阅读说明：本技术 用于外科缝合装置中的附属物的释放的系统 (System for the appendicular release in surgical stapling device ) 是由 M·J·温德里 P·武尔霍普 J·L·哈里斯 F·E·谢尔顿四世 D·C·亚特斯 于 2018-02-13 设计创作，主要内容包括：本发明提供了用于将附属物与外科缝合装置的端部执行器的钳口分离的系统和方法。端部执行器(包括被构造成能够将组织夹紧在两者间的第一钳口和第二钳口)包括可释放地保持在钳口中的至少一者上的附属材料。端部执行器还包括击发杆,该击发杆被构造成能够在端部执行器的近侧端部处的未击发位置和端部执行器的远侧端部处的击发位置之间移动。可驻留在钳口中的附属物移除组件被构造成能够联接到击发杆并与击发杆一起移动,以在与附属物移除组件联接的击发杆从击发位置返回到未击发位置时将附属材料与外科缝合装置分离。(The present invention provides the system and method for separating adjunct with the jaw of the end effector of surgical stapling device.End effector (including being configured to the first jaw and the second jaw by clamp tissue between the two) includes the attaching material being releasably held at least one of jaw.End effector further includes trigger shaft, which is configured to move between the firing position at the distal end of the non-firing position at the proximal end of end effector and end effector.The adjunct that can reside in jaw removes component and is configured to be connected to trigger shaft and move together with trigger shaft, to separate attaching material with surgical stapling device when returning to non-firing position from firing position in the trigger shaft for removing component connection with adjunct.)

1. a kind of surgical stapling device, comprising:

First jaw of end effector, first jaw have storehouse, and the storehouse, which has, is configured to make nail to rest upon Multiple nail cavities therein, the nail cavity is in the storehouse towards tissue surface upper opening；

Second jaw of the end effector, second jaw is opposite with first jaw and has anvil block, described Anvil block, which has, is formed in it towards multiple nail forming cavities on tissue surface, wherein first jaw and the second jaw quilt It is constructed to be permeable to clamp tissue between first jaw and second jaw；

Attaching material, the attaching material are releasably held at least one of first jaw and second jaw On；

Trigger shaft, the trigger shaft are configured to non-firing position and institute at the proximal end of the end effector It states and is moved between the firing position at the distal end of end effector；With

Adjunct removes component, the adjunct remove component be configured to be connected to the trigger shaft and with the percussion Bar moves together, will when returning to non-firing position from firing position in the trigger shaft coupled with adjunct removal component The attaching material is separated with the surgical stapling device.

2. the apparatus according to claim 1, wherein the trigger shaft includes knife and nail at least one of driving assembly, The nail driving assembly is configured to fire the nail from the nail cavity against the nail forming cavity.

3. the apparatus according to claim 1, wherein the adjunct is removed component and is arranged with following configuration in the end At the distal end of actuator: wherein when the surgical stapling device is in pre- percussion configuration, the adjunct removes component It is not coupled to the trigger shaft.

4. surgical stapling device according to claim 1, wherein the adjunct removes component and is configured to along institute State the knife channel longitudinal movement in storehouse.

5. the apparatus according to claim 1, in which:

The trigger shaft includes the first mating features,

It includes that adjunct removes features and the second mating features, second mating features that the adjunct, which removes component, It is configured to cooperate when the trigger shaft is activated to reach the firing position with first mating features；And And

The adjunct removes component and is configured to match when second mating features with first mating features It is moved together when conjunction with the trigger shaft, so that when the adjunct removes component and the trigger shaft moves together, it is described Adjunct removes features and separates the attaching material with one of first jaw and second jaw.

6. device according to claim 5, wherein the adjunct removes component and is operably associated with the storehouse.

7. surgical stapling device according to claim 5, wherein it includes plate that the adjunct, which removes features, the plate It is configured to slide between the attaching material and one of first jaw and second jaw.

8. surgical stapling device according to claim 5, wherein first mating features includes being located at the percussion Chamber in bar.

9. surgical stapling device according to claim 8, wherein second mating features includes being configured to With at least one protrusion of the chamber cooperation in the trigger shaft.

10. surgical stapling device according to claim 9, wherein at least one described protrusion includes a pair of of bar, and described one Bar is configured such that when adjunct removal component is connected to the trigger shaft and moves together with the trigger shaft When, the trigger shaft is between the bar.

11. a kind of surgical method, comprising:

The trigger shaft of actuating end effector, the end effector include the first jaw and the second jaw, first jaw With storehouse, the storehouse, which has, is configured to make nail to rest upon in multiple nail cavities wherein, second jaw and described first Jaw is opposite and has anvil block, and the anvil block has at it towards the multiple nail forming cavities formed on tissue surface, wherein institute It states the non-firing position that trigger shaft is actuated to from the proximal end of the end effector and is moved to the end execution Firing position in the distal end of device；

When the trigger shaft is in the firing position, the adjunct of the end effector is made to remove component and the percussion Bar engagement；

The trigger shaft is activated so that it returns to the non-firing position from the firing position, so that working as the trigger shaft quilt When actuating is with the non-firing position described in, the adjunct removes component and moves together with the trigger shaft, so that The attaching material and described at least one being releasably held at least one of first jaw and second jaw A jaw separation.

12. surgical method according to claim 11, wherein the trigger shaft includes knife and follows closely in driving assembly at least One, the nail driving assembly are configured to fire the nail from the nail cavity against the nail forming cavity.

13. surgical method according to claim 11, wherein the adjunct is removed component and is arranged with following configuration in institute It states at the distal end of end effector: described attached wherein when the surgical stapling device is in pre- percussion configuration Object removes component and is not coupled to the trigger shaft.

14. surgical method according to claim 11, wherein the trigger shaft includes the first mating features, and is made The adjunct of the end effector removes component and is engaged with the trigger shaft including making the adjunct remove component Second mating features is engaged with first mating features.

15. surgical method according to claim 11, wherein the adjunct removes component and is configured to along described Knife channel longitudinal movement in storehouse.

Technical field

The present disclosure relates generally to the attaching 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 operative 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

Surgical stapling device includes first jaw with storehouse, which, which has, is configured to make nail to rest upon wherein Multiple nail cavities.Nail cavity is in storehouse towards tissue surface upper opening.Surgical stapling device includes the second jaw, second jaw and the One jaw is opposite and has anvil block, which has at it towards the multiple nail forming cavities formed on tissue surface.First pincers Mouth and the second jaw are configured to clamp tissue between the first jaw and the second jaw.Surgical stapling device further includes The attaching material being releasably held at least one of the first jaw and the second jaw.Surgical stapling device further includes hitting It sends out bar and adjunct removes component, which is configured to the non-firing position at the proximal end of end effector It is moved between the firing position at the distal end of end effector, and the adjunct removes component and is configured to join It is connected to trigger shaft and is moved together with trigger shaft, to be returned in the trigger shaft coupled with adjunct removal component from firing position Attaching material is separated with surgical stapling device when non-firing position.

Surgical stapling device can be varied in many ways.In one embodiment, trigger shaft includes knife and nail driving group At least one of part, the nail driving assembly are configured to fire nail from nail cavity against nail forming cavity.In another reality It applies in scheme, adjunct is removed component and is arranged at the distal end of end effector with following configuration: wherein working as surgical stapling When device is in pre- percussion configuration, adjunct removes component and is not coupled to trigger shaft.

In one embodiment, adjunct removes component and is configured to the longitudinal movement of the knife channel in storehouse.In In another embodiment, trigger shaft includes the first mating features.It includes that adjunct removes features that adjunct, which removes component, With the second mating features, second mating features be configured to when trigger shaft is activated to reach firing position with The cooperation of first mating features.Adjunct removes component and is configured to when the second mating features and the first mating features It is moved together when cooperation with trigger shaft, so that adjunct removes feature when adjunct removes component and trigger shaft moves together Portion separates attaching material with one of the first jaw and the second jaw.

In one embodiment, adjunct removes component and is operably associated with storehouse.In another embodiment, It includes plate that adjunct, which removes features, which is configured in attaching material and one of the first jaw and the second jaw Between slide.In another embodiment, the first mating features includes the chamber in trigger shaft.In another embodiment party In case, the second mating features includes at least one protrusion being configured to the chamber cooperation being located in trigger shaft.Another In one embodiment, at least one protrusion includes a pair of of bar, which is configured such that remove component connection when adjunct When being connected to trigger shaft and moving together with trigger shaft, trigger shaft is between bar.

A kind of surgical method includes the trigger shaft of actuating end effector.The trigger shaft of end effector includes the first jaw With the second jaw, which has storehouse, which, which has, is configured to make nail to rest upon in multiple nail cavities wherein, this Two jaws it is opposite with first jaw and have anvil block, the anvil block have its towards the multiple nails formed on tissue surface at Shape chamber.First jaw and the second jaw are configured to clamp tissue between the first jaw and the second jaw.Trigger shaft It is actuated to from the distal end that the non-firing position from the proximal end of end effector is moved to end effector Firing position.The surgical method further includes that the adjunct of end effector is made to remove component when trigger shaft is in firing position It is engaged with trigger shaft.The surgical method further includes actuating trigger shaft so that it is from firing position back to non-firing position, so that When trigger shaft is activated to return to non-firing position, adjunct removes component and moves together with trigger shaft, so that can The attaching material being releasably retained at least one of the first jaw and the second jaw is separated at least one jaw.

In a specific implementation of this method, trigger shaft includes at least one of knife and nail driving assembly, which drives Dynamic component is configured to fire nail from nail cavity against nail forming cavity.It is attached in another specific implementation of this method Object is removed component and is arranged at the distal end of end effector with following configuration: wherein when surgical stapling device is in pre- percussion When configuration, adjunct removes component and is not coupled to trigger shaft.

In a specific implementation of this method, trigger shaft includes the first mating features, and makes end effector Adjunct removes component and engages the second mating features and the first mating feature including making adjunct remove component with trigger shaft Portion's engagement.In another specific implementation of this method, it is vertical that adjunct removal component is configured to the knife channel in storehouse To movement.

Detailed description of the invention

By being described in detail below in conjunction with made by attached drawing, invention will be more fully understood, 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 A shows the appendicular example towards tissue surface for releasably holding surgical stapling device；

Fig. 6 B shows the cross-sectional view for the tissue being clamped between the upper jaw of surgical stapling device and lower jaw；

Fig. 6 C shows the perspective view of the embodiment of the distal end of the trigger shaft of surgical stapling device；

Fig. 7 A is the side view of the embodiment of the jaw of end effector, and it illustrates the pincers for being in pre- percussion configuration Mouthful；

Fig. 7 B is the side view of the jaw of Fig. 7 A, and it illustrates the jaws for being in percussion configuration；

Fig. 8 shows the exemplary perspective view of adjunct removal system；

Fig. 9 shows the top view of the jaw of end effector；And

Figure 10 shows the perspective partial cut-way view of the jaw of the end effector of Fig. 9.

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, and because This not necessarily completely illustrates each features of the similar component of each title in a particular embodiment.In addition, public in institute Using in the linear or degree of circular dimension in the description for the systems, devices and methods opened, such size is not intended to limit can In conjunction with 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 Shape can easily determine such linear and circular dimension equivalent dimension.System and the size and shape of device and its component can The anatomical structure, system and device that are used for subject therein will be used therewith at least dependent on system and device The size and shape and system and device of component 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, herein in relation to diagram use space term such as "vertical" and "horizontal".However, surgical instruments is in many It is used on orientation and position, and these spatial terminologies and non-limiting and absolute.

In some embodiments, device and method as described herein are arranged for open surgery, and In other embodiments, device and method setting is used 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 " adjunct ") help improve surgical operation.Although a variety of different surgical end-effectors can benefit from appendicular make With, but in some example embodiments, end effector can be surgical stapling device.When combination surgical stapling device uses When, one or more adjuncts may be provided between the jaw of stitching unstrument and/or thereon, be integrated to the nail being arranged in jaw It is placed in storehouse or otherwise adjacent to nail.When disposing nail, which can be held together in treatment with nail Position then provides many benefits.For example, one or more adjuncts can enhance the tissue for the treatment of site, prevent from controlling It treats to be followed closely at position and tear or tearing.If organize illness, from another kind treatment such as irradiation treatment, pharmaceutical treatment it is such as chemical Therapy or other tissue properties change situation healing, then tissue may be needed to enhance and tear tissue to prevent non-magnetic shim.In some cases Under, which can make to follow closely the histokinesis around site of perforation neutralization (for example, atelectasis, gastrointestinal tract are expanded Deng) minimize, this histokinesis can occur because of the suture metaplasia of generation later.Those skilled in the art will recognize that It arrives, nail site of perforation can be used as stress concentration portion, and when surrounding tissue is under tension, by following closely the big of the hole generated It is small to increase.The size that the histokinesis around these site of perforation can make hole that can increase under tension is limited to minimize. In some cases, which is configured to wick or absorb the beneficial stream for further promoting healing Body, such as sealant, blood, sticker, and in some cases, which is configured to drop Solution further promotes the gel of healing, such as sealant to be formed.In some cases, which can be used for Help to be sealed in nail be implanted tissue, in blood vessel and various other objects or body part when by following closely the hole formed.The one kind or A variety of adjuncts can also by the interval of any fiber associated with the one or more adjuncts or strand, positioning and/or Orientation is to influence tissue growth.In addition, in some cases, adjunct can be used for distributing the pressure applied by nail, to reduce Nail across tissue (may frangible) and cannot as expected fastening tissue (so-called " cheese wiring ") a possibility that.In addition, attached Belonging to object can be at least partly stretchable, and therefore allows at least part of proper motion of tissue (for example, lung during breathing The expansion and contraction of tissue).In some embodiments, staple line can be flexible, as such as on September 26th, 2014 submit The U.S. Patent Publication 2016/0089142 of entitled " Method for Creating a Flexible Staple Line " Described in, which is incorporated by reference accordingly is incorporated herein.

Surgery suturing appliance

Various surgical instruments can make in conjunction with one or more adjuncts disclosed herein and/or one or more medicaments With." adjunct " is also referred herein as " attaching material ".Surgical instruments may include surgical stapling device.Various surgeries can be used Stitching unstrument, such as linear surgical stapler and circular stapler.In general, linear staplers are configured to generate longitudinal nail Line and may include elongated nip, the elongated nip have the storehouse of the longitudinal staple of the receiving for being connected to it.Elongated nip may include The knife or other cutting elements that notch is generated between staple can be woven in along the group being maintained in jaw.In general, circular stapler It is configured to generate annular staple line, and may include the round jaw with the storehouse for accommodating annular staple.Round jaw It may include knife or other cutting elements, the knife or other cutting elements can form notch in staple to limit across being maintained at The opening of tissue in jaw.Stitching unstrument can be used for various tissues in a variety of different surgical operations, such as in thoracic surgery In operation or stomach operation.

Fig. 1 shows the linear surgical stapler 10 for being suitble to be used together with one or more adjuncts and/or medicament One example.The axis that stitching unstrument 10 generally includes handle assembly 12, extends from the distal end 12d of handle assembly 12 towards distal side 14, and the end effector 30 at the distal end 14d of axis 14.End effector 30 has opposite lower jaw and upper Jaw 32,34, but other kinds of end effector can be together with axis 14, handle assembly 12 and component associated there It uses.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 pincers Mouth 34 has towards lower jaw 32 and is configured to be operated as anvil block to help to dispose the anvil faces of the nail of nail bin 40 33 (nail is blocked in fig. 1 and 2).At least one of the opposite lower jaw and upper jaw 32,34 can be relative under The other of jaw and upper jaw 32,34 are moved to clamp the tissue being disposed there between and/or other objects.Some specific In implementation, at least one of the opposite lower jaw and upper jaw 32,34 be can be fixed or otherwise immovable 's.In some specific implementations, both the opposite lower jaw and upper jaw 32,34 can be movable.The portion of trigger system Part is configured to inject in clamped tissue across at least part of end effector 30 will follow closely.Various In specific implementation, blade 36 (referring to Fig. 3) or other cutting elements can be associated with trigger system to cut during suture operation Cut tissue.The nail that cutting element is configured to and is emitted at least partly cuts tissue simultaneously.In some cases, If cutting tissue after nail has been emitted and organizes to be fixed, can be advantageous.Therefore, if surgical operation is wanted It asks cutting to be trapped in the tissue between jaw, then promotes knife 36 to be breaking at after nail is projected from nail bin 40 and grasp in jaw Between 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 be designed to manipulate and operate end effector 30 associated there it is many not Same construction.In the example shown, handle assembly 12 has pistol grasping type shell 18, which has setting The various features of instrument 10 are operated in various mechanical and/or electronic components wherein.For example, handle assembly 12 may include with The knob 26 of the adjacent installation of its distal end 12d, the knob can be conducive to axis 14 and/or end effector 30 around the vertical of axis 14 Rotation to axis L relative to handle assembly 12.Handle assembly 12 may also include as the clamping activated by clamping trigger 22 The firing components of the clamping component of a part of system and a part as the trigger system activated by firing trigger 24.Folder Tight trigger 22 and firing trigger 24 can be for example biased into the open position relative to fixed handle 20 by torque spring.It clamps Clamping system, which may be actuated, in the movement of trigger 22 towards fixed handle 20 can make jaw 32,34 toward each other as described below It collapses thus by clamp tissue between jaw 32,34.Trigger system may be actuated in the movement of firing trigger 24, as described below, It can make nail be placed in set by it nail bin 40 therein project 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 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.It is supported in nail pallet 37 in the nail bin 40 wherein with multiple nails, the nail pallet Then it is supported in the warehouse channel of lower jaw 32.Upper jaw 34 has multiple nail shapes pit (not shown), the nail shapes pit Each of be located in from the upper surface of the corresponding nail for receiving multiple nails in nail bin 40.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 keeps anvil faces 33 mobile, and the nail shapes pit being formed thereon is towards opposite nail bin 40 It is mobile.

Various clamping components can be used for realizing the opening and closing of jaw 32,34, selectively to clamp clamp tissue Between mouth 32,34.As shown, the pivoted end 34p of upper jaw 34 is wrapped at it with the distal side in the pivotal attachment portion of nail channel 56 Include closure feature portion 34c.Accordingly, in response to clamping trigger 22, closed tube 46 is selectively proximally longitudinal in closed tube 46 34 opening action of upper jaw is assigned during movement and is moved in closed tube towards the closure of upper jaw 34 is assigned during the longitudinal movement of distal side Make, the distal end of the closed tube includes the shape of a hoof hole 46a for engaging closure feature portion 34c.As described above, in various specific realities The opening and closing of Shi Zhong, end effector 30 can relative motion, upper jaws 34 by lower jaw 32 relative to upper jaw 34 It is realized relative to the relative motion of lower jaw 32 or 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.Staple drivers 48 move up the power upward to each application in multiple nails in storehouse 40, thus Anvil faces 33 against upper jaw 34 push up nail, and generate 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.Specifically, a pair of of ejector pin and a pair of of bottom One or both of engageable upper jaw and lower jaw 32,34 are sold, when trigger shaft 35 is advanced through end effector 30 Jaw 32,34 is compressed toward each other.Meanwhile the knife 36 extended between ejector pin and bottom pin is configured to cutting and is captured 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 features of stitching unstrument 10 can be as needed by user To manipulate to realize desired locations of the jaw 32,34 in surgical site and tissue relative to jaw 32,34.It is suitable having realized After positioning, clamping trigger 22 can be pulled towards fixed handle 20 to activate clamping system.Clamping trigger 22 can make The component of clamping system works, so that closed tube 46 is advanced through at least part of axis 14 towards distal side to cause jaw 32,34 At least one of collapse towards another one to clamp and tissue between jaw 32,34 is arranged in.It then, can be by clamping trigger 24 The operation of components so that trigger system is pulled towards fixed handle 20, so that trigger shaft 35 and/or electron beam 38 are pushed into 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 handle assembly 52, The handle assembly has axis 54, which extends from handle assembly towards distal side and have in the distal end of axis for treating tissue End effector 60.The upper jaw and lower jaw 64,62 of end effector 60 are configured to that capture will be organized upper Between jaw and lower jaw 64,62, by sutured from 66 percussion nail of storehouse being arranged in lower jaw 62 tissue and/or Notch is generated in tissue.In the specific implementation, the attachment part 67 in the proximal end of axis 54 is configured to allow Axis 54 and end effector 60 are removably attached to handle assembly 52.Specifically, the mating features 68 of attachment part 67 can Cooperate with the complementary fit features 71 of handle assembly 52.Mating features 68,71 is configured to via for example buckling Formula connection, bayonet type connection etc. are linked together, but any amount of complementary fit features and any kind of can be used It fetches and axis 54 is removably coupled to handle assembly 52.Although the entire axis 54 of shown specific implementation is configured to from handle Parts 52 remove, but in some specific implementations, and attachment part 67 is configured to allow the only distal part of axis 54 It removes.The detachable connection of axis 54 and/or end effector 60 allows selectively to be attached desired end for particular procedure Portion's actuator 60, 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 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 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 removable jaw 62,64 is moved to closed position.Trigger 74 passes through the towards 70 further movement of fixed handle Firing components may be actuated in two actuating ranges, so that nail projects from nail bin 66 and/or make knife or other cutting element (not shown) Tissue of the propulsion 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, which has an axis 84, and the axis is from handle Parts extend towards distal side and have the end effector 90 for treating tissue in the distal end of the axis.End executes Device 90 may include storehouse component 92 and anvil block 94, the tissue contact that the storehouse component and anvil block respectively have its substantially circular Surface.Storehouse component 92 and anvil block 94 can be connected in one via the axis 98 for the handle assembly 82 for extending to stitching unstrument 80 from anvil block 94 It rises, and manipulate the actuator 85 in handle assembly 82 to bounce back with cardan shaft 98 so that anvil block 94 is moved relative to storehouse component 92 It is dynamic.Anvil block 94 and storehouse component 92 can carry out various functions, and be configured to that capture will be organized in anvil block 94 and storehouse group Between part 92, by suturing tissue from 96 percussion nail of the storehouse of storehouse component 92, and/or notch can be generated in the tissue.One As for, storehouse component 92 can accommodate comprising nail storehouse, and can will nail deployment circular staple pattern is formed 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 releasably coupled to allow anvil block 94 to separate with storehouse component 92, this is allowed anvil Seat 94 and storehouse component 92 are located in the bigger flexibility in the body of patient.For example, the first part of axis 98 may be provided at storehouse group It extends to except storehouse component 92, is terminated in the mating features of distal side in part 92 and towards distal side.The second part of axis 98 is settable It in anvil block 94 and extends proximally to except storehouse component 92, terminates in nearside mating features.When in use, which matches Closing features and distal side mating features can be linked together to allow anvil block 94 and storehouse component 92 to be moved relative to 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 uses In the trigger 85 of the actuating of end effector 90.Trigger 85 moves across the first actuating range towards fixed handle 87 and may be actuated The component of clamping system is to approach jaw, that is, moves anvil block 94 towards storehouse component 92.Trigger 85 is worn towards the movement of fixed handle 87 Crossing the second actuating range may be actuated the component of trigger system so as to dispose nail from nail bin groupware 92 and/or promote knife to cut The disconnected tissue being trapped between storehouse component 92 and anvil block 94.

The shown example of surgery suturing appliance 10,50,80 is provided only and can be used in combination with disclosure provided herein Many different configurations and associated method of use several examples.Although shown example is structured to can be used in minimally invasive Operation, but it is to be understood that be configured for instrument (such as on 2 28th, 2007 titles submitted of open surgery For " Surgical Stapling Devices That Produce Formed Staples Having Different Opening linear stitching unstrument described in the United States Patent (USP) 8,317,070 of Lengths ") it can be with disclosure provided herein knot It closes and uses.The more details of shown example and the additional example of surgical stapling device, its component and its associated method of use with It is provided in lower announcement: entitled " the Systems And Methods For Controlling A submitted on March 26th, 2014 The U.S. Patent Publication 2015/0277471 of Segmented Circuit "；On 2 8th, the 2013 entitled " Layer submitted The United States Patent (USP) 8,393,514 of Comprising Deployable Attachment Members "；It mentions on September 30th, 2010 The United States Patent (USP) 8 of entitled " the Selectively Orientable Implantable Fastener Cartridge " that hands over, 393,514；Entitled " the Surgical Stapling Devices That Produce submitted on 2 28th, 2007 The United States Patent (USP) 8,317,070 of Formed Staples Having Different Lengths "；On June 21st, 2005 submits Entitled " Surgical Instrument Incorporating EAP Blocking Lockout Mechanism " United States Patent (USP) 7,143,925；Entitled " the Sealing Materials For Use In submitted on November 8th, 2013 The U.S. Patent Publication 2015/0134077 of Surgical Stapling "；On November 8th, 2013 submits entitled "Sealing Materials for Use in Surgical Procedures"；On November 8th, 2013 submits entitled The U.S. Patent Publication 2015/ of " Hybrid Adjunct Materials for Use in Surgical Stapling " 0134076；Entitled " the Positively Charged Implantable Materials submitted on November 8th, 2013 The U.S. Patent Publication 2015/0133996 of and Method of Forming the Same "；What on November 8th, 2013 submitted The U.S. Patent Publication of entitled " Tissue Ingrowth Materials and Method of Using the Same " 2015/0129634；Entitled " the Hybrid Adjunct Materials for Use in submitted on November 8th, 2013 The U.S. Patent Publication 2015/0133995 of Surgical Stapling "；On March 26th, 2014 submits entitled The U.S. Patent Publication 2015/0272575 of " Surgical Instrument Comprising a Sensor System "；With And entitled " the Adjunct Materials and Methods of Using Same in that on June 4th, 2010 submits The U.S. Patent Publication 2015/0351758 of Surgical Methods for Tissue Sealing ", these full patent texts evidences This is herein incorporated by reference.

Implantable adjunct

As indicated above, provide for be used in combination with surgery suturing appliance it is various can plant it is attached Object.The adjunct can have a variety of configurations and can be formed of a variety of materials.In general, adjunct can be by film, foam, injection molding thermoplastic Property one or more of plastics, vacuum thermoforming material, fibre structure and its mixture formed.The adjunct may also include one Kind or a variety of bio-derived materials and one or more drugs.Each of these materials are begged in greater detail below By.

Adjunct can be by formation of foam, such as closed-cell foam, open celled foam or sponge.How can manufacture such appendicular Example is the collagen (such as pig tendon) from animal derived, then can be processed and be lyophilized into foaming structure.Gelatin can also It is used and is processed into foam.What the various appendicular examples of foam were 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.

Adjunct can also be made of the film that any suitable material discussed below or combination of materials are formed.The film may include one A or multiple layers, each layer can have different degradation rates.In addition, film can have various regions formed therein, for example, The reservoir of one or more various forms of medicaments can be releasably held.One or more different coatings can be used Sealing is provided with the reservoir of at least one medicament, which may include absorbable or nonabsorable polymer.Film can It is formed in various ways.For example, it can be film squeeze out or compression molded.Medicament can also be by noncovalent interaction such as On Hydrogen Binding Adsorption to film or it is integrated to film.

Adjunct can also be formed by injection molded thermoplastic's material or vacuum thermoforming material.On 2 8th, 2013 titles submitted For " Fastener Cartridge Comprising A Releasably Attached Tissue Thickness The various appendicular examples of molding are further described in the U.S. Patent Publication 2013/0221065 of Compensator ", this is specially Benefit, which is incorporated by reference, to be incorporated herein.Adjunct is also possible to the lattice based on fiber, can be weaven goods, knitted fabric or non- The loose weaven goods of weaven goods, such as melt-blown, needle thorn or heat building.Adjunct can have can be by the lattice or inhomogeneity of same type The trellis of type at multiple regions, these lattice can be formed together adjunct in a number of different manners.For example, fiber can weave, Braiding, knitting are otherwise interconnected to formation rule or irregular structure.Fiber can be connected with each other, so that institute The adjunct relative loose obtained.Alternatively, adjunct may include the fiber closely interconnected.Adjunct can be sheet material, tubing, spiral shell It revolves or any other may include the form of the structure of flexible portion and/or more rigid strengthening part.Adjunct can be configured to Enable to its some regions that there can be finer and close fiber, and other regions have the fiber compared with low-density.Based on adjunct Intended application, fibre density can change in different directions along appendicular one or more dimensions.Adjunct can be by weaving , knitting or the fiber that otherwise interconnects formed, this allows adjunct to stretch.For example, adjunct is configured to It is enough to be stretched on the direction along its longitudinal axis and/or in transverse direction perpendicularly to the longitudinal axis.Although at least two It is stretchable in size (for example, X-direction and Y-direction), but adjunct can provide reinforcement along its thickness (for example, Z-direction), so that It stretches but resists nail tearing and pulls.It is configured to be implanted and make them appendicular non-with tissue stretching Limitative examples are described in entitled " the Method for Creating a Flexible submitted on September 26th, 2014 The above-mentioned U.S. Patent Publication 2016/0089142 of Staple Line ", which is incorporated by reference accordingly is incorporated herein.

Adjunct is also possible to mix construction, such as laminated composites or melting locking interconnected fibrous.A variety of mixing structures Make the U.S. that appendicular example is also described in entitled " the Adhesive Film Laminate " that submits on 2 8th, 2013 Patent 9,282,962 and entitled " the Minimally Invasive Medical Implant submitted on September 12nd, 2007 The United States Patent (USP) 7 of And Insertion Device And Method For Using The Same ", 601,118, full text It is hereby incorporated by reference.

It can be formed by a variety of materials according to the adjunct of the technology.These materials can be used in various embodiments with In different purposes.These materials can be selected according to the expectation treatment to be delivered to tissue to be conducive to the inside life of tissue It is long.These materials may include bioabsorbable polymer and biocompatible polymer, including homopolymer and copolymer.It can give birth to The polymer that object absorbs can be absorbability, absorbable, biological absorbable or biodegradable polymer.Adjunct It may also include activating agent, such as competent cell culture is (for example, the autologous tissue of stripping and slicing, the reagent (example for stem cell therapy Such as, Biosutures and Cellerix SL), hemostat and organization healing agent).

Adjunct can be releasably retained to lack a kind of medicament that can be selected from a large amount of different agents.Medicament includes but unlimited In be included in adjunct in or the drug or other reagents with desired function relevant to adjunct.Medicament includes but is not limited to Such as antimicrobial (such as antibacterial agent and antibiotic), antifungal agent, antivirotic, anti-inflammatory agent, growth factor, anodyne, Anesthetic, periplast's degeneration inhibitor, anticancer agent, hemostat and other reagents for causing biological respinse.Adjunct can also be by The reagent of visibility during enhancing imaging is made or including the reagent, such as antiviral material or wireless opaque material Material.

For being also described in 2015 on August 31, from the various adjuncts of adjunct release medicament and the example of various technologies Entitled " the Medicant Eluting Adjuncts and Methods of Using Medicant Eluting submitted The U.S. Patent application 14/840,613 of Adjuncts ", the full text of this application is hereby incorporated by reference.