embodiment, firing member is such as through group Knit firing member 10052(Figure 23 6 of thickness compensation part 14120) such as can be by the non-phase in tissue thickness's compensating part 14120 The improper prevention of compression stress hoped.In some other embodiment, refer again to Figure 36 0, the far-end of tissue thickness's compensating part 14120 14125 such as can be retrained by the nose 14103 of nail bin 14100.In this specific embodiment, similarly as described above, tissue thickness The far-end 14125 of degree compensating part 14120 can be retrained by nose 14103, in order to reduces tissue thickness's compensating part 14120 and supporting part Divide the probability of 14110 premature disengagement.Under any circumstance, due to mentioned above, big internal pressure can result from far-end In 14125, this internal pressure can stop the propelling of firing member 10052, especially arrives far-end 14125 when firing member 10052 Time.More specifically, in some cases, when firing member 10052 transecting patient tissue thickness compensation part 14120, firing member can Promote towards distally, plough removes and/or shifts tissue thickness's compensating part 14120.Therefore, the biggest internal pressure can result from In the far-end 14125 of tissue thickness's compensating part 14120.In order at least partly eliminate this pressure in tissue thickness's compensating part 14120 Power, nose 14103 can be made up of flexible material.This flexible material can make nose 14103 such as towards distal flex and thick for tissue Degree compensating part 14120 produces additional space.In certain embodiments, referring now to Figure 36 2 and Figure 36 3, the nose of nail bin can Including the part can slided towards distally.More specifically, the nose 14203 of nail bin 14200 can include slidably part 14204, should Slidably part can be slidably attached to nose 14203 so that when anvil block 10060 is closed and/or firing member 10052 When being advanced in the far-end of nail bin 14200, slidably part 14204 can be slided towards distally and is tissue thickness's compensating part 14200 produce additional space, and at least partly alleviate internal pressure therein.In at least one embodiment, nose 14203 and slidably the one in part 14204 can include one or more guide rail, and nose 14203 and slidably part Another one in 14204 can include the one or more passages that can slidingly receive guide rail wherein.At at least one this type of In embodiment, passage and guide rail such as can cooperate the motion limiting slidably part 14204 to longitudinally distal passage.

In all cases, to being described further above, the such as farthest side nail in nail bin such as can capture tissue Bigger part for the following closely compared to the nearside in nail bin of thickness compensation part.In such cases, therefore, follow closely compared to nearside For, the tissue that can be captured in distad following closely applies big clamping pressure.Although as it has been described above, tissue thickness's compensating part can be by The material of the substantially homogeneity with substantial constant thickness is constituted, but when at least some of of tissue thickness's compensating part is turned When moving on to and/or gather during use the far-end of nail bin, may occur in which these situations.In all cases, it is desirable to some Follow closely and apply bigger clamping pressure to tissue compared with other nails.Wherein, in various embodiments, support section and/or tissue Thickness compensation part is configurable to and is arranged to control which nail to apply bigger clamping force to tissue and which nail can Less clamping force is applied to tissue.Referring now to Figure 36 4, nail bin 14300 can include support section 14310, and removes this it Outside fix tissue thickness's compensating part 14320 on the platform surface 14311 of support section 14310.With institute in present patent application Disclosed in include other embodiment phases with the support section 14310 of smooth or the most smooth platform surface Ratio, platform surface 14311 can tilt between the far-end 14305 of support section 14310 and near-end 14306 and/or decline.Extremely In a few embodiment, the platform surface 14311 of support section 14310 can include the podium level at its far-end 14305, and this is put down Platform height is less than the podium level at its near-end 14306.In at least one this type of embodiment, the far-end of nail bin 14300 Nail 10030 may extend into distance bigger above platform surface 14311 compared to the nail 10030 of proximal end.It is available for choosing various In the embodiment selected, the platform surface of support section can include the height of its far-end, and this height is higher than the height of its proximal end. Referring again to Figure 36 4, tissue thickness's compensating part 14320 can include along the thickness that its longitudinal length is different.In various embodiments, Tissue thickness's compensating part 14320 such as can include the thickness at its far-end 14325, and this thickness is thicker than its near-end 14326.At least In one this type of embodiment, tissue thickness's compensating part 14322 can include lower surface 14322, this lower surface tiltable or under Fall, the inclination with coupling or at least substantially mating support section 14310 or the platform surface 14311 declined.Therefore, tissue thickness The degree top of compensating part 14320 or tissue contacting surface 14321 can include can positioning above the smooth of T in a organized way or at least base Surface smooth in basis.Under any circumstance, due to tissue thickness's compensating part 14320 at its far-end 14325 thicker, the farthest Side nail 10030 can capture the major part of tissue thickness therein compensating part 14320 compared to nearside nail 10030.Therefore, distally Nail 10030 can apply bigger compression stress, the especially clearance distance between anvil block 10060 and platform surface 14311 to tissue T Nail bin be proximally and distally constant or substantial constant time.But in some cases, anvil block 10060 can arrive Fully closed position, therefore the clearance distance between anvil block 10060 and platform surface 14311 is at the far-end ratio of nail bin 14300 Proximal end is bigger.In all cases, distally nail 10030 is likely not to have and is fully formed, and answering this distally to follow closely 10030 may not be to group Knit T and apply desired clamping pressure.At tissue thickness's compensating part in the thicker embodiment of the far-end of nail bin, tissue thickness is mended Repay part can compensate for 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 such as can include support section 14410 And the tissue thickness's compensating part 14420 being in addition positioned on the platform surface 14411 of support section 14410.Similar In mentioned above, platform surface 14411 tiltable and/or decline so that at least one embodiment, support section 14410 Far-end 14405 such as can have the podium level of the podium level at less than near-end 14406.In certain embodiments, tissue Thickness compensation part 14420 can include constant or the most constant thickness along its length.Therefore, tissue thickness's compensating part The top of 14420 or tissue contacting surface 14421 can be parallel to or at least substantially parallel to the profile of platform surface 14411. In various embodiments, when following closely 10030 and being in its non-firing position, it is thick that the nail 10030 of nail bin 14400 can be completely embedded into tissue In degree compensating part 14420 and support section 14410.In certain embodiments, when following closely 10030 and being in its non-firing position, quilt The nail 10030 of the proximal end being positioned at nail bin 14400 can be completely embedded into tissue thickness's compensating part 14420 and support section 14410 In；And due to the decline slope of platform 14411 and top surface 14421, when following closely 10030 and being in its non-firing position, some Nail 10030, including the nail 10030 of the far-end being positioned in nail bin 14400, can the top of Tu Chuan tissue thickness compensating part 14420 Surface, portion 14421.

In various embodiments, as it has been described above, tissue thickness's compensating part can be made up of single material, the most whole tissue is thick Degree compensating part can have identical or the most identical material behavior, such as density, rigidity, elastic ratio from start to finish Rate, hardness and/or elasticity.In other embodiments various, referring now to Figure 36 8, tissue thickness's compensating part such as tissue thickness Compensating part 14520 such as can include multiple material or material layer.In at least one embodiment, tissue thickness's compensating part 14520 Can include first or central stratum 14520a, be attached on opposite sides thereof ground floor 14520a second or intermediate layer 14520b, And the 3rd or outer layer 14520c of each being attached in second layer 14520b the.In certain embodiments, may utilize at least Intermediate layer 14520b is attached to central stratum 14520a by a kind of binding agent, and similarly, at least one binding agent can be used to incite somebody to action Outer layer 14520c is attached to the second layer 14520.Than adhesives or replace binding agent, such as can by one or more mutually Layer 14520a-14520c is kept together by lock construction and/or securing member.Under any circumstance, internal layer 14520a such as can be by First material with first group of material behavior is constituted；Intermediate layer 14520b can be by second material with second group of material behavior Constitute；And outer layer 14520c can be made up of the 3rd material with the 3rd group of material behavior.These several groups of material behaviors such as may be used Including density, rigidity, flexible ratio, hardness and/or elasticity.In certain embodiments, nail bin such as can include six nails 10030, wherein a nail 10030 such as can at least be partially positioned in each in outer layer 14520c and internal layer In each in 14520b, and wherein two nails 10030 can at least be partially positioned in internal layer 14520a.Using In, similarly as described above, nail 10030 can penetrate from nail bin so that the nail lower limb 10032 of nail 10030 penetrates tissue thickness and compensates The top surface 14521 of part 14520, penetrates the tissue positioned against top surface 14521 by anvil block and contacts anvil subsequently Seat so that lower limb 10032 deforms with the tissue thickness's compensating part 14520 in capture nail 10030 and tissue.It is also similar to institute above Stating, when firing member is advanced through nail bin, tissue thickness's compensating part 14520 can be crosscutting by firing member.At at least one In this type of embodiment, firing member such as can be along the passage limited by axis 14529 crosscutting internal layer 14520a and tissue.

In various embodiments, to being described further above, the many nails 10030 being positioned in internal layer 14520a can Staple including the edge closest to the tissue being crosscut.Correspondingly, the many nails 10030 being positioned in outer layer 14520c can be wrapped Include the staple that the edge of the tissue that distance is crosscut is farthest.In certain embodiments, including the first material example of internal layer 14520a As included such as lower density: this density is higher than the density of the second material including intermediate layer 14520b；And similarly, the second material The density of material can be higher than the density of the 3rd material including outer layer 14520c.In all cases, therefore, compared to being positioned in For the compression stress produced in nail 10030 in intermediate layer 14520b and outer layer 14520c, bigger compression stress can be positioned Produce in nail 10030 in internal layer 14520a.Similarly, produce compared in the nail 10030 being positioned in outer layer 14520c For raw compression stress, bigger compression stress can produce in the nail 10030 in being located in intermediate layer 14520b.Various can In selective embodiment, the first material including internal layer 14520a such as can include such as lower density: during this density is less than including The density of second material of interbed 14520b；And similarly, the density of the second material can be less than including the of outer layer 14520c The density of three materials.In all cases, therefore, compared to the nail being positioned in intermediate layer 14520b and internal layer 14520a For the compression stress produced in 10030, bigger compression stress can produce in the nail 10030 in being located in outer layer 14520c. Similarly, for the compression stress produced in the nail 10030 being positioned in internal layer 14520a, bigger compression stress can be Produce in the nail 10030 being located in the 14520b of intermediate layer.In other embodiments various, any other suitable structure can be used Layer, material and/or the material behavior made.Under any circumstance, in various embodiments, the layer of tissue thickness's compensating part 14520 14520a-14520c can keep being attached to one another after it is implanted.In some other embodiment, tissue thickness's compensating part The layer 14520a-14520c of 14520 can maintain separately from each other after it is implanted.In at least one this type of embodiment, layer 14520a-14520c can utilize one or more bioabsorbable binding agents to combine, these one or more can be biological First layer can be remained to together by the binding agent absorbed, and passage the most in time makes layer from discharging each other.

As it has been described above, tissue thickness's compensating part of nail bin such as tissue thickness's compensating part 14520 such as can include multiple vertical To layer.In other embodiments various, referring now to Figure 36 9, nail bin can include that tissue thickness's compensating part such as tissue thickness is mended Repaying part 14620, this tissue thickness's compensating part such as can include multiple level course.In at least one this type of embodiment, tissue thickness Degree compensating part 14620 can include first or bottom 14620a, be attached to bottom 14620a second or intermediate layer 14620b and It is attached to the 3rd or top layer 14620c of intermediate layer 14620b the.In various embodiments, ground floor 14620a such as can include putting down Smooth or substantially flat lower surface 14626a and the top surface 14625a of triangle or taper.At at least one this In class embodiment, second layer 14620b can include lower surface 14626b of triangle or taper, and this lower surface can be parallel to And the top surface 14625a of adjacent ground floor 14620a.Similarly as described above, second layer 14620b can include triangle or The top surface 14625b of taper, this top surface such as can be parallel to and adjoin bottom triangle or the cone of third layer 14620c Lower surface 14626c of shape.In various embodiments, the top surface of third layer 14626c can include smooth or at least base Tissue contacting surface 14621 smooth in basis.Being also similar to mentioned above, tissue thickness's compensating part 14620 such as can be at it In store six nails at least in part and such as follow closely 10030, wherein firing member such as can be along the passage extending through axis 14629 Tissue thickness's compensating part 14620 between the staple of crosscutting two inner sides.Similarly as described above, each layer of 14620a, 14620b, and 14620c can be made up of the different materials including dissimilar material properties, and due to the three of layer 14620a-14620c Dihedral or conical configuration, tissue thickness's compensating part 14620 within it can have different overall characteristic in each position.Such as, Outermost many nails 10030 can capture more more third layer 14620c than ground floor 14620a wherein, and inner side is many Nail 10030 can capture third layer 14620c more less than ground floor 14620a.Therefore, although tissue thickness's compensating part 14620 Can have the identical or the most identical general thickness across it, but tissue thickness's compensating part 14620 such as can Enough compression in the way of being different from the tissue in compression is trapped in inner side nail 10030 is trapped in outermost nail 10030 Interior tissue.

In various embodiments, referring now to Figure 28 6, tissue thickness's compensating part of nail bin, the such as tissue of nail bin 14700 Thickness compensation part 14720, such as, can include being limited to what the thickness making tissue thickness's compensating part 14720 therein changed Space, pit, passage and/or groove.In at least one this type of embodiment, tissue thickness's compensating part 14720 can be against nail bin The platform surface 14711 of the support section 14710 of 14700 positions so that be limited to the bottom table of tissue thickness's compensating part 14720 Space 14723 in face 14722 can overlay on some nail chamber 10012, and above rather than other are followed closely on chambeies.In various embodiments, empty Gap 14723 can transverse to support section 14710 cutter slit 14715, be perpendicular to cutter slit 14715 and/or to be parallel to cutter narrow Groove 14715 extends.In certain embodiments, space 14723 can be in the lower surface 14722 of tissue thickness's compensating part 14720 Limit bearing-surface pattern.Under any circumstance, when such as nail 10030 is such as deployed nail from support section 14710, join now Seeing Figure 28 7 and 288, some nail 10030 can comprise the region IT tissue thickness compensating part 14720 in space 14723；And its He follows closely 10030 can be located in the region IT tissue thickness compensating part 14720 in the middle of space 14723.Except institute above Outside stating or replace mentioned above, tissue thickness's compensating part 14720 such as can include being limited to top or tissue contacting surface Space, pit, passage and/or groove in 14721.In certain embodiments, referring now to Figure 36 6 and Figure 36 7, nail bin 14800 can include tissue thickness's compensating part 14820, and this tissue thickness's compensating part can include multiple bearing-surface 14823, the plurality of At least one in bearing surface for example, situations below: upwardly extend from the top surface 14821 of tissue thickness's compensating part 14820, Extend internally and/or towards the far-end of nail bin 14800 towards distal extension towards central authorities' groove 14825.In at least one this type of embodiment In, bearing-surface 14823 such as can by passage, slit and/or groove such as passage 14824 separately.In all cases, due to Mentioned above, the general thickness of tissue thickness's compensating part can change between staple and/or change between nail in staple.? In some cases, the part of bearing-surface or thickness may be structured to and be arranged so that when tissue thickness's compensating part is compressed, The part of bearing surface or thickness the most inwardly can flow along desired direction.

In various embodiments, referring now to Figure 30 3, nail bin such as nail bin 14900 such as can include support section 14910 And in addition against tissue thickness's compensating part 14920 that support section 14910 is positioned.Similarly as described above, support Part 14910 can include can being disposed, by nail, the staple drivers that sliding part is lifted up, in order to lifts nail and such as follows closely 10030, this nail Such as towards anvil block, such as it is positioned in the anvil block 10060 on nail bin 14900 opposite and is at least partially positioned at support section In 14910.In certain embodiments, support section 14910 can include six nail chambeies, the such as two nail chambeies in outside, inner side Two nail chambeies and be positioned at the nail chamber, centre two in the middle of inboard row and outboard row.Wherein anvil block 10060 can include and nail chamber Six aliging or at least substantially aliging line up shape pit 10062.In various embodiments, inner side nail chamber row can include being positioned at Staple drivers 14940a therein；Middle nail chamber row can include the staple drivers 14940b being positioned in；And nail chamber, outside Row can include the staple drivers 14940c being positioned in.Wherein each in staple drivers 14940a can include supporting The support 14949a of nail 10030；Wherein can include can the support of support nail 10030 for each in staple drivers 14940b 14949b；And wherein can include can the support 14949c of support nail 10030 for each in staple drivers 14940c.At it At non-firing position, i.e. when staple drivers 14940a-14940c is placed in the driver extended to below support section 14910 Time on support member 14926, the support 14949b compared to staple drivers 14940b and the support 14949c of staple drivers 14940c, The support 14949a of staple drivers 14940a can position closer to anvil block 10060.In this type of position, the first forming distance can be limited It is scheduled on support 14949a and is positioned between the shaping pit 10062 on support 14949a；Second forming distance can be defined Between support 14949b and the shaping pit 10062 being positioned on support 14949b；And the 3rd forming distance can be limited It is scheduled on support 14949c and is positioned between the shaping pit 10062 on support 14949c.Wherein, in various embodiments, Such as first forming distance can be shorter than the second forming distance, and the second forming distance can be shorter than the 3rd molding distance.When nail drives Dynamic device 14940a-14940c when its non-firing position (Figure 30 3) moves to its firing position, each staple drivers 14940a- 14940c can be disposed sliding part by nail and move upward equal or the most equal distance towards anvil block 10060 so that the Its respective nail 10030 is driven the first forming height by one driver 14940a；Second driver 14940b is by its respective nail 10030 drive the second forming height；And its respective nail 10030 is driven the 3rd forming height by the 3rd driver 14940c. Wherein, the such as first forming height can be shorter than the second forming height, and the second forming height can be shorter than the 3rd forming height.If Having thought other embodiments various, wherein the first staple drivers 14940a is by upward displacement the first distance；Second staple drivers 14940b is by upward displacement second distance, and the 3rd staple drivers 14940c is by upward displacement the 3rd distance.Wherein, first away from One or more in, second distance, the 3rd distance can be different.

In various embodiments, refer again to Figure 30 3, relative to the tissue contacting surface 10061 of anvil block 10060, support The platform surface 14911 of part 14910 can in height be varied from.In certain embodiments, this height change can be laterally Upper generation, and at least one embodiment, such as the height around the platform surface 14911 of nail chamber, inner side row can be higher than enclosing Height around the platform surface 14911 of nail chamber, outside row.In various embodiments, the bottom table of tissue thickness's compensating part 14920 Face 14922 can be parallel to or at least substantially parallel to the platform surface 14911 of support section 14910.To entering one above Step describes, and tissue thickness's compensating part 14920 also can be varied from thickness.Wherein, at least one embodiment, tissue thickness Top or the tissue contacting surface 14921 of degree compensating part 14920 can slope inwardly from its outward flange or lateral edge.At least one In this type of embodiment individual, due to mentioned above, tissue thickness's compensating part 14920 can be located in the district on the row of nail chamber, inner side In territory relatively thin, and be located in outside nail chamber row on region in thicker.In various embodiments, referring now to figure 304, the platform surface of support section 15010 such as can include staged platform surface, the wherein the highest step of stepped surface Can arrange around nail chamber, inner side, and the minimum step of stepped surface can be arranged around nail chamber, outside.At at least one, this type of is implemented In example, the step with intermediate altitude can be arranged around nail chamber, centre.In certain embodiments, tissue thickness's compensating part is such as organized Thickness compensation part 15020 such as can include lower surface, and this lower surface is parallel to and adjoins the platform table of support section 15010 Face.In at least one embodiment, top or the tissue contacting surface 15021 of tissue thickness's compensating part such as can include arch , parabolical and/or curved surface, at least one this type of embodiment, this surface can be from tissue thickness's compensating part First cross side of 15020 extends to the second cross side of tissue thickness's compensating part 15020, wherein summit and nail bin 15000 Center alignment or at least substantially align.In various embodiments, referring now to Figure 29 9, nail bin 15300 such as can include supporting Part 15310, be movably positioned in be defined in support section 15310 nail intracavity multiple staple drivers 15340 and It is positioned at the tissue thickness's compensating part 15320 above the platform surface 15311 of support section 15310.Nail bin 15300 may also include One or more bottom plate parts 15326, this bottom plate part could attach to support section 15310 and extends to support section The bottom periphery of 15310, and supporting driver 15340 and be in the nail 15330 of its non-firing position.When sliding part quilt disposed by nail When being advanced through nail bin, along with staple drivers 15340 and nail 15330 are lifted up through tissue thickness's compensating part by sliding part 15320, sliding part also can be supported by bottom plate part 15326.In at least one embodiment, tissue thickness's compensating part 15320 The first or internal 15322a on being positioned at nail chamber, inner side arranges can be included, be centrally positioned second or middle on the row of nail chamber Part 15322b and be positioned at the 3rd on a nail chamber or outside 15322c.Wherein, such as internal 15322a can be thicker than Mid portion 15322b, and mid portion 15322b can be thicker than outside 15322c.In at least one embodiment, tissue thickness Compensating part 15320 such as can include being limited to vertical passage therein, and this vertical passage can produce tissue thickness's compensating part 15320 Thinner part 15322b and 15322c.In various alternative embodiments, vertical passage can be limited at tissue thickness In the top surface of compensating part and/or lower surface.In at least one embodiment, the top of tissue thickness's compensating part 15320 Surface 15321 such as can include smooth or the most smooth surface.

In various embodiments, referring now to Figure 29 6, nail bin such as can include tissue thickness's compensating part such as tissue thickness Compensating part 15120, this tissue thickness's compensating part can include the some with different-thickness.In at least one embodiment, Tissue thickness's compensating part 15120 can include the first with the first thickness or internal 15122a, extend from Part I 15122a Have the second thickness second or mid portion 15122b and from Part II 15122b extend to have the 3rd thick 3rd or outside 15122c of degree.In at least one this type of embodiment, the such as the 3rd thickness can be thicker than the second thickness, and Two thickness can be thicker than the first thickness, but can use any suitable thickness in other embodiments various.In various embodiments, Part 15122a-15122c of tissue thickness's compensating part 15120 can include the step with different-thickness.Implement at least one In example, similarly as described above, nail bin can include many nails 10030 and have multiple staple drivers of differing heights, and this nail drives Dynamic device can make nail 10030 be deformed into different forming heights.Being also similar to mentioned above, nail bin can include the first staple drivers 15140a, it can drive nail 10030 to the first forming height, the second staple drivers 15140b being supported on, and it can drive Nail 10030 to the second forming height being supported on and the 3rd staple drivers, it can drive the nail being supported on 10030 to the 3rd forming heights.Wherein, the such as first forming height can be shorter than the second forming height, and the second forming height The 3rd forming height can be shorter than.In various embodiments, as shown in Figure 29 6, each nail 10030 can include identical or substantially Identical unshaped or do not fire height.In some other embodiment, referring now to Figure 29 6A, the first driver 15140a, Second driver 15140b and/or the 3rd driver 15140c can support the nail with different unshaped height.At at least one In this type of embodiment, the first staple drivers 15140a can support the nail 15130a with the first unshaped height, and the second nail drives Device 15140b can support the nail 15130b with the second unshaped height, and the 3rd staple drivers 15140c is sustainable has the The nail 15130c of three unshaped height.Wherein, the such as first unshaped height can be shorter than the second unshaped height, and second not Forming height can be shorter than the 3rd unshaped height.In various embodiments, refer again to Figure 29 6A, nail 15130a, 15130b and/ Or the end of 15130c can be located at or is at least substantially positioned in identical plane, and in other embodiments, follow closely 15130a, The end of 15130b and/or 15130c can not be positioned in identical plane.In certain embodiments, referring now to Figure 29 7, nail bin Can include tissue thickness's compensating part 15220 with some, the plurality of part has different thickness, and this tissue thickness is mended Repay part to be located against tissue T by nail 15130a, 15130b and 15130c and implant, as mentioned above.In at least one embodiment In, referring now to Figure 29 8, nail 15130a, 15130b and/or 15130c can be deformed to different forming heights.Wherein the first nail 15130a can be deformed to the first forming height, and the second nail 15130b can be deformed to the second forming height, and the 3rd nail 15130c Can be deformed to the 3rd forming height, and wherein the first forming height such as can be shorter than the second forming height, and second shapes Height can be shorter than the 3rd forming height.Contemplate other embodiments, wherein follow closely 15130a, 15130b and 15130c and can be configured to appoint What suitable forming height and/or any relative forming height.

In various embodiments, as it has been described above, the anvil block of surgery suturing appliance can be between the open and the closed positions Motion.In such cases, when anvil block moves to its make position, it is final that the tissue contacting surface of anvil block is moveable to it Or shaping position.Once anvil block is in its make position, and in certain embodiments, tissue contacting surface can be no longer adjustable 's.In some other embodiment, referring now to Figure 35 1, surgical stapling device such as surgical stapling device 15500 such as can include anvil Seat passage 15560 and the adjustable tissue contact anvil block adjustable plate 15561 being positioned in anvil channel 15560.Real at this type of Execute in example, anvil plate 15561 can in anvil channel 15560 elevated and/or reduce, in order to relative to being positioned at anvil plate The nail bin on 15561 opposites regulates the position of the tissue contacting surface of anvil plate 15561.In various embodiments, surgical stapling Device 15500 can include adjusting slider 15564.Seeing Figure 35 6 and Figure 35 7, this adjusting slider can be at anvil channel 15560 and anvil block Plate 15561 middle slip, in order to control the distance between anvil plate 15561 and nail bin.In certain embodiments, figure is referred again to 351 and Figure 35 2, surgical stapling device 15500 may also include the actuator 15562 being attached to adjusting slider 15564, and this actuator can Proximally slide to make adjusting slider 15564 proximally slide and/or sliding to make adjusting slider 15564 court towards distally Slide in distally.In various embodiments, referring again to Figure 35 6 and Figure 35 7, actuator 15562 can make a reservation at two or more Slide between position, in order between two or more positions, regulate anvil plate 15561 respectively.In at least one embodiment In, this type of precalculated position such as can be divided into demarcation line 15563(Figure 35 1 on surgical stapling device 15500).Implement at some In example, seeing Figure 35 7, adjusting slider 15564 such as can include multiple stayed surface, such as the first stayed surface 15565a, Two stayed surface 15565b and the 3rd stayed surface 15565c, the plurality of stayed surface can respectively with the back side of anvil plate 15561 On multiple plate locating surfaces alignment, such as the first locating surface 15569a, the second locating surface 15569b and the 3rd location table Face 15569c, in order to anvil plate 15561 is positioned at primary importance.In order to anvil plate 15561 is positioned in the second position, cause Dynamic device 15562 and slide block 15564 such as can proximally slide, in order to by the stayed surface 15565a-15565c phase of slide block 15564 Locating surface 15569a-15569c for anvil plate 15561 realigns.More specifically, see Figure 35 6, slide block 15564 can Slide towards distally so that the first stayed surface 15565a of slide block 15564 can be positioned in the second location table of anvil plate 15561 After the 15569b of face, and make the second stayed surface 15565b of slide block 15564 can be positioned in the 3rd of anvil plate 15561 After locating surface 15569c, in order to anvil plate 15561 is moved to closer to nail bin.When anvil plate 15561 is from its first Put when moving to its second position, in such cases, adjustable anvil plate 15561 can further compression set at anvil plate Tissue T between 15561 and nail bin.In addition to the above, when anvil plate 15561 is conditioned and is limited to anvil plate Shaping pit in 15561 will be moved to closer to and/or during further from nail bin, the forming height of nail can be by anvil plate 15561 Control relative to the position of nail bin.Although foregoing describes only two positions, but slide block 15564 being slid into suitable quantity Position in, with anvil plate 15561 is moved to closer to and/or further from nail bin.Under any circumstance, once anvil plate 15561 are properly oriented, and nail is disposed sliding part 15550 and can be slided towards distally in nail bin, in order to by staple drivers 15540 He Follow closely 15530 lift towards anvil plate 15561 and sew up tissue T, as shown in Figure 35 4.Similar surgical stapling device is disclosed in 2011 The U.S. Patent Application Serial Number 13/ of entitled " SURGICAL STAPLING INSTRUMENT " that on February 28, in submits to 036,647, the entire disclosure is incorporated by reference herein.

In various embodiments, referring now to Figure 35 3, nail bin can be positioned in the staple cartridge channel of surgical stapling device 15500 In 15570, this staple cartridge channel such as can include tissue thickness's compensating part, such as tissue thickness's compensating part 15520.Work as anvil plate 15561 towards nail bin move time, as it has been described above, anvil plate 15561 compressible tissue thickness compensating part 15520 and/or be positioned at anvil Tissue T in the middle of seat board 15561 and tissue thickness's compensating part 15520.When following closely 15530 and being deployed from nail bin, see Figure 35 5, Nail 15530 can be against tissue T compression implanting tissue thickness compensation part 15520.In various embodiments, when anvil plate 15561 Position and organize when not also being placed between anvil plate 15561 and tissue thickness's compensating part 15520 against slide block 15564, can When anvil plate 15561 is in its primary importance at anvil plate 15561 and the top surface of tissue thickness's compensating part 15520 Gap is limited between 15521.When anvil plate 15561 moves to the second position, anvil plate 15561 can contact tissue thickness compensation Part 15520.In various alternative embodiments, when anvil plate 15561 against slide block 15564 position and organize the most not by When being placed between anvil plate 15561 and tissue thickness's compensating part 15520, can work as anvil plate 15561 be in its primary importance and/or Between the top surface 15521 of anvil plate 15561 and tissue thickness's compensating part 15520, gap is limited during the second position.Extremely In few this type of embodiment, anvil plate 15561 can not contact with tissue thickness compensating part 15520.Other available Embodiment in, be not also placed in anvil plate 15561 and tissue when anvil plate 15561 positions against slide block 15564 and organizes Time between thickness compensation part 15520, anvil plate 15561 such as can connect with the top surface 15521 of tissue thickness compensating part 15520 Touch, regardless of whether whether anvil plate 15561 is in primary importance and/or the second position.Although only describing anvil plate 15611 herein Two positions, anvil plate 15611 can be positioned or index in any appropriate number of position.

In various embodiments, due to mentioned above, surgery suturing appliance can include the forming height for regulating nail Device, this device can compensate different tissue thicknesses in all cases.Additionally, surgery suturing appliance such as can include for mending Repay different tissue thicknesses and/or the device of in-house thickness change.In at least one this type of embodiment, anvil plate 15561 can be adjusted up or be adjusted to away from relative nail bin, to increase shaping or the percussion height of nail.Correspondingly, anvil block Plate 15561 can downwards or be regulated towards relative nail bin, to reduce shaping or the percussion height of nail.In various embodiments, The gap shaped between pit and the nail that are limited to the regulation such as scalable of anvil plate 15561 in anvil plate 15561 drive The percussion height of the percussion height of dynamic device or the most such as staple drivers support.Even if having the forming height of regulating nail This type of ability to be such as responsible for processing thicker and/or relatively thin tissue, tissue thickness's compensating part can also compensate for thicker and/or relatively Thin tissue, and/or compensate the change of in-house thickness, as mentioned above.In this type of embodiment, can be at same surgical stapling Multiple compensation device is provided for surgeon in apparatus.

As mentioned above and as shown in multiple embodiments, surgery suturing appliance can use nail bin, and this nail bin has linear arrangement Nail chamber and nail, wherein firing member can be advanced through towards distally nail bin with from nail chamber dispose nail.In certain embodiments, nail Storehouse can include nail chamber and the staple of bending.In at least one embodiment, referring now to Figure 34 5 and Figure 34 6, surgery suturing appliance Such as stiching instrument 15600 such as can include the one or more round ring being limited in circle or annular support portion 15610 Staple chamber is arranged.This type of circular staple such as can include nail chamber 15612, the inner side row of circle and circular nail chamber 15613, outside row. In at least one this type of embodiment, circular nail chamber row can be around the circle being limited in stiching instrument 15600 or looping pit 15615, this hole can accommodate and is removably positioned in circle therein or endless knife.In use, tissue can be against support section The platform surface 15611 of 15610 positions, and anvil block (not shown) can by extend through and/or be positioned in hole 15615 Actuator group installs to surgical stapling device 15600 so that when actuator activated, and anvil block can be clamped towards support section 15610, And against platform surface 15611 compression tissue.Once organize and be sufficiently compressed, be positioned in nail chamber 15612 and 15613 Nail can penetrate from support section 15610 and pass tissue so that nail can contact anvil block and fully deform to capture tissue therein. When nail just fired and/or when nail by fired after, circular knife can be pushed into transecting patient tissue.Then, anvil block is movable far Separate from support section 15610 and/or with surgical stapling device 15600 so that anvil block and surgical stapling device 15600 can be from Surgeries Position is removed.This type of surgical stapling device 15600 and this type of surgical technic can be utilized in various embodiments, big such as to connect Two parts of intestinal.In all cases, the some of large intestine can be maintained in the case of organization healing by circular staple row Together, and meanwhile some elastic stretch of large intestine are made.Similar surgery suturing appliance and surgical technic are disclosed in The United States Patent (USP) of entitled " SURGICAL ANASTOMOSIS STAPLING INSTRUMENT " that on February 15th, 1994 submits to In 5,285,945, the entire disclosure is incorporated by reference herein.

In various embodiments, to being described further above, tissue thickness's compensating part such as can be against surgical stapling The support section 15610 of device 15600 positions and/or is attached to the support section 15610 of surgical stapling device 15600.At least one In individual embodiment, tissue thickness's compensating part can be made up of circular or annular material ring, and this rings of material such as includes that inside radius is with outer Radius.In some cases, tissue can position against this rings of material, and when anvil block will be for organizing towards support section 15610 During motion, tissue thickness's compensating part can be compressed between tissue and platform surface 15611.During use, nail can be fired Through tissue thickness's compensating part and tissue so that nail joint is touched anvil block and is deformed into its firing position, organizing and tissue thickness The part capture of compensating part is in nail.In all cases, to being described further above, including tissue thickness's compensating part Rings of material must be the most with resilience, so that the some around the large intestine of nail row stretches.In various embodiments, again join See that Figure 34 5 and Figure 34 6, flexible tissue thickness's compensating part 15620 such as can include the flexible internal ring 15624 of circle or annular, This internal ring can limit circle or looping pit 15625 at least one embodiment.In certain embodiments, internal ring 15624 can quilt It is configured to make it not be trapped in the nail that surgical stapling device 15600 is disposed；But, at least one embodiment, internal ring 15624 radially-inwardly can position relative to nail chamber 15612, inner side row.In at least one this type of embodiment, tissue thickness is mended Repay multiple attachments that part 15620 can include such as extending, such as interior attachment 15622 and outer attachment 15623 from it so that When nail deformation, attachment can at least partly be captured in nail.More specifically, referring first to Figure 34 5, each interior attachment 15622 can include such as head portion: this head is positioned on the nail chamber 15612 being defined in surgical stapling device 15600, wherein Head such as can be attached to internal ring 15624 by cervical region 15626；And the most each outer attachment 15623 can include as follows Head: this head is positioned on the nail chamber 15613 being defined in surgical stapling device 15600, and wherein head such as can pass through Cervical region 15627 is attached to internal ring 15624.In various embodiments, interior attachment 15622 and the head example of outer attachment 15623 As any suitable shape can be included, the most circular, avette and/or oval.Cervical region 15626 and/or 15627 may also include appoints What suitable shape, the most at least one embodiment, is connected to the neck of internal ring 15624 by the head of outer attachment 15623 Portion 15627 can extend between the adjacent nail chamber, inner side 15612 in support section 15610 so that cervical region 15627 is not caught Obtain in the nail disposed from nail chamber 15612, inner side.

In various embodiments, referring now to Figure 34 7 and Figure 34 8, flexible tissue thickness's compensating part 15720 such as can wrap Include circle or the flexible outer shroud 15724 of annular.In certain embodiments, outer shroud 15724 may be structured to make it not be captured In the nail that surgical stapling device 15600 is disposed；But, at least one embodiment, outer shroud 15724 can be relative to outside Nail chamber 15613 row be located radially outward.In at least one this type of embodiment, tissue thickness's compensating part 15720 can include such as The multiple attachments extended from it, such as interior attachment 15622 and outer attachment 15623 so that when nail deformation, attachment can At least partly captured in nail.More specifically, referring first to Figure 34 7, each interior attachment 15622 can include such as head portion: This head is positioned on the nail chamber 15612 being defined in surgical stapling device 15600, and wherein head such as can pass through cervical region 15726 are attached to outer shroud 15724；And the most each outer attachment 15623 can include such as head portion: this head is positioned in On the nail chamber 15613 being defined in surgical stapling device 15600, wherein head such as can be attached to outer shroud by cervical region 15727 15724.In various embodiments, the head of interior attachment 15622 and outer attachment 15623 such as can include any suitable shape Shape, the most circular, avette and/or oval.Cervical region 15726 and/or 15727 may also include any suitable shape, Qi Zhong In at least one embodiment, the cervical region 15727 that the head of interior attachment 15622 is connected to outer shroud 15724 can be adjacent Outside extends between nail chamber 15613 so that cervical region 15726 is not trapped in the nail disposed from nail chamber 15613, outside.At some In alternative embodiment, tissue thickness's compensating part can include circle or the flexible internal ring of annular, circular or annular flexibility Outer shroud and be in addition connectable to multiple attachments of internal ring and/or outer shroud.In at least one embodiment, some is attached Fitting is connectable to internal ring, and some other attachment is connectable to outer shroud.In certain embodiments, in attachment at least Some are connectable to internal ring and outer shroud.Under any circumstance, to being described further above, tissue thickness's compensating part The internal ring 15624 of 15620, the outer shroud 15724 of tissue thickness's compensating part 15720 and/or any other suitable tissue thickness are mended Repaying part can elastic stretch and/or contraction, in order to adapt to stretching, extension and/or the contraction of tissue, this tissue thickness's compensating part against This tissue is implanted.Although additionally, various embodiment is being described herein as including circle or annular brace ring, but tissue thickness Degree compensating part can include the supporting construction of any suitable shape for attachment is connected to it.In various embodiments, right It is described further above, surgical stapling device advances the tissue being trapped between anvil block and support section is cut The circular knife cut also can cut backing material.In at least one this type of embodiment, cutter can such as can be by cutting attachment Inside support ring is separated by cervical region with attachment.

In various embodiments, to being described further above, tissue thickness's compensating part can include separable and/or The most movable position, this position can make tissue thickness's compensating part stretch and/or shrink, in order to adapt to the motion of tissue, This tissue thickness's compensating part is implanted against this tissue.Referring now to Figure 34 9 and Figure 35 0, when tissue thickness's compensating part 15820 Just against when organizing implanted, circular or annular tissue thickness's compensating part 15820 can be against being maintained at un-extended position The platform surface 15611 of the surgical stapling device 15600 of (Figure 34 9) positions, and/or by being maintained at the surgery of un-extended position The platform surface 15611 of stiching instrument 15600 supports；After tissue thickness's compensating part 15820 is the most implanted, tissue thickness's compensating part 15820 can flex outward, as shown in Figure 35 0.In various embodiments, tissue thickness's compensating part 15820 can include multiple bow Shape part 15822, the plurality of arcuate section such as can be joined together by internal ring 15824.In at least one embodiment, Arcuate section 15822 can be separated from each other by seam 15828.In at least one other embodiment, arcuate section 15822 can be each other Connecting, wherein at least one this type of embodiment, the structure in hole can make arcuate section 15822 be separated from each other.In any one In the case of, in various embodiments, arcuate section 15822 such as can include interlocking structure, such as protuberance 15826 and recess 15823, this interlocking structure can cooperate with limiting between arcuate section 15822 before tissue thickness's compensating part 15820 is implanted Relative motion.To being described further above, each arcuate section 15822 such as can pass through one or more adapters 15827 are connected to internal ring 15824, and arcuate section 15822 can be releasably held in place by these one or more adapters.When Use the nail 10030 that nail is such as stored in support section 15610 against tissue implanting tissue thickness compensation part 15620 After, referring first to Figure 35 0, adapter 15827 can separate with internal ring 15824, and makes tissue thickness's compensating part 15820 at least part of Stretch to adapt to the motion in tissue below.In all cases, all arcuate sections 15822 can separate with internal ring 15824, And in other cases, more only can separate with internal ring 15824 in arcuate section 15822.In some alternative enforcement In example, arcuate section 15822 can be connected by flexible portion, and this flexible portion can make arcuate section 15822 be movable with respect to But it is the most separated from one another.In at least one this type of embodiment, flexible portion can not accommodate nail wherein, and can stretch and/or Shrink with the relative motion adapting to arcuate section 15822.In the embodiment shown in Figure 34 9 and Figure 35 0, tissue thickness's compensating part 15820 such as can include eight arcuate sections 15822.In some other embodiment, tissue thickness's compensating part such as can include Any appropriate number of arcuate section, such as two or more arcuate sections.

To being described further above, tissue thickness's compensating part 15620,15720 and/or 15820 such as can compensate for It is trapped in the thicker and/or relatively thin tissue between the support section 15610 of anvil block and surgical instruments 15600.In various realities Execute in example, similarly as described above, can by towards and/or carry out the shaping of regulating nail away from support section 15610 motion anvil block Or percussion height.More specifically, anvil block is moveable to closer to support section 15610 to reduce the forming height of nail, and corresponding Ground, anvil block can be moved further into away from support section 15610 to increase the forming height of nail.In this type of embodiment, because of This, anvil block can be adjusted to process thickness tissue away from support section 15610 with responsible by surgeon, and is adjusted to towards support Part 15610 is with responsible process thin tissue.In other embodiments various, surgeon can determine not regulate anvil block, and relies on Tissue thickness's compensating part is responsible for processing relatively thin and/or thicker tissue.In various embodiments, therefore, surgical instruments 15600 Can include that at least two device is for compensating different tissue thicknesses and/or tissue thickness's change.

In various embodiments, as it has been described above, tissue thickness's compensating part could attach to the support section of nail bin.Real at some Executing in example, the lower surface of tissue thickness's compensating part can include hook layer or overlap the one in circular layer, and the platform table of support section Face can include the another one in hook layer and set circular layer.In at least one this type of embodiment, hook and the collar can be engaged with each other also Tissue thickness's compensating part is releasably held support section.In various embodiments, each hook such as can include from cervical region The head of the expansion extended.In certain embodiments, the multiple pads including the collar such as can be adhered to tissue thickness's compensating part Lower surface, and include that multiple pads of hook can be adhered to the platform surface of support section.In at least one embodiment, supporting part Dividing and such as can include one or more hole and/or groove, these one or more holes and/or groove can accommodate wherein and include hook And/or the insert of the collar.In addition to the above or replace mentioned above, tissue thickness's compensating part such as can use this Class hook and the collar are removably attachable to anvil block.In various embodiments, hook and the collar such as can include fiber surface.

In various embodiments, as it has been described above, nail bin can include support section and be attached to the tissue thickness of support section Compensating part.In certain embodiments, as also described above, support section can include that the longitudinal direction that can accommodate cutting element wherein is narrow Groove, and tissue thickness's compensating part can include being maintained at the holding component in longitudinal slit.In at least one embodiment, Referring now to Figure 38 6, nail bin 16000 can include support section 16010, and this support section includes platform surface 16011 and longitudinal direction Slit 16015.Nail bin 16000 may also include the tissue thickness's compensating part 16020 being positioned at above platform surface 16011.Respectively Planting in embodiment, tissue thickness's compensating part 16020 can include that the longitudinal direction extended downwardly in longitudinal slit 16015 keeps component 16025.In at least one this type of embodiment, keep component 16025 can be pressed down in slit 16015 to keep component Interaction between 16025 and slit 16015 can be resisted between support section 16010 and tissue thickness's compensating part 16020 Relative motion.In various embodiments, the main body of tissue thickness's compensating part 16020 can be made up of the first material, and keeps structure Part 16025 can be made up of second or different materials.In certain embodiments, the main body of tissue thickness's compensating part 16020 can be by having The material having the first hardness is constituted, and keeps component 16025 can be made up of the material with the second hardness, wherein the second hardness Such as can be higher than the first hardness.In use, at least one embodiment, nail 10030 can be pushed up by staple drivers 10040 It is dynamic so that the end of nail 10030 may pass through the main body of tissue thickness's compensating part 16020 and exposes from tissue contacting surface 16021, And at least some of against target tissue capture tissue thickness compensation part 16020.In various embodiments, when nail 10030 just by During deployment, the cutting element through slit 16015 can crosscutting holding component 16025.Once tissue thickness's compensating part 16020 by Implant, in various embodiments, keep component 16025 to be pulled out slit 16015.In some other embodiment, tissue thickness The main body of degree compensating part 16020 can separate with keeping component 16025.

Referring now to Figure 38 7 and Figure 38 9, nail bin 17000 can include support section 17010, and this support section includes platform Surface 17011 and longitudinal slit 17015.Nail bin 17000 may also include the tissue thickness's benefit being positioned at above platform surface 17011 Repay part 17020.In various embodiments, tissue thickness's compensating part 17020 can include extending downwardly in longitudinal slit 17015 Longitudinally keep component 17025.In at least one this type of embodiment, keep component 17025 can be pressed down in slit 17015, Make to keep the interaction between component 17025 and slit 17015 can resist support section 17010 and tissue thickness's compensating part Relative motion between 17020.In various embodiments, component 17025 is kept to can extend across whole tissue thickness compensating part 17020 to its top surface 17021, and wherein the main part 17024 of tissue thickness's compensating part 17020 could attach to keep component The opposite side of 17025.In at least one this type of embodiment, keep component 17025 can also such as resist tissue thickness and compensate The lateral deflection of part 17020.In various embodiments, main part 17024 can be made up of the first material, and keeps component 17025 can be made up of second or different materials.In certain embodiments, main part 17024 can be by the material with the first hardness Material is constituted, and keeps component 17025 can be made up of the material with the second hardness, and wherein the second hardness such as can be higher than first Hardness.In various embodiments, to being described further above, when following closely 10030 and being just deployed, through slit 17015 Cutting element can crosscutting holding component 17025.Once tissue thickness's compensating part 17020 is the most implanted, in various embodiments, protects Hold component 17025 and be pulled out slit 17015.In some other embodiment, main part 17024 can be with holding component 17025 separate.

Referring now to Figure 38 8, nail bin 18000 can include support section 18010, and this support section includes platform surface 18011 and longitudinal slit 18015.Nail bin 18000 may also include the tissue thickness's compensating part being positioned at above platform surface 18011 18020.In various embodiments, tissue thickness's compensating part 18020 can include extending downwardly into the longitudinal direction in longitudinal slit 18015 Keep component 18025.In at least one this type of embodiment, keep component 18025 can be pressed down in slit 18015 so that Keep the interaction between component 18025 and slit 18015 can resist support section 18010 and tissue thickness's compensating part Relative motion between 18020.In various embodiments, component 18025 is kept to can extend across whole tissue thickness compensating part 18020 to its top surface 18021, and wherein the main part 18024 of tissue thickness's compensating part 18020 could attach to keep component The opposite side of 18025.In at least one embodiment, component 18025 is kept can to include amplifier section 18026, this amplifier section May be housed in the cavity 18016 being defined in slit 18015.In at least one this type of embodiment, amplifier section 18026 can Resist and keep component 18025 to withdraw from from slit 18015.

Can i.e. process after being designed as being intended for single use by device disclosed in this invention, or can they be designed as can It is used for multiple times.But, in either case, described device all can be repaired, to reuse after using at least one times. Again the combination in any that can comprise the steps is repaired: dismantle this device, then clean or replace some part and group subsequently Dress.Specifically, described device can be dismantled, and it is any number of the most optionally to replace or remove this device Specific component or part.Clean and/or after displacement specific part, this device can re-assembly so that subsequently at restoration facilities Use, or will be re-assemblied by surgical team before carrying out surgical operation.Those skilled in the art is it will be appreciated that fill That puts repairs the available multiple technology for dismantling, clean/replace and re-assemblying.The use of these technology and gained Prosthetic device is within the scope of the present invention.

Preferably, device as herein described is processed before surgery.First, obtain new or used device, and must When wanting, device is cleaned.Then device is carried out disinfection.In a kind of disinfection technology, this device is placed in Guan Bi and seals Container in, such as in plastics or TYVEK bag.Then container and device are placed in the radiation area that can penetrate this container, such as Gamma-radiation, x-ray or high energy electron.Radiate and the antibacterial on device and in container is killed.Then the device after sterilizing is preserved In disinfecting container.Apparatus is kept aseptic by this sealing container, until opening this container in armarium.

Any patent, announcement or other the open materials in full or being partly expressly incorporated herein with way of reference the most only also The material entered is not expressly incorporated herein with in existing definition of the present invention, statement or other open afoul scopes of material.By This, under necessary degree, replacement is incorporated by reference any phase punching herein by the disclosure herein explicitly illustrated Prominent material.If according to state be incorporated by reference herein but with existing definition as herein described, statement or other open materials Afoul any material or its part, only do not produce the degree of conflict between the material being incorporated to and existing open material Under be expressly incorporated herein.

Although the present invention being described as exemplary design, it is also possible in the spirit and scope of the disclosure In the present invention is modified.Therefore present patent application is intended to use any modification pattern of its general principles, use Way or remodeling.Additionally, present patent application be intended in art of the present invention to come from known or used have in practical framework de- Pattern from the disclosure.

Claims

1. a nail bin, including:

Warehouse, described warehouse includes multiple nail chamber；

Multiple nails, at least some of of the most each described nail is stored in a described nail intracavity, the most each institute removedly State nail to move between non-firing position and firing position, and the most each described nail includes not firing height and percussion Highly；And

Including the implanted tissue thickness compensating part of uncompressed height, described uncompressed height is described equal to or higher than described nail Percussion height, wherein said tissue thickness compensating part is made up of single continuous sheet and can capture at the plurality of nail In, and wherein said tissue thickness compensating part can take different compression heights in different described nails.

Nail bin the most according to claim 1, wherein said tissue thickness compensating part is made up of porous material, described porous material Material has the porosity more than 85%.

Nail bin the most according to claim 1, wherein said tissue thickness compensating part is made up of elastomeric material, described elastic material Material has the hardness less than 15 Durometer A hardness.

Nail bin the most according to claim 1, the described uncompressed height of wherein said tissue thickness compensating part is less than described The twice of the described percussion height of nail.

Nail bin the most according to claim 1, the described uncompressed height of wherein said tissue thickness compensating part is described nail Described percussion height twice.

Nail bin the most according to claim 1, the described uncompressed height of wherein said tissue thickness compensating part is described nail Described percussion height three times.

Nail bin the most according to claim 1, the described uncompressed height of wherein said tissue thickness compensating part is described nail Described percussion height four times.

Nail bin the most according to claim 1, described in the described uncompressed aspect ratio of wherein said tissue thickness compensating part not The same solid height in compression height big at least 50%.

Nail bin the most according to claim 1, described in the described uncompressed aspect ratio of wherein said tissue thickness compensating part not The same solid height big 10% in compression height.

Nail bin the most according to claim 8, described in the described uncompressed aspect ratio of wherein said tissue thickness compensating part not The same solid height in compression height is greatly less than 100 times.

11. nail bins according to claim 1, also include:

Multiple staple drivers that described nail moves between its non-firing position and its firing position can be made；And

Described warehouse can be traversed and promote the sliding part of described staple drivers.

12. 1 kinds of nail bins, including:

Warehouse, described warehouse includes multiple nail chamber；

Including the implanted tissue thickness compensating part of uncompressed height, wherein said tissue thickness compensating part is by single continuous print bullet Property material piece constitute, described elastomeric material has the hardness less than 15 Durometer A hardness, and wherein said tissue thickness compensating part can Capture is in the plurality of nail, and wherein said tissue thickness compensating part can take different pressures in different described nails Contracting height.

13. nail bins according to claim 12, wherein said tissue thickness compensating part is made up of porous material, described porous Material has the porosity more than 85%.

14. nail bins according to claim 12, the described uncompressed height of wherein said tissue thickness compensating part is higher than institute State the described percussion height of nail, and the twice of the described percussion height less than described nail.

15. nail bins according to claim 12, the described uncompressed height of wherein said tissue thickness compensating part is higher than institute State the described percussion height of nail, and be described fire height three times of described nail.

16. nail bins according to claim 12, the described uncompressed height of wherein said tissue thickness compensating part is higher than institute State the described percussion height of nail, and be described fire height four times of described nail.

17. nail bins according to claim 12, described in the described uncompressed aspect ratio of wherein said tissue thickness compensating part The different solid height in compression height big at least 50%.

18. nail bins according to claim 11, described in the described uncompressed aspect ratio of wherein said tissue thickness compensating part The different solid height in compression height is greatly less than 100 times.

19. nail bins according to claim 8, also include:

20. 1 kinds of nail bins, including:

Warehouse, described warehouse includes multiple nail chamber；

Including the implanted tissue thickness compensating part of uncompressed height, wherein said tissue thickness compensating part is by single continuous and many The material piece in hole is constituted, and described porous material has the porosity of at least 85%, and wherein said tissue thickness compensating part can be caught Obtain in the plurality of nail, and wherein said tissue thickness compensating part can take different compressions in different described nails Highly.

21. nail bins according to claim 20, wherein said tissue thickness compensating part is made up of elastomeric material, described elasticity Material has the hardness less than 15 Durometer A hardness.

22. nail bins according to claim 20, the described uncompressed height of wherein said tissue thickness compensating part is higher than institute State the described percussion height of nail, and the twice of the described percussion height less than described nail.

23. nail bins according to claim 20, described in the described uncompressed aspect ratio of wherein said tissue thickness compensating part The different solid height in compression height big at least 50%.

24. nail bins according to claim 20, described in the described uncompressed aspect ratio of wherein said tissue thickness compensating part The different solid height in compression height is greatly less than 100 times.

25. nail bins according to claim 20, also include:

26. 1 kinds of nail bins, including:

Including the warehouse in multiple nail chambeies, the plurality of nail chamber arranges along stringer；

Implanted tissue thickness compensating part, described implanted tissue thickness compensating part is made up of single continuous sheet and combines The plurality of nail work, provides variable compression stress with the tissue between along described stringer for described nail.