Curved tip surgical stapler buttress assembly applicator having an opening feature for curved tip alignment

Abstract

The present invention relates to a buttress applicator cartridge assembly, which includes a buttress assembly and a buttress applicator cartridge for use with an end effector of a surgical stapler. The buttress assemblies each include a buttress for supporting a staple formed therein and an adhesive for adhering to the end effector. The buttress applicator cartridge includes a housing, a platform extending longitudinally and supporting the buttress assembly, and an opening configured to accommodate a curved end of the end effector when the end effector is clamped on the platform to transfer the buttress assembly to the end effector.

Description

Background Art

[0001] In some environments, endoscopic surgical instruments are preferred over traditional open surgical devices because smaller incisions can reduce postoperative recovery time and complications. Therefore, some endoscopic surgical instruments may be suitable for placing the distal end effector at the desired surgical site through the cannula of a trocar. These distal end effectors (e.g., internal cutters, graspers, cutters, staplers, clip appliers, access devices, drug / gene therapy delivery devices, and energy delivery devices using ultrasound, RF, lasers, etc.) can engage tissue in a variety of ways to achieve diagnostic or therapeutic effects. Endoscopic surgical instruments may include a shaft between the end effector and the handle portion manipulated by the clinician. Such a shaft can be inserted to a desired depth and rotated around the longitudinal axis of the shaft to facilitate positioning the end effector in the patient's body. The end effector may also be further facilitated by including one or more articulation joints or features so that the end effector can selectively articulate or otherwise deflect relative to the longitudinal axis of the shaft.

[0002] Examples of endoscopic surgical instruments include surgical staplers. Some such staplers are operable to clamp tissue layers, cut through the clamped tissue layers, and drive staples through the tissue layers to substantially seal the severed tissue layers together near the severed ends of the tissue layers. Surgical staplers, for exemplary purposes only, are disclosed in the following U.S. patents: U.S. Patent 4,805,823, entitled "Pocket Configuration for Internal Organ Staplers," issued February 21, 1989; U.S. Patent 5,415,334, entitled "Surgical Stapler and Staple Cartridge," issued May 16, 1995; U.S. Patent 5,465,895, entitled "Surgical Stapler Instrument," issued November 14, 1995; U.S. Patent 5,597,107, entitled "Surgical Stapler Instrument," issued January 28, 1997; U.S. Patent 5,632,432, entitled "Surgical Instrument," issued May 27, 1997; and U.S. Patent 5,632,432, entitled "Surgical Stapler Instrument," issued October 7, 1997. U.S. Patent No. 5,673,840, entitled “Surgical Stapling Instrument”; U.S. Patent No. 5,704,534, entitled “Articulation Assembly for Surgical Instruments”, issued on January 6, 1998; U.S. Patent No. 5,814,055, entitled “Surgical Clamping Mechanism”, issued on September 29, 1998; U.S. Patent No. 6,978,921, entitled “Surgical Stapling Instrument Incorporating an E-Beam Firing Mechanism”, issued on December 27, 2005; U.S. Patent No. 7,000,818, entitled “Surgical Stapling Instrument Having Separate Distinct Closing and Firing Systems”, issued on February 21, 2006; U.S. Patent No. 7,143,923, entitled “Surgical Stapling Instrument Having a Firing Lockout for an Unclosed Anvil”, issued on December 5, 2006;U.S. Patent No. 7,303,108, entitled “Surgical Stapling Instrument Incorporating a Multi-Stroke Firing Mechanism with a Flexible Rack,” published on December 4, 2007; U.S. Patent No. 7,367,485, entitled “Surgical Stapling Instrument Incorporating a Multistroke Firing Mechanism Having a Rotary Transmission,” published on May 6, 2008; U.S. Patent No. 7,380,695, entitled “Surgical Stapling Instrument Having a Single Lockout Mechanism for Prevention of Firing,” published on June 3, 2008; U.S. Patent No. 7,380,696, entitled “Articulating Surgical Stapling Instrument Incorporating a Two-Piece E-Beam Firing Mechanism,” published on June 3, 2008; U.S. Patent No. 7,380,697, entitled “Surgical Stapling and Cutting Instrument Incorporating a Single Lockout Mechanism for Prevention of Firing,” published on July 29, 2008. Device”; U.S. Patent 7,404,508, entitled “Surgical Stapling Instrument Having Multistroke Firing with Opening Lockout”, published on October 14, 2008; U.S. Patent 7,721,930, entitled “Disposable Cartridgewith Adhesive for Use with a Stapling Device”, published on May 25, 2010; U.S. Patent 8,408,439, entitled “Surgical Stapling Instrument with An Articulatable End Effector”, published on April 2, 2013;and U.S. Patent No. 8,453,914, entitled “Motor-Driven Surgical Cutting Instrument with Electric Actuator Directional Control Assembly,” issued on June 4, 2013. The disclosures of each of the above-referenced U.S. patents and U.S. patent publications are incorporated herein by reference.

[0003] Although the surgical stapler involved above is described as being used in endoscopic surgery, it should be understood that such surgical staplers can also be used in laparotomy and / or other non-endoscopic surgeries. By way of example only, in thoracic surgery, a surgical stapler can be inserted through a thoracotomy and thus positioned between the patient's ribs to reach one or more organs, and the thoracic surgery does not use a trocar as a conduit for the stapler. Such surgery may include using a stapler to cut off and close the blood vessels leading to the lungs. For example, before an organ is removed from the chest cavity, the blood vessels leading to the organ can be cut off and closed by a stapler. Of course, the surgical stapler can be used in various other situations and operations.

[0004] Examples of surgical staplers that may be particularly suitable for use through a thoracotomy are disclosed in the following U.S. patents: U.S. Patent 9,186,142, entitled “Surgical Instrument End Effector Articulation Drive with Pinion and Opposing Racks,” issued on November 17, 2015; U.S. Patent 9,717,497, entitled “Lockout Feature for Movable Cutting Member of Surgical Instrument,” issued on August 1, 2017; U.S. Patent 9,517,065, entitled “Integrated Tissue Positioning and Jaw Alignment Features for Surgical Stapler,” issued on December 13, 2016; U.S. Patent 9,839,421, entitled “Jaw Closure Feature for End Effector of Surgical Instrument,” issued on December 12, 2017; and U.S. Patent 9,839,421, entitled “Surgical Instrument with Articulation Lock having a Detenting Binary and U.S. Patent No. 9,867,615, entitled “Spring”; U.S. Patent No. 9,622,746, entitled “Distal Tip Features for End Effector of Surgical Instrument”, published on April 18, 2017; U.S. Patent No. 10,092,292, entitled “Staple Forming Features for Surgical Stapling Instrument”, published on October 9, 2018; U.S. Patent No. 9,795,379, entitled “Surgical Instrument with Multi-Diameter Shaft”, published on October 24, 2017; and U.S. Patent No. 9,808,248, entitled “Installation Features for Surgical Instrument End Effector Cartridge”, published on November 7, 2017. The disclosure of each of the above-referenced U.S. patent publications is incorporated herein by reference.

[0005] Additional surgical stapling instruments are disclosed in the following U.S. patents: U.S. Patent 8,801,735, entitled “Surgical Circular Stapler with Tissue Retention Arrangements,” published on August 12, 2014; U.S. Patent 8,141,762, entitled “Surgical Stapler Comprising a Staple Pocket,” published on March 27, 2012; U.S. Patent 8,371,491, entitled “Surgical End Effector Having Buttress Retention Features,” published on February 12, 2013; U.S. Patent 9,597,082, entitled “Method and Apparatus for Sealing End-to-End Anastomosis,” published on March 21, 2017; and U.S. Patent 9,597,082, entitled “Rotary Powered Surgical Instruments with Multiple Degrees of U.S. Patent Publication No. 2013 / 0206813, entitled “Linear Stapler,” published on August 15, 2013; U.S. Patent Publication No. 2008 / 0169328, entitled “Buttress Material for Use with a Surgical Stapler,” published on July 17, 2008; U.S. Patent No. 9,848,871, entitled “Woven and Fibrous Materials for Reinforcing a Staple Line,” published on December 26, 2017; U.S. Patent No. 9,936,954, entitled “Devices and Methods for Sealing Staples in Tissue,” published on April 10, 2018; and U.S. Patent Publication No. 2016 / 0089146, entitled “Radially Expandable Staple Line,” published on March 31, 2016. The disclosures of each of the above-cited US patents, US patent publications, and US patent applications are incorporated herein by reference.

[0006] In some cases, it may be desirable to equip surgical stapling instruments with a buttress material to enhance the mechanical fastening of the tissue provided by the staples. Such a buttress can prevent the applied staples from pulling through the tissue and can otherwise reduce the risk of tissue tearing at or near the site where the staples are applied.

[0007] While various surgical stapling instruments and associated components have been made and used, it is believed that no one prior to the inventors has made or used the invention described in the appended claims. BRIEF DESCRIPTION OF THE DRAWINGS

[0008] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the invention and, together with the general description of the invention given above and the detailed description of the embodiments given below, serve to explain the principles of the invention.

[0009] Figure 1 shows a perspective view of an exemplary articulating surgical stapling instrument;

[0010] Figure 2 Shown Figure 1 A side view of the device;

[0011] Figure 3 Shown Figure 1 A perspective view of an open end effector in an instrument;

[0012] Figure 4A Shown Figure 3 The end effector along Figure 3 a side cross-sectional view taken along line 4-4 of FIG. 1 , wherein the firing beam is in a proximal position;

[0013] Figure 4B Shown Figure 3 The end effector along Figure 3 a side cross-sectional view taken along line 4-4 of FIG. 1 , wherein the firing beam is in a distal position;

[0014] Figure 5 Shown Figure 3 The end effector along Figure 3 an end cross-sectional view taken along line 5-5;

[0015] Figure 6 Shown Figure 3 An exploded perspective view of an end effector;

[0016] Figure 7 Shown Figure 3 A perspective view of an end effector positioned at tissue and having been actuated once in the tissue;

[0017] Figure 8shows a perspective view of an alternative version of an end effector having an angled anvil and an angled cartridge;

[0018] Figure 9 Shown Figure 8 An enlarged side view of the end effector;

[0019] Figure 10 Shown Figure 8 An enlarged top view of the end effector;

[0020] Figure 11 shows a perspective view of an exemplary surgical stapling instrument having an end effector with a curved or angled elastically deformable end segment;

[0021] Figure 12A Shown Figure 11 an enlarged side view of a distal portion of an end effector;

[0022] Figure 12B Shows something like Figure 11 an enlarged side view of a distal portion of an alternative end effector of the end effector;

[0023] Figure 13 shows a perspective view of an alternative version of an end effector having an angled anvil and an angled cartridge;

[0024] Figure 14 shows a perspective view of an alternative version of an end effector having an angled anvil and an angled cartridge;

[0025] Figure 15 A perspective view of an exemplary end effector of a surgical stapler and an exemplary buttress assembly applicator is shown, with the end effector proximate the buttress assembly applicator;

[0026] Figure 16 Shown Figure 15 a perspective view of an end effector and a buttress assembly applicator of FIG. 1 , wherein the buttress assembly applicator is positioned in the end effector;

[0027] Figure 17A Shown Figure 15 A cross-sectional end view of a portion of an end effector, wherein Figure 15 applying the buttress assembly to the end effector, wherein the tissue is positioned between the buttresses in the end effector, and wherein the anvil is in an open position;

[0028] Figure 17B Shown Figure 17A a cross-sectional end view of a combined end effector and buttress assembly of wherein tissue is positioned between buttresses in the end effector and wherein the anvil is in a closed position;

[0029] Figure 17C Shows that it has passed Figure 15 The end effector is fixed to the tissue by a staple and Figure 17A a cross-sectional view of a support assembly;

[0030] Figure 18 Shows that it has passed Figure 15 The end effector is fixed to the tissue by a staple and Figure 17A A perspective view of a support assembly;

[0031] Figure 19 shows a perspective view of an exemplary buttress assembly applicator including an example of a buttress assembly applicator implementing an example of a buttress assembly for an upper jaw and another example of a buttress assembly for a lower jaw;

[0032] Figure 20 Shown Figure 19 An exploded perspective view of a support assembly applicator of FIG. 1 , the support assembly applicator including a base and a platform in addition to a pair of support assemblies;

[0033] Figure 21 Shown Figure 20 A front perspective view of the base;

[0034] Figure 22 Shown Figure 20 A front perspective view of the platform;

[0035] Figure 23 Shown Figure 20 Rear perspective view of the platform;

[0036] Figure 24 Shown Figure 20 A front and side view of the platform;

[0037] Figure 25 Shown Figure 20 a top perspective view of a left actuator slide of a support assembly applicator;

[0038] Figure 26 Shown Figure 25 a bottom perspective view of the left actuator slide;

[0039] Figure 27 Shown Figure 20 a top perspective view of a right actuator slide of a support assembly applicator;

[0040] Figure 28 Shown Figure 27 a bottom perspective view of the right actuator slide;

[0041] Figure 29 Shown with Figure 25 and Figure 27 The paired left and right actuator slides Figure 21 and Figure 22 perspective view of the base and platform;

[0042] Figure 30 Shown along Figure 29 The section line 30-30 is taken Figure 29 a cross-sectional view of the base, platform and actuator slide of the embodiment of the present invention;

[0043] Figure 31 Shown in restricted position Figure 29 A top view of the base, platform, and actuator slide of FIG.

[0044] Figure 32 Shown with Figure 31 a similar top view of the base, platform, and actuator slide, but showing the actuator slide from the restrained position toward the released position;

[0045] Figure 33 Shown with Figure 32 a similar top view of the base, platform, and actuator slide, but showing the actuator slide in a released position;

[0046] Figure 34 A top view of an exemplary end effector of a surgical instrument is shown, showing the end effector positioned between the upper and lower jaws of the end effector in a closed position. Figure 19 a support assembly application device;

[0047] Figure 35 Shown Figure 34 A bottom view of an end effector of FIG. 1 showing the end effector positioned between the upper and lower jaws of the end effector in a closed position Figure 19 a support assembly application device;

[0048] Figure 36 A top view of an exemplary end effector of a surgical instrument is shown, showing the end effector positioned between the upper and lower jaws of the end effector in a closed position. Figure 19 a support assembly application device;

[0049] Figure 37 Shown Figure 36 Side elevational view of an end effector of FIG, showing the end effector in cross-section and positioned between the upper and lower jaws of the end effector in a closed position Figure 19 a support assembly application device;

[0050] Figure 38 Shown along Figure 19 The line 38-38 is intercepted Figure 19 a cross-sectional view of a support assembly applicator;

[0051] Figure 39 Shows that Figure 19 a perspective view of an exemplary alignment feature for use with a buttress assembly applicator;

[0052] Figure 40 Shown with Figure 20 The base is connected Figure 39 A perspective view of an alignment feature;

[0053] Figure 41 Shown with Figure 19 a perspective view of another exemplary alignment feature coupled to a base of a buttress assembly applicator and shown with an end effector, wherein the buttress assembly applicator is positioned between upper and lower jaws of the end effector in a closed position;

[0054] Figure 42 Shown Figure 41 A cross-sectional view of the alignment features and base of the support assembly applicator shown positioned in a closed position Figure 41 a buttress assembly applicator between the upper jaw and the lower jaw of the end effector;

[0055] Figure 43 shows a top view of another exemplary buttress assembly applicator for use with an end effector of a surgical instrument;

[0056] Figure 44 A side elevation view of an exemplary end effector having a curved tip is shown in cross-section and positioned between the upper and lower jaws of the end effector in an open position. Figure 43 a support assembly application device;

[0057] Figure 45 Shown Figure 44 Side elevational view of an end effector of FIG, showing the end effector in cross-section and positioned between the upper and lower jaws of the end effector in a closed position Figure 43 a support assembly application device;

[0058] Figure 46 illustrates a side elevational view of an exemplary end effector having a deformable curved tip showing an exemplary buttress assembly applicator in cross-section and positioned between upper and lower jaws of the end effector in an open position;

[0059] Figure 47 Shown Figure 46Side elevational view of an end effector of FIG, showing the end effector in cross-section and positioned between the upper and lower jaws of the end effector in a closed position Figure 46 a support assembly applicator; and

[0060] Figure 48 Shown Figure 47 Top view of the end effector and support assembly of the applicator.

[0061] The accompanying drawings are not intended to be limiting in any way, and it is contemplated that various embodiments of the invention may be carried out in a variety of other ways, including those not necessarily shown in the drawings. The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate several aspects of the invention and, together with the description, serve to explain the principles of the invention; it should be understood, however, that the invention is not limited to the precise arrangements shown. DETAILED DESCRIPTION

[0062] The following description of certain examples of the present invention should not be used to limit the scope of the present invention. Based on the following description shown by way of example, other examples, features, aspects, embodiments and advantages of the present invention will be apparent to those skilled in the art, and a best mode is contemplated for implementing the present invention. As will be appreciated, the present invention can have other different and obvious aspects, all of which do not depart from the present invention. Therefore, the drawings and description should be considered to be illustrative and non-restrictive in nature.

[0063] It should also be understood that any one or more of the teachings, expressions, embodiments, examples, etc. described herein may be combined with any one or more of the other teachings, expressions, embodiments, examples, etc. described herein. Therefore, the following teachings, expressions, embodiments, examples, etc. should not be considered in isolation from each other. Based on the teachings herein, various suitable ways in which the teachings herein can be combined will be apparent to those of ordinary skill in the art. Such modifications and variations are intended to be included within the scope of the claims.

[0064] For clarity of the disclosure, the terms "proximal" and "distal" are defined herein relative to a human or robotic operator of a surgical instrument. The term "proximal" refers to a position of an element that is closer to a human or robotic operator of a surgical instrument and further away from a surgical end effector of the surgical instrument. The term "distal" refers to a position of an element that is closer to a surgical end effector of a surgical instrument and further away from a human or robotic operator of the surgical instrument. In addition, the terms "upper," "lower," "lateral," "transverse," "bottom," and "top" are relative terms to provide additional clarity to the description of the figures provided below. Therefore, the terms "upper," "lower," "lateral," "transverse," "bottom," and "top" are not intended to unnecessarily limit the invention described herein.

[0065] Additionally, the terms "first" and "second" are used herein to distinguish one or more parts of a surgical instrument. For example, a first component and a second component could alternatively be described as a second component and a first component, respectively. The terms "first" and "second," as well as other numerical designations, are merely examples of such terms and are not intended to unnecessarily limit the invention described herein.

[0066] I. Exemplary Surgical Staplers

[0067] Figures 1 to 7 An exemplary surgical stapling and severing instrument (10) is depicted, Figure 1 In the non-articulated state depicted in FIG, it is sized to be inserted through a cannula of a trocar into a surgical site of a patient in order to perform a surgical procedure. By way of example only, such a trocar may be inserted into the patient's abdomen between two ribs or elsewhere. In some cases, the instrument (10) is used without the presence of a trocar. For example, the instrument (10) may be inserted directly through a thoracotomy or other type of incision. The instrument (10) of this example includes a handle portion (20) connected to a shaft (22). The shaft (22) terminates distally in an articulation joint (11), which is further coupled to an end effector (12). It should be understood that terms such as "proximal" and "distal" used herein refer to the handle portion (20) of the instrument (10) as grasped by the clinician. Thus, the end effector (12) is located distally relative to the more proximal handle portion (20). It should also be understood that for convenience and clarity, spatial terms such as "vertical", "horizontal", "upper" and "lower" are used herein with respect to the accompanying drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and absolute.

[0068] In some versions, shaft (22) is constructed in accordance with at least some of the teachings of U.S. Patent No. 9,795,379, entitled “Surgical Instrument with Multi-Diameter Shaft,” issued on October 24, 2017, the disclosure of which is incorporated herein by reference. Other suitable configurations for shaft (22) will be apparent to those of ordinary skill in the art in view of the teachings herein.

[0069] Once the articulation joint (11) and end effector (12) are inserted through the cannula channel of the trocar, the articulation joint (11) can be remotely articulated via the articulation control (13), such as Figure 1 , depicted in phantom, so that the end effector (12) can be deflected from the longitudinal axis (LA) of the shaft (22) at a desired angle (α). As a result, the end effector (12) can reach the back of an organ or approach tissue from a desired angle or for other reasons. In some versions, the articulation joint (11) is capable of deflecting the end effector (12) along a single plane. In some other versions, the articulation joint (11) is capable of deflecting the end effector along more than one plane. The articulation joint (11) and the articulation control (13) can be constructed according to the teachings of any of the multiple references cited herein. Alternatively, the articulation joint (11) and / or the articulation control (13) can have any other suitable configuration. By way of example only, the articulation control (13) can be alternatively constructed as a knob that rotates about an axis perpendicular to the longitudinal axis (LA) of the shaft (22).

[0070] In some versions, the articulation joint (11) and / or articulation control (13) are constructed and operated in accordance with at least some of the teachings of the following U.S. patent application: U.S. Patent No. 9,186,142, filed on November 17, 2015, entitled "Surgical Instrument End Effector Articulation Drive with Pinion and Opposing Racks," the disclosure of which is incorporated herein by reference. The articulation joint (11) may also be constructed and operated in accordance with at least some of the teachings of the following U.S. patent application: U.S. Patent No. 9,795,379, published on October 24, 2017, entitled "Surgical Instrument with Multi-Diameter Shaft," the disclosure of which is incorporated herein by reference. Various other suitable forms that the articulation joint (11) and articulation control (13) may take will be apparent to those of ordinary skill in the art in view of the teachings herein.

[0071] The end effector (12) of this example includes a lower jaw (16) and a pivotable anvil (18). In this example, the anvil (18) can also be considered as an upper jaw. In addition, in some versions, such as in this example, the upper jaw or anvil (18) pivots relative to the fixed lower jaw (16); however, in some other versions, the upper jaw or anvil (18) is fixed and the lower jaw (16) pivots. In some versions, the lower jaw (16) is constructed according to at least some of the teachings of the following U.S. patent: U.S. Patent No. 9,808,248, entitled "Installation Features for Surgical Instrument End Effector Cartridge," published on November 7, 2017, the disclosure of which is incorporated herein by reference. The anvil (18) may be constructed in accordance with at least some of the teachings of U.S. Patent No. 9,517,065, entitled "Integrated Tissue Positioning and Jaw Alignment Features for Surgical Stapler," published on December 13, 2016, the disclosure of which is incorporated herein by reference; U.S. Patent No. 9,839,421, entitled "Jaw Closure Feature for End Effector of Surgical Instrument," published on December 12, 2017, the disclosure of which is incorporated herein by reference; and / or U.S. Patent No. 10,092,292, entitled "Staple Forming Features for Surgical Stapling Instrument," published on October 9, 2018, the disclosure of which is incorporated herein by reference. Various other suitable forms that the lower jaw (16) and anvil (18) may take will be apparent to those of ordinary skill in the art in light of the teachings herein.

[0072] The handle portion (20) includes a pistol grip (24) and a closure trigger (26). The closure trigger (26) is capable of pivoting toward the pistol grip (24) so ​​that the anvil (18) is clamped or closed toward the lower jaw (16) of the end effector (12). Such closure of the anvil (18) is provided by a closure tube (32) and a closure ring (33), both of which translate longitudinally relative to the handle portion (20) in response to pivoting of the closure trigger (26) relative to the pistol grip (24). The closure tube (32) extends along the length of the shaft (22); and the closure ring (33) is positioned distally of the articulation joint (11). The articulation joint (11) is operable to transmit / transmit longitudinal motion from the closure tube (32) to the closure ring (33).

[0073] The handle portion (20) also includes a firing trigger (28). An elongated member (not shown) extends longitudinally through the shaft (22) and, in response to actuation of the firing trigger (28), transmits a longitudinal firing motion from the handle portion (20) to the firing beam (14). This distal translation of the firing beam (14) causes the tissue clamped in the end effector (12) to be sutured and severed, as will be described in more detail below. The triggers (26, 28) are then released to release the tissue from the end effector (12).

[0074] Figures 3 to 6 The end effector (12) is shown as employing a firing beam (14) in the form of an electron beam to perform various functions. It should be understood that the electron beam form is merely an illustrative example. The firing beam (14) may take any other suitable form, including but not limited to non-electron beam forms. As best seen in Figures 4A to 4B The firing beam (14) includes a transversely oriented upper pin (38), a firing beam cap (44), a transversely oriented middle pin (46), and a distally located cutting edge (48). The upper pin (38) is positioned within the longitudinal anvil slot (42) of the anvil (18) and is capable of translating within the longitudinal anvil slot. The firing beam cap (44) is positioned by extending the firing beam (14) through the lower jaw slot (45) ( Figure 4B The lower jaw slot (45) is formed through the lower jaw (16) and slidably engages the lower surface of the lower jaw (16). The middle pin (46) slidably engages the top surface of the lower jaw (16) to cooperate with the firing beam cover (44). Therefore, the firing beam (14) is necessarily spaced apart from the end effector (12) during firing.

[0075] Some non-electron beam versions of the firing beam (14) may lack the upper pin (38), the middle pin (46), and / or the firing beam cap (44). Some such versions of the instrument (10) may rely solely on the closed ring (33) or some other feature structure to pivot the anvil (18) to the closed position and maintain the anvil (18) in the closed position when the firing beam (14) is advanced to the distal position. By way of example only, the firing beam (14) and / or associated lockout feature may be constructed and operated in accordance with at least some of the teachings of the following U.S. Patent No. 9,717,497, entitled “Lockout Feature for Movable Cutting Member of Surgical Instrument,” published on August 1, 2017, the disclosure of which is incorporated herein by reference. Other suitable forms that the firing beam (14) may take will be apparent to one of ordinary skill in the art in light of the teachings herein.

[0076] Figure 3 The present example is shown with the firing beam (14) positioned proximally and the anvil (18) pivoted to the open position, thereby allowing an unspent staple cartridge (37) to be removably installed into the channel of the lower jaw (16). As best seen in Figures 5 and 6 The staple cartridge (37) of this example includes a cartridge body (70) that presents an upper platform (72) and is coupled to a lower cartridge tray (74). Figure 3 As best shown in FIG, a vertical slot (49) is formed through a portion of the staple cartridge (37). Figure 3 As best shown in FIG, three rows of nail holes (51) are formed through the upper platform (72) on one side of the vertical slot (49), and another set of three rows of nail holes (51) are formed through the upper platform (72) on the other side of the vertical slot (49). Of course, any other suitable number of nail rows may be provided (e.g., two rows, four rows, or other number). See again Figures 4A to 6 , a wedge-shaped slide (41) and a plurality of nail drivers (43) are captured between the magazine body (70) and the tray (74), wherein the wedge-shaped slide (41) is located proximal to the nail driver (43). The wedge-shaped slide (41) is capable of moving longitudinally within the nail magazine (37); and the nail driver (43) is capable of moving vertically within the nail magazine (37). The nails (47) are also positioned within the magazine body (70), above the corresponding nail drivers (43). Specifically, each nail (47) is driven vertically by the nail driver (43) within the magazine body (70) to drive the nail (47) out through the associated nail hole (51). As Figures 4A to 4B and Figure 6As best shown in FIG, wedge sled (41) presents an inclined cam surface that urges the staple drivers (43) upwardly as the wedge sled (41) is driven distally through the staple cartridge (37).

[0077] In some versions, the staple cartridge (37) is constructed and operates in accordance with at least some of the teachings of U.S. Patent No. 9,517,065, entitled "Integrated Tissue Positioning and Jaw Alignment Features for Surgical Stapler," published on December 13, 2016, the disclosure of which is incorporated herein by reference. Additionally or alternatively, the staple cartridge (37) may be constructed and operate in accordance with at least some of the teachings of U.S. Patent No. 9,808,248, entitled "Installation Features for Surgical Instrument End Effector Cartridge," published on November 7, 2017, the disclosure of which is incorporated herein by reference. Other suitable forms that the staple cartridge (37) may take will be apparent to one of ordinary skill in the art in view of the teachings herein.

[0078] By advancing the closure tube (32) and the closure ring (33) distally to allow the end effector (12) to Figures 4A to 4B In the closed position shown, the firing beam (14) is advanced into engagement with the anvil (18) by passing the upper pin (38) into the longitudinal anvil slot (42). Figure 5 ) is located at the distal end of the firing beam (14) and is configured to engage the wedge slide (41) so that when the firing trigger (28) is actuated, the push block (80) pushes the wedge slide (41) distally as the firing beam (14) advances distally through the staple cartridge (37). During such firing, the cutting edge (48) of the firing beam (14) enters the vertical slot (49) of the staple cartridge (37), thereby severing the tissue clamped between the staple cartridge (37) and the anvil (18). Figures 4A to 4B As shown, the intermediate pin (46) and the push block (80) together actuate the nail magazine (37) by entering the narrow slot (49) in the nail magazine (37) to drive the wedge slide (41) into upward contact with the nail driver (43), thereby driving the nail (47) outward through the nail hole (51) and causing the nail to engage with the nail forming recess (53) on the inner surface of the anvil (18) ( Figure 3 ) to form contact. Figure 4BThe firing beam (14) is shown fully translated distally after severing and stapling the tissue. Figures 4A to 4B The nail forming recess (53) is intentionally omitted in the view in FIG; however, the nail forming recess (53) is as shown in FIG. Figure 3 It should also be understood that Figure 5 The anvil (18) is intentionally omitted from the view.

[0079] Figure 7 The end effector (12) is shown having been actuated through tissue (90) in a single stroke. As shown, the cutting edge (48) ( Figure 7 1 and 2. The staples (47) are arranged in a manner that is not shown in the figure and that is not shown in the figure. The staples (47) are arranged in a manner that is not shown in the figure and that is not shown in the figure. The staples (47) are arranged in a manner that is not shown in the figure and that is not shown in the figure. The staples (47) are arranged in a manner that is not shown in the figure and that is not shown in the figure. The staples (47) are arranged in a manner that is not shown in the figure and that is not shown in the figure. The staples (47) are arranged in a manner that is not shown in the figure and that is not shown in the figure. The staples (47) are arranged in a manner that is not shown in the figure and that is not shown in the figure. The staples (47) are arranged in a manner that is not shown in the figure and that is not shown in the figure. The staples (47) are arranged in a manner that is not shown in the figure and that is not shown in the figure. The staples (47) are arranged in a manner that is not shown in the figure and that is not shown in the figure.

[0080] It will be appreciated that during each actuation stroke, the cutting edge (48) can sever tissue substantially simultaneously with the driving of the staples (47) therethrough. In this example, the cutting edge (48) lags only slightly behind the driving of the staples (47) such that the staples (47) are driven through the same region of tissue just before the cutting edge (48) is driven therethrough, but it will be appreciated that this order can be reversed or that the cutting edge (48) can be synchronized directly with the adjacent staples. While Figure 7 The end effector (12) is shown being actuated in two layers (92, 94) of tissue (90), but it should be understood that the end effector (12) can be actuated through a single layer of tissue (90) or more than two layers (92, 94) of tissue. It should also be understood that the formation and positioning of the staples (47) adjacent to the cut line created by the cutting edge (48) can substantially seal the tissue at the cut line, thereby reducing or preventing bleeding and / or leakage of other body fluids at the cut line. In addition, although Figure 7 The end effector (12) is shown actuating in two substantially flat opposing planar layers (92, 94) of tissue, but it should be understood that the end effector (12) may also be actuated on tubular structures such as blood vessels, portions of the gastrointestinal tract, etc. Therefore, it should not be considered that Figure 7No limitations are to be construed as to the contemplated uses of end effector (12). Various suitable situations and procedures in which instrument (10) may be used will be apparent to those of ordinary skill in the art in view of the teachings herein.

[0081] In one form, the instrument (10) provides motorized control of the firing beam (14). Exemplary components that can be used to provide motorized control of the firing beam (14) are shown and described in the following U.S. publication: U.S. Patent No. 9,622,746, entitled "Distal Tip Features for End Effector of Surgical Instrument," published on April 18, 2017, the disclosure of which is incorporated herein by reference. In addition to or in lieu of the foregoing, at least part of the motorized control can be constructed according to at least some of the teachings of U.S. Patent No. 8,210,411, entitled "Motor-Driven Surgical Instrument," published on July 3, 2012, the disclosure of which is incorporated herein by reference. In addition to or in lieu of the foregoing, the features operable to drive the firing beam (14) may be constructed in accordance with at least some of the teachings of U.S. Patent No. 8,453,914, the disclosure of which is incorporated herein by reference; and / or constructed in accordance with at least some of the teachings of U.S. Patent No. 8,453,914, the disclosure of which is incorporated herein by reference. Other suitable components, features, and configurations for providing motorization of the firing beam (14) will be apparent to one of ordinary skill in the art in light of the teachings herein. It will also be understood that some other versions may provide for manual actuation of the firing beam (14), such that a motor may be omitted. By way of example only, the firing beam (14) may be actuated in accordance with at least some of the teachings of any other patent / publication reference cited herein.

[0082] The instrument (10) may also include a lockout switch and a lockout indicator, as shown and described in U.S. Patent No. 9,622,746, entitled “Distal Tip Features for End Effector of Surgical Instrument,” issued on April 18, 2017, the disclosure of which is incorporated herein by reference. Additionally, the lockout switch and / or lockout indicator and associated components / functionality may be constructed in accordance with at least some of the teachings of U.S. Patent No. 7,644,848, entitled “Electronic Lockouts and Surgical Instrument Including Same,” issued on January 12, 2010, the disclosure of which is incorporated herein by reference.

[0083] The instrument (10) further includes a manual return switch (116) configured to act as a "panic" feature, enabling an operator to quickly retract the firing beam (14) proximally during the firing stroke. In other words, the manual return switch (116) can be manually actuated when the firing beam (14) is only partially advanced distally. The manual return switch (116) can provide additional functionality in accordance with at least some of the teachings of U.S. Patent No. 9,622,746, entitled "Distal Tip Features for End Effector of Surgical Instrument," published on April 18, 2017, the disclosure of which is incorporated herein by reference.

[0084] When describing the operation of the instrument (10), the use of the term "pivot" (and similar terms to the underlying "pivot") should not be interpreted as necessarily requiring pivotal movement about a fixed axis. In some versions, the anvil (18) pivots about an axis defined by a pin (or similar feature) that slides along an elongated slot or channel as the anvil (18) moves toward the lower jaw (16). In this type of version, the pivot axis translates along a path defined by the slot and channel while the anvil (18) simultaneously pivots about the axis. In addition or as an alternative, the pivot axis may first slide along the slot / channel and then the anvil (18) pivots about the pivot axis after the pivot axis has slid a certain distance along the slot / channel. It should be understood that such sliding / translational pivoting movement is encompassed by terms such as "pivot," "pivoting," "pivotable," etc. Of course, some versions may provide for pivotal movement of the anvil (18) about an axis that remains fixed and does not translate within the slot or channel, etc.

[0085] It will be appreciated that the apparatus (10) may be constructed and operated in accordance with the teachings of the following U.S. Patents: U.S. Patent 4,805,823; U.S. Patent 5,415,334; U.S. Patent 5,465,895; U.S. Patent 5,597,107; U.S. Patent 5,632,432; U.S. Patent 5,673,840; U.S. Patent 5,704,534; U.S. Patent 5,814,055; U.S. Patent 6,978,921; U.S. Patent 7,000,818; U.S. Patent 7,143,923; U.S. Patent 7,303,108; U.S. Patent 7,367,485; U.S. Patent 7,380,695; U.S. Patent 7,380,696; U.S. Patent 7,404,508; U.S. Patent 7,434,715; U.S. Patent 7,721,930; U.S. Patent 8,408,439; and / or U.S. Patent 8,453,914. As mentioned above, the disclosure of each of these patents is incorporated herein by reference. Other exemplary modifications that may be provided for the apparatus (10) will be described in more detail below. Various suitable ways in which the following teachings may be incorporated into the apparatus (10) will be apparent to one of ordinary skill in the art. Similarly, various suitable ways in which the following teachings may be combined with the various teachings of the patents / publications cited herein will be apparent to one of ordinary skill in the art. It should also be understood that the following teachings are not limited to the apparatus (10) or devices taught in the patents cited herein. The following teachings may be readily applied to various other types of apparatus, including apparatus that will not be classified as surgical staplers. Various other suitable devices and situations in which the following teachings may be applied will be apparent to one of ordinary skill in the art based on the teachings herein.

[0086] II. Exemplary End Effectors with Visualization, Introduction, and Collection Features

[0087] In some cases, it may be desirable to provide the user with a clearer view of the end effector 12. Specifically, after inserting the end effector (12) into the surgical site, the user may rotate the shaft (22) of the instrument (10) during surgery. The end effector (12) thereby also rotates. As the end effector (12) rotates, the user may wish to see the surgical site. For example, the user may want to see the contact surface or point of contact between the tissue (90) and the end effector (12). Because the end effector (12) can be rotated about the longitudinal axis (LA) relative to the handle portion (20), the user may see the lower jaw (16) of the end effector instead of the anvil (18) when observing the surgical site. Alternatively, the end effector (12) can be rotated to a position such that the user can see the anvil (18) when observing the end effector (12). The user may desire to be able to see more than what is seen when using a surgical tool. Figure 1The range of the surgical site that can be seen when the instrument (10) is used is large. For example, in the case where a user uses the device to perform some surgical procedures involving cutting and then suturing a vessel through which body fluids flow, it may be desirable to visually determine that the anvil (18) and the lower jaw (16) have completely covered the vessel to be cut, thereby ensuring that the vessel can be completely cut and sutured with a single actuation of the device. In other words, the user may want to avoid a situation where only a portion of the vessel is cut and sutured. Therefore, it may be desirable to take some visual monitoring and / or feedback measures to let the user know that the end effector (12) is properly positioned in the surgical site, and then the user can manipulate the end effector to allow the anvil (18) and the lower jaw (16) to fully clamp the vessel. A feasible way to monitor the surgical site may include improving the visibility of the area adjacent to the distal end of the lower jaw (16) and the anvil (18). Furthermore, not only may visualization of the distal end of the end effector (12) be desired, but it may also be desired to construct the end effector (12) such that the distal end of the anvil (18) is configured to push tissue (e.g., a large blood vessel) proximally into the space between the anvil (18) and the lower jaw (16) when the anvil (18) is closed toward the lower jaw (16).

[0088] Figure 8 An exemplary end effector (212) is shown including an anvil (218) and a lower jaw (216). It should be understood that the end effector (212) can be used in place of the end effector (12) of the instrument (10). The end effector (212) can be integrally formed with the instrument (10) or, alternatively, can be interchangeable with the end effector (12) of the instrument (10).

[0089] The anvil (218) is operable to pivot relative to the lower jaw (216). The anvil (218) and the lower jaw (216) may be similar to those of Figure 1 The anvil (18) and lower jaw (16) are shown to perform the clamping to clamp tissue (90). The end effector (212) also includes a cartridge (237) that is connected to the end effector (212). Figure 3 The illustrated cartridge (37) is similarly operable to be placed within the lower jaw (216).

[0090] If you can Figures 8 to 10The anvil (218) seen in FIG has an elongated shape, wherein the distal portion of the anvil (218) is angled toward the cartridge (237). The distal portion of the anvil (218) is angled toward the cartridge (237) such that the distal-most end (219) of the anvil (218) extends longitudinally further distally than the cartridge (237). However, in some versions, the distal end (219) may extend longitudinally to be flush with the cartridge (237) or to a position proximal to the distal-most point of the cartridge (237). Furthermore, the anvil (218) is angled toward the cartridge (237) at a gentle slope. Figure 10 As best shown in FIG, the anvil (218) includes sides (241) that taper as they approach the distal-most end (219) of the anvil (218). For example, the anvil (218) Figure 8 The anvil (218) is shaped like an inverted ski top. An anvil (218) with an angled shape can make it easier for the end effector (212) to be inserted into the surgical site. For example, an anvil (218) with a gentle slope or an inverted ski top shape can provide an atraumatic tissue deflection surface when contacting tissue or moving through tissue. This atraumatic tissue deflection can include pushing tissue, for example, a large blood vessel, into the space between the anvil (218) and the lower jaw (216) when the anvil (218) is closed toward the lower jaw (216). Once placed at the surgical site, the angled shape of the anvil (218) can also provide better maneuverability of the end effector (212) and better visibility of the distal end of the end effector (212) relative to the anatomical structure at the surgical site. Those of ordinary skill in the art can easily conceive of other suitable forms of anvil (218) based on the teachings of this article.

[0091] The bin (237) is operable to hold Figure 4A A staple similar to the staple (47) shown in FIG. 1 is used to drive into tissue. Figure 9 As shown, the distal end of the cartridge (237) has a triangular profile. Specifically, the distal end of the cartridge (237) includes an upper tapered surface (239) and a lower tapered surface (238). Additionally, the distal end of the cartridge (237) includes a tapered side surface (243) on each side. In this example, each tapered side surface (243) of the cartridge (237) is generally aligned with the taper presented by the side (241) of the anvil (218). Thus, as Figure 10As shown, the side surface (243) of the cartridge (237) does not extend outward from the longitudinal axis (LA) of the end effector (212) beyond the side (241) of the anvil (218). The upper tapered surface (239) and the lower tapered surface (238) converge at the distal end of the cartridge (237). The lower tapered surface (238) defines a sight line (240) so that once the user inserts the end effector (212) into the surgical site, the sight line (240) can be observed along the sight line (240). The sight line (240) extends along the edge of the lower tapered surface (238). It should be understood that the lower tapered surface (238) is manipulated to have a planar shape to allow the user to see and / or roughly see the distal end (219) of the anvil (218). Specifically, the sight line (240) intersects the longitudinal axis (LA) extending longitudinally through the end effector (212) to form an angle of view (θ).

[0092] The viewing angle (θ) can determine the user's relative visibility of the distal tip (219). Specifically, the user may be in front of the distal tip (219) along any line of sight that passes through the intersection of the sight line (240) and the longitudinal axis (LA) within the viewing angle (θ). For example, as the viewing angle (θ) increases, the user may have greater visibility of the area directly in front of the distal tip (219) from a proximal vantage point; however, as the viewing angle (θ) decreases, the user may have less visibility of the area in front of the distal tip (219) from a proximal vantage point. In some embodiments, the viewing angle (θ) defines an angle greater than 90 degrees. Furthermore, in some embodiments, the viewing angle (θ) defines an angle greater than 135 degrees. Other suitable angles for the viewing angle (θ) can be readily envisioned by one of ordinary skill in the art based on the teachings herein. In the illustrated version, the user typically views along the sight line (240) or along some other line of sight within the viewing angle (θ), so that the user can view not only the area along the sight line but also any area within the viewing angle (θ). The underside of the distal tip (219) may also be slightly rounded to help the user see the intersection of the longitudinal axis (LA) and the sight line (240).

[0093] When the tissue (90) is clamped between the closed chamber (237) and the anvil (218), the user can observe along the sight line (240) or at other positions within the viewing angle (θ), for example, clearly see where the anvil (218) is clamping the tissue (90). In addition, the user will be able to determine whether the tissue is completely clamped between the anvil (218) and the chamber (237). Only by determining that the tissue is completely clamped can the tissue be ensured not to overflow the end of the end effector (212). It is also possible to visually present to the user the extent to which the anvil (218) and the chamber (237) clamp the tissue (90). It should be understood that in some cases, the end effector (212) can be rotated before, during, or after clamping the tissue (90). Therefore, the tapered shape of the anvil (218) also makes it easier for the user to observe the distal end (219), or the area generally adjacent to the distal end (219). The tapered anvil (218) together with the lower tapered surface (238) of the cartridge (237) further facilitates easy insertion of the end effector (212) into tissue in an atraumatic manner. In addition, because the end effector (212) has a tapered end, the user can more easily push the end effector (212) through the trocar or other device operable to guide the end effector (212) into the surgical site. For example, once the user loads the distal end (219) into the trocar, the lower tapered surface (238) and the tapered anvil (218) can be used as an introduction end to guide the rest of the end effector (212) into the trocar. Based on the teachings herein, one of ordinary skill in the art will further understand that the tapered design of the two sides (241) of the anvil (218) and each side (243) of the cartridge (237) can enhance visibility and maneuverability.

[0094] In addition to the foregoing, the end effector (212) and the type of instrument (10) incorporating the end effector (212) may be constructed and operated in accordance with at least some of the teachings of: U.S. Patent No. 9,186,142, entitled “Surgical Instrument End Effector Articulation Drive with Pinion and Opposing Racks,” issued on November 17, 2015, the disclosure of which is incorporated herein by reference; U.S. Patent No. 9,717,497, entitled “Lockout Feature for Movable Cutting Member of Surgical Instrument,” issued on August 1, 2017, the disclosure of which is incorporated herein by reference; U.S. Patent No. 9,517,065, entitled “Integrated Tissue Positioning and Jaw Alignment Features for Surgical Stapler,” issued on December 13, 2016, the disclosure of which is incorporated herein by reference; and U.S. Patent No. 9,517,065, entitled “Jaw Alignment Features for Surgical Stapler,” issued on December 12, 2017. and / or U.S. Patent No. 9,839,421, entitled “Closure Feature for End Effector of Surgical Instrument,” issued on April 18, 2017, the disclosure of which is incorporated herein by reference; U.S. Patent No. 9,622,746, entitled “Distal Tip Features for End Effector of Surgical Instrument,” issued on April 18, 2017, the disclosure of which is incorporated herein by reference; U.S. Patent No. 10,092,292, entitled “Staple Forming Features for Surgical Stapling Instrument,” issued on October 9, 2018, the disclosure of which is incorporated herein by reference; U.S. Patent No. 9,795,379, entitled “Surgical Instrument with Multi-Diameter Shaft,” issued on October 24, 2017, the disclosure of which is incorporated herein by reference; and / or U.S. Patent No. 9,839,421, entitled “Closure Feature for End Effector of Surgical Instrument,” issued on April 18, 2017, the disclosure of which is incorporated herein by reference; Cartridge", the disclosure of which is incorporated herein by reference.Additional modifications that may be incorporated into end effector (212) are described in greater detail below.

[0095] III. Exemplary End Effectors Having Curved or Angled Elastically Deformable Anvil Tips

[0096] In some procedures, it may be necessary to cut along or through tissue where more than one cutting sequence is required to complete the procedure - in other words, sequential cutting along a continuous path. In such procedures, this sequential cutting technique may be defined as "marching". For procedures involving marching, the instrument (10) may be placed at the surgical site, the instrument activated to cut and suturing, then removed from the surgical site for installation of a new cartridge (37), and then placed back at the surgical site again to perform the next cut and suturing along the same path where the previous cutting and suturing cycle occurred. This process is repeated until the cutting and suturing procedure is complete. Figures 4A to 4B and Figure 7 As can be seen in the figure, the distal end configuration of the end effector (12) provides a gap between the distal end of the anvil (18) and the distal end of the cartridge (37). This gap can facilitate advancement by providing an atraumatic space for tissue to enter the distal end of the end effector (12) at the beginning of each advancement step.

[0097] As described above, the distal end configuration of the end effector (212) is different from the distal end configuration of the end effector (12); wherein the different configurations of the end effector (212) provide different potential advantages. Specifically, the distal end configuration of the end effector (212) can improve maneuverability and improve visibility of the relationship between the distal end of the end effector (212) and adjacent anatomical structures. In addition, the distal end configuration of the end effector (212) can provide a tissue collection effect by pushing tissue proximally into the space between the anvil (218) and the lower jaw (216) when the anvil (218) is closed toward the lower jaw (216). However, in a configuration where all structures of the end effector (212) are rigid, the curved configuration of the distal tip (219) of the anvil (218) may not be suitable for advancing operations because the distal tip (219) may traumatize tissue that is not collected in the space between the anvil (218) and the lower jaw (216) when the anvil (218) is closed toward the lower jaw (216). Therefore, in a configuration where all structures of the end effector (212) are rigid, the end effector (212) may be best suited for cutting and stapling operations (e.g., vessel transection) where all tissue to be cut and stapled is collected proximal to the distal tip (219).

[0098] In view of the foregoing, it may be desirable to provide a variation of an end effector (12, 212) that provides the travel capability of the end effector (12), improved visibility associated with the end effector (212), and tissue acquisition capability of the end effector (212) without increasing the risk of trauma that may otherwise be associated with a completely rigid version of the end effector (212). Several merely illustrative examples of such variations of the end effector (12, 212) are described below. In the following examples, the anvil has a distal tip that is resiliently biased to assume a curved or angled configuration similar to the distal tip (219); however, the resiliently biased distal tip can be deflected away from the lower jaw in response to a sufficient load on the distal tip. Based on the teachings herein, it should be understood that providing an anvil with an elastically deformable angled distal tip portion can provide an additional level of maneuverability benefit in navigating through tissue to a surgical site. In this way, the deformable distal tip portion can be deflected or deformed to facilitate smooth and atraumatic movement of the end effector through tissue, particularly during advancement operations. Additionally, with the anvil having a bias to an angled position when not in a loaded state or in contact with surrounding tissue, enhanced visualization during tissue capture and cutting can be achieved compared to using an end effector with a straight or non-angled anvil. Furthermore, an anvil with a distal tip that is biased to an angled position can provide a degree of tissue collection effect until a load point associated with advancement is reached, rather than being associated with simply collecting relatively small tissue structures between the anvil and the lower jaw.

[0099] Figure 11Another exemplary instrument (310) configured as a surgical stapler is shown. The instrument (310) includes a handle portion (320) and a shaft (322). The instrument (310) has a modular configuration such that the shaft (322) can be selectively removed from the handle portion (320) and can be attached to the handle portion. The instrument (310) is constructed similarly to the instrument (10) such that the operability and use of the instrument (310) are the same as those described above for the instrument (10), wherein the additional feature of the instrument (310) is the modular configuration. Through its modular configuration, the instrument (310) provides a method for replacing the end effector. Such changes can be made in the end effector to replace an otherwise worn end effector, or to provide different end effector configurations based on the procedure or user preference. In addition to or in lieu of the foregoing, features operable to provide a modular configuration for the apparatus (310) may be constructed in accordance with at least some of the teachings of U.S. Patent Publication No. 2017 / 0086823, entitled "Surgical Stapling Instrument with Shaft Release, Powered Firing, and Powered Articulation," issued on March 30, 2017, the disclosure of which is incorporated herein by reference. Other suitable components, features, and configurations for providing an apparatus (310) having a modular configuration will be apparent to one of ordinary skill in the art from the teachings herein. Furthermore, one of ordinary skill in the art will appreciate from the teachings herein that the apparatus (10) may be modified to incorporate a modular configuration, as shown and described with respect to the apparatus (310) or other apparatus incorporated herein by reference.

[0100] exist Figure 11 In the example shown in FIG. 3 , the instrument ( 310 ) includes an end effector ( 312 ) having an anvil ( 318 ) having an angled distal end ( 319 ). Furthermore, the distal end ( 319 ) of the anvil ( 318 ) is elastically deformable. In this manner, and as Figure 12A and Figure 12BAs best shown in FIG, the angled distal tip (319) is operable to elastically deform from a first angled position to a second position. The second position of the angled distal tip (319) can be substantially straight in some versions, but can be angled to a certain degree (e.g., slightly above or slightly below the longitudinal axis (A1)) in other versions. It should be understood that the second position of the angled distal tip (319) can be defined by the characteristics (e.g., thickness, density, etc.) of the tissue captured between the anvil (318) and the lower jaw (16). In this example, the end effector (312) is disposed on a shaft (322) that is detachable from the handle portion (320). By way of example only, shaft (322) may be detachable from handle portion (320) in accordance with at least some of the teachings of U.S. Patent 9,913,642, entitled “Surgical Instrument Comprising a Sensor System,” which issued on March 13, 2018, the disclosure of which is incorporated herein by reference. In some other versions, shaft (322) may not be detachable from handle portion (320).

[0101] It should be understood that the end effector (312) may be used instead of Figure 1 . In some versions, the end effector (312) may be integrally formed with the shaft (22), or alternatively, the end effector may be formed separately and then assembled. In some versions, the end effector (312) may be provided for use with a robotic system. In such a robotic system, a modular shaft (322) having the end effector (312) can be attached to a portion of the robotic system for use so that the handle portion (320) is replaced by a component of the robotic system. In still other examples, the end effector (312) may be adapted for use with a robotic system in a manner wherein the end effector (312) is connected to the robotic system without having to connect the entire modular shaft (322). Other ways of incorporating an end effector having an angled, elastically deformable anvil tip into a user-operated or robotically operated instrument will be apparent to one of ordinary skill in the art in light of the teachings herein.

[0102] Figure 12AAn enlarged side view of the distal end of the end effector (312) is shown. The end effector (312) includes an anvil (318) and a lower jaw (16) that receives the cartridge (37) as described above with respect to the instrument (10). As described above with respect to the instrument (10), the anvil (318) is pivotally rotatable toward the lower jaw (16) in the same manner as the anvil (18). In this configuration, the end effector (312) is similar to the end effector (12), however, the anvil (318) includes an angled distal tip (319) that is elastically deformable. As Figure 12A As shown, the tip (319) is biased to an angled position that is Figure 11 Shown in and Figure 12A When the end effector (312) is not clamping tissue and is open, the tip (319) adopts this angled position, as shown in FIG. Figure 11 as shown; or closed without clamping the tissue, as shown Figure 12A . When end effector (312) is in this angled state or position, end effector (312) may be considered unloaded or in an unloaded state or position. Conversely, when end effector (312) is clamping tissue, end effector (312) may be considered loaded or in a loaded state or position.

[0103] When closed and not clamping tissue between the anvil (318) and the lower jaw (16), the tip (319) contacts the cartridge (37). In this position, the underside surface (324) of the tip (319) defines a plane that intersects the longitudinal axis (A1) defined by the shaft (322) to form an angle (θ1). When closed and clamping tissue (90) between the anvil (318) and the lower jaw (16), the underside surface (324) of the tip (319) contacts the tissue (90). In this position, the underside surface (324) of the tip (319) defines a plane that intersects the longitudinal axis (A1) to form an angle (θ2). Figure 12AIn the illustrated example, the angles (θ1, θ2) are relative to the longitudinal axis (A1), and the sum of the angles (θ1, θ2) represents the range of movement experienced by the distal tip (319). By way of example only and not limitation, in some examples, in a downward direction from the longitudinal axis (A1) toward the cartridge (37), the angle (θ1) is between about 20 and about 70 degrees, or more specifically, between about 30 and about 50 degrees. By way of example only and not limitation, in some examples, in an upward direction away from the longitudinal axis (A1) toward the cartridge (37), the angle (θ2) is between about 0 and about 90 degrees. By way of example only and not limitation, in some examples, the range of movement experienced by the tip (319) is between about 20 and about 110 degrees. The angles described for angles (θ1, θ2) are exemplary only and not limiting. Other suitable angles will be apparent to one of ordinary skill in the art based on the teachings herein.

[0104] Additionally, in some cases, the longitudinal axis (A1) represents a zero degree reference and angles relative to it can be positive or negative. For example, where the angle is in a downward direction from the longitudinal axis (A1) toward the bin (37), the angle can be characterized as a negative angle. Similarly, where the angle is in an upward direction away from the longitudinal axis (A1) away from the bin (37), the angle can be characterized as a positive angle. When using these provisions, the range of movement of the distal tip (319) due to deformation can be understood as the sum of the absolute value of the angle when the distal tip (319) is in a position contacting the bin (37) and the angle when the distal tip (319) is in a deformed state (when clamping tissue).

[0105] Figure 12B Shown with Figure 12A Another side view of an alternative end effector (412) similar to the end effector (312) of FIG. With respect to the end effector (312), when the anvil (318) is in its angled and undeformed state (as in FIG. Figure 12A When the anvil (318) is deformed so that it deflects upward, the end of the distal tip (319) extends to the distal side of the distal end of the cartridge (37). Figure 12B As shown, when the anvil (318) is in its angled and undeformed state (as in Figure 12B, the anvil (318) extends to a point flush with or close to the distal end of the cartridge (37). When the anvil (318) is deformed so that it deflects upward, the end of the distal tip (319) of the anvil (318) extends to a point flush with or close to the distal end of the cartridge (37). In this way, when the anvil (318) is in its angled state or deformed state, the anvil (318) of the end effector (412) is flush with or close to the distal end of the cartridge (37), so that no matter whether the anvil (318) is in an angled and undeformed state or in a deformed state, the anvil (318) will not extend beyond the distal end of the cartridge (37). In some cases, this can be achieved by modifying the anvil (318) so that the length of the distal tip (319) of the anvil is shortened. In other cases, the instrument (10, 310) may be modified to provide a slight proximal retraction of the anvil (318) when clamping. Other ways to modify the end effector (412) as it relates to controlling the position of the anvil (318) will be apparent to those of ordinary skill in the art in view of the teachings herein.

[0106] IV. Another Exemplary End Effector for a Surgical Stapler

[0107] Figure 13 Another exemplary end effector (512) configured to be used with a surgical stapling instrument as described herein is shown. The end effector (512) includes an anvil (518) and a lower jaw (516). It should be understood that the end effector (512) can be used in place of the end effector (12) of the instrument (10). The end effector (512) can be integrally formed with the instrument (10), or alternatively, can be interchangeable with the end effector (12) of the instrument (10).

[0108] The anvil (518) is operable to pivot relative to the lower jaw (516). The anvil (518) and the lower jaw (516) may be similar to those of Figure 1 The anvil (18) and lower jaw (16) are shown to perform the clamping to clamp tissue (90). The end effector (512) also includes a cartridge (537) that is connected to the end effector (512). Figure 3 The illustrated cartridge (37) is similarly operable to be placed within the lower jaw (516).

[0109] The anvil (518) has an elongated shape, wherein the distal side of the anvil (518) is angled toward the cartridge (537) so that the anvil (518) includes a curved end. The distal portion of the anvil (518) is angled toward the cartridge (537) so that the distal-most end (519) of the anvil (518) extends further distally than the cartridge (537) in the longitudinal direction. However, in some versions, the distal end (519) may extend longitudinally to be flush with the cartridge (537) or to a position proximal to the distal-most point relative to the cartridge (537). In addition, the distal portion of the anvil (518) includes a side (541) that tapers when approaching the distal-most end (519) of the anvil (518). This shape of the anvil (518) can make it easier to insert the end effector (512) into the surgical site. For example, when the anvil (518) contacts the tissue or moves through the tissue, the shape of the anvil (518) can provide an atraumatic tissue deflection surface. This atraumatic tissue deflection can include pushing tissue (e.g., a large blood vessel) into the space between the anvil (518) and the lower jaw (516) toward the proximal side when the anvil (518) is closed toward the lower jaw (516). Once placed at the surgical site, the shape of the anvil (518) can also provide better maneuverability of the end effector (512) and better visibility of the distal end of the end effector (512) relative to the anatomical structure at the surgical site. Those of ordinary skill in the art can readily envision other suitable forms of anvil (518) based on the teachings herein.

[0110] The bin (537) is operable to hold Figure 4A The staples (47) shown in FIG are similar to the staples (47) shown in FIG. 5 for driving into tissue. The distal end of the cartridge (537) has an inclined profile. Specifically, the distal end of the cartridge (537) includes an upper tapered surface (539) that converges at the distal-most end of the cartridge (537).

[0111] When tissue (90) is clamped between the closed chamber (537) and the anvil (518), the user can see at what position the anvil (518) is clamping the tissue (90). In addition, the user can determine whether the tissue is completely clamped between the anvil (518) and the chamber (537). Only by determining that the tissue is completely clamped can the tissue be ensured not to overflow the end of the end effector (512). It is also possible to visually present to the user the extent to which the anvil (518) and the chamber (537) clamp the tissue (90). It should be understood that in some cases, the end effector (512) can be rotated before, during, or after clamping the tissue (90). Therefore, the shape of the anvil (518) can also make it easier for the user to observe the distal end (519). The shape of the anvil (518) and the chamber (537) can further facilitate the easy insertion of the end effector (512) into the tissue in a non-traumatic manner. In addition, because the end effector (512) has a tapered end, the user can more easily push the end effector (512) through the trocar or other device operable to guide the end effector (512) into the surgical site. For example, once the distal end (519) is loaded into the trocar, the shape of the anvil (518) can be used as an introduction end to guide the rest of the end effector (512) into the trocar. Based on the teachings herein, one of ordinary skill in the art will further understand that the tapered design of the two sides (541) of the distal portion of the anvil (518) can enhance visibility and maneuverability.

[0112] Still see Figure 13By way of example only and not limitation, in one example of the end effector (512), the curved tip of the anvil (518) may be configured as a dissecting tip for separating tissue. In some such embodiments, the curved tip of the anvil (518) may be used to achieve such tissue dissection. In such cases, the curved tip of the anvil (518) is a rigid structure without sharp cutting blades or surfaces, and the dissection is performed by separating and / or dissecting the tissue it contacts with sufficient force by the rigid curved tip. In some embodiments in which the curved tip of the anvil (518) is configured as a dissecting tip, the tip of the dissecting tip terminates between a plane defined by the tissue contact surface and the bottom surface. Additionally, when the end effector is in a closed position, the tip of the dissecting tip is spaced apart from the distal end of the cartridge. In this manner, the curved tip is configured as a dissecting tip that can separate and / or dissect tissue without the need for the anvil tip to engage or interlock with the distal end of the cartridge. Also in this manner, the curved tip is configured as a dissecting tip having a certain shape so that a user can slide the tip behind certain tissue to separate and / or dissect the tissue it contacts when sufficient force is applied. Of course, the curved tip of anvil (518) need not be configured as a dissecting tip in all versions of anvil (518), and thus, in other versions, the curved tip of anvil (518) may be an atraumatic tip or placement tip as described above that is not configured to sever tissue.

[0113] Figure 14 Another exemplary end effector (612) configured to be used with a surgical stapling instrument as described herein is shown. The end effector (612) includes an anvil (618) and a lower jaw (616). It should be understood that the end effector (612) can be used in place of the end effector (12) of the instrument (10). The end effector (612) can be integrally formed with the instrument (10), or alternatively, can be interchangeable with the end effector (12) of the instrument (10).

[0114] The anvil (618) is operable to pivot relative to the lower jaw (616). The anvil (618) and the lower jaw (616) may be similar to those of Figure 1 The anvil (18) and lower jaw (16) are shown to perform the clamping to clamp tissue (90). The end effector (612) also includes a cartridge (637) that is connected to the end effector (612). Figure 3 The illustrated cartridge (37) is similarly operable to be placed within the lower jaw (616).

[0115] The anvil (618) has an elongated shape, wherein the distal portion of the anvil (618) is angled toward the cartridge (637). The distal portion of the anvil (618) is angled toward the cartridge (637) so that the distal-most end (619) of the anvil (618) extends further distally than the cartridge (637) in the longitudinal direction. However, in some versions, the distal end (619) may extend longitudinally to be flush with the cartridge (637) or to a position proximal to the distal-most point of the cartridge (637). In addition, the distal portion of the anvil (618) includes sides (641) that bend inwardly when approaching the distal-most end (619) of the anvil (618). This shape of the anvil (618) can make it easier to insert the end effector (612) into the surgical site. For example, the shape of the anvil (618) can provide an atraumatic tissue deflection surface when the anvil (618) contacts or moves through tissue. This atraumatic tissue deflection can include pushing tissue (e.g., a large blood vessel) proximally into the space between the anvil (618) and the lower jaw (616) as the anvil (618) closes toward the lower jaw (616). The shape of the anvil (618) can also provide better maneuverability of the end effector (612) and better visibility of the distal end of the end effector (612) relative to the anatomical structures at the surgical site once placed at the surgical site. Other suitable forms of anvil (618) can be readily envisioned by one of ordinary skill in the art based on the teachings herein.

[0116] The bin (637) is operable to hold Figure 4A The staples (47) shown in FIG are similar to the staples (47) shown in FIG. 6 for driving into tissue. The distal end of the cartridge (637) has an inclined profile. Specifically, the distal end of the cartridge (637) includes an upper tapered surface (639) that converges at the distal-most end of the cartridge (637).

[0117] When tissue (90) is clamped between the closed chamber (637) and the anvil (618), the user can see at what position the anvil (618) is clamping the tissue (90). In addition, the user can determine whether the tissue is completely clamped between the anvil (618) and the chamber (637). Only by determining that the tissue is completely clamped can the tissue be ensured not to overflow the end of the end effector (612). It is also possible to visually present to the user the extent to which the anvil (618) and the chamber (637) clamp the tissue (90). It should be understood that in some cases, the end effector (612) can be rotated before, during, or after clamping the tissue (90). Therefore, the shape of the anvil (618) can also make it easier for the user to observe the distal end (619). The shape of the anvil (618) and the chamber (637) can further facilitate the easy insertion of the end effector (612) into the tissue in a non-traumatic manner. Furthermore, because the end effector (612) has a tapered end, the user can more easily push the end effector (612) through a trocar or other device operable to guide the end effector (612) into the surgical site. For example, once the distal end (619) is loaded into the trocar, the shape of the anvil (618) can be used as an introduction end to guide the remainder of the end effector (612) into the trocar. Based on the teachings herein, one of ordinary skill in the art will further appreciate that the curved design of the two sides (641) of the distal portion of the anvil (618) can enhance visibility and maneuverability.

[0118] In addition to the foregoing, the end effectors (512, 612) and the types of instruments (10) incorporating the end effectors (512, 612) may be constructed and operated in accordance with at least some of the teachings of: U.S. Patent No. 9,186,142, entitled “Surgical Instrument End Effector Articulation Drive with Pinion and Opposing Racks,” issued on November 17, 2015, the disclosure of which is incorporated herein by reference; U.S. Patent No. 9,717,497, entitled “Lockout Feature for Movable Cutting Member of Surgical Instrument,” issued on August 1, 2017, the disclosure of which is incorporated herein by reference; and U.S. Patent No. 9,717,497, entitled “Integrated Tissue Positioning and Jaw Alignment Features for Surgical and U.S. Patent No. 9,517,065, entitled “Jaw Closure Feature for End Effector of Surgical Instrument,” issued on December 12, 2017, the disclosure of which is incorporated herein by reference; U.S. Patent No. 9,839,421, entitled “Jaw Closure Feature for End Effector of Surgical Instrument,” issued on April 18, 2017, the disclosure of which is incorporated herein by reference; U.S. Patent No. 9,622,746, entitled “Distal Tip Features for End Effector of Surgical Instrument,” issued on October 9, 2018, the disclosure of which is incorporated herein by reference; U.S. Patent No. 10,092,292, entitled “Staple Forming Features for Surgical Stapling Instrument,” issued on October 24, 2017, the disclosure of which is incorporated herein by reference; Shaft”, the disclosure of which is incorporated herein by reference; and / or U.S. Patent 9,808,248, entitled “Installation Features for Surgical Instrument End Effector Cartridge,” published on November 7, 2017, the disclosure of which is incorporated herein by reference.Additional modifications that may be incorporated into end effector (212) are described in greater detail below.

[0119] V. Exemplary Support Loading and Application

[0120] Figure 15 and Figure 16 An exemplary end effector (40) configured to be able to apply a support to a tissue site where a cutting and stapling operation is performed is shown. The end effector (40) includes a distal end (141) and is connected to the shaft assembly (30). The end effector (40) includes an anvil (60), a lower jaw (50) and a staple cartridge (170) received by the lower jaw (50). It should be understood that the end effector (40) can be used in place of the end effector (12) of the instrument (10). The end effector (40) can be formed integrally with the instrument (10), or alternatively, can be interchangeable with the end effector (12) of the instrument (10).

[0121] Figure 15 and Figure 16 Also shown is an exemplary support applicator (200). Support applicator (200) is configured to selectively retain support assemblies (100, 110). In this example, support assembly (100) is selectively retained on the top side of applicator (200), and support assembly (110) is selectively retained on the bottom side of applicator (200). In some other versions, applicator (200) may be configured so that only one support assembly (100, 110) is selectively retained by support applicator (200).

[0122] To load the buttress assembly (100, 110) for the end effector (40) using the buttress applicator (200), the operator will first position the applicator (200) and the end effector (40) such that the end effector (40) is aligned with the open end (202) of the applicator (200), as shown. Figure 1 The operator will then advance the end effector (40) distally (and / or retract the applicator (200) proximally) to position the buttress assembly (100, 110) between the anvil (60) and the staple cartridge (170), as shown. Figure 2As shown. To load the buttress assembly (100, 110) on the end effector (40), the operator can simply close the end effector (40) by pivoting the anvil (60) toward the staple cartridge (170). Closing the end effector (40) causes the distal end of the anvil (60) and the staple cartridge (170) to abut against a retaining feature (204) of the buttress applicator (200), which is configured to selectively retain the buttress assembly (100, 110) using the buttress applicator (200). This contact deflects such retaining feature (204) of the buttress applicator (200), thereby allowing the surface of the anvil (60) to contact the buttress assembly (100) on one side of the buttress applicator (200) and allowing the surface of the staple cartridge (170) to contact the buttress assembly (110) on the other side of the buttress applicator (200). The buttress assemblies (100, 110) include adhesive on their respective surfaces so that when the end effector (40) is clamped between the two buttress assemblies (100, 110), the buttress assemblies (100, 110) adhere to the underside of the anvil (60) and the desk surface of the staple cartridge (170), respectively. The end effector (40) can then be reopened (i.e., the anvil (60) is pivoted away from the staple cartridge (170)) and pulled away from the buttress applicator (200). With the retaining feature (204) of the applicator (200) disengaged from the buttress assemblies (100, 110), the end effector (40) can freely pull the buttress assemblies (100, 110) away from the buttress applicator (200) as the end effector (40) is pulled away from the buttress applicator (200). With the buttress assemblies (100, 110) loaded onto the end effector (40), the end effector (40) may then be used as described below with reference to Figures 17A to 18 Further description.

[0123] 17A to 17C A sequence is shown in which an end effector (40) loaded with buttress assemblies (100, 110) is actuated to drive staples (190) through two juxtaposed layers of tissue (T1, T2), wherein the buttress assemblies (100, 110) are secured to the same layer of tissue (T1, T2) by staples (190). Specifically, Figure 3A shows a layer of tissue (T1, T2) positioned between anvil (60) and staple cartridge (170), wherein anvil (60) is in an open position. As shown, anvil (60) includes staple forming recesses (64). Support assembly (100) is adhered to the underside (65) of anvil (60) via an adhesive; and support assembly (110) is adhered to the platform (73) of staple cartridge (170) via an adhesive. Thus, the layer of tissue (T1, T2) is interposed between support assemblies (100, 110). Next, the end effector (40) is closed, which drives the anvil (60) to the position as shown in FIG. Figure 17B , and the staple cartridge (170) engages the opposing surfaces of the tissue (T1, T2) layers. The end effector (40) is then actuated, whereby the staple driver (75) drives the staples (190) through the staple assemblies (100, 110) and the tissue layers (T1, T2). Figure 17C As shown, the crown (92) of the driven staple (190) captures and holds the buttress assembly (110) against the layer of tissue (T2). The deformed leg (94) of the staple (190) captures and holds the buttress assembly (100) against the layer of tissue (T1).

[0124] It will be appreciated that a series of staples (190) will similarly capture and hold buttress assembly (100, 110) against layers of tissue (T1, T2), thereby securing buttress assembly (100, 110) to tissue (T1, T2), as shown. Figure 18 As shown. Because the end effector (40) is pulled away from the tissue (90) after the staples (190) and support assembly (100, 110) are deployed, the support assembly (100, 110) is disengaged from the end effector, so that the support assembly (100, 110) remains fixed to the tissue (T1, T2) with the staples (190). The support assembly (100, 110) thus provides structural reinforcement for the rows of staples (190). As shown Figure 18 As can also be seen, a knife member (not shown) passes through the end effector (40) and in doing so also cuts through the centerline of the support assembly (100, 110), thereby dividing each support assembly (100, 110) into corresponding pairs of segments so that each segment remains fixed to the corresponding severed area of ​​the tissue (T1, T2).

[0125] In the aforementioned examples, the buttress assembly (100) is sized to span the entire width of the underside (65) of the anvil (60) such that the knife member (not shown) cuts through the buttress assembly (100) during actuation of the end effector (40). In some other examples, the buttress assembly (100) is disposed in two separate, laterally spaced portions, one of which is disposed on the underside (65) of the anvil (60) on one half of the anvil (60) and the other portion is disposed on the underside (65) of the anvil (60) on the other half of the anvil (60). In this type of configuration, the knife member (not shown) does not cut through the buttress assembly (100) during actuation of the end effector (40).

[0126] Likewise, buttress assembly (110) may be sized to span the entire width of platform (73) such that a knife member (not shown) cuts through buttress assembly (110) during actuation of end effector (40). Alternatively, buttress assembly (110) may be provided in two separate, laterally spaced portions, with one portion provided on platform (73) on one half and the other portion provided on platform (73) on the other half. In this type of arrangement, knife member (not shown) does not cut through buttress assembly (110) during actuation of end effector (40).

[0127] In addition to the foregoing, it should be understood that any of the various support assemblies described herein may be further constructed and operated in accordance with at least some of the teachings of U.S. Patent Publication 2016 / 0278774, entitled “Method of Applying a Buttress to a Surgical Stapler,” published on September 29, 2016, the disclosure of which is incorporated herein by reference.

[0128] VI. Exemplary Support Applicator Cartridge Assemblies

[0129] In some cases, it may be desirable to use Figure 19An exemplary buttress applicator cartridge assembly (710) is shown to equip a surgical instrument with a buttress assembly (712) for forming staples in tissue using buttresses (714). In some cases, the buttress applicator cartridge assembly (710) may be referred to as a buttress assembly applicator (710). As used herein, these terms should be understood to be interchangeable. The buttresses (714) prevent the formed staples from being pulled through the tissue, thereby reducing the risk of tissue tearing at or near the site of the formed staples. In addition to providing structural support and integrity for a row of staples, or alternatively, the buttresses (714) may provide various other types of effects, such as spacing or gap filling, administration of therapeutic agents, and / or other effects. Prior to use with a surgical instrument, one or more buttress assemblies (712) are releasably retained on a buttress applicator cartridge (716), which is configured to deposit one or more buttress assemblies (712) onto the end effector of the surgical instrument, as discussed below.

[0130] Figure 19 A buttress applicator cartridge assembly (710) is shown that includes a pair of buttress assemblies (712) releasably retained on a buttress applicator cartridge (716) that supports and protects the buttress assemblies (712) prior to use and further facilitates loading the buttress assemblies (712) onto the surgical instrument (10) (see Figure 1 ). The support applicator bin (716) of this example includes an open end (718) and a closed end (720). The open end (718) is configured to receive an end actuator, such as any of those described herein, including but not limited to end actuators (12, 212, 312, 412, 512, 612). The support applicator bin (716) also includes a housing assembly (724) having an upper housing (726) and a lower housing (728), each of which generally defines a "U" shape to present the open end (718). Various components are interposed between the upper housing (726) and the lower housing (728). Specifically, these components include a base (736) of a support platform (730), which is also referred to as a compression layer (730).

[0131] The platform or compression layer (730) of this example supports the upper support assembly (712) on one side of the platform (730) and supports the lower support assembly (712) on the other side of the platform (730). The platform (730) is exposed in a groove formed between the prongs of the "U" configuration of the upper shell (726) and the lower shell (728). Thus, the upper shell (726) has an upper gap (737) extending along the upper surface of the platform (730) to the open end (718), and the lower shell (728) similarly has a lower gap (738) extending along the lower surface of the platform (730) to the open end (718). The position of the platform (730) and the support assembly (712) in such a groove prevents inadvertent contact between the support assembly (712) and other devices in the operating room. In other words, upper housing (726) and lower housing (728) may provide a degree of physical shielding for support assembly (712) when the support assembly is retained on platform (730).

[0132] Additional features may be combined with the following examples of buttress applicator cartridge assembly (710) where applicable. Such features are described in the following patents: U.S. patent application entitled “Adhesive Distribution on Buttress for Surgical Stapler” [Attorney Docket No. END8634USNP.0663974], filed on the same date as the present application; U.S. patent application entitled “Closure Assembly for Linear Surgical Stapler” [Attorney Docket No. END8635USNP.0663976], filed on the same date as the present application; U.S. patent application entitled “Surgical Stapler Buttress with Tissue In-Growth Promotion” [Attorney Docket No. END8636USNP.0663978], filed on the same date as the present application; U.S. patent application entitled “Packaging for Surgical Stapler Buttress” [Attorney Docket No. END8638USNP.0663983], filed on the same date as the present application; and U.S. patent application entitled “Curved Tip Surgical Stapler Buttress Assembly Applicator with Compression Layer Pocket”, filed on the same date as the present application. Feature” [Attorney Docket No. END9075USNP1.0714570]; U.S. Patent Application Titled “Curved Tip Surgical Stapler Buttress Assembly Applicator with Proximal Alignment Feature” [Attorney Docket No. END9073USNP1.0714572], filed on the same date as the present application; U.S. Patent Application Titled “Method of Applying Buttresses to Surgically Cut and Stapled Sites” [Attorney Docket No. END9071USNP1.0714576], filed on the same date as the present application; U.S. Patent Application Titled “Applicator for Surgical Stapler Buttress” [Attorney Docket No. END8639USDP.0663985], filed on the same date as the present application; U.S. Patent Application Titled “Buttress for Surgical Stapler” [Attorney Docket No. END8640USDP.0663994]; U.S. Patent Application entitled “Tray for Surgical Stapler Buttress Applicator” [Attorney Docket No. END8641USDP.0663996], filed on the same date as this application; U.S. Patent Application entitled “Applicator for a Surgical Stapler Buttress” [Attorney Docket No. END9080USDP1.0714568], filed on the same date as this application; and U.S. Patent Application entitled “Buttress Assembly for a Surgical Stapler” [Attorney Docket No. END9081USDP1.0714566], filed on the same date as this application, the disclosures of which are hereby incorporated by reference.

[0133] A. Exemplary Support Components

[0134] refer to Figure 19 , the upper and lower support assemblies (712) are structurally identical, except for their relative positions maintained on the support applicator cartridge (716). The support applicator cartridge assembly (710) can therefore be used with the surgical instrument (10) and its corresponding end effector that can be coupled thereto in more than one orientation. It should be understood that, except for the respective orientations, the following description of the upper support assembly (712) is similarly applicable to the lower support assembly (712).

[0135] The upper support assembly (712) includes a support (714) and an upper adhesive layer (742). More specifically, the support (714) of this example has a three-layer polymer construction comprising a core layer sandwiched between two outer layers to provide a strong yet flexible support for a row of staples. In this example, the core layer is polyglactin 910 material, which is manufactured by Ethicon, Inc., Somerville, New Jersey and sold as VICRYL, and each outer layer is a polydioxanone (PDO) film material. The support (714) of this example is formed by laminating the core layer between the outer layers at a predetermined pressure, a predetermined temperature, and a predetermined time. The support (714) is further mechanically cut to size to inhibit rough edges, such as burrs and / or delamination, that can damage sensitive tissue. It should be understood that alternative methods of cutting the support (714), such as laser cutting or hot knife cutting, may similarly be used.

[0136] By way of further example only, each buttress (714) can comprise one or more of: NEOVEIL absorbable PGA felt from Gunze Limited, Kyoto, Japan; SEAMGUARD polyglycolic acid:trimethylene carbonate (PGA:TMC) reinforcement material from WL Gore & Associates, Inc., Flagstaff, Arizona; PERI-STRIPS DRY with VERITAS collagen matrix (PSDV) reinforcement material from Baxter Healthcare Corporation, Deerfield, Illinois; BIODESIGN biograft from Cook Medical, Bloomington, Indiana; and / or SURGICEL NU-KNIT hemostatic material from Ethicon, Inc., Somerville, New Jersey. Still other suitable materials that can be used to form each buttress (714) will be apparent to those of ordinary skill in the art in view of the teachings herein.

[0137] In addition or alternatively, each support (714) may include the following materials, including, for example, hemostatic agents such as fibrin to help coagulate blood and reduce bleeding along the cut and / or suture surgical site of tissue. As another merely illustrative example, each support (714) may include other adjuvants or hemostatic agents such as thrombin that may be used so that each support (714) can help coagulate blood and reduce the amount of bleeding at the surgical site. Other adjuvants or agents that can be incorporated into each support (714) may also include, but are not limited to, medical fluids or matrix components. Only illustrative examples of materials that can be used to form each support (714) and materials that can be otherwise incorporated into each support (714) are disclosed in U.S. Publication No. 2016 / 0278774, entitled "Method of Applying a Buttress to a Surgical Stapler," published on September 29, 2016, the disclosure of which is incorporated herein by reference. Alternatively, any other suitable material may be used.

[0138] By way of further example only, each support (714) may be constructed in accordance with at least some of the teachings of the following U.S. patents: U.S. Patent No. 10,123,798, entitled “Tissue Thickness Compensator Comprising Controlled Release and Expansion,” published on November 13, 2018, the disclosure of which is incorporated herein by reference; U.S. Patent Publication No. 2013 / 0068816, entitled “Surgical Instrument and Buttress Material,” published on March 21, 2013, the disclosure of which is incorporated herein by reference; U.S. Patent No. 9,999,408, entitled “Surgical Instrument with Fluid Fillable Buttress,” published on June 19, 2018, the disclosure of which is incorporated herein by reference; U.S. Patent No. 9,999,408, entitled “Surgical Instrument with Fluid Fillable Buttress,” published on August 26, 2014, the disclosure of which is incorporated herein by reference; and U.S. Patent No. 8,814,025, entitled “Adhesive”, the disclosure of which is incorporated herein by reference; U.S. Patent No. 8,899,464, entitled “Attachment of Surgical Staple Buttress to Cartridge”, issued on December 2, 2014, the disclosure of which is incorporated herein by reference; U.S. Patent No. 9,492,170, entitled “Device for Applying Adjunct in Endoscopic Procedure”, issued on November 15, 2016, the disclosure of which is incorporated herein by reference; U.S. Patent No. 8,998,060, entitled “Resistive Heated Surgical Staple Cartridge with Phase Change Sealant”, issued on April 7, 2015, the disclosure of which is incorporated herein by reference; U.S. Patent No. 8,998,060, entitled “Surgical Staple Assembly with Hemostatic U.S. Patent No. 9,393,018, entitled “Surgical Staple Cartridge with Self-Dispensing Staple Buttress,” issued on August 11, 2015, the disclosure of which is incorporated herein by reference;U.S. Patent No. 9,198,644, entitled “Anvil Cartridge for Surgical Fastening Device,” published on December 1, 2015, the disclosure of which is incorporated herein by reference; U.S. Patent Publication No. 2013 / 0075447, entitled “Adjunct Therapy for Applying Hemostatic Agent,” published on March 28, 2013, the disclosure of which is incorporated herein by reference; U.S. Patent No. 9,211,120, entitled “Tissue Thickness Compensator Comprising a Plurality of Medicaments,” published on December 15, 2015, the disclosure of which is incorporated herein by reference; U.S. Patent Publication No. 2015 / 0351758, entitled “Adjunct Materials and Methods of Using Same in Surgical Methods for Tissue Sealing,” published on December 10, 2015, the disclosure of which is incorporated herein by reference; and U.S. Patent No. 2015 / 0351758, entitled “Implantable U.S. Patent Publication No. 2017 / 0049444, entitled “Layers for a Surgical Instrument,” the disclosure of which is incorporated herein by reference; U.S. Patent Publication No. 2017 / 0055986, entitled “Drug Eluting Adjuncts and Methods of Using Drug Eluting Adjuncts,” published on March 2, 2017, the disclosure of which is incorporated herein by reference; U.S. Patent Publication No. 2017 / 0086837, entitled “Compressible Adjunct with Crossing Spacer Fibers,” published on March 30, 2017, the disclosure of which is incorporated herein by reference; U.S. Patent Publication No. 2017 / 0086842, entitled “Method for Applying an Implantable Layer to a Fastener Cartridge,” published on March 30, 2017, the disclosure of which is incorporated herein by reference;

[0139] Furthermore, buttress (714) is configured to be cut by a knife (not shown) along a mid-portion of buttress (714) from a proximal portion of buttress (714) and further through a distal portion of buttress (714) such that an inward edge is adjacent to the cut tissue. Buttress (714) further includes a longitudinally extending pre-cut slit (744) configured to receive a knife (not shown) and facilitate dividing a lateral portion of buttress (714) into inward edges formed there along.

[0140] An upper adhesive layer (742) is disposed on the outer layer of the buttress (714) to adhere the buttress (714) within the end effector described herein. Adhesion of the buttress (714) can be performed by various mechanisms, including but not limited to pressure-sensitive adhesives. With respect to pressure-sensitive adhesion, adhesion occurs when at least a predetermined minimum force is applied. In some versions, each adhesive layer (742) comprises a pressure-sensitive adhesive material. Examples of various suitable materials that can be used to form the adhesive layer (742) are disclosed in U.S. Patent Publication No. 2016 / 0278774, entitled "Method of Applying a Buttress to a Surgical Stapler," published on September 29, 2016, the disclosure of which is incorporated herein by reference. Alternatively, any other suitable material may be used. As shown in this example, the adhesive layer (742) is applied to form a continuous outer seal, thereby extending the life of the buttress once applied to the end effector.

[0141] It should be understood that the term "adhesive" as used herein may include, but is not limited to, viscous materials and materials that are flexible or waxy and adhere to complex geometries via deformation and conformation. Some suitable adhesives can provide this flexibility to adhere to complex geometries via deformation and conformation without having to provide high initial tack. In some cases, adhesives with lower tack can be removed more cleanly from a surface. Based on the teachings herein, various suitable materials that can be used to form the adhesive layer (742) will be apparent to those of ordinary skill in the art.

[0142] V. Exemplary Support Applicator Cartridge

[0143] like Figure 20As shown, the support applicator cartridge (716) includes a base (736) of a support platform (730) and an upper housing (726) and a lower housing (728) of a housing assembly (724), the upper housing and the lower housing being configured to be connected together to define an interior space (750). An upper left actuator slide (752) and an upper right actuator slide (754) are movably connected to the upper base (736) within the interior space (750), while a lower left actuator slide (752) and a lower right actuator slide (754) are movably connected to the lower side of the base (736) within the interior space (750). The upper right and upper left actuator slides (752, 754) hold the upper support assembly (712) on the platform (730) in a restrained position, but are configured to be movable from the restrained position to a released position for depositing the upper support assembly (712) on an end effector (such as any of the end effectors described herein). Similarly, the lower right and lower left actuator slides (752, 754) hold the lower support assembly (712) on the platform (730) in a restrained position, but are configured to be movable from the restrained position to a released position for depositing the lower support assembly (712) on an end effector (such as any of the end effectors described herein). In this example, the left actuator slide (752) is different from the right actuator slide (754) for reasons that will be discussed in more detail below. Additionally, the upper right actuator slide (752) and the lower right actuator slide (752) are structurally identical to one another, and the upper left actuator slide (754) and the lower left actuator slide (754) are structurally identical to one another. Thus, the upper actuator slide (752) and the lower actuator slide (754) are interchangeable in this respect, and any discussion contained herein relating to a pair of upper actuator slides (752, 754) is similarly applicable to a pair of lower actuator slides (752, 754).

[0144] Each actuator slide (752, 754) includes a pair of arms (755a, 755b) that extend laterally inward to selectively and releasably secure the support assembly (712) to the platform (730). The arms (755a, 755b) may also be referred to as retaining features or retaining members, similar to the above description of the retaining members. Figure 15 and Figure 16 Specifically, Figure 20Arms (755a, 755b) are shown positioned so that support assembly (712) is interposed between the arms (755a, 755b) and the free ends of platform (730). Arms (755a, 755b) can be moved laterally outward to disengage the arms (755a, 755b) from support assembly (712), thereby enabling support assembly (712) to be removed from platform (730). In this example, arms (755a, 755b) are configured to abut support assembly (712) in a restrained position, thereby clamping support assembly (712) against platform (730). Other suitable ways in which arms (755a, 755b) can engage support assembly (712) will be apparent to those of ordinary skill in the art in view of the teachings herein.

[0145] The base (736) is configured to cooperate with the upper housing (726) and the lower housing (728) to provide mechanical grounding for the components of the mobile support applicator chamber (716) and provide structural support for the components of the support applicator chamber (716). The base (736) also includes an integral gripping feature (756) exposed on the opposite side of the housing assembly (724). The gripping feature (756) has a surface geometry configured to facilitate an operator's gripping of the support applicator chamber (716) during use of the support applicator chamber (716). Other suitable configurations for the gripping feature (756) will be apparent to those of ordinary skill in the art based on the teachings herein. Various surface treatments (e.g., elastomeric materials, etc.) that can be applied to the gripping feature (756) will be apparent to those of ordinary skill in the art based on the teachings herein.

[0146] refer to Figure 21The platform (730) is connected to and supported by the base (736) to secure the platform (730) relative to the upper housing (726) and the lower housing (728). In this example, the platform (730) is integrally formed and molded to a rigid mesh portion (758) that includes a frame (760) and defines a plurality of holes (762, 764, 766) configured to provide a material overlap for mold securement. The holes (762, 764, 766) more specifically include an upper slot (762) and a central slot (764) extending through the frame (760) and a plurality of through holes (766) laterally spaced about the slots (762, 764). The frame (760) also extends laterally across the central slot (764) at the bridging portion (768) to provide additional structural rigidity to the base (736) while providing sufficient clearance for the platform (730) to deform elastically, as discussed in more detail below. Thus, the slots (762, 764) and through-holes (766) receive a resilient elastomeric material to form and secure the material to the base (736) as the platform (730). While the present platform (730) is molded to the base (736), it should be understood that the platform (730) may alternatively be secured to the base (736), and thus, the attachment of the platform (730) to the base (736) is not intended to be limited to the specific rigid mesh portion (758) and molding as discussed herein. A variety of suitable materials and structural configurations that may be used to form the platform (730) will be apparent to one of ordinary skill in the art in view of the teachings herein.

[0147] The base (736) further includes a plurality of slider clearance holes (770) arranged in paired rows on opposite lateral sides of the base (736). The left actuator slider (752) and the right actuator slider (754) are connected together on opposite sides of the base (736) through such slider clearance holes (770) to slide inwardly together in connected pairs. Additional details regarding the connection and actuation of the left actuator slider (752) and the right actuator slider (754) will be discussed in more detail below. However, it should be understood that any such hole that passes through the base (736) to provide fastening clearance for the left actuator slider (752) and the right actuator slider (754) may be used, and the present invention is not intended to be unnecessarily limited to the slider clearance holes (70) as discussed herein.

[0148] i. Exemplary Variable Stiffness Platform for Supporting a Support Assembly

[0149] Figures 22 to 24Also shown in detail is an example of a platform (730) comprising a pad (772) and a peripheral region (774) extending laterally therefrom. The peripheral region (774) is positioned within the frame (760) and extends into the through hole (766) to secure the pad (772) to the base (736). In some versions, the platform (730) is formed of a material that provides a high coefficient of friction, thereby reducing any tendency of the support assembly (712) to otherwise slide along the corresponding surface of the platform (730). For example, the platform (730) may include a resilient elastomeric material, such as silicone, to be molded to form the fixing portion (774) and the pad (772). An exemplary silicone material is a Shore A silicone having a hardness of 30. To this end, the pad (772) is formed with varying stiffness along its longitudinal length to accommodate parallel cambered orientations, over-cambered orientations, and under-cambered orientations of the end effector while providing sufficient reaction force for at least a predetermined minimum force for adhesion, as discussed in more detail below. As used herein, the term "parallel cambered orientation" means that the upper jaw and lower jaw of the end effector are functionally parallel to each other. The term "over-cambered orientation" means that the upper jaw of the end effector is over-rotated relative to the lower jaw of the end effector. The term "under-cambered orientation" means that the upper jaw of the end effector is under-rotated relative to the lower jaw of the end effector.

[0150] refer to Figure 22 and Figure 23 , the resilient proximal end (778) of the pad (772) has a proximal end stiffness and a proximal lateral depth, while the resilient distal end (780) of the pad (772) has a distal end stiffness and a distal lateral depth. In this example, the proximal end stiffness is generally greater than the distal end stiffness, such that initial compression of the distal end (780) requires less compressive force than compression of the proximal end (778). Of course, further compression of the distal end (780) relative to the proximal end (778) can cause the distal end stiffness to increase to or even exceed the proximal end stiffness, as long as less stiffness of the distal end (780) is included to accommodate an over-arching orientation of the end effector.

[0151] In addition, the distal lateral depth is greater than the proximal lateral depth. Thus, the greater distal lateral depth effectively supports the buttress assembly (712) to improve engagement with an end effector in an under-cambered orientation, but the reduced distal end stiffness allows for greater compression to accommodate an end effector in an over-cambered orientation. The pad (772) of this example is wedge-shaped, having opposing ramp surfaces (782) that taper continuously from the distal end (780) to the proximal end (778) to accommodate parallel cambered orientations, over-cambered orientations, and under-cambered orientations along the entire longitudinal length of the pad (772). In some examples, the depth and stiffness along the pad (772) are configured to accommodate a full range of over-cambered to under-cambered orientations based on determined manufacturing tolerances for the end effector.

[0152] Figures 22 to 24 The pad (772) shown is integrally formed of an elastic material having a uniform stiffness throughout. Such longitudinally varying stiffness is thus achieved by forming a plurality of relief portions (such as channels (784)) in at least the distal end (780) to reduce the distal end stiffness relative to the proximal end stiffness. In this example, the channels (784) (such as five channels (784)) are equidistantly spaced laterally from one another and extend longitudinally from the distal end (780) to the proximal end (778). The channels (784) further define varying channel depths in the longitudinal direction along the pad (772). More specifically, the upper channel (784) extends laterally downward from the upper ramp surface (782) to the upper base surface (786), while the lower channel (784) extends laterally upward from the lower ramp surface (782) to the lower base surface (786). In turn, a plurality of ribs (788) are defined between channels (784) and similarly extend from ramp surface (782) to base surface (786) to support support assembly (712) and have varying stiffness from proximal end (778) to distal end (780) on each opposing side of pad (772).

[0153] ii. Example Constraint Features for Holding a Support Assembly on a Variable Stiffness Platform

[0154] Figure 20 and Figures 25 to 28Restriction features, such as the left and right actuator slides (752, 754) discussed briefly above, are shown for releasably securing the support assembly (712) to the platform (730) in a restricted position. Each of the left and right actuator slides (752, 754) has arms (755a, 755b) configured to accommodate varying lateral depths along the longitudinal length of the pad (772). More specifically, the arms (755a, 755b) include distal arms (755a) and proximal arms (755b) that are longitudinally spaced apart from one another and extend laterally inward toward the platform (730). Each distal arm (755a) and proximal arm (755b) of the left actuator slide (752) or the right actuator slide (754) extends laterally toward the platform (730) such that each of the distal arm (755a) and the proximal arm (755b) is deflected laterally from the other arm (755a, 755b). Thus, the distal arm (755a) and the proximal arm (755b) are laterally spaced apart from the ramp surface (782) to outline the ramp surface (782).

[0155] refer to Figure 25 and Figure 26 The left upper actuator slide (752) has a longitudinally extending left upper slide body (790), wherein the distal arm (755a) and the proximal arm (755b) extend laterally inward toward the right. Each arm (755a, 755b) of the left actuator slide (752) has a cam surface (791) that is configured to receive an end effector against it to push the left actuator slide (752) toward the release position. In addition, the dowel holes (792) open downwardly and are respectively located on a portion of the left upper slide body (790). The dowels (794) extend downwardly from the left slide body (790) and are longitudinally aligned with the outer dowel holes (792). To stop the movement of the upper left actuator slide (752) in the restricted and released positions, a distal cantilever catch (796) extends laterally to the left from the distal portion of the upper left slide body (790), and a proximal cantilever catch (798) extends laterally to the left from the proximal portion of the upper left slide body (790). The distal cantilever catch (796) and the proximal cantilever catch (798) are part of the distal stopper coupling (800) and the proximal stopper coupling (802), respectively, discussed in more detail below.

[0156] refer to Figure 27 and Figure 28, the right upper actuator slide (754) has a longitudinally extending right upper slide body (804), wherein the distal arm (755a) and the proximal arm (755b) extend laterally inward toward the left. Each arm (755a, 755b) of the right actuator slide (754) has a cam surface (805) that is configured to receive an end effector against it to urge the left actuator slide (752) toward the release position. In addition, a dowel hole (806) opens downwardly and is positioned on the right upper slide body (804). A dowel (808) extends downwardly from the right slide body (804) and is positioned in longitudinal alignment with the inner dowel hole (806). To stop the movement of the upper right actuator slide (754) in the restricted and released positions, another distal cantilever catch (796) extends laterally to the right from the distal portion of the upper right slide body (804), and another proximal cantilever catch (796) extends laterally to the right from the proximal portion of the upper right slide body (804). Similarly, the distal cantilever catch (796) and the proximal cantilever catch (798) are part of the distal stopper coupling (800) and the proximal stopper coupling (802), respectively, discussed in more detail below.

[0157] Figure 20 and Figure 29 and Figure 30 The upper right and upper left actuator slides (752) and (754) and the lower right and lower left actuator slides (752) and (754) are shown as discussed in detail above. As briefly discussed above, the description of the upper right and upper left actuator slides (752) and (754) applies similarly to the lower right and lower left actuator slides (752) and (754), wherein like features have like numbers but with reversed lateral directions (e.g., lower, upper, etc.). To this end, when the outer dowel (808) snaps into the outer dowel hole (792) and the inner dowel (794) snaps into the inner dowel hole (806), the upper left and lower right actuator slides (752) and (754) are connected together with the base (736) positioned therebetween. The upper right actuator slide (754) and the lower left actuator slide (752) are similarly connected together with the outer dowel (808) snapped into the outer dowel hole (792) and the inner dowel (794) snapped into the inner dowel hole (806), with the base (736) positioned therebetween. Each of the inner dowel (794) and the outer dowel (808) extends through the slider clearance hole (770) to slidably connect the left actuator slide (752) and the right actuator slide (754) to the base (736).

[0158] Figure 30An example of a pair of distal arms (755a) and a pair of proximal arms (755b) is shown, each having a platform (730) positioned therebetween and outlining opposing ramp surfaces (782). FIG12 shows a center plane (810) bisecting the upper and lower portions of the support applicator cartridge (716) through the center core of the platform (730). The distal arm (755a) has a distal retaining surface (812a) that is laterally deflected a relatively large distance from the center plane (810), and the proximal arm (755b) has a proximal retaining surface (812b) that is laterally deflected a relatively small distance from the center plane (810). Thus, the greater and lesser distances of the distal and proximal retaining surfaces 812a, 812b outline a tapered ramp surface 782 from the distal end 780 of the pad 772 to the proximal end 778 of the pad 772. Thus, the distal and proximal retaining surfaces 812a, 812b are laterally offset from each other and from the center plane 810. In this example, each of the distal and proximal arms 755a, 755b is laterally spaced apart from the ramp surface 782 by an equal lateral dimension, such that the arms 755a, 755b similarly outline a tapered ramp surface 782 from the distal end 780 of the pad 772 to the proximal end 778 of the pad 772.

[0159] like Figures 31 to 33 , the left and right actuator slides (752, 754) are each urged outwardly from the restrained position to a released position away from the platform to disengage the arms (755a, 755b) from the support assembly (712) on the platform (730), as discussed herein. More specifically, the distal stopper coupling (800) and the proximal stopper coupling (802) releasably connect the left and right actuator slides (752, 754) to the base (736) to prevent movement of the left and right actuator slides (752, 754) in the restrained and released positions. The distal stopper coupling (800) and the proximal stopper coupling (802) include distal cantilever catches (796) and proximal cantilever catches (798) extending from each of the left actuator slide (752) and the right actuator slide (754), as briefly discussed above. Furthermore, the distal stopper coupling (800) and the proximal stopper coupling (802) also include distal grounding cams (814) and proximal grounding cams (816), respectively, extending from the base (736) and engaging the distal cantilever catches (796) and the proximal cantilever catches (798), respectively.

[0160] exist Figure 31In the restrained position shown, each distal cantilever catch (796) engages each distal grounding cam (814), and each proximal cantilever catch (798) engages each proximal grounding cam (816), respectively, to urge the left actuator slide (752) and the right actuator slide (754) inwardly toward the restrained position. Figure 32 As shown, when the distal cantilever catch (796) and the proximal cantilever catch (798) follow the distal ground cam (814) and the proximal ground cam (816), the left actuator slide (752) and the right actuator slide (754) are guided outward from the restrained position toward the released position so that the distal cantilever catch (796) and the proximal cantilever catch (798) are elastically deflected. When the distal cantilever catch (796) and the proximal cantilever catch (798) pass around the distal ground cam (814) and the proximal ground cam (816), the distal cantilever catch (796) and the proximal cantilever catch (798) reach the distal cantilever catch (796) and the proximal cantilever catch (798) and push the left actuator slide (752) and the right actuator slide (754) to Figure 33 814, and each proximal cantilever catch (798) engages each proximal ground cam (816) to urge the left and right actuator slides (752, 754) outwardly toward the release position. Thus, the distal stopper coupling (800) and the proximal stopper coupling (802) effectively hold the left and right actuator slides (752, 754) in the release position to prevent the arms (755a, 755b) from accidentally returning inwardly and capturing the buttress assembly (712) when removing the end effector as discussed herein.

[0161] iii. Exemplary Adhesion of a Buttress to a Surgical Stapler and Cutting of a Buttress Assembly to Tissue

[0162] As described above, the upper and lower support assemblies (712) include upper and lower adhesive layers (742) (or other forms of adhesive material) to adhere the respective support (714) to the underside of the anvil and platform of the staple cartridge of the end effector. This adhesive can provide for proper positioning of the support (714) before and during actuation of the end effector; and then allow the support (714) to be separated from the end effector after the end effector has been actuated without causing damage to the support (714) sufficient to impair proper subsequent function of the support (714). The support assembly (712) can also incorporate the teachings of the following patent: U.S. patent application entitled "Adhesive Distribution on Buttress for Surgical Stapler" [Attorney Docket No. END8634USNP.0663974] filed on the same date as this application, the disclosure of which is hereby incorporated by reference.

[0163] By way of example only and not limitation, buttress applicator cartridge assembly (710) may be used to apply buttress assembly (712) with end effector (40), such as with respect to Figures 15 to 18 As shown and described above. In this case, the support assembly (712) is attached to the end effector (40) in the same manner as described in conjunction with the support assembly (100, 110). In addition, the other end effectors described herein can be used to replace the end effector (40), so that the support applicator cartridge assembly (710) can be used to apply the support assembly (712) to any of those end effectors. As shown and described above, the various end effectors may have a straight configuration, a bent end configuration in which the anvil includes a rigid bent (bent or curved) end, or a bent end configuration in which the anvil includes a deformable curved end. Despite these different configurations, as will be further described below, the support applicator cartridge assembly (710) is configured to be able to be used with an end effector of any such configuration. In addition, as described above, the support applicator cartridge assembly (710) is configured to be able to accommodate alternative camber orientations of the end effector, including a parallel camber orientation, an over-camber orientation, and an under-camber orientation. As described above, the pad (772) provides sufficient compression so that the adhesive layer (742) of the support (714) contacts the corresponding portion of the end actuator completely or at least substantially along its longitudinal length to adhere the support (712) to the end actuator, regardless of whether the end actuator is constructed with an over-arching orientation, an under-arching orientation, or a parallel-arching orientation.

[0164] iv. Exemplary Opening Features to Accommodate a Bent End Effector

[0165] See for example Figures 19 to 33As shown, the buttress applicator cartridge (716), another feature of the buttress applicator cartridge (716) relates to the ability of the buttress applicator cartridge (716) to be used with various end effectors (including those with curved tips) that can be used as part of an anvil or even as part of a cartridge. In this regard, the buttress applicator cartridge (716) includes an opening (701). The opening (701) is configured as a space or gap in which a portion of the end effector can pass through the buttress applicator cartridge (716) from the top or upper side to the bottom or lower side. As will be further described below, when used with an end effector having a curved tip, the opening (701) allows the jaws of the end effector to close, wherein the curved tip passes through the opening (701) so that the upper and lower jaws of the end effector can be closed to a point where at least the upper and lower jaws contact the buttress assembly (712) along their entire longitudinal length or at least substantially along their longitudinal length. At the same time, the opening (701) does not prevent or hinder the use of an end effector with a straight tip design.

[0166] Now see Figure 19 and Figures 29 to 33 , in this example, the opening (701) is defined by the base (736) along the distal portion of the opening (701) and the lateral sides of the opening (701). In addition, the opening is defined by the platform (730) along the proximal portion of the opening (701). Thus, in this example, multiple structures or components of the support applicator bin (716) are combined to define the opening (701). In some other versions, the opening (701) may be defined by fewer, additional or other components. Also in this example, the opening (701) is defined by the base (736) and the platform (730) such that the opening (701) comprises a U-shaped opening. Based on the teachings herein, other ways of defining the opening (701) to provide alternative opening shapes will be apparent to those of ordinary skill in the art.

[0167] See also Figure 34 and Figure 35 , the buttress applicator cartridge assembly (710) is shown in use with an end effector (912). The end effector (912) includes a straight tip configuration similar to the end effectors (12, 40) described above. The end effector (912) includes an anvil (918) and jaws (916) that hold the staple cartridge (937). Figure 34 As shown, when the end effector (912) is positioned within the buttress applicator cartridge assembly (710) and closed, the opening (701) reveals a portion of the cartridge (937) on the other side of the platform (730). In this example, this is the case because the end effector (912) is configured such that when the end effector (912) is closed, the cartridge (937) extends further distally than the anvil (918). Figure 35As shown, a view from the other side of this configuration shows that opening (701) is visually blocked by the distal portion of cartridge (937). However, buttress applicator cartridge assembly (710) is configured for use with a straight-tipped end effector, such as end effectors (12, 40, 912) described herein.

[0168] See also Figure 36 and Figure 37 , the buttress applicator cartridge assembly (710) is shown for use with an end effector (1012). The end effector (1012) includes a curved tip configuration similar to the end effectors (212, 312, 412, 512, 612) described above. The end effector (1012) includes an anvil (1018) and jaws (1016) that hold the staple cartridge (1037). Figure 36 As shown, when the end effector (1012) is positioned within the buttress applicator cartridge assembly (710) and closed, the opening (701) reveals a portion of the cartridge (1037) on the other side of the platform (730). In this example, this is the case because the end effector (1012) is configured such that when the end effector (912) is closed and contacts the platform (730), the cartridge (1037) extends further distally than the anvil (918). Figure 37 As shown, with the end effector (1012) closed and contacting the platform (730), the curved tip (1014) of the anvil (1018) passes through the opening (701) extending toward the cartridge (1037). In this example, the curved tip (1014) is rigid in some versions and deformable in other versions. In either configuration of the curved tip (1014), the buttress applicator cartridge assembly (710) having the opening (701) accommodates the anvil (1018) and the curved tip (1014) such that when the buttress assembly (712) is loaded onto the end effector (1012), the curved tip (1014) extends through the opening (701).

[0169] v. Exemplary Distal Alignment Features for Openings to Accommodate Bent End Effectors

[0170] As described above, the opening (701) is partially defined by the base (736) along the distal end of the opening (701) and the lateral sides of the opening (701). In this manner, the base (736) includes, for example, Figure 19 and Figure 21 The edge (703) is shown. The edge (703) extends in a U-shaped manner along a portion of the perimeter of the opening (701), thereby partially defining the opening (701).

[0171] See also Figure 38, the opening (701) includes an alignment feature (705) that is configured to guide a curved tip of an end effector, such as the curved tip (1014) of the end effector (1012), into and through the opening (701). In addition to guiding the curved tip, the alignment feature (705) also helps align the end effector relative to the buttress applicator cartridge assembly (710) such that the jaws of the buttress assembly (712) and the end effector are aligned in a parallel or substantially parallel orientation, wherein the jaws of the end effector are centered or substantially centered relative to the buttress assembly (712). With this orientation, the buttress assembly (712) can be adhered to the end effector such that both the end effector and the buttress assembly (712) share a common longitudinal axis.

[0172] like Figure 38 As shown, in one example, the alignment feature (705) is defined by the edge (703) of the opening (701). The alignment feature (705) includes tapered surfaces that converge at the center of the thickness of the base (736). In addition, the tapered surfaces of the alignment feature (705) are oriented or inclined so that when the jaws of the end effector contact them, the jaws are guided toward the center of the opening (701). As described above, this guiding and alignment action not only aligns the curved tip of the end effector, but also facilitates alignment of the end effector as a whole relative to the support applicator cartridge assembly (710). In addition, this alignment action facilitated by the alignment feature (705) occurs during the clamping of the end effector because the curved tip extends further through the opening (701) to clamp and contact the platform (730) when the end effector is moved to the closed position, thereby ultimately attaching the support assembly (712) to the end effector.

[0173] In some versions, opening (701) is sized so that it is narrower than the maximum width of the curved tip of the end effector. By way of example, end effector (1012) has an anvil (1018) with a curved tip (1014). Curved tip (1014) gradually widens as it extends proximally, as shown in FIG. Figure 36As shown. Thus, in such examples, the opening (701) is narrower than the widest portion of the curved end (1014). And when the end effector (1012) is closed and clamped on the platform (730), the curved end (1014) will contact the edge (703) of the opening (701). This, in turn, will cause the alignment feature (705) to guide or direct the curved end (1014) and the end effector (1012) to align with the support assembly (712) held on the platform (730) to adhere to the end effector (1012). In accordance with the teachings herein, various sizes and configurations of the opening (701), edge (703), and alignment feature (705) that can be used with the support applicator cartridge assembly (710) will be apparent to those of ordinary skill in the art.

[0174] See also Figure 39 and Figure 40 , shows another exemplary alignment feature (707). The alignment feature (707) is configured to be coupled to a base (736), such as Figure 40 As shown. The alignment feature (707) can be configured to be removed from the base (736) and / or replaced with the base. However, in other versions, the alignment feature (707) can be permanently attached to the base (736). In this example, the base (736) includes a pair of cylindrical members (709) that are configured to engage a pair of holes (711) of the alignment feature (707). The base (736) also includes a pair of guide members (713) located proximal to the cylindrical members (709). The guide members (713) are each configured to receive an end portion of one of the pair of lateral side arms (715) of the alignment feature (707), as shown. Figure 40 shown.

[0175] In this example, the arms (715) of the alignment feature (707) are configured to be resiliently biased and self-centering. In this manner, the arms (715) are configured to deflect outward when the end effector is clamped onto the platform (730). This deflection of the arms (715) allows the alignment feature (707) to be used with end effectors having varying sizes and curved tip geometries. Furthermore, the arms (715) are configured to utilize their resilient bias to guide the curved tip portion of the end effector to a centered orientation relative to the opening (701). In some other versions, the arms (715) and alignment feature (707) are sized for a specific size or range of sizes of the end effector, such that the arms (715) may be rigid and therefore not configured to deflect under the clamping force of the end effector, but still provide guidance and centering of the end effector through the interaction of the alignment feature (707) with the curved tip of the end effector, as further described below.

[0176] The arms (715) of the alignment feature (707) also include tapered surfaces (717) that are configured to contact and interact or engage with the jaws of the end effector such that when the jaws of the end effector contact them, the jaws are directed or guided toward the center of the opening (701). This guiding and aligning action of the alignment feature (707) not only aligns the curved tip of the end effector, but also facilitates alignment of the end effector as a whole relative to the buttress applicator cartridge assembly (710).

[0177] With an opening (701) and a curved tip end effector, an alignment action facilitated by alignment features (707) occurs when the end effector is clamped, as the curved tip extends further through the opening (701). By way of example, the end effectors (212, 512, 612) have corresponding anvils (218, 518, 618) having curved tips with tapered sides (241, 541, 641). When an end effector (212, 512, 612), etc., is used with a support applicator cartridge assembly (710), the tapered surface (717) of the alignment feature (707) contacts the curved end of the end effector (212, 512, 612) when the end effector (212, 512, 612) is clamped onto the platform (730), and further contacts the tapered side (241, 541, 641) of the end effector (212, 512, 612) when the end effector (212, 512, 612) is clamped onto the platform (730). This contact or engagement causes alignment feature (707) to guide or direct the curved tip of end effector (212, 512, 612) such that end effector (212, 512, 612) is directed into alignment with buttress assembly (712) held on platform (730) for eventual adhesion to end effector (212, 512, 612). Other configurations of arms (715) of alignment feature (707) that may be used with buttress applicator cartridge assembly (710) will be apparent to those of ordinary skill in the art in view of the teachings herein.

[0178] See also Figure 41 and Figure 42 , another exemplary alignment feature (719) is shown as an anvil alignment rib. The alignment feature (719) is configured to be coupled to the base (736), such as Figure 41As shown. In this example, the alignment feature (719) is configured to be fixed or formed together with the base (736). However, in other versions, the alignment feature (719) can be selectively attached to the base (736). In this example, the alignment feature (719) extends laterally across the opening (701), wherein the ends (721, 723) are connected to the base (736) on each side of the opening (701). The alignment feature (719) extends further from the proximal side to the distal side relative to the opening (701), wherein the center portion (725) is located at the farthest side and is connected to the corresponding side portions (727, 729). In this way, the alignment feature (719) tapers as it extends from the proximal side to the distal side. In addition, the center portion (725) includes a curved portion (731, 733) that is ultimately connected to the side portions (727, 729). With this configuration, as alignment feature (719) spans opening (701) and tapers from proximal to distal, the alignment feature defines a non-linearly decreasing pitch.

[0179] The alignment feature (719) further includes a tapered surface (735) extending along the side portions (727, 729) and the central portion (725). In this manner, the tapered surface (735) of the alignment feature (719) tapers from proximal to distal. Furthermore, the tapered surface (735) is configured to contact the tapered side of the curved tip (1014) of the end effector (1012) when the end effector (1012) is clamped on the platform (730), as shown in FIG. Figure 41 and Figure 42 As shown. This ultimately guides the curved tip (1014) and end effector (1012) into alignment with the opening (701) and ultimately with the support assembly (712) held on the platform (730). As described above, the alignment and guidance of the alignment feature (719) operates in a similar manner to the other alignment features described above, wherein the clamping action of the end effector on the platform (730) promotes contact or engagement of the curved tip of the end effector and its tapered side with the alignment feature (719) and its tapered surface (735) to center and align the end effector with the holding support assembly (712) on the platform (730). In view of the above description and examples of alignment features, other configurations of one or more alignment features for use with the support applicator cartridge assembly (710) or other such support applicators will be apparent to one of ordinary skill in the art.

[0180] VII. Exemplary Alternative Support with Distal Opening and Alignment Features to Accommodate a Curved End Effector Applicator silo

[0181] In other versions of the buttress applicator cartridge, alternative openings similar to the opening (701) described above may be incorporated into the buttress applicator cartridge to accommodate an end effector having a curved tip. Figures 43 to 45 , a support applicator cartridge assembly (1110) is shown that is similar to the support applicator cartridge assembly (710) shown and described above. In this regard, the teachings above with respect to the support applicator cartridge assembly (710) are equally applicable to the support applicator cartridge assembly (1110), except for the following differences described below.

[0182] The buttress applicator cartridge assembly (1110) includes a buttress applicator cartridge (1116) having a housing assembly (724) having an upper housing (726) and a lower housing (728). The buttress applicator cartridge (1116) also includes a base (1136) and a platform (1130). In this example, the housing assembly (724) defines a channel (1103) that is configured to accommodate an end effector, such as an Figure 44 and Figure 45 The end effector (1012) is shown. Figure 43 As best shown in FIG, the platform (1130) is configured to hold the buttress assembly (712) in the same manner as described above with respect to the buttress applicator cartridge (716). In this example, the platform (1130) extends from proximal to distal such that the space or area defined by the channel (1103) is surrounded by the platform (1130). The platform (1130) also includes an opening (1101) defined by a hole or cutout in the platform (1130). In this manner, the opening (1101) is formed in the platform (1130) and is defined on all sides by the platform (1130). Similar to the opening (701) described above, the opening (1101) is configured to allow the curved end (1014) of the end effector (1012) or another similar end effector to pass through the platform (1130) and the base (1136). In this manner, the curved end (1014) extends laterally from one side of the combined base (1136) and platform (1130) to the other side. The opening (1101) can be configured to be oversized relative to the curved end (1014), undersized relative to the curved end (1014), or equal to or substantially equal to the curved end (1014). In some cases, the platform (1130) includes a resilient material so that the opening (1101) defined by the platform (1130) is expandable, for example, when the curved end (1014) extends through the opening (1101) and presses against the sides of the opening (1101). Other configurations of the opening (1101) will be apparent to one of ordinary skill in the art in light of the teachings herein.

[0183] In addition to the opening (1101), similar to the platform (730), the platform (1130) is configured to be thicker at its distal portion proximal to the opening (1101) than at the proximal portion of the platform (1130). In this manner, the platform (1130) includes a taper from its distal portion to its proximal portion. In this example, the platform (1130) also includes a stop (1132) located at its proximal end. The stop (1132) is configured to prevent the jaws of the end effector (1012) from being accidentally or prematurely grasped by the platform (1130) and the support assembly (712) before the end effector (1012) is intentionally clamped to the platform (1130). In other words, the stop (1132) is configured to prevent the first and second jaws of the end effector (1012) from prematurely making substantial contact with the platform (103) and support assembly (712) before the end effector (1012) is clamped. Figure 45 As shown, the limit portion (1132) is capable of compressing like the platform (1130) so that when the end actuator (1012) is clamped, the limit portion (1132) compresses and no longer prevents the jaws of the end actuator (1012) from gripping the platform (1130) and thereby picking up the support assembly (712).

[0184] See also Figure 43 , the channel (1103) includes a distal portion (732) defined by lateral sides (734). As shown, the distal portion (732) includes a taper that converges from proximal to distal as the lateral sides (734) converge at the distal-most end of the distal portion (732). Thus, the lateral sides (734) are configured to guide the curved tip (1014) of the end effector (1012) toward the centerline of the opening (1101) so as to align the end effector (1012) with the support assembly (712) held on the platform (1130). As described above, tapered surfaces may be included on the lateral sides (734) to further facilitate guiding the curved tip (1014) of the end effector (1012). Additional or other alignment features other than the lateral sides (734) that may be incorporated into the support applicator cartridge (1116) will be apparent to one of ordinary skill in the art in light of the teachings herein.

[0185] VIII. Exemplary Alternative Support Applicator Cartridge for Accommodating a Deformable Curved Distal End Effector

[0186] In other versions of the buttress applicator cartridge, the buttress applicator cartridge may be configured for use with a curved tip end effector, but wherein the curved tip is deformable. In such examples, while an opening such as opening (701) or opening (1101) may be used, the opening may also be omitted. See Figures 46 to 48, a support applicator cartridge assembly (1210) is shown that is similar to the support applicator cartridge assembly (710) shown and described above. In this regard, the teachings above with respect to the support applicator cartridge assembly (710) are equally applicable to the support applicator cartridge assembly (1210), except for the following differences described below.

[0187] The buttress applicator cartridge assembly (1210) includes a buttress applicator cartridge (1216) having a housing assembly (724) having an upper housing (726) and a lower housing (728). The buttress applicator cartridge (1216) also includes a base (1236) and a platform (1230). In this example, the housing assembly (724) defines a channel (1203) that is configured to accommodate an end effector, such as an Figures 46 to 48 The end effector (1312) is shown. Figure 46 and Figure 47 As best shown in FIG, platform (1230) is configured to retain buttress assembly (712) in the same manner as described above with respect to buttress applicator cartridge (716). In this example, platform (1230) extends from proximal to distal such that the space or area defined by channel (1203) is enclosed by platform (1230). In this example, platform (1230) is a continuous surface, or at least substantially continuous, such that the curved tip (1314) of end effector (1312) cannot pass through platform (1230). Platform (1230) includes a proximal end portion (1278) and a distal end portion (1280). Extending further distally from distal end portion (1280), platform (1230) includes contact portion (1282). Similar to platform (730), platform (1230) is configured to be compressible and is thicker at distal end portion (1280) than at proximal end portion (1278). In this manner, platform (1230) includes a taper from distal end portion (1280) to proximal end portion (1278).

[0188] See also Figure 46 , the end effector (1312) is shown within the channel (1203) of the buttress applicator cartridge (1216), but in an unclamped or open state. As shown, when the curved tip (1314) touches the contact portion (1282) without a clamping force, the curved tip (1314) does not deform and the jaws of the end effector (1312) remain free of contact with the buttress assembly (712). See Figure 47, when the end effector (1312) having a deformable curved tip (1314) is clamped, the curved tip (1314) deforms so as to deflect or straighten. This deformation occurs because the curved tip (1314) contacts or touches the contact portion (1282) of the platform (1230), rather than passing through the opening as described above with respect to other buttress applicator cartridges. The deformation of the curved tip (1314) allows for sufficient clamping action of the end effector (1312) on the platform (1230) such that the jaws of the end effector (1312) contact the buttress assembly (712), causing the buttress assembly to be applied to the jaws of the end effector (1312). As Figure 47 As shown in the clamped state of FIG, the center portion (1282) of the platform (1230) in this example is configured to be able to deflect. In this way, the contact portion (1282) is resilient so that it remains straight when not subjected to the clamping force from the end effector (1312). In other versions, the center portion (1282) may be non-deflectable. However, in some cases where the contact portion (1282) is able to deflect, a certain degree of deflection of the contact portion (1282) can reduce the stress on the connection between the curved tip (1314) and the rest of the anvil of the end effector (1312).

[0189] See also Figure 48 , end effector (1312) is shown in the Figure 47 Similar clamping state. As shown, the size of the deformable curved end (1314) in its deformed state is slightly expanded outward relative to the width of the rest of the end effector (1312). In addition, the size of the edge (1205) of the distal end of the channel (1203) defining the housing assembly (724) is set so that when the end effector (1312) is clamped, the housing assembly (724) is slightly larger than the curved end (1314) in its deformed state. Therefore, this provides sufficient clearance or space to achieve complete clamping of the end effector (1312) to the platform (1230) to transfer the support assembly (712) to the jaws of the end effector (1312). Based on the teachings of this document, other ways of constructing a support applicator cartridge (1216) for use with a deformable curved end end effector will be apparent to those of ordinary skill in the art.

[0190] The various buttress applicator cartridges described herein can be used with any of the end effectors described herein. By way of example and not limitation, those features of a buttress applicator cartridge that are configured to work with and / or accommodate an end effector having a curved tip make the buttress applicator cartridge suitable for use with end effectors having various styles and configurations for curved tips. For example, a buttress applicator cartridge having features for an end effector having a curved tip as described herein can be used with an end effector in which the curved tip can be gradually curved, or in which the curved tip can be misaligned or angled relative to the axis of the anvil so that the curved tip has a configuration that is more angled or more curved rather than gradually curved. Additionally, a buttress applicator cartridge having features for accommodating an end effector having a curved tip as described herein can be used with an end effector or be configured to be used with an end effector in which the curved tip portion is spaced apart from the distal end of the cartridge or terminates at the same or similar point as the distal end of the cartridge. Additionally, a buttress applicator cartridge having features for accommodating an end effector having a curved tip as described herein can be used or configured for use with an end effector having a curved tip configured for different uses or applications, such as an atraumatic tip, a dissection tip, a visualization tip, a placement tip, a deflectable or deformable tip, combinations thereof, etc. Still other ways of configuring a buttress applicator cartridge as described herein for use with an end effector as described herein will be apparent to those of ordinary skill in the art in view of the teachings herein.

[0191] IX. Exemplary Combinations

[0192] The following examples relate to various non-exhaustive ways in which the teachings herein may be combined or applied. It should be understood that the following examples are not intended to limit the coverage of any claims that may be provided at any time in this patent application or subsequent submissions of this patent application. It is not intended to make a disclaimer. The following examples are provided solely for illustrative purposes. It is contemplated that the various teachings herein may be arranged and applied in a variety of other ways. It is also contemplated that some variations may omit certain features mentioned in the following examples. Therefore, any of the aspects or features mentioned below should not be considered decisive unless otherwise expressly indicated as such by the inventor or the inventor's successor at a later date, for example. If any claim set forth in this patent application or subsequent submissions related to this patent application includes additional features other than those mentioned below, these additional features should not be assumed to be added for any reason related to patentability.

[0193] Example 1

[0194] A buttress applicator cartridge is configured to hold one or more buttress assemblies. The buttress applicator cartridge is further configured to be used with an end effector of a surgical stapler to apply the one or more buttress assemblies to a selected one or more of a first jaw and a second jaw of the end effector. The first jaw of the end effector includes an anvil, and the second jaw of the end effector includes a staple cartridge. The support applicator magazine includes: (a) a base defining an opening extending in a longitudinal direction so that the opening is configured to receive the end actuator; (b) a platform extending longitudinally from a proximal platform portion to a distal platform portion and operatively connected to the base, wherein the platform supports the one or more support components thereon, and wherein the thickness of the platform increases from the proximal portion to the distal portion; and (c) an opening extending laterally from a first side of the base and the platform to a second side of the base and the platform opposite the first side of the base and the platform, wherein the size and configuration of the opening are set to receive the curved end of the end actuator, thereby allowing at least a portion of the curved end to extend from the first side of the base and the platform to the second side of the base and the platform.

[0195] Example 2

[0196] The buttress applicator cartridge of embodiment 1 , wherein the platform is compressible.

[0197] Example 3

[0198] A buttress applicator cartridge according to any one or more of embodiments 1-2, wherein the platform tapers continuously from the distal platform portion toward the proximal platform portion.

[0199] Example 4

[0200] The support applicator magazine according to any one or more of Examples 1 to 3 further includes one or more alignment features, which are configured to guide the curved end of the end actuator to align the end actuator with the one or more support components configured to be supported on the platform.

[0201] Example 5

[0202] A support applicator magazine according to any one or more of Examples 1 to 4, wherein clamping the end actuator on the platform causes the curved end of the end actuator to contact the one or more alignment features to align the end actuator with the one or more support components.

[0203] Example 6

[0204] A buttress applicator cartridge according to any one or more of embodiments 1 to 5, wherein the one or more alignment features are located on an edge of the opening.

[0205] Example 7

[0206] The support applicator magazine according to any one or more of Examples 1 to 6 further includes a housing assembly defining a channel configured to accommodate the end actuator, wherein the channel includes a distal end defined by two lateral sides, wherein the one or more alignment features are located on the two lateral sides.

[0207] Example 8

[0208] The buttress applicator cartridge of any one or more of Examples 1 to 7, wherein the one or more alignment features comprise a non-linearly decreasing pitch from proximal to distal.

[0209] Example 9

[0210] The buttress applicator cartridge of any one or more of Examples 1 to 8, wherein the one or more alignment features are formed with or connected to the base.

[0211] Example 10

[0212] The buttress applicator cartridge of any one or more of Examples 1 to 9, wherein the one or more alignment features comprise a pair of resiliently biased, self-centering lateral side arms.

[0213] Example 11

[0214] A support applicator magazine according to any one or more of Examples 1 to 10, wherein the one or more alignment features include a tapered surface configured to contact the tapered side of the curved end of the end actuator when the end actuator is clamped onto the platform.

[0215] Example 12

[0216] The buttress applicator cartridge of any one or more of embodiments 1 to 11, wherein the tapered surface of the alignment feature tapers from proximal to distal.

[0217] Example 13

[0218] A buttress applicator cartridge according to any one or more of embodiments 1 to 12, wherein the opening is formed in the platform.

[0219] Example 14

[0220] A buttress applicator cartridge according to any one or more of embodiments 1 to 12, wherein the opening is defined by a space between the platform and the base.

[0221] Example 15

[0222] The buttress applicator cartridge of any one or more of Examples 1 to 14, wherein the adhesive selectively attaches the one or more buttress components to the end effector.

[0223] Example 16

[0224] The buttress applicator cartridge of any one or more of Examples 1 to 15, wherein the curved end of the end effector is a dissecting end.

[0225] Example 17

[0226] The support applicator magazine according to any one or more of Examples 1 to 16 further includes a movable slide, each of which includes a pair of arms, and the pair of arms are configured to be contacted by the end actuator to drive the movable slide laterally relative to the platform, thereby releasing the one or more support components for application to the end actuator.

[0227] Example 18

[0228] A support applicator magazine according to any one or more of Examples 1 to 17, wherein the platform includes a limit portion along the proximal portion, wherein the limit portion is configured to prevent the first jaw and the second jaw of the end actuator from making substantial contact with the platform prematurely before clamping the end actuator.

[0229] Example 19

[0230] A buttress applicator cartridge assembly configured for use with an end effector of a surgical stapler. The buttress applicator cartridge assembly comprises: (a) a buttress applicator cartridge comprising: (i) a base defining an opening extending in a longitudinal direction such that the opening is configured to receive the end effector, (ii) a platform extending longitudinally from a proximal platform portion to a distal platform portion and operatively connected to the base, and (iii) an opening extending laterally from a first side of the base and the platform to a second side of the base and the platform opposite the first side of the base and the platform, wherein the opening is sized and configured to receive a curved end of the end effector, thereby allowing at least a portion of the curved end to be positioned adjacent the base. and (b) a support assembly comprising: (i) a support supported by the platform, and (ii) an adhesive on a surface of the support, wherein the adhesive is configured to selectively adhere the support assembly to the jaws of the end actuator when the end actuator is clamped on the platform.

[0231] Example 20

[0232] A buttress applicator cartridge assembly is configured to hold one or more buttress assemblies. The buttress applicator cartridge assembly is further configured to be used with an end effector of a surgical stapler having a deformable curved tip to apply the one or more buttress assemblies to a selected one or more of a first jaw and a second jaw of the end effector. The support applicator magazine includes: (a) a shell, which defines a channel extending in a longitudinal direction so that the channel is configured to receive the end actuator, wherein the shell also defines a distal space, which is configured to accommodate the deformable curved end when the deformable curved end is in an expanded state; and (b) a platform, which extends longitudinally from a proximal platform portion to a distal platform portion and is directly or indirectly operatively connected to the shell, wherein: (i) the platform supports the one or more support components thereon, (ii) the thickness of the platform increases from the proximal portion to the distal portion, (iii) the platform is compressible when subjected to a clamping force from the end actuator, and (iv) the platform is deflectable along the distal platform portion when subjected to a clamping force from the end actuator.

[0233] X. Miscellaneous

[0234] It should be understood that any one or more of the teachings, expressions, embodiments, examples, etc. described herein may be combined with any one or more of the other teachings, expressions, embodiments, examples, etc. described herein. Therefore, the above teachings, expressions, embodiments, examples, etc. should not be considered in isolation from each other. Based on the teachings herein, various suitable ways in which the teachings herein can be combined will be apparent to those of ordinary skill in the art. Such modifications and variations are intended to be included within the scope of the claims.

[0235] It should also be understood that the teachings herein can be readily combined with the various teachings of the following U.S. patent application: U.S. Patent No. 836,198, entitled “Surgical Stapler End Effector with Varying Deck Height and Tissue Gripping Features,” published on December 18, 2018, the disclosure of which is incorporated herein by reference. Various suitable ways in which the teachings herein can be combined with the teachings of U.S. Patent No. 836,198 will be apparent to those of ordinary skill in the art.

[0236] It should also be understood that the teachings herein can be readily combined with various teachings of the following U.S. patent application: U.S. Patent No. 833,010, entitled “Circular Surgical Stapler End Effector with Varying Deck Height and Tissue Gripping Features,” published on November 6, 2018, the disclosure of which is incorporated herein by reference. Various suitable ways in which the teachings herein can be combined with the teachings of U.S. Patent No. 833,010 will be apparent to those of ordinary skill in the art.

[0237] It will also be understood that the teachings herein can be readily combined with various teachings of the following U.S. patent application: U.S. Patent Publication No. 2018 / 0235610, entitled “Surgical Stapler with Insertable Distal Anvil Tip,” published on August 23, 2018, the disclosure of which is incorporated herein by reference. Various suitable ways in which the teachings herein can be combined with the teachings of U.S. Patent Publication No. 2018 / 0235610 will be apparent to those of ordinary skill in the art.

[0238] It will also be understood that the teachings herein can be readily combined with various teachings of the following U.S. patent application: U.S. Patent Publication No. 2018 / 0235611, entitled “Surgical Stapler with Cooperating Distal Tip Features on Anvil and Staple Cartridge,” published on August 23, 2018, the disclosure of which is incorporated herein by reference. Various suitable ways in which the teachings herein can be combined with the teachings of U.S. Patent Publication No. 2018 / 0235611 will be apparent to those of ordinary skill in the art.

[0239] It should also be understood that the teachings herein can be readily combined with various teachings of the following U.S. patent application: U.S. Patent No. 836,199, entitled “Surgical Stapler with Bent Anvil Tip and Angled Staple Cartridge Tip,” published on December 18, 2018, the disclosure of which is incorporated herein by reference. Various suitable ways in which the teachings herein can be combined with the teachings of U.S. Patent No. 836,199 will be apparent to those of ordinary skill in the art.

[0240] It will also be understood that the teachings herein can be readily combined with various teachings of the following U.S. patent application: U.S. Patent Publication No. 2018 / 0235619, entitled “Surgical Stapler with Bent Anvil Tip, Angled Staple Cartridge Tip, and Tissue Gripping Features,” published on August 23, 2018, the disclosure of which is incorporated herein by reference. Various suitable ways in which the teachings herein can be combined with the teachings of U.S. Patent Publication No. 2018 / 0235619 will be apparent to those of ordinary skill in the art.

[0241] It should also be understood that the teachings herein can be readily combined with various teachings in the following U.S. patent application: U.S. patent application Ser. No. 16 / 035,893, filed on July 16, 2018, entitled “Method of Surgical Stapling with End Effector Component Having a Curved Tip,” the disclosure of which is incorporated herein by reference. Various suitable ways in which the teachings herein can be combined with the teachings of U.S. patent application Ser. No. 16 / 035,893 will be apparent to those of ordinary skill in the art.

[0242] It should be understood that any patent, patent publication, or other public material, whether in whole or in part, allegedly incorporated herein by reference is incorporated herein only to the extent that the incorporated material does not conflict with existing definitions, statements, or other public materials set forth in this disclosure. Accordingly, and to the extent necessary, the disclosure expressly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, allegedly incorporated herein that conflicts with existing definitions, statements, or other public materials set forth herein will be incorporated only to the extent that no conflict arises between the incorporated material and the existing public materials.

[0243] The types of devices described above can be applied to traditional medical treatments and surgeries performed by medical professionals, as well as to robotic-assisted medical treatments and surgeries. By way of example only, the various teachings herein can be readily incorporated into robotic surgical systems, such as the DAVINCI® system from Intuitive Surgical, Inc. (Sunnyvale, California). TMSimilarly, one of ordinary skill in the art will recognize that the various teachings herein may be readily combined with the various teachings of any of the following U.S. Patents: U.S. Patent 5,792,135, entitled “Articulated Surgical Instrument For Performing Minimally Invasive Surgery With Enhanced Dexterity and Sensitivity,” issued August 11, 1998, the disclosure of which is incorporated herein by reference; U.S. Patent 5,817,084, entitled “Remote Center Positioning Device with Flexible Drive,” issued October 6, 1998, the disclosure of which is incorporated herein by reference; U.S. Patent 5,878,193, entitled “Automated Endoscope System for Optimal Positioning,” issued March 2, 1999, the disclosure of which is incorporated herein by reference; U.S. Patent 5,878,193, entitled “Automated Endoscope System for Optimal Positioning,” issued May 15, 2001, the disclosure of which is incorporated herein by reference; U.S. Patent No. 6,231,565, entitled “Robotic Surgical Tool with Ultrasound Cauterizing and Cutting Instrument,” issued on August 31, 2004, the disclosure of which is incorporated herein by reference; U.S. Patent No. 6,783,524, entitled “Robotic Surgical Tool with Ultrasound Cauterizing and Cutting Instrument,” issued on April 2, 2002, the disclosure of which is incorporated herein by reference; U.S. Patent No. 7,524,320, entitled “Mechanical Actuator Interface System for Robotic Surgical Tools,” issued on April 28, 2009, the disclosure of which is incorporated herein by reference; U.S. Patent No. 7,691,098, entitled “Platform Link Wrist Mechanism,” issued on April 6, 2010, the disclosure of which is incorporated herein by reference;U.S. Patent No. 7,806,891, entitled “Repositioning and Reorientation of Master / Slave Relationship in Minimally Invasive Telesurgery,” issued on October 5, 2010, the disclosure of which is incorporated herein by reference; U.S. Patent No. 8,844,789, entitled “Automated End Effector Component Reloading System for Use with a Robotic System,” issued on September 30, 2014, the disclosure of which is incorporated herein by reference; U.S. Patent No. 8,820,605, entitled “Robotically-Controlled Surgical Instrument with Force-Feedback Capabilities,” issued on September 2, 2014, the disclosure of which is incorporated herein by reference; U.S. Patent No. 8,820,605, entitled “Robotically-Controlled Surgical Instrument with Force-Feedback Capabilities,” issued on December 31, 2013, the disclosure of which is incorporated herein by reference; Tool”, the disclosure of which is incorporated herein by reference; U.S. Patent 8,616,431, entitled “Surgical Stapling Instruments with Cam-Driven Staple Deployment Arrangements”, issued on November 5, 2013, the disclosure of which is incorporated herein by reference; U.S. Patent 8,602,288, entitled “Robotically-Controlled Motorized Surgical End Effector System with Rotary Actuated Closure Systems Having Variable Actuation Speeds”, issued on December 10, 2013, the disclosure of which is incorporated herein by reference; U.S. Patent 9,301,759, entitled “Robotically-Controlled Surgical Instrument with Selectively Articulatable End Effector”, issued on April 5, 2016, the disclosure of which is incorporated herein by reference;U.S. Patent No. 8,783,541, entitled “Robotically-Controlled Surgical End Effector System,” issued on July 22, 2014, the disclosure of which is incorporated herein by reference; U.S. Patent No. 8,479,969, entitled “Drive Interface for Operably Coupling a Manipulatable Surgical Tool to a Robot,” issued on July 9, 2013, the disclosure of which is incorporated herein by reference; U.S. Patent No. 8,800,838, entitled “Robotically-Controlled Cable-Based Surgical End Effectors,” issued on August 12, 2014, the disclosure of which is incorporated herein by reference; and / or U.S. Patent No. 8,573,465, entitled “Robotically-Controlled Surgical End Effector System with Rotary Actuated Closure Systems,” issued on November 5, 2013, the disclosure of which is incorporated herein by reference;

[0244] The devices of the types described above can be designed to be discarded after a single use, or they can be designed to be reusable. In either case or both cases, these types can be repaired for reuse after at least one use. Repair can include any combination of the following steps: disassembling the device, then cleaning or replacing specific parts and subsequently reassembling. Specifically, some types of devices can be disassembled, and any number of specific parts or parts of the device can be selectively replaced or removed in any combination. When cleaning and / or replacing specific parts, some types of the device can be reassembled at a repair facility or reassembled by the user before surgery is about to be performed for subsequent use. Those skilled in the art will appreciate that the repair of the device can utilize a variety of techniques to disassemble, clean / replace, and reassemble. The use of such technology and the resulting repair device are all within the scope of this application.

[0245] By way of example only, the devices described herein can be sterilized before and / or after surgery. In one sterilization technique, the device is placed in a closed and sealed container, such as a plastic bag or a TYVEK bag. The container and device can then be placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or high-energy electrons. The radiation kills bacteria on the device and in the container. The sterilized device can then be stored in a sterile container for later use. The device can also be sterilized using any other technique known in the art, including but not limited to beta or gamma radiation, ethylene oxide, or steam.

[0246] Various embodiments of the present invention have been shown and described, and further improvements to the methods and systems described herein may be achieved by appropriate modifications by those skilled in the art without departing from the scope of the present invention. Several such possible modifications have been mentioned, and other modifications will be apparent to those skilled in the art. For example, the embodiments, implementations, geometries, materials, dimensions, ratios, steps, etc. discussed above are illustrative and not required. Accordingly, the scope of the present invention should be considered in light of the following claims and should be understood not to be limited to the details of construction and operation shown and described in the specification and drawings.

Claims

1. A buttress applicator cartridge configured to hold one or more buttress assemblies, wherein the buttress applicator cartridge is further configured to be used with an end effector of a surgical stapler to apply the one or more buttress assemblies to a selected one or more of a first jaw and a second jaw of the end effector, wherein the first jaw of the end effector comprises an anvil and the second jaw of the end effector comprises a staple cartridge, wherein the buttress applicator cartridge comprises: (a) a base defining an opening extending in a longitudinal direction such that the opening is configured to receive the end effector; (b) a platform extending longitudinally from a proximal platform portion to a distal platform portion and operatively connected to the base, wherein the platform is configured to support the one or more support assemblies thereon, and wherein a thickness of the platform increases from the proximal portion to the distal portion; as well as (c) an opening extending laterally from a first side of the base and the platform to a second side of the base and the platform opposite the first side of the base and the platform, wherein the opening is sized and configured to receive a curved end of the end actuator to allow at least a portion of the curved end to extend from the first side of the base and the platform to the second side of the base and the platform.

2. The support applicator cartridge of claim 1, wherein: The platform is compressible.

3. The support applicator cartridge assembly of claim 1, wherein: The platform tapers continuously from the distal platform portion toward the proximal platform portion.

4. The support applicator magazine according to claim 1 further includes one or more alignment features, which are configured to guide the curved end of the end actuator so that the end actuator is aligned with the one or more support components configured to be supported on the platform.

5. The support applicator cartridge of claim 4, wherein: Clamping the end effector on the platform causes the curved tip of the end effector to contact the one or more alignment features to align the end effector with the one or more buttress assemblies.

6. The support applicator cartridge of claim 4, wherein: The one or more alignment features are located on an edge of the opening.

7. The support applicator magazine according to claim 4 further includes a shell assembly, which defines a channel configured to accommodate the end actuator, wherein the channel includes a distal end defined by two lateral sides, and wherein the one or more alignment features are located on the two lateral sides.

8. The support applicator cartridge of claim 4, wherein: The one or more alignment features include a spacing that decreases non-linearly from proximal to distal.

9. The support applicator cartridge of claim 4, wherein: The one or more alignment features are formed with or connected to the base.

10. The support applicator cartridge of claim 4, wherein: The one or more alignment features include a pair of resiliently biased self-centering lateral side arms.

11. The support applicator cartridge of claim 4, wherein: The one or more alignment features include a tapered surface configured to contact a tapered side of the curved tip of the end effector when the end effector is clamped to the platform.

12. The support applicator cartridge of claim 11, wherein: The tapered surface of the alignment feature tapers from proximal to distal.

13. The support applicator cartridge of claim 1, wherein: The opening is formed in the platform.

14. The support applicator cartridge of claim 1, wherein: The opening is defined by a space between the platform and the base.

15. The support applicator cartridge of claim 1, wherein: The adhesive selectively attaches the one or more buttress components to the end effector.

16. The support applicator cartridge of claim 1, wherein: The curved end of the end effector is a dissecting end.

17. The support applicator magazine according to claim 1 also includes a movable sliding member, each of which includes a pair of arms, and the pair of arms are configured to be contacted by the end actuator to drive the movable sliding member laterally relative to the platform, thereby releasing the one or more support components for application to the end actuator.

18. The support applicator of claim 1, wherein: The platform includes a stop along the proximal portion, wherein the stop is configured to prevent the first jaw and the second jaw of the end effector from prematurely making substantial contact with the platform prior to clamping the end effector.

19. A buttress applicator cartridge assembly configured for use with an end effector of a surgical stapler, wherein the buttress applicator cartridge assembly comprises: (a) a support applicator compartment, the support applicator compartment comprising: (i) a base defining an opening extending in a longitudinal direction such that the opening is configured to receive the end effector, (ii) a platform extending longitudinally from the proximal platform portion to the distal platform portion and operatively connected to the base, (iii) an opening extending laterally from a first side of the base and platform to a second side of the base and platform opposite the first side of the base and platform, wherein the opening is sized and configured to receive a curved tip of the end effector to allow at least a portion of the curved tip to extend from the first side of the base and platform to the second side of the base and platform, and (iv) an alignment feature configured to guide the curved tip of the end effector during clamping of the end effector on the platform so that the end effector is substantially centered along its longitudinal length relative to the platform; and (b) a support assembly, the support assembly comprising: (i) a support supported by the platform, and (ii) an adhesive located on a surface of the buttress, wherein the adhesive is configured to selectively adhere the buttress assembly to the jaws of the end effector when the end effector is clamped on the platform.

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