阅读说明：本技术 具有辅料材料的端部执行器 (End effector with dressing material ) 是由 F·E·谢尔顿四世 J·L·哈里斯 M·J·温德里 于 2018-02-13 设计创作，主要内容包括：本发明提供了一种用于外科器械的端部执行器,该端部执行器具有不同类型的特征结构,以用于可释放地保持至少一种辅料材料。该端部执行器具有第一钳口和第二钳口,该第一钳口具有仓,该第二钳口具有砧座。附接特征结构包括保持细丝,该保持细丝具有中间部分以及第一端部和第二端部,该第一端部和第二端部设置在中间部分的相对侧上,并且具有端部特征结构,该端部特征结构被构造成能够与第一钳口和第二钳口中的至少一个钳口配合。该附接特征结构被布置成保持辅料材料,使得中间部分的至少一部分设置在该辅料材料上方并且使得第一端部和第二端部间隔开。(The present invention provides a kind of end effector for surgical instruments, which has different types of feature structure, for being releasably retained to less a kind of dressing material.The end effector has the first jaw and the second jaw, which has storehouse, which has anvil block.Attachment features structure includes keeping filament, the holding filament has middle section and first end and the second end, the first end and the second end are arranged on the opposite side of middle section, and there is end features structure, which is configured to cooperate at least one jaw in the first jaw and the second jaw.The attachment features structure is arranged to holding dressing material, so that at least part of middle section is arranged above the dressing material and makes first end and the second end to be spaced apart.)

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

First jaw, first jaw have storehouse, and the storehouse has multiple nail cavities, and the nail cavity is configured to that appearance will be followed closely It is contained in wherein, 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 group Knit clamping therebetween；

Attachment features structure, the attachment features structure include keeping filament, and the holding filament has

Middle section；

The opposite side of the middle section is arranged in first end and the second end, the first end and the second end On, each of the first end and the second end have end features structure, and the end features structure is by structure It causes to cooperate at least one jaw in first jaw and second jaw；With

Dressing material, the dressing material are releasably held at least one described jaw by the attachment features structure On, the attachment features structure is arranged such that at least part of the middle section is arranged above the dressing material And the first end and the second end are spaced apart.

2. end effector according to claim 1, further include at least one first holding member and at least one second Holding member, a side on the surface towards tissue of neighbouring at least one jaw of at least one described first holding member The side on the surface towards tissue described at least one described jaw, and at least one described second holding structure is arranged in edge Another opposite edge on the part surface towards tissue be arranged at least one jaw another is opposite Side, first holding member and second holding member are configured to engagement and are arranged in above the dressing material The part of the middle section.

3. end effector according to claim 2, wherein in first holding member and second holding member At least one include a pair of adjacent column, each column is configured to engage the middle section for keeping filament At least partially.

4. end effector according to claim 2, wherein the dressing material includes at least one formed therein Notch, the dressing material are releasably held at least one described jaw, so that first holding member and described At least one of second holding member is arranged in the notch.

5. end effector according to claim 1, wherein the first end feature structure and the second end are special Structure setting is levied on the side opposite with its surface towards tissue of at least one jaw, so that the first end Cutting element interchannel with the second end across at least one jaw separates, and the cutting element channel is across institute The middle part for stating jaw longitudinally extends.

6. end effector according to claim 1, wherein keep at least described of filament for described using jointing material Middle section is connected at least one described jaw.

7. end effector according to claim 1, further includes positioned at least one jaw and it is towards tissue The opposite side in surface at least one coarse part, wherein the middle section for keeping filament surround it is described extremely The opposite side wall of a few jaw, and wherein the first end and the second end include vane member, the leaf Sheet element is configured to be frictionally engaged with the corresponding coarse part of at least one coarse part.

8. end effector according to claim 7, wherein the phase that the vane member passes through holding filament described in hot pressing Pair end and formed.

9. end effector according to claim 7 further includes being located at least one of described opposite side wall At least one second coarse part, wherein surrounding the part of the middle section of the holding filament of the opposite side wall It is frictionally engaged with corresponding second coarse part on one in the side wall.

10. end effector according to claim 1 further includes at least one spindle-type holding member, the spindle-type Holding member is formed on the side opposite with its surface towards tissue of at least one jaw, and wherein described the At least one of one end and the second end are configured to keep via the spindle-type holding member.

11. end effector according to claim 10, wherein at least one described spindle-type holding member, which has, to be formed At least one recessed portion on it, and at least one described recessed portion is configured to keep the first end wherein At least one described a part in portion and the second end.

12. end effector according to claim 1, further includes

First pair of recessed portion, first pair of recessed portion are formed in the surface towards tissue of at least one jaw, institute First pair of recessed portion is stated to be spaced apart with the opposite edge on the surface towards tissue, and

Second pair of recessed portion, second pair of recessed portion are formed in described at its position corresponding with first pair of recessed portion In dressing material,

Wherein, the part of the middle section for keeping filament is configured to extend through second pair of recess Portion, so that the first end and the second end be allowed to be located in first pair of recessed portion.

13. end effector according to claim 12, wherein the first end and the second end are including variable Shape element, the deformable element are configured to reversibly deform when allowing and being located in first pair of recessed portion.

14. end effector according to claim 13, wherein the deformable element includes t shape barb component.

15. end effector according to claim 12, wherein at least one described jaw is first jaw, and And wherein first pair of recessed portion is formed at the distal end of the jaw, positioned at the outer periphery of the multiple nail cavity it Outside.

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

First jaw, first jaw have storehouse, and the storehouse has multiple nail cavities, and the nail cavity is configured to that appearance will be followed closely It is contained in wherein, 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 group Knit clamping therebetween；

First dressing material, first dressing material are configured to be releasably held on first jaw and have There are proximal end and distal end, first dressing material has the first mating feature structure at its described proximal end；

Second dressing material, second dressing material are configured to be releasably held on second jaw and have There are proximal end and distal end, second dressing material separates with first dressing material and in its proximal end There is the second mating feature structure at portion；With

Attachment features structure, the attachment features structure are formed at the proximal end of the end effector and are configured to It can match at least one of the first mating feature structure of the dressing material and the second mating feature structure It closes.

17. end effector according to claim 16, wherein the first mating feature structure and second cooperation Feature structure includes open ring feature structure, and the open ring feature structure is configured to movably surround described attached Connect feature structure.

18. end effector according to claim 17, wherein the first mating feature structure and second cooperation Feature structure is configured to engage the attachment features structure, so that the first mating feature structure is with described second Mating feature structure engages the engagement attachment features structure at the different position in position of the attachment features structure.

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

First jaw, first jaw have storehouse, and the storehouse has multiple nail cavities, and the nail cavity is configured to that appearance will be followed closely It is contained in wherein, 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 group Knit clamping therebetween；

First dressing material, first dressing material are configured to be releasably held on first jaw and have There are proximal end and distal end, first dressing material has the first mating feature structure at its described proximal end； With

Second dressing material, second dressing material are configured to be releasably held on second jaw and have There are proximal end and distal end, second dressing material separates with first dressing material and in its proximal end There is the second mating feature structure at portion；

Wherein, the first mating feature structure and described second of first dressing material and second dressing material is matched It closes feature structure to be configured to be coupled to each other, so that first auxiliary material and second auxiliary material are coupled to each other.

End effector according to claim 19, wherein the attachment features structure is auxiliary including being formed in described first Expect the slit at the proximal end of material, and wherein the second mating feature structure includes from the second auxiliary material material The proximal end of material extends and is configured to the protruding portion being received in the slit.

Technical field

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

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, And other fluids can ooze out and by following closely the opening formed, even after nail is fully formed.Processed tissue Can reason suture caused by wound and inflammation.In addition, in combination with the operation of suture is similar to come the nail being implanted into and other objects The some features for the tissue that they are implanted into are generally deficient of with material.For example, nail and other objects and material can lack them The natural flexibility for the tissue being implanted into.It will be appreciated by the person skilled in the art that it is generally desirable to groups to be woven in nail setting wherein After 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 some respects, a kind of end effector for surgical instruments is provided, includes in some embodiments First jaw, second jaw opposite with the first jaw, attachment features structure and dressing material.First jaw has storehouse, the storehouse With multiple nail cavities, these nail cavities are configured to that receiving will be followed closely wherein, surface towards tissue of these nail cavities in storehouse Upper opening.Second jaw has anvil block, which has the multiple nail forming cavities being formed on its surface towards tissue.First Jaw and the second jaw are configured to clamp tissue therebetween.Attachment features structure includes keeping filament, and the holding is thin There is silk middle section and first end and the second end, the first end and the second end the opposite of middle section is arranged in On side, each of the first end and the second end have end features structure, the end features structure be configured to At least one jaw cooperation in first jaw and the second jaw.Dressing material is releasably held in by attachment features structure On at least one jaw, which is arranged such that at least part of middle section is arranged on dressing material Side and first end and the second end are spaced apart.

End effector can change in a multitude of different ways.For example, end effector may include at least one first holding Component and at least one second holding member, at least one first holding member is adjacent at least one jaw towards tissue The side on the surface towards tissue of at least one jaw, and at least one second holding structure is arranged in one edge on surface Another opposite side of at least one jaw is arranged in another opposite edge on the neighbouring surface towards tissue of part.First protects It holds component and the second holding member is configured to a part for the middle section that engagement is arranged in above dressing material.One In a little embodiments, at least one of the first holding member and the second holding member are or including a pair of adjacent columns, each Column is configured at least part that engagement keeps the middle section of filament.

Dressing material may include at least one notch formed therein, and dressing material can be releasably held in On at least one jaw, so that at least one of the first holding member and the second holding member are arranged in notch.

First end feature structure and the second end feature structure can be set that at least one jaw and it is towards group On the opposite side in the surface knitted, so that the cutting element channel spacing of first end and the second end across at least one jaw It opens, which longitudinally extends across the middle part of jaw.In some embodiments, it will keep thin using jointing material At least middle section of silk is connected at least one jaw.

In some embodiments, end effector includes positioned at least one jaw and its surface phase towards tissue Pair side at least one coarse part, wherein the middle section of filament is kept to surround the opposite side of at least one jaw Wall, and wherein first end and the second end include vane member, and these vane members are configured to and at least one The corresponding coarse part of coarse part is frictionally engaged.In some embodiments, end effector further includes positioned at opposite At least one second coarse part at least one of side wall, wherein surrounding the middle part of the holding filament of opposite side wall The part divided is frictionally engaged with corresponding second coarse part on one in side wall.

In some specific implementations, end effector includes at least one spindle-type holding member, which keeps structure Part is formed on the side opposite with its surface towards tissue of at least one jaw.In such specific implementation, keep thin At least one of first end and the second end of silk are configured to keep via spindle-type holding member.Spindle-type is protected Holding component can change in many different ways.For example, it can have at least one recessed portion being formed thereon, and extremely A few recessed portion is configured in a part for wherein keeping at least one of first end and the second end.

In some specific implementations, end effector also has first pair of recessed portion and second pair of recessed portion, and this first pair Recessed portion is formed in the surface towards tissue of at least one jaw, the phase of first pair of recessed portion and the surface towards tissue Pair edge be spaced apart, and second pair of recessed portion is formed in dressing material at its position corresponding with first pair of recessed portion In.Keeping the part of the middle section of filament can be configured to extend through second pair of recessed portion, to allow first End and the second end are located in first pair of recessed portion.The first end and the second end for keeping filament may include or can be Deformable element, these deformable elements are configured to reversibly deform when allowing and being located in first pair of recessed portion.In In at least one embodiment, deformable element is or including t shape barb component.In some embodiments, at least one is clamped Mouth is the first jaw, and first pair of recessed portion is formed at the distal end of jaw, except the outer periphery of multiple nail cavities.

In other respects, a kind of end effector for surgical instruments is provided, includes in some embodiments First jaw, is configured to be releasably held on the first jaw first at second jaw opposite with the first jaw Dressing material is configured to the second dressing material being releasably held on the second jaw and attachment features structure. First jaw has storehouse, which has multiple nail cavities, these nail cavities are configured to that receiving will be followed closely wherein, these nail cavities exist The surface upper opening towards tissue in storehouse.Second jaw has anvil block, which, which has, is formed on its surface towards tissue Multiple nail forming cavities.First jaw and the second jaw are configured to clamp tissue therebetween.First dressing material tool There are proximal end and distal end and the first mating feature structure at its proximal end.With proximal end and distal end portion Second dressing material in portion and the first dressing material separate and have the second mating feature structure at its proximal end.Attachment Feature structure is formed at the proximal end of end effector and is configured to the first mating feature with dressing material The cooperation of at least one of structure and the second mating feature structure.

End effector can change in a multitude of different ways.For example, the first mating feature structure and the second mating feature knot Structure can be or may include open ring feature structure, these open ring feature structures are configured to movably surround Attachment features structure.First mating feature structure and the second mating feature structure can be configured to bond attachments feature knot Structure, so that the first mating feature structure is at the position different from the position of the second mating feature structure bond attachments feature structure Bond attachments feature structure.

In another aspect, a kind of end effector for surgical instruments is provided, includes in some embodiments First jaw, is configured to be releasably held on the first jaw first at second jaw opposite with the first jaw Dressing material and it is configured to the second dressing material being releasably held on the second jaw.First jaw has Storehouse, the storehouse have multiple nail cavities, these nail cavities are configured to that receiving will be followed closely wherein, these nail cavities are in storehouse towards tissue Surface upper opening.Second jaw has anvil block, which has the multiple nails forming being formed on its surface towards tissue Chamber.First jaw and the second jaw are configured to clamp tissue therebetween.First dressing material have proximal end and Distal end and the first mating feature structure at its proximal end.The second auxiliary material with proximal end and distal end Material and the first dressing material separate and have the second mating feature structure at its proximal end.First dressing material and The the first mating feature structure and the second mating feature structure of two dressing materials are configured to be coupled to each other, thus by first Auxiliary material and the second auxiliary material are coupled to each other.

End effector can change in a multitude of different ways.For example, in some specific implementations, attachment features structure be or Slit at proximal end including being formed in the first dressing material, and the second mating feature structure is or including auxiliary from second The proximal end of material material extends and is configured to be received in the protruding portion in slit.

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 the another embodiment of surgical stapling device；

Fig. 6 is the perspective view of the jaw of end effector, which has using the attachment features structure according to the technology It is releasably attached to dressing material thereon；

Fig. 7 is the local perspective view of the jaw of the dressing material with Fig. 6；

Fig. 8 is the perspective view of the side opposite with its tissue contact side of the jaw of Fig. 6, shows attachment features structure End features structure；

Fig. 9 is another perspective view of the jaw of end effector, which has using special according to the attachment of the technology Sign structure is releasably attached to dressing material thereon；

Figure 10 is the exemplary schematic diagram for showing the coarse part that can be formed on the jaw of Fig. 6 and the jaw of Fig. 9；

Figure 11 is the perspective view of the upside of the jaw of end effector, which has using the spindle-type according to the technology Attachment features structure is releasably attached to dressing material thereon；

Figure 12 is the perspective view of the jaw of end effector, which is configured to using the attachment according to the technology Feature structure releasably holds dressing material thereon；

Figure 13 is the perspective partial transparent print of the jaw of Figure 12, shows attachment features structure releasedly for dressing material It is maintained on jaw；

Figure 14 is the perspective view of the jaw of end effector, which is configured to releasably hold the thereon One dressing material and the second dressing material；

Figure 15 is the perspective view of the jaw of Figure 14, shows the first dressing material being releasably held on jaw and the Two dressing materials；

Figure 16 is another perspective view of the jaw of end effector, which is configured to releasably hold it On the first dressing material and the second dressing material；

Figure 17 is the perspective view of the first dressing material of Figure 16 and a part of the second dressing material, shows dressing material One of in protruding portion engaged with the slit in the another kind in dressing material；

Figure 18 is the perspective view of the jaw of end effector, which is configured to releasably hold thereon auxiliary Expect material；

Figure 19 A is the schematic diagram for showing a part of dressing material of Figure 18；And

Figure 19 B is the schematic diagram for showing a part of the dressing material of Figure 19 A and engaging with a part of the jaw of Figure 18.

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 with reference 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, herein in conjunction with diagram use space term such as "vertical" and "horizontal".However, surgical instruments takes in many To with used on position, and these spatial terminologies and non-limiting and absolute.

In some embodiments, device and method setting as described herein is used for open surgery, and at it In his embodiment, the setting of these device and method is used for laparoscopic type, endoscope type and other micro-wound surgical operations.These dresses Setting can directly be fired or the long-range percussion under the directly controlling of robot or similar manipulation instrument by human user.However, ability Domain the skilled person will understand that, various method and apparatus disclosed herein can be used for many surgical operations and application in.Ability The technical staff in domain will be further understood that various instruments disclosed herein can be inserted into body in any way, such as logical Cross nature aperture, by the notch or perforation that are formed in the tissue or by entering device (such as trocar cannula).For example, The working portion or end effector portion of the instrument can be directly inserted into the body of patient or can be by inserting into device Enter, 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, this is one or more Auxiliary material can make to follow closely histokinesis (for example, atelectasis, gastrointestinal tract expansion etc.) minimum that site of perforation neutralizes surrounding, this tissue Movement can occur because of the suture metaplasia of generation later.Those skilled in the art will recognize that nail site of perforation is available Make stress concentration portion, and when surrounding tissue is under tension, the size by following closely the hole formed will increase.Limit these The size that histokinesis around site of perforation can make hole that can increase under tension minimizes.In some cases, this one Kind or multiple auxiliary materials be configured to wick or absorb further promote healing beneficial fluid, such as sealant, blood, Sticker, and in some cases, which is configured to degradation and further promotes healing to be formed Gel, such as sealant.In some cases, one or more auxiliary materials can be used for help be sealed in nail be implanted tissue, By following closely the hole formed when in blood vessel and various other objects or body part.One or more auxiliary materials can also by with the one kind Or interval, positioning and/or the orientation of the associated any fiber of multiple auxiliary materials or strand are to influence tissue growth.

In addition, in some cases, auxiliary material can be used for distributing the pressure applied by nail, so that reducing nail (can across tissue Can be frangible) and cannot as expected fastening tissue (so-called " cheese wiring ") a possibility that.In addition, auxiliary material can be at least portion It is point stretchable and therefore can permit tissue at least partly naturally movement (for example, during breathing the expansion of lung tissue with It shrinks).In some embodiments, staple line can be flexible, such as be submitted on September 26th, 2014 entitled It is retouched in the U.S. Patent Publication 2016/0089142 of " Method for Creating a Flexible Staple Line " It states, the full content of the document is incorporated by herein by reference.

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 the various different surgical operations of various tissues, such as thoracic surgery or stomach hand Art.

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 and the end effector 30 at the distal end 14d of axis 14 stretched.End effector 30 has opposite lower pincers Mouth 32 and upper jaw 34, but other kinds of end effector can be with axis 14, handle assembly 12 and component associated there It 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 Upper jaw 34 has towards lower jaw 32 and is configured to be operated as anvil block to help to dispose the anvil block of the nail of nail bin 40 Surface 33 (nail is blocked in fig. 1 and 2).At least one of the opposite lower jaw 32 and upper jaw 34 can be relative to The other of lower jaw 32 and upper jaw 34 are moved to clamp the tissue being disposed there between and/or other objects.In some tools During body is implemented, at least one of the opposite lower jaw 32 and upper jaw 34 be can be fixed or otherwise immovable 's.In some specific implementations, both the opposite lower jaw 32 and upper jaw 34 can be movable.The component of trigger system It is configured to inject in clamped tissue across at least part of end effector 30 will follow closely.In various tools During body is implemented, blade 36 (referring to Fig. 3) or other cutting elements can be associated with trigger system to cut during suture operation Tissue.Cutting element can be configured at least partly cut tissue while the nail being emitted.In some cases Under, if cutting tissue may be advantageous after nail has projected and organized to be fixed.Therefore, if surgical operation needs It is breaking at the tissue captured between jaw, then is being followed closely after the injection of nail bin 40, blade 36 advances to cut off between jaw The tissue of grasping.

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 feature structures that instrument 10 is operated in various mechanical and/or electronic components wherein.For example, handle assembly 12 can wrap The knob 26 of installation adjacent with its distal end 12d is included, which 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 being activated by clamping trigger 22 The percussion portion of the clamping component of a part of clamping system and a part as the trigger system activated by firing trigger 24 Part.Clamping trigger 22 and firing trigger 24 can be for example biased into the open position relative to fixed handle 20 by torque spring It sets.Clamping system, which may be actuated, in the movement of clamping trigger 22 towards fixed handle 20 can make jaw 32,34 as described below Collapse toward each other and thereby by clamp tissue between them.Trigger system may be actuated in the movement of firing trigger 24, as follows It is described, can make to follow closely projected from the nail bin 40 being disposed therein and/or promote blade 36 with cut off capture jaw 32,34 it Between tissue.Those skilled in the art will recognize that various configurations (mechanical, the hydraulic, gas for trigger system can be used Dynamic, electromechanical, robot or other) component project nail and/or cutting tissue.

As shown in Fig. 2, the end effector 30 of the specific implementation illustrated has as storehouse component or carries the lower jaw of part 32 and the opposite upper jaw 34 as anvil block.It is supported in nail pallet 37 in the nail bin 40 wherein with multiple nails, the nail support Disk is then supported in the warehouse channel of lower jaw 32.Upper jaw 34 has multiple nail shapes pit (not shown), and nail forming is recessed The top of the corresponding nail for multiple nails that each of hole is located in be self contained in nail bin 40.Although in shown specific implementation In, upper jaw 34 only has nearside pivoted end 34p in the distal side of itself and the engagement of axis 14, and the nearside pivoted end is pivotly It is received 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 When pivoting downwards, upper jaw 34 moves anvil faces 33 and makes the nail shapes pit being formed thereon towards opposite nail bin 40 movements.

Various hold assemblies can be used to realize the opening and closing of jaw 32,34 selectively by clamp tissue at it Between.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 Feature structure 34c.Accordingly, in response to clamping trigger 22, closed tube 46 is selectively in the proximally longitudinal action of closed tube 46 Period assigns 34 opening action of upper jaw and in closed tube towards 34 closed action of upper jaw is assigned during the longitudinal action of distal side, should The distal end of closed tube includes the shape of a hoof hole 46a for engaging closure feature structure 34c.As described above, in various specific implementations In, the opening and closing of end effector 30 can relative motion by lower jaw 32 relative to upper jaw 34,34 phase of upper jaw Relative motion for lower jaw 32 is realized by the movement of both jaws 32,34 relative to each other.

The firing components of the specific implementation of illustration include the hitting with electron beam 38 as shown in Figure 3 in its distal end Send out bar 35.Trigger shaft 35 is included in axis 14, for example, in longitudinal trigger shaft slot 14s of axis 14, and by from shank 12 Firing action guidance.The actuating of firing trigger 24 can influence electron beam 38 across at least part of remote of end effector 30 Side movement, to cause the percussion for the nail being contained in nail bin 40 whereby.As shown, the distal end from electron beam 38 is outstanding The engageable wedge-shaped slides 47 as shown in Figure 2 of guiding piece 39, staple drivers 48 can then be pushed up and are passed through by this Nail cavity 41 in nail bin 40.Staple drivers 48 move upwards the power upward to each application in 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 with the interval of 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 34 and lower jaw 32 are sold in a pair of of bottom, to be advanced through end effector in trigger shaft 35 Jaw 32,34 is compressed toward each other when 30.Meanwhile the knife 36 extended between ejector pin and bottom pin is configured to cutting quilt Capture the tissue 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 feature structure 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 pushed away towards distal side It is captured jaw 32,34 into across at least part of end effector 30 with realizing the percussion of nail and optionally turning off Tissue.

It is as shown in Figure 4 with another example of the surgical instruments of the form of linear surgical stapler 50.Stitching unstrument 50 is usual It can be similarly constructed and use with the stitching unstrument 10 of Fig. 1.Similar to the surgical instruments 10 of Fig. 1, surgical instruments 50 includes shank group Part 52 and axis 54, the axis extend from handle assembly towards distal side and have the end for treating tissue in the distal end of axis Actuator 60.The upper jaw 64 and lower jaw 62 of end effector 60 are configured to that capture will be organized between them, lead to 66 percussion nail of storehouse from being arranged in lower jaw 62 is crossed to suture tissue and/or generate notch in the tissue.It is specific at this In implementation, the attachment part 67 in the proximal end of axis 54 is configured to allow axis 54 and end effector 60 removedly It is attached to handle assembly 52.In particular, the mating feature structure 68 of attachment part 67 can be with the complementary fit of handle assembly 52 Feature structure 71 cooperates.Mating feature structure 68,71 is configured to via the connection of such as buckle-type, bayonet type connection etc. Be linked together, but can be used any amount of complementary fit feature structure and it is any kind of connection by axis 54 removedly It is connected to handle assembly 52.Although the entire axis 54 of shown specific implementation is configured to separate from handle assembly 52, In some specific implementations, attachment part 67 is configured to that the only distal part of axis 54 is allowed to remove.Axis 54 and/or end are held The separable connection of row device 60 allows selectively to be attached desired end effector 60 for particular procedure, and/or Handle assembly 52 is recycled for multiple and different operations.

Handle assembly 52 can have disposed thereon for manipulate and the one or more features of operation end actuator 60 Structure.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 portion's actuator 60 relative to handle assembly 52.Handle assembly 52 may include as the clamping 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, So that opposite jaw 62,64 is close to each other to reach closed position.In some specific implementations, in opposite jaw 62,24 Only one can move so that jaw 62,64 is moved to closed position.Trigger 74 is towards 70 further movement of fixed handle Firing components may be actuated across the second actuating range, so that nail projects from nail bin 66 and/or make knife or other cutting elements (not Show) tissue of the propulsion cutting capture between jaw 62,64.

It is as shown in Figure 5 with an example of the surgical instruments of the form of circular surgical staplers 80.Stitching unstrument 80 usually may be used It is similarly constructed and uses with the linear staplers 10,50 of Fig. 1 and Fig. 4, but some of feature structures adapt to it as round The function of stitching unstrument.Similar to surgical instruments 10,50, surgical instruments 80 includes handle assembly 82 and axis 84, and the axis is from shank Component extends towards distal side 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 contact table that the storehouse component and anvil block respectively have its substantially circular Face.Storehouse component 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 manipulating the 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 Seat 94 and storehouse component 92 can carry out various functions, and be configured to organize to capture between them, by from storehouse 96 percussion nail of storehouse of component 92 sutures tissue, and/or can generate notch in the tissue.In general, storehouse component 92 can The storehouse comprising nail is accommodated, and nail deployment can be formed to circular staple pattern against anvil block 94, such as nail surrounds tubular body device The periphery of official.

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 feature structure of distal side in storehouse component 92 and towards distal side.The second part of axis 98 It may be provided in anvil block 94 and extend proximally to except storehouse component 92, terminate in nearside mating feature structure.When in use, The nearside mating feature structure and distal side mating feature structure can be linked together with allow anvil block 94 and storehouse component 92 relative to It moves each other.

The various actuators that the handle assembly 82 of stitching unstrument 80 can have the controllable stitching unstrument being disposed thereon to move.Example Such as, handle assembly 82, which can have, is disposed thereon in order to position the knob 86 of end effector 90 via rotation, and/or Trigger 85 of the person for the actuating of end effector 90.Trigger 85 moves across the first actuating range towards fixed handle 87 The component of actuatable clamping system is to approach jaw, that is, moves anvil block 94 towards storehouse component 92.Trigger 85 is towards fixed handle Portion 87, which moves across the second actuating range, may be actuated the component of trigger system so as to dispose nail from nail bin groupware 92 and/or make Knife is promoted to cut off the tissue being trapped between storehouse component 92 and anvil block 94.

The illustrated example of surgery suturing appliance 10,50,80 is provided only and can be used in combination with disclosure provided herein Many various configurations and associated application method several examples.Although the example illustrated is configured to minimally invasive hand Art, but it is to be understood that be configured to the instrument of open surgery, such as entitled " Surgical Stapling Devices that Produce Formed Staples Having Different Lengths " and in 2 months 2007 28 The United States Patent (USP) 8 that day submits, opening linear stitching unstrument described in 317,070 can be with disclosure provided herein knot It closes and uses.The additional example of the exemplary more details and surgical stapling device, its component and its associated method of use that illustrate, It is provided in following patent: entitled " the Systems And Methods For submitted on March 26th, 2014 What U.S. Patent Publication on 2 8th, 2015/0277471,2013 of Controlling A Segmented Circuit " were submitted The U.S. Patent Publication 2013/ of entitled " Layer Comprising Deployable Attachment Members " Entitled " the Selectively Orientable Implantable Fastener submitted on September 30th, 0256377,2010 28 days 2 months 8,393,514,2007 years entitled " the Surgical Stapling submitted of United States Patent (USP) of Cartridge " The United States Patent (USP) 8,317 of Devices That Produce Formed Staples Having Different Lengths ", Entitled " the Surgical Instrument Incorporating EAP Blocking submitted on June 21st, 070,2005 Entitled " the Sealing that the United States Patent (USP) of Lockout Mechanism " is submitted on November 8th, 7,143,925,2013 Entitled " the Sealing that Materials For Use in Surgical Stapling " and on November 8th, 2013 submit U.S. Patent Publication 2015/0134077,2013 11 of Materials for Use in Surgical Procedures " The beauty of entitled " Hybrid Adjunct Materials for Use in Surgical Stapling " that the moon is submitted on the 8th Entitled " the Positively Charged that state's patent disclosure is submitted on November 8th, 2015/0134076,2013 Implantable Materials and Method of Forming the Same " U.S. Patent Publication 2015/ Entitled " the Tissue Ingrowth Materials and Method of submitted on November 8th, 0133996,2013 Entitled " the Hybrid that the U.S. Patent Publication of Using the Same " is submitted on November 8th, 2015/0129634,2013 The U.S. Patent Publication 2015/0133995 of Adjunct Materials for Use in Surgical Stapling ", The beauty of entitled " the Surgical Instrument Comprising a Sensor System " that submits on March 26th, 2014 Entitled " the Adjunct Materials and that state's patent disclosure 2015/0272575 and 2014 is submitted on June 10, The U.S. Patent Publication of Methods of Using Same in Surgical Methods for Tissue Sealing " 2015/0351758, all full patent texts are incorporated herein by reference whereby.

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.Also it can be used bright Glue is simultaneously 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.

Dressing material can also be made of the film being formed by any suitable material or combination of materials that are discussed below.The film can Including one or more layers, each layer can have different degradation rates.In addition, film can have various areas formed therein Domain, for example, the reservoir of one or more various forms of medicaments can be releasably held.It can be used one or more different Coating to seal the reservoir for being provided at least one medicament, which may include absorbable or the polymerization of nonabsorable Object.The film can be formed in various ways.For example, it can be extrusion die plastic film or compression molding film.Medicament can also be via Non-covalent reciprocation such as Hydrogenbond is adsorbed on film or in conjunction with film.

Auxiliary material can also be formed by injection molded thermoplastic's material or vacuum thermoforming material.The example of the auxiliary material of various moldings is into one Step is described in entitled " the Fastener Cartridge Comprising A Releasably submitted on 2 8th, 2013 The U.S. Patent Publication 2013/0221065 of Attached Tissue Thickness Compensator ", the full patent texts with Way of reference is incorporated herein.Auxiliary material is also possible to the lattice based on fiber, can be weaven goods, knitted fabric or non-woven fabric, all Such as the loose weaven goods of melt-blown, needle thorn or heat building.Auxiliary material can have can by same type lattice or different types of trellis at Multiple regions, these lattice can be formed together auxiliary material in a number of different manners.For example, fiber can weave, weave, being knitted or with Other modes interconnect so as to formation rule or irregular structure.Fiber can interconnect, so that resulting auxiliary material relative loose.Or Person, auxiliary material may include the fiber closely interconnected.Auxiliary material can be sheet material, tubing, spiral or any other may include flexible portion And/or the form of the structure of more rigid strengthening part.Auxiliary material is configured to so that its some regions can have more causes Close fiber, and other regions have the fiber of low densification.Intended application based on auxiliary material, fibre density can be along the one of auxiliary material A or multiple dimensions change in different directions.Auxiliary material can be formed by woven, the interconnection of knitting or other modes fiber, This allows auxiliary material to be stretched.For example, auxiliary material can by be configured to along its longitudinal axis direction and/or along perpendicular to The transverse direction of longitudinal axis stretches.Although stretchable at least two dimensions (for example, X and Y-direction), auxiliary material can edge Its thickness (for example, Z-direction) provides enhancing, is torn and is pulled through by nail so that it stretches but resists.At above-mentioned September in 2014 26th The U.S. Patent Publication 2016/ of entitled " the Method for Creating a Flexible Staple Line " that submits Describing to be configured to be implanted into 0089142 shows them with the non-limiting of auxiliary material stretched together is organized Example, which is incorporated by reference accordingly is incorporated herein.

Auxiliary material is also possible to mix construction, such as laminated composites or melting locking fiber interconnection.Various hydridization buildings The United States Patent (USP) 9 of entitled " Adhesive Film Laminate " that the example of body auxiliary material was submitted on 2 8th, 2013, 282,962 and entitled " the Minimally Invasive Medical Implant And that was submitted on September 12nd, 2007 It is further retouched in the United States Patent (USP) 7,601,118 of Insertion Device and Method For Using The Same " It states, these patents are incorporated by reference accordingly to be incorporated to.

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 for not Same purpose.These materials can treat to select the ingrowing to be convenient for tissue according to the expectation to be delivered to tissue.These Material may include bioabsorbable polymer and biocompatible polymer, including homopolymer and copolymer.It is bioabsorbable Polymer can be absorbable, can reabsorbing, biological absorbable or biodegradable polymer.Auxiliary material can also wrap Include 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 CellerixSL), hemostat and organization healing agent).

Auxiliary material can be releasably retained to lack a kind of medicament that can be selected from a large amount of different agents.Medicament includes but is not limited to In auxiliary material or the drug or other reagents with desired function associated with auxiliary material.Medicament includes but is not limited to for example Antimicrobial (such as antibacterial agent and antibiotic), antifungal agent, antivirotic, anti-inflammatory agent, growth factor, anodyne, anesthesia Agent, periplast's degeneration inhibitor, anticancer agent, hemostat and other reagents for causing biological respinse.Auxiliary material can also be by being imaged The reagent of period enhancing visibility be made or the reagent including enhancing visibility such as, such as echogenic material or radiopaque material 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 The various auxiliary materials of medicament and the example of various technologies are discharged in auxiliary material, which is herein incorporated by reference.