阅读说明：本技术 被构造成能够与辅料材料配合的端部执行器 (It is configured to the end effector cooperated with dressing material ) 是由 F·E·谢尔顿四世 J·L·哈里斯 P·武尔霍普 M·J·温德里 G·斯科特 K·威多克 于 2018-02-13 设计创作，主要内容包括：本发明公开了一种与外科器械中的端部执行器一起使用的辅料材料,该辅料材料具有至少一个突起部,该至少一个突起部被构造成能够与形成在该端部执行器的至少一个钳口诸如仓或砧座中的对应凹陷部配合。该至少一个突起部可以是在该辅料材料的远侧端部和近侧端部之间延伸的一个或多个离散突起部或一个或多个纵向突起部。施用器构件可以用于向该辅料材料施加力,从而使该辅料材料与该端部执行器的该钳口配合。该施用器构件可以被构造成能够保持该辅料材料,并且可以被夹紧在该端部执行器的该钳口之间以将该辅料材料释放到该钳口上。另外,施用器构件可以用于将辅料材料的各部分推入到钳口中的对应凹陷部中。(The invention discloses a kind of dressing materials that the end effector with surgical instruments is used together, the dressing material has at least one protrusion, which is configured to cooperate with the corresponding recessed portion at least one the jaw such as storehouse or anvil block that are formed in the end effector.At least one protrusion can be the one or more discrete projections portions extended between the distal end and proximal end of the dressing material or one or more longitudinal protrusions.Applicator component can be used for the dressing material applied force, so that the jaw of the dressing material and the end effector be made to cooperate.The applicator component can be configured to keep the dressing material, and can be clamped between the jaw of the end effector so that the dressing material to be discharged on the jaw.In addition, in the correspondence recessed portion that applicator component can be used for for each section of dressing material being pushed into jaw.)

1. a kind of end effector for surgical instruments, comprising:

First jaw, first jaw have storehouse, and the storehouse, which has, to be configured in the multiple nail cavities for wherein disposing nail, Surface upper opening towards tissue of the nail cavity in the storehouse；

Second jaw, second jaw is opposite with first jaw and has anvil block, and the anvil block, which has, is formed in it Multiple nail forming cavities on surface towards tissue, wherein first jaw and second jaw are configured to clamp Tissue between the two；

At least one recessed portion, at least one described recessed portion are formed in first jaw and second jaw at least In one jaw；

Dressing material, the dressing material have at least one protrusion, at least one described protrusion be configured to The cooperation of described at least one recessed portion is the dressing material to be maintained at least one described jaw, and described at least one is prominent The portion of rising is arranged at the proximal end and distal end of the dressing material；

Applicator component can be removed, the removable applicator component is configured to the dressing material applied force, with Just at least one described protrusion of the dressing material is made to be accepted in the correspondence being formed at least one described jaw recessed In concave portion, so that the dressing material be made to be releasably mating with at least one described jaw.

2. end effector according to claim 1, wherein at least one described protrusion includes being formed in the auxiliary material It at least one first discrete projections portion at the distal end of material and is formed at the proximal end of the dressing material extremely A few second discrete projections portion, and at least one the described recessed portion being wherein formed at least one described jaw includes The first recessed portion for being formed at the distal end of at least one jaw and the nearside for being formed at least one jaw Second recessed portion of end.

3. end effector according to claim 1, wherein the applicator component be removably coupled to it is described at least One jaw.

4. end effector according to claim 1, wherein the applicator component is configured to releasedly protect The dressing material is held, to release when the applicator component is clamped between first jaw and second jaw Put the dressing material.

5. end effector according to claim 1, wherein the applicator component includes at least one applicator component Protrusion, at least one described applicator component protrusion are formed in the applicator component towards the dressing material At upper position corresponding with the position of at least one protrusion of the dressing material.

6. end effector according to claim 4, wherein when the applicator component is configured to described auxiliary When expecting that material applies the power, at least one described applicator component protrusion is configured to make the institute of the dressing material At least one protrusion is stated at least partly to be accepted at least one described recessed portion.

7. end effector according to claim 4 further includes polymer attachment layer, the polymer attachment layer is constructed At can be located between at least one described jaw and the dressing material, the polymer attachment layer include at least one the Two protrusions, at least one described second connecting portion are formed in the polymer attachment layer towards the dressing material At position corresponding with the position of at least one protrusion described in the dressing material.

8. end effector according to claim 7, wherein when the applicator component is configured to described auxiliary Described in material material and the polymer attachment layer being located between at least one described jaw and the dressing material apply When power, at least one described applicator component protrusion is configured to make at least one described protrusion of the dressing material At least one described second connecting portion of portion and the polymer material is at least partly accepted at least one described recess In portion.

9. end effector according to claim 1, wherein at least one described protrusion includes being formed in the auxiliary material First longitudinal direction protrusion on the side of material and be formed in the dressing material another, it is second on opposite side vertical To protrusion, the distal end and nearside of the first longitudinal direction protrusion and the second longitudinal direction protrusion in the dressing material Extend between end.

10. end effector according to claim 6, wherein the first longitudinal direction protrusion and the second longitudinal direction are prominent At least one of the portion of rising has the mating features being formed thereon, and the mating features is configured to be accepted in In the correspondence recessed portion of at least one recessed portion, and wherein, at least one described longitudinal protrusion is by least partly Material flexible is formed, so that the longitudinal direction is prominent when at least one described longitudinal protrusion is accepted in corresponding recessed portion The portion of rising is shunk because of the power that the applicator component applies, and is then expanded and to be adapted be received in the recessed portion It is interior.

11. end effector according to claim 1, wherein be formed on the dressing material it is described at least one Protrusion includes multiple discrete projections portions, and the multiple discrete projections portion is formed and had by least partly flowable material There is variable configuration, so that when the applicator component applies the power so that in the discrete projections portion to the dressing material When each is at least partly accepted in the correspondence recessed portion at least one described jaw, at least partly it is accepted in The configuration in each discrete projections portion in the corresponding recessed portion changes to conform to the configuration of the corresponding recessed portion.

12. end effector according to claim 11, wherein each of described discrete projections portion is adapted to It is enough to separate and be retained in the recessed portion with the dressing material after the nail is shaped against the nail forming cavity, The dressing material to be applied to the tissue being clamped between first jaw and second jaw.

13. a kind of end effector for surgical instruments, comprising:

First jaw, first jaw have storehouse, and the storehouse, which has, to be configured in the multiple nail cavities for wherein disposing nail, Surface upper opening towards tissue of the nail cavity in the storehouse；

Second jaw, second jaw is opposite with first jaw and has anvil block, and the anvil block, which has, is formed in it Multiple nail forming cavities on surface towards tissue, wherein first jaw and second jaw are configured to clamp Tissue between the two；

Multiple recessed portions, the multiple recessed portion are formed at least one jaw in first jaw and second jaw In；

Dressing material, the dressing material are formed by least partly stretchable material；

Applicator component, the applicator component have multiple protrusions, and each of the multiple protrusion is configured to It can cooperate with the corresponding recessed portion at least one described jaw, the applicator component is configured to the auxiliary material Material applied force, so as to make each protrusion being formed on the applicator component be accepted in be formed in it is described at least one In correspondence recessed portion in jaw, to make to be arranged in described auxiliary between at least one described jaw and the applicator component A part of material material is releasably held in the corresponding recessed portion at least one described jaw.

14. end effector according to claim 13, wherein be formed in the multiple at least one described jaw At least one of recessed portion have at least one keep features, it is described at least one keep features be configured to by Described a part of the dressing material is releasably held in the corresponding recessed portion.

Technical field

The present disclosure relates generally to the dressing materials that the end effector with surgical instruments is used together.

Background technique

Surgical stapling device is used in surgical operation, to close at tissue, blood vessel involved in particular procedure, conduit, divide Opening in flow tube or other objects or body part.These openings such as blood vessel or can be similar to stomach to be naturally occurring Internal in access or they can such as pass through puncture group to be formed during surgery by surgeon It knits or blood vessel is to form bypass or anastomotic part or by cutting tissue during suture operation.

Most of suture tool pelmatozoas, the shank have elongated shaft, which has one be formed on its end To movable opposite jaw, for keeping following closely between jaw and shaping nail.Nail is generally held in nail bin, the nail Storehouse can accommodate multiple rows of nail and one of be generally arranged at two jaws in inject to surgical site for that will follow closely.It is using Period, jaw are positioned such that object to be stapled is arranged between jaw, and in jaw closure and device actuating It projects nail and shapes.Some stitching unstruments include knife, which is configured to advance between the staple in nail bin, with longitudinal direction Suture tissue between ground cutting and/or opening staple.

Although surgical stapling device has been subjected to be improved for many years, there are still multiple problems for their own.One common problem encountered is that When nail penetrates other objects of tissue or in which setting nail leakage can be generated because nail forms hole.Blood, air, gastro-intestinal Fluid, It can be oozed out and by following closely the opening formed with other fluids, even after nail is fully formed.Processed tissue can also Wound and inflammation caused by reason sutures.In addition, in combination be similar to the operation of suture come the nail being implanted into and other objects and Material is generally deficient of some features for the tissue that they are implanted into.For example, nail and other objects and material can lack their institutes The natural flexibility of the tissue of implantation.It will be appreciated by the person skilled in the art that after being woven in nail setting wherein it is generally desirable to group Keep its natural feature as much as possible.

Therefore, it is still necessary to improved device and method, for suturing tissue, blood vessel, conduit, isocon or other are right As or body part so that leakage and inflammation minimize and are still kept substantially the physical feature for the treatment of region simultaneously.

Summary of the invention

In one aspect, a kind of end effector for surgical instruments, in some embodiments, the end are provided Actuator include in the first jaw, the second jaw and at least one jaw for being formed in the first jaw and the second jaw extremely A few recessed portion.First jaw has storehouse, which, which has, is configured in the multiple nail cavities for wherein disposing nail, these nails Surface upper opening towards tissue of the chamber in storehouse.Second jaw opposite with the first jaw has anvil block, which, which has, forms Multiple nail forming cavities on its surface towards tissue.First jaw and the second jaw are configured to clamp between the two Tissue.End effector includes dressing material, which has at least one protrusion, at least one protrusion is by structure Cause to cooperate at least one recessed portion so that dressing material to be maintained at least one jaw, this at least one it is prominent The portion of rising is arranged at the proximal end and distal end of dressing material.End effector further includes that applicator structure can be removed Part, this can be removed applicator component and is configured to dressing material applied force, so as to make dressing material at least one is prominent The portion of rising is accepted in the correspondence recessed portion being formed at least one jaw, to make dressing material and at least one pincers Mouth is releasably mating with.

End effector can any one of in various ways variation.For example, at least one protrusion can be formed in At least one first discrete projections portion at the distal end of dressing material and be formed at the nearside of dressing material at least one The form in a second discrete projections portion, wherein at least one recessed portion being formed at least one jaw is formed at least one The first recessed portion at the distal end of a jaw and the second recessed portion being formed at the proximal end of at least one jaw Form.

Applicator component can have a variety of configurations.For example, applicator component can be removably coupled at least one Jaw.In some embodiments, applicator component can be configured to releasably hold dressing material, to apply Dressing material is discharged when being clamped between the first jaw and the second jaw with device component.In some embodiments, applicator Component may include at least one applicator component protrusion, at least one applicator component protrusion towards dressing material, and And it is formed on applicator component at position corresponding with the position of at least one protrusion of dressing material.When applicator component When being configured to dressing material applied force, at least one applicator component protrusion is configured to make dressing material At least one protrusion be at least partly accepted at least one recessed portion.

In some embodiments, end effector further includes polymer attachment layer, which is configured to It can be located between at least one jaw and dressing material, polymer attachment layer includes at least one second connecting portion, this is extremely A few second connecting portion is formed at least one protrusion in polymer attachment layer with dressing material towards dressing material At the corresponding position in the position in portion.When applicator component is configured to dressing material and is located at least one jaw When polymer attachment layer applied force between dressing material, at least one applicator component protrusion is configured to make auxiliary At least one second connecting portion of at least one protrusion and polymer material for expecting material is at least partly accepted in this extremely In a few recessed portion.

In some embodiments, at least one protrusion of dressing material includes being formed on the side of dressing material First longitudinal direction protrusion and be formed in dressing material another, the second longitudinal direction protrusion on opposite side either formed The first longitudinal direction protrusion on the side of dressing material and be formed in dressing material another, second on opposite side The distal end and proximal end of the form of longitudinal protrusion, first longitudinal direction protrusion and second longitudinal direction protrusion in dressing material Between extend.

In some embodiments, at least one of first longitudinal direction protrusion and second longitudinal direction protrusion can have shape At mating features on it, which is configured to be accepted in the corresponding recess of at least one recessed portion In portion.At least one longitudinal protrusion can be formed by least partly material flexible, so that when at least one longitudinal protrusion When portion is accepted in corresponding recessed portion, which shrinks because of the power that applicator component applies, and then expands To be adapted it is received in recessed portion.

In some embodiments, at least one protrusion being formed on dressing material include multiple discrete projections portions or Person is the form in multiple discrete projections portions, and multiple discrete projections portions are formed by least partly flowable material and had can Allosteric type, so that when applicator component is to dressing material applied force so that each of discrete projections portion is at least partly connect When being contained in the correspondence recessed portion at least one jaw, each of at least partly it is accepted in corresponding recessed portion discrete prominent The configuration in the portion of rising changes to conform to the configuration of corresponding recessed portion.Each of discrete projections portion is configured to support in nail After nail forming cavity forming, separates and be retained in recessed portion with dressing material, dressing material is applied to clamped Tissue between the first jaw and the second jaw.

On the other hand, a kind of end effector for surgical instruments, in some embodiments, the end are provided Actuator include the first jaw, the second jaw, formed at least one jaw in the first jaw and the second jaw it is multiple Recessed portion, by dressing material and applicator component that at least partly stretchable material is formed.First jaw has storehouse, should Storehouse, which has, to be configured in the multiple nail cavities for wherein disposing nail, surface upper opening towards tissue of these nail cavities in storehouse. Second jaw opposite with the first jaw has an anvil block, the anvil block have multiple nails for being formed on its surface towards tissue at Shape chamber.First jaw and the second jaw are configured to clamp tissue between the two.Applicator component has multiple protrusions, Each of multiple protrusions are configured to cooperate with the corresponding recessed portion at least one jaw, and applicator structure Part is configured to dressing material applied force, to make each protrusion being formed on applicator component be accepted in shape At in the correspondence recessed portion at least one jaw, to make to be arranged between at least one jaw and applicator component A part of dressing material is releasably held in the correspondence recessed portion at least one jaw.

End effector can any one of in various ways variation.For example, being formed in multiple at least one jaw At least one of recessed portion can have at least one and keep features, which is configured to A part of dressing material is releasably held in corresponding recessed portion.

Detailed description of the invention

By the way that the disclosure will be more fully understood below in conjunction with detailed description made by attached drawing, in the accompanying drawings:

Fig. 1 is the perspective view of an embodiment of surgical stapling device；

Fig. 2 is the exploded view of the distal part of the surgical stapling device of Fig. 1；

Fig. 3 is the perspective view of the trigger shaft of the surgical stapling device of Fig. 1；

Fig. 4 is the perspective view of another embodiment of surgical stapling device；

Fig. 5 is the perspective view of another embodiment of surgical stapling device；

Fig. 6 is according to the perspective partial exploded view of the end effector of the technology, which has releasable Ground dressing material mounted thereto；

Fig. 7 is the partial exploded side view of the end effector of Fig. 6；

Fig. 8 A is the cross-sectional view of the dressing material of Fig. 7 and a part of polymeric layer material；

Fig. 8 B is the cross-sectional view of a part of the end effector of Fig. 7, which has releasedly protects thereon Hold the dressing material of polymeric layer material；

Fig. 9 is that the end effector, which has, to be releasably attached to according to the perspective view of the end effector of the technology Dressing material thereon；

Figure 10 is the perspective view of applicator component, which is configured to dressing material being applied to Fig. 9 End effector；

Figure 11 is the cross-sectional view for releasably holding a part of the end effector of Fig. 9 of dressing material thereon；

Figure 12 is according to the perspective partial exploded view of the end effector of the technology, which has releasable Ground the first dressing material and the second dressing material mounted thereto；

Figure 13 is the perspective partial exploded view of the end effector of Figure 12, shows the of the tissue for being applied to patient's body One dressing material and the second dressing material；

Figure 14 is the perspective view of applicator component, which is configured to the first dressing material and second Dressing material is applied to the end effector of Figure 12；

Figure 15 is to be formed with recess on the jaw according to the perspective diagram of the jaw of the end effector of the technology Portion, the recessed portion are configured to cooperate with each section of dressing material；

Figure 16 is that the jaw of Figure 15 and the perspective diagram of applicator component, the applicator component are configured to make Each section of dressing material is accepted in the recessed portion in jaw；

Figure 17 be Figure 15 jaw perspective diagram, show be received in using applicator component it is recessed in jaw Each section of dressing material in concave portion；

Figure 18 is that the end effector, which has, to be releasably attached to according to the perspective view of the end effector of the technology Dressing material thereon；

Figure 19 is the cross-sectional view for releasably holding the end effector of Figure 18 of dressing material thereon；

Figure 20 is that the end effector, which has, to be releasably attached to according to the perspective view of the end effector of the technology Dressing material thereon；

Figure 21 is the perspective view of applicator component, which is configured to dressing material being applied to Figure 20 End effector；And

Figure 22 is the cross-sectional view for releasably holding a part of the end effector of Figure 20 of dressing material thereon.

Specific embodiment

Certain exemplary implementation schemes will now be described, structure, function with offer to apparatus and method as disclosed herein Can, manufacture and purposes principle comprehensive understanding.One or more examples of these embodiments are shown in the accompanying drawings.This field Technical staff will be understood that specifically described herein and devices, systems, and methods being shown in the accompanying drawings are non-limited Exemplary implementation scheme, and the scope of the present invention is limited only by the appended claims.Show in conjunction with an exemplary implementation scheme Out or the features of description can be combined with the features of other embodiments.Such modifications and variations are intended to be included in this hair Within the scope of bright.

In addition, in the disclosure, the similar component of title usually has a similar features in each embodiment, therefore In specific embodiment, each features of the similar component of each title are not necessarily completely illustrated.In addition, disclosed Using in the linear or degree of circular dimension in the description of systems, devices and methods, such size is not intended to limit combinable The type for the shape that such systems, devices and methods use.Those skilled in the art are it will be recognized that be directed to any geometry It can easily determine such linear and circular dimension equivalent dimension.System and the size and shape of device and its component can be at least The component that will be used therewith the anatomical structure, system and device that are used for subject therein depending on system and device Size and shape and system and device will be used for method and regulation therein.

It should be appreciated that come herein in relation to the user such as clinician for grasping instrument shank using term " nearside " and " distal side ".Other spatial terminologies of such as " preceding " and " rear " correspond similarly to distally and proximally respectively.It is also understood that for just For the sake of sharp and clear, knot illustrates use space term such as "vertical" and "horizontal" herein.However, surgical instruments is in many orientations It is used on position, and these spatial terminologies and non-limiting and absolute.

In some embodiments, device and method as described herein are provided for open surgery, and In other embodiments, which is provided for laparoscopic type, endoscope type and other micro-wound surgical operations.These Device can directly be fired by human user or the long-range percussion under the directly controlling of robot or similar manipulation instrument.However, this Field the skilled person will understand that, various method and apparatus disclosed herein can be used for many surgical operations and application in.This The technical staff in field will be further understood that various instruments disclosed herein can be inserted into body in any way, such as By natural aperture, by the notch or perforation that are formed in the tissue or by entering device (such as trocar cannula).Example Such as, the working portion of the instrument or end effector portion can be directly inserted into the body of patient or can be by entering device Insertion, this enters the service aisle that there is device the end effector of surgical instruments and elongated shaft can be advanced through.

It may need that surgical instruments is combined (to be referred to as herein using one or more biomaterials and/or synthetic material For " auxiliary material ") help improve surgical operation.Although a variety of different surgical end-effectors can benefit from the use of auxiliary material, In some example embodiments, end effector can be surgical stapling device.When combine surgical stapling device in use, this one Kind or multiple auxiliary materials may be provided between the jaw of stitching unstrument and/or thereon, be integrated in the nail bin being arranged in jaw or with The neighbouring nail of other modes is placed.When disposing nail, which can be retained in together therapentic part with nail, then mention For many benefits.For example, one or more auxiliary materials can enhance the tissue for the treatment of site, prevents from being followed closely in treatment site and tear It opens or tearing.If organizing illness, treating such as irradiation treatment, pharmaceutical treatment such as chemotherapy or its hetero-organization from another kind Property changes situation healing, then tissue may be needed to enhance and tear tissue to prevent non-magnetic shim.In some cases, one or more auxiliary Material can make to follow closely in site of perforation and surrounding histokinesis (for example, atelectasis, gastrointestinal tract expansion etc.) minimizes, this group It knits the metaplasia that movement can occur after suture due to occurs.In addition, in some cases, auxiliary material can be used for being distributed to be applied by nail Pressure, thus reduce nail be drawn through tissue (it can be frangible) and can not as expected fastening tissue (so-called " line cuts milk Junket ") a possibility that.In addition, auxiliary material can be at least partly stretchable, and therefore allow at least partly transporting naturally for tissue Dynamic the expansion and contraction of lung tissue (for example, during breathing).In some embodiments, staple line can be flexible as described, example Such as, it is entitled " the Method for Creating a Flexible Staple Line " submitted on September 26th, 2014 U.S. Patent Publication 2016/0089142 in be described, the document is incorporated by reference is incorporated herein accordingly.

Those skilled in the art will recognize that nail site of perforation can be used as stress concentration portion, and work as surrounding group When knitting under tension, the size by following closely the hole formed will increase.Limiting the histokinesis around these site of perforation can make The size that hole can increase under tension minimizes.In some cases, which is configured to core The beneficial fluid for further promoting healing, such as sealant, blood, sticker are inhaled or absorb, and in some cases, this one Kind or multiple auxiliary materials are configured to degrade to form the gel for further promoting healing, such as sealant.In some cases Under, which can be used for helping to be sealed in nail and be implanted tissue, blood vessel and various other objects or body part By following closely the hole formed when middle.One or more auxiliary materials can also by any fiber associated with the one or more auxiliary materials or Interval, positioning and/or the orientation of strand are to influence tissue growth.

Surgery suturing appliance

Various surgical instruments can make in conjunction with one or more auxiliary materials disclosed herein and/or one or more medicaments With." auxiliary material " is also referred herein as " dressing material ".Surgical instruments may include surgical stapling device.Various surgeries can be used to stitch Clutch, such as linear surgical stapler and circular stapler.In general, linear staplers are configured to generate longitudinal staple line It and may include elongated nip, which has the storehouse of the longitudinal staple of the receiving for being connected to it.Elongated nip may include energy It is enough that the knife or other cutting elements that notch is generated between staple are woven in along the group being maintained in jaw.In general, circular stapler can It is configured to form annular staple line, and may include the round jaw with the storehouse for accommodating annular staple.Round jaw can Including knife or other cutting elements, the knife or other cutting elements can form notch in staple to limit across being maintained at pincers The opening of tissue in mouthful.Stitching unstrument can be used for carrying out various different surgical operations, such as thoracic surgery hand in various tissues Art or featural sursery operation.

Fig. 1 shows the linear surgery for being suitble to be used together with a kind of or more clock auxiliary materials and/or one or more medicaments and stitches One example of clutch 10.Stitching unstrument 10 generally includes handle assembly 12, prolongs from the distal end 12d of handle assembly 12 towards distal side The axis 14 stretched, and the end effector 30 at the distal end 14d of axis 14.End effector 30 has opposite lower pincers Mouth and upper jaw 32,34, but other kinds of end effector can be with axis 14, handle assembly 12 and portion associated there Part is used together.As shown in Fig. 2, lower jaw 32 has the nail channel 56 (referring to fig. 2) for being configured to support nail cartridge 40, and And upper jaw 34 has towards lower jaw 32 and is configured to the nail that can help to dispose nail bin 40 as anvil block operation Anvil faces 33 (nail be blocked in fig. 1 and 2).At least one of the opposite lower jaw and upper jaw 32,34 energy It is enough to move relative to the other of lower jaw and upper jaw 32,34 to clamp the tissue being disposed there between and/or other objects. In some specific implementations, at least one of the opposite lower jaw and upper jaw 32,34 be can be fixed or with other Mode is immovable.In some specific implementations, both the opposite lower jaw and upper jaw 32,34 can be movable.(energy Hinge movement is enough surrounded, and can also rotatably be moved around the axis of axis), the component (quantity of trigger system) can be with At least part across end effector 30 is configured to will follow closely in the tissue for injecting to clamping.In various specific realities Shi Zhong, blade 36 (referring to Fig. 3) or other cutting elements can be associated with trigger system to cut tissue during suture operation. The nail that cutting element is configured to and is emitted at least partly cuts tissue simultaneously.In some cases, if Nail has been emitted and has organized to cut tissue after being fixed, then may be advantageous.Therefore, if surgical operation needs to cut off Capture tissue between jaw, then nail from nail bin 40 be emitted after propulsion blade 36 be clamped between jaw with cutting off Tissue.

The operation of end effector 30 can begin at user (for example, clinician, surgeon etc.) in handle assembly Input at 12.Handle assembly 12 can have many that is designed to manipulate and operate end effector 30 associated there Different configurations.In the example shown, handle assembly 12 has pistol grasping type shell 18, which, which has, sets Set the various features that instrument 10 is operated in various mechanical and/or electronic components wherein.For example, handle assembly 12 may include The knob 26 of installation adjacent with its distal end 12d, the knob can be conducive to axis 14 and/or end effector 30 around axis 14 Rotation of the longitudinal axis L relative to handle assembly 12.Handle assembly 12 may also include as the folder activated by clamping trigger 22 The firing components of the clamping component of a part of clamping system and a part as the trigger system activated by firing trigger 24. Clamping trigger 22 and firing trigger 24 can be for example biased into the open position relative to fixed handle 20 by torque spring.Folder Clamping system, which may be actuated, in the movement of tight trigger 22 towards fixed handle 20 can make jaw 32,34 towards that as described below This collapse and thus by clamp tissue between them.Trigger system may be actuated in the movement of firing trigger 24, as described below, Nail can be made to be placed in nail bin 40 therein set by it to project and/or promote blade 36 to cut off capture between jaw 32,34 Tissue.Those skilled in the art will recognize that can be used for trigger system various configurations (it is mechanical, hydraulic, pneumatic, Electromechanical, robot or other) component project nail and/or cutting tissue.

As shown in Fig. 2, the end effector 30 of shown specific implementation has as storehouse component or carries the lower jaw 32 of part With the opposite upper jaw 34 for being used as anvil block.Wherein with multiple nails nail bin 40 be supported on nail pallet 37 in, the nail pallet after And it is supported in the warehouse channel of lower jaw 32.Upper jaw 34 has multiple nail shapes pit (not shown), in the nail shapes pit Each multiple nails for being located in be self contained in nail bin 40 corresponding nail top.Although in shown specific implementation, Upper jaw 34 only has nearside pivoted end 34p in the distal side of itself and the engagement of axis 14, which pivotly connects It is contained in the proximal end 56p of nail channel 56, but upper jaw 34 can be connected to lower jaw 32 in various ways.When upper jaw 34 to When lower pivot, upper jaw 34 moves anvil faces 33 and makes the nail shapes pit being formed thereon towards opposite nail bin 40 Movement.

Various clamping components can be used to realize the opening and closing of jaw 32, jaw 34 selectively to clamp between the two Tissue.As shown, the pivoted end 34p of upper jaw 34 includes closure in the distal side in itself and the pivotal attachment portion of nail channel 56 Features 34c.Accordingly, in response to clamping trigger 22, closed tube 46 is selectively in the proximally longitudinal movement phase of closed tube 46 Between assign 34 opening action of upper jaw and closed tube towards during the longitudinal movement of distal side assign 34 closed action of upper jaw, this is closed The distal end for closing pipe includes the shape of a hoof hole 46a for engaging closure feature portion 34c.As described above, in various specific implementations, end The opening and closing of portion's actuator 30 can by lower jaw 32 relative to the relative motion of upper jaw 34, upper jaw 34 relative under The relative motion of jaw 32 is realized by the movement of both jaws 32,34 relative to each other.

The firing components of shown specific implementation include the percussion in its distal end with electron beam 38 as shown in Figure 3 Bar 35.Trigger shaft 35 is included in axis 14, for example, in longitudinal trigger shaft slot 14s of axis 14, and by hitting from shank 12 Send out motion guiding.The actuating of firing trigger 24 can influence at least part of distal side that electron beam 38 passes through end effector 30 Movement, to cause the percussion for the nail being contained in nail bin 40 whereby.As shown, drawing from the distal end of electron beam 38 is outstanding The engageable wedge-shaped slides 47 as shown in Figure 2 of guiding element 39, staple drivers 48 can then be pushed up and be passed through nail by this Nail cavity 41 in storehouse 40.Moving upwards for staple drivers 48 applies upward power to each of multiple nails in storehouse 40, from And nail is pushed up into the anvil faces 33 against upper jaw 34 and generates forming nail.

Other than firing nail, electron beam 38 is further configured to be conducive to the closure of jaw 32,34, upper jaw 34 separating relative to nail bin 40, and/or capture the cutting of the tissue between jaw 32,34.In particular, a pair of of ejector pin and One or both of engageable upper jaw and lower jaw 32,34 are sold in a pair of of bottom, are executed with being advanced through end in trigger shaft 35 Jaw 32,34 is compressed toward each other when device 30.Meanwhile the knife 36 extended between ejector pin and bottom pin is configured to cut off The tissue being trapped between jaw 32,34.

When in use, surgical stapling device 10 may be provided in intubation or mouth and be arranged in surgical site.To be cut and seam The tissue of conjunction can be placed between the jaw 32,34 of surgical stapling device 10.The features of stitching unstrument 10 can by user according to It needs to manipulate to realize desired locations of the jaw 32,34 in surgical site and tissue relative to jaw 32,34.It is real Now after appropriate positioning, clamping trigger 22 can be pulled towards fixed handle 20 to activate clamping system.Clamping trigger 22 The component of clamping system can be made to work, so that closed tube 46 is advanced through at least part of axis 14 towards distal side to cause jaw 32, at least one of 34 collapse towards another one to clamp the tissue being disposed there between.It then, can be by firing trigger 24 pull towards fixed handle 20 so that the component of trigger system works, so that trigger shaft 35 and/or electron beam 38 are promoted towards distal side Across at least part of end effector 30 to realize the percussion of nail and optionally turn off the group captured jaw 32,34 It knits.

Another example of the surgical instruments of 50 form of linear surgical stapler is as shown in Figure 4.Stitching unstrument 50 usually can be with The stitching unstrument 10 of Fig. 1 is similarly constructed and uses.Similar to the surgical instruments 10 of Fig. 1, surgical instruments 50 includes having axis 54 Handle assembly 52, which extends from handle assembly towards distal side and have in the distal end of axis holds for treating the end of tissue Row device 60.The upper jaw and lower jaw 64,62 of end effector 60 are configured to that capture will be organized between them, pass through Tissue is sutured from 66 percussion nail of storehouse being arranged in lower jaw 62 and/or generates notch in the tissue.In the specific reality Shi Zhong, the attachment part 67 in the proximal end of axis 54 are configured to allow axis 54 and end effector 60 removedly attached It is connected to handle assembly 52.In particular, the mating features 68 of attachment part 67 can be with the complementary fit feature of handle assembly 52 Portion 71 cooperates.Mating features 68,71 is configured to be connected in one via the connection of such as buckle-type, bayonet type connection etc. It rises, but any amount of complementary fit features and any kind of connection can be used that axis 54 is removably coupled to shank Component 52.Although the entire axis 54 of shown specific implementation is configured to remove from handle assembly 52, in some specific realities Shi Zhong, attachment part 67 are configured to that the only distal part of axis 54 is allowed to remove.Axis 54 and/or end effector 60 can Disassembly connection allows selectively to be attached desired end effector 60 for particular procedure, and/or for multiple and different Operation recycles handle assembly 52.

Handle assembly 52 can have disposed thereon for manipulate and the one or more features of operation end actuator 60 Portion.As non-limiting example, the knob 72 being mounted in the distal end of handle assembly 52 can be conducive to axis 54 and/or end Rotation of the actuator 60 relative to handle assembly 52.Handle assembly 52 may include as the clamping system activated by movable trigger 74 The clamping component of a part of system and as can also be by the firing components of a part for the trigger system that trigger 74 activates.Cause This, in some specific implementations, trigger 74, which moves across the first actuating range towards fixed handle 70, may be actuated clamping component, make It is close to each other to reach closed position to obtain opposite jaw 62,64.In some specific implementations, in opposite jaw 62,24 only One is movable so that jaw 62,64 moves to closed position.Trigger 74 passes through second towards 70 further movement of fixed handle Firing components may be actuated in actuating range, so that nail projects from nail bin 66 and/or make knife or other cutting element (not shown) Promote tissue of the cutting capture between jaw 62,64.

One example of the surgical instruments of 80 form of circular surgical staplers is as shown in Figure 5.Stitching unstrument 80 usually can be with Fig. 1 It is similarly constructed and uses with the linear staplers 10,50 of Fig. 4, but some of features adapt to it as circular stapler Function.Similar to surgical instruments 10,50, surgical instruments 80 includes handle assembly 82 and axis 84, and the axis is from handle assembly towards remote Side extends and has the end effector 90 for treating tissue in the distal end of the axis.End effector 90 may include Storehouse component 92 and anvil block 94, the tissue contacting surface that the storehouse component and anvil block respectively have its substantially circular.Storehouse group Part 92 and anvil block 94 can be linked together via the axis 98 for the handle assembly 82 for extending to stitching unstrument 80 from anvil block 94, and be manipulated Actuator 85 in handle assembly 82 can bounce back with cardan shaft 98 so that anvil block 94 is moved relative to storehouse component 92.Anvil block 94 and storehouse Component 92 can carry out various functions, and be configured to will to organize capture between them, by from storehouse component 92 96 percussion nail of storehouse sutures tissue, and/or can generate notch in the tissue.In general, storehouse component 92, which can accommodate, includes The storehouse of nail, and nail deployment can be formed to circular staple pattern against anvil block 94, such as nail surrounds the periphery of tubular body organ.

One specific implementation in, axis 98 can be formed by first part and second part (not shown), the first part and Second part is configured to be linked together releasably to allow anvil block 94 to separate with storehouse component 92, this is allowed Bigger flexibility anvil block 94 and storehouse component 92 being located in the body of patient.For example, the first part of axis 98 may be provided at It extends to except storehouse component 92, is terminated in the mating features of distal side in storehouse component 92 and towards distal side.The second part of axis 98 can It is arranged in anvil block 94 and extends proximally to except storehouse component 92, terminates in nearside mating features.When in use, this is close Side mating features and distal side mating features can be linked together to allow anvil block 94 and storehouse component 92 to be movable with respect to each other.

The handle assembly 82 of stitching unstrument 80 can have the various actuators that can control stitching unstrument movement being disposed thereon. It is disposed thereon for example, handle assembly 82 can have in order to position the knob 86 of end effector 90 via rotation, and/or The trigger 85 of actuating for end effector 90.Trigger 85 moves across the first actuating range towards fixed handle 87 and can cause The component of dynamic clamping system is to approach jaw, that is, moves anvil block 94 towards storehouse component 92.Trigger 85 is moved towards fixed handle 87 Across the second actuating range may be actuated trigger system component so that from nail bin groupware 92 dispose nail and/or promote knife with Cutting is trapped in the tissue between storehouse component 92 and anvil block 94.

The shown example of surgery suturing appliance 10,50 and 80 is provided only and can be used in combination with disclosure provided herein Many various configurations and associated method of use several examples.Although shown example is each configured to can be used in minimally invasive hand Art, it is to be understood that, the device for being adapted to be enough in open surgery is used in combination with disclosure provided herein Tool, such as entitled " the Surgical Stapling Devices That Produce submitted on 2 28th, 2007 Opening linear described in the United States Patent (USP) 8,317,070 of Formed Staples Having Different Lengths " Stitching unstrument.Shown exemplary more details and the additional example of surgical stapling device, its component and its associated method of use provide In following patent disclosure: entitled " the Systems And Methods For submitted on March 26th, 2014 The U.S. Patent Publication 2015/0277471 of Controlling A Segmented Circuit " was submitted on 2 8th, 2013 Entitled " Layer Comprising Deployable Attachment Members " U.S. Patent Publication 2013/ 0256377, entitled " the Selectively Orientable Implantable submitted on September 30th, 2010 The U.S. Patent Publication 8,393,514 of Fastener Cartridge ", submitted on 2 28th, 2007 it is entitled “Surgical Stapling Devices That Produce Formed Staples Having Different The U.S. Patent Publication 8,317,070 of Lengths ", the entitled " Surgical submitted on June 21st, 2005 The U.S. Patent Publication 7,143 of Instrument Incorporating EAP Blocking Lockout Mechanism ", 925, entitled " the Sealing Materials For Use In Surgical submitted on November 8th, 2013 The U.S. Patent Publication 2015/0134077 of Stapling ", the entitled " Sealing submitted on November 8th, 2013 The U.S. Patent Publication of Materials for Use in Surgical Procedures " was submitted on November 8th, 2013 The U.S. Patent Publication of entitled " Hybrid Adjunct Materials for Use in Surgical Stapling, " 2015/0134076, entitled " the Positively Charged Implantable submitted on November 8th, 2013 Materials and Method of Forming the Same, " U.S. Patent Publication 2015/0133996, in 2013 Entitled " the Tissue Ingrowth Materials and Method of Using the Same, " submitted November 8 U.S. Patent Publication 2015/0129634, entitled " the Hybrid Adjunct that is submitted on November 8th, 2013 Materials for Use in Surgical Stapling, " U.S. Patent Publication 2015/0133995, in 2014 3 The United States Patent (USP) of entitled " Surgical Instrument Comprising a Sensor System, " that the moon is submitted on the 26th Announce 2015/0272575, and entitled " the Adjunct Materials and submitted on June 10th, 2014 Methods of Using Same in Surgical Methods for Tissue Sealing, " U.S. Patent Publication 2015/0351758, all full patent texts are hereby incorporated by reference.

Implantable auxiliary material

As indicated above, the various implantable auxiliary materials for being used in combination with surgery suturing appliance are provided. The auxiliary material can have a variety of configurations and can be formed of a variety of materials.In general, auxiliary material can by film, foam, injection molded thermoplastic's plastics, The formation of one or more of vacuum thermoforming material, fibre structure and its mixture.The auxiliary material may also include one or more Bio-derived material and one or more drugs.Each of these materials discuss in greater detail below.

Auxiliary material can be by formation of foam, such as closed-cell foam, open celled foam or sponge.How the example of such auxiliary material can be manufactured It is the collagen (such as pig tendon) from animal derived, then can be processed and be lyophilized into foaming structure.Gelatin can also be used And it is processed into foam.What the example of various foam auxiliary materials was in the previously mentioned submits entitled for Septembers in 2010 30th In the United States Patent (USP) 8,393,514 of " Selectively Orientable Implantable Fastener Cartridge " It further describes.

Auxiliary material can also be formed by the film that the combination of any suitable material or material that are discussed below is formed.The film may include One or more layers, each layer can have different degradation rates.In addition, film can have various regions formed therein, example Such as, the reservoir of one or more various forms of medicaments can be releasably held.One or more different packets can be used Clothing is provided with the reservoir of at least one medicament to seal, which may include absorbable or nonabsorable polymer. The film may be formed in various ways.For example, it can be film squeeze out or compression molding.Medicament can also pass through non-covalent phase interaction It is adsorbed on film or is integrated on film with the bonding of such as hydrogen.

Auxiliary material can also be formed by injection molded thermoplastic's material or vacuum thermoforming material.The example of various molding auxiliary materials is Entitled " the Fastener Cartridge Comprising A Releasably Attached submitted on 2 8th, 2013 There is further description in the U.S. Patent Publication 2013/0221065 of Tissue Thickness Compensator ", this is specially Benefit is announced to be incorporated by reference accordingly and is incorporated herein.Auxiliary material is also possible to the lattice based on fiber, can be weaven goods, knitting The loose weaven goods of object or non-woven fabric, such as melt-blown, needle thorn or heat building.Auxiliary material can have can be by the lattice or not of same type The trellis of same type at multiple regions, these lattice can be formed together auxiliary material in a number of different manners.For example, fiber can be knitted Make, weave, being knitted or being otherwise interconnected to formation rule or irregular structure.Fiber can be connected with each other, and be made Obtain resulting auxiliary material relative loose.Alternatively, auxiliary material may include the fiber closely interconnected.Auxiliary material can be sheet material, tubing, spiral or Any other may include the form of the structure of flexible portion and/or more rigid strengthening part.Auxiliary material is configured to make Finer and close fiber can be had by obtaining its some regions, and other regions have the fiber compared with low-density.Expection based on auxiliary material is answered With fibre density can change in different directions along one or more dimensions of auxiliary material.

Auxiliary material can be formed by fiber that is weaving, knitting or otherwise interconnecting, this allows auxiliary material to be stretched.Example Such as, auxiliary material is configured on the direction along its longitudinal axis and/or in transverse direction perpendicularly to the longitudinal axis It stretches.Although stretchable at least two dimensions (for example, X and Y-direction), auxiliary material can be mentioned along its thickness (for example, Z-direction) For enhancing, so that it stretches but resists the tearing of nail and pulls.It is configured to be implanted and allows them to draw with tissue The non-limiting example for the auxiliary material stretched is in upper entitled " the Method for Creating a for being set forth in and submitting on September 26th, 2014 Be described in the U.S. Patent Publication 2016/0089142 of Flexible Staple Line ", the patent disclosure accordingly full text It is herein incorporated by reference.

Auxiliary material is also possible to mix construction, such as laminated composites or melting interlocking fibers.A variety of mixing construct auxiliary material Example have in following patent disclosure and further describe: in entitled " the Adhesive Film that on 2 8th, 2013 submit Laminate " United States Patent (USP) 9,282,962, and entitled " the Minimally Invasive submitted on September 12nd, 2007 The United States Patent (USP) of Medical Implant And Insertion Device And Method For Using The Same " 7,601,118, these full patent texts are hereby incorporated by reference.

It can be formed by a variety of materials according to the auxiliary material of the technology.These materials can be used in various embodiments to be used for Different purposes.These materials can treat to select the ingrowing to be convenient for tissue according to the expectation to be delivered to tissue.This A little materials may include bioabsorbable polymer and biocompatible polymer, including homopolymer and copolymer.It can biology suction The polymer of receipts can be absorbable, can reabsorbing, bioresorbable or biodegradable polymer.Auxiliary material may be used also Including activating agent, such as competent cell culture (for example, the autologous tissue of stripping and slicing, for stem cell therapy reagent (for example, Biosutures and Cellerix SL), hemostat and organization healing agent).

Auxiliary material can be releasedly in at least one medicament for wherein keeping can be selected from a large amount of different agents.Medicament include but It is not limited to interior auxiliary material or the drug with desired function relevant to auxiliary material or other agent.Medicament includes but is not limited to example Such as antimicrobial (such as antibacterial agent and antibiotic), antifungal agent, antivirotic, anti-inflammatory agent, growth factor, anodyne, fiber crops Liquor-saturated dose, periplast's degeneration inhibitor, anticancer agent, hemostat and other agent for causing biological respinse.Dressing material can also be by increasing The reagent of visibility during strong imaging is made or may include the reagent, for example, antiviral material or wireless opaque material.

Entitled " the Medicant Eluting Adjuncts and Methods of submitted on August 31st, 2015 Further described in the U.S. Patent application 14/840,613 of Using Medicant Eluting Adjuncts " for from Discharge the various auxiliary materials of medicament and the example of various technologies in auxiliary material, U.S. Patent application full text is accordingly by reference simultaneously Enter.