CN101873834B

CN101873834B - Washer for use with a surgical stapling instrument

Info

Publication number: CN101873834B
Application number: CN200880101756.8A
Authority: CN
Inventors: W·B·威森伯格; C·J·赫斯; L·E·小威尔斯; D·J·西贝纳尔; T·W·修特玛; J·R·莫甘; M·A·默里; A·M·茨沃林斯基
Original assignee: Ethicon Endo Surgery Inc
Current assignee: Ethicon Endo Surgery Inc
Priority date: 2007-06-29
Filing date: 2008-06-11
Publication date: 2012-12-05
Anticipated expiration: 2028-06-11
Also published as: CN101873834A

Abstract

A surgical stapler including a 'breakaway' washer that is inserted into an anvil. In various embodiments, the washer can include a circular inner portion and a circular outer portion. In one various embodiment, the outer portion may include a number of staple guide sections that define openings through which staple ends of surgical staples are driven when the surgical stapler is fired and are thereafter bent, or turned, by the anvil. In various embodiments, the staple ends may then contact and be retained by the staple guide sections so that the staple ends do not re-penetrate or otherwise re-puncture stapled tissue. In one various embodiment, the washer can be dissolvable or bioabsorbable.

Description

The packing ring that uses with surgical stapling instrument

Background technology

The present invention relates to the following U.S. Patent application of owning together, it incorporates this paper into way of reference in full:

(1) name of meanwhile submitting to is called RE-LOADABLE SURGICAL STAPLINGINSTRUMENT (formula of can resetting surgical stapling instrument), attorney is the U.S. Patent application of END6152USNP13/070199;

(2) name of meanwhile submitting to is called SURGICAL STAPLE HAVING A SLIDABLECROWN (the surgical operation seam nail with slideable hat), attorney is the U.S. Patent application of END6152USNP1/070099;

(3) name of meanwhile submitting to is called METHOD OF MANUFACTURING STAPLES (making the method for seam nail), attorney is the U.S. Patent application of END6152USNP2/070100;

(4) name of meanwhile submitting to is called SURGICAL STAPLES WITH IMPROVEDTISSUE COMPRESSION FEATURES (the surgical operation seam nail with tissue compression characteristic of improvement), attorney is the U.S. Patent application of END6152USNP3/070101;

(5) name of meanwhile submitting to is called STAPLE CARTRIDGE CAVITYCONFIGURATIONS (structure in nail bin nail bin chamber), attorney is the U.S. Patent application of END6152USNP4/070102;

(6) name of meanwhile submitting to is called STAPLE CARTRIDGE CAVITYCONFIGURATION WITH COOPERATIVE SURGICAL STAPLE (structure of being furnished with the nail bin nail bin chamber of surgical operation seam nail), attorney is the U.S. Patent application of END6152USNP5/070103;

(7) name of meanwhile submitting to is called SURGICAL STAPLE HAVING A SLIDABLECROWN (the surgical operation seam nail with slideable hat), attorney is the U.S. Patent application of END6152USNP6/070111;

(8) name of meanwhile submitting to is called SURGICAL STAPLING INSTRUMENTSHAVING A RELEASABLE STAPLE-FORMING POCKET (but having the surgical stapling instrument that the release type seam is followed closely the shaping pit), attorney is the U.S. Patent application of END6152USNP7/070112;

(9) name of meanwhile submitting to is called the SURGICAL PROCEDURE USING A CUTTINGAND STAPLING INSTRUMENT HAVING RELEASABLE STAPLE-FORMINGPOCKETS surgical operation of the cutting and stapling instrument with release type seam nail shaping pit (but use), the attorney U.S. Patent application as END6152USNP8/070113;

(10) name of meanwhile submitting to is called SURGICAL STAPLE HAVING A DEFORMABLEMEMBER WITH A NON-CIRCULAR CROSS-SECTIONAL GEOMETRY (the surgical operation seam nail with deformable member of non-circular cross sections geometry), attorney is the U.S. Patent application of END6152USNP9/070114;

(11) name of meanwhile submitting to is called SURGICAL STAPLE HAVING A DEFORMABLEMEMBER WITH A NON-CIRCULAR CROSS-SECTIONAL GEOMETRY (the surgical operation seam nail with deformable member of non-circular cross sections geometry), attorney is the U.S. Patent application of END6152USNP10/070115;

(12) name of meanwhile submitting to is called the SURGICAL STAPLING INSTRUMENT HAVINGA RELEASABLE BUTTRESS MATERIAL surgical stapling instrument of release type backing material backing material (but have), attorney is the U.S. Patent application of END6152USNP11/070197; And

(13) name of meanwhile submitting to is called SURGICAL STAPLE HAVI NG ANEXPANDABLE PORTION (the surgical operation seam nail with expandable part), attorney is the U.S. Patent application of END6152USNP12/070198.

1. technical field

The present invention relates generally to surgical operating instrument, more particularly, relates to surgical stapling instrument and with the seam of its use nail.

2. the explanation of association area

The surgical operation stiching instrument can be used during the multiple surgical technic of enforcement.During implementing at least a surgical technic, can the surgical operation stiching instrument be inserted in patient's body through intubate or the pipe that is positioned in the little otch.These surgical technics are called splanchnoscopy and/or laparoscopy surgical technic, and they are superior to conventional or open surgical technic usually, because they can shorten patient's recovery time.Surgical operation stiching instrument implementing to use between this technical phase generally includes the end effector that can be used for realizing multiple diagnosis and/or therapeutic effect.In a plurality of embodiment, this surgical operation stiching instrument can comprise can cut soft tissue and will stitch the end effector in the soft tissue on the nail insertion otch opposite side.In at least one embodiment, end effector can comprise a pair of cooperation jaw member of passing intubate, and wherein in the jaw member can comprise the nail bin nail bin, and another jaw member can comprise anvil block.In at least one this embodiment, nail bin can be constructed at least two row seam nails are navigated in the tissue, and anvil block can comprise the seam nail shaping pit that is constructed to make the distortion when being positioned of seam nail.

Some surgical operation stiching instrument; For example be published in November 14 nineteen ninety-five day, and be called the United States Patent(USP) No. 5 of SURGICAL STAPLER INSTRUMENT (surgical stapling instrument); Described in 465,895 those (disclosure of this patent is incorporated this paper into way of reference) can comprise the end effector with cutting element and seam staple drivers; For example, wherein cutting element can move along straight line, bending and/or curved path in end effector with the seam staple drivers.Usually this surgical operation stiching instrument is called inner cutter, utilizes during its surgical technic that can detour at the stomach that (for example) implements to reduce patient's stomach size.Detour a kind of in the surgical technic of modal stomach is Roux-en-Y gastric bypass operation method.In this technology, can the stomach crosscut be become at least two parts, wherein can in these parts be shaped to the tiny pocket at the middle part (being jejunum) that can be directly connected to patient's small intestinal.Under multiple situation, available inner cutter is the cutting stomach along required path, and will stitch to follow closely and navigate in the gastric tissue, so that gastric tissue is kept together.As the result of above-mentioned technology, can walk around another crosscut part of stomach and the top (being duodenum) of small intestinal through gastral food.

Developed other surgical operation stiching instrument, for example stiching instrument or circular stapler in the tube chamber are to assist the surgeon during implementing to be commonly referred to as the surgical technic of anastomosis.Anastomosis is a kind of surgical technic, and in this operation, crosscut small intestinal and/or large intestine excise its part, and rest parts is bonded together.This technology needs surgeon's crosscut small intestinal usually, for example in two position crosscuts that form first end, second end and mid portion.Afterwards, can mid portion be removed, and first terminal and second end is set to adjacent one another are.In order to connect first terminal and second end; Can first terminal and second end be positioned in the tube chamber in stiching instrument or the circular stapler; Feasible can the seam nail being navigated in first end and second end of its periphery, so that first end and second end are kept together.This stiching instrument is called the United States Patent(USP) No. 5 of INTRALUMINAL ANASTOMOTIC SURGICAL STAPLER WITH DETACHED ANVIL (have the intracavity that separates anvil block coincide surgical stapling device) being published in April 14 in 1992 day; 104; 025 and be published in Mays 10 in 1994 day, and be called the United States Patent(USP) No. 5 of CIRCULAR STAPLER TISSUE RETENTIONSPRING METHOD (circular stapler tissue keep SPRING METHOD OF STONE); 309; Have disclosedly in 927, its disclosure is incorporated this paper into way of reference.

Summary of the invention

In various ways of the present invention, the end effector of surgical operation stiching instrument can comprise anvil block and nail bin, and wherein nail bin can be constructed to removably storage slots nail therein.In a plurality of embodiment, nail bin can comprise the chamber, is stitched staple drivers from wherein locating but the chamber is constructed to the storage slots nail until them, and the seam staple drivers can be constructed to cross nail bin and the seam nail is moved towards anvil block.In at least one embodiment, each seam nail all can comprise at least one deformable member, when it contacts with anvil block, can deform, and makes deformable member can catch the soft tissue between (for example) hat and the deformable member.In at least a form of the present invention, deformable member can comprise non-circular cross sections, and its (in a plurality of embodiment) can determine direction and the mode that deformable member is crooked.In at least one embodiment, non-circular cross sections can comprise flat, and it can cause that deformable member is crooked with the direction of flat.In a plurality of embodiment, the non-circular portion of cross section can be constructed to apply compression stress or pressure in abutting connection with soft tissue and to it.In at least one this embodiment; The hat of surgical operation seam nail can be made up of soluble or biological absorbable material at least in part; Feasible hat can dissolve when soft tissue heals, and can (according to deformable element cross-section geometry) reduces deformable member and be applied to the power on the soft tissue.

In at least a form of the present invention, surgical operation seam nail can comprise deformable member and hat, and wherein deformable member can slide with respect to hat.In at least one embodiment, nail bin can comprise chamber and platform, and its lumen can be constructed to admit at least a portion of deformable member, and hat can be positioned in the opening in the platform.In a plurality of embodiment, when soft tissue is trapped between anvil block and the nail bin, even before the seam staple drivers was pushed deformable member to anvil block, hat all can apply compression stress or pressure to soft tissue.Therefore, at least one this embodiment, power of obtaining between surgical operation seam nail and the soft tissue and/or compression stress or pressure can improve.In a plurality of embodiment, the hat of two or more adjacent seam nails can be connected.In at least one this embodiment, hat can apply the pressure of homogeneous to soft tissue, and under multiple situation, after the seam nail navigated in the soft tissue, hat can increase the hardness of soft tissue.

In various ways of the present invention, for example can surgical operation seam nail be navigated in the soft tissue, so that especially after cutting soft tissue, reduce or eliminate hemorrhage from what wherein produce.In a plurality of embodiment, can the seam nail be arranged in the nail bin, make them navigate in the soft tissue, so that make the vasoconstriction in the soft tissue with the form of at least two row or two row.In at least one embodiment, nail bin can comprise the first seam nail chamber and the second seam nail chamber wherein, and wherein first chamber can limit first axle, and second chamber can limit second axis, and first axle can cross second axis.In at least one this embodiment, first chamber and second chamber can uneven each other direction be extended, and because the arrangement mode of the seam nail that wherein is provided with, the seam nail can make the vasoconstriction in the soft tissue better and reduce the blood flow of flowing through here.In various ways of the present invention; Surgical operation seam nail can comprise the characteristic that can cooperate with the seam nail chamber in the nail bin; When (for example) seam staple drivers promoted the seam nail, especially when the seam nail be orientated with different directions, this characteristic can reduce or even suppress the seam nail and follow closely intracavity and shake or tilt stitching.In at least one this embodiment, the hat of seam nail can comprise arc and/or cylindrical structural, and it can cooperate with the arc and/or the cylindrical structural in seam nail chamber, unnecessaryly between the chamber relatively moves or rotates with stitching to follow closely so that reduce the seam nail.

In various ways of the present invention, surgical operation seam nail can comprise that (for example) can further reduce the hemorrhage structure of soft tissue.In at least one embodiment; The seam nail can comprise at least one deformable member; Can be when it inserts via soft tissue in the soft tissue middle punch; And in a plurality of embodiment, deformable member can comprise above that or can be made up of this material that this material is inflatable and can fill the perforation in the soft tissue basically.In a plurality of embodiment, at least a portion of deformable member can use (for example) hydrophilic material to apply, and is inflatable during other liquid in being exposed to water or human body of this hydrophilic material, and applies compression stress to the periphery of perforation.This compression stress can reduce hemorrhage from what bore a hole, thereby reduces any possible complication that causes thus.In at least a form of the present invention, the hat that surgical operation stitches nail can comprise that around the structure of deformable member or contiguous its setting its compressible soft tissue around deformable member also increases its compression stress that applies or pressure.Because compression stress or pressure increase, can reduce the blood flow that causes by deformable member from perforation.

In various ways of the present invention, the surgical operation stiching instrument can comprise anvil block, nail bin and the backing material that removably remains to anvil block and/or nail bin.In a plurality of embodiment, nail bin can comprise that at least one removably is kept at seam nail wherein, and when from location wherein or when penetrating, the seam nail can contact backing material and backing material is removed from anvil block and/or nail bin.In at least one embodiment; Anvil block can comprise at least one antelabium and/or groove; It is constructed to backing material is removably remained to anvil block, and is crooked and be directed to and contact backing material by anvil block up to the deformable member (for example) that extends from surgical operation seam nail.In a plurality of embodiment, backing material can be constructed to make the soft tissue hardening and/or hinder the seam nail at least and tear soft tissue.In at least a form of the present invention, but the anvil block of surgical operation stiching instrument can comprise release type pit element, and it can catch the end that seam localized or that penetrate is followed closely.In a plurality of embodiment, the pit element can separate from anvil block, makes that after the seam nail penetrated, the pit element kept together with the tissue that stitches nail and sew up.When location slit is followed closely; The end that pit element in the anvil block can curve or curved slot is followed closely; Afterwards, the end of seam nail can contact the seam of pit element and follow closely terminal fixed surface, and this fixed surface can suppress seam nail end and pierce through or otherwise penetrate once more soft tissue once more.In at least one embodiment, the power that produces during the stitching of stiching instrument and/or the cutting action can overcome and the pit element is remained on being press-fitted in the anvil block makes a concerted effort, and makes that the pit element is separated when nailing.But release type pit element can be by processing with the hat identical materials of seam nail, and it can be made up of (for example) biological absorbable material and/or abiotic absorbable material.

Another general aspect, various ways of the present invention relates to the surgical operation that uses seam nail as herein described and suture instruments, for example Roux-en-Y gastric bypass operation method or other operation method.Especially, can carry out multiple surgical operation, wherein band is disposed in around the soft tissue that (for example) cut and sewed up.In this technology, can use and stitch nail and/or suture instruments, wherein will stitch and follow closely terminal the insertion in the soft tissue is unexposed afterwards, makes that stitching the nail end can not gall or otherwise damage band, under multiple situation, seam is followed closely terminal meeting stimulates soft tissue.For example, but can use above-mentioned apparatus proposing the regional suture tissue of putting band with release type pit element.But release type pit element is in case just can protect soft tissue and band to avoid stitching the terminal damage of nail from the anvil block separation.Under multiple situation, the clinician can use two kinds of apparatuses to be used for this operation: but a kind of do not have a release type pit element, is used for the otch that forms in the soft tissue area that band is not set; But another kind of apparatus then has release type pit element, is used for proposing the otch that the soft tissue area of putting band forms.In other embodiments, the clinician can use a kind of apparatus, but and optionally load anvil block with release type pit element to apparatus, to be used for the proposing otch that the soft tissue area of putting band forms.

In yet another aspect, various ways of the present invention relates to the stiching instrument with so-called " release type " packing ring in the insertion anvil block.In a plurality of embodiment, packing ring can comprise circular outer and circular interior.In at least one this embodiment, said outside can comprise a plurality of seams nail targeting parts, and it limits, and to drive the seam nail of surgical operation seam nail when being pulled the trigger terminal by its opening that passes when apparatus, and will stitch the bending of nail end by anvil block subsequently or turn to.After turning to, seam nail end can contact and stitch the nail targeting part, and can be held, and makes seam nail end can not penetrate or otherwise pierce through once more the tissue of stitching once more.In a plurality of embodiment, this surgical operating instrument can also comprise cutter, and when surgical operating instrument was pulled the trigger, this cutter can cut packing ring, thereby inner from external discrete, and therefore, the outside can keep together with the seam nail after the seam nail is injected in the soft tissue.Therefore, the outside of packing ring can provide fixed seam nail line, and it especially can be favourable to the anastomosis of some type.In a plurality of embodiment, packing ring can be processed with abiotic absorbable material, but in other embodiments, packing ring can be processed by the absorbable material of biology.

Description of drawings

In conjunction with the drawings with reference to the following explanation of the embodiment of the invention, above-mentioned and further feature of the present invention and advantage and acquisition methods thereof will become more apparent, and can understand invention itself better, wherein:

Fig. 1 is the perspective view according to the surgical operating instrument of a non-limiting example of the present invention;

Fig. 2 is the perspective view of the surgical operating instrument of Fig. 1;

Fig. 3 is the exploded view of end effector of the surgical operating instrument of Fig. 1;

Fig. 4 is the perspective view that is used for the surgical operating instrument of the Fig. 1 that cuts and sew up soft tissue;

Fig. 5 is in the not front view of the surgical operation seam nail of deformed shape;

Fig. 6 is the front view of seam nail that is in Fig. 5 of first deformed shape;

Fig. 7 is the front view of seam nail that is in Fig. 5 of second deformed shape;

Fig. 8 is the front view of seam nail that is in Fig. 5 of the 3rd deformed shape;

Fig. 9 is the vertical view of the seam nail of Fig. 5, and it is in the 3rd deformed shape of Fig. 8;

Figure 10 is used for the partial cross section view that the surgical operation seam nail of Fig. 5 is navigated to the surgical operation stiching instrument of the Fig. 1 in the soft tissue;

Figure 10 A is the front view that is in the surgical operation seam nail of part deformed shape;

Figure 11 is the first deformable member of surgical operation seam nail and the perspective view of the second deformable member;

Figure 12 is for coating the perspective view of the soluble or biological absorbable material on the deformable member that is molded into Figure 12;

Figure 13 is the perspective view of seam nail that is in Figure 12 of deformed shape;

Figure 14 is the perspective view of the seam nail of Figure 12, and wherein the part of soluble material is dissolved, and the first deformable member and the second deformable member move relative to each other;

Figure 15 dissolves the perspective view of the seam nail of Figure 12 afterwards fully for soluble material;

Figure 16 is used for the partial cross section view that the surgical operation seam nail of Figure 12 is navigated to the surgical operation stiching instrument in the soft tissue;

Figure 17 is the extra partial cross section view of the surgical operation stiching instrument of Figure 16;

Figure 18 is the perspective view according to the deformable member of the seam nail of a non-limiting example of the present invention;

Figure 19 is the vertical view of the deformable member of Figure 18;

Figure 20 coats the perspective view of the soluble or biological absorbable material on the deformable member that is molded into Figure 18 for a non-limiting example according to the present invention;

Figure 21 is according to the first deformable member of the seam nail of a non-limiting example of the present invention and the perspective view of the second deformable member;

Figure 22 is the vertical view of the deformable member of Figure 21;

Figure 23 coats the perspective view of the soluble or biological absorbable material on the deformable member that is molded into Figure 21 for a non-limiting example according to the present invention;

Figure 24 is the perspective view of seam nail that is in Figure 23 of deformed shape;

Figure 25 is the perspective view of the seam nail of Figure 23, and wherein the part of soluble material is dissolved, and the first deformable member and the second deformable member move relative to each other;

Figure 26 dissolves the perspective view of the seam nail of Figure 24 afterwards fully for soluble or biological absorbable material;

Figure 27 is according to the first deformable member with the inflatable coating that forms above that of a non-limiting example of the present invention and the perspective view of the second deformable member;

Figure 28 is the vertical view of the deformable member of Figure 27;

The perspective view of the soluble or biological absorbable material on the first deformable member that Figure 29 is molded into Figure 27 for a non-limiting example according to the present invention coats and the second deformable member;

Figure 30 is the perspective view of seam nail that is in Figure 29 of deformed configuration;

Figure 31 is the perspective view of the seam nail of Figure 29 afterwards that at least a portion of soluble material has been dissolved and expandable material has expanded;

Figure 32 is the vertical view of seam nail that Figure 29 of the inflatable coating that is in expanded form is shown;

Figure 33 dissolves the perspective view of the seam nail of Figure 29 afterwards fully for soluble material and expandable material;

Figure 34 is the perspective view according to the end of the deformable member of a non-limiting example of the present invention;

Figure 35 is the deformable element cross-section figure of Figure 34;

Figure 36 is the perspective view according to the end of another deformable member of a non-limiting example of the present invention;

Figure 37 is the deformable element cross-section figure of Figure 36;

Figure 38 is the perspective view according to the end of another deformable member of a non-limiting example of the present invention;

Figure 39 is the deformable element cross-section figure of Figure 38;

Figure 40 is the perspective view according to the end of another deformable member of a non-limiting example of the present invention;

Figure 41 is the deformable element cross-section figure of Figure 40;

Figure 42 is the perspective view according to the end of another deformable member of a non-limiting example of the present invention;

Figure 43 is the deformable element cross-section figure of Figure 42;

Figure 44 is the perspective view according to the end of another deformable member of a non-limiting example of the present invention;

Figure 45 is the deformable element cross-section figure of Figure 44;

Figure 46 is the perspective view according to the end of another deformable member of a non-limiting example of the present invention;

Figure 47 is the deformable element cross-section figure of Figure 46;

Figure 48 is the perspective view according to the end of another deformable member of a non-limiting example of the present invention;

Figure 49 is the deformable element cross-section figure of Figure 48;

Figure 50 is the perspective view according to the end of another deformable member of a non-limiting example of the present invention;

Figure 51 is the deformable element cross-section figure of Figure 50;

Figure 52 is the perspective view according to the end of another deformable member of a non-limiting example of the present invention;

Figure 53 is the deformable element cross-section figure of Figure 52;

Figure 54 is the perspective view according to the end of another deformable member of a non-limiting example of the present invention;

Figure 55 is the deformable element cross-section figure of Figure 54;

Figure 56 is the perspective view according to the end of another deformable member of a non-limiting example of the present invention;

Figure 57 is the deformable element cross-section figure of Figure 56;

Figure 58 is the slidably front view of the surgical operation seam nail of hat that has according to a non-limiting example of the present invention;

Figure 59 is the slidably front view of another surgical operation seam nail of hat that has according to a non-limiting example of the present invention;

Figure 60 is the slidably front view of another surgical operation seam nail of hat that has according to a non-limiting example of the present invention;

Figure 61 is the upward view of the surgical operation seam nail of Figure 58;

Figure 62 is the upward view of the surgical operation seam nail of Figure 59;

Figure 63 is the upward view of the surgical operation seam nail of Figure 60;

Figure 64 is the vertical view of the surgical operation seam nail of Figure 58;

Figure 65 is the vertical view of the surgical operation seam nail of Figure 59;

Figure 66 is the vertical view of the surgical operation seam nail of Figure 60;

Figure 67 is positioned the no-fix of the Figure 58 in the nail bin for a non-limiting example according to the present invention surgical operation stitches the perspective cross-sectional view of following closely;

Figure 68 is the perspective cross-sectional view of seam nail that is in Figure 67 of part position location;

Figure 69 is the perspective cross-sectional view of seam nail that is in Figure 67 of complete position location;

Figure 70 is the perspective view of seam nail that is in Figure 67 of complete position location;

Figure 71 is the perspective view of the nail bin of Figure 67, and it illustrates some surgical operation seam nails that are in the no-fix position;

Figure 72 is the perspective view according to the assembly of the seam nail of a plurality of Figure 58 that pass through the bridgeware connection of a non-limiting example of the present invention;

Figure 73 is another perspective view of the assembly of Figure 72;

Figure 74 is for being positioned at the vertical view of nail bin of the assembly of Figure 72 wherein according to having of a non-limiting example of the present invention;

Figure 75 is the fragmentary, perspective view of the nail bin of Figure 74;

Figure 76 is according to the nail bin of a non-limiting example of the present invention and the vertical view of seam screw assembly;

Figure 77 is for according to the slideable hat of having of a non-limiting example of the present invention with from the front view of the seam nail of the convexity of wherein extending;

Figure 78 is the front view of seam nail that is in Figure 77 of position location;

Figure 79 is the vertical view of the seam nail of Figure 77;

Figure 80 is the perspective view according to some assemblies of the surgical operation seam nail of Figure 77 that passes through the bridgeware connection of a non-limiting example of the present invention;

Figure 81 is positioned the fragmentary, perspective view of the assembly of the Figure 80 in the nail bin for a non-limiting example according to the present invention;

Figure 82 is the perspective cross-sectional view of nail bin with Figure 81 of the seam screw assembly that is in the no-fix position;

Figure 83 is the perspective cross-sectional view of nail bin with Figure 81 of the seam screw assembly that is in the position location;

Figure 84 is the cross-sectional view of the surgical operation stiching instrument of the seam nail of location Figure 77;

Figure 85 is used to form the plane graph of the slender member of seam nail for a non-limiting example according to the present invention;

Figure 86 is the plane graph of the slender member of Figure 85, and it illustrates and coats the hat that is molded on the seam nail base portion, and its centre joint nail has the jointing with the hat interconnection;

Figure 87 is the plane graph that the slender member of the Figure 85 that has removed jointing is shown;

Figure 88 is along the plane graph of the slender member of Figure 86 of axis cutting;

Figure 89 is the plane graph according to the substituting slender member of a non-limiting example of the present invention;

Figure 90 is the plane graph of the deformable member that has been provided with separately from the slender member of Figure 89 according to a non-limiting example of the present invention;

Figure 91 is the plane graph according to another substituting slender member of a non-limiting example of the present invention;

Figure 92 coats the plane graph of the substituting slender member of the Figure 91 that is molded into the hat on the seam nail base portion for a non-limiting example according to the present invention illustrates;

Figure 93 is the plane graph of the slender member of the Figure 92 after axis cutting slender member;

Figure 94-99 is the plane graph according to a plurality of substituting deformable members of non-limiting example of the present invention;

The side view of the seam nail of the independent setting that Figure 100 is processed by the slender member of Figure 85 for a non-limiting example according to the present invention;

Figure 101 is the front view of the seam nail of Figure 100;

Figure 102 is the perspective view of the seam nail of Figure 100;

Figure 103 is used for the perspective view of the transfer block that is in closed configuration of molded a plurality of each seam nails for a non-limiting example according to the present invention;

Figure 104 stitches the perspective view of the transfer block of the Figure 103 that is in open configuration that follows closely for a non-limiting example according to the present invention is used for molded a plurality of each;

Figure 105 is the plane graph according to the substituting transfer block of a non-limiting example of the present invention;

Figure 106 is the plane graph according to another substituting transfer block of a non-limiting example of the present invention;

Figure 107 is the perspective view according to the nail bin of a non-limiting example of the present invention;

Figure 108 is the vertical view of the nail bin of Figure 107;

Figure 109 is the detail drawing of the nail bin of Figure 107;

Figure 110 is the extra detail drawing of the nail bin of Figure 107;

Figure 110 A is the detail drawing according to the nail bin of a non-limiting example of the present invention;

Figure 111 is the perspective view of surgical operation seam nail of seam nail intracavity that is constructed to be positioned the nail bin of Figure 107;

Figure 112 is the plane graph of the surgical operation seam nail of Figure 111;

Figure 113 is the plane graph according to the seam nail chamber of the nail bin of a non-limiting example of the present invention;

Figure 114 is the plane graph according to the seam nail chamber of the nail bin of a non-limiting example of the present invention;

Figure 115 is the plane graph according to the seam nail chamber of the nail bin of a non-limiting example of the present invention;

Figure 116 is the plane graph according to the seam nail chamber of the nail bin of a non-limiting example of the present invention;

Figure 117 is that wherein pattern has the seam nail of substantially parallel row along the vertical view of the seam nail pattern of otch;

Figure 118 is the vertical view that seam is followed closely the nail bin of pattern that has according to a non-limiting example of the present invention;

Figure 119 is the perspective view of the nail bin of Figure 118;

Figure 120 is the partial plan layout of the nail bin with seam nail pattern according to an alternative embodiment of the invention;

Figure 121 is the partial top view that seam is followed closely the nail bin of pattern that has according to another alternate embodiment of the present invention;

Figure 122 is for according to anvil block, the nail bin of a non-limiting example of the present invention and the perspective view of part that removably remains to the backing material of anvil block;

Figure 123 is the anvil block of Figure 122 and the cross-sectional view of backing material;

Figure 124 is according to the anvil block of an alternative non-limiting example of the present invention and the cross-sectional view of backing material;

Figure 125 is the cross-sectional view of anvil block, nail bin and the backing material of the embodiment of Figure 122 of being in the no-fix position with respect to soft tissue setting and surgical operation seam nail;

Figure 126 is the extra cross-sectional view of the embodiment of Figure 125, and it illustrates the seam nail that is in the position location;

Figure 127 is the extra cross-sectional view of the embodiment of Figure 125, and it illustrates the anvil block that is shown in an open position;

Figure 128 is illustrated in the sketch map that has carried out the harmonization of the stomach small intestinal after the Roux-en-Y gastric bypass operation method on it;

Figure 129 illustrates the flow chart of gastric bypass operation method step for a non-limiting example according to the present invention;

Figure 130 is the cross-sectional view that can follow closely the anvil block of the part that breaks away from through the surgical operation seam that has according to a non-limiting example of the present invention;

Figure 131 illustrates the extra view that the surgical operation that is in the location configuration stitches the embodiment of the Figure 130 that follows closely;

Figure 132 is the cross-sectional view that can follow closely the anvil block of the part that breaks away from through the surgical operation seam that has according to an alternative non-limiting example of the present invention;

Figure 133 illustrates the extra view that the surgical operation that is in the location configuration stitches the embodiment of the Figure 120 that follows closely;

Figure 134 is the perspective view according to the circular surgical stapling instrument of a non-limiting example of the present invention;

Figure 135 is the fragmentary, perspective view of suture instruments of Figure 134 that has removed some part of suture instruments;

Figure 136 is the exploded view of the suture instruments of Figure 134;

Figure 137 is the exploded view of anvil block and " disengaging " packing ring of the surgical operating instrument of Figure 134;

Figure 138 is the anvil block of Figure 137 and the installation diagram of packing ring;

Figure 139 is the plane graph of the assembly of Figure 138;

Figure 140 is the perspective view according to the anvil member of the circular stapler of a non-limiting example of the present invention;

Figure 141 is the perspective view according to the nail bin mechanism of the circular stapler of a non-limiting example of the present invention;

Figure 142 is assembled into the perspective view of nail bin mechanism of Figure 141 of the anvil member of Figure 140 for a non-limiting example according to the present invention;

Figure 143 is the perspective view according to the anvil member of the circular stapler of an alternative non-limiting example of the present invention;

Figure 144 is the perspective view according to the nail bin mechanism of the circular stapler of an alternative non-limiting example of the present invention;

Figure 145 is assembled into the perspective view of nail bin mechanism of Figure 143 of the anvil member of Figure 144 for a non-limiting example according to the present invention;

Figure 146 is the perspective view according to the anvil member of the circular stapler of another alternative non-limiting example of the present invention;

Figure 147 is the perspective view according to the nail bin mechanism of the circular stapler of another alternative non-limiting example of the present invention; And

Figure 148 is assembled into the perspective view of nail bin mechanism of Figure 146 of the anvil member of Figure 147 for a non-limiting example according to the present invention;

Corresponding reference marks shows the corresponding component that runs through some views.Example shown in this paper (with a kind of form) illustrates the preferred embodiments of the present invention, should this example be interpreted as it is to limit scope of the present invention by any way.

The specific embodiment

To describe certain exemplary embodiment now the complete understanding to structure, function, manufacturing and the use principle of disclosed apparatus of this paper and method will be provided.One or more instances among these embodiment are shown in the drawings.Those of ordinary skill in the art will be understood that special description of this paper and apparatus illustrated in the accompanying drawings and method are nonrestrictive exemplary embodiment, and the scope of a plurality of embodiment of the present invention only is defined by the claims.The characteristic that illustrates or describe in conjunction with an exemplary embodiment can with the characteristics combination of other embodiment.This modification and variations are intended to comprise within the scope of the invention.Fig. 1 and Fig. 2 illustrate an embodiment of surgical operation stitching and cutting device (being inner cutter 30), and it can put into practice unique advantage of the present invention.Yet, will be appreciated that, without departing from the spirit and scope of the present invention, can advantageously combine multiple other stiching instrument and suture instruments to use uniqueness of the present invention and novel aspect.Therefore, should the protection domain that give a plurality of embodiment of the present invention be limited to the surgical operation that only is used for particular type as herein described sews up and cutting device.

Referring to Fig. 1 and Fig. 2, surgical instruments 30 can comprise shank 32, axle 34 and the hinged end executor 36 who is pivotably connected to axle 34 at articulation pivot 38 places.Can be through the control device adjustment end executor's 36 on the shank 32 position and orientation, control device comprises: (a) knob 40, and it is used for rotating shaft 34 and end effector 36 around axis; And (b) articulation control 44; It is used to realize that end effector 36 centers on articulation pivot 38 and implements rotation or hinged with respect to axle 34; As being called the owning together of SURGICAL INSTRUMENT HAVING ANARTICULATING END EFFECTOR (surgical instruments), common unsettled U.S. Patent application No.11/329 being filed in January 10 in 2006 day, with hinged end executor; More detailed description is arranged in 020, and the disclosure of this patent is incorporated this paper into way of reference.In a plurality of embodiment, the shank 32 of apparatus 30 can comprise the closed trigger 46 and firing trigger 48 that is used for actuation end executor 36, like more detailed description hereinafter.Yet, should be appreciated that the apparatus with the end effector that is constructed to carry out different surgical operation tasks can have the trigger of varying number or type or be used for other appropriate control device of operative end executor 36.In addition, should be appreciated that in this article the doctor's lever 32 with respect to apparatus 30 has used term " near-end " and " far-end ".Therefore, end effector 36 is a far-end with respect to shank 32.

In the illustrated embodiment, end effector 36 can be constructed to (for example) and clamp, cuts off and sew up soft tissue.In other embodiments, can use dissimilar end effectors, for example grasper, sickle, stiching instrument, Clip Applier, access to plant, medicine/gene therapy device, ultrasonic, radio frequency and/or laser aid.In addition, end effector 36 also can comprise seam nail passage 50 and transferable clamping component, and for example anvil block 52, and its centre joint nail passage 50 can be oppositely arranged or separate with anvil block 52, the soft tissue that is clipped in the end effector 36 is correctly sewed up and is cut guaranteeing.Shank 32 can comprise pistol grip 54, can closed trigger 46 be dragged to this handle pivotly, so that following closely passage 50 towards seam, moves anvil block 52, and the tissue of clamping and positioning between anvil block 52 and passage 50.In other words, in case the clinician is satisfied to the location of end effector 36, just can with closed trigger 46 be retracted to make anvil block 52 fully closures positions and with trigger 46 locks in place.This device is called the U.S. Patent application No.11/343 of SURGICAL CUTTING AND FASTENING INSTRUMENT WITHCLOSURE TRIGGER LOCKING MECHANISM (surgical cutting and fastening instrument with closed trigger lock mechanism) being filed in January 31 day; Further description is arranged in 321, and the disclosure of this patent is incorporated this paper by reference into.

, can firing trigger 48 be pivotly dragged to pistol grip 54, be clipped in the soft tissue in the end effector 36 to sew up and to cut off thereafter.More particularly, referring to Fig. 3, end effector 36 can further comprise cutting element or cutter 60, sled 62, removably be positioned nail bin 64 and helical axis 66 in the passage 50.After starting firing trigger 48; Helical axis 66 is rotatable; Move with respect to passage 50 with sled 62 so that drive cutting element 60, make cutting element 60 can cut the tissue that is clipped in the end effector 36, sled 62 then can be located the seam nail that removably is stored in the nail bin 64.In a plurality of embodiment, sled 62 can comprise a plurality of inclined-planes, and it can be constructed to the seam nail that removably is stored in the nail bin 64 is pushed in the tissue of clamping.In at least one embodiment, anvil block 52 can be constructed to after the seam nail inserts tissue, make at least a portion distortion of seam nail.This apparatus is being published in the United States Patent(USP) No. 6 that December 27 day, in 2005 are called SURGICAL STAPLING INSTRUMENTINCORPORATING AN E-BEAM FIRING MECHANISM (surgery suturing appliance that has combined the electron beam trigger mechanism); 978; 921; And be filed in Augusts 31 in 2005 day, and be called the U.S. Patent application No.11/216 of STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERINGFORMED STAPLE HEIGHTS (being used to form the nail bin of seam nail) with different molding staple heights; Have disclosedly in 562, its disclosure is incorporated this paper into way of reference.In a plurality of embodiment; Helical axis 66 can be by United States Patent(USP) No. 5 As mentioned above; 465; Manual gear assembly described in 895 drives; Or by as be filed in January 31 in 2006 day, and be called the U.S. Patent application No.11/343 of MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITHUSER FEEDBACK SYSTEM (motor driven type surgical cutting and fastening instrument), the motor driven described in 498 (its disclosure is incorporated this paper by reference into) with user feedback system.

In a plurality of embodiment, nail bin 64 can comprise the seam staple drivers (not shown) that is positioned wherein, and this driver can be promoted by sled 62, and can be constructed to drive surgical operation seam nail towards anvil block 52.In other a plurality of embodiment, surgical operation seam nail can directly be promoted by anvil block 52.In this embodiment, the hat of surgical operation seam nail can comprise the domatic or inclined-plane on it, and it can cooperate with sled 62, to promote aforesaid surgical operation seam nail.This surgical operation seam nail is called the U.S. Patent application No.11/529 of SURGICAL STAPLES HAVING ATTACHED DRIVERSAND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME (having the surgical operation seam nail of secondary actuator and the suture instruments that is used to dispose said seam nail) being filed in JIUYUE 29 in 2006 day; More detailed description is arranged in 935, and the disclosure of this patent is incorporated this paper by reference into.In a plurality of embodiment, referring to Figure 10, sled 62 can pass nail bin 64, and 64 far-end 147 advances from position shown in Figure 10 towards nail bin.Along with sled 62 moves to far-end along nail bin 64, but the hat 122 of sled 62 joint closes nail 120 makes seam nail 120 promoted towards anvil block 52 by sled 62 continuously.More particularly, hat 122 can comprise inclined-plane 148 (Fig. 5 and Fig. 6), and it can be constructed to cooperate with the inclined-plane 150 of sled 62, makes hat 122 can slide sled surface 150.

Fig. 4 illustrates and uses any to organizing 100 cutting and the stitchings carried out in multiple surgical operation cutting as herein described and the suture instruments.As shown in Figure 4, the part 102 of tissue 100 has been cut open, and sews up along otch 106.Triplex row seam nail 107 has been inserted each side of organizing 100 cutting path 106 through inner cutter 30.The clinician cuts and sews up after the first 102, will fetch apparatus, so that new nail bin 64 is installed.Fig. 4 is illustrated in beginning cutting for the second time and the sewing process position of end effector 36 before.Can find out that from Fig. 4 the thickness T ' of the part 102 of the tissue of having sewed up 100 is less than the thickness T of other part 104 of tissue 100 ".

In at least one embodiment, referring to Fig. 5-9, seam nail 120 can comprise hat 122 and deformable shank or member 124 and 126 from wherein extending.In a plurality of embodiment, deformable member can be made up of the prolongation wire rod of cross section basically identical.In other a plurality of embodiment, shank 124 and 126 can comprise first recess 130, second recess 132 and the 3rd recess 133 wherein.Referring to Fig. 6 because shank 124 and 126 cross sections at (for example) first recess 130 places reduce, so shank 124 and 126 in these positions easy deformation more.In at least one embodiment, when shank 124 and 126 is crooked at recess 130 places, first section 138 can (for example) with respect to shank 124 and second section 140 one-tenth about an angle of 90 degrees bendings of 126.In other embodiments, first section 138 can be with respect to second section 140 with any suitable angular bend.In use, referring to Fig. 5 and Figure 10, when shank 124 when 126 end 128 contacts the pit 134 of anvil block 52, shank 124 and 126 can curve inwardly at first recess 130, second recess 132 and the 3rd recess 133 places.In other a plurality of embodiment, referring to Figure 10 A, seam nail 120 ' can comprise shank 124 ' and 126 ', can it be shaped so that their outside distortion, promptly away from each other.In at least one this embodiment, comparable base portion 121 weak points of the length of the base portion of these seam nails make shank 124 ' and 126 ' can contact the part of anvil block pit 134, and outwards distortion.Therefore, in a plurality of embodiment, these seam nails can use to enterolithic identical anvil block with being used to make seam nail 120 as stated together.Except mentioned above, although also not shown, any other suitable seam nail as herein described also can comprise can be constructed to the outwards shank of distortion.

In a plurality of embodiment, referring to Fig. 8, along with

shank

124 and 126 becomes shape shown in Figure 8 from shape shown in Figure 7, deformable member 124 can contact hat 122 with 126 end 128.In order to help the bending of deformable member, hat 122 can comprise profiled surface or anvil block, is preced with at 122 o'clock and can leads them and/or make its distortion to contact with 126 at shank 124.For the end 128 that leads, the anvil block 143 of hat 122 can comprise groove 144, and its end 128 that can lead makes it as shown in Figure 8 outwards mobile, or moves with any other suitable direction.In a plurality of embodiment, groove 144 can not make

shank

124 and 126 significantly be out of shape, yet in the illustrated embodiment, groove 144 can be constructed to make

shank

124 and 126 angular distortions with about 90 degree.Therefore, in a plurality of embodiment, the anvil block 52 of stiching instrument 30 can cooperate with the anvil block 143 of hat 122, makes seam nail 120 become (for example) shape shown in Figure 8, or any other suitable shape.

Referring to Fig. 5 and 6, the base portion 121 of seam nail 120 can embed in the hat 122.In a plurality of embodiment, can hat 122 coatings be molded on the base portion 121, make hat 122 can tightly center on and seal base portion 121.In at least one embodiment, material 123 can form around the single continuous wire that comprises base portion 121 and deformable member 124 and 126.In other embodiments, deformable member 124 and 126 can be distinguished in the insert material 123.In any case, at least one embodiment, hat 122 can comprise that coating is molded into the material 123 on the base portion 121, and wherein material 123 can be made up of plastic material, for example soluble, biological decomposable or biological absorbable plastic material.In the embodiment that uses this material, plastic material can comprise that (for example) derives from Ethicon, the Vicryl of Inc. or PDS.As used herein, term is soluble, biology is absorbable and the biological decomposable material that can be absorbed at least in part by human body after typically referring in implanting (for example) patient body.In a plurality of embodiment, perhaps alternatively, plastic material can comprise insoluble, abiotic decomposable or abiotic absorbable plastic material except above-mentioned plastic material.In any case, in a plurality of other embodiment, can make hat 122 separately, and then be assembled into base portion 121.

Except mentioned above, at least one embodiment, soluble, biological decomposable or biological absorbable material can dissolve in agglutination at least in part, thereby allows to be compressed in tissue stretch and the growth in the seam nail 120.In at least one embodiment; Referring to Figure 11-15; Seam nail 160 can comprise hat 162, the first deformable member 164 and the second deformable member 166, and wherein deformable member 164 and 166 respectively can comprise base portion 168, deformable shank 170 and second shank 172.When seam nail 160 was positioned at first, deformable member 164 can apply bigger compression stress to the soft tissue that is positioned to stitch in the nail 160 with 166, to limit wherein hemorrhage.Yet along with hat 162 decomposes, deformation element 164 and 166 can become greatly with the gap of being preced with between 162, thereby alleviates the compression stress that acts on the soft tissue.In some applications, alleviating these compression stresses in the agglutination can make to be organized in and slowly stretch and recover its normal thickness in a period of time.In certain embodiments, hat 162 can apply with hydrophilic material, and this material is initial inflatable to be captured in the tissue in the seam nail with compression, can dissolve then.In these embodiment, hydrophilic material can absorb water from surrounding tissue or absorb liquid and expand through (for example).

As The above results, in the time of in a plurality of seams being followed closely 160 insertion soft tissues, seam nail 160 can make the soft tissue hardening, and under multiple situation, can suppress to be organized in and move in the agglutination and stretching, extension.Yet after the hat 162 that stitches nail 160 dissolved at least in part, the

deformable member

164 and 166 of seam nail 160 can relative to each other move, and will keep together by following tissue simultaneously.More particularly, referring to Figure 14, the material of hat 162 can decompose a certain degree, and wherein first member 164 and the second deformable member 166 can become separated from one another, shown in figure 15.First member 164 is with after second member 166 separates, and they can relative to each other move, and soft tissue can become soft slightly.In a plurality of embodiment, fully the required time of dissolving can be depending on used material and/or is preced with 162 size hat 162.For example, Polyglatin 910 materials of selling with trade name Vicryl can dissolve in 7 to 14 days.

In a plurality of embodiment, deformable member 164 and 166 can be made up of insoluble or abiotic absorbable material basically, for example titanium, titanium alloy or rustless steel.In other embodiments, at least one in the deformable member 164 and 166 can be made up of the absorbable material of biology, for example magnesium or ferrum.In at least one embodiment, ferrum is pure iron.In any case, can select, make that their rate of dissolution is identical with hat 162 soluble material, more slowly or faster the soluble material of member 164 and 166.For example, can select to be preced with 162 material makes it when deformable member 164 and 166 will soft tissue keeps together, dissolve fully.In addition, in a plurality of embodiment, can select the material of the first deformable member 164 to make its material dissolves get faster than the second deformable member 166.Therefore, in these embodiment, deformable member 164 and 166 can allow the staggered release organized.Except that mentioned above, in a plurality of embodiment, can will stitch nail 160 navigate in the tissue before and/or through bridgeware at least two adjacent seams nails 160 are linked together afterwards.In these embodiment, the first seam nail 160 can get faster that bioabsorbable material constitutes by the material dissolves than the connected second seam nail 160.Similarly, the bridgeware that connects seam nail 160 can be followed closely 160 identical and/or material different by the rate of dissolution and first and second seams and constitute.In these embodiment, the first seam nail 160 can dissolve prior to the second seam nail 160, thereby with mentioned above similar, the permission tissue is staggered to be discharged.

In a plurality of embodiment, referring to Figure 12, hat 162 can be included in part 176 and the 178 intermediary cross sections that dwindle 174.In use, because mid portion 174 has than part 176 and 178 littler cross sections, so it can dissolve prior to part 176 and 178 fully, thereby before whole hat 162 dissolves, first member 164 is become with second member 166 be not connected (Figure 15).In at least one embodiment, can select part 174,176 to make deformable member 164 separate in the required stage of agglutination with 166 with 178 cross section.In other embodiments, hat 162 can comprise the indentation (not shown), and it can reduce to be preced with 162 thickness in scored areas.In at least one embodiment, the hat 162 (Figure 11-15) of the hat 122 (Fig. 5-9) of seam nail 120 and/or seam nail 160 can comprise at least a curative drug.In these embodiment, when soluble material was decomposed, curative drug can be by the tissue absorption around the seam nail.In certain embodiments; Medicine is scattered in the whole soluble material, makes medicine in agglutination, stablize and discharge, yet; In other embodiments; Curative drug can be dispersed in the whole soluble material unevenly, or can be in material and/or on material stratification, to increase the drug dose of moment in the agglutination.

In a plurality of embodiment, referring to Figure 18-20, surgical operation seam nail 200 can comprise base portion 202, the first deformable member 204 and the second deformable member 206, and wherein

deformable member

204 and 206 can extend from base portion 202.In at least one embodiment, at least a portion of base portion 202, the first deformable member 204 and/or the second deformable member 206 can have non-circular cross sections.More particularly, referring to Figure 19, the cross section of for example deformable member 204 can comprise arch section 203 and flat 205.In a plurality of embodiment, referring to Figure 18, base portion 202 and

deformable member

204 and 206 can constitute wire rod 201, and wherein wire rod 201 can comprise along the constant basically cross section of the whole length of wire rod 201.Yet in other embodiments, for example, the first deformable member 204 and the second deformable member 206 can have different cross-sectional areas.In at least one this embodiment, the first deformable member 204 can comprise the cross section that is essentially circular, and the second deformable member 206 then can comprise non-circular cross sections.In other a plurality of embodiment, the first deformable member 204 can comprise the non-circular cross sections different with the non-circular cross sections of the second deformable member 206.

In a plurality of embodiment, as stated,

deformable member

204 and 206 cross-sectional geometry may command they during by anvil block 52 distortion, mode and direction that

deformable member

204 and 206 bends.In at least one embodiment, referring to Figure 19, can be orientated flat 205 and make them face with each other and/or towards axis 207, therefore, when when it applies power, flat 205 can make

deformable member

204 and 206 towards axis 207 bendings.In other a plurality of embodiment, flat 205 can any suitable manner be orientated, and is crooked along required direction to allow deformable member.In fact, the size of flat 205 and position can influence the moment of inertia of cross section, and correspondingly influence deformable member to applying the response mode of bending stress above that.In this embodiment, deformable member 204 of may command and 206 distortion are so that the soft tissue in being captured in seam nail 200 applies required compression stress.More particularly, at least one embodiment, deformable member is flexible to apply compression stress until their contact soft tissues and to soft tissue, and wherein the size of power is mainly determined by the amount and the direction of

deformable member

204 and 206 distortion.

In at least one embodiment, referring to Figure 19 and 20, can hat 208 is molded or be positioned on the base portion 202, wherein being preced with 208 can be made up of soluble, biological decomposable or biological absorbable material.In a plurality of embodiment, hat 208 can comprise compressive surfaces, and in the time of in soft tissue is trapped in seam nail 200, soft tissue can be pressed on this surface.In at least one embodiment, referring to Figure 20, seam nail 200 can comprise compressive surfaces 209, and wherein compressive surfaces 209 can have than wideer profile in the surface of base portion 202 211 or bigger surface area.Therefore, in this embodiment, compressive surfaces 209 wideer surface areas can reduce to be applied to the stress on the soft tissue that is captured in wherein.More particularly, for the given compression stress on being applied to soft tissue, the stress of the gained in the soft tissue is inversely proportional to the area that applies compression stress.In other words, in the time of on power being applied to than the soft tissue of small size, the stress of gained is bigger, and when identical power was applied on the larger area soft tissue, the stress of gained was less.According to mentioned above, the size that can select compressive surfaces 209 is to realize required stress in the soft tissue in being captured in seam nail 200.

In a plurality of embodiment, as stated, flat 205 can cooperate with control with the compressive surfaces 209 of hat 208 and/or reduce to be applied to the stress on the soft tissue that is captured in the seam nail 200.More particularly, in the embodiment of the circular portion of deformable member contact soft tissue, the compression stress that is applied on the soft tissue can be applied on the very little area, thereby possibly cause stress concentration very high in the soft tissue.Flat at deformable member contacts among the embodiment of soft tissue, and the power that is applied on the soft tissue can be applied on the bigger surface area, thereby causes lower stress concentration.According to mentioned above, the size of the member 204 of selectable variable shape and 206 cross-sectional geometry and compressive surfaces 209 makes them can cooperatively interact to apply required stress to soft tissue.As stated, in the embodiment that hat 208 is made up of soluble, biological decomposable or biological absorbable material, the compression stress or the stress that are applied on the soft tissue can reduce along with hat 208 dissolvings.More particularly; In at least one embodiment, when seam nail 200 was inserted in the soft tissue at first, flat 205 can limit first distance between the two with compressive surfaces 209; At this moment can produce first power and the stress that are applied on the soft tissue; After at least a portion of compressive surfaces 209 dissolved, flat 205 can limit big distance between the two with compressive surfaces 209 then, and it can make the compression stress and the corresponding stress that are applied on the soft tissue reduce.In a plurality of embodiment, at least one in the deformable member 204 and 206 can be made up of soluble, biological decomposable or biological absorbable material.In this embodiment, with mentioned above similar, deformable member 204 and 206 solvable the taking off of part are to reduce to be applied to compression stress and the stress on the soft tissue.

Referring to Figure 21-26, seam nail 252 can comprise the first deformable member 256 and the second deformable member 258, and wherein each deformable member all can comprise base portion 260, the first deformable shank 262 and the second deformable shank 263.Seam nail 252 also can comprise hat 254, and it can be made up of the molded or co-molded material of at least a coating.In at least one embodiment, for example, hat 254 can be molded into first material of deformable member 256 and 258 and second material that coating is molded into first material constitutes by coating.In at least one this embodiment, second material can be configured to dissolve rapidly, thereby allows deformable member 256 and 258 separated from one another in early days at agglutination.Yet, can select first material to make its rate of dissolution slower, even so that the hat 254 of seam nail 252 still can continue to soft tissue compression stress to be provided after second material dissolves fully than second material.In at least one embodiment, can be on deformable member 256 and 258 with the first material injection-molded, then with before the second material injection-molded is to first material, let first material cured and/or solidify basically.In other a plurality of embodiment, can with first material and second material basically side by side or in extremely rapid succession injection-molded on deformable member 256 and 258.In these embodiment, can first material and second material be combined through chemical method, so that enough intensity to be provided between the two, to make and can under first material and the unseparated each other situation of second material, handle seam nail 252.In other embodiments, first material and second material can form mechanical interlock, to obtain identical result.

With mentioned above similar, referring to Figure 21-26, deformable member 256 and at least a portion of 258 can comprise non-circular cross sections.In a plurality of embodiment shown in Figure 34-57, that deformable element cross-section can comprise is smooth, the multiple combination of arc and/or curved surfaces.For example, in Figure 34 and embodiment shown in Figure 35, deformable element cross-section can comprise a plurality of curved surfaces 282.In Figure 36 and embodiment shown in Figure 37, deformable element cross-section can comprise a plurality of smooth basically surfaces 278 and 280.In a plurality of embodiment, cross section can have triangle, rectangle, square, ellipse, hexagon, pentagon, trapezoidal or any other suitable shape.In any case, cross section is symmetric or asymmetrical.In a plurality of embodiment, as stated, cross section can be constructed to allow deformable member crooked with specific direction.In at least one embodiment, referring to Figure 40 and 41,

flat surfaces

278 and 280 can comprise groove or groove 283, and it can reduce the moment of inertia around at least one cross section, and wherein deformable member is more flexible around this axle.

As stated, for example, when

deformable member

256 and 258 inserted via soft tissue, deformable member can pierce through soft tissue, formed the hole therein.Therefore, although deformable member can be filled perforation basically, at least at first, the soft tissue around the perforation still can be hemorrhage.In a plurality of embodiment of the present invention, at least a portion of deformable member is inflatable and apply compression stress to soft tissue, to stop or alleviating at least the hemorrhage of perforation surrounding soft tissue.In at least one embodiment, at least a portion referring to the deformable member 256 of Figure 27-33, the first and the second deformable member 258 can apply expandable coating 274.In a plurality of embodiment, referring to Figure 28, expandable coating 274 can have first diameter when inserting via soft tissue at first, and can apply first compression stress to the soft tissue around deformable member according to the size of deformable member and perforation.Thereafter, referring to Figure 32, the size of inflatable coating 274 can increase, thereby applies the bigger compression stress or second compression stress to the soft tissue around deformable member.In a plurality of embodiment, this second compression stress can be enough to closure or the blood vessel in the compression perforation surrounding soft tissue at least, thereby eliminates or alleviate the hemorrhage of this place at least.

In a plurality of embodiment, expandable coating 274 can have any other suitable material of affinity to constitute by hydrophilic material or to glassware for drinking water, and it can absorb blood or other liquid of surgical site, thus as indicated above expanding.In at least one embodiment, can insert the liquid into surgical site, this can make expandable coating 274 expand.In a plurality of embodiment, expandable coating 274 can be had the cross-linked esterification compound formation of Polyethylene Glycol based polyalcohol by (for example).In at least one this embodiment, can expandable coating 274 be coated at least a portion that is molded into seam nail 252 through injection molding.In other a plurality of embodiment, deformable member and/or hat can all be made up of expandable material.In any case, after expandable material 274 expanded, its at least a portion can begin dissolving and can be absorbed by patient's body.In this embodiment, second compression stress that is applied on the soft tissue can reduce, and can allow soft tissue to stretch and growth, so that fill perforation.When deformable member also was made up of aforesaid soluble or biological absorbable material, this embodiment was particularly useful.In a plurality of embodiment, expandable coating also can comprise (for example) therapeutic agent, and it can discharge along with expandable coating 274 dissolvings.

Although the seam nail in conjunction with having the deformable member that is essentially circular cross section illustrates expandable coating 274; But also can expandable coating 274 be applied on the deformable member with non-circular cross sections, these cross sections include, but is not limited to disclosed cross section among Figure 34-57.In other a plurality of embodiment, can expandable coating 274 be applied on the surgical fastener part of any other suitable type.In at least one this embodiment, suture or surgical thread can be coated with expandable coating at least in part.In use, when inserting suture or surgical thread in the soft tissue, their can form perforation in soft tissue, and expandable coating is then inflatable to fill perforation, as stated.

In a plurality of embodiment, referring to Figure 58-66, seam nail 302 can comprise base portion 304, the first deformable member 306 and the second deformable member 308.In at least one embodiment, seam nail 302 also can comprise hat 310, and it has the hole 312 that is limited to wherein, and this hole can be constructed to admit the first deformable member 306 and the second deformable member 308.As more detailed description hereinafter, deformable member 306 and 308 can be constructed in hole 312, move or slide, and makes base portion 304 to move with respect to hat 310.In at least one this embodiment, each hole 312 can limit the axle 314 that is extended through by it, and wherein deformable member 306 and 308 can be constructed to when they move in the hole, can move along axle 314.In a plurality of embodiment, referring to Figure 61-63, hat 310 can comprise groove 320, and it can be constructed to admit base portion 304 and limit relatively moving between (even not stoping) base portion 304 and the hat 310 at least.In at least one embodiment, can base portion 304 be positioned in the groove 320 movably, make groove 320 can allow deformable member 304 and 306 to move, move but stop base portion 304 to cross axle 314 at least along axle 314.In a plurality of embodiment, groove 320 can be constructed to admit base portion 304 with interference fit and/or snap configuration, make base portion 304 be set in the groove 320 after base portion 304 can be fixing basically with respect to hat 310.

In a plurality of embodiment,, can seam nail 302 removably be stored in the nail bin (for example nail bin 318) referring to Figure 67-70.In at least one embodiment, nail bin 318 can comprise main body 326, and it has the chamber 316 that is limited to wherein.Nail bin main body 326 also can comprise the platform 328 with top surface 330, and its lumen 316 can comprise opening in top surface 330.In a plurality of embodiment, each chamber 316 can be constructed to admit the base portion 304 of seam nail 302 and at least a portion of

deformable member

306 and 308, and wherein platform 328 can comprise groove 334, and it can be constructed to admit hat 310.In use, referring to Figure 67, base portion 304 can be arranged in the primary importance in chamber 316 before moving towards hat 310.In at least one embodiment, it is terminal 336 that

deformable member

306 and 308 can comprise, wherein in this primary importance, terminal 336 can be positioned in the hole 312 or near it.Therefore, in this embodiment, when

deformable member

306 and 308 moved with respect to hat 310 as stated,

deformable member

306 and 308 alignd with axle 314, and can reduce

deformable member

306 and 308 and depart from the probability in hole 312.

In a plurality of embodiment, referring to Figure 67 and 68, can through driver 338 make deformable member 306 and 308 and base portion 304 move or slide with respect to hat 310.In at least one embodiment, nail bin also can comprise sled, and it is constructed to promote driver 338 and base portion 304 is moved towards hat 310.Although in Figure 67 and Figure 68 and not shown sled, exemplary haul device is described to some extent in present patent application and is illustrated, and comprises the sled 62 among Fig. 3 and Figure 10.In a plurality of embodiment, referring to Figure 68, driver 338 base portion 304 that can promote or slide contacts hat 310 as stated and engage with groove 320 up to base portion 304, and deformable member 306 and 308 is inserted in the soft tissue that is positioned on the top surface 330.Thereafter, referring to Figure 69, driver 338 forces base portion 304 and hat 310 to move up, and makes hat 310 break away from groove 334.In a plurality of embodiment, can be in groove 334 with hat 310 interference fits or snap, make driver 338 must apply enough power so that be preced with 310 and remove from groove 334.In other a plurality of embodiment, although not shown, being preced with 310 can be Unitarily molded with platform 328, makes driver 338 to apply enough power to base portion 304 and shakes off nail bin main body 326 so that be preced with 310.

In a plurality of embodiment, driver 338 can be constructed to drive

deformable member

306 and 308 and lean anvil block, makes anvil block with the deformable deformation of member, as stated.Thereafter, as indicated above, deformable member can be caught soft tissue and it is leaned hat 310 compressions.In a plurality of embodiment, hat 310 also can comprise tissue contacting surface 324, and it can be used for controlling the compression stress that is applied on the soft tissue.More particularly, when surface 324 have can compress soft tissue than large tracts of land the time, be applied to compression stress on the soft tissue can be much smaller than surface 324 compression stress when having than small size.In at least one embodiment, tissue contacting surface 324 can have first width, and base portion 304 can have second width.In at least one this embodiment, second width of the comparable base portion 304 of first width of tissue contacting surface 324 is wideer, makes in the process that pushes or penetrate seam nail 302, has only tissue contacting surface 324 to contact with tissue.

In a plurality of embodiment, will stitch the nail 302 navigate in the soft tissue before, can tissue be caught and be compressed between nail bin 318 and the anvil block.In at least one embodiment, can hat 310 be positioned in the groove 334 of nail bin main body 326, make the surface 324 of hat 310 to align with the top surface 330 of platform 328 or to flush basically.In at least one this embodiment, platform 328 can be substantially the same with compression stress or pressure that hat 310 is applied on the soft tissue.In other a plurality of embodiment, can hat 310 be positioned in the groove 334, make that surface 324 is positioned to stitch on the top surface 330 of nail platform 328.In this embodiment, hat 310 is applied to compression stress or the pressure that compression stress or pressure on the soft tissue can apply greater than platform 318.In a plurality of embodiment, can select the relative distance between surface 324 and the top surface 330, so that compression stress or pressure before required the pushing to be provided to soft tissue.In other a plurality of embodiment, can the surface 324 be positioned under the top surface 330 of platform 328, make surface 324 be applied to compression stress or pressure that compression stress or pressure on the soft tissue apply less than platform 328.

In a plurality of embodiment, referring to Figure 59, Figure 62 and Figure 65, seam nail 302 ' can comprise

deformable member

306 and 308, and it can be constructed to pierce through hat 310 ', rather than passes hole 312.In this embodiment, the end 336 of deformable member can be enough sharp keen, to pierce through hat 310 ', and forms the hole therein, and this hole can allow

deformable member

306 and 308 to move or slide with respect to it.In other a plurality of embodiment,, can be with deformable member 306 referring to Figure 60, Figure 63 and Figure 66 " and 308 " be positioned to be preced with 310 " periphery outside.In at least one this embodiment,, be preced with 310 although not shown " can comprise groove or slit, it can be constructed to admit slidably deformable member 306 " and 308 ".

In a plurality of embodiment, referring to Figure 72-76, can some seams nail be linked together, so that control is applied to compression stress or the distribution of pressure on the soft tissue that is captured in the seam nail.In at least one embodiment, can link together through the hat 310 of bridgeware 340 with some seams nail 302, make bridgeware 340 and hat 310 can soft tissue than large tracts of land on apply compression stress, and reduce to be applied to pressure and stress on the soft tissue.In a plurality of embodiment, bridgeware 340 also can help inhibition seam nail 302 to tear soft tissue or from soft tissue, haul out.More particularly, when when specific seam nail 302 applies great power, can this power be distributed on one or more other seam nails 302 through bridgeware 340, and possibly suppress soft tissue injury.In a plurality of embodiment, tissue contacting surface 324 can be positioned on the bridgeware 340, makes compression stress or the pressure that compression stress that bridgeware 340 applies to soft tissue or pressure apply less than hat 310.In other a plurality of embodiment, although not shown, the top surface of bridgeware 340 can align with surface 324 or flush basically, makes hat 310 and bridgeware 340 to apply substantially the same compression stress or pressure to soft tissue.In a plurality of embodiment, bridgeware 340 flat, waveform, arc or any other suitable shape, and can have any suitable cross-sectional layout.

In a plurality of embodiment, referring to Figure 74 and 75, nail bin 318 also can comprise the intermediate groove 342 that is limited in the platform 328, and its further groove 342 can be constructed to admit bridgeware 340.In a plurality of embodiment, can bridgeware 340 be positioned in the groove 342, make that they can be from wherein breaking away from when location slit follows closely 302 as stated.In other a plurality of embodiment, bridgeware 340 can with platform 328 interference fits, snap or Unitarily molded.With mentioned above similar, the seam staple drivers can be constructed to apply enough power so that bridgeware 340 is removed from platform 328 to seam nail 302 and/or bridgeware 340.In any case, although also not shown in Figure 72-76, the seam nail 302 that driver can be constructed to be located by connecting simultaneously basically.In other a plurality of embodiment, bridgeware 340 can be enough pliable and tough, with the seam nail 302 that allows driver to be located by connecting continuously.In a plurality of embodiment,, can use more than one bridgeware 340 to connect the hat 310 of adjacent seam nail 302 although not shown.In at least one embodiment, can connect four or more a plurality of adjacent seam nail 302 through bridgeware 340, yet, also can imagine other embodiment that comprises greater or less than the seam nail of four connections.

In a plurality of embodiment, referring to Figure 74, can seam nail 302 be arranged to several rows or a few row, wherein bridgeware 340 can connect with the nail of the seam in delegation and/or the different rows 302.By way of example,, can the hat 310 of the seam nail 302 in first row be linked together, simultaneously in same embodiment, can the hat 310 of these seam nails and the seam in second row and/or the third line be followed closely 302 hat 310 and be connected referring to Figure 74-76.In a plurality of embodiment, can and be preced with 310 injection-molded to base portion 304 with bridgeware 340.In at least one embodiment, bridgeware 340 can be made up of absorbable, biological decomposable or soluble material with a hat 310 or their part.In a plurality of embodiment, bridgeware 340 can be made up of aforesaid curative drug with hat 310 at least in part.

In a plurality of embodiment, as indicated above, before the seam nail was located from nail bin, soft tissue can be compressed between (for example) anvil block and the nail bin.In a plurality of embodiment, referring to Figure 84, the top surface 330 that soft tissue 360 can be compressed in anvil block 346, nail bin 318 is with between 310 the tissue contacting surface 324 of coming of age.In at least one embodiment, before will stitching nail insertion soft tissue, blood or other liquid are extruded in this compression meeting from soft tissue 360, and the thickness of soft tissue 360 is reduced, and this can make the seam nail in soft tissue, obtain bigger clamping force or obtain power.In at least one embodiment, anvil block 346 can comprise compressive surfaces 350, and it can be constructed to contact as stated soft tissue 360.In a plurality of embodiment, compressive surfaces 350 comprises the anvil block pit 348 that is limited to wherein, and it can be constructed to admit the end 336 of deformable member 306 and 308 and make its distortion, makes seam nail 302 can soft tissue 360 be captured in wherein.Yet at least one embodiment, soft tissue 360 can flow in the anvil block pit 348, thereby allows soft tissue before inserting the seam nail, to stretch.Therefore, the soft tissue in the anvil block pit 348 following zones can be thicker, and correspondingly, the soft tissue around the deformable member 306 and 308 is also thicker, and this can reduce seam and follow closely the clamping force in soft tissue or obtain power.

In a plurality of embodiment, surgical operation seam nail (for example) can comprise and can hinder or even suppress the characteristic that this phenomenon takes place.More particularly, referring to Figure 77-79, surgical operation seam nail 302 can comprise that it can cooperate with anvil block pit 348, thereby is positioned the suffered pressure of soft tissue between the two from being preced with the convexity 344 of 310 extensions.In at least one embodiment, protruding 344 can be constructed to make protruding 344 with anvil block pit 348 between distance and be preced with 310 tissue contacting surface 324 and the tissue compression surperficial 350 of anvil block 346 between distance substantially the same.Therefore, in these embodiment, be applied to power or pressure on soft tissue homogeneous basically before seam nail 302 gets into soft tissues.In other a plurality of embodiment, the distance between convexity 344 and the anvil block pit 348 can be less than the distance between seam nail surface 324 and the anvil block compressive surfaces 350.In this embodiment, the power or the pressure that are applied on the soft tissue are bigger in the soft tissue area around deformable member 306 and 308.Therefore, at least one embodiment, more blood or liquid can be extruded from deformable member 306 and 308 soft tissue on every side, and seam nail 302 can produce bigger clamping force or pressure.In a plurality of embodiment, protruding 344 also can cooperate with anvil block pit 348, hemorrhage with the soft tissue that alleviates perforation place that deformable member 306 and 308 forms in soft tissue.In this embodiment, protruding 344 can play the effect of clamp basically, and can improve the hemorrhage relevant problem with perforation surrounding soft tissue.

In a plurality of embodiment; As stated, protruding 344 position can be adjacent with

deformable member

306 and 308, yet; Also can imagine other embodiment, wherein can use one or more convexities to be applied to power or pressure on the soft tissue at any correct position of seam nail with control.In at least one embodiment, for example, protruding 344 can form with hat 310a in the injection-molded process, and/or can be assembled on the seam nail 302 protruding 344.In any case, convexity 344 can be by constituting with the identical or different material of material that constitutes hat 310.Though describe and show convexity 344 to be generally semi-circular portion, protruding 344 can comprise that also any (for example) can be with tissue compression other suitable shape in anvil block pit 348.In a plurality of embodiment, although also not shown, convexity 344 or any other suitable convexity can be extended from the platform 328 and/or the

deformable member

306 and 308 of nail bin 318.

In a plurality of embodiment of the present invention, surgical operation seam nail can be through the injection molding preparation.In at least one embodiment, referring to Figure 85-88 and Figure 105, can slender member 402 be placed mould.In a plurality of embodiment, can slender member 402 directly be placed mould, perhaps as other a kind of selection,, can slender member 402 be placed transfer block 404, and then transfer block 404 is placed mould, like the hereinafter more detailed description referring to Figure 105.In any case, referring to Figure 85, slender member 402 can have a plurality of deformable members 406, and wherein each deformable member 406 all can comprise base portion 408 and at least one shank 410.

In a plurality of embodiment, slender member 402 can be made up of any suitable material, for example plastics, titanium or any other suitable metal.In at least one embodiment, referring to Figure 85, slender member 402 can be made up of wire rod, and can have the shape that is generally snakelike.In a plurality of embodiment, term " snakelike " can comprise any non-linear shape that can allow slender member to be divided into two seam nail parts.In at least one embodiment, can be before slender member 402 being placed mould or transfer block 404 and/or during slender member 402 is shaped to the shape that is generally snakelike.

Except mentioned above, slender member 402 can have the shape of cross section that comprises above-mentioned Any shape, or is suitable for preparing any other shape of cross section of seam nail.

In a plurality of embodiment, referring to Figure 105, can slender member 402 be placed mould or transfer block 404, make the base portion 408 of deformable member 406 can be arranged in a plurality of chambeies 409 that limit in advance.In at least one embodiment, for example, can mould be closed, make can melted material be injected and water oral cavity 411 and flow into flow passage chamber 403, so that fill chamber 409 and closed base 408 at least in part with melted material.In a plurality of embodiment, melted material can comprise plastics, metal and/or any other suitable material.After chamber 409 was melted the material filling, melted material can stop to flow, and referring to Figure 86, melted material can harden subsequently, coated molded hat 426 thereby form.In a plurality of embodiment, hat 426 can have the shape in chamber 409, and at least one embodiment, also can at least a portion of shank 410, form hat 426.Thereafter, in a plurality of embodiment, slender member 402 can constitute seam nailing strip 412, and it can link together through the shank 410 of jointing 434 and the first seam nail, the 413 and second seam nail 415.

In a plurality of embodiment, as stated, as the result of molding process, each seam nailing strip 412 all can comprise jointing 434.More particularly, mould or transfer block 404 can comprise the flow passage chamber 403 that can let chamber 409 (for example) be communicated with fluid each other.This flow passage chamber 403 can be used for guaranteeing that each chamber 409 all is melted material and fills, and because melted material hardens in flow passage chamber 403, jointing 434 can extend between the hat 426 of (for example) first seam nail 413 and second seam nail 415.Referring to Figure 87, in a plurality of embodiment, can jointing 434 be removed from the first seam nail, the 413 and second seam nail 415.In at least one embodiment, can remove jointing 434 from the seam nail through cutting mechanism or the hot cutter that (for example) operationally engages with mould and/or transfer block 404.In other embodiments, can after from mould and/or transfer block 404, taking out seam nailing strip 412, again jointing 434 be removed from seam nail 413 and 415.In other a plurality of embodiment; In the time will stitching nailing strip 412 and pack in the nail bin, jointing 434 can be connected with 415 maintenances with seam nail 413, and in a plurality of embodiment; Can behind nail bin location, jointing 434 be removed from seam nailing strip 412 will stitching nailing strip 412, or still be connected with its maintenance.

After removing jointing 434, before or simultaneously, can cut seam nailing strip 412, so that the first seam nail 413 and the second seam nail 415 are separated.In a plurality of embodiment, referring to Figure 88, can be along line 401 cutting shanks 410, make the same length of shank 410.In alternative embodiment, referring to Figure 87, for example can be along line 401 ' and/or 401 " cutting shank 410, make that the length of shank 410 is different.In a plurality of embodiment, for example, to compare with the seam nail that has than long leg, the seam nail that has than short leg can provide different compression power or pressure to the soft tissue that is captured in wherein.In this embodiment, can shank 410 be cut into required length, make them to apply required compression stress or pressure to soft tissue.In any case, in not removing a plurality of embodiment of jointing 434 as yet,, can the shank 410 of the first seam nail 413 be separated with the shank 410 of the second seam nail 415, so that divide gap nailing strip 412 referring to Figure 88.Although the seam nailing strip with substantially linear illustrates seam nailing strip 412, stitch annulus or any other suitable configuration that nailing strip 412 can form the seam nail.In the embodiment that removes jointing 434,, can the first seam nail 413 be separated with the second seam nail 415 through cutting referring to Figure 87.

In a plurality of embodiment, referring to Figure 105, can be through using transfer block 404 to cut when slender member 402 has been positioned in the transfer block 404.More particularly, transfer block 404 can comprise a plurality of slits 428, and it can be constructed to admit the cutting element (not shown), and wherein cutting element can cut-out shank 410 as indicated above.In at least one embodiment, cutting element can be constructed to and can cut off shank 410 by any correct position in slit 428, makes and can shank 410 be cut into suitable length.In a plurality of embodiment, for example, can cut the first seam nail 413 and make it have shank 410 than the second seam nail, 415 weak points.In other a plurality of embodiment, cutting element also can cut off shank 410 in the more than position in slit 428.In this embodiment, transfer block 404 can remain closed, and when separating shank 410, will stitch nailing strip 412 maintenances in place.In other embodiments, can after opening mould or transfer block 404, cut.In a plurality of embodiment, can after from mould, taking out transfer block 404, cut, make and can cut in cutting work station through hands or any other suitable cutting method.

In a plurality of embodiment, the method for preparing the seam nail can comprise automatic mode.In at least one embodiment, automatic mode can comprise wire forming machinery, and it can be with bending wire to form slender member 402.Automatic mode also can comprise transfer block 404, and it can be positioned on rotating disk or the conveyer, and can be constructed to admit slender member 402.In a plurality of embodiment, automatic mode also can comprise mechanical arm or other transfer device that is used for one or more slender members 402 are put into transfer block 404.Thereafter, automatic mode (for example) the capable of using mechanism of shuttling back and forth moves to transfer block 404 in the mould, wherein can melted material be injected this mould.In a plurality of embodiment, for example, the mechanism of shuttling back and forth can take out transfer block 404 from mould, makes can transfer block 404 be moved to aforesaid cutting work station, with cutting slender member 402 and/or jointing 434.In other embodiments, as stated, can, transfer block 404 cut when being positioned in the mould.In any case, can open transfer block 404, and the

seam nail

413 and 415 that takes out seam nailing strip 412 and/or be provided with separately, and then repeat this automation process.

In other a plurality of embodiment, referring to Figure 89, slender member 402 ' deformable member 406 ' each can comprise two base portions 408 ', two legs portion 410 ' and can be connected base portion 408 ' mid portion 420.In at least one embodiment, referring to Figure 90, can cut off mid portion 420 to form two middle leg portion 418.In other a plurality of embodiment, referring to Figure 91-93, the deformable member 406 of slender member 430 " can be arranged to feasible seam nail with configuration setting arranged side by side, and connect through adapter 432.In this embodiment, each seam nail can have two deformable shanks 424, two base portions 416, and at least one embodiment, can mid portion 420 be separated to form aforesaid two middle leg portion 418.In at least one this embodiment, referring to Figure 106, for example, can slender member 430 be placed in the transfer block 404 ', make and can hat 426 ' (referring to Figure 92) be molded on the base portion 416.In at least one various embodiment, transfer block 404 ' can comprise hole or slit 428 ', and cutting element can pass this hole or slit operationally makes adapter 432 separate with shank 424.In a plurality of embodiment, with mentioned above similar, the diverse location place that cutting element can be constructed in slit 428 ' cuts off shank 424, so that optionally shank 424 is cut into required length.

In other a plurality of embodiment,, can isolating deformable member 436 be placed on mould and/or transfer block 404 referring to Figure 94-104 " in.In at least one this embodiment; Referring to Figure 94; Each deformable member 436 can comprise at least one shank 438 and at least one base portion 440; Wherein can each base portion 440 be positioned mould or transfer block 404 " chamber 409 " in (referring to Figure 104), to admit molded hat 426 above that ".

In a plurality of embodiment of the present invention, as stated, can surgical operation seam nail removably be stored in the nail bin, and can it be located from nail bin, and sled can be constructed to cross nail bin through sled.In at least one embodiment, as stated, nail bin also can comprise driver, and it can be promoted and can correspondingly seam be followed closely and locate from nail bin by sled.In a plurality of embodiment, also as indicated above, the seam nail can comprise the characteristic that can directly cooperate with sled, makes that can under the situation of no driver, will stitch nail locatees from nail bin.In any case, location slit when nail seam nail can move in the seam nail chamber of nail bin, and under multiple situation, the seam nail can or tilt in the intracavity rotation of seam nail, and this can cause stitching nail with the orientation positions do not expected or be stuck in seam nail intracavity.In a plurality of embodiment of the present invention, seam nail and/or nail bin chamber can comprise can hinder rotation or the oblique features that the generation of (even not suppressing) seam nail is not expected at least.

In a plurality of embodiment, referring to Figure 107-110, nail bin 451 can comprise that at least one is limited to seam nail chamber 452 wherein.In at least one embodiment; At first referring to Figure 109 and Figure 110; Seam nail chamber 452 can comprise one or more arch sections or side 454, its can be constructed to be positioned chamber 452 in surgical operations seam nail cooperates, make the seam nail can not rotate basically with respect to axle 450.In a plurality of embodiment, referring to Figure 111 and Figure 112, surgical operation seam nail 456 can comprise hat 462 and at least one shank 460, wherein is preced with 462 and can comprises arch section or side 464, and it can be constructed to cooperate with the arch section 454 that stitches nail chamber 452.More particularly; The arch section 454 in seam nail chamber 452 can provide bearing-surface; When seam nail 456 when the z axle in chamber or axle 450 move, the arch section 464 of seam nail 456 can lean this bearing-surface, this can suppress or hinder seam nail 456 and hat 462 454 medium dips or shake in the chamber at least.In at least one embodiment, hat 462 arch section 464 can have the frictionally arch section 454 of engagement cavity 452, makes frictional force homogeneous basically on the arch section 464 that acts on hat 462.Under multiple situation, for example, referring to the zone among Figure 110 465, arch section 454 also can make chamber 452 closely arrange.

In a plurality of embodiment, referring to Figure 111-113, the arch section 464 of seam nail 456 can have cylindrical or be columniform part at least in part, and wherein cylindrical part can suppress seam nail 456 in seam nail chamber 452 tilt or shake.More particularly, cylindrical part can cooperate with the arch section 454 in seam nail chamber 452, makes an end of seam nail 456 can not be below or above the other end of seam nail 456 basically.In at least one embodiment, referring to Figure 110-112, seam nail 456 can comprise far-end 457 and near-end 459, and in addition, seam nail chamber 452 also can comprise far-end 461 and near-end 463.In a plurality of embodiment, the end 461 in chamber 452 and 463 can be constructed to along axle 450 guiding hat 462, make terminal 457 and 459 basically not can towards or deviate from axle 450 inclinations or shake.Therefore, in this embodiment, anvil block can make deformable member 460 distortion basically simultaneously, and can make its deflection substantially the same, applies substantially the same compression stress with the soft tissue in being captured in seam nail 456.In a plurality of embodiment, the hat of surgical operation seam nail can comprise whole arcwall face (not shown), and referring to Figure 116, seam nail chamber can comprise curved wall 454, and it can be constructed to cooperate with aforesaid seam nail arcwall face.

Although preceding text have been described arc and cylindrical part, the present invention is not limited to this configuration.In a plurality of embodiment, referring to Figure 110-112, seam nail chamber 454 can comprise and be essentially orthogonal recess 470, and it can be constructed to admit from being preced with 462 convexities 486 of extending.In at least one embodiment, recess 470 and protruding 486 can be constructed to inhibition or hinder seam nail 456 rotation or inclination in chamber 454 at least, as stated.In a plurality of embodiment, referring to Figure 114-116, the hat of surgical operation seam nail can comprise at least one part (not shown) oblique or that become the angle, and its centre joint nail chamber can comprise the part 472 oblique or that become the angle that cooperates with it.In a plurality of alternative embodiment, referring to Figure 110 A, nail bin 451 ' can comprise seam nail chamber 452 ', its lumen 452 ' can comprise one or more side's or the angle 454 ' of the side of being essentially at least.In this embodiment, angle 454 ' can be constructed to be positioned chamber 452 ' in the corresponding corner that nails on of seam or be essentially quadrate angle and cooperate, with inhibition or be limited at least on x axle shown in Figure 110 A and the y axle and relatively move.In a plurality of embodiment, when seam nail sled moved with the direction shown in the arrow D nail bin 451 ' in, sled can make seam nail in the chamber 452 ' along direction D skew, and the one or more corners that make seam follow closely align in corner 454 '.In these cases, the corner characteristic of cooperation can suppress or resist the seam nail at least with respect to (for example) x axle and the rotation of y axle.Except mentioned above, the alignment corner also can suppress or hinder at least the seam nail squeeze or be stuck in the seam nail chamber 452 '.In a plurality of embodiment, shown in Figure 110 A, seam nail chamber 452 ' can comprise arc and square structure simultaneously, and obtains the advantage of above-mentioned each structure at least.

In a plurality of embodiment, referring to Figure 107-110, nail bin 451 can comprise nail bin main body 453, and it comprises first terminal 474 and second terminal 476.In at least one embodiment, can between first terminal 474 and second terminal 476, form slit 478, wherein slit 478 can be constructed to admit cutting element.Except mentioned above, slit 478 can limit first side 480 and second side 482 of nail bin main body 453, wherein can limit a plurality of seam nails chamber 452 on first side 480 of nail bin main body 453 and/or second side 482.In at least one embodiment, the chamber 452 on first side 480 and second side 482 can be crossed slit 478 or acutangulated with it, and at least one embodiment, chamber 452 can be parallel basically.

In a plurality of embodiment, as stated, the surgical operation stiching instrument can be constructed on the opposite side of otch, insert the surgical operation seam nail of parallel row.In this embodiment, referring to Figure 117, available delegation or multirow seam nail 500 connect or compression soft tissue 502, and be hemorrhage with the soft tissue that suppresses or alleviate on (for example) otch 504 both sides.In a plurality of embodiment, these rows' seam nail 500 can relative to each other squint or be staggered, makes seam nail 500 mutual bracings also compress the blood vessel in the soft tissue 502, especially perpendicular to or be substantially perpendicular to the blood vessel of otch 504 extensions.Although this seam nail pattern also can make improvements applicable to its intended purposes, especially relate to cross and/or be parallel to blood vessel that otch 504 extends aspect improve.

In a plurality of embodiment, referring to Figure 118 and 119, nail bin 506 can comprise nail bin main body 508, and wherein nail bin main body 508 can comprise top surface 510, lower surface 512, far-end 514, near-end 516 and two sidewalls 518.In at least one embodiment, the sidewall 518 of nail bin main body 508 can extend between top surface 510 and lower surface 512, and top surface 510 and lower surface 512 can be limited between far-end 514 and the near-end 516.In a plurality of embodiment, referring to Figure 118 and Figure 119, nail bin main body 508 also can comprise slit 520, and wherein the longitudinal axis of slit 520 can be parallel to or be arranged essentially parallel to the longitudinal axis of main body 508.In at least one embodiment, " substantially parallel " can refer to regard to this paper with in about 15 degree of arbitrary deviation in driction parallel direction.In a plurality of embodiment, for example, slit 520 can limit through near-end 516 and/or far-end 514, and can be constructed to admit the cutting element that is suitable for cutting off soft tissue.In any case, slit 520 can limit first side 522 and second side 524 of nail bin main body 508.

In a plurality of embodiment, referring to Figure 118 and Figure 119, nail bin main body 508 can comprise at least one first seam nail chamber 526 and at least one second seam nail chamber 528, and wherein first chamber 526 and second chamber 528 can be limited in top surface 510 and/or the lower surface 512.In at least one embodiment, first chamber 526 and second chamber 528 can be positioned on first side 522 and/or second side 524 of nail bin main body 508.In a plurality of embodiment; Each all can have first terminal 530 and second end 532 first chamber 526 and second chamber 528; Wherein between first terminal 530 and second end 532 in first chamber 526, can limit first axle 534; Similarly, between first terminal 530 and second end 532 in second chamber 528, can limit second axis 536.In at least one this embodiment, the first axle 534 in first chamber 526 can cross second axis 536 in second chamber 528, makes can form acute angle or obtuse angle between axis 534 and 536.In other a plurality of embodiment, the first axle 534 in first chamber 526 can perpendicular to or be substantially perpendicular to second axis 536 in second chamber 528.In a plurality of embodiment, still referring to Figure 118 and Figure 119, a plurality of first chambeies 526 can be parallel or substantially parallel, and same, a plurality of second chambeies 528 also can be parallel or substantially parallel.In other a plurality of embodiment, a plurality of first chambeies 526 can be not parallel or substantially parallel, and a plurality of second chambeies 528 are not parallel or substantially parallel yet.

In at least one embodiment, first chamber 526 can be constructed to admit the first seam nail, and second chamber 528 can be constructed to admit the second seam nail, and wherein each seam nail all can comprise first shank 544 and second shank 546.In at least one embodiment, referring to Figure 120, first shank 544 of the first seam nail can be positioned at first terminal 548 places in first chamber 538, and second shank 546 of the first seam nail can be positioned at second terminal 550 places in first chamber 538.In a similar manner, first shank 544 of the second seam nail can be positioned at first terminal 548 places in second chamber 540, and second shank 546 of the second seam nail can be positioned at second terminal 550 places in second chamber 540.In a plurality of embodiment, second shank 546 of first shank 544 of the first seam nail and the second seam nail all can be positioned on the common axis 552 or this axle of next-door neighbour.In this embodiment, common axis 552 can limit the first common axis side 554 and the second common axis side 556.In a plurality of embodiment, second shank 546 of the seam nail of first in first chamber 538 can be positioned on the first common axis side 554, and first shank 544 of the seam nail of second in second chamber 540 can be positioned on the second common axis side 556.As the result of this configuration, referring to Figure 120, for example, the first and second seam nails can be constructed to compress or tighten the blood vessel that extends perpendicular to axle 552, and the blood vessel that crosses and/or be parallel to axle 552 extensions.

In a plurality of embodiment; Referring to Figure 120; First axle 558 can be limited between first shank 544 and second shank 546 of the first seam nail in first chamber 538, and similarly, second axis 560 can be limited between first shank 544 and second shank 546 of the second seam nail in second chamber 540.In at least one embodiment, first axle 558 can cross second axis 560, and feasible in fact first chamber 538 and second chamber 540 can be horizontal each other.In other a plurality of embodiment, first axle 558 can perpendicular to or be substantially perpendicular to second axis 560, the chamber 538 of winning is perpendicular to one another with second chamber 540.

In a plurality of embodiment; Referring to Figure 121; Nail bin main body 508 can comprise a plurality of first chambeies 562 and a plurality of second chambeies 564 that are limited to wherein, and said chamber can be constructed to admit respectively the first seam nail and the second seam nail, and wherein each seam nail all can comprise first shank 568 and second shank 570.In a plurality of embodiment, with mentioned above similar, first shank 568 of the first seam nail can be positioned at first terminal 574 places in first chamber 562, and similarly, second shank 570 of the first seam nail can be positioned at second terminal 576 places in first chamber 562.In at least one embodiment, first shank 568 of the second seam nail can be positioned at first terminal 574 places in second chamber 564, and second shank 570 of the second seam nail can be positioned at second terminal 576 places in second chamber 564.In a plurality of embodiment, refer again to Figure 121, first shank 568 of the first seam nail can be positioned on the side of axle 578, and second shank 570 of the first seam nail can be positioned on the opposite side of axle 578.In at least one embodiment, first shank 568 of the second seam nail can be positioned on the same side of axle 578 with second shank 570 of the first seam nail.In a plurality of embodiment, first shank 568 of second shank 570 of the second seam nail and the second seam nail can be positioned on the opposite side of axle 578.In other a plurality of embodiment, the first seam nail and the second seam nail can be arranged according to any other suitable configuration, as long as the shank 568 and 570 of the shank 568 of the first seam nail 566 and the 570 and second seam nail 572 lays respectively on the opposite side of common axis 578 separately.

In a plurality of embodiment of the present invention, the soft tissue after available backing material stiffened and/or reinforcement are sewed up.In at least one embodiment, referring to Figure 122-127, can backing material 600 be used in combination with the surgical operation stiching instrument, wherein the surgical operation stiching instrument can comprise anvil block 602 and nail bin 610.In this embodiment, surgical operation seam nail can be located from nail bin 610 and by anvil block 602 distortion, so that catch backing material 600 it leaned against on the soft tissue 612 between nail bin 610 and the anvil block 602.In a plurality of embodiment, backing material 600 releasably is retained on anvil block 602 and/or the nail bin 610.More particularly, at least one embodiment, anvil block 602 can comprise first antelabium 604 that extends from wherein, and it can be constructed to releasably backing material 600 captured on the anvil block 602.In a plurality of embodiment, first antelabium 604 can center on the periphery of backing material 600 fully, or in other embodiments, first antelabium 604 can not contact the whole periphery of backing material 600.In a plurality of embodiment, term " periphery " can comprise how much peripheries of backing material, and the outside of backing material, outer rim or outskirt.In at least one embodiment, anvil block 602 also can comprise from second antelabium 606 that wherein extends, its can with first antelabium, the 604 similar backing materials 600 of releasably catching.In at least one alternative embodiment, referring to Figure 124, anvil block 602 can comprise one or more recesses or slit 608, and it releasably remains on backing material 600 on the anvil block 602.In a plurality of embodiment, for example, recess or slit 608 can be used in combination with first antelabium 602 and/or second antelabium 604.

In a plurality of embodiment, as stated, anvil block 602 can constitute jaw member with nail bin 610, and it can be constructed to apply compression stress or pressure to the soft tissue 612 that is captured between the two.Referring to Figure 125, nail bin 610 can comprise a plurality of seam nails 614 that are positioned at wherein, and wherein each seam nail 614 can comprise that all at least one has terminal 616 deformable member.In at least one embodiment, backing material 600 can comprise the hole 620 that is positioned at wherein, and its mesopore 620 can be constructed to admit the seam nail terminal 616, makes the deformable member of seam nail 614 to move or slide with respect to backing material 600.In alternative embodiment, seam nail terminal 616 can be constructed to pierce through backing material 600, to form the hole therein.In any case, can make seam follow closely the anvil block pit 618 that end 610 can contact in the anvil block 602 towards anvil block 602 location slit nail 614, and the deformable member of seam nail 614 can bend shown in Figure 126.Therefore, at least one embodiment, deformable member can contact backing material 600 and apply power to it, thereby backing material 600 successful anvil blocks 602 are removed.In other words, but deformable member first direction extend through backing material 600 and by anvil block 602 distortion back with second direction contact backing material 600.In at least one embodiment, backing material 600 can break away from anvil block 602 immediately behind the deformable deformation of member.In this embodiment, referring to Figure 127, backing material 600 can break away from anvil block 602 when anvil block 602 gets into its open position.

In a plurality of embodiment, as stated, backing material 600 can be strengthened or stiffened soft tissue 612.More particularly, at least one embodiment, backing material 600 can increase the elastic modelling quantity of soft tissue after on being attached to soft tissue.In a plurality of embodiment, backing material can be distributed to the compression load of seam nail on the bigger area, thus the stress that reduces in soft tissue, to produce.In at least one embodiment, backing material 600 (for example) can suppress or hinder soft tissue at least to get into anvil block pit 618.More particularly,, this pressure is reduced when being closed into anvil block 602 on the soft tissue and when it applied compression stress, soft tissue can flow into anvil block pit 618, and the therefore correct ability that engages and keep soft tissue of influence seam nail.Yet when having used backing material 600, backing material 600 can be constructed to stop or stop soft tissue to get into anvil block pit 618 at least basically.In a plurality of embodiment, backing material 600 can be made up of absorbable, biological decomposable or soluble material, as the above-mentioned material that can be used for forming hat 310 and bridgeware 340.In at least one embodiment, backing material 600 can comprise the therapeutic substance that can discharge as stated with the promotion healing.In a plurality of embodiment, can adopt toughness, rigidity or semi-rigid material to form backing material 600.

A plurality of embodiment of the present invention relates to the surgical operation that uses inner cutter 30 (referring to Fig. 1); Wherein at least a portion of this operation, the end effector 36 of inner cutter 30 is loaded onto nail bin 64 (referring to Fig. 3) with seam nail (with integrated hat-driver).In addition, integrated hat-driver can comprise groove, and for example the groove shown in Fig. 5-9 144 is used to curve the end that seam is followed closely.This nail bin 64 can be used for Roux-en-Y gastric bypass operation method.In this operation, in conjunction with Figure 128, form tiny pocket 10 through top stomach is diminished at stomach 12, wherein can microgastria bag 10 be directly connected to the middle part (jejunum) 14 of small intestinal, thereby walk around the top (duodenum) 18 of the remainder 16 and the small intestinal of stomach.Shown in Figure 128, sometimes adjustable band 20 is arranged around stomach bag 10, with the expansion of control tiny pocket 10.The pressure that band 20 is applied on the stomach bag 10 can be through port 22 controls that are communicated with band 20.In conjunction with Fig. 1 and Fig. 3, can the inner cutter that be used to perform the operation 30 be loaded onto the nail bin 64 that has with the seam nail of integrated hat-driver (can have or seamless nail end curves groove 144), near proposing the position of putting stomach band 20, to cut.Like this, will protective tissue and/or the outer surface of band 20 avoid stitching the terminal injury of nail, thereby reduce the terminal cutting of seam nail or gall or otherwise damage the probability of band 20, and reduce the probability that band 20 increases the weight of to stitch the nail burden.

In a plurality of embodiment, the clinician can use an inner cutter 30 in operation.Can inner cutter 30 be loaded onto the nail bin (for example United States Patent (USP) 5,465, and 895 is said) with conventional seam nail, be used for not in the cutting in band 20 zones, for example the zone among Figure 128 820,821.For the cutting in the zone 822 of band 20, can inner cutter 30 be loaded onto the nail bin that has with the seam nail of integrated hat-driver.In another embodiment, the clinician can use two (or more a plurality of) independent inner cutter 30 in operation.Inner cutter 30 can be used for the cutting near the zone band 20 820,821 not, and another inner cutter 30 (nail bin that has with the seam nail of integrated hat-driver has been installed) then is used for the cutting in the zone 822 in band 20 zones.

Figure 129 is the flow chart according to the method for a plurality of embodiment.In step 830, the clinician uses the inner cutter 30 with conventional nail bin, is used for the cutting in zone 820 (referring to Figure 128).Certainly, in a plurality of embodiment, will use different conventional nail bins for the each cutting in the zone 820.Near after proposing the zone 822 of putting band 20, in step 832, can inner cutter 30 be loaded onto the nail bin that has with the seam nail of integrated hat-driver the clinician.In step 834, the clinician can carry out necessary once cutting or repeatedly cutting to zone 822 then.Certainly, if need once above cutting in the zone 822, for each this cutting, can inner cutter 30 be loaded onto the nail bin that has with the seam nail of integrated hat-driver.The clinician cross propose the zone of putting band 20 after, in step 836, can inner cutter 30 be loaded onto conventional nail bin, be used for each in addition essential cutting (step 838) in the zone 821, to form tiny pocket 10.In case form tiny pocket 10, in step 840, just can the middle part (jejunum) 14 of patient's small intestinal be sewn onto on the stomach bag 10.In step 842, can stomach band 20 be arranged around stomach bag 10 then, make band 20 be placed on and use in the zone of following closely with the seam of integrated hat-driver.Like this, reduced the terminal probability that galls or wear out band 20 of seam nail, and band 20 increases the weight of to stitch the probability of nail burden.According to a plurality of embodiment, can the inner cutter 30 that the nail bin 64 with integrated hat-driver is housed be used to form each cutting of stomach bag 10.

Therefore; According to a plurality of embodiment; The present invention relates to be used to carry out the method for Roux-en-Y gastric bypass operation; It comprises that use inner cutter 30 repeatedly cuts/fixing step on patient's Weishang, stomach be cut into two parts (like tiny pocket 10 and the stomach of walking around 16) and follow closely two partly sealings with seam along cutting path.For each cutting, can inner cutter 30 be loaded onto new nail bin, and at least once cutting, nail bin comprises the seam nail with integrated hat-driver, as stated.Can use (for example) technology known in the art that the middle part (jejunum) 14 of patient's small intestinal is sewn onto on the stomach bag 10 then.Can stomach band 20 be arranged around stomach bag 10 then, make band 20 be placed on and use in the zone of following closely with the seam of integrated hat-driver.

Figure 130 and 131 is the cross-sectional side view according to the part of the end effector 36 of other a plurality of embodiment of the present invention.In the illustrated embodiment, but a plurality of release type pit elements 650 are installed in the anvil block 52.In the illustrated embodiment, but each seam nail 652 all has corresponding release type pit element 650 in the nail bin, but in other embodiments, further said like hereinafter, also can use the discharged pit element 650 of different ratios and stitch nail.But release type pit element 650 can (for example) forms with anvil block 52 before using inner cutter 30, with its snap or otherwise insert wherein.

Shown in the embodiment of Figure 130 and Figure 131, but release type pit element 650 can limit pit 654, and when inner cutter 30 nailings, the end 656 of seam nail 652 is pushed into this pit.During nailing, shown in Figure 131, terminal 656 can at first engage the upper surface 658 of pit 654 and by its bending.The upper surface 658 of pit 654 can turn to the end 656 of seam nail 652 the terminal surface 660 that keeps of seam nail of pit element 650 lower limbs.The terminal surface 660 that keeps of seam nail can keep the end 656 of seam nail 652 or catch in pit 654.

The power of nailing operation is preferably more than pit element 650 is remained on the power in the anvil block 52, makes pit element 650 when nailing, separate or ejection from anvil block 52, shown in Figure 131.Like this, after cutting/fixing operation, pit element 650 can keep together with the seam nail 652 in the tissue 662, shown in Figure 131.Can find out also that from Figure 131 for example, pit element 650 can discharge the back separation from anvil block 52, and moves with tissue 662.

The end 656 that keeps surface 660 can suppress to stitch nail 652 stretches out from pit 654 and gets into to be followed closely in the 652 fixed tissues 662 by seam.In addition; For the operation of around the tissue of having sewed up, using band; Stomach band 20 (referring to Figure 128) in the for example above-mentioned Roux-en-Y gastric bypass operation method, pit element 650 can suppress to stitch the end 656 damage bands 20 of nail 652, and suppress band 20 and damage seam nail lines.In addition, this also can reduce the risk that band arranges that the position generation is infected.

Keep surface 660 preferably enough tough, the end 656 of feasible seam nail 652 can not pierce through and keep surface 660, and tough as to be enough to resist with pit element 650 from the required power of anvil block 52 separation.In addition, keep surface 660 preferably enough little, make that can not hinder seam nail terminal 656 inserts pit 654.According to a plurality of embodiment, keep surface 660 similar with the remainder of pit element 650, available heat plastic material (for example Victrex PEEK plastics) is processed.Keep the thickness on surface 660 to select, and, keep the thickness on surface 660 to can be about 0.010 inch according to a plurality of embodiment according to the size of used seam nail 652.

According to a plurality of embodiment, pit element 650 can be by processing with hat 664 identical materials of seam nail 652.For example, their absorbable materials of all available biology or abiotic absorbable material are processed.In addition, pit element 650 and/or be preced with 664 and can be mixed with or otherwise comprise the therapeutic agent or the medicine that can be absorbed by surrounding tissue 662, for example analgesic or antibacterial.

But Figure 132 and Figure 133 illustrate another embodiment of release type pit element 650, but wherein each release type pit element 650 of illustrated embodiment all has a pit 654.Like this, in this embodiment, can corresponding two pit elements 650 for each seam nail 652.Should be noted that, in a plurality of embodiment, the different pit elements 650 that a plurality of confessions are used simultaneously can be set in anvil block 52.For example, for once using, some pit elements 650 can have two (or more a plurality of) pits 654, and some then can only have a pit 654.Typical nail bin 64 has into 66 seam nails (each triplex row of each side of otch) of six row.Therefore preferably, be arranged in all the pit elements 650 in the anvil block 52 and have 132 pits, that is to say each seam nail 652 corresponding two pit (being each seam nail terminal 656 corresponding pit).

Inner cutter with anvil block 52 that this release pit element has been installed also can be used for will be in the cutting step in the zone of organizing the arranged around band of cutting, for example above-mentioned Roux-en-Y gastric bypass operation method.The clinician can use independent inner cutter 30; But it has the anvil block 52 of band release type pit element 650; Be used for cutting proposing the zone of putting band 20, perhaps the clinician can use an inner cutter 30 in operation, and wherein surgeon (and/or its Team Member) can improve anvil block 52; But, be used for cutting proposing the zone of putting band 20 to its insertion release type pit element 650.In another embodiment, inner cutter 30 can allow to use interchangeable anvil block 52, but one of them anvil block 52 does not have release type pit element 650, and another then has.Then, but can the anvil block 52 with release type pit element 650 be used for the cutting in band 20 zones.

In a plurality of embodiment, above-mentioned or not only can be used for linear stiching instrument with the surgical operation seam nail that way of reference is incorporated this paper into, also can be used for the circular surgical stiching instrument.In the embodiment of circular stapler, surgical operation seam nail can have and identical characteristic, function and the composition of above-mentioned seam nail.No longer seam is bound in a plurality of chambeies of the nail bin with linear configuration, but seam is bound in a plurality of chambeies of the nail bin with circular in configuration.

In a plurality of embodiment, referring to Figure 134-136, circular stapler 900 can comprise head 902, anvil block 904, adjusting knob assembly 906 and trigger 908, and wherein head 902 can be connected to shank assembly 910 through arc shaft assembly 912.In at least one embodiment, trigger 908 can be supported by shank assembly 910 pivotly, and when discharging the release mechanism (not shown), can play the effect of operation stiching instrument 900.When activating trigger 908, nailing mechanism (Figure 134 is not shown) can turn round in shaft assembly 912, and feasible seam nail 914 902 penetrates or the location from the head, and formation contacts with anvil block 904.Simultaneously, the cutter 916 that operationally is supported in the head 902 can be used for cutting the tissue that is clipped between head 902 and the anvil block 904.Can stiching instrument 900 be taken off from operative site then, be retained in its original position sewing up good tissue.

Figure 135 and Figure 136 show the anvil block 904 of a plurality of embodiment uses that can combine the invention of this theme and a kind of form of head 902.From these figure, can find out that anvil block 904 can comprise circular body part 920, it has the anvil shaft 922 that is used to connect the trocar (not shown).In at least one embodiment, anvil block main body 920 can comprise the seam nail profiled surface 924 on it, and also can comprise the covering 926 that is attached to its far-end.Anvil block 904 also can be provided with a pair of trocar fixation clamp or leaf formula spring 928, and it can be used for releasably fixedly trocar, makes it keep engaging with anvil shaft 922.In a plurality of embodiment, can plastics knife plate 930 be installed in the chamber 932 of anvil block main body 904.

In a plurality of embodiment; Referring to Figure 136; Head 902 can have housing member 940; It supports the nail bin supporting assembly of circular seams staple drivers assembly 942 forms wherein, and circular seams staple drivers assembly 942 is suitable for being connected with circular nail bin 944 and driving the seam nail 914 that is supported in wherein, it is formed with the seam nail profiled surface 924 of anvil block 904 contact.In at least one embodiment, circular knife member 916 also centered in seam staple drivers assembly 942.In a plurality of embodiment, the near-end of housing member 940 can be connected on the outer tubular covering 946 of arc shaft assembly 912 through distal collar member 948.About more details of circular seams nail and stiching instrument are found in that on JIUYUE 29th, 2006 submitted to, as to be called SURGICAL CUTTING AND STAPLING DEVICE WITH CLOSUREAPPARATUS FOR LIMITING MAXIMUM TISSUE COMPRESSION FORCE (the surgical operation cutting and stapling instrument with the closing device that is used for the limiting maximum tissue compression stress) U.S. Patent application No.11/541; 151, the disclosure of this patent is incorporated this paper by reference into.

When carrying out anastomosis, available circular surgical stiching instrument is sewed up lumen (for example large intestine or small intestinal), on target part (being sample) each side of intestinal, lays at least two row seam nails.In a plurality of embodiment, sew up while cut the target part usually.Next, after removing sample, the surgeon can insert anvil block the near-end of lumen at seam nail line nearside.In at least one embodiment, this can accomplish at the inlet that nearly lumen cuts through anvil head being inserted the surgeon.Sometimes, but per anum or even per os place anvil block, i.e. far-end through anvil head being placed on stiching instrument and insert apparatus through rectum or mouth respectively.For anvil block is operationally engaged with the surgical operation stiching instrument, in a plurality of embodiment, for example, can the far-end per anum of stiching instrument be inserted.The surgeon can tie up to the near-end of intestinal on the anvil shaft with the conventional device that binds of stitching thread or other then.Next, the surgeon can cut away the unnecessary tissue of contiguous knotting place, and can anvil block be connected on the actuator shaft of stiching instrument.Then the surgeon can closed anvil block and nail bin between the gap, thereby make the intestinal near-end and the distal engagement of cutting in the gap.Then, the surgeon can start stiching instrument, make to drive at least two row seam nails and passes the intestinal near-end and the far-end of incision, thereby the end of intestinal is linked together and forms tubular conduit in the seam nail back that is shaped.Simultaneously, when driving and fashion seam nail, can drive concentric circular shear blade, cutter or cutting element and pass the intestinal tissue end, thus the end of the contiguous expert's seam of cutting nail.The surgeon can take out stiching instrument from intestinal then, and accomplishes anastomosis.

In a plurality of embodiment, referring to Figure 137-139, the present invention relates to surgical operation stiching instrument 900, it has the packing ring 970 that inserts anvil block 904, shown in Figure 137 (for the exploded view of packing ring 970 and anvil block 904) and Figure 138 (packing ring 970 that inserts anvil block 904 is shown).In at least one embodiment, can with packing ring 904 interference fits or snap in the opening of anvil block 904, make packing ring 904 in operation process, keep in place.Can find out that from Figure 139 packing ring 904 can comprise inner 972 and outside 974.Outside 974 can comprise the expert 976 and layman 978 of seam nail targeting part.In a plurality of embodiment, each seam nail targeting part 976,978 all can comprise hole 979, when circular stapler 900 nailings, can drive the expert of seam nail 914 and layman's end respectively and pass through this hole.After the end of seam nail was passed hole 979 by driving, it can be by nail shaping pit 901 bendings of the seam of anvil block 904 or distortion.After by anvil block 904 bendings, the end of seam nail 914 can contact seam nail targeting part 976,978, thereby the end that suppresses seam nail 914 stretches into the tissue that is cut/sews up.Can find out also that from Figure 139 the outside 974 of packing ring 970 can have the spring section 980 between expert 976 and layman's 978 seam nail targeting part.In at least one embodiment, spring section 980 can provide the pliability with respect to the discrete magnitude of ring 972 nominal diameters.In addition, inner seam nail targeting part 976 can be connected to the inside 972 of packing ring through contact pin 982.

In a plurality of embodiment, comprise that inner 972 and outside 974 packing ring 970 can form with molded plastics.Its reason hereinafter will be obvious, and packing ring 970 can be processed by nonabsorbable material (for example PEEK board thermoplastic), and still, in other embodiments, at least a portion of packing ring 970 can be processed by absorbable plastic material.In use; When by percussion; Cutter 916 can cut contact pin 982; Thereby the outside 974 of packing ring 970 is broken off the inside 972 from packing ring 970 at contact pin 982 places, make inner 972 can behind cutting/stitching step, be retained in the anvil block 904, and outside 974 can be kept together after removing stiching instrument 900 with seam nail and tissue.Have and thisly after operation, can have some advantages with the ring spacer part 972 that seam nail and tissue keep together.For example; For the patient that acceptance reduces the volumetrical operation of stomach (for example Roux-en-Y gastric bypass operation method), ring spacer part 972 can suppress the expansion at stomach intestinal anastomosis place through the seam nail line (promptly fixing through the size of ring spacer part 972) that fixed dimension is provided.Fixedly the size at stomach intestinal anastomosis place can suppress to make the expansion of mouth, alleviates thereby possibly make the patient obtain long-term weight.

According to other embodiment, but spring section 980 can be formed by the elastomeric material of overmold on ring 972.And, although to be roughly circle ring 972 is shown among the figure, will be appreciated that ring 972 also can be imagined other shape, for example oval.In intestinal anastomosis, vesica piscis 972 possibly provide the lumen bigger than circular rings.In addition, use nonabsorbable material if encircle 972, lumen then possibly keep constant size and form.

In addition, in a plurality of embodiment, ring 972 can be mixed with or otherwise comprise rehabilitation agent, when its contact tissue, will help the healing of anastomotic position tissue.In addition, but the material that ring 972 can comprise or otherwise have remote detection, and it allows afterwards sensing ring 972 in intravital position of patient and orientation.For example, ring 972 can by the radio wave impermeable of some frequency or otherwise can process by the detected material of electromagnetic radiation.Like this, ring 972 is confirmed in anastomotic part bit position and orientation available (for example) X ray machines.In other embodiments, ring 972 can be processed by the material that has or otherwise comprise the fluorescent nano particles that available cryptoscope device detects.Nanoparticle is (for example) inorganic nano-particle, like semiconductor nano; Nanoparticle based on silicon dioxide; As being called FLUORESCENT SILICA-BASED NANOPARTICLES (based on the fluorescent nano particles of silicon dioxide) in name, being filed in the U.S. Patent application No.11/536 on November 26th, 2003; 569; Name is called PHOTOLUMINESCENT SILICA-BASED SENSORS ANDMETHODS OF USE (based on the luminescence generated by light pick off and the method for using thereof of silicon dioxide), is filed in the U.S. Patent application No.11/119 on May 2nd, 2005; 969; And name is called FLUORESCENT SILICA-BASED NANOPARTICLES (based on the fluorescent nano particles of silicon dioxide), is filed in the U.S. Patent application No.11/306 on November 26th, 2002, those described in 614, and the disclosure of above patent is incorporated this paper into way of reference; Or any other can combine or comprise the inorganic particulate of fluorescent material.Nanoparticle is organic nano particle also, like liposome microsphere, dimeric structure or can combine or comprise other organic structure of fluorescent material.

In other embodiments, the seam of anvil block 904 nail shaping pit 901 can be integrated with ring 972.Like this, ring 972 will comprise the pit (not shown) to each leg opening 979, and it makes shank will be leaned against the pit bending on ring 972 from encircling 972 plane to remote extension.In this embodiment, can need not the pit in the anvil block 904.

In a plurality of embodiment, referring to Figure 140-148, circular surgical stiching instrument 700 can comprise nail bin mechanism 702, slender axles 704 and anvil member 706.In at least one embodiment, nail bin mechanism 702 can removably be attached on the surgical operation stiching instrument 700, be made after the seam nail of winning in the nail bin mechanism 702 is positioned, and for example can take off the first nail bin mechanism 702 and be replaced by the second nail bin mechanism 702.In a plurality of embodiment, referring to Figure 141 and Figure 144, nail bin mechanism 702 can comprise nail bin part 716 and the actuator shaft 714 from wherein extending.In at least one embodiment, referring to Figure 140-142, actuator shaft 714 can be constructed to extend through the hole 712 in the anvil member 706.In this embodiment, surgical operation stiching instrument 700 also can comprise actuating mechanism (not shown among Figure 140-148), and it can be constructed to actuate actuator shaft 714, and therefore nail bin mechanism 702 is moved with respect to anvil member 706.In at least one embodiment, hole 712 can be positioned the far-end of actuating mechanism, and can be constructed to admit actuator shaft 714 with the arrangement of snap and/or interference fit.In a plurality of embodiment, although not shown, at least one the comprised arrestment mechanism in actuator shaft 714 and the actuating mechanism, it releasably remains on actuator shaft 714 on the actuating mechanism.

In a plurality of embodiment, when actuator shaft 714 is bonded in the above-mentioned hole 712 or otherwise operationally engage with actuating mechanism, the distance between actuating mechanism may command anvil member 706 and the nail bin mechanism 702.In at least one embodiment; In order to locate the seam nail that removably is stored in the nail bin 716; Surgeon or clinician can start this actuating mechanism, so that actuator shaft 714 is spurred towards anvil member 706, and therefore make the seam nail joint touch anvil member 706; And fix soft tissue wherein, as stated.In a plurality of embodiment; Nail bin mechanism 702 also can comprise seam staple drivers (not shown), and it operationally engages with actuator shaft 714, makes when actuating mechanism pulling actuator shaft 714; Actuator shaft 714 can make the seam staple drivers move with respect to nail bin part 716, and from the nail of location slit wherein.In any case, actuator shaft 714 and actuating mechanism are broken away from, and take out exhausted nail bin mechanism 702.In this embodiment, for example, when new nail bin mechanism 172 was installed, the remainder of surgical operation stiching instrument 700 can be stayed operative site.This embodiment is the improvement to previous surgical operating instrument, and the latter needs the surgeon to take out whole surgical operating instrument from operative site, so that reinstall new nail bin.In a plurality of embodiment, can shorten the time of accomplishing particular surgeries, and under multiple situation, operation can be littler to patient's wound.

In a plurality of alternative embodiment, referring to Figure 146 and 147, the nail bin part 716 of nail bin mechanism 702 can be separated with actuator shaft 714.In this embodiment, when changing exhausted nail bin part 716, actuator shaft 714 can keep operationally engaging with actuating mechanism.In any case, in a plurality of embodiment, cutter or cutting element 718 can be installed in that anvil member 706 (Figure 140) goes up or nail bin mechanism 702 (Figure 144) on.When cutting element 718 being installed in 706 last times of anvil member, referring to Figure 140, cutter 718 can be installed in the inboard of a plurality of anvil block pits 710, and can towards or move axially away from nail bin mechanism 702.When being installed in 702 last times of nail bin mechanism, referring to Figure 144, cutter 718 can be installed in the inboard of nail bin 716, and can towards or move axially away from anvil member 706.In at least one various embodiment, rotatable during cutting element 718 as indicated above moving axially, and can be constructed to prune part near the intestinal of seam nail line.

Apparatus disclosed herein can be designed to abandon after single uses, and perhaps they can be designed to and can use repeatedly.Yet, in either case, all can repair, so that using once the back to reuse at least to this apparatus.Any combination that reparation can may further comprise the steps: disconnecting apparatus and disengaging gear, clean then or the replacing specific component, and re-assembly.Especially, detachable this apparatus, and can change or pull down any amount of specific component or the parts of apparatus according to any combination selection property ground.After cleaning and/or the replacing specific features, can before being right after surgical operation, on prosthetic appliance or by surgical team, apparatus be re-assemblied, for follow-up use.One skilled in the art will appreciate that multiple technologies capable of using are dismantled, cleaned/change and re-assembly when repairing apparatus.The reparation apparatus of the use of this technology and gained all within the scope of the invention.

Preferably, invention as herein described is handled before orthopaedic surgical operations is performed the operation.At first, obtain new or exhausted apparatus, and clean as required.Then apparatus is carried out disinfection.In a kind of disinfection technology, apparatus is placed container closed and sealing, for example in plastics or the TYVEK pocket.Then container and apparatus are placed the radiation field of penetrable this container, for example gamma-radiation, X ray or high energy electron.Radiation will kill on the apparatus with container in antibacterial.Can the apparatus after the sterilization be kept in the disinfecting container then.The sealing container remains on aseptic condition with apparatus, up in armarium, opening this container.

Although with the present invention as an example the property design be described, can also in spirit of the present disclosure and scope, make amendment to the present invention.Therefore the present invention is intended to contain any modification pattern, purposes or the adaptive version that adopts General Principle of the present invention.In addition, the present invention be intended to contain outside the present invention but under the present invention field known or be used to have the deviation pattern in the practical framework.

Claims

1. a circle is cut and the stitching surgical operating instrument, comprising:

Head, it comprises:

The circle cutter tool; With

Nail bin, it comprises a plurality of seam nails;

Anvil block, it is towards said head; With

Packing ring; It inserts in the said anvil block, makes said packing ring between said anvil block and said head, and wherein said packing ring comprises inside and outside; Said packing ring also is included in the contact pin between said inside and the said outside; Said contact pin is connected internally to said outside with said, and wherein said packing ring is built in the said anvil block, makes when said circular cutting and stitching surgical operating instrument are pulled the trigger; Said circle cutter tool cuts said contact pin, makes said inside from said external discrete.

2. circular cutting according to claim 1 and stitching surgical operating instrument; The said outside of wherein said packing ring comprises a plurality of seam nail targeting parts; Each seam nail targeting part limits at least one opening; Make when said circular cutting and when sewing up surgical operating instrument and being pulled the trigger, the end of the said seam nail of said nail bin is passed said opening by driving and leans said anvil block shaping.

3. circular cutting according to claim 2 and stitching surgical operating instrument; Wherein each seam nail targeting part is constructed to make in said circular cutting and when sewing up surgical operating instrument and being pulled the trigger, and the said end of said seam nail is leaning the said anvil block said seam nail of the back contact targeting part that is shaped.

4. circular cutting according to claim 3 and stitching surgical operating instrument, wherein said packing ring comprises abiotic absorbable material.

5. circular cutting according to claim 3 and stitching surgical operating instrument, wherein said packing ring comprises rehabilitation agent.

6. circular cutting according to claim 3 and stitching surgical operating instrument, but wherein said packing ring comprises the material of remote detection.

7. circular cutting according to claim 6 and sew up surgical operating instrument, but the material of wherein said remote detection comprises the material that can be detected by electromagnetic radiation.

8. circular cutting according to claim 7 and stitching surgical operating instrument, wherein said electromagnetic radiation comprises X ray.

9. circular cutting according to claim 6 and stitching surgical operating instrument, but the material of wherein said remote detection comprises fluorescent nano particles.

10. circular cutting according to claim 3 and stitching surgical operating instrument, wherein:

Said nail bin comprises that at least expert seam nail and layman stitch nail; With

The said outside of said packing ring comprises:

Expert seam nail targeting part, it aligns with said expert seam nail; With

The layman stitches the nail targeting part, and it stitches nail with said layman and aligns.

11. circular cutting according to claim 10 and stitching surgical operating instrument; The said outside of wherein said packing ring also comprises a plurality of springs, makes each spring in said expert seam nail targeting part stitch between one that follows closely in the targeting part with said layman.

12. circular cutting according to claim 1 and stitching surgical operating instrument, the said outside of wherein said packing ring is circular.

13. circular cutting according to claim 1 and stitching surgical operating instrument, the said outside of wherein said packing ring is oval.

14. circular cutting according to claim 1 and stitching surgical operating instrument also comprise:

Shaft assembly, it is connected to said head;

The shank assembly, it is connected to said shaft assembly; With

Trigger, it is connected to said shank assembly to be used to make said circular cutting and the percussion of stitching surgical operating instrument.

15. circular cutting according to claim 10 and stitching surgical operating instrument also comprise:

Shaft assembly, it is connected to said head;

The shank assembly, it is connected to said shaft assembly; With

16. circular cutting according to claim 10 and stitching surgical operating instrument, wherein said anvil block comprise seam nail profiled surface, it makes that towards said head said seam screw top leans on the said seam nail profiled surface of said anvil block to be shaped when being pulled the trigger.

17. circular cutting according to claim 10 and stitching surgical operating instrument, the said outside of wherein said packing ring comprise seam nail shaping pit.

18. circular cutting according to claim 10 and stitching surgical operating instrument, wherein said packing ring is processed by the plastics of injection-molded.

19. circular cutting according to claim 1 and stitching surgical operating instrument, wherein said packing ring is processed by the plastics of injection-molded.

20. circular cutting according to claim 1 and stitching surgical operating instrument, wherein said packing ring is processed by the plastics of nonabsorbable injection-molded.