Compressible non-fibrous adjuncts

Abstract

Stapling assemblies for use with surgical staplers are provided. In one exemplary embodiment, the stapling assembly includes a cartridge (4502) having a plurality of staples disposed therein and a non-fibrous adjunct (4500) formed from at least one fused bioabsorbable polymer and configured to be releasably retained on the cartridge. An adjunct system for use with a surgical stapler is also provided. Surgical end effectors using the stapling assembly are also provided. Methods for manufacturing and using the stapling assembly are also provided.

Description

[0001] Cross-reference to related applications

[0002] This application claims priority to U.S. Provisional Patent Application No. 62 / 900,708, filed September 16, 2019, entitled “Bioabsorbable Resin for Additive Manufacturing”; U.S. Provisional Patent Application No. 62 / 913,227, filed October 10, 2019, entitled “Bioabsorbable Resin for Additive Manufacturing”; and U.S. Provisional Patent Application No. 63 / 053,863, filed July 20, 2020, entitled “Compressible 3D Printed Scaffolds”, the entire disclosure of which is incorporated herein by reference. Technical Field

[0003] Compressible non-fibrous appendages and methods for manufacturing and using such compressible non-fibrous appendages are provided. Background Technology

[0004] Surgical sutures are used in surgical procedures to close openings in tissues, blood vessels, catheters, shunts, or other objects or body parts involved in a particular surgical procedure. These openings can be naturally occurring, such as passages in blood vessels or internal organs similar to the stomach, or they can be created by a surgeon during the surgical procedure, such as by puncturing tissue or blood vessels to create bypasses or anastomoses or by cutting tissue during suturing.

[0005] Some surgical staplers require the surgeon to select the appropriate staple with the correct staple height for the tissue being sutured. For example, the surgeon may choose a long staple for thick tissue and a short staple for thin tissue. However, in some cases, the tissue being sutured does not have a uniform thickness, so the staple cannot achieve the desired firing configuration at every staple site. Consequently, the desired seal cannot be formed at or near all suture sites, allowing blood, air, gastrointestinal fluids, and other fluids to leak through the unsealed areas.

[0006] Furthermore, like other objects and materials that can be implanted using suture-like surgical techniques, nails, which act as recessed channels, often lack some of the characteristics of the tissue they are implanted in. For example, nails and other objects and materials may lack the natural flexibility of the tissue they are implanted in, and therefore cannot withstand the varying intra-tissue pressure at the implantation site. This can lead to undesirable tissue tearing at or near the suture site, and consequently, leakage.

[0007] Therefore, there is still a need for improved instruments and methods to address the current problems with surgical sutures. Summary of the Invention

[0008] An appendage system for a surgical suture device is provided. In one exemplary embodiment, the appendage system includes a first appendage and a second appendage. The first appendage is configured to be releasably retained on a first staple cartridge, the first appendage being formed of a first plurality of repeatedly interconnected cells such that the first appendage experiences strain within a first range under applied stress in the range of 30 kPa to 90 kPa. The second appendage, distinct from the first appendage and configured to be releasably retained on a second staple cartridge, is formed of a second plurality of repeatedly interconnected cells such that the second appendage experiences strain within a second range under applied stress in the range of 30 kPa to 90 kPa. At least a portion of the first range overlaps with the second range, wherein the combined range of the first and second ranges is at least 0.1 to 0.9.

[0009] In some implementations, the combined range of the first and second ranges can be at least 0.1 to 0.7.

[0010] The first plurality of interconnected cells can have various configurations. For example, in some embodiments, the first plurality of interconnected cells can be formed of a first material, and the second plurality of interconnected cells can be formed of a second material different from the first material. In other embodiments, each cell in the first plurality of interconnected cells can have a first geometry, wherein each cell in the second plurality of interconnected cells can have a second geometry different from the first geometry. In some embodiments, at least one of the first plurality of interconnected cells and the second plurality of interconnected cells can include a triple-periodic minimal surface structure.

[0011] In some embodiments, at least one of the first plurality of interconnected cells and the second plurality of interconnected cells may include a Schwarz-P structure. In other embodiments, each cell in the first plurality of interconnected cells may be a first Schwarz-P structure, and each cell in the second plurality of interconnected cells may be a second Schwarz-P structure different from the first Schwarz-P structure.

[0012] In some embodiments, each of the first plurality of repeatedly interconnected cells may include a first top portion, a first bottom portion, and a first spacer connecting the first top portion and the first bottom portion, the first top portion being formed by the first plurality of spacers defining a first plurality of openings between the first plurality of spacers, and the first bottom portion being formed by a second plurality of spacers defining a second plurality of openings between the second plurality of spacers. In some embodiments, the second plurality of repeatedly interconnected cells may include a Schwarz-P structure. In other embodiments, each of the second plurality of repeatedly interconnected cells may include a second top portion, a second bottom portion, and a second spacer connecting the second top portion and the second bottom portion, the second top portion being formed by a third plurality of spacers defining a third plurality of openings between the third plurality of spacers, and the second bottom portion being formed by a fourth plurality of spacers defining a fourth plurality of openings between the fourth plurality of spacers.

[0013] The first and second appendages can have various configurations. For example, in some embodiments, the first appendage may be formed from a first bioabsorbable polymer, and the second appendage may be formed from a second bioabsorbable polymer. In such embodiments, the first and second bioabsorbable polymers may each comprise polylactide (PLA), polycaprolactone (PCL), polyglycolic acid (PGL), polydioxanone (PDO), polytrimethylene carbonate (PTMC), polyethylene glycol (PEG), polyethylene diglycolate (PEDG), polypropylene fumarate (PPF), poly(ethoxyethylene diglycolate), poly(ether ester) (PEE), poly(amino acid), copolymers thereof, or any combination thereof. In other embodiments, at least one of the first and second bioabsorbable polymers may be formed from a photopolymerizable resin. In some embodiments, the photopolymerizable resin may include a (meth)acrylate-terminated bioabsorbable polyester oligomer present in an amount of 5% to 90% by weight of the resin, one or more non-reactive diluents present in an amount of 1% to 70% by weight of the resin, and one or more photoinitiators present in an amount of 0.1% to 4% by weight of the resin. In some embodiments, the photopolymerizable resin may also include one or more reactive diluents present in an amount of 1% to 50% by weight of the resin. In other embodiments, the photopolymerizable resin may also include one or more fillers present in an amount of 1% to 50% by weight of the resin. In some embodiments, the photopolymerizable resin may also include one or more additional crosslinking agents present in an amount of 1% to 10% by weight of the resin.

[0014] In some embodiments, the first and second appendages may each have an average length of 20 mm to 100 mm. In some embodiments, the first and second appendages may each have an average width of 5 mm to 10 mm. In other embodiments, the first and second appendages may each have an average thickness of 1 mm to 8 mm. In some embodiments, at least one of the first and second appendages may include a fragile label formed during manufacturing, wherein the label has a unique identifier. Attached Figure Description

[0015] The invention will be more fully understood from the following detailed description taken in conjunction with the accompanying drawings, in which:

[0016] Figure 1 A perspective view of an exemplary embodiment of a conventional surgical suturing and cutting instrument;

[0017] Figure 2A To and Figure 1 A top view of a staple cartridge used in conjunction with surgical suturing and cutting instruments;

[0018] Figure 2B for Figure 2A Side view of the staple cartridge;

[0019] Figure 2C for Figure 2A A perspective view of a portion of the tissue contact surface of the staple cartridge;

[0020] Figure 3 It can be set to Figure 4 A side view of the staple cartridge of the surgical cartridge assembly in an unfired (pre-deployed) configuration with staples in the cartridge.

[0021] Figure 4 for Figure 1 A perspective view of the scalpel and firing pin (“E-beam”) of a surgical suturing and cutting instrument;

[0022] Figure 5 for Figure 1 A perspective view of the wedge-shaped slide of the staple cartridge for surgical suturing and cutting instruments;

[0023] Figure 6A A longitudinal cross-sectional view of an exemplary embodiment of a surgical cartridge assembly having compressible non-fibrous appendages attached to the top surface or platform surface of the staple cartridge;

[0024] Figure 6B This is a longitudinal sectional view of a surgical end effector having an anvil pivotally connected to a narrow pin channel and Figure 6AThe surgical chamber assembly is set within and connected to the slender screw channel, and the figure shows the anvil in a closed position with no tissue between the anvil and the appendage;

[0025] Figure 7 To show Figures 6A to 6B A partial schematic diagram of an appendage under organizational deployment conditions;

[0026] Figure 8A This is a perspective view of another exemplary embodiment of a compressible non-fibrous appendage;

[0027] Figure 8B for Figure 8A Side view of the appendages;

[0028] Figure 8C for Figure 8A A top view of the appendages;

[0029] Figure 8D for Figure 8C A cross-sectional view of the appendage taken at point 8D-8D along the line;

[0030] Figure 8E for Figure 8C A cross-sectional view of the appendage taken at point 8E-8E along the line;

[0031] Figure 8F for Figure 8C An enlarged view of a portion of the appendage taken at 8F;

[0032] Figure 8G To show Figure 8A A partial schematic diagram of the appendages in an organized deployment state;

[0033] Figure 9A for Figure 8A A side view of a single cell of an appendage;

[0034] Figure 9B for Figure 9A A perspective view of a single cell;

[0035] Figure 10A This is a schematic diagram of an example cell in a pre-compressed state;

[0036] Figure 10B for Figure 10A A diagram illustrating the cells in the first compressed state;

[0037] Figure 10C for Figure 10A A diagram illustrating the cells in the second compression state;

[0038] Figure 10D for Figure 10AA diagram illustrating a cell in a dense state;

[0039] Figure 11 for Figures 10A to 10D A schematic diagram showing the relationship between the state of the cells and the stress-strain curve of the resulting compressible non-fiber appendages;

[0040] Figure 12A A top view of an exemplary embodiment of a compressible non-fiber appendage formed by repeating cells of an embodiment of a modified Schwarz-P structure;

[0041] Figure 12B A top view of an exemplary embodiment of a compressible non-fiber appendage formed by repeating cells of another embodiment of the modified Schwarz-P structure;

[0042] Figure 12C A top view of an exemplary embodiment of a compressible non-fiber appendage formed by repeating cells of another embodiment of the modified Schwarz-P structure;

[0043] Figure 12D A top view of an exemplary embodiment of a compressible non-fiber appendage formed by repeating cells of another embodiment of the modified Schwarz-P structure;

[0044] Figure 13A A perspective view of another exemplary implementation of a single cell;

[0045] Figure 13B For the reason Figure 13A A top view of an exemplary embodiment of a compressible non-fiber appendage formed by repeating cells;

[0046] Figure 14A A perspective view of another exemplary implementation of a single cell;

[0047] Figure 14B For the reason Figure 14A A top view of an exemplary embodiment of a compressible non-fiber appendage formed by repeating cells;

[0048] Figure 15A A perspective view of another exemplary implementation of a single cell;

[0049] Figure 15B For the reason Figure 15A A top view of an exemplary embodiment of a compressible non-fiber appendage formed by repeating cells;

[0050] Figure 16A A perspective view of another exemplary implementation of a single cell;

[0051] Figure 16B For the reason Figure 16A A top view of an exemplary embodiment of a compressible non-fiber appendage formed by repeating cells;

[0052] Figure 17A A perspective view of another exemplary embodiment of a compressible non-fibrous appendage;

[0053] Figure 17B for Figure 17A A cross-sectional view of the appendages taken at line 17B-17B;

[0054] Figure 17C for Figure 17A A cross-sectional view of the appendage taken at point 17C-17C along the line;

[0055] Figure 18 A perspective view of another exemplary embodiment of a compressible non-fibrous appendage disposed on a staple cartridge;

[0056] Figure 19A A perspective view of another exemplary embodiment of a compressible non-fibrous appendage having a channel attachment;

[0057] Figure 19B for Figure 19A A cross-sectional view of the appendages taken at line 19B-19B;

[0058] Figure 20 A partial perspective view of another exemplary embodiment of a compressible non-fibrous appendage having a channel attachment;

[0059] Figure 21 A partial perspective view of another exemplary embodiment of a compressible non-fibrous appendage having a channel attachment;

[0060] Figure 22A The following is a partially exploded perspective view of an exemplary embodiment of a suture assembly having compressible non-fibrous appendages releasably held on a staple cartridge, each compressible non-fibrous appendage having a corresponding edge attachment feature.

[0061] Figure 22B An enlarged cross-sectional view taken at line 22B to 22B of a portion of the suture assembly shows the two edge attachment features prior to joining;

[0062] Figure 22C for Figure 22B A cross-sectional view of a portion of the suture assembly, showing the two edge attachment features joined together;

[0063] Figure 23AThis is a perspective view of another exemplary embodiment of a suture assembly having compressible non-fibrous appendages releasably held on a staple cartridge, each compressible non-fibrous appendage having a corresponding edge attachment feature, the figure showing the joined edge attachment features;

[0064] Figure 23B for Figure 23B A magnified view of a portion of the suture assembly;

[0065] Figure 24 A perspective view of another exemplary embodiment of a staple cartridge having end attachment features;

[0066] Figure 25 A perspective view of another exemplary embodiment of a staple cartridge having end attachment features;

[0067] Figure 26A An exploded view of another exemplary embodiment of a suture assembly having a staple cartridge and a compressible non-fibrous appendage, wherein the attachment features are releasably held on the compressible non-fibrous appendage;

[0068] Figure 26B for Figure 26A A cross-sectional view of the suture assembly taken at line 26B-26B;

[0069] Figure 26C for Figure 26A A cross-sectional view of the suture assembly taken at line 26C-26C;

[0070] Figure 27 This is a partial cross-sectional view of another exemplary embodiment of a suture assembly having a compressible non-fibrous appendage that can be releasably held on the staple cartridge;

[0071] Figure 28A This is a partial cross-sectional view of another exemplary embodiment of a suture assembly having a compressible non-fibrous appendage that can be releasably held on the staple cartridge;

[0072] Figure 28B To show Figure 28A A partial schematic diagram of an appendage under organizational deployment conditions;

[0073] Figure 29 This is a partial cross-sectional view of another exemplary embodiment of a suture assembly having a compressible non-fibrous appendage that can be releasably held on the staple cartridge;

[0074] Figure 30A A perspective view of another exemplary embodiment of a compressible non-fibrous appendage;

[0075] Figure 30B for Figure 30AFront plan view of the appendages;

[0076] Figure 31A A perspective view of one embodiment of a compressible non-fibrous appendage;

[0077] Figure 31B for Figure 31A A perspective view of a single cell of an appendage;

[0078] Figure 31C for Figure 31B The side view of the cell;

[0079] Figure 31D for Figures 31B to 31C An alternative side view of the cell;

[0080] Figure 32A A perspective view of another exemplary embodiment of a compressible non-fibrous appendage;

[0081] Figure 32B for Figure 32A A perspective view of a single cell of an appendage;

[0082] Figure 32C for Figure 32B The side view of the cell;

[0083] Figure 32D for Figures 32B to 32C The cell along Figure 32C Top view of the cross-section at the point where line 32D-32D is cut;

[0084] Figure 33A A perspective view of another exemplary embodiment of a compressible non-fibrous appendage;

[0085] Figure 33B for Figure 33A A perspective view of a single cell of an appendage;

[0086] Figure 33C for Figure 33B The side view of the cell;

[0087] Figure 33D for Figures 33B to 33C The cell along Figure 33C Top view of the cross-section at the 33D-33D section;

[0088] Figure 33E for Figures 33B to 33C An alternative side view of the cell;

[0089] Figure 34A A perspective view of another exemplary embodiment of a compressible non-fibrous appendage;

[0090] Figure 34Bfor Figure 34A A perspective view of a single cell of an appendage;

[0091] Figure 34C for Figure 34B The side view of the cell;

[0092] Figure 34D for Figures 34B to 34C A top view of the cell;

[0093] Figure 34E for Figures 34B to 34C An alternative side view of the cell;

[0094] Figure 35 A perspective view of another exemplary implementation of the cell;

[0095] Figure 36 A perspective view of another exemplary implementation of the cell;

[0096] Figure 37A A partial exploded perspective view of another exemplary embodiment of a suture assembly having a staple cartridge and compressible non-fibrous appendages;

[0097] Figure 37B for Figure 37A A cross-sectional view of a portion of the suture assembly taken at line 37B-37B;

[0098] Figure 38A for Figure 37B A schematic diagram of a portion of a suture assembly, showing tissue attached to an appendage;

[0099] Figure 38B To show Figure 37A A partial schematic diagram of an appendage under organizational deployment conditions;

[0100] Figure 39A An exploded view of an exemplary embodiment of a suture assembly having a staple cartridge and an appendage, wherein only the second outer layer of the appendage is shown;

[0101] Figure 39B for Figure 39A Front view of the stitching assembly;

[0102] Figure 40 A perspective view of another exemplary embodiment of the suture assembly, which has a compressible non-fibrous appendage releasably retained on the staple cartridge;

[0103] Figure 41A A perspective view of another exemplary embodiment of a compressible non-fibrous appendage;

[0104] Figure 41B for Figure 41AA cross-sectional view of a portion of an appendage that is cut off at line 41B-41B and releasably held on the staple cartridge;

[0105] Figure 41C for Figure 41A A cross-sectional view of a portion of an appendage that is cut off at line 41C-41C and releasably held on the staple cartridge;

[0106] Figure 42A A perspective view of another exemplary embodiment of a compressible non-fibrous appendage;

[0107] Figure 42B To show Figure 42A A partial schematic diagram of an appendage under organizational deployment conditions;

[0108] Figure 43A A perspective view of another exemplary embodiment of a compressible non-fibrous appendage;

[0109] Figure 43B for Figure 43A A cross-sectional view of the appendage taken at line 43B-43B;

[0110] Figure 44A A cross-sectional view of another exemplary embodiment of a compressible non-fibrous appendage, showing only a portion of the appendage releasably held on the staple cartridge;

[0111] Figure 44B To illustrate being clamped in the anvil and Figure 44A A partial schematic diagram of the organization between a portion of the appendages, wherein the staples are partially deployed from the staple cartridge through the appendages;

[0112] Figure 44C To show Figure 44A A partial schematic diagram of an appendage under organizational deployment conditions;

[0113] Figure 45A A partially exploded perspective view of another exemplary embodiment of a suture assembly having a compressible non-fibrous appendage releasably retained on the staple cartridge;

[0114] Figure 45B for Figure 45A A top view of a portion of the stitching assembly;

[0115] Figure 45C for Figure 45B A cross-sectional view of the suture assembly taken at 45°C-45°C.

[0116] Figure 46A A perspective view of another exemplary embodiment of a suture assembly having a compressible non-fibrous appendage releasably held on a staple cartridge;

[0117] Figure 46B for Figure 46A A top view of a portion of the stitching assembly;

[0118] Figure 47A A cross-sectional front view of an exemplary embodiment of a surgical end effector having an anvil and a suture assembly having a compressible non-fibrous appendage releasably held on a staple cartridge. The figure illustrates a surgical end effector in a closed position with no tissue positioning between the anvil and the suture assembly.

[0119] Figure 47B for Figure 47A A cross-sectional front view of the surgical end effector shows tissue held between the anvil and the suture assembly and sutured to a compressible non-fibrous appendage;

[0120] Figure 47C for Figure 47A A front view of the cross-section of only the stitched components;

[0121] Figure 48A A cross-sectional front view of another exemplary embodiment of a surgical end effector having an anvil and a suture assembly having a compressible non-fibrous appendage releasably held on a staple cartridge. The figure illustrates a surgical end effector in a closed position with no tissue positioning between the anvil and the suture assembly.

[0122] Figure 48B for Figure 48A A cross-sectional front view of the surgical end effector, showing tissue held between the anvil and the suture assembly and sutured to a compressible non-fibrous appendage;

[0123] Figure 48C for Figure 48A A front view of the cross-section of only the stitched components;

[0124] Figure 49 A perspective view of another exemplary embodiment of a compressible non-fibrous appendage;

[0125] Figure 50A A side view of an exemplary embodiment of a surgical end effector having an anvil and a suture assembly having a compressible non-fibrous appendage releasably held on a staple cartridge. The figure illustrates a surgical end effector in a closed position with no tissue positioning between the anvil and the suture assembly.

[0126] Figure 50B for Figure 50A A side view of the surgical end effector, showing tissue held between the anvil and the suture assembly;

[0127] Figure 50C for Figure 50AA side view of only the stitched components;

[0128] Figure 51A A cross-sectional front view of another exemplary embodiment of a surgical end effector having an anvil and a suture assembly having a compressible non-fibrous appendage releasably held on a staple cartridge. The figure illustrates a surgical end effector in a closed position with no tissue positioning between the anvil and the suture assembly.

[0129] Figure 51B for Figure 51A A front view of a section of only compressible non-fibrous appendages;

[0130] Figure 52A A cross-sectional front view of another exemplary embodiment of a surgical end effector having an anvil and a suture assembly having a compressible non-fibrous appendage releasably held on a staple cartridge. The figure illustrates a surgical end effector in a closed position with no tissue positioning between the anvil and the suture assembly.

[0131] Figure 52B for Figure 52A A magnified front view of a section of only a portion of the suture assembly;

[0132] Figure 53 A cross-sectional view of a portion of another exemplary embodiment of a compressible, non-fibrous appendage that can be releasably held on a staple cartridge;

[0133] Figure 54 A cross-sectional view of a portion of another exemplary embodiment of a compressible non-fibrous appendage releasably held on a staple cartridge, showing only three staples from three staple rows of the staple cartridge;

[0134] Figure 55 for Figure 54 A schematic diagram of the stress-strain curves of the appendage at each of the three nails;

[0135] Figure 56 A graph illustrating the stress-strain curves of the exemplary compressible non-fibrous appendages (appendage 1) of Examples 9 and 10;

[0136] Figure 57 A graph illustrating the stress-strain curves of the exemplary compressible non-fibrous appendages (appendages 2-5) of Examples 9 and 10; and

[0137] Figure 58 A graph illustrating the stress-strain curves of six exemplary embodiments of the compressible non-fibrous appendage of Example 11. Detailed Implementation

[0138] Certain exemplary embodiments will now be described to provide a full understanding of the principles of structure, function, manufacture, and use of the appendages, systems, and methods disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. Those skilled in the art will understand that the appendages, systems, and methods specifically described herein and illustrated in the drawings are non-limiting exemplary embodiments, and that the scope of the invention is defined only by the claims. Features shown or described in conjunction with one exemplary embodiment may be combined with features of other embodiments. Such modifications and variations are intended to be included within the scope of the invention.

[0139] Surgical suture assemblies and methods of manufacturing and using them are provided. Typically, a surgical suture assembly may include a staple cartridge configured to be releasably held on the cartridge by a compressible, bioresorbable, non-fibrous appendage, and staples are disposed within the cartridge. In some embodiments, the non-fibrous appendage may be formed from a matrix comprising at least one molten bioresorbable polymer, and thus the non-fibrous appendage may be three-dimensionally printed. In other embodiments, the non-fibrous appendage may be partially or completely formed by any suitable non-additive manufacturing process, such as injection molding, foaming, and molding processes as understood by those skilled in the art. As discussed herein, various appendages may be configured to compensate for variations in tissue properties (such as variations in tissue thickness) and / or promote inward tissue growth when the appendage is sutured to the tissue. For example, an appendage may be configured to cause the appendage to experience a strain in the range of about 0.1 (10% deformation) to 0.9 (90% deformation) when subjected to an applied stress in the range of about 30 kPa to 90 kPa. In other words, when the appendage described herein is subjected to stress between (and / or including) about 30 kPa and 90 kPa, for example, when the appendage is in a deployed state, the appendage can be configured to undergo deformation from about 10% to 90%.

[0140] Exemplary suture assemblies may include various features to facilitate the application of surgical staples, as described herein and illustrated in the accompanying drawings. However, those skilled in the art will recognize that suture assemblies may include only some of these features and / or may include several other features known in the art. The suture assemblies described herein are intended merely to illustrate certain exemplary embodiments. Furthermore, while the appendages are described in conjunction with surgical staple cartridge assemblies, the appendages may be used in conjunction with staple reloaders or any type of surgical instrument that is not based on a staple cartridge.

[0141] Figure 1An exemplary surgical suturing and cutting device 100 suitable for use with implantable appendages is shown. The illustrated surgical suturing and cutting device 100 includes a nail application assembly 106 or end effector having an anvil 102 pivotally coupled to an elongated nail channel 104. Thus, the nail application assembly 106 can be in an open position (e.g., Figure 1 (As shown) the movement between a closed position and a closed position, wherein the anvil 102 is positioned adjacent to the elongated nail channel 104 to engage tissue therebetween. The nail application assembly 106 may be attached at its proximal end to the elongated shaft 108 forming the tool portion 110. When the nail application assembly 106 is closed or at least substantially closed (e.g., the anvil 102 moves from...), Figure 1 (The open position in the middle moves toward the narrow nail channel), the tool portion 110 can present a cross section small enough to allow the nail application component 106 to be inserted through the cannula. Although the device 100 is configured to suture and cut tissue, surgical devices configured to suture but not cut tissue are also considered herein.

[0142] In various configurations, the nail application assembly 106 can be operated by a handle 112 connected to an elongated shaft 108. The handle 112 may include: user controls such as a knob 114 that rotates the elongated shaft 108 and the nail application assembly 106 about the longitudinal axis of the elongated shaft 108; and a closing trigger 116 that is pivotable relative to a pistol grip 118 to close the nail application assembly 106. For example, when the closing trigger 116 is clamped, a closing release button 120 may be present outwardly on the handle 112 such that the closing release button 120 can be pressed down to release the closing trigger 116 and open the nail application assembly 106.

[0143] The firing trigger 122, pivotable relative to the closing trigger 116, allows the staple application assembly 106 to simultaneously cut and suture the tissue clamped therein. In various applications, the firing trigger 122 can be used to employ multiple firing strokes to reduce the amount of force required by the surgeon's hand per stroke. In some embodiments, the handle 112 may include one or more rotatable indicator wheels, such as a rotatable indicator wheel 124 indicating firing progress. If desired, a manual firing release lever 126 allows the firing system to retract before full firing progression is complete, and furthermore, in the event of jamming and / or failure of the firing system, the firing release lever 126 allows the surgeon or other clinician to retract the firing system.

[0144] Additional details regarding the surgical suturing and cutting device 100 and other surgical suturing and cutting devices suitable for use with this disclosure are described, for example, in U.S. Patent No. 9,332,984 and U.S. Patent Publication No. 2009 / 0090763, the entire disclosure of which is incorporated herein by reference. Additionally, the surgical suturing and cutting device does not necessarily include a handle, but may have a housing configured to be coupled to a surgical robot, for example, as described in U.S. Patent Application No. 2019 / 0059889, the entire disclosure of which is incorporated herein by reference.

[0145] like Figure 1 As further shown, the staple cartridge 200 can be used with the instrument 100. In use, the staple cartridge 200 is placed within and connected to the elongated staple channel 104. Although the staple cartridge 200 can have various configurations, in this illustrated embodiment, Figures 2A to 2B The staple cartridge 200, shown in more detail, has a proximal end 202a and a distal end 202b, wherein the longitudinal axis (L) C ) extends therein. Therefore, when the staple cartridge 200 is inserted into the elongated staple channel 104 ( Figure 1 When ), the longitudinal axis (L) C ) and the longitudinal axis (L) of the slender shaft 108 S Alignment. Additionally, the pellet magazine 200 includes a longitudinal slot 210 defined by two opposing walls 210a, 210b and configured to receive at least a portion of the firing member of the firing assembly, such as... Figure 4 The firing assembly 400 is discussed further below. As shown, a longitudinal slot 202 extends from the proximal end 202a of the staple cartridge 200 toward the distal end 202b. In other embodiments, the longitudinal slot 202 may be omitted.

[0146] The illustrated staple cartridge 200 includes staple cavities 212, 214 defined therein, each staple cavity 212, 214 being configured to removably accommodate at least a portion of a staple (not shown). The number, shape, and location of the staple cavities can vary and may depend at least on the size and shape of the staples removably disposed therein. In this illustrated embodiment, the staple cavities are arranged in two sets of three longitudinal rows, wherein the first set of staple cavities 212 is positioned on a first side of the longitudinal slot 210, and the second set of staple cavities 214 is positioned on a second side of the longitudinal slot 210. On each side of the longitudinal slot 210, and thus for each row, the staple cavities 212a, 214a of the first longitudinal row extend along the longitudinal slot 210, the staple cavities 212b, 214b of the second row extend along the staple cavities 212a, 214b of the first row, and the staple cavities 212c, 214c of the third row extend along the staple cavities 212b, 214b of the second row. For each row group, the first row of nail cavities 212a, 214b, the second row of nail cavities 212b, 214b, and the third row of nail cavities 214c, 214c are parallel to each other and to the longitudinal slot 210. Additionally, as shown, for each row group, the second row of nail cavities 212b, 214b are staggered relative to the first row of nail cavities 212a, 212c and the third row of nail cavities 214a, 214c. In other embodiments, the rows of nail cavities 212, 214 in each group are not parallel to each other and / or to the longitudinal slot 210.

[0147] The nails releasably stored in the nail cavities 212, 214 can have various configurations. An exemplary nail 300 that can be releasably stored in each of the nail cavities 212, 214 is shown in its unfired (pre-deployed, unformed) configuration. Figure 3 The illustrated nail 300 includes a crown (base) 302 and two legs 304 extending from each end of the crown 302. In this embodiment, the crown 302 extends in a linear direction, and the nail legs 304 have the same unshaped height; in other embodiments, the crown may be a stepped crown, such as a similar... Figure 28A The crowns in the figures 2804c, 2806c, and 2808c, and / or the legs may have different unformed heights (see [reference]). Figure 29 Additionally, before the nail 300 is deployed, the nail crown 302 may be supported by a nail driver positioned within the nail cartridge 200, and simultaneously, the nail legs 304 may be at least partially accommodated within the nail cavities 212, 214. Furthermore, when the nail 300 is in its unfired position, the nail legs 304 may extend beyond the top surface of the nail cartridge 200, such as the top surface 206. In some cases, such as... Figure 3 As shown, the end 306 of the nail leg 304 can be sharp and pointed, which can cut into and penetrate tissue.

[0148] In use, the nail 300 can deform from an unfired position to a firing position, causing the nail legs 304 to move through the nail cavities 212, 214, penetrate the tissue positioned between the anvil 102 and the nail cartridge 200, and contact the anvil 102. As the nail legs 304 deform against the anvil 102, each nail leg 304 can capture a portion of tissue within each nail 300 and apply compressive force to that tissue. Additionally, each nail leg 304 can deform downwards toward the crown 302 of the nail 300 to form a nail retention area in which tissue can be captured. In various cases, the nail retention area can be defined between the inner surface of the deformed leg and the inner surface of the crown of the nail. For example, the size of the nail retention area can depend on several factors, such as the length of the leg, the diameter of the leg, the width of the crown, and / or the degree of leg deformation.

[0149] In some embodiments, all staples disposed within the staple cartridge 200 may have the same unfired (pre-deployed, unshaped) configuration. In other embodiments, the staples may include at least two sets of staples, each set having a different unfired (pre-deployed, unshaped) configuration relative to each other, for example, varying in height and / or shape relative to each other. For example, the staple cartridge 200 may include a first set of staples disposed in a first row of staple cavities 212a, 214a with a first height, a second set of staples disposed in a second row of staple cavities 212b, 214b with a second height, and a third set of staples disposed in a third row of staple cavities 212c, 214c with a third height. In some embodiments, the first height, second height, and third height may be different, wherein the third height is greater than the first height and the second height. In other embodiments, the first height and the second height are the same, but the third height is different and greater than the first height and the second height. Those skilled in the art will understand that other combinations of staples are considered herein.

[0150] Additionally, the nail may include one or more external coatings, such as sodium stearate lubricant and / or an antimicrobial agent. The antimicrobial agent may be applied to the nail as a coating on its own or incorporated into another coating, such as a lubricant. Non-limiting examples of suitable antimicrobial agents include 5-chloro-2-(2,4-dichlorophenoxy)phenol, chlorhexidine, silver preparations (e.g., nanocrystalline silver), ethyl arginine laurylate (LAE), ostinidine, polyhexamethylene biguanide (PHMB), taurine, lactic acid, citric acid, acetic acid, and their salts.

[0151] Re-reference Figures 2A to 2B The staple cartridge 200 extends from a top surface or platform surface 206 to a bottom surface 208, wherein the top surface 206 is configured to face the tissue, and the bottom surface 208 is configured to face the channel. Therefore, when the staple cartridge 200 is inserted into the elongated staple channel 104, as... Figure 1As shown, the top surface 206 faces the anvil 102, and the bottom surface 208 (which is obscured) faces the elongated nail channel 104.

[0152] In some embodiments, the top surface 206 may include surface features defined therein. For example, the surface feature may be a recessed channel defined within the top surface 206. Figure 2C As shown in more detail, a first recessed channel 216 surrounds each first nail cavity 212a, 214a. Each first recessed channel 216 is defined by a generally triangular wall 216a having a proximal vertex, a distal vertex, and a laterally outward vertex. Additionally, each first recessed channel 216 includes a first base plate 206a at a first height from the top surface 206. A second recessed channel 218 surrounds each second nail cavity 212b, 214b. Each second recessed channel 218 is defined by a generally rhomboid wall 218a including a proximal vertex, a distal vertex, a laterally inward vertex, and a laterally outward vertex relative to the longitudinal axis. Additionally, each second recessed channel 218 includes a second base plate 206b at a second height from the top surface 206. A third recessed channel 220 surrounds each third nail cavity 212c, 214c. Each third recessed channel 220 is defined by a substantially triangular wall 220a, which includes a proximal vertex, a distal vertex, and a laterally inward vertex relative to a longitudinal axis. Additionally, each third recessed channel 220 includes a third base plate 206c at a third height from the top surface 206. In some embodiments, the first height of the first recessed channel 216, the second height of the second recessed channel 218, and the third height of the third recessed channel 220 may have the same height. In other cases, the first height, the second height, and / or the third height may be different. Additional details regarding surface features and other exemplary surface features can be found in U.S. Patent No. 2016 / 0106427, the entire contents of which are incorporated herein by reference. Furthermore, as will be discussed in more detail below, these recessed channels 216, 218, 220 can be used to interact with appendages, such as… Figures 26A to 26C The attachment 2600 is releasably held on the top surface of the compartment prior to nail deployment.

[0153] refer to Figure 4 and Figure 5 Firing components such as firing component 400 can be used with surgical suture and cutting devices (such as...) Figure 1 Used together with device 100 in the middle. The firing assembly 400 may be configured to advance a wedge-shaped slide 500 having a wedge 502, which is configured to deploy a nail from the nail magazine 200 to a nail captured in the anvil (e.g., Figure 1 The anvil 102 and the staple cartridge (such as Figure 1 The staples are placed in the tissue between the staple cartridge 200. Furthermore, an E-beam 402 at the distal portion of the firing assembly 400 can fire staples from the staple cartridge. During firing, the E-beam 402 also pivots the anvil toward the staple cartridge, and thus moves the staple application assembly from an open position to a closed position. The illustrated E-beam 402 includes a pair of top pins 404, a pair of intermediate pins 406 that follow a portion 504 of the wedge-shaped slide member 500, and a bottom pin or foot 408. The E-beam 402 may also include a sharp cutting edge 410 configured to cut the captured tissue as the firing assembly 400 advances distally, and thus toward the distal end of the staple cartridge. Furthermore, an integrally formed, proximal-projecting top guide 412 and intermediate guide 414 supporting each vertical end of the cutting edge 410 further define a tissue accumulation area 416, thereby facilitating the guidance of tissue to the sharp cutting edge 410 before cutting the tissue. The intermediate guide 414 can also be used to engage and fire nails in the nail magazine via a stepped central member 506 adjacent to the wedge-shaped slider 500, which influences nail formation via the nail application assembly 106.

[0154] During use, by pressing Figure 1 Closed trigger in the middle to advance Figure 4 E-shaped beam 402 in the middle, Figure 1 The anvil 102 can be moved to a closed position. The anvil can abut the tissue against, as shown in 2A. Figure 2C The staple cartridge 200 is positioned at least on its top surface 206. Once the anvil has been properly positioned, Figure 3 The 300 nails set in the nail pod can then be deployed.

[0155] To deploy nails from the nail repository, as discussed above, Figure 5 The slider 500 can move from the proximal end toward the distal end of the cartridge, and therefore toward the distal end of the staple cartridge. When Figure 4 When the firing assembly 400 is advanced, the slider can contact and lift the staple driver within the staple cartridge upward within the staple cavities 212, 214. In at least one example, the slider and the staple driver may each include one or more ramps or inclined surfaces that cooperate to move the staple driver upward from its unfired position. As the staple drivers are lifted upward within their respective staple cavities, the staples are advanced upward, causing them to emerge from their cavities and penetrate into the tissue. In various cases, as part of a firing sequence, the slider can simultaneously move several staples upward.

[0156] As described above, the suturing device can be used in combination with compressible appendages. Those skilled in the art will understand that although appendages are shown and described below, the appendages disclosed herein can be used with other surgical instruments and do not need to be attached to the staple cartridge as described. Furthermore, those skilled in the art will understand that the staple cartridge does not need to be replaceable.

[0157] As discussed above, for some surgical staplers, surgeons often need to select appropriate staples with suitable staple heights for the tissue to be sutured. For example, surgeons will utilize long staples for thick tissues and short staples for thin tissues. However, in some cases, the tissue to be sutured does not have a uniform thickness, and therefore the staples cannot achieve the desired firing configuration for each section of the sutured tissue (e.g., thick and thin tissue sections). Inconsistent tissue thickness can also lead to undesirable tissue leakage and / or tearing at the staple site, especially when staples with the same or substantially larger heights are used, particularly when the staple site is exposed to intra-tissue pressure at the staple site and / or along the staple line.

[0158] Therefore, various embodiments of non-fibrous appendages are provided, which can be configured to compensate for variations in tissue thickness trapped within the firing (deploying) staples, thus avoiding the need to consider staple height when suturing tissue during surgical procedures. That is, the appendages described herein allow a set of staples of the same or similar height to be used for suturing tissues of varying thicknesses (e.g., from thin to thick tissues), while also providing sufficient tissue compression within and between the firing staples in combination with the appendage. Thus, the appendages described herein maintain appropriate compression of thin or thick tissue sutured to the appendage, thereby minimizing tissue leakage and / or tearing at the suture site.

[0159] Alternatively or otherwise, non-fibrous appendages may be configured to promote inward tissue growth. In various cases, it is desirable to promote inward tissue growth within implantable appendages to facilitate the healing of treated tissue (e.g., sutured tissue and / or cut tissue) and / or accelerate patient recovery. More specifically, inward tissue growth within implantable appendages can reduce the incidence, extent, and / or duration of inflammation at the surgical site. Inward tissue growth within and / or around implantable appendages can control the spread of infection at the surgical site, for example. Inward growth of blood vessels, particularly leukocytes, within and / or around implantable appendages can resist infection in and / or surrounding the implantable appendage and adjacent tissues. Inward tissue growth can also facilitate the acceptance of foreign bodies (e.g., implantable appendages and staples) by the patient's body and reduce the likelihood of the patient's body rejecting the foreign body. Rejection of foreign bodies can lead to infection and / or inflammation at the surgical site.

[0160] Unlike conventional appendages (e.g., non-3D printed appendages such as foam appendages and woven / nonwoven non-fibrous appendages), these non-fibrous appendages are 3D printed and therefore can be formed with consistent and reproducible microstructures (units). That is, unlike other manufacturing methods, 3D printing significantly improves control over microstructural features such as the placement and connection of components. Therefore, the variability of both the microstructure and associated properties of the appendages of the present invention is reduced compared to conventional appendages. For example, the appendages of the present invention can be structured such that they are compressed in a substantially uniform manner by a predetermined amount. Fine control over the microstructure also allows for customization of the appendage's porosity to enhance tissue inward growth. The non-fibrous appendages of the present invention are also suitable for use with a variety of staples and tissue types.

[0161] Generally, the appendages provided herein are designed and positioned on top of a staple cartridge (such as staple cartridge 200). When a staple is fired (deployed) from the cartridge, the staple penetrates the appendage and enters the tissue. As the legs of the staple deform against an anvil positioned opposite the staple cartridge, the deforming legs capture a portion of the appendage and a portion of the tissue within each staple. That is, when the staple is fired into the tissue, at least a portion of the appendage becomes positioned between the tissue and the fired staple. While the appendages described herein may be configured to attach to a staple cartridge, it is also envisioned that the appendages may be configured to mate with the anvil of other instrument components, such as surgical suture devices. Those skilled in the art will understand that the appendages provided herein can be used with replaceable cartridges or non-cartridge-based staple reloaders.

[0162] Methods of suturing tissue

[0163] Figures 6A to 6B An exemplary embodiment of a suture assembly 600 is shown, which includes a staple cartridge 602 and an appendage 604. For simplicity, the appendage 604 is typically... Figures 6A to 6B The various structural configurations of the appendages are shown in the diagram and described in more detail below. Apart from the differences described in detail below, the staple cartridge 602 may be similar to the staple cartridge 200 (…). Figures 1 to 3 Therefore, common features are not described in detail here. As shown in the figure, the appendage 604 is positioned against the staple cartridge 602. Although in Figures 6A to 6B The middle part is partially obscured, but the stinger 602 includes components similar to... Figure 3 The staple 300 has a staple 606, which is configured to be deployed into tissue. The staple 606 may have any suitable unformed (pre-deployment) height. For example, the staple 606 may have an unformed height between about 2 mm and 4.8 mm. Before deployment, the crown of the staple may be supported by a staple driver (not shown).

[0164] In the illustrated embodiments, the appendage 604 may mate with at least a portion of the top surface or platform surface 608 of the staple cartridge 602. In some embodiments, the top surface 608 of the staple cartridge 602 may include one or more surface features, three-dimensional, such as... Figure 2A and Figure 2C The recessed channels 216, 218, and 220 are shown. This one or more surface features may be configured to engage the appendage 604 to prevent undesirable movement of the appendage 604 relative to the staple cartridge 602 and / or to prevent premature release of the appendage 604 from the staple cartridge 602. Exemplary surface features are described in U.S. Patent Publication No. 2016 / 0106427, the entire contents of which are incorporated herein by reference.

[0165] Figure 6B It shows that it was placed with Figure 1 The surgical end effector 106 is similar to the surgical end effector 601, residing within the elongated staple channel 610 and connected to the suture assembly 600 of the elongated staple channel. The anvil 612 is pivotally connected to the elongated staple channel 610 and thus moves between an open and closed position relative to the elongated staple channel 610 (and therefore relative to the staple cartridge 602). Figure 6B The closed position is shown, and the tissue gap T is created between the staple cartridge 602 and the anvil 612. G More specifically, the interstitial space T G The distance between the tissue-compression surface 612a of the anvil 612 (e.g., the tissue engagement surface between the pin-forming recesses in the anvil) and the tissue contact surface 604a of the appendage 604 is defined. In this illustrated embodiment, both the tissue-compression surface 612a of the anvil 612 and the tissue contact surface 604a of the appendage 604 are planar or substantially planar (e.g., planar within manufacturing tolerances). Therefore, when the anvil 612 is in the closed position, as... Figure 6B As shown, when no tissue is placed in it, the tissue gap T G They are typically uniform (e.g., nominally identical within manufacturing tolerances). In other words, the interstitial space T G On the end effector 601 (e.g., in the y-direction), it is typically constant (e.g., constant within manufacturing tolerances). In other embodiments, the tissue-compression surface of the anvil may include a stepped surface having longitudinal steps between adjacent longitudinal portions, thus creating a stepped profile (e.g., in the y-direction). In such embodiments, the tissue gap T G It can change.

[0166] The appendage 604 is compressible to allow for varying heights of compression, thereby compensating for differences in tissue thickness trapped within the deployed staple. The appendage 604 has an uncompressed (undeformed) or pre-deployed height and is configured to deform to one of a plurality of compressed (deformed) or deployed heights. For example, the appendage 604 may have a firing height greater than that of the staple 606 disposed within the staple cartridge 602 (e.g., Figure 7 The uncompressed height (H) of the firing pin 606a. That is, the appendage 604 may have an undeformed state, wherein the maximum height of the appendage 604 is greater than the maximum height of the firing pin (e.g., a pin in a shaped configuration). In one embodiment, the uncompressed height of the appendage 604 may be about 10%, about 20%, about 30%, about 40%, about 50%, about 60%, about 70%, about 80%, about 90%, or about 100% higher than the firing height of the pin 606. In some embodiments, for example, the uncompressed height of the appendage 604 may be more than 100% higher than the firing height of the pin 606.

[0167] During use, once the surgical suture and cutting device (such as...) Figure 1 The device 100 is guided to the surgical site, and tissue is positioned between the anvil 612 and the suture assembly 600, such that the anvil 612 is positioned adjacent to a first side of the tissue, and the suture assembly 600 is positioned adjacent to a second side of the tissue (e.g., the tissue may be positioned against the tissue contact surface 604a of the appendage 604). Once the tissue is positioned between the anvil 612 and the suture assembly 600, the surgical stapler can be actuated, for example as discussed above, to clamp the tissue between the anvil 612 and the suture assembly 600 (e.g., between the tissue-compression surface 612a of the anvil 612 and the tissue contact surface 604a of the appendage 604), and staples are deployed from the cartridge through the appendage and into the tissue to suture and attach the appendage to the tissue.

[0168] like Figure 7 As shown, when pin 606 is fired, a portion of tissue (T) and appendage 604 is captured by the fired (formed) pin 606a. As discussed above, each firing pin 606a defines a retention area therein for accommodating the captured appendage 604 and tissue (T). The retention area defined by the firing pin 606a is at least partially limited by the height (H) of the firing pin 606a. For example, the height of the firing pin 606a may be about 0.160 inches or less. In some embodiments, the height of the firing pin 606a may be about 0.130 inches or less. In one embodiment, the height of the firing pin 606a may be from about 0.020 inches to 0.130 inches. In another embodiment, the height of the firing pin 606a may be from about 0.060 inches to 0.160 inches.

[0169] As described above, the appendage 604 can be compressed within multiple fired nails, regardless of whether the thickness of the tissue trapped within the nails is the same or different in each fired nail. In at least one exemplary embodiment, the nails within the nail wire or nail row are deformable such that the firing height is, for example, about 2.75 mm, within which the tissue (T) and appendage 604 can be compressed. In some cases, the tissue (T) may have a compression height of about 1.0 mm, and the appendage 604 may have a compression height of about 1.75 mm. In some cases, the tissue (T) may have a compression height of about 1.50 mm, and the appendage 604 may have a compression height of about 1.25 mm. In some cases, the tissue (T) may have a compression height of about 1.75 mm, and the appendage 604 may have a compression height of about 1.00 mm. In some cases, the tissue (T) may have a compression height of about 2.00 mm, and the appendage 604 may have a compression height of about 0.75 mm. In some cases, the tissue (T) may have a compression height of about 2.25 mm, and the appendage 604 may have a compression height of about 0.50 mm. Therefore, the sum of the compression heights of the captured tissue (T) and the appendage 604 may be equal to or at least substantially equal to the height (H) of the firing pin 606a.

[0170] Furthermore, most structures typically exhibit a pattern where the strain (deformation) of the material increases with increasing stress applied to the material. However, for surgical sutures, it is desirable for the strain of the appendage to increase over a relatively narrow stress range, and therefore, as discussed in more detail below, the appendages described herein can be structured in such a way that they can exhibit a flat or moderately sloping “stress plateau.” Typically, a stress plateau is a scheme in the stress-strain curve of a porous material under compression that corresponds to a gradual collapse of the unit cell through elastic buckling and depends on the solidity of the material being manufactured. That is, when a given structure deforms under compression, the strain can increase without significantly increasing the stress, and thus result in a stress plateau, which advantageously delays the densification of the structure (e.g., solidity height). Therefore, the appendages described herein can be designed to undergo compression over an extended time period across the entire stress range, which is typically applied to the appendage when it is in a tissue-deployed state (e.g., when the appendage is sutured into the tissue).

[0171] Therefore, the structure of the appendage can be designed such that when the appendage and tissue are trapped within the firing pin, the appendage experiences a strain in the range of 0.1 to 0.9 kPa under an applied stress in the range of 30 kPa to 90 kPa. When the appendage is in the tissue deployment state, the applied stress is the stress applied by the sutured tissue against the appendage. Those skilled in the art will understand that the stress applied to the tissue depends on various suturing conditions (e.g., tissue thickness, formed pin height, intra-tissue pressure). For example, high blood pressure is generally considered to be 210 mmHg, and therefore it is desirable for the appendage of the present invention to withstand an applied stress equal to or greater than 210 mmHg for a predetermined period of time without becoming densified. In other embodiments, the strain may be in the range of about 0.1 to 0.8, about 0.1 to 0.7, about 0.1 to 0.6, about 0.2 to 0.8, about 0.2 to 0.7, about 0.3 to 0.7, about 0.3 to 0.8, about 0.3 to 0.9, about 0.4 to 0.9, about 0.4 to 0.8, about 0.4 to 0.7, about 0.5 to 0.8, or about 0.5 to 0.9. Therefore, the appendage described herein can be configured to deform and thus not reach its solid height under a predetermined amount of applied stress.

[0172] To design an appendage constructed to withstand strains ranging from approximately 0.1 to 0.9 under applied stresses in the range of approximately 30 kPa to 90 kPa, the principle of Hooke's Law (F=kD) can be used. For example, given the force (stress) to be applied to the tissue deployment appendage, the appendage can be designed to have a predetermined stiffness (k). The stiffness can be set by tuning the geometry of the appendage (e.g., the shape, wall thickness, height, and / or interconnectivity of the cells, such as angles and spaces between cells and / or the diameter of the struts of the cells and / or the interconnectivity of the struts of the cells, such as angles and spaces between struts). Additionally, the appendage can be designed to have a maximum amount of compressive displacement for a minimum tissue thickness (e.g., 1 mm), and therefore the length of the displacement D can be a combination of the minimum tissue thickness (e.g., 1 mm) plus the thickness of the appendage when sutured to the tissue at a given maximum staple height (e.g., 2.75 mm). For example, in one embodiment, the appendage can be structured to have a maximum suture height greater than 2.75 mm, and can be compressed to a height of 1.75 mm when sutured to tissue with a minimum thickness of 1 mm. Therefore, the appendage can vary in compressibility to maintain a constant length of displacement D, such that the stiffness (k) and total thickness (D) of the captured tissue and appendage can apply 3 gf / mm to the captured tissue. 2The stress. It should be noted that those skilled in the art will understand that the foregoing formula can be modified to account for temperature changes, for example, when the appendage is brought from room temperature to body temperature after implantation. Furthermore, the preceding discussion of Hooke's Law represents an approximation. Therefore, those skilled in the art will understand that the principles of large deformation mechanics (also known as finite elasticity) can be used to more accurately predict the relationship between stress and strain by using constitutive equations tailored to the material of interest.

[0173] Therefore, the compressibility profile of the appendage can be controlled by at least the structural configuration of the cells and their interconnectivity. Thus, the structural configuration of the cells can be customized to achieve an appendage with the desired mechanical properties for sutured tissue. Due to the finite range of intra-tissue pressure, tissue thickness, and staple height, an appropriate geometry for the appendage can be determined, and therefore the cells can be determined, that geometry effectively allows the appendage to withstand a desired amount of strain at a substantially constant rate while applying a desired amount of stress. In other words, the structural configuration of the cells can be designed to produce an appendage that can apply a substantially continuous desired stress (e.g., at least 3 gf / mm²) to the sutured tissue under a range of suture conditions. 2 This lasts for a given amount of time. That is, as described in more detail below, the appendage of the present invention is formed of a compressible material and is geometrically configured to allow the appendage to compress to different heights within a predetermined plane when sutured to tissue. Furthermore, the response of the appendage to such changes in intratissue pressure when exposed to fluctuations in intratissue pressure can also allow the appendage to maintain its application of a continuous desired stress to the tissue, where such fluctuations in intratissue pressure can occur when the appendage is sutured to the tissue (e.g., a peak in blood pressure).

[0174] Accessories

[0175] The appendage can have various configurations. It typically includes a tissue contact surface and a chamber contact surface, with an elongated body (e.g., an internal structure) positioned therebetween. In some embodiments, the tissue contact surface and / or chamber contact surface may have a different structure from the elongated body, thereby forming a tissue contact layer and a chamber contact layer. As described in more detail below, the appendage can have a strut-based configuration, a non-strut-based configuration, or a combination thereof.

[0176] Additionally, each exemplary appendage is shown in partial form (e.g., not its full length), so those skilled in the art will understand that the length of the appendage (i.e., along its longitudinal axis (L)) is not necessarily its full length. AThe length can be longer, as identified in each embodiment. This length can vary based on the length of the staple cartridge or anvil. The width can also vary as needed. Additionally, each exemplary appendage is configured to be positioned on the surface of the cartridge or anvil such that the longitudinal axis L of each appendage is aligned with the longitudinal axis (L...) of the cartridge or anvil. A These appendages are aligned and extend along the longitudinal axis. They are structured to compress when exposed to compressive forces (e.g., stress or load).

[0177] The appendages described herein may have various average lengths, widths, and thicknesses. For example, in some embodiments, the appendage may have an average length ranging from about 20 mm to 100 mm or from about 40 mm to 100 mm. In other embodiments, the appendage may have an average width ranging from about 5 mm to 10 mm. In yet another embodiment, the appendage may have an average thickness ranging from about 1 mm to 6 mm, about 1 mm to 8 mm, about 2 mm to 6 mm, or about 2 mm to 8 mm. In one embodiment, an exemplary appendage may have an average length ranging from about 20 mm to 100 mm, an average thickness ranging from 5 mm to 10 mm, and an average thickness ranging from about 1 mm to 8 mm.

[0178] The elongated body can be formed from one or more grid structures formed by freely interconnected cells. While the cells can have various configurations, in some embodiments, the cells can be strut-free cells, while in other embodiments, the cells can be strut-based cells. The struts can be non-hollow rods or bars formed wholly or substantially of a solid material. In some embodiments, one or more grid structures can be formed from interconnected repeating cells. Additionally, in some embodiments, the elongated body may include at least one grid structure formed from strut-free cells and at least one grid structure formed from strut-based cells (see [link to relevant documentation]). Figure 54 ).

[0179] Each grid structure extends from a first surface (e.g., a top surface) to a second surface (e.g., a bottom surface). Depending on the overall structural configuration of the appendage, at least a portion of the first surface of at least one grid structure may serve as a tissue contact surface of the appendage, and at least a portion of the second surface of at least one grid structure may serve as a compartment contact surface of the appendage. Those skilled in the art will understand that each grid structure may have additional tissue contact surfaces (e.g., one or more lateral surfaces relative to the top surface).

[0180] In some embodiments, the appendage may include a tissue contact layer disposed on at least a portion of a first surface of at least one grid structure of the internal structure. The tissue contact layer has a thickness extending between a first surface (e.g., a top surface) and a second surface (e.g., a bottom surface). Thus, the first surface of the tissue contact layer, alone or in combination with at least a portion of the first surface of at least one grid structure, can serve as the tissue contact surface of the resulting appendage. The tissue contact layer may have various configurations. For example, in some embodiments, the tissue contact layer is in the form of a grid structure formed by interconnected repeating lattices, which may differ from the grid structure of an elongated body, while in other embodiments, the tissue contact layer is in the form of a film.

[0181] Alternatively or additionally, the appendage may include a compartment contact layer disposed on at least a portion of a second surface of at least one grid structure. The compartment contact layer may have a thickness extending from a first surface (e.g., a top surface) to a second surface (e.g., a bottom surface). Thus, the second surface of the compartment contact layer, alone or in combination with at least a portion of the second surface of at least one grid structure, can serve as the compartment contact surface of the resulting appendage. The compartment contact layer may have various configurations. For example, in some embodiments, the compartment contact layer is in the form of a grid structure formed by interconnected repeating lattice cells, which may differ from the grid structure of an elongated body, while in other embodiments, the compartment contact layer is in the form of a membrane. In some embodiments, the membrane may be a pressure-sensitive adhesive, while in other embodiments, the membrane may include one or more extended attachment features.

[0182] Based on non-strut appendages

[0183] As described above, the appendages may include a grid structure formed by strut-based cells (e.g., repeating strut-based cells). In other words, strut-based cells can be characterized by curved surfaces, compared to strut-based cells, which are characterized by the presence of acute or sharp angles. For example, the cells may be based on triple periodic minimum surfaces (TPMS). TPMS is a minimum surface that repeats itself in three dimensions. As used herein, the term "minimum surface" refers to a minimum surface as known in mathematics. Thus, in some embodiments, the cells may be Schwarz structures (e.g., Schwarz-P, Schwarz Diamond), modified Schwarz structures, spiral (e.g., Schoen Gyroid) structures, cosine structures, and coke can structures.

[0184] As discussed in more detail below, the strut-free cells can have various structural configurations (e.g., height, width, wall thickness, shape). In some embodiments, the strut-based cells of the appendage can be substantially uniform (e.g., nominally identical within manufacturing tolerances), while in other embodiments, at least a portion of the strut-free cells of the appendage can vary in shape and / or size relative to the remainder of the strut-based cells.

[0185] For example, in some embodiments, each cell in the strutless cell may have a wall thickness of about 0.05 mm to 0.6 mm. In some embodiments, the wall thickness may be about 0.1 mm to 0.3 mm. In one embodiment, the wall thickness may be about 0.2 mm. In some embodiments, the wall thickness of all strutless cells of the appendage may be substantially uniform (e.g., nominally the same within manufacturing tolerances). In other embodiments, for example, where the appendage is formed by two or more sets of cells, each set of cells may have a different wall thickness. For example, in one embodiment, the appendage may include a first repeating cell each having a first wall thickness, a second repeating cell each having a second wall thickness greater than the first wall thickness, and a third repeating cell each having a third wall thickness greater than the second wall thickness. Alternatively or additionally, the first repeating cell may have a first height (e.g., a maximum height), a second height greater than the first height (e.g., a maximum height), and a third height greater than the second height (e.g., a maximum height).

[0186] In some implementations, the surface-to-volume ratio of each cell can be about 5 to 30. In some implementations, the surface-to-volume ratio of each cell can be about 7 to 20.

[0187] Schwarz-P structure

[0188] Figures 8A to 8F This is an exemplary embodiment of appendage 800, which has a tissue contact surface 802 and a compartment contact surface 804. Appendage 800 includes interconnected repeating unsupported bar cells 810, one of which is in… Figures 9A to 9BThe details are shown in more detail below. Although the appendage 800 is shown as having four longitudinal rows (L1, L2, L3, L4), each having 20 repeating cells 810, those skilled in the art will understand that the number of rows and quantities of cells of the appendage can depend at least on the size and shape of the staple cartridge and / or anvil to which the appendage will be applied, and therefore the appendage is not limited to the longitudinal rows and number of cells shown in the figure. Furthermore, although only one type of repeating unsupported cells is shown, in other embodiments, the appendage may be formed by a combination of a first repeating unsupported cell and a second repeating unsupported cell different from the first repeating unsupported cell, etc.

[0189] Given that appendage 800 is formed by repeating cells 810 having substantially the same structural configuration (e.g., nominally identical within manufacturing tolerances), the following discussion concerns a single repeating cell 810. Figures 9A to 9B As shown, the repeating cell 810 has a top portion 812, a bottom portion 814, and a middle portion 816 extending therebetween.

[0190] In this exemplary embodiment, the repeating cell 810 is constructed as a Schwarz-P structure, and therefore, the surface profile of cell 810 is defined by a minimum surface. That is, the outer surface 820 and the inner surface 822 of cell 810 are each defined by a minimum surface. Therefore, in this exemplary embodiment, the outer surface 820 and the inner surface 822 are generally concave, thus forming the arcuate side surface 821 of cell 810. In addition, the inner surface 822 defines the internal volume 824 of cell 810. Therefore, cell 810 can be characterized as hollow. The Schwarz-P minimum surface can be functionally represented as: cos(x) + cos(y) + cos(z) = 0.

[0191] Cell 810 also includes a connection interface 826, which can be used to interconnect cell 810 to other cells 810, thereby forming Figures 8A to 8EThe accessory 800 is shown. In this illustrated embodiment, the cell includes six connection interfaces 826 that form the six outermost surfaces of the cell 810, such as top and bottom outermost surfaces 827a, 827b, left and right outermost surfaces 829a, 829b, and front and rear outermost surfaces 831a, 831b. The top and bottom outermost surfaces 827a, 827b are generally planar with respect to each other (e.g., planar within manufacturing tolerances) and offset in the x-direction; the left and right outermost surfaces 829a, 829b are generally planar with respect to each other (e.g., planar within manufacturing tolerances) and offset in the y-direction; and the front and rear outermost surfaces 831a, 831b are generally planar with respect to each other (e.g., planar within manufacturing tolerances) and offset in the z-direction. Therefore, the total outer surface of cell 810 includes planar surfaces (e.g., the outermost surfaces 827a, 827b, 829a, 829b, 831a, 831b) and non-planar surfaces (e.g., the outer surface 820 extending between the connection interfaces 826). Additionally, since appendage 800 is formed only by repeating cells 810, the top portion 812, including the topmost outer surface 812a, forms the tissue contact surface 802 of appendage 800, and the bottommost outer surface 814a (e.g., in the x-direction) of the bottom portion 814 of the cell forms the compartment contact surface 804 of appendage 800. Therefore, the tissue contact surface 802 is formed by both planar and non-planar surfaces.

[0192] Furthermore, based on the overall geometry of the repeating cells 810 and their interconnections at their corresponding connection interfaces 826, the overall outer surface of the resulting appendage 800 is formed by generally planar surfaces (e.g., planar within manufacturing tolerances) separated by non-planar surfaces. As shown, the top and bottom outermost surfaces 850a and 850b of the appendage 800 are furthest from the bisectors extending in the YZ plane, the left and right outermost surfaces 852a and 852b of the appendage 800 are furthest from the bisectors extending in the XZ plane, and the front and rear outermost surfaces 854a and 854b of the appendage are furthest from the bisectors extending in the XY plane. Additionally, as shown in the figure, the top and bottom outermost surfaces 850a and 850b are generally planar with respect to each other (e.g., planar within manufacturing tolerances) and offset in the x-direction; the left and right outermost surfaces 852a and 852b are generally planar with respect to each other (e.g., planar within manufacturing tolerances) and offset in the y-direction; and the front and rear outermost surfaces 854a and 854b are generally planar with respect to each other (e.g., planar within manufacturing tolerances) and offset in the z-direction. Therefore, these outermost surfaces 850a, 850b, 852a, 852b, 854a, and 854b form planar segments of the outer surface of the appendage 800. It is understood that portions of the appendage 800 extending between these outermost surfaces 850a, 850b, 852a, 852b, 854a, and 854b are defined by the outer surfaces 820 of adjacent cells 810, thereby forming non-planar surfaces of the outer surface of the appendage 800.

[0193] As further shown, six connection interfaces 826 define corresponding circular openings that are in fluid communication with the internal volume 824 of cell 810. Therefore, cell 810 is in fluid communication with all six Cartesian sides (on...) Figure 9B The appendix (represented by arrows 1, 2, 3, 4, 5, 6) has an opening. These openings can provide various functions, such as: facilitating connection with adjacent units; creating an opening that allows immediate tissue growth when the appendix is ​​sutured to the tissue; allowing the drainage of manufacturing materials used in the production of the resulting appendix, such as materials used during 3D manufacturing processes; allowing easy transfer of bodily fluids throughout the appendix; contributing to the mechanical properties of the appendix, such as creating mechanical properties that prevent the compaction of the appendix into a compressed profile; and / or minimizing the solid height of a fully compressed appendix.

[0194] Furthermore, when cells 810 are interconnected at corresponding connection interfaces (e.g., at least two connection interfaces), hollow tubular interconnects 828 (e.g., cavities) are formed therebetween, such as... Figures 8D to 8EAs shown, the interconnect allows the internal volumes 824 of the interconnected cells 810 to be fluidly connected to each other. Therefore, a continuous network of channels or paths exists within the appendage. Thus, when the appendage 800 is sutured to the tissue (T) and is in a tissue deployment state, as... Figure 8G As shown, one or more fluids (including those entering cells within appendage 800), for example through an opening in the connection interface 826a of the top portion 812 of at least one cell 810, can thus migrate through appendage 800 in an organized deployment state via interconnected cells, such as... Figure 8G As shown, and thus can ultimately accelerate the inward growth of tissue within appendage 800. That is, while appendage 800 is in a tissue-deployed state, at least a portion of the hollow tubular interconnects 828 can at least partially maintain at least a portion of cell 810 or through fluid communication between all internal volumes, and thereby encourage cell mobility throughout appendage 800.

[0195] While the hollow tubular interconnect 828 defines openings that can have various sizes (e.g., diameters), in some embodiments, the diameter of the opening can be from about 100 micrometers to 3500 micrometers. For example, the diameter of the opening can be from about 100 micrometers to 2500 micrometers or from about 500 micrometers to 2500 micrometers. In some embodiments, the diameter of the opening can be from about 945 micrometers to 1385 micrometers. In one embodiment, the diameter of the opening can be greater than 2000 micrometers. In some embodiments, all openings have substantially the same diameter (e.g., nominally the same within manufacturing tolerances). As used herein, the “diameter” of an opening is the maximum distance between any pair of vertices of the opening.

[0196] Since the repeating cells 810 are interconnected at the corresponding connection interfaces 826, the appendage 800 takes the form of a grid structure with predetermined compressed regions 830 and predetermined uncompressed regions 840, as shown below. Figure 8C As shown more clearly in the diagram. While the predetermined compressed region 830 and the predetermined uncompressed region 840 can have various configurations, in this illustrated embodiment, the predetermined compressed region 830 is defined by cell 810, and the predetermined uncompressed region 840 is in the form of gaps 845 defined between the cell 810. In this embodiment, each gap 845 is formed between four adjacent interconnected cell 810. For example, as... Figure 8F As shown, a gap 845a is defined between four adjacent cells 810a, 810b, 810c, and 810d. Therefore, the space between adjacent cells defines a predetermined uncompressible region. In other words, the uncompressible region 840 of the appendage is not defined by the internal volume of the cells.

[0197] As described in more detail below, the structural configuration of repeating cells allows the cells to move along their height H for a period of time under applied stress (see below). Figure 9A The cells deform or buckle continuously at different locations (e.g., until opposite sides of the inner surfaces of the cells contact each other). Therefore, during such a period, the cells can deform or buckle at a constant or substantially constant rate under applied stress (e.g., 30 kPa to 90 kPa). In other words, in some embodiments, the repeated cell structure can result in stress plateaus, for example, as... Figure 11 It is shown schematically in the middle.

[0198] Figures 10A to 10D The illustration shows a repeating cell (e.g., Figures 8A to 9B Cell 810 in the diagram describes the compressive behavior under a certain range of applied stress. Specifically, in... Figure 10A The repeated cell 1010 is shown in a pre-compressed (undistorted) state; Figure 10B The repeating cell is shown in a first compressed state, where each of the top portion 1012 and the bottom portion 1014 of cell 1010 begins to compress towards the middle portion 1016 of cell 1010, causing the middle portion 1016 to begin to deflect; Figure 10C The repeating cell is shown in a second compressed state, where the middle portion 1016 continues to deflect outwards; and... Figure 10D The repeating cell is shown in a dense state, wherein the opposite sides 1018a, 1018b of the inner surface 1018 of the middle portion 1016 are in contact with each other, such that the cell 810 reaches its solid height.

[0199] exist Figure 11 The diagram schematically illustrates the undeformed state U of repeating cell 1010. Figure 10A Compression states C1 and C2 Figures 10B to 10C ) and dense state D ( Figure 10D The relationship between the stress-strain curve of the obtained appendage and the stress-strain curve of the appendage.

[0200] The stress-strain response of the appendage begins with elastic deformation (bending), characterized by Young's modulus, for example, as the repeating cells begin to deform from their uncompressed state toward their first compressed state. This elastic deformation continues until the yield stress is reached. Once the yield stress is reached, a stress plateau can occur, corresponding to the progressive cell collapse through elastic buckling, for example, as the repeating cells continue to deform through their first and second compressed states. Those skilled in the art will understand that the stress plateau depends at least on the properties of the material from which the cells are made. The stress plateau continues until densification occurs, meaning the cells collapse throughout the appendage, for example, as the repeating cells reach their dense state, and thus, the appendage has reached its solidity height.

[0201] Those skilled in the art will understand that the stress-strain curve of an appendage depends on various factors, such as uncompressed height, composition (including material properties), and / or structural configuration. For example, Table 1 below shows the stress-strain response of an exemplary appendage, differing only in its uncompressed height (UH), and the appendage being compressed to a first compression height (CH1) of 1.75 mm under an applied stress of 30 kPa, to a second compression height (CH2) of 0.75 mm under an applied stress of 90 kPa, and to a third compression height (CH3) of 0.45 mm under an applied stress of 90 kPa.

[0202] Table 1: Stress-strain relationships for various attachment heights

[0203]

[0204] In another embodiment, the repeating, unsupported cells can be a modified Schwarz-P structure. For example, a Schwarz-P structure can be stretched in one or more directions to form a stretched Schwarz-P structure, such as... Figure 12A As shown. Alternatively or in addition, in some embodiments, the wall thickness of the Schwarz-P structure can be reduced. For example, as Figure 12B As shown, the Schwarz-P structure is stretched and thinned. In yet another embodiment, as... Figure 12C As shown, the Schwarz-P structure can be cut, for example, where the top portion H of the Schwarz-P structure... T (See) Figure 9A ) and / or bottom part H B (See) Figure 9A The height of the structure is reduced. Alternatively, or in addition to the foregoing exemplary modifications, additional openings can be added to the walls of the Schwarz-P structure, for example, as shown in the example. Figure 12D As shown, this can help densify the resulting appendages.

[0205] Other TPMS structures can be used for repeating, unsupported cells. For example, such as... Figure 13A As shown, the unsupported cell 1300 can be formed from a sheet-like diamond structure with a diamond minimum area having a Schwarz D surface lattice structure. This particular minimum surface is called "diamond" because it has two interlocking congruent labyrinths, each labyrinth having a tubular shape with diamond bond structures. Schwarz D can be functionally expressed as:

[0206] sin(x)sin(y)sin(z)+sin(x)cos(y)cos(z)+cos(x)sin(y)cos(z)+cos(x)cos(y)sin(z)=0.

[0207] Figure 13B An exemplary appendage 1310 is shown, formed by repeating cells 1300 and thus a sheet-like diamond structure.

[0208] In another implementation, such as Figure 14A As shown, cell 1400 without support bars can be a spiral structure. The minimum surface of the spiral can be functionally expressed as:

[0209] sin(x)cos(y)+sin(y)cos(z)+sin(z)cos(x)=0.

[0210] Figure 14B An exemplary appendage 1410 is shown, formed by repeating cells 1500 and thus a spiral structure. In other embodiments, the cells without struts may be in a cosine structure 1500 ( Figure 15A ) in the form of or in the structure of a coke can 1600 ( Figure 16A The two forms are each defined by a minimum curved surface. Figure 15B and Figure 16B Exemplary appendages 1510 and 1610 are shown, formed by corresponding repeating cells 1500 (cosine structure) and 1600 (coke can structure).

[0211] Edge conditions

[0212] In some implementations, certain strut-free cells, when interconnected to form an appendage, can create undesirable edge conditions for tissue suturing. For example, when tissue slides across the appendage during use, the edge conditions can interact with the tissue in a way that causes at least a portion of the appendage to prematurely detach from the staple cartridge. These edge conditions can be a result of geometry (e.g., having generally planar (e.g., planar within manufacturing tolerances) and non-planar outer surfaces) and the interconnectivity of the strut-free cells constituting the appendage. Therefore, to improve these edge conditions and thus suppress premature detachment of the appendage, an outer layer with a different geometry can be placed on top of one or more tissue-contacting surfaces of the appendage.

[0213] Re-reference Figures 9A to 9B As described above, the Schwarz-P structure 810 has a non-planar outer surface with arcuate sides 821 extending between the connection interfaces 826 of the cell 810. Therefore, when the Schwarz-P structures 810 are interconnected to form appendages such as... Figures 8A to 8F When the appendage is 800, the tissue contact surface can form a surface with both planar and non-planar surfaces, such as Figures 8A to 8B The tissue contact surface 802 in the appendage. This is a result of the structural configuration of at least the top portion 812 of each cell 810 (e.g., the exposed topmost outer surface 827a and the arcuate side surface 821 of the top portion 812) and the spacing relationship between them. Therefore, the edge conditions of the appendage can be minimized by applying an outer layer with a generally planar geometry (e.g., a plane within manufacturing tolerances) positioned on at least one additional tissue contact surface of the appendage, such as Figures 8A to 8F The tissue contact surface 802 of the appendage 800. Therefore, this reduces the tissue load (applied stress) on the appendage during placement of the suture device. In addition, this simplifies the attachment requirements between the appendage and the chamber.

[0214] Although the outer layer can have various configurations, in some embodiments, the outer layer can consist of one or more planar arrays of struts. Figures 17A to 17C In other embodiments, the outer layer may be in the form of a film. Figure 18 ).

[0215] Figures 17A to 17C An exemplary appendage 1700 is shown, having a first grid structure 1702 formed by interconnected repeating cells 1704 and at least one planar array 1706, 1708. Each cell 1704 is similar to... Figures 9A to 9BCell 810 in the document is used, and therefore common features are not described in detail herein. In this illustrative embodiment, there are two planar arrays 1706 and 1708, wherein a first planar array 1706 (e.g., in the YZ plane) extends across the top tissue-facing surface 1712 of the first grating structure 1702, and a second planar array 1706 (e.g., in the XZ plane) extends across at least one side tissue-facing surface 1714 of the first grating structure 1702. In other embodiments, the first planar array 1706 or the second planar array 1708 may be omitted. In further embodiments, the appendage 1700 may include additional planar arrays.

[0216] Although planar arrays 1706 and 1708 can have various configurations, in this illustrated embodiment, the first planar array 1706 and the second planar array 1708 each include a longitudinal axis (L) parallel to the appendage 1700. A The longitudinal strut 1716 extends along the longitudinal axis. Although not shown, it is conceivable that additional struts may be added to the first planar array 1706 and the second planar array 1708. For example, in one embodiment, the first planar array 1706 and / or the second planar array 1708 may include intersecting struts that extend at an angle relative to the longitudinal axis and intersect the first longitudinal strut and / or the second longitudinal strut (e.g., thereby creating a repeating X pattern).

[0217] In use, when the appendage 1700 is releasably held on the container, such as... Figures 1 to 2C When the attachment 1700 is in the bin 200, it overlaps with the pin array disposed within the bin. Therefore, the first planar array 1706 can be added to the final solid height of the attachment 1700, and thus accelerate its densification. However, to minimize the effect of the first planar array 1706 on densification, the first planar array 1706 can be designed in a manner that does not overlap with the pin array. For example, as... Figures 17A to 17C As shown, the first planar array 1706 is divided into four spaced portions 1706a, 1706b, 1706c, and 1706d, such that three gaps 1718, 1720, and 1722 are formed therebetween and along the longitudinal axis (L) of the appendage 1700. A ).like Figure 17C As shown, the three gaps 1718, 1720, and 1722 can coincide with the three pin rows 1724, 1726, and 1728 of the bin (not shown), and therefore the first planar array 1706 will not be captured or will be minimized by the pins during deployment.

[0218] As described above, in some embodiments, the absorbable membrane may be positioned on at least a portion of at least one of the non-planar tissue-facing surfaces of the grid structure to substantially prevent the tissue from causing premature detachment of the appendage from the compartment as the tissue slides across it. In other words, the absorbable membrane can minimize edge conditions, thereby reducing friction that would otherwise be present on the tissue-contact surface of the appendage.

[0219] Figure 18 An exemplary embodiment of an appendage 1800 disposed on a bin 1801 is shown. The appendage 1800 includes a grid structure 1802 on at least a portion of which an absorbable membrane 1804 is disposed. Similar to... Figure 8A The grid structure 1802 of the appendage 800 is formed by interconnected repeating cells 1806, each of which is similar to Figures 9A to 9B Cell 810 in the figure, and therefore common features are not described in detail herein. As shown, an absorbable membrane 1804 may be disposed on all tissue-facing surfaces of the grid structure 1802. In this illustrated embodiment, the absorbable membrane includes a top tissue-facing surface 1808 (e.g., extending in the x-direction), a first longitudinal side surface 1810a (e.g., extending in the z-direction), a second opposing longitudinal side surface 1810b, a first transverse side surface 1812a (e.g., extending in the y-direction), and a second opposing transverse side surface (obscured). In other embodiments, the absorbable membrane is not disposed on all tissue-facing surfaces of the grid structure, for example, the first transverse side surface and / or the second transverse side surface.

[0220] The absorbable membrane can have various configurations. For example, in some embodiments, the absorbable membrane is designed to have a thickness that nominally influences the densification of the appendage under applied stress and / or when formed from one or more materials, which help reduce friction in the tissue contact layer for tissue manipulation. In some embodiments, the thickness of the absorbable membrane can be less than or equal to about 15 micrometers, for example, about 5 micrometers to 15 micrometers, or about 8 micrometers to 11 micrometers. In one embodiment, the absorbable membrane can be formed from polydioxanone.

[0221] Attachment feature

[0222] In some embodiments, the non-stirring-based appendage includes one or more attachment features that extend at least partially along the length of the appendage and are configured to engage the staple cartridge, thereby holding the appendage on the cartridge prior to staple deployment. The one or more attachment features can have various configurations. For example, the one or more attachment features may be a channel attachment (…). Figures 19A to 21 (), Figures 22A to 22B) and / or end attachments ( Figures 24 to 25 The channel attachment is configured to engage (e.g., crimp or snap into) an elongated cut slot formed between opposing longitudinal edges in the staple cartridge, and the end attachment is configured to engage with a recessed end channel defined within the staple cartridge. Apart from the differences discussed in detail below, attachments 1900, 2000, 2100, and 2200 are substantially similar. Figures 8A to 8F The appendages 800 are included, and therefore the common features are not discussed in detail in this paper.

[0223] In some embodiments, the channel attachment may include one or more compressible members structurally configured to be inserted into a longitudinal slot of the staple cartridge to engage the opposing walls of the longitudinal slot. In some embodiments, the one or more compressible members may include a compressible opening extending therethrough, for example, along the length of the cartridge contact surface of the attachment in the longitudinal direction.

[0224] Figures 19A to 19B An exemplary embodiment of an appendage 1900 is shown, comprising a channel attachment 1910 having two compressible members 1912, 1914 interconnected by at least one common elongated joint 1916. While the two compressible members 1912, 1914 can have various configurations, in this illustrated embodiment, each compressible member 1912, 1914 is in the form of an elongated rod having a triangular cross-sectional shape cut across its width (e.g., in the y-direction), through which hollow triangular channels 1912a, 1914a extend along their length (e.g., in the z-direction). As shown, the two elongated rods 1912, 1914 are interconnected at corresponding vertices to form the elongated joint 1916, which defines a central connection region with a narrow thickness (e.g., in the x-direction). Figure 19B As shown, when the appendage 1900 is set in a similar manner... Figures 1 to 2C When in the compartment 1901 of the compartment 200, at least one elongated joint 1916 (and therefore the central connecting area) is positioned equidistant from the opposing walls 1903a, 1903b of the longitudinal slot 1903, as... Figure 19BAs shown. Therefore, the central connecting region is aligned with the advance line of the cutting member, and thus, due to the narrow width of the central connecting region, the risk of clogging the cutting member as it advances through the appendage 1900 can be minimized or prevented. That is, the central connecting region minimizes the additional appendages that need to be cut in other ways as the cutting member advances through the longitudinal slot 1903. In addition, the hollow triangular channels 1912a, 1914a reduce the amount of material on each side of the advance line, which also minimizes the contact between the cutting edge of the appendage and the cutting member as the appendage further advances through the longitudinal slot 1903.

[0225] Although the total width W of the channel attachment 1910 C The total width W can vary, but in this illustrated implementation, it is always W. C Width W greater than the longitudinal slot 1903 L (For example, the distance between two opposing slot walls 1903a, 1903b). Therefore, when the channel attachment 1910 is inserted into the longitudinal slot 1903, the compressible member deforms and engages (e.g., compresses against) the corresponding slot walls 1903a, 1903b due to the outward lateral force generated by the hollow triangular channels 1912a, 1914a. Thus, a pressure fit or friction fit is created between the compressible members 1912, 1914 and the corresponding slot walls 1903a, 1903b of the compartment 1901.

[0226] Channel attachments may have other configurations (e.g., shape and / or size). For example, such as Figure 20 As shown, accessory 2000 is similar to Figures 8A to 8G The accessory 800 shown, in addition to accessory 2000, includes a channel attachment 2010 in the form of an elongated protrusion. This channel attachment extends outward from the compartment contact surface 2004 of accessory 2000 and is positioned between two inner repeating cells 2010a, 2012a. The elongated protrusion 2010 is configured to be inserted into a longitudinal slot in the compartment, such as... Figure 2A and Figure 2C The longitudinal slot 210 of the middle compartment 200.

[0227] While the elongated protrusion 2010 can have various configurations, in this illustrated embodiment, the elongated protrusion 2010 is formed by two compressible longitudinal bars 2010a, 2010b, with a crossbar 2010c extending therebetween. In some embodiments, the width of the elongated protrusion 2010 (e.g., in the y-direction) is greater than the width of the longitudinal slot of the staple cartridge (e.g., the distance between two opposing slot walls). Therefore, when the elongated protrusion 2010 is inserted into the longitudinal slot, as... Figures 2A to 2CThe longitudinal slots 210 of the central compartment 200, the two longitudinal bars are configured to engage (e.g., compress against) the opposing slot walls due to the outward lateral force generated by the crossbar 2010c. Thus, a pressure fit or friction fit is formed between the elongated protrusion 2010 and the slot wall of the compartment.

[0228] Figure 21 Another embodiment of the accessory 2100 with a channel attachment is shown. The accessory 2100 is similar to... Figure 20 The accessory 2000 shown is different in that the channel attachment has discrete protrusions 2110 ( Figure 21 Only two are shown in the diagram, and the discrete protrusion is along the longitudinal axis L of the appendage 2100. A They are spaced apart from each other. While the protrusions 2110 can have various configurations, in this illustrated embodiment, each protrusion 2110 is in the form of an annular boss with an elliptical shape. In other embodiments, the protrusions 2110 can be any other suitable shape and / or vary in size / shape relative to each other. Each annular boss 2110 can be configured to be compressible, and in some embodiments, its dimensions are set such that the width of each boss (e.g., in the y-direction) can be greater than the width of the longitudinal slot of the staple cartridge (e.g., the distance between two opposing slot walls), such as... Figures 2A to 2C The longitudinal slot 210 in the cartridge 200. Therefore, when discrete annular bosses 2110 are inserted into the longitudinal slot of the cartridge, their outer surfaces 2110a are configured to engage (e.g., compressively abut) the opposing slot walls due to the outward radial force of the annular bosses. Thus, a pressure fit or friction fit is formed between the annular bosses 2110a and the slot walls of the longitudinal slot.

[0229] Alternatively or in addition, in some embodiments, the appendage may include an edge attachment feature configured to engage a corresponding edge attachment feature of the appendage. For example, such as Figures 22A to 22CAs shown, the accessory 2200 may include three sets of opposing clamps 2202a, 2202b, 2204a, 2204b, 2206a, 2206b, each extending laterally outward and away from the opposing outer surfaces 2200a, 2200b of the accessory 2200. Although the three sets of clamps 2202a, 2202b, 2204a, 2204b, 2206a, 2206b may have various configurations, in this illustrated embodiment, the three sets of clamps 2202a, 2202b, 2204a, 2204b, 2206a, 2206b each have a hook-shaped configuration that engages with corresponding edge attachment features 2208a, 2208b, 2210a, 2210b, 2212a, 2212b of the compartment 2201. In this illustrated embodiment, each edge attachment feature 2208a, 2208b, 2210a, 2210b, 2212a, 2212b has an inverted L-shaped configuration, thereby creating a flange extending laterally outward from the staple cartridge 2201. Figures 22B to 22C Only one flange is shown in detail in the image.

[0230] Figure 22C The image shows the engagement of a clamp 2204a of accessory 2200 and a flange 2210a of compartment 2201. For simplicity, repeating cells of accessory 2200 are omitted. As shown, the inner surface 2214a of the end portion 2214 of clamp 2204 engages the outer bottom surface 2216 of flange 2210a, thereby causing a portion of the outer surface 2218 of flange 2210a to abut against a corresponding portion of the inner surface 2220 of clamp 2204a (e.g., protruding engagement / recessed engagement). Additionally, as... Figure 22C As shown, flange 2210a is biased outward, and therefore, when a portion of the outer surface 2218 of flange 2210a is engaged, it is pressed against the corresponding portion of the inner surface 2220a of clamp 2204a.

[0231] Figures 23A to 23B Another embodiment of the appendage is shown, having three sets of opposing clamps 2302a, 2302b (partially obscured), 2304a, 2304b (partially obscured), 2306a, 2306b (partially obscured), which are configured to engage corresponding sets of opposing receiving members 2308, 2310 (partially obscured), 2312, 2314 (partially obscured), 2316, 2318 (partially obscured) of the staple cartridge 2301.

[0232] In this illustrated embodiment, each clamp is structurally identical and has an inverted T-shaped configuration. Additionally, as shown, each set of receiving members is structurally identical and includes two inverted L-shaped members spaced apart and facing each other to form a T-shaped gap therebetween. For example, Figure 23B The figure shows in more detail the engagement of a clamp 2302a with its corresponding set of receiving members 2308a, 2308b. As shown, the transverse segments 2316a, 2316b of the clamp 2302a (e.g., extending in the z-direction) are configured to engage with the corresponding inner surface (only one inner surface 3118 is shown) of each L-shaped member 2308a, 2308b, and the vertical segment 2320 of the clamp 2302a (e.g., extending in the x-direction) is configured to be positioned between the two facing surfaces (only one facing surface 2322 is shown) of the L-shaped members 2308a, 2308b. Thus, the vertical segment 2320 helps maintain the longitudinal alignment of the appendage 2300 relative to the staple cartridge 2301 (and therefore relative to the staples (not shown) disposed therein) During use, the vertical section 2320 also helps prevent premature disengagement of the clamp 2302a from the corresponding set of receiving members 2308a, 2308b and thus from the appendages 2300 of the compartment 2301.

[0233] Alternatively or in addition, in some embodiments, the appendage may include end attachment features, such as opposing proximal and distal group bosses configured to engage (e.g., pressure fit) into corresponding proximal and distal group recesses defined in the staple cartridge. For example, in one embodiment, the appendage may have a rectangular boss configured to engage... Figure 24 The staple cartridge 2400 has rectangular recesses 2402a, 2402b, 2404a, and 2404b in its proximal and distal groups. In another embodiment, the appendage may have a circular boss configured to engage. Figure 25 The circular recesses 2502a, 2502b, 2504a, and 2504b of the proximal and distal groups of the staple cartridge 2500.

[0234] As described above, in some embodiments, the staple cartridge may include a surface feature in the form of a recessed channel, for example, such as Figure 2A and Figure 2C The recessed channels 216, 218, and 220 are shown. In such embodiments, the appendage may be designed to engage with the recessed channel to achieve a releasable attachment mechanism between the appendage and the staple cartridge, even when the frequency of staples in a longitudinal staple row (e.g., the number of staples per length staple row) is different from (e.g., greater than) the frequency of repeating cells in a corresponding longitudinal cell row (e.g., the number of cells per length cell row).

[0235] Figures 26A to 26C An accessory 2600 is shown disposed on the staple cartridge 2602, which is similar to Figures 2A to 2CThe staple cartridge 200 is described in detail herein, and therefore common features are not described in detail. The staple cartridge 2602 includes staple cavities arranged in longitudinal rows 2604a, 2604b, 2604c, 2606a, 2606b, 2606c and recessed channels surrounding each staple cavity 2604a, 2604b, 2604c, 2606a, 2606b, 2606c. As shown, a first recessed channel 2608 surrounds each first staple cavity 2604a, 2606a, a second recessed channel 2610 surrounds each second staple cavity 2604b, 2606b, and a third recessed channel 2612 surrounds each third staple cavity 2604c, 2606c. The first, second, and third recessed channels each include corresponding base plates 2614, 2616, and 2618, located at a corresponding height (e.g., extending in the x-direction) from the top surface 2602a of the staple cartridge 2602. In this illustrated embodiment, the corresponding heights are the same, while in other embodiments, the corresponding heights may be different.

[0236] While the appendage 2600 may have various configurations, in this illustrated embodiment, the appendage 2600 is formed by repeating cells 2620 and attachment features 2622 extending from at least a portion of the plurality of cells 2620. Each attachment feature 2622 is configured to be inserted into and engage with at least a portion of the recessed channels 2608, 2610, 2612 of the staple cartridge 2602, thereby holding the appendage 2600 to the staple cartridge 2602 prior to staple deployment.

[0237] Although the attachment feature 2622 can have various configurations, each attachment feature has a different geometry, allowing each attachment feature to engage with a corresponding recessed channel. This difference in geometry, compared to the frequency of the staples 2605 in the staple cavities 2604a, 2604b, 2604c, 2606a, 2606b, 2606c of the staple cartridge 2602, is due to the difference in the frequency of the cell. Therefore, the attachment feature 2622 is positioned on the corresponding cell 2620 at a predetermined location corresponding to the recessed channels 2608, 2610, 2612. Figure 26A As shown, and in Figures 26B to 26C The image shows half of the appendage 2600 (e.g., the left half) in more detail, and the corresponding geometry of the attachment feature 2622 is configured to engage the recessed channels 2608, 2610, 2612 relative to the longitudinal axis L of the staple cartridge 2602. A The corresponding vertices 2608a, 2610a, 2610b, and 2612a point laterally outward. In other embodiments, the geometry of the attachment feature may be configured to engage other portions of the recessed channel.

[0238] The geometry of the attachment feature 2622 may vary laterally and / or longitudinally relative to the longitudinal axis of the chamber. The geometric variation depends at least on the frequency of the cell 2620 relative to the frequency of the nail 2605 and the shape of the nail cavities 2604a, 2604b, 2604c, 2606a, 2606b, 2606c. For example, the attachment feature 2622 may vary relative to each other in at least one of height (e.g., in the x-direction), width (e.g., in the y-direction), length (e.g., in the z-direction), and shape. For example, as... Figure 26B As shown, the height H1 of the first attachment feature 2622a extending from the first repeating cell 2620a is greater than the height H2 of the second attachment feature 2622b extending from the second repeating cell 2620b, and therefore the heights of the first attachment feature 2622a and the second attachment feature 2622b are relative to the longitudinal axis L of the storage compartment 2602. A Different laterally. In this illustrated implementation, such as Figure 26A and Figure 26B As further shown, the shape of each of the first attachment feature 2622a and the second attachment feature 2622b is also relative to the longitudinal axis L of the compartment 2602. A Laterally varying. The first attachment feature 2622a has a cylindrical configuration, and the second attachment feature 2622b has an arcuate configuration. Alternatively or otherwise, the length of two or more attachment features may be along the longitudinal axis of the compartment 2602. A L changes. For example, as Figure 26A As shown, the third repeating cell 2620c and the fourth repeating cell 2620d respectively include a third attachment feature 2622c and a fourth attachment feature 2622d, which are located along the longitudinal axis L of the storage compartment 2602. A Variations in length (e.g., extending in the z-direction) and shape. In this illustrative embodiment, the third attachment feature 2622c has a cylindrical configuration, while the fourth attachment feature 2622d has a triangular configuration.

[0239] In some embodiments, lateral variations in the shape and / or height of the attachment features may correspond to lateral variations in the recessed channel. For example, although not shown, in some embodiments, at least a portion of the wall of the recessed channel may extend at an angle relative to the longitudinal axis of the compartment, and thus one or more attachment features may vary in shape and / or height to correspond to the recessed channel. In other embodiments, the length of the recessed channel may vary laterally, and one or more attachment features may vary in shape and / or height to correspond to the recessed channel.

[0240] Cell frequency

[0241] The thickness of the non-stirred appendage can vary longitudinally (e.g., along its length, e.g., in the z-direction) and / or laterally (e.g., along its width, e.g., in the y-direction). Therefore, when the frequency of nails within a longitudinal row of nails (e.g., the number of nails per row of nails per length) differs from (e.g., is greater than) the frequency of repeating cells within a corresponding longitudinal row of cells (e.g., the number of cells per row of cells per length), the leg of each nail can advance through different portions of the appendage, where each portion has a relative thickness difference, such as... Figure 27 As shown.

[0242] Figure 27 An exemplary embodiment of a suture assembly 2700 is shown, which has a staple cartridge 2702, as... Figures 1 to 2C The staple cartridge 200 has staples arranged in longitudinal rows (only a portion of the first longitudinal staple row 2712 is shown, consisting of four staples 2704, 2706, 2708, and 2710). An appendage 2714 is disposed on the top surface 2702a of the staple cartridge 2702. The appendage 2714 comprises interconnected, repeating, unsupported cells arranged along a longitudinal axis (only a portion of the first longitudinal cell row 2717 is shown), such as... Figures 8A to 9B The repeated cells 810 (only five repeated cells 2716a, 2716b, 2716c, 2716d, and 2716e are shown). As shown, the first vertical row of cells 2717 overlaps with the first vertical row of pins 2712, and the frequencies of pins 2704, 2706, 2708, and 2710 are different from the frequencies of cells 2716a, 2716b, 2716c, 2716d, and 2716e (e.g., not multiple pins). Therefore, for example, when the appendage 2714 is sutured to the tissue, each leg 2704b, 2706a, 2706b, 2708a, 2708b, 2710a of the corresponding staples 2704, 2706, 2708, 2710 is aligned with the different corresponding portions 2718, 2720, 2722, 2724, 2726 of the first longitudinal cell row 2712 (and therefore the appendage 2714), and will thus penetrate those different corresponding portions. Additionally, as... Figure 27 As shown, due to the structural configuration of repeating cells 2716a, 2716b, 2716c, 2716d, 2716e (e.g., not typically square), at least two or more of these different portions 2718, 2720, 2722, 2724, 2726, 2728 may have different relative thicknesses T1, T2, T3, T4, T5 (e.g., thick and thin thicknesses), and thus the thickness of the appendage 2714 trapped within the firing pin will vary between adjacent pins sutured to the consistent tissue.

[0243] In some implementations, the difference in relative thickness of the appendage may be paired with a corresponding difference in the length of the pin legs. For example, when the pin and cell frequencies are the same, the leg length of any pin configured to be advanced through the thicker portion of the appendage may be longer than the leg length of any pin configured to be advanced through the thinner portion of the appendage. Alternatively or otherwise, the difference in relative thickness may be paired with a corresponding difference in the depth of the anvil recess, or, if the pin drivers are at the same height, with a difference in the tissue gap between the first and second pin legs (if the pin drivers are at the same height).

[0244] Figure 28A It shows the relationship with Figure 27 An exemplary embodiment of the suture assembly 2700 is similar to the suture assembly 2800, except that the structural configuration of the appendage 2801 has been modified so that the staple frequency and cell frequency are the same. Therefore, the first staple legs 2804a, 2806a, 2808a of each staple 2804, 2806, 2808 are configured to pass through corresponding portions of the appendage having the same first thickness T1, and the second staple legs 2804b, 2806b, 2808b of each staple 2804, 2806, 2808 are configured to pass through corresponding portions of the appendage 2801 having the same second thickness T2. As shown, the first thickness T1 is greater than the second thickness T2, and therefore, to compensate for the difference in thickness, the first leg length L1 of each staple 2804, 2806, 2808 may be greater than the second leg length L2. In this illustrated embodiment, the crowns 2804c, 2806c, 2808c of each staple 2804, 2806, 2808 have a non-planar configuration (e.g., a stepped configuration) to achieve differences in staple leg lengths. Additionally, when staples 2804, 2806, 2808 are deployed and appendage 2801 is sutured to tissue T, each staple will have two different formed staple heights H1, H2, as shown below. Figure 28B As shown. Figure 29 Another exemplary embodiment of a suture assembly 2900 similar to suture assembly 2800 is shown, except that the crowns 2904c, 2906c, 2908c of each stud 2904, 2906, 2908 are generally planar (e.g., typically straight or linear within manufacturing tolerances), and therefore, the stud heights of the first studs will be generally uniform (e.g., nominally the same within manufacturing tolerances).

[0245] Appendage based on struts

[0246] As described above, the appendage may comprise a grid structure formed by strut-based cells (e.g., defined by planar interconnected struts). Typically, such appendages may comprise tissue contact layers, chamber contact layers, and internal structures (e.g., buckling structures). The internal structures typically include struts (e.g., spacer struts) that connect the tissue contact layers and chamber contact layers in a spaced-apart relationship. These struts may be configured to collapse without contacting each other when the appendage is compressed under stress. Therefore, densification of the appendage can be delayed, and thus can occur at higher strains.

[0247] The tissue contact layer and the compartment contact layer can have various configurations. In some embodiments, at least one of the tissue contact layer and the compartment contact layer may include a plurality of struts defining an opening. In some embodiments, both the tissue contact layer and the compartment contact layer are generally planar (e.g., planar within manufacturing tolerances). The tissue contact layer and the compartment contact layer may be oriented parallel to each other along a longitudinal axis extending from a first end to a second end of the appendage, and may further define a vertical axis extending therebetween.

[0248] The support bar can have various configurations. For example, in some embodiments, the support bar can have a generally uniform (uniform within manufacturing tolerances) cross-section, while in other embodiments, the support bar can have different cross-sections. In some embodiments, the appendage can have an average support bar thickness in the range of about 0.1 mm to 0.5 mm, about 0.1 mm to 0.4 mm, or about 0.1 mm to 0.3 mm.

[0249] Figures 30A to 30B An exemplary strut-based appendage 3000 is shown. The appendage 3000 includes a tissue contact layer 3002, a compartment contact layer 3004, and an internal structure 3006 extending therebetween. The internal structure 3006 is configured to collapse (compress) the appendage 3000 under applied stress, and thus cause the appendage 3000 to compress when sutured to tissue.

[0250] Although the tissue contact layer 3002 and the compartment contact layer 3004 can have various configurations, in this illustrated embodiment, they are both generally planar (e.g., planar within manufacturing tolerances). Furthermore, the tissue contact layer 3002 and the compartment contact layer 3004 are aligned along a longitudinal axis (L) extending from the first end 3000a of the appendage 3000 to the second end 3000b. A The tissue contact layer 3002 and the chamber contact layer 3004 are parallel to each other. As shown in the figure, the tissue contact layer 3002 and the chamber contact layer 3004 are inverted images of each other, where the thickness (T) of the chamber contact layer 3004 is... C The thickness of the 3002 surface layer at the tissue contact point is greater than that of the tissue contact surface (T). TTherefore, for simplicity, the following description pertains to tissue contact layer 3002. However, those skilled in the art will understand that the following discussion also applies to warehouse contact layer 3004.

[0251] The tissue contact layer 3002 has a first longitudinal support 3008a, a second longitudinal support 3010a, and a third longitudinal support 3012a extending along the longitudinal axis (L) of the appendage 3000, wherein the second longitudinal support 3010a is positioned between but spaced apart from the first and third longitudinal supports 3008a and the third longitudinal support 3012a. The tissue contact layer 3002 also includes a first cross support 3014a and a second cross support 3016a. Each of the first cross support 3014a is connected to the first longitudinal support 3008a and the second longitudinal support 3010a. Although the first cross support 3014a may be oriented in various different locations, in this illustrated embodiment, the first cross support 3014a is orthogonally oriented relative to the first longitudinal support 3008a and the second longitudinal support 3010a. Similarly, each of the second cross braces 3016a is connected to the second longitudinal brace 3010a and the third longitudinal brace 3012a. While the second cross braces 3016a may be oriented in various different locations, in this illustrated embodiment, the second cross braces 3016a are orthogonally oriented relative to the second longitudinal braces 3010a and the third longitudinal braces 3012a. Additionally, as shown, the first cross brace 3014a is aligned with the second cross brace 3016a in the y-direction.

[0252] Furthermore, the first cross braces 3014a are longitudinally spaced apart from each other at a first distance D1, and the second cross braces are longitudinally spaced apart from each other at a second distance D2. Thus, an opening 3018a is created within the tissue contact layer 3002. While the opening 3018a can have various sizes and shapes, in this illustrated embodiment, D1 and D2 are the same or substantially the same, and therefore, in combination with the orientation of the first cross braces 3014a and the second cross braces 3016a, the resulting opening 3018a is rectangular in form with substantially uniform dimensions (e.g., nominally identical within manufacturing tolerances).

[0253] While the internal structure 3006 can have various configurations, in this illustrated embodiment, the internal structure 3006 includes a spacer 3020 extending between the tissue contact layer 3002 and the compartment contact layer 3004. The spacer 3020 includes first angled supports 3022a, 3022b and second angled supports 3024a, 3024b, each of which extends at an angle (e.g., 45 degrees) relative to the tissue contact layer 3002 and the compartment contact layer 3004. The first angled supports include a first angled support 3022a extending from a first longitudinal support 3008a of the tissue contact surface 3002 to a second longitudinal support 3010b of the compartment contact layer 3004, and a second angled support 3022b extending from the first longitudinal support 3008b of the compartment contact layer 3004 to the second longitudinal support 3010a of the tissue contact layer 3002. Therefore, the first angled support strip 3022a and the second angled support strip 3022b alternate along the length (L) of the appendage. The second set of alternating angled support strips includes a third angled support strip 3024a and a fourth angled support strip 3024b. The third angled support strip 3024a is similar to the first angled support strip 3022a, except that it extends from the second longitudinal support strip 3010a of the tissue contact layer 3002 to the third longitudinal support strip 3012b of the compartment contact layer 3004. The fourth angled support strip 3024b is similar to the second angled support strip 3022b, except that it extends from the second longitudinal support strip 3010b of the compartment contact layer 3004 to the third longitudinal support strip 3012a of the tissue contact layer 3002. Therefore, in this illustrative embodiment, the first angled support bar 3022a and the third angled support bar 3024a extend in the same direction relative to each other, and the second angled support bar 3022b and the fourth angled support bar 3024b extend in the same direction relative to each other.

[0254] like Figure 30A As further shown, the opening 3018b is formed within the compartment contact layer 3004 between the first cross brace 3014b and the second cross brace 3016b. Additionally, the angled braces 3022a, 3022b, 3024a, and 3024b substantially overlap with the corresponding opening 3018b in at least the compartment contact layer 3004, and as described above, the compartment contact layer 3004 has a thickness T greater than that of the tissue contact layer 3002. T Thickness T CTherefore, the opening 3018b defined in the contact layer 3004 can be configured to receive at least a portion of the corresponding angled strut as the appendage 3000 bends when compressed under applied stress. This creates additional space within the internal structure 3006 for buckling and thus reduces the solid height of the appendage 3000. Consequently, in use, densification of the appendage 3000 can be delayed, allowing the appendage 3000 to undergo a wider range of deformations without reaching its solid height.

[0255] Furthermore, a concentrated area 3030 is created within the internal structure 3006 by alternating angled support bars 3022a, 3022b, 3024a, and 3024b. As shown in the figure, this concentrated area 3030 extends longitudinally along the appendage between the first and second sets of angled support bars 3022a, 3022b, 3024a, and 3024b. Therefore, no support bar 3020 overlaps with this concentrated area 3030 within the internal structure 3006, as... Figure 30B This is shown in more detail below. In other words, this concentration zone 3030 is designed as a space without struts, where no struts cross into this space before or during the compression of the appendage. Therefore, the presence of this concentration zone 3030 increases the densification point of the appendage 3000 while suturing the appendage to the tissue (e.g., reducing the solidity height of the appendage). Additionally, the concentration zone can overlap with the cutting line of the appendage, thus reducing the amount of material along that cutting line. This can help facilitate the advancement of the cutting elements of the suturing device and therefore make cutting the appendage easier.

[0256] Figure 31A , Figure 32A , Figure 33A and Figure 34A Various other exemplary strut-based appendages 3100, 3200, 3300, and 3400 are shown. Each exemplary appendage has a grid structure formed by repeating, interconnected strut-based cells. Figures 31B to 31D , Figures 32B to 32D , Figures 33B to 33E and Figures 34B to 34E This is shown in more detail below. These appendages are structured to allow for compression when exposed to compressive forces (e.g., stresses applied when sutured to tissue).

[0257] Figure 31AAnother exemplary appendage 3100 in the form of a lattice structure is shown, comprising a top portion 3102, a bottom portion 3104, and an internal structure 3106 extending therebetween. The top portion 3102 is configured to contact tissue and thus form a tissue contact layer of the appendage 3100, while the bottom portion 3104 is configured to attach to a compartment and thus form a compartment contact layer of the appendage 3100. The internal structure 3106 may be configured, for example, to be compressible into a deformable state under load when sutured to tissue. The lattice is formed by an array of repeating cells 3110, one of which is in... Figures 31B to 31D The details are shown in more detail below. Therefore, for simplicity, the following description concerns the top portion 3102, the bottom portion 3104, and the internal structure 3106 of a cell.

[0258] While the top portion 3102 and the bottom portion 3104 can have various configurations, in this illustrated embodiment, the top portion 3102 and the bottom portion 3104 are inverted images of each other, and therefore, for simplicity, the following description pertains to the top portion 3102 of a cell 3110. However, those skilled in the art will understand that the following discussion also applies to the bottom portion 3104.

[0259] like Figures 31A to 31D As shown, the top portion 3102 includes a first cross brace 3112 and a second cross brace 3114, and a first angled brace 3116 and a second angled brace 3118 extending therebetween. In this illustrated embodiment, the first angled brace 3116 extends at a first angle from a first end of the first cross brace 3112 and terminates at a middle portion of the second cross brace 3114, and the second angled brace 3118 extends at a second angle from a second opposite end of the first cross brace 3112 and terminates at a middle portion of the second cross brace 3114. Thus, the first angled brace 3116 and the second angled brace 3118 converge and connect at a central segment 3114a of the second cross brace 3114. In other embodiments, the first angled brace 3116 and the second angled brace 3118 may extend at any other suitable angle.

[0260] While the internal structure 3106 can have various configurations, in this illustrated embodiment, the internal structure 3106 includes three spacer struts 3120a, 3120b, and 3120c. For example... Figures 31B to 31DAs shown, the first spacer 3120a and the third spacer 3120c each interconnect the first cross support 3112 of the top portion 3102 to the first cross support 3112 of the bottom portion 3104, and the second spacer 3120b interconnects the center segment 3114a of the second cross support 3114 of the top portion 3102 to the center segment 3114a of the second cross support 3114 of the bottom portion 3104.

[0261] Figure 32A Another exemplary appendage 3200 in the form of a grid structure is shown, the grid structure including a top portion 3202, a bottom portion 3204, and an internal structure 3206 extending therebetween. The top portion 3202 is configured to contact tissue and thus form a tissue contact layer of the appendage 3200, while the bottom portion 3204 is configured to attach to a compartment and thus form a compartment contact layer of the appendage 3200. Except for the differences described below, the appendage 3200 is similar to... Figure 31A As shown in 31D, the appendage 3100. The grid is formed by an array of repeating cells 3201, where one of the repeating cells is in... Figures 32B to 32D The following is shown in more detail. Therefore, for simplicity, the following description concerns the top portion 3202, the bottom portion 3204, and the internal structure 3206 of a cell.

[0262] like Figures 32B to 32D As shown, the top portion 3202 is offset from the bottom portion 3204 in the first and second dimensions (X, Z). The top portion 3202 includes two separate sets of interconnecting struts 3202a, 3202b, which are connected to each other by connecting struts 3203. The bottom portion 3204 includes eight interconnecting struts 3204a, six of which form the first hexagonal face of cell 3201. The internal structure 3206 includes two sets of spacer struts 3208a, 3208b, 3208c, 3210a, 3210b, 3210c extending from the top portion 3202 to the bottom portion, thereby forming two additional hexagonal faces of cell 3201, as shown. Figure 32B As shown.

[0263] Figure 33A Another exemplary appendage 3300 in the form of a lattice structure is shown, comprising a top portion 3302, a bottom portion 3304, and an internal structure 3306 extending therebetween. The top portion 3302 is configured to contact tissue and thus forms a tissue contact layer of the appendage 3300, while the bottom portion 3304 is configured to attach to a compartment of a surgical suture device and thus forms a compartment contact layer of the appendage 3300. Except for the differences described below, the appendage 3300 is similar to... Figure 31AAs shown in 31D, the appendix 3100. The grid is formed by an array of repeating cells 3310, where one of the repeating cells is in... Figures 33B to 33E The details are shown in more detail below. Therefore, for simplicity, the following description concerns the top portion 3302, the bottom portion 3304, and the internal structure 3306 of a cell 3310.

[0264] While the top portion 3302 and the bottom portion 3304 can have various configurations, in this illustrated embodiment, the top portion 3302 and the bottom portion 3304 are substantially identical to each other, and therefore, for simplicity, the following description pertains to the top portion 3302 of a cell 3310. However, those skilled in the art will understand that the following discussion also applies to the bottom portion 3304.

[0265] like Figures 33A to 33E As shown, the top portion 3302 includes a first pair of opposing outer struts 3312a, 3312b and a second pair of opposing outer struts 3312c, 3312d. The first and second pairs of outer struts 3312a, 3312b, 3312c, 3312d are connected in the form of a parallelogram having four corners 3316a, 3316b, 3316c, 3316d. In this illustrated embodiment, the parallelogram is a square. The top portion 3302 also includes a first cross strut 3318 connecting the first pair of opposing outer struts 3312a, 3312b and a second cross strut 3320 connecting the second pair of opposing outer struts 3312c, 3312d. As shown, the first cross strut 3318 and the second cross strut 3320 intersect each other at a 90-degree angle at the middle of the top portion 3302.

[0266] Although the internal structure 3306 can have various configurations, in this illustrated embodiment, the internal structure 3306 includes a first side 3322a, a second adjacent side 3322b, a third side 3322c opposite to the first side 3322a, and a fourth side 3322d opposite to the second side 3322b (see [link to previous embodiment]). Figure 33D Although each side may have various configurations, in this illustrated embodiment, the first side 3322a and the third side 3322c are substantially the same as each other, and the second side 3322 and the fourth side 3322d are substantially the same as each other.

[0267] like Figures 33B to 33EAs shown, the first side 3322a of the internal structure 3306 includes a first angled spacer 3324a and a second angled spacer 3324b, which extend in opposite directions from the center segment 3313 of the outer spacer 3312a of the bottom portion 3304 to the first corner 3316a and the second corner 3316b of the top portion 3302, respectively. Similarly, the third side 3322c of the internal structure includes a third angled spacer 3326a and a fourth angled spacer 3326b, which extend in opposite directions from the center segment (obscured) of the outer spacer 3312b (obscured) of the bottom portion 3304 to the third corner 3316c and the fourth corner 3316c of the top portion 3302, respectively.

[0268] Additionally, the second side 3322b of the internal structure 3306 includes a fifth angled spacer 3328a and a sixth angled spacer 3328b, which extend in opposite directions from the central segment 3315 of the outer spacer 3312c of the top portion 3302 to the first corner 3316a and the fourth corner 3316d of the bottom portion 3304, respectively. Similarly, the fourth side 3322d of the internal structure 3306 includes a seventh spacer 3330a and an eighth angled spacer (which is obscured), which extend in opposite directions from the central segment 3317 of the outer spacer 3312d of the top portion 3302 to the second corner 3316b and the third corner (the third corner of the bottom portion 3304 is obscured) of the bottom portion 3304.

[0269] The internal structure 3306 also includes a first pair of angled spacer bars 3332a and 3332b. The first angled spacer bar 3332a extends from the middle of the top portion 3302 to the center segment 3334 of the outer spacer bar 3312c of the bottom portion 3304. Similarly, the second spacer bar 3332b extends from the middle of the top portion 3302 to the center segment (obscured) of the outer spacer bar 3312d of the bottom portion 3304. Thus, the first pair of angled spacer bars 3332a and 3332b extend from the middle of the top portion 3302 in opposite directions.

[0270] Additionally, the internal structure 3306 includes a second pair of angled spacer bars 3336a and 3336b. The first angled spacer bar 3336a extends from the middle of the bottom portion 3304 to the center segment 3338 of the outer spacer bar 3312b of the top portion 3302. Similarly, the second spacer bar 3336b extends from the middle of the bottom portion 3304 to the center segment (which is obscured) of the outer spacer bar 3312a of the top portion 3302. Therefore, the second pair of angled spacer bars 3336a and 3336b extend from the middle of the bottom portion 3304 in opposite directions.

[0271] Figure 34A Another exemplary appendage 3400 in the form of a lattice structure is shown, comprising a top portion 3402, a bottom portion 3404, and an internal structure 3406 extending therebetween. The top portion 3402 is configured to contact tissue and thus forms a tissue contact layer of the appendage 3400, while the bottom portion 3404 is configured to attach to a compartment of a surgical suture device and thus forms a compartment contact layer of the appendage 3400. Except for the differences described below, the appendage 3400 is similar to... Figure 31A As shown in 31D, the appendix 3100. The grid is formed by an array of repeating cells 3410, where one of the repeating cells is in... Figures 34B to 34E This is shown in more detail below. Therefore, for simplicity, the following description concerns the top portion 3402, the bottom portion 3404, and the internal structure 3406 of a cell.

[0272] While the top portion 3402 and the bottom portion 3404 may have various configurations, in this illustrated embodiment, the top portion 3402 and the bottom portion 3404 are substantially identical to each other, and therefore, for simplicity, the following description pertains to the top portion 3402 of a cell 3410. However, those skilled in the art will understand that the following discussion also applies to the bottom portion 3404.

[0273] like Figures 34B to 34EAs shown, the top portion 3402 includes four intersecting braces 3408a, 3408b, 3408c, and 3408d connected together at the middle of the top portion 3402. While the four intersecting braces 3408a, 3408b, 3408c, and 3408d can be connected relative to each other at different angles, in this illustrated embodiment, the four intersecting braces 3408a, 3408b, 3408c, and 3408d are connected relative to each other at 90 degrees, thus forming a cross shape with four outer ends 3411a, 3411b, 3411c, and 3411d. The top portion 3402 also includes four braces 3412a, 3412b, 3412c, and 3412d connected in a manner that forms a square with four corners 3414a, 3414b, 3414c, and 3414d. Each square strut 3412a, 3412b, 3412c, 3412d and the central segments 3416a, 3416b, 3416c, 3416d of one of the four cross-shaped struts 3408a, 3408b, 3408c, 3408d (see...) Figure 34D )intersect.

[0274] While the internal structure 3406 can have various configurations, in this illustrated embodiment, the internal structure 3406 includes four sets of angled outer support bars, wherein each set of angled outer support bars includes two angled support bars 3418a, 3418b, 3420a, 3420b, 3422a, 3422b, 3424a, and 3424b. The four sets of angled outer support bars can have various configurations. As shown in the figure, in this illustrated embodiment, the first and second sets of outer support bars are mirror images of each other, and the third and fourth sets of outer support bars are also mirror images of each other.

[0275] like Figure 34B As shown, the first angled support bar 3418a and the second angled support bar 3418b of the outer support bar of the first composition angle each extend in opposite directions from the first corner 3414a of the square of the bottom portion 3404 to one of the first corner 3411a and the second corner 3411b of the intersection of the top portion 3402. Similarly, the first angled support bar 3420a and the second angled support bar 3420b of the outer support bar of the second composition angle each extend in opposite directions from the third corner 3414c (obscured) of the square of the bottom portion 3404 to the remaining corners of the intersection of the top portion 3402 (e.g., the third corner 3411c and the fourth corner 3411d, respectively).

[0276] like Figure 34BAs further shown, the first angled support bar 3422a and the second angled support bar 3422b of the third angled outer support bar each extend in opposite directions from the second corner 3414b of the square of the top portion 3404 to one of the second corner 3411b and the third corner 3411c of the cross-shaped structure of the bottom portion 3404. Similarly, the first angled support bar 3424a and the second angled support bar 3424b of the fourth angled outer support bar each extend in opposite directions from the fourth corner 3414d of the square of the top portion 3404 to one of the first corner 3411a and the fourth corner 3411d (obscured) of the cross-shaped structure of the bottom portion 3404.

[0277] The internal structure 3406 also includes two sets of angled internal bracing bars, each set comprising two angled bracing bars 3426a, 3426b, 3428a, and 3428b. The two sets of angled internal bracing bars can have various configurations. For example... Figure 34B As shown, the first angled support bar 3426a and the second angled support bar 3426b of the first angled inner support bar extend in opposite directions from the middle of the cross shape of the top portion 3402 to one of the second corner 3414b and the fourth corner 3414d (obscured) of the square of the bottom portion 3404. In this illustrated embodiment, the first angled support bar 3428a and the second angled support bar 3428b of the second angled inner support bar are opposite to the first angled support bar 3426a and the second angled support bar 3426b. That is, as Figure 34B As shown, the first angled support 3428a and the second angled support 3428b of the second set of inner support bars extend from the middle of the square of the bottom portion 3404 in opposite directions to one of the first corner 3414a and the third corner 3414c (obscured) of the square of the top portion 3402.

[0278] like Figures 30A to 34E As shown, the strut-based configuration of the appendage creates multiple openings throughout the appendage, thereby creating fewer cell infiltration barriers compared to non-strut-based appendage configurations. In other words, these multiple openings allow cells to flow into the appendage more rapidly when it is sutured to the tissue. This increased rate of inward tissue growth, compared to other appendages, enhances the rate of tissue growth.

[0279] Although Figures 31A to 34EThe openings in the top and bottom portions of the appendage shown are regular and symmetrically defined by struts; however, in other embodiments, the top and bottom portions may instead be planar sheets (e.g., “Swiss cheese” type sheets) in which regular or irregular openings are formed, or non-planar sheets (e.g., corrugated or wavy) in which regular or irregular openings are formed. These openings in both planar and non-planar appendage configurations can also promote inward cell growth within the appendage when the appendage is sutured to tissue.

[0280] In other embodiments, the repeating units based on the strut appendages may have other structural configurations. For example, Figure 35 An exemplary support bar-based cell 3500 is shown that can be used to form the appendages described herein. Cell 3500 includes a top portion 3502, a bottom portion 3504, and an internal structure 3506 extending therebetween.

[0281] While the top portion 3502 and the bottom portion 3504 may have various configurations, in this illustrated embodiment, the top portion 3502 and the bottom portion 3504 are substantially identical to each other, and therefore, for simplicity, the following description pertains to the top portion 3502. However, those skilled in the art will understand that the following discussion also applies to the bottom portion 3504.

[0282] like Figure 35 As shown, the top portion 3502 includes a first pair of opposing outer struts 3512a, 3512b and a second pair of opposing outer struts 3514a, 3514b. The first and second pairs of outer struts 3512a, 3512b, 3514a, 3514b are connected in the form of a parallelogram having four corners 3516a, 3516b, 3516c, 3516d. In this illustrated embodiment, the parallelogram is a square. The top portion 3502 also includes a first cross strut 3518 connecting the first pair of opposing outer struts 3512a, 3512b and a second cross strut 3520 connecting the second pair of opposing outer struts 3514a, 3514b. As shown, the first cross strut 3518 and the second cross strut 3520 intersect each other at a 90-degree angle at the middle of the top portion 3502.

[0283] While the internal structure 3506 can have various configurations, in this illustrated embodiment, the internal structure 3506 includes a first side 3522a, a second adjacent side 3522b, a third side 3522c opposite to the second side 3522b, and a fourth side 3522d opposite to the first side 3522a. Although each side can have various configurations, in this illustrated embodiment, the first side 3522a, the second side 3522b, the third side 3522c, and the fourth side 3522d are different. In this illustrated embodiment, the fourth side 3522d does not include any spacer struts.

[0284] like Figure 35 As shown, the first side 3522a of the internal structure 3506 includes a first angled spacer 3524a and a second angled spacer 3524b extending parallel to each other. The first angled spacer 3524a extends from a first corner 3516a of the bottom portion 3504 to a central segment 3513a of a first outer spacer 3512a of the top portion 3502, and the second angled spacer extends from a central segment 3513b of the first outer spacer 3512a of the bottom portion 3504 to a second corner 3516b of the top portion 3502.

[0285] The second side 3522b of the internal structure 3506 includes a third angled spacer 3526a and a fourth angled spacer 3526b extending parallel to each other. The third angled spacer 3526c extends from the second corner 3516b of the bottom portion 3504 to the center segment 3515 of the second outer spacer 3514b of the top portion 3502, and the fourth angled spacer 3526b extends from the center segment of the second outer spacer (obscured) of the bottom portion 3504 to the third corner 3516c of the top portion 3502.

[0286] Additionally, the third side 3522c of the internal structure 3506 includes a fifth angled spacer 3528a and a sixth angled spacer 3528b extending parallel to each other. The fifth angled spacer 3528a extends from the fourth corner 3516d of the bottom portion 3504 to the center segment 3517 of the second outer spacer 3514a of the top portion 3502, and the sixth angled spacer 3528b extends from the center segment 3517 of the first outer spacer 3514a of the bottom portion 3504 to the first corner 3516a of the top portion 3502.

[0287] The internal structure 3506 also includes two sets of internally angled support bars. The first set includes three internally angled support bars 3530a, 3530b, and 3530c, each extending from the middle of the top portion 3502 to the central segments 3513, 3517, and 3519 of the outer support bars 3512a, 3514a, and 3512b of the bottom portion 3504, respectively. Therefore, in the first set, the first internally angled support bar 3530a and the third internally angled support bar 3530c extend in opposite directions, and the second internally angled support bar 3530b extends in a different direction relative to the first internally angled support bar 3530a and the third internally angled support bar 3530c. The second group includes three internally angled support bars 3532a, 3532b, and 3532c, each extending from the middle of the bottom portion 3504 to the central segments 3513, 3515, and 3519 of the outer support bars 3512a, 3514b, and 3512b of the top portion 3502, respectively. Therefore, in the second group, the first internally angled support bar 3532a and the third internally angled support bar 3532c extend in opposite directions, and the second internally angled support bar 3532b extends in a different direction relative to the first internally angled support bar 3532a and the third internally angled support bar 3532b.

[0288] In other embodiments, the repeating units based on the strut appendages may have other structural configurations. For example, Figure 36 An exemplary support bar-based cell 3600 is shown that can be used to form the appendages described herein. Cell 3600 includes a top portion 3602, a bottom portion 3604, and an internal structure 3606 extending therebetween.

[0289] While the top portion 3602 and the bottom portion 3604 can have various configurations, in this illustrated embodiment, the top portion 3602 and the bottom portion 3604 are substantially identical to each other, and therefore, for simplicity, the following description pertains to the top portion 3602. In this embodiment, the bottom portion 3604 is an inverted image of the top portion 3602. However, those skilled in the art will understand that the following discussion also applies to the bottom portion 3604.

[0290] like Figure 36As shown, the top portion 3602 includes a first pair of cross braces 3612a, 3612b and a second pair of cross braces 3612c, 3612d. The first and second pairs of cross braces 3612a, 3612b, 3612c, 3612d are connected in such a manner that the top portion 3602 is in the form of a sparse tetrahedron with five corners 3616a, 3616b, 3616c, 3616d, 3616e. The first pair of cross braces 3612a, 3612b intersect at point 3617 on the top portion. Cross brace 3612a connects to cross brace 3612c at corner 3616d, and cross brace 3612b connects to cross brace 3612d at corner 3616c. As shown in the figure, the cross braces 3612a and 3612b intersect each other at a 90-degree angle at the intersection point 3617 in the middle of the top portion 3602.

[0291] like Figure 36 As shown, the internal structure 3606 includes a first angled spacer 3620a and a second angled spacer 3620b extending parallel to each other. The first angled spacer 3620a extends from a first corner 3616a of the top portion 3602 to a corner 3616e of the bottom portion 3604, and the second angled spacer 3620b extends from a third corner 3616c of the top portion 3602 to the intersection point 3617 of the bottom portion 3604. Additionally, the internal structure 3606 includes a third angled spacer 3622a and a fourth angled spacer 3622b extending parallel to each other. The third angled spacer 3622a extends from the second corner 3616b of the top portion 3602 to the corner 3616e of the bottom portion 3604, and the fourth angled spacer 3622b extends from the fourth corner 3616d of the top portion 3602 to the intersection point 3617 of the bottom portion 3604. Therefore, the first angled spacer 3620a and the third angled spacer 3622a extend in opposite directions, and the second angled spacer 3620b and the fourth angled spacer 3622b extend in opposite directions.

[0292] outer layer

[0293] In some embodiments, the appendage may include a grid structure (e.g., a first grid structure or an inner grid structure) and at least one outer layer extending from a top surface to a bottom surface, each outer layer having a different compression ratio (e.g., the ratio of pre-compression height to compression height). Therefore, the grid structure and the at least one outer layer have different compression characteristics and can thus be tailored to perform different functions (e.g., tissue inward growth, compartmentalization, etc.) while also collectively achieving an overall compression profile of the appendage that is desired for varying pin conditions and / or pin heights. For example, based on the resulting overall compression profile of the appendage, the appendage is configured to withstand strains in the range of about 0.1 kPa to 0.9 kPa when subjected to applied stresses in the range of about 30 kPa to 90 kPa. In other embodiments, the strain may be in the range of about 0.1 to 0.8, about 0.1 to 0.7, about 0.1 to 0.6, about 0.2 to 0.8, about 0.2 to 0.7, about 0.3 to 0.7, about 0.3 to 0.8, about 0.3 to 0.9, about 0.4 to 0.9, about 0.4 to 0.8, about 0.4 to 0.7, about 0.5 to 0.8, or about 0.5 to 0.9.

[0294] While the grid structure and at least one outer layer can have various configurations, in some embodiments, the compression ratio of the first grid structure is greater than that of the at least one outer layer. For example, in one embodiment, the first grid structure may be configured to compress within a range of about 3 mm to 1 mm under applied stress, and thus its compression ratio may be 3, while at least the outer layer may be configured to compress within a range of about 2 mm to 1 mm under the same applied stress, and thus its compression ratio may be 2.

[0295] In some embodiments, the appendage may include an outer layer in the form of a second grid structure or an absorbable membrane, positioned on at least a portion of the top surface of the first grid structure and configured to be positioned against tissue. This outer layer may also be configured to promote inward tissue growth within the appendage and / or create a smooth or substantially smooth tissue contact surface that can easily slide against tissue, thus reducing tissue load (applied stress) on the appendage during suture device placement and / or simplifying attachment requirements between the appendage and the cartridge. Alternatively or additionally, the appendage may include an outer layer in the form of a membrane or a third grid structure, positioned on at least a portion of the bottom surface of the first grid structure and configured to be positioned against the cartridge. Thus, this outer layer may be configured to attach the appendage to the cartridge. For example, this outer layer may be in the form of an adhesive film and / or include one or more attachment features designed to releasably engage with the cartridge. In some embodiments, the compression ratio of the grid structure is greater than that of at least one outer layer.

[0296] Figures 37A to 37B An exemplary embodiment of an appendage 3700 disposed on a compartment 3800 is shown. The compartment 3800 is similar to... Figures 1 to 2C The compartment 200 is described in detail herein, and therefore common features are not described in detail herein. The appendage 3700 includes an internal grid structure 3702 and two outer layers 3704, 3710, each outer layer having a different compression ratio relative to each other. The internal grid structure 3702 is generally formed of interconnected repeating cells, and any repeating cells disclosed herein may be used when the repeating cells are omitted from this illustration, for example, repeating cells based on struts or repeating cells based on struts. Additionally, a first outer layer 3704 is disposed on the top surface 3702a of the internal grid structure 3702 and configured to contact tissue, and a second outer layer 3706 is disposed on the bottom surface 3702b of the internal grid structure 3702 and configured to contact compartment 3800.

[0297] While the first outer layer 3704 can have various configurations, in this illustrated embodiment, the first outer layer 3704 is a grid structure formed by struts 3710 interconnected in a manner that creates hexagonal openings 3712 extending through the first outer layer 3704. These openings 3712 can be configured to facilitate inward tissue growth. Those skilled in the art will understand that the struts can be interconnected in various other ways, resulting in openings of different sizes and shapes, and therefore the grid structure of the first outer layer is not limited to the grid structure shown in the figures. Additionally, the first outer layer 3704 can have a lower compression ratio and therefore less compressibility compared to at least the inner grid structure 3702. Therefore, when the appendage 3700 is sutured to the tissue, this allows the tissue to penetrate further into the openings 3712 and thus into the appendage 3700, thereby further facilitating inward tissue growth (see [reference]). Figure 38A and Figure 38B ).

[0298] While the second outer layer 3706 can have various configurations, in this illustrated embodiment, the second outer layer 3706 takes the form of a membrane 3714 having protrusions 3716 extending outwardly therefrom. The protrusions 3716a, 3716b, and 3716c are configured to mate with surface features 3802, 3804, and 3806 of the chamber 3800, such as... Figures 1 to 2C The surface feature sections 216, 218, and 220 of the Zhongcang 200. For example... Figure 37B and Figure 38AAs shown, this mating interaction essentially prevents the appendage 3700 from sliding relative to the chamber 3800. The shapes and dimensions of the protrusions 3716a, 3716b, and 3716c (which may be triangular or rhomboid) are complementary to the shapes and dimensions of the corresponding surface features 3802, 3804, and 3806 (which may be triangular or rhomboid recessed channels). In other embodiments, the shapes and dimensions of the protrusions and surface features may differ.

[0299] Alternatively or additionally, the second outer layer 3706 may include an elongated protrusion 3730 configured to be inserted into a longitudinal slot 3808 of the compartment 3800. While the elongated protrusion may have various configurations, in this illustrated embodiment, the elongated protrusion 3730 has a rectangular shape. In some embodiments, the elongated protrusion 3730 may extend along the entire length of the appendage (e.g., in the z-direction), while in other embodiments, the elongated protrusion 3730 may extend along a portion of that length. In some embodiments, the elongated protrusion 3730 may be decomposed into smaller, elongated discrete portions.

[0300] In other implementations, such as Figure 39A As shown, the second outer layer 3900 may include four sets of contacts 3902a, 3902b, 3904a, 3904b, 3906a, 3906b, 3908a, and 3908b. Figure 39A The middle part partially obscures 3902b, 3904b, 3906b and 3908b), these tabs each face outward and away from the relatively outer surfaces 3900a, 3900b of the second outer layer 3900 ( Figure 39B Extending. Although the four sets of tabs 3902, 3904, 3906, and 3908 can have various configurations, in this illustrated embodiment, each of the four sets of tabs 3902, 3904, 3906, and 3908 has a hook-shaped configuration that engages with corresponding portions of the opposing outer flanges 3910a, 3910b, 3910a, 3910b, 3914a, 3914b, 3914a, and 3914b of the housing 3901. Additionally, when the housing 3901 includes a longitudinal slot 3918, such as a tool slot, the second outer layer 3900 may include a pin feature 3912 configured to engage the longitudinal slot 3918. For example, the pin feature 3912 may include multiple sets of two opposing pins spaced apart from each other intermittently along the longitudinal slot 3918 (in... Figures 39A to 39B Only one set of two opposing contacts, 3912A and 3912B, is shown in the image. Figure 39B As shown in more detail, the first pin 3912a engages the first wall 3918a of the longitudinal slot 3918, and the second pin 3912b engages the second opposite wall 3918b of the longitudinal slot 3918.

[0301] As described above, in some embodiments, the second outer layer may be an adhesive film. In one exemplary embodiment, such as... Figure 40 As shown, accessory 4000 is installed in warehouse 4001 (e.g. Figure 1 The appendage 4000 is located on the top surface 4001a of the compartment 200 in Figure 2c. The appendage 4000 includes an internal structure 4002, a first outer layer 4004 disposed on the top surface 4002a of the internal structure 4002, and a second outer layer 4006 disposed on the opposite bottom surface 4000b, opposite the top surface 4002a of the internal structure 4002. Except for the differences discussed below, the appendage 4000 may be similar to... Figures 37A to 38A The appendage 3700 is included, and therefore common features are not described in detail herein. As shown in the figure, the internal structure 4002 consists of interconnected repeating cells 4008 (such as...). Figures 8A to 9B Cell 810 in the image is formed. Additionally, the second outer layer 4006 is in the form of an adhesive film attached to the top surface 4001a of the chamber 4001. In this illustrated embodiment, the second layer 4006 is an adhesive film formed of a pressure-sensitive adhesive. Further details regarding the adhesive film and other attachment methods can be found in U.S. Patent No. 10,349,939, the entire contents of which are incorporated herein by reference.

[0302] Nail-shaped grille

[0303] In some embodiments, the appendage may further include a grid structure extending from the second outer layer and configured to be inserted into a nail recess or channel in the nail cartridge. For example, as Figure 41A As shown, the appendage 4100 includes an internal grid structure 4102 extending between two outer layers 4104, 4106. The internal grid structure 4102 is generally formed of interconnected repeating cells, and any repeating cells disclosed herein may be used when the repeating cells are omitted from this illustration. Additionally, each of the two outer layers 4104, 4106 may be formed by a grid structure or as a membrane, and thus, each of the two outer layers is approximately... Figures 41A to 41C As shown in the diagram. The first outer layer 4106 is configured to contact tissue, and as... Figures 41B to 41C As shown, the second outer layer 4104 is configured to contact the compartment 4101. The compartment 4101 is similar to... Figures 1 to 2C The warehouse is 200, and therefore the common features are not described in detail in this paper.

[0304] like Figures 41A to 41CAs further shown, the appendage 4100 includes nail pit grids 4110a, 4110b, and 4110c extending outward from the second outer layer 4104. The nail pit grids can serve as separate compression zones for the appendage 4100; for example, the nail pit grids 4110a, 4110b, and 4110c can have a different compression ratio than the appendage as a whole, so as not to substantially increase the overall solid height of the appendage. While the nail pit grids can have various configurations, in this illustrated embodiment, two sets of three longitudinal rows of nail pit grids 4110a, 4110b, and 4110c are present on opposite sides of the intended cut line of the appendage. Although the nail pit grids can have various configurations, each nail pit grid is formed by five U-shaped struts. The shape and size of the perimeter surrounding each nail recess grid 4110a, 4110b, 4110c can be triangular or rhomboid, and can be complementary to the shape and size (which can be triangular or rhomboid) of the corresponding nail recesses 4112a, 4112b, 4112c. In other embodiments, the grid structure and the shape and size of the nail recesses can be different. Figures 41B to 41C As shown, once the appendage 4100 is placed on the magazine 4101, at least a portion of the staples 4114a, 4114b, 4114c within the magazine 4101 extends through the corresponding staple recess grid 4110a, 4110b, 4110c, and is thus captured by the staple crown when the appendage is sutured to the tissue. Therefore, the staple recess grid also aids in attaching the appendage to the staple magazine and / or aligning the appendage relative to the staples.

[0305] The structural configuration of the cells disclosed herein can also be customized to achieve variable mechanical responses within the same appendage, such as in the lateral and / or longitudinal directions (e.g., the y-direction and / or z-direction, respectively). For example, in some embodiments, the appendage may be formed by at least two or more different grid structures placed side by side to produce at least two fundamentally different compressive properties within the same appendage.

[0306] like Figure 42AGenerally speaking, the appendage 4200 may have an inner grid structure 4202 and two outer grid structures 4204, 4206, wherein each grid structure 4202, 4204, 4206 defines a corresponding compression zone C1, C2, C3 of the appendage 4200. In this embodiment, the first and second outer grid structures are structurally identical, and therefore C2 and C3 are identical. As shown, the grid structures 4202, 4204, 4206 are laterally offset from each other relative to the longitudinal axis of the appendage 4200. That is, the first outer grid structure 4204 is positioned directly adjacent to the first longitudinal side (obscured) of the inner grid structure 4202, and the second outer grid structure 4206 is positioned directly adjacent to the second opposite longitudinal side (obscured) of the inner grid structure 4202. Since each grid structure can be formed by any repeating cell disclosed herein, three grid structures 4202, 4204, 4206 without any cells are shown. Those skilled in the art will understand that each grid structure can be formed by repeating cells based on struts or by repeating cells without struts.

[0307] As further shown, the expected cutting line C of appendage 4200 L Confined across the internal grid structure 4202 and along the longitudinal axis L of the appendage 4200 A Limited. Therefore, in this illustrated embodiment, the inner grid structure 4202 can be constructed to be more rigid than the outer grid structures 4204, 4206, thus exhibiting higher compressive strength. Therefore, the resulting appendage 4200 can be positioned relative to the cut line C of appendage 24200. L It has variable compressive strength in the transverse direction (e.g., the y-direction). Therefore, this variable compressive strength facilitates the transition of tissue compression at the outermost staple row 4210 when the appendage is sutured to the tissue, as... Figure 42B As shown.

[0308] Figures 43A to 43B It shows the relationship with respect to its longitudinal axis L A Another embodiment of the appendage 4300 has variable compressive strength along the lateral direction (e.g., the y-direction). In this illustrated embodiment, the appendage 4300 is formed by three different grid structures 4310, 4320, and 4330, each grid structure being formed by different repeating units. More specifically, the first grid structure 4310 is formed by interconnected first repeating cells 4310a, one of which is in Figure 43A As shown, the second grid structure 4320 is formed by interconnected second repeating cells 4320a, one of which is in Figure 43A As shown, the third grid structure 4330 is formed by interconnected third repeating cells 4330a, one of which is in Figure 43A As shown in the figure. As described in more detail below, by designing each grid structure differently, the resulting appendages can have a variety of lateral compression responses.

[0309] While repeating cells 4310a, 4320a, and 4330a can have various configurations, in this illustrated embodiment, repeating cells 4310a, 4320a, and 4330a are cells based on all the struts. Furthermore, depending on the position of the corresponding grid structure, the repeating cells can be structurally configured to be stiffer or less stiff than repeating cells in other grid structures, as described in more detail below.

[0310] Although the three grid structures 4310, 4320, and 4330 can be positioned relative to each other in various different configurations, the first grid structure 4310 is the intended cutting line C of its appendage 4300. L Extending through it and along the longitudinal axis L A The central grid structure of the appendages. Therefore, compared to the second and third repeating cells, the first repeating cell 4310a can have a less compact structural configuration and is therefore more flexible, for example, as... Figure 43A As shown. Additionally, the first grille structure 4310 extends along the entire length L of the appendage 4300. The second grille structure 4320 is divided into two longitudinal portions 4325a and 4325b. The first longitudinal portion 4325a of the second grille structure 4320 is positioned against the first longitudinal sidewall L1 of the first grille structure 4310, and the second longitudinal portion 4325b of the second grille structure 4320 is positioned against the second opposing longitudinal sidewall L2 of the first grille structure 4310 (see...). Figure 43B Based on its relationship with the cutting line C. L In terms of position, compared to the first repeating cell 4310a and the third repeating cell 4330a, the second repeating cell 4320a can be constructed to be the most compact and therefore the most rigid, for example, as Figure 43A As shown.

[0311] like Figure 43A As further shown, the third grille structure is divided into two U-shaped portions 4335a and 4335b, each U-shaped portion being positioned against the outer wall of the corresponding first longitudinal portion 4325a and second longitudinal portion 4325b of the second grille structure 4320. Figure 43BOnly the outer longitudinal walls L3 and L4 of each portion 4325a, 4325b are shown. Therefore, the third grid structure 4320 defines at least a portion of the outer periphery of the appendage 4300. Based on the position of the third grid structure 4330, compared to the first repeating grid 4310a and the second repeating grid 4320a, the third repeating cell can be configured to impart an intermediate density, and thus an intermediate stiffness, such as... Figure 43A As shown, this can facilitate the transition of tissue compression. Additionally, the structural configuration of the third repeating cell 4330a can be configured to promote tissue growth. In some embodiments, the third grid structure can also be disposed on at least a portion of the top surface of the second grid structure, which can further enhance inward tissue growth into the appendage.

[0312] In some implementations, the dimensions (e.g., wall thickness and / or height) of repeating cells can vary among other repeating cells. For example, Figures 44A to 44C Another embodiment of the appendage 4400 is shown, which has variable compressive strength relative to its longitudinal axis (e.g., the z-direction) along the transverse direction (e.g., the y-direction) due to the varying dimensions of the repeating cells without struts. Figures 44A to 44B As shown, only half (e.g., the left half) of the appendage 4400 is depicted on the staple cartridge 4401, which has three rows of staples 4405a, 4405b, and 4405c. While the three rows of staples 4405a, 4405b, and 4405c may be substantially uniform (e.g., nominally identical within manufacturing tolerances), in this illustrated embodiment, the staple height of the third row of staples 4405c (e.g., the outermost row) is greater than that of the first row of staples 4405a and the second row of staples 4405b. This difference in staple height can contribute to the overall compression behavior of the appendage. In this illustrated embodiment, the third row of staples 4405c will exert a compressive force on the captured tissue and appendages, for example, within the staple retention area, which is less than the compressive force exerted by the first row of staples 4405a and the second row of staples 4405b on the corresponding captured tissue and appendages within their respective staple retention areas. The appendage 4400 comprises two sets of repeating cells in three longitudinal arrays. Since both groups are identical, Figures 44A to 44C It shows only one set of three arrays 4410, 4412, 4414 and only one repeating cell 4410a, 4412a, 4414a for each of the three arrays.

[0313] Repeating cells 4410a, 4412a, and 4414a can have various configurations. In this illustrated embodiment, repeating cells 4410a, 4412a, and 4414a are similar in overall shape to... Figures 9A to 9BThe repeating cell 810 is similar. However, the wall thickness and height between at least two repeating cells can vary. As shown in the figure, the wall thickness W from the innermost repeating cell 4410a (e.g., the first repeating cell) to the outermost repeating cell 4414a (e.g., the third repeating cell) is... T Decrease. That is, decrease the wall thickness W of the innermost repeating cell 4410a. T1 The wall thickness W is greater than the middle repeating cell 4412a. T2 And the wall thickness W of the repeating grid 4412a in the middle. T2 The wall thickness W is greater than the outermost repeating cell 4414. T3 Additionally, although the heights H1 and H2 of each of the innermost repeating cell 4410a and the middle repeating cell 4412a are the same, their heights H1 and H2 are greater than the height H3 of the outermost repeating cell 4414a. In other embodiments, only the wall thickness or height varies between arrays, or the wall thickness varies between only two of the three arrays, or the height varies between all three arrays.

[0314] Alternatively or otherwise, the shape of repeating cells may be consistent with the Schwarz-P structure (such as...). Figures 8A to 9B In a case similar to the Schwarz-P structure 810, the length of the hollow tubular interconnects between repeating cells in different arrays can vary. For example, as... Figure 44A As further shown, the hollow tubular interconnect 4416 between the innermost repeating cell 4410a and the middle repeating cell 4412a extends with a first length L1, and the hollow tubular interconnect 4418 between the middle repeating cell 4412a and the outermost repeating cell 4414a extends with a second length L2 greater than the first length L1.

[0315] exist Figures 44B to 44CThe diagram schematically illustrates the compression behavior of repeating cells 4410, 4410a of appendage 4400 as appendage 4400 is sutured to tissue. Therefore, the variation in the size of the repeating cells in the lateral direction results in three distinct compression zones with different compression intensities: a first zone defined by a first longitudinal array 4410 of first repeating cells 4410a having a first compression intensity (e.g., the structure's ability to withstand compressive force in the x-direction); a second zone defined by a second longitudinal array 4412 of second repeating cells 4412a; and a third zone defined by a third longitudinal array 4414 of third repeating cells 4414a having a third compression intensity. While the compression intensity in each array can vary, in this illustrated embodiment, the first compression intensity is greater than the second compression intensity, and the second compression intensity is greater than the third compression intensity. Therefore, the first repeating cell 4410a is stiffer than the second repeating cell 4412a, and the second repeating cell 4412a is stiffer than the third repeating cell 4414a.

[0316] Warehouse surface features

[0317] In some embodiments, the staple cartridge may include surface features (e.g., staple recess protrusions) configured to interact with an appendage to help retain the appendage to the cartridge prior to staple deployment. For example, in some embodiments, the surface feature may include a protrusion extending outward from the top surface of the cartridge. Alternatively or otherwise, the outer surface feature may include a recessed channel defined within the top surface of the cartridge. Thus, the appendages described herein can be designed in a variety of different configurations adapted to interact with the surface features of the cartridge, if present, and thus achieve a releasable attachment mechanism between the appendage and the cartridge. Alternatively or otherwise, the appendages described herein can be designed in various configurations adapted to interact with staple legs extending outward from their respective cavities within the cartridge.

[0318] Figures 45A to 45C An exemplary embodiment based on a strutless appendage 4500 is shown, which can be configured to interact with surface features 4504 of the staple cartridge 4502. Alternatively or additionally, the appendage 4500 can be configured to interact with legs of staples 4506, 4507, 4508 at least partially disposed within the staple cartridge 4502 (see [link to documentation]). Figures 45B to 45C While the staple cartridge 4502 can have various configurations, in this illustrated embodiment, the staple cartridge 4502 is similar to... Figures 1 to 2CThe staple cartridge 200, except for the surface feature 4504, is a U-shaped protrusion extending outward from the top surface 4502a of the staple cartridge and positioned around the corresponding end portion of the staple cavity defined within the staple cartridge 4502. As shown, the staple cavity is disposed in three longitudinal rows 4510a, 4510b, 4510c, 4512a, 4512b, 4512c in the first and second groups and positioned on the first and second sides of the longitudinal slot 4514, respectively. In addition, for each group, the first and third longitudinal rows 4510a, 4510c, 4512a, 4512c are parallel to each other, while the second longitudinal rows 4510b, 4512b are staggered relative to them.

[0319] like Figures 45A to 45C As further shown, the appendage 4500 is formed by interconnected repeating cells 4516, wherein each cell is structurally similar to Figures 9A to 9B The repeated cell 810 in the text. Therefore, appendix 4500 is similar to... Figures 8A to 8F The difference between the appendix 800 and the repeating cell 4515 is that the repeating cell is relative to... Figure 8A Rotate 45 degrees around the X-axis. In other words, the appendage 800 is shown in a configuration of 0 to 90 degrees, while the appendage 4500 is shown in an orientation of ±45 degrees. Therefore, the repeating cell 4516 is oriented in a manner that can coincide with the position of the surface feature 4504 and / or the nail cavities 4510a, 4510b, 4510c, 4512a, 4512b, 4512c (e.g., repeating pattern).

[0320] like Figure 45A As shown, repeating cells 4516 are interconnected and arranged in seven vertical rows 4516a, 4516b, 4516c, 4516d, 4516e, 4516f, 4516g, where each vertical row has a defined gap between adjacent cells (in Figure 45A Only gaps 4518a, 4518b, 4518c, 4520a, 4520b, and 4520c are shown. Figures 45B to 45C Only gaps 4518a, 4518b, 4518c, 4522a, 4522b, 4524a, 4524b, and 4524c are shown. The first three longitudinal rows 4516a, 4516b, and 4516c are configured to overlap with the corresponding nail cavity rows 4510a, 4510b, and 4510c; the middle row 4516d is configured to overlap with the longitudinal slot 4514; and the last three longitudinal rows 4516e, 4516f, and 4516g are configured to overlap with the corresponding nail cavity rows 4512a, 4512b, and 4512c. Therefore, as Figures 45B to 45CAs shown in the middle section, based on the position of the surface feature 4504 relative to the nail cavity, each surface feature 4504 overlaps with and at least partially extends through the corresponding gap. Therefore, each gap is configured to receive and engage at least one surface feature, thereby holding the appendage 4500 on the cartridge 4502 prior to nail deployment. In other embodiments, all or some of the gaps may be replaced with a thinner area of ​​material into which at least one surface feature can penetrate.

[0321] In addition, such as Figures 45B to 45C As shown in the middle section, for each row of nail cavities and the corresponding repeating cells in the row, each nail ( Figure 45B Only nails 4506, 4507, 4508 and their corresponding nail cavity rows 4510a, 4510b, 4510c are shown. These extend across the corresponding repeating cells, such that each nail leg overlaps with the corresponding gap positioned on one side of the repeating cell. For example, as... Figure 45B As shown, regarding the repeating cell 4515a and the corresponding pin 4508 in the first cell row 4516a, the first leg 4508a and the second leg 4508b of the pin 4508 overlap with the first gap 4518a and the second gap 4518b respectively, which are on the opposite side of the repeating cell 4515b in the second cell row 4516b. Figure 45C As further shown, when the appendage 4500 is positioned on the top surface 4502a of the staple cartridge 4502, the staple legs 4507a and 4507b extend through the gaps 4522a and 4522b, respectively. This further retains the appendage 4500 in the cartridge 4502 before staple deployment. Therefore, repeating cells of the appendage can be configured to be positioned and engaged with the first and second staple legs of the corresponding staple.

[0322] Figures 46A to 46B Another exemplary embodiment of a strut-based appendage 4600 that can be configured to interact with surface features of the staple cartridge 4602 is shown. The staple cartridge 4602 is similar to... Figure 39A The staple cartridge 3901 is described in detail herein, and therefore common features are not described in detail. Each surface feature has a U-shaped configuration and is positioned around the corresponding end portion of each staple cavity, and thus extends along the corresponding longitudinal row of staple cavities. Figures 46A to 46B Only the nail cavities 4603a, 4603b, and 4603c of the three longitudinal rows are shown, and therefore the surface features of the three longitudinal rows are shown.

[0323] like Figure 46BAs shown in more detail, the first surface features of the longitudinal row (only four first surface features 4604a, 4604b, 4604c, 4604d are shown) and the third surface features of the longitudinal row (only four third surface features 4608a, 4608b, 4608c, 4608d are shown) are laterally aligned with each other in the y-direction, thus forming a set of first transverse rows 4605a, 4605b, 4605c, 4605d, each transverse row having a corresponding first and third surface features. The second surface features of the longitudinal row (only four second surface features 4606a, 4606b, 4606c, 4606d are shown) are laterally offset relative to the first and second surface features in the z-direction, thus forming a set of second transverse rows 4607a, 4607b, 4607c, 4607d, each transverse row having a corresponding second surface feature.

[0324] In addition, apart from the differences described in detail below, accessory 4600 is similar to Figures 30A to 30B The appendage 3000. The appendage 4600 includes a tissue contact layer 4616, a cavity contact layer 4618, and an internal structure 4620 extending therebetween.

[0325] like Figure 46A As shown, and in Figure 46B As shown in more detail, each opening within the cartridge contact layer 4618 (only eight openings 4622a, 4622b, 4622c, 4622d, 4622e, 4622f, 4622g, 4622h are shown) is configured to receive at least one corresponding surface feature. Therefore, when the appendage 4600 is positioned on the cartridge 4602, the corresponding surface feature extends into and engages with the corresponding opening within the cartridge contact layer 4618. For example, as... Figure 46B As shown, the first surface feature portion 4604a and the third surface feature portion 4608a of the first transverse row 4605a extend into the first opening 4622a and engage with at least the first cross brace 4624a, while the second surface feature portion 4606a of the second transverse row 4607a extends into the second opening 4622b and engages with at least the first cross brace 4624a and the opposite cross brace 4624b.

[0326] Cross bracing of the 4618 contact layer of the warehouse ( Figure 46BOnly eight cross braces 4624a, 4624b, 4624c, 4624d, 4624e, 4624f, and 4624g are shown, and they can have various configurations. For example, in some embodiments, the width of the cross braces (e.g., in the z-direction) can be substantially uniform (e.g., uniform within manufacturing tolerances), while in other embodiments, the width of the cross braces can be non-uniform. In this illustrated embodiment, the widths of the cross braces 4624a, 4624c, 4624e, and 4624g are uniform, while the widths of the remaining cross braces 4624b, 4624d, and 4624f are non-uniform. Those skilled in the art will understand that the structural configuration of the cross braces in the warehouse contact layer can depend at least on the structural configuration of the surface feature. For example, in this illustrated embodiment, at least a portion of the cross braces includes a curved section to accommodate a U-shaped configuration of the surface feature. Based on the orientation of the U-shaped configuration, some of the curved segments have a convex configuration, while others have a concave configuration. Furthermore, although the tissue contact layer 4616 of the cross braces 4626a, 4626b, 4626c, 4626d, 4626e, 4626f, and 4626g can have various configurations, such as... Figure 46A As shown, however, the cross braces 4626a, 4626b, 4626c, 4626d, 4626e, 4626f, and 4626g are structurally similar to the corresponding cross braces 4624a, 4624b, 4624c, 4624d, 4624e, 4624f, and 4624g of the warehouse contact layer 4618.

[0327] Variable tissue space

[0328] In some embodiments, a variable tissue gap between the appendage and the anvil may be desired to enhance tissue grip and stability during suturing and / or cutting. However, a variable tissue gap can adversely affect the appendage's ability to apply substantially uniform pressure to the sutured tissue. Therefore, and as described in more detail below, the appendages disclosed herein may be configured to create a variable tissue gap for tissue manipulation, and when sutured to tissue, the appendage may be further configured to apply substantially uniform pressure (e.g., pressure in the range of about 30 kPa to 90 kPa) to the sutured tissue for a predetermined period of time (e.g., at least 3 days). In some embodiments, the appendage may apply pressure of at least about 30 kPa for at least three days. In such embodiments, after 3 days, the appendage may be configured to apply an effective amount of pressure (e.g., about 30 kPa or less) to the tissue, such that the tissue remains sealed through the tissue's healing cycle (e.g., about 28 days). For example, the appendage may be configured to apply pressure to the sutured tissue, wherein the pressure decreases from about 30 kPa (e.g., linearly) to 0 kPa over a predetermined time period of about 3 to 28 days.

[0329] Typically, an appendage may include a tissue contact surface, a compartment contact surface, and an internal structure extending therebetween, wherein the internal structure comprises at least two grid structures, each grid structure having a different compressive strength. The at least two grid structures may vary laterally along their width and / or longitudinally along their length in terms of structure, shape, or interconnection to form variable tissue gaps. In some embodiments, the base geometry of the appendage may be formed by cells based on strut-free structures. In such embodiments, the external geometry of the appendage may be formed by a strut-based grid structure. In other embodiments, the base geometry may be formed by cells based on struts.

[0330] Figures 47A to 47B An exemplary embodiment of a surgical end effector 4700 having an anvil 4702 and a suture assembly 4704 is shown. The suture assembly 4704 includes an appendage 4706 releasably retained on the top surface or platform surface 4707a of a staple cartridge 4707 (e.g., the staple cartridge surface facing the anvil). The staple cartridge 4707 is similar to... Figures 1 to 2C The chamber 200 is included, and therefore common features are not described in detail herein. Although not shown, the anvil 4702 is pivotally connected to the elongated nail channel, as... Figure 1 The anvil 4702 contains a slender nail channel 104, and the sewing assembly 4704 is positioned within and connected to the slender nail channel. While the anvil 4702 can have various configurations, such as... Figures 47A to 47BAs shown, however, the anvil includes a surface facing the chamber, which has nail recesses 4708 defined therein, wherein a generally planar tissue-compression surface 4710 (e.g., flat within manufacturing tolerances) extends between the nail recesses 4708 (e.g., extending in the y direction). Figure 47A The surgical end effector 4700 is shown in a fully closed position, and therefore the anvil 4702 is also shown. Figure 47B Tissue T is shown clamped between anvil 4702 and suture assembly 4704 and sutured to appendage 4706 via staples (only two sets of three staples 4712a, 4712b, 4712c, 4714a, 4714b, 4714c are shown). Prior to deployment, in some embodiments, such as Figure 47A and 47C As shown, the nails may be completely disposed within the nail magazine 4707, while in other embodiments, some or all of the nails may be partially disposed within the nail magazine 4707. Although nails 4712a, 4712b, 4712c, 4714a, 4714b, and 4714c may have various configurations, in this illustrated embodiment, nails 4712a, 4712b, 4712c, 4714a, 4714b, and 4714c have at least a substantially uniform pre-expanded (e.g., unformed) nail height (e.g., nominally identical within manufacturing tolerances). In some embodiments, nails 4712a, 4712b, 4712c, 4714a, 4714b, and 4714c may be substantially uniform (e.g., nominally identical within manufacturing tolerances).

[0331] like Figure 47A As shown, and in Figure 47C More specifically, the appendage 4706 has a tissue contact surface 4716, a compartment contact surface 4718, and an internal structure 4720 extending therebetween. While the internal structure 4720 can have various configurations, in this illustrated embodiment, the internal structure includes two grid structures 4722 and 4724, each with a different compressive strength, such that the appendage 4706, when in a tissue deployment state, is configured to apply substantially uniform pressure to the sutured tissue for a predetermined period of time. In this illustrated embodiment, the first grid structure 4722 is configured to have a first compressive strength, and the second grid structure 4724 is configured to have a second compressive strength greater than the first compressive strength.

[0332] Each of the first grid structure 4722 and the second grid structure 4724 may generally be formed of cells, such as those disclosed herein, such as strut-free cells and / or strut-based cells. For example, in some embodiments, one or more cells may include at least one triple-periodic minimal surface structure, such as those disclosed herein. Alternatively or otherwise, one or more cells may be defined by interconnecting struts (e.g., planar struts), such as strut-based cells disclosed herein. In some embodiments, the first grid structure 4722 and the second grid structure 4724 may vary in density (e.g., the number of cells) and / or shape. Therefore, a specific structural configuration of each of the first grid structure 4722 and the second grid structure 4724 is not shown, except for general shape and thickness.

[0333] The first grid structure 4722 and the second grid structure 4724 each extend from the top surfaces 4722a and 4724a to the bottom surfaces 4722b and 4724b. Depending on the overall structural configuration of the appendage, at least a portion of the top surface of at least one grid structure can be used as a tissue contact surface of the appendage, and at least a portion of the bottom surface of at least one grid structure can be used as a compartment contact surface of the appendage. In this illustrated embodiment, the first grid structure 4722 is positioned on top of the second grid structure 4724 such that the bottom surface 4722b of the first grid structure 4722 contacts the top surface 4724a of the second grid structure 4724. Therefore, the top surface 4722a of the first grid structure 4722 forms a tissue contact surface 4716, and the bottom surface 4724b of the second grid structure 4724 forms a compartment contact surface 4718. Therefore, the shape of the top surface 4722a of the first grid structure 4722 can create a tissue gap between the anvil 4702 and the suture assembly 4704, which is independent of the shape of the top surface or platform surface 4707a of the staple cartridge 4707.

[0334] The top and bottom surfaces 4722a, 4724a, 4724a, 4724b of each grid structure 4722, 4724 can have various different shapes. In this illustrated embodiment, the top and bottom surfaces 4722a, 4722b of the first grid structure 4722 each have a convex configuration. Therefore, the top surface 4724a of the second grid structure 4724 has a concave configuration. In addition, since the top surface or platform surface 4707a of the staple cartridge 4707 has a generally planar configuration (e.g., in the YZ plane), the bottom surface 4724b of the second grid structure 4724 also has a generally planar configuration (e.g., in the YZ plane). Therefore, the resulting overall geometry of the appendage 4706 produces a curved tissue contact surface 4716 relative to the tissue-compression surface 4710 of the anvil 4702, and thus creates a variable tissue gap between the anvil 4702 and the suture assembly 4704 (e.g., two different gap amounts are shown as T). G1 T G2 ).

[0335] In this illustrated embodiment, due to the concave shape of the top surface 4722a of the first grid structure 4722, the total thickness T at the center of the appendage 4706 (indicated by the dashed line 4726, for example, equidistant from the two opposite end-facing laterally oriented edges 4728a, 4728b) C (For example, in the x-direction) the total thickness T greater than the total thickness T at each of the laterally facing edges 4728a, 4728b of the appendage 4706 (e.g., the outer longitudinal periphery of the appendage 4706 extending in the z-direction). P1 T P2 (For example, in the x-direction). Therefore, the total uncompressed thickness of the appendage 4706 varies laterally outward along its width relative to its center (e.g., in the ±y-direction), and thus laterally relative to the longitudinal axis of the appendage 4706 (e.g., extending in the z-direction). Therefore, the uncompressed thickness of the appendage decreases laterally as the interstitial space increases. Additionally, since the two laterally facing edges 4728a, 4728b are shown to have the same thickness, the variation in lateral thickness from the center of the appendage 4706 to each edge is the same. In other embodiments, the two laterally facing edges may have different thicknesses, and therefore, the variation in lateral thickness from the center of the appendage to the respective edges will be different.

[0336] As further illustrated, due to the concave-convex surface relationship between the first grid structure 4722 and the second grid structure 4724, as well as their position relative to each other and compressive strength, the thickness of each grid structure (e.g., in the x-direction) also varies laterally outward (e.g., in the ±y-direction) along its respective length relative to its corresponding center (which in this embodiment is also the center of the appendix 4706 (indicated by the dashed line 4726)). Therefore, in this illustrated embodiment, the first grid structure 4722 is thicker than the second grid structure 4724 at the center of the appendix, and the second grid structure 4724 is thicker than the first grid structure 4722 at each of the laterally facing edges 4728a, 4728b of the appendix 4706. Thus, the appendix 4706 is most compressible at its center and least compressible at its laterally facing edges 4728a, 4728B, and therefore, when in an organized deployment state, the appendix 4706 can be compressed to a substantially uniform thickness T. 压缩 (See) Figure 47B This allows the appendage 4706 to apply pressure disproportionate to its uncompressed variable thickness. Therefore, when the appendage is sutured to a substantially uniform tissue T (e.g., tissue with the same or substantially the same thickness across the width of the appendage in the y-direction) using staples 4712a, 4712B, 4712c, 4714a, 4714B, 4714c), the appendage 4706 can apply a substantially uniform pressure P to the sutured tissue T (see...). Figure 47B ).

[0337] Figures 48A to 48B Another exemplary embodiment of a surgical end effector 4800 having an anvil 4802 and a suture assembly 4804 is shown. The suture assembly 4804 includes an appendage 4806 releasably retained on the top surface or platform surface 4807a of the staple cartridge 4807 (e.g., the staple cartridge surface facing the anvil). Except for the differences described below, the anvil 4802 is similar to... Figures 47A to 47B The anvil 4702 and the staple cartridge 4807 are similar to Figures 1 to 2C The common features of the container 200, except that the top surface or platform surface 4807a is curved, are not described in detail herein. Figure 48A The surgical end effector 4800 is shown in a fully closed position, and therefore the anvil 4802 is also shown. Figure 48B Tissue T is shown clamped between anvil 4802 and suture assembly 4802 and sutured to appendage 4806 via staples (only two sets of three staples 4812a, 4812b, 4812c, 4814a, 4814b, 4814c are shown). Prior to deployment, in some embodiments, such as Figure 48A and 48CAs shown, the nails can be completely disposed within the nail magazine 4807, while in other embodiments, some or all of the nails can be partially disposed within the nail magazine 4807. Although the two sets of nails 4812a, 4812b, 4812c, 4814a, 4814b, 4814c can have various configurations, in this illustrated embodiment, the two sets of nails are identical, and therefore for each set, the first nails 4812a, 4814a (e.g., the nails in the innermost row) have a first height, the second nails 4812b, 4814b (e.g., the nails in the middle row) have a second height greater than the first height, and the third nails 4812c, 4814c (e.g., the nails in the outermost row) have a third height greater than the second height.

[0338] like Figure 48A As shown, and in Figure 48C More specifically, the appendage 4806 has a tissue contact surface 4816, a compartment contact surface 4818, and an internal structure 4820 extending therebetween. While the internal structure 4820 can have various configurations, in this illustrated embodiment, the internal structure 4820 includes two grid structures 4822 and 4824, each grid structure having a different compressive strength, such that the appendage 4806, when in a tissue deployment state, is configured to apply substantially uniform pressure to the sutured tissue for a predetermined period of time. In this illustrated embodiment, the first grid structure 4822 is configured to have a first compressive strength, and the second grid structure 4824 is configured to have a second compressive strength greater than the first compressive strength.

[0339] Each of the first grid structure 4822 and the second grid structure 4824 may generally be formed of cells, such as those disclosed herein, such as strut-free cells and / or strut-based cells. For example, in some embodiments, one or more cells may include at least one triple-periodic minimal surface structure, such as those disclosed herein. Alternatively or otherwise, one or more cells may be defined by interconnecting struts (e.g., planar struts), such as strut-based cells disclosed herein. Therefore, apart from general shape and thickness, specific structural configurations of each of the first grid structure 4822 and the second grid structure 4824 are not shown.

[0340] The first grid structure 4822 and the second grid structure 4824 each extend from the top surfaces 4822a, 4824a to the bottom surfaces 4822b, 4824b. Depending on the overall structural configuration of the appendage, at least a portion of the top surface of at least one grid structure can be used as a tissue contact surface of the appendage, and at least a portion of the bottom surface of at least one grid structure can be used as a compartment contact surface of the appendage. In this illustrated embodiment, the first grid structure 4822 is narrower (e.g., in the y-direction) than the second grid structure, and is therefore positioned only on top of the central region 4823 of the second grid structure 4824. Therefore, the entire bottom surface 4822b of the first grid structure 4822 only contacts a portion of the top surface 4824a of the second grid structure 4824, for example, only the top surface 4823a of the central region 4823. Therefore, the two exposed portions 4825a and 4825b of the top surface 4822a of the first grid structure 4822 and the top surface 4824a of the second grid structure 4824 form the tissue contact surface 4816, and the bottom surface 4824b of the second grid structure 4824 forms the chamber contact surface 4818.

[0341] The top and bottom surfaces 4822a, 4824a, 4824a, 4824b of each grid structure 4822, 4824 can have various different shapes. Those skilled in the art will understand that the shape of the top and bottom surfaces can depend at least on the top surface or platform surface of the staple cartridge on which the appendage will be releasably held. In this illustrated embodiment, the top and bottom surfaces 4822a, 4822b of the first grid structure 4822 each have a convex configuration. Therefore, the top surface 4823a of the central region 4823 of the second grid structure 4824 has a convex configuration, while the two exposed portions 4825a, 4825b of the top surface 4824a of the second grid structure 4824 each have a generally planar configuration (e.g., extending in the y-direction). Furthermore, since the top surface or platform surface 4807a of the staple cartridge 4807 has a convex configuration, the bottom surface 4824b of the second grid structure 4824 has a concave configuration.

[0342] In this illustrated embodiment, due to the structural interconnection between the first grid structure 4822 and the second grid structure 4824 and the resulting shape of the tissue contact surface 4816, the total thickness T at the center of the appendage 4806 (indicated by the dashed line 4826, e.g., equidistant from the outermost end-facing laterally oriented edges 4828a, 4828b) C (For example, in the x-direction) less than the total thickness T at the outermost end of the appendage facing the transverse edges 4828a, 4828b (for example, the outer longitudinal periphery of the appendage 4806 extending in the z-direction). P1 T P2(For example, in the x direction). Therefore, the total uncompressed thickness of the appendage 4806 varies laterally outward relative to its center along its width (e.g., in the ±y direction). Therefore, the total uncompressed thickness of the appendage varies laterally relative to the longitudinal axis of the appendage 4806 (e.g., extending in the z direction).

[0343] As further illustrated, due to the structural relationship between the first grid structure 4822 and the second grid structure 4824, and the combination of their compressive strength relative to each other and the bending configuration of the top surface 4807a of the staple cartridge 4807, the thickness of each grid (e.g., in the x-direction) also varies laterally outward along its respective length relative to its corresponding center (e.g., in the ±y-direction), which in this embodiment is also the center of the appendage 4806 (indicated by dashed line 4826). Therefore, in this illustrated embodiment, the first grid structure 4822 is thicker than the second grid structure 4824 at the center of the appendage 4806. Consequently, the appendage 4806 is most compressible at its center and least compressible at its outermost, laterally facing edges 4828a, 4828b. This allows the appendage 4806 to be subjected to substantially uniform pressure regardless of variations in its compressive thickness. Therefore, when the appendage is sutured to a substantially uniform tissue T (e.g., tissue with the same or substantially the same thickness across the width of the appendage in the y direction, e.g., in the x direction) using staples 4812a, 4812B, 4812c, 4814a, 4814B, 4814c), the appendage 4806 is compressed to a non-uniform compression thickness while still applying a substantially uniform pressure P to the sutured tissue T (see...). Figure 48B As further shown, in this illustrated embodiment, only the second grille 4824 overlaps with the outermost nails 4812c and 4814c.

[0344] In other embodiments, the width of the second grid structure may be narrower than the width of the first grid structure. For example, as... Figure 49 As shown, the appendage 4900 includes a first grid structure 4906 and a second grid structure 4908 having a semi-circular concentric configuration, wherein the first grid structure 4906 surrounds the second grid structure 4908. Therefore, the top surface 4906a of the first grid structure 4906 forms the tissue contact surface 4902 of the appendage 4900, and the bottom surfaces 4906b and 4908b of the first grid structure 4906 and the second grid structure 4908 form the compartment contact surface 4904 of the appendage 4900.

[0345] As described above, the appendage may have two grid structures that vary longitudinally (e.g., in the z-direction) in terms of structure, shape, or interconnection along the length of the appendage. For example, as Figures 50A to 50BAs shown, the appendage 5002 includes two grid structures 5004 and 5006, each grid structure being relative to each other and along the length of the appendage (e.g., along the longitudinal axis L). A (Extending in the z-direction) changes in structure and shape.

[0346] Figures 50A to 50B An exemplary embodiment of a surgical end effector 5000 is shown, which is similar to surgical end effector 5000 except that the appendage 5002 has a variable compressive strength along its length along the longitudinal axis L. A Extend (e.g., in the z-direction). For example... Figure 50A As shown, and in Figure 50C As shown in more detail, the appendage 5002 is positioned on the top surface or platform surface 5003a of the staple cartridge 5003. The staple cartridge 5003 is similar to... Figures 47A to 47C The pin reservoir 4707 contains pins 4712a, 4712b, 4712c, 4714a, 4714b, and 4714c, and therefore common features are not described in this paper.

[0347] The appendage 5002 has a tissue contact surface 5008, a compartment contact surface 5010, and an internal structure 5012 extending therebetween. While the internal structure 5012 can have various configurations, the first grid structure 5004 and the second grid structure 5006 each have different compressive strengths, such that the appendage 5002, when in a tissue deployment state, is configured to apply substantially uniform pressure (e.g., pressure in the range of 30 kPa to 90 kPa) to the tissue sutured thereto for a predetermined period of time (e.g., at least 3 days). In this illustrated embodiment, the first grid structure 5004 is configured to have a first compressive strength, and the second grid structure 5006 is configured to have a second compressive strength greater than the first compressive strength. Therefore, the second grid structure 5004 is stiffer than the first grid structure 5006. In other embodiments, the first grid structure may be stiffer than the second grid structure.

[0348] Each of the first grid structure 5004 and the second grid structure 5006 may generally be formed of cells, such as those disclosed herein, such as strut-free cells and / or strut-based cells. For example, in some embodiments, one or more cells may include at least one triple-periodic minimal surface structure, such as those disclosed herein. Alternatively or otherwise, one or more cells may be defined by interconnecting struts (e.g., planar struts), such as strut-based cells disclosed herein. In some embodiments, the first grid structure 5004 and the second grid structure 5006 may vary in density (e.g., the number of cells) and / or shape. Therefore, a specific structural configuration of each of the first grid structure 5004 and the second grid structure 5006 is not shown, except for general shape and thickness.

[0349] The first grid structure 5004 and the second grid structure 5006 each extend from the top surfaces 5004a and 5006a to the bottom surfaces 5004b and 5006b. Depending on the overall structural configuration of the appendage, at least a portion of the top surface of at least one grid structure can be used as a tissue contact surface of the appendage, and at least a portion of the bottom surface of at least one grid structure can be used as a compartment contact surface of the appendage. In this illustrated embodiment, the first grid structure 5004 is positioned on top of the second grid structure 5006 such that the bottom surface 5004b of the first grid structure 5004 contacts the top surface 5006a of the second grid structure 5006. Therefore, the top surface 5004a of the first grid structure 5004 forms a tissue contact surface 5008, and the bottom surface 5006b of the second grid structure 5006 forms a compartment contact surface 5010.

[0350] Although the first grid structure 5004 and the second grid structure 5006 can have various configurations, each grid structure has an uncompressed thickness (e.g., in the x direction) that varies along the length of the appendage (e.g., extending in the z direction). As shown, the top surface 5004a of the first grid structure 5004 slopes from the proximal end 5002a to the distal end 5002b of the appendage 5002. Furthermore, since the top surface or platform surface 5003a of the staple cartridge 5003 has a generally planar configuration (e.g., in the XZ plane), the bottom surface 5006b of the second grid structure 5006 also has a generally planar configuration (e.g., in the XZ plane). Therefore, variable tissue gaps (e.g., two different gap amounts are shown as T) are possible. G1 T G2 A variable tissue gap is created between the anvil 5001 and the appendage 5002, and this gap is independent of the shape of the top surface or platform surface 5003a of the staple cartridge 5003.

[0351] When the appendage is sutured to the tissue, such as Figure 50B As shown, the variation in the uncompressed thickness of each grid structure along the appendage length, combined with the first and second compressive strengths and the variable tissue gap, allows the appendage to apply a substantially uniform pressure P to the sutured tissue T (see [reference]). Figure 50B ).

[0352] Consistent tissue spacing

[0353] In some embodiments, a consistent tissue gap between the appendage and the anvil may be desired to enhance tissue grip and stability during suturing and / or cutting. However, a consistent tissue gap can adversely affect the appendage's ability to apply substantially uniform pressure to the sutured tissue. Therefore, and as described in more detail below, the appendages disclosed herein may be configured to produce a consistent tissue gap for tissue manipulation, and when sutured to tissue, the appendage may be further configured to apply substantially uniform pressure (e.g., pressure in the range of about 30 kPa to 90 kPa) to the sutured tissue for a predetermined period of time (e.g., at least 3 days). In some embodiments, the appendage may apply pressure of at least about 30 kPa for at least three days. In such embodiments, after 3 days, the appendage may be configured to apply an effective amount of pressure to the tissue (e.g., pressure linearly reduced, e.g., about 30 kPa or less) such that the tissue remains sealed through the tissue's healing cycle (e.g., about 28 days). For example, the appendage may be configured to apply pressure to the sutured tissue, wherein the pressure decreases from about 30 kPa (e.g., linearly) to 0 kPa over a predetermined time period of about 3 to 28 days.

[0354] In some embodiments, the appendage may be designed with at least a portion of a generally planar (e.g., in the y-direction) tissue contact surface and a nonplanar relative cartridge contact surface (e.g., along the width of the appendage, e.g., in the y-direction). The nonplanar surface of the cartridge contact surface may vary proportionally along and relative to, for example, the curved or stepped top surface or platform surface of the cartridge (e.g., the cartridge surface facing the anvil) or the stepped tissue-compression surface of the anvil.

[0355] Typically, an appendage may include a tissue contact surface, a cartridge contact surface, and an internal structure extending therebetween. In some embodiments, the appendage may be formed of at least two grid structures, wherein a first grid structure has a non-planar bottom surface defining at least a portion of the cartridge contact surface; and a second grid structure (e.g., a main grid structure) has a top surface having at least a generally planar portion and defining at least a portion of the tissue contact surface. In other embodiments, the internal structure may be formed of a single grid structure of repeating cells that vary in shape and / or size in the transverse direction relative to the longitudinal axis of the appendage. Thus, the appendage may have an overall geometry that produces a tissue contact surface having both planar and non-planar surfaces and a non-planar cartridge contact surface (e.g., a cartridge surface facing the anvil) configured to fit into a curved or stepped top or platform surface of the cartridge. Thus, a generally uniform tissue gap can be created independently of the shape of the top or platform surface of the cartridge.

[0356] In some implementations, the dimensions (e.g., wall thickness and / or height) of the repeating cells can be varied such that, when the appendage is sutured to the tissue, it can apply substantially uniform pressure (e.g., pressure in the range of 30 kPa to 90 kPa) to the sutured tissue for a predetermined period of time (e.g., at least three days). For example, the repeating cells in a longitudinal row can vary relative to the repeating cells in adjacent longitudinal rows. Therefore, the appendage can be designed such that, prior to staple deployment, it creates a tissue gap consistent with the anvil, and, when in the tissue deployment state, it can apply substantially uniform pressure (e.g., pressure in the range of 30 kPa to 90 kPa) to the sutured tissue for a predetermined period of time (e.g., at least three days).

[0357] Figure 51A An exemplary embodiment of a surgical end effector 5100 having an anvil 5102 and a suture assembly 5104 is shown. The suture assembly 5104 includes an appendage 5106 releasably retained on the top surface or platform surface 5108a of the cartridge 5108 (e.g., the cartridge surface facing the anvil). Except for the differences described below, the cartridge 5108 is similar to... Figures 48A to 48C The chamber 4807 is included, and therefore common features are not described in detail herein. Although not shown, the anvil 5102 is pivotally connected to the elongated nail channel, as... Figure 1 The anvil 5102 contains a slender nail channel 104, and the sewing assembly 5104 is positioned within and connected to the slender nail channel. While the anvil 5102 can have various configurations, in... Figure 51AIn the illustrated embodiment, the anvil 5102 includes a surface facing the chamber having staple recesses 5110 defined therein, wherein a generally planar tissue-compression surface 5112 extends between the staple recesses 5110. Figure 51A A surgical end effector 5100 in a fully closed position is shown, and thus an anvil 5102 is shown, wherein tissue is not positioned between the anvil 5102 and the appendage 5106 and the staples are not disposed within the staple cartridge 5108 (only two sets of three staples 5114a, 5114b, 5114c, 5116a, 5116b, and 5116c are shown). Prior to deployment, in some embodiments, such as Figure 51A As shown, nails 5114a, 5114b, 5114c, 5116a, 5116b, and 5116c may be partially disposed within nail magazine 5108, while in other embodiments, some or all of the nails may be completely disposed within nail magazine 5108. Although nails 5114a, 5114a, 5114c, 5116a, 5116b, and 5116c may have various configurations, in this illustrated embodiment, nails 5114a, 5114a, 5114c, 5116a, 5116b, and 5116c have at least a substantially uniform pre-expanded (e.g., unformed) nail height (e.g., nominally identical within manufacturing tolerances). In some embodiments, nails 5114a, 5114a, 5114c, 5116a, 5116b, and 5116c may be substantially uniform (e.g., nominally identical within manufacturing tolerances).

[0358] like Figure 51A As shown, and in Figure 51B More specifically, the appendage 5106 has a tissue contact surface 5118, a compartment contact surface 5120, and an internal structure 5122 extending therebetween. While the internal structure 5122 can have various configurations, in this illustrated embodiment, the internal structure 5122 includes two distinct grid structures 5124, 5126. The first grid structure 5124 and the second grid structure 5126 each extend from the top surfaces 5124a, 5126a to the bottom surfaces 5124b, 5126b.

[0359] The first grille structure 5124 can typically be composed of, for example Figures 52A to 52B The struts 5228a, 5228b, 5228c, 5228d, 5230a, 5230b, 5230c, 5230d, or cells such as those disclosed herein (e.g., based on cells without struts and / or cells based on struts) are formed. Therefore, apart from the general overall shape and thickness, the specific structural configuration of the first grid structure 5124 is not shown.

[0360] The first grid structure 5124 extends between the second grid structure 5126 and the top surface or platform surface 5108a of the staple cartridge 5108. As shown, the uncompressed thickness of the first grid structure 5124 is relative to the longitudinal axis L of the longitudinal appendage 5106. A (For example, L extending in the z direction) A The thickness of the appendage 5106 varies laterally. These lateral variations can be proportional to the curved top surface or platform surface 5108a of the staple cartridge 5108, such that a portion of the staple cartridge contact surface 5120 of the appendage 5106 formed by the bottom surface 5124b of the first grid structure 5124 is shaped to complement the curved top surface or platform surface 5108a of the staple cartridge 5108 (e.g., a concave configuration). Therefore, variations in the thickness of the first grid structure 5124 can conform to variations in the top surface or platform surface 5108a. Additionally, this causes the compression ratio of the first grid structure 5124 to also vary laterally, which, in this illustrated embodiment, increases due to the lateral increase in uncompressed thickness, such that the compression behavior of the appendage 5106 is primarily driven by the compression characteristics of the second grid structure 5126.

[0361] The second grid structure 5126 is formed by interconnected repeating cells arranged in two sets of three longitudinal arrays, wherein the first set is positioned on one side of the intended cutting line of the appendage, and the second set is positioned on the second side of the intended cutting line of the appendage. For simplicity, only three cells from each set 5132a, 5132b, 5132c, 5134a, 5134b, 5134c are shown. Although the repeating cells can have various configurations, in this illustrated embodiment, all repeating cells have substantially uniform dimensions (e.g., nominally identical within manufacturing tolerances) and are similar in appearance to... Figures 9A to 9B The repeated cells 810 in the text, and therefore common features are not described in detail here. Thus, the second grid structure is similar to... Figures 8A to 8F The appendage 800 is included, and therefore the common features are not described in this paper.

[0362] As shown, at least a portion of the top surface 5126a is generally planar, and therefore includes generally planar surfaces 5127 (e.g., each surface in the y-direction), with non-planar surfaces 5129 extending therebetween. The top surface 5126a defines the tissue contact surface 5118 of the appendage 5106, and thus the tissue contact surface 5118 is formed by the planar surfaces 5127 and the non-planar surfaces 5129. Because the generally planar surfaces 5127 and the non-planar surfaces 5129 of the top surface (and therefore the tissue contact surface 5118) alternate along the width of the second grating structure 5126 (extending in the y-direction), a consistent tissue gap (e.g., alternating between a generally uniform tissue gap and a variable tissue gap) is created between the anvil 5102 and the appendage 5106. In this illustrated embodiment, each generally uniform tissue gap T... G This occurs between the generally planar surface 5127 of the tissue-compression surface 5112 of the anvil 5102 and the tissue contact surface 5118. Variable tissue gaps (only two variable gaps are shown as T) G1 T G2 This occurs between the tissue-compression surface 5112 of the anvil 5102 and the non-planar surface 5129 of the tissue contact surface 5118, which extends between adjacent cells of the second grid structure 5126. Those skilled in the art will understand that the length of the generally uniform and variable tissue gap (extending in the x-direction) can depend at least on the structural configuration of the tissue contact surface, and therefore on the structural configuration of the second grid structure.

[0363] Although the heights between repeating cells 5132a, 5132b, 5132c, 5134a, 5134b, and 5134c are approximately uniform, the wall thicknesses can vary, resulting in different compression ratios. In this illustrated embodiment, the two sets of three longitudinal arrays are identical, and therefore for each set, the wall thickness W from the first repeating cells 5132a, 5134a (e.g., the innermost repeating cells) to the third repeating cells 5132c, 5134c (e.g., the outermost repeating cells) is... T Similarly, it decreases. Therefore, Figure 51B Only one set of three vertical arrays is shown. The wall thickness W of the first repeating cell 5132a (not shown) is... T1 The wall thickness W is greater than that of the second repeating cell 5132b (e.g., the middle repeating cell). T2 And the wall thickness W of the second repeating grid 5132b T2 The wall thickness W is greater than that of the third repeating cells 5132c and 5134c. T3Therefore, the compression ratio increases from the first repeating cells 5132a, 5134a to the third repeating cells 5132c, 5134c, and thus the first repeating cells 5132a, 5134a will be compressed the least (e.g., the most compressed), and the third repeating cells 5132c, 5134c will be compressed the most (e.g., the least compressed). That is, the first compression ratio of the first repeating cells 5132a, 5134a is less than each of the second and third compression ratios of the second and third repeating cells 5132b, 5134b, 5132c, 5134c, and the second compression ratio is less than the third compression ratio. Therefore, these compression ratios, combined with the laterally varying compression ratios of the first grid structure 5124, will produce a varying total compression ratio of the appendage 5106, such that when the appendage is sutured to the tissue using substantially uniform staples 5114a, 5114b, 5114c, 5116a, 5116b, 5116c (e.g., nominally identical within manufacturing tolerances), the appendage 5106 is configured to apply substantially uniform pressure to the sutured tissue for a predetermined period of time.

[0364] In some implementations, the first grid structure can be constructed in such a way that it does not overlap with the staple row when the appendage is releasably held on the staple cartridge. Therefore, the first grid structure will not be captured by the staples or will be captured to a minimal extent during deployment. Thus, when in the organizational deployment state, the first grid structure will not contribute to, or will contribute to, the solidity height of the appendage to a minimal extent. Therefore, the densification of the appendage can be delayed.

[0365] Figure 52A Another exemplary embodiment of a surgical end effector 5200 having an anvil 5202 and a suture assembly 5204 is shown. The suture assembly 5204 includes an appendage 5206 releasably retained on the top surface or platform surface 5208a of the cartridge 5208 (e.g., the cartridge surface facing the anvil). Except for the differences described below, the anvil 5202 and cartridge 5208 are similar to... Figures 52A to 52B The anvil 5102 and the staple cartridge 5208 are included, and therefore common features are not described in detail herein.

[0366] Accessory 5204 is similar to Figures 51A to 51B The appendage 5104 differs in that the first grid structure 5224 is formed by two sets of four longitudinally spaced vertical planar struts (e.g., in the x-direction), which extend between the second grid structure 5226 and the top surface or platform surface 5208a of the staple cartridge 5208. As shown, the first set is positioned at the intended cutting line C of the appendage 5206. L On one side, and the second set is positioned at the intended cutting line C of the appendage 5206. LOn the second side. For simplicity, only four struts from each group 5228a, 5228b, 5228c, 5228d, 5230a, 5230b, 5230c, 5230d are shown. Although the two groups of struts can have various configurations, in this illustrated embodiment, the two groups of struts are identical, and therefore for each group, the first struts 5228a, 5230a (e.g., the struts in the innermost row) have a first height, the second struts 5228b, 5228b (e.g., the struts in the innermost middle row) have a second height greater than the first height, the third struts 5228c, 5230c (e.g., the struts in the outermost middle row) have a third height greater than the second height, and the fourth struts 5228d, 5230d (e.g., the struts in the outermost row) have a fourth height greater than the second height. Therefore, the uncompressed thickness of the first grid structure 5224 (e.g., along the width of the appendage, in the y-direction) is relative to the longitudinal axis L of the longitudinal appendage 5206. A (For example, L extending in the z direction) A The thickness of the staple cartridge 5206 varies laterally. These lateral variations can be proportional to the curved top surface or platform surface 5208a of the staple cartridge 5208, such that a portion of the staple cartridge contact surface 5220 of the appendage 5206 formed by the bottom surface 5224b of the first grid structure 5224 is shaped to complement the curved top surface or platform surface 5208a of the staple cartridge 5208 (e.g., a concave configuration). Therefore, variations in the thickness of the first grid structure 5224 can conform to variations in the top surface or platform surface 5208a.

[0367] like Figure 52A As further illustrated, to minimize the effect of the first grid structure 5224 on the densification of the appendage 5206, the first grid structure 5224 can be designed such that it does not overlap with the nails 5214a, 5214a, 5214c, 5216a, 5216b, 5216c. For example, in this illustrated embodiment, none of the struts 5228a, 5228b, 5228c, 5228d, 5230a, 5230b, 5230c, 5230d overlap with any of the nails 5214a, 5214b, 5214c, 5216a, 5216b, 5216c, and therefore, the first grid structure 5224 will not be captured by the nails during deployment. Therefore, when the appendage 5206 is sutured to the tissue, the pressure exerted by the appendage 5206 on the sutured tissue can depend entirely or substantially entirely on the compressibility characteristics of the second grid structure 5226.

[0368] In some implementations, the wall thickness and height of each repeating cell can vary among the other repeating cells. For example, Figure 53Another exemplary embodiment of an appendage 5300 releasably retained on the top surface or platform surface 5302a of the staple cartridge 5302 (e.g., the cartridge surface facing the anvil) is shown. Apart from the differences described below, the staple cartridge 5302 is similar to... Figures 51A to 51B The warehouse in question is 5108, and therefore, common features are not described in detail in this paper. For example... Figure 53 As shown, only half (e.g., the right half) of the appendage 5300 is displayed on the staple cartridge 5302, in which three rows of staples 5304, 5306, and 5308 are partially disposed, with the innermost row 5304 having the smallest staple height and the outermost row 5308 having the largest staple height. As mentioned above, the difference in staple height can contribute to the overall compression behavior of the appendage when it is sutured to the tissue.

[0369] Although the appendage 5300 can have various configurations, it is formed by interconnected repeating cells arranged in two sets of three vertical arrays, with the first set positioned at the intended cutting line C of the appendage 5300. L On one side, and the second set (not shown) is positioned at the intended cutting line C of the appendage 5300. L On the second side. Since both sets are identical, therefore Figure 53 Only one repeating cell, 5310, 5312, 5314, of a set of three vertical arrays is shown.

[0370] Repeating cells 5310, 5312, and 5314 can have various configurations. In this illustrated embodiment, repeating cells 5310, 5312, and 5314 are similar in overall shape, except that the wall thickness and height vary among the three repeating cells 5310, 5312, and 5314. As shown, each repeating cell has a varying height (e.g., in the X direction) from its respective outermost top surfaces 5310a, 5312a, and 5314a (laterally offset in the y direction and aligned relative to each other) to its respective outermost bottom surfaces 5310b, 5312b, and 5314b. Therefore, for simplicity, the minimum height H of repeating cell 5310 is shown. 1A and maximum height H 1B The minimum height H of repeating cell 5312 2A and maximum height H 2B And the minimum height H of the repeating cell 5314. 3A and maximum height H 3B .

[0371] As shown in the figure, a portion of the top surface 5300a of the appendage 5300 is generally planar and therefore includes generally planar surfaces 5316 (e.g., each surface in the y-direction), with non-planar surfaces 5318 extending therebetween. The top surface 5300a defines the tissue contact surface 5320 of the appendage 5300, and thus the tissue contact surface 5320 is formed by the planar surfaces 5316 and the non-planar surfaces 5318. Since the generally planar surfaces 5316 and the non-planar surfaces 5318 of the top surface 5300a (and therefore the tissue contact surface 5320) alternate along the width of the appendage 5300 (extending in the y-direction), thus in... Figure 51A The anvil 5102 in the anvil and the appendage 5300 create a consistent tissue gap (e.g., alternating between a generally uniform tissue gap and a variable tissue gap). In this illustrated embodiment, each generally uniform tissue gap occurs at the tissue-compression surface (e.g., Figure 51A The tissue-compression surface 5112 of the anvil 5102 is between the generally planar surface 5316 of the tissue contact surface 5320. Variable tissue gaps occur between the tissue-compression surface (e.g., ...) Figure 51A Between the tissue-compression surface 5112 of the anvil 5102 and the non-planar surface 5318 of the tissue contact surface 5320 (which extends between adjacent cells of the appendage 5300). Those skilled in the art will understand that the length of the generally uniform and variable tissue gap (extending in the x-direction) can depend at least on the structural configuration of the tissue contact surface, and therefore on the structural configuration of the appendage.

[0372] Furthermore, the wall thickness and height between at least two repeating cells can vary, thus resulting in different compression ratios. In this illustrated embodiment, the wall thickness W from the first repeating cell 5310 (e.g., the innermost repeating cell) to the third repeating cell 5314 (e.g., the outermost repeating cell) is... T And H increases. That is to say, the wall thickness W of the first repeating cell 5310. T1 and the wall thickness W whose height H1 is less than the second repeating cell 5312 (e.g., the middle repeating cell). T2 and height H2, and wall thickness W of the second repeating grid 5312. T2 The height H2 is less than the wall thickness W of the third repeating cell 5314. T3And height H3. Therefore, the compression ratio decreases from the first repeating cell 5310 to the third repeating cell 5314. That is, the first compression ratio of the first repeating cell 5310 is greater than each of the second and third compression ratios of the second repeating cell 5312 and the third repeating cell 5314, and the second compression ratio is greater than the third compression ratio. Therefore, these compression ratios will produce a total compression ratio of variation in the appendage 5300, such that when the appendage is sutured to the tissue with staples 5304, 5306, 5308 with different staple heights (e.g., the innermost staple 5304 has the smallest top height and the outermost staple 5308 has the largest top height), the appendage 5300 is configured to apply substantially uniform pressure to the sutured tissue for a predetermined period of time.

[0373] As described above, the appendages may include a combination of cells without struts and cells with struts and / or spaced struts. For example, Figure 54 An exemplary embodiment of an appendage 5400 releasably held on the top surface or platform surface 5402a of the staple cartridge 5402 (e.g., the cartridge surface facing the anvil) is shown. Apart from the differences described below, the staple cartridge 5402 is similar to... Figures 1 to 2C The warehouse is 200, and therefore common features are not described in detail in this paper. Figure 54 As shown, only half (e.g., the left half) of the appendage 5400 is shown on the staple cartridge 5402, in which three longitudinal rows of substantially uniform staples 5404a, 5404b, 5404c are arranged.

[0374] Although the appendage 5400 can have various configurations, as shown, the appendage has an internal grid structure 5406 formed by two sets of repeating, strutless cells in two longitudinal arrays, wherein the first set is positioned at the intended cut line C of the appendage 5400. L On one side, and the second set (not shown) is positioned at the intended cutting line C of the appendage 5400. L On the second side. Since both sets are identical, therefore Figure 54 Only one repeating cell 5408, 5410 of two longitudinal arrays is shown. Additionally, appendage 5400 includes a first outer grid structure and a second outer grid structure (only the first outer grid structure 5412 is shown) that are structurally similar and positioned on opposite sides of the inner grid structure. Although only the first outer grid structure 5412 and the first repeating cell 5408 and the second repeating cell 5410 of appendage 5400 are shown, those skilled in the art will understand that the following discussion also applies to the second grid structure and the repeating cells of the second set of longitudinal arrays.

[0375] The first repeating cell 5408 and the second repeating cell 5410 can have various configurations. In this illustrated embodiment, the repeating cells 5408 and 5410 are substantially uniform (e.g., nominally identical within manufacturing tolerances) and structurally similar. Figures 9A to 9B The repeating cell 810 in the figure, and therefore the common features are not described in detail herein. As shown in the figure, the first repeating cell 5408 and the second repeating cell 5410 are oriented in a manner similar to Figures 45A to 45C The repeating cells 4516 in the grid, and therefore the internal grid structure 5406 can have the same Figures 45A to 45C The appendage 4500 has a similar configuration. Therefore, the repeating cells 5408, 5410 are oriented in a manner that coincides with the position of the pins in one or more rows of pins that can overlap with the inner grid structure 5406 (e.g., in a repeating pattern). As further shown, the first outer grid structure 5412 includes strut-based cells (only two grids 5414a, 5414b are shown in full). While the strut-based cells can have various configurations, the first strut-based cell 5414a has a triangular configuration, and the second strut-based cell 5414b has an inverted triangular configuration. As further shown, a portion of the second strut-based cell 5414b intersects through the first strut-based cell 5414a.

[0376] As shown in the figure, the grid structures 5406 and 5412 are relative to the longitudinal axis L of the appendage 5400. A (For example, L extending in the z direction) A The first outer grid structure 5412 is positioned directly adjacent to the first longitudinal side 5406a of the inner grid structure 5406. Furthermore, the inner grid structure 5406 overlaps with the first pin row 5403a and the second pin row 5303b (e.g., the innermost pin row and the middle pin row), and thus overlaps with the first pin 5404a and the second pin 5404b respectively, while the first outer grid structure 5412 overlaps with the third pin row 5404c (e.g., the outermost pin row), and thus overlaps with the third pin 5404c. In this illustrated embodiment, the first repeating cell 5408 of the first longitudinal array and the second repeating cell 5410 of the second longitudinal array are staggered relative to each other and are thus oriented in a manner that coincides with the positions of the first pin 5404a and the second pin 5404b (e.g., a repeating pattern).

[0377] The alignment of the grid structures 5406, 5412 with respect to the first nail 5404a, the second nail 5404b, and the third nail 5404c, combined with different structural configurations of the grid structures 5406, 5412, can result in at least two different stress-strain profiles when the appendage is sutured to the tissue. Given the orientation of the first and second repeating cells relative to the first and second nails, the resulting stress-strain profiles of the appendage at the first and second nails can be the same or substantially the same. The compressive behavior of the appendage 5300 at each of the first nail 5404a, the second nail 5404b, and the third nail 5404c is as follows: Figure 55 The diagram schematically illustrates the stress-strain curve of the appendage at the first nail 5404a, where S1 represents the stress-strain curve at the second nail 5404b, and S3 represents the stress-strain curve at the third nail 5404c. In this schematic, the stress-strain curve S1 at the first nail and the stress-strain curve S2 at the second nail are shown as the same curve. Those skilled in the art will understand that the stress-strain curve at each nail may vary.

[0378] Accessory system

[0379] Typically, the appendage system described herein may include at least two distinct appendages, each of which is configured to undergo a corresponding strain within a corresponding stress range of about 30 kPa to 90 kPa under a corresponding applied stress. In some embodiments, the at least two corresponding strain ranges may at least partially overlap, while in other embodiments, the at least two corresponding ranges do not overlap. Additionally or alternatively, combinations of the corresponding strain ranges may produce a combined range of at least 0.1 to 0.9. In other embodiments, the combination range may be about 0.1 to 0.8, about 0.1 to 0.7, about 0.1 to 0.6, about 0.1 to 0.5, about 0.1 to 0.4, about 0.1 to 0.3, about 0.2 to 0.8, about 0.2 to 0.7, about 0.3 to 0.7, about 0.3 to 0.8, about 0.3 to 0.9, about 0.4 to 0.9, about 0.4 to 0.8, about 0.4 to 0.7, about 0.5 to 0.8, or about 0.5 to 0.9. Although an appendage system may include at least two different appendages, for simplicity, the following description pertains to an appendage system having only a first appendage and a second appendage. However, those skilled in the art will understand that the following discussion also applies to additional appendages of the appendage system.

[0380] In some embodiments, the appendage system may include a first appendage and a second appendage, wherein the first appendage experiences strain within a first range when subjected to an applied stress in the range of about 30 kPa to 90 kPa, and the second appendage experiences strain within a second range when subjected to an applied pressure in the range of about 30 kPa to 90 kPa. The stress-strain response of each appendage depends at least on the structural configuration and composition of each appendage. Therefore, the first and second appendages can be tailored to achieve a desired strain response within the applied stress and / or the range of applied stress. For example, in some embodiments, the first appendage may be configured such that, under an applied stress in the range of about 60 kPa to 90 kPa, the first appendage experiences strain in the first range of about 0.2 to 0.5, while the second appendage may be configured such that, under an applied stress in the range of about 40 kPa to 70 kPa, the second appendage experiences strain in the second range of about 0.3 to 0.7. In another embodiment, the first appendage may be configured such that, under an applied stress in the range of about 30 kPa to 90 kPa, the first appendage experiences a strain in a first range of about 0.1 to 0.7, and the second appendage may be configured such that, under an applied stress in the range of about 30 kPa to 90 kPa, the second appendage experiences a strain in a second range of about 0.3 to 0.9. In another embodiment, the first appendage may be configured such that, under an applied stress in the range of about 30 kPa to 90 kPa, the first appendage experiences a strain in a first range of about 0.2 to 0.6, and the second appendage may be configured such that, under an applied stress in the range of about 30 kPa to 90 kPa, the second appendage experiences a strain in a second range of about 0.4 to 0.8. In another embodiment, the first appendage may be configured such that when subjected to an applied stress in the range of about 40 kPa to 80 kPa, the first appendage experiences a strain in the first range of about 0.1 to 0.7, and the second appendage may be configured such that when subjected to an applied stress in the range of about 30 kPa to 90 kPa, the second appendage experiences a strain in the second range of about 0.2 to 0.8.

[0381] The first and second appendages can have various structural configurations. For example, the first appendage can have a configuration similar to any of the exemplary appendages described herein, and the second appendage can have a different configuration than the first appendage and be similar to another appendage among the exemplary appendages described herein. In some embodiments, the first appendage can be a non-strut-based appendage, and the second appendage can be another non-strut-based appendage or a strut-based appendage as described herein. In other embodiments, the first appendage can be a strut-based appendage, and the second appendage can be another strut-based appendage or a non-strut-based appendage.

[0382] In some embodiments, the first appendage has a first internal structure formed by a first plurality of repeatedly interconnected cells, and the second appendage has a second internal structure formed by a second plurality of repeatedly interconnected cells. In some embodiments, the first plurality of repeatedly interconnected cells may be formed of a first material, and the second plurality of repeatedly interconnected cells may be formed of a second material different from the first material. The first and second materials may be any materials described herein and in more detail below. Alternatively or additionally, each cell in the first plurality of repeatedly interconnected cells has a first geometry, and each cell in the second plurality of repeatedly interconnected cells has a second geometry different from the first geometry.

[0383] In some embodiments, each cell of at least one of the first plurality of repeatedly interconnected cells and the second plurality of repeatedly interconnected cells is a triple-periodic minimal surface structure (e.g., a Schwarz P structure). In one embodiment, each cell of the first plurality of repeatedly interconnected cells is a first triple-periodic minimal surface structure, and each cell of the second plurality of repeatedly interconnected cells is a second triple-periodic minimal surface structure different from the first triple-periodic minimal surface structure. For example, the first triple-periodic minimal surface structure and the second triple-periodic minimal surface structure may differ in geometry (e.g., shape, size (e.g., height, wall thickness, etc.) or combinations thereof).

[0384] In some embodiments, each of the first plurality of repeatedly interconnected cells may include a first top portion, a first bottom portion, and a first spacer connecting the first top portion and the first bottom portion, the first top portion being formed by the first plurality of spacers defining a first plurality of openings between the first plurality of spacers, and the first bottom portion being formed by a second plurality of spacers defining a second plurality of openings between the second plurality of spacers. In such embodiments, each of the second plurality of repeatedly interconnected cells may be a Schwarz-P structure. In other embodiments, each of the second plurality of repeatedly interconnected cells may include a second top portion, a second bottom portion, and a second spacer connecting the second top portion and the second bottom portion, the second top portion being formed by a third plurality of spacers defining a third plurality of openings between the third plurality of spacers, and the second bottom portion being formed by a fourth plurality of spacers defining a fourth plurality of openings between the fourth plurality of spacers.

[0385] Material

[0386] The appendages described herein may be formed from one or more polymers, such as bioabsorbable polymers, non-bioabsorbable polymers, bioresorbable polymers, or any combination thereof. For clarity only, the term “polymer” as used herein may be understood to encompass one or more polymers, including one or more macromolecular monomers. Non-limiting examples of suitable polymers include: polylactide (PLA), polycaprolactone (PCL), polyglycolic acid (PGA), polydioxane (PDO), polytrimethylene carbonate (PTMC), polyethylene glycol (PEG), polyethylene diglycolate (PEDG), polypropylene fumarate (PPF), poly(ethoxyethylene diglycolate), poly(ether ester) (PEE), poly(amino acid), poly(epoxy carbonate), poly(2-oxypropylene carbonate), poly(citrate glycol), polymethacrylic anhydride, and poly(N-isopropylacrylamide), copolymers of any of these, or any combination thereof. Non-limiting examples of suitable copolymers include: random copolymers such as PLGA-PCL, block copolymers such as poly(lactide-co-glycolic acid) (PLGA), triblock copolymers such as PLGA-PCL-PLGA or PLGA-PEG-PLGA, or any combination thereof. Further non-limiting examples of suitable polymers are disclosed, for example, in U.S. Patent Nos. 9,770,241, 9,873,790, 10,085,745, and 10,149,753; and U.S. Patent Publication No. 2017 / 0355815, the entire contents of which are incorporated herein by reference.

[0387] In some embodiments, the polymer may be formed from a resin. Generally, the resins described herein are suitable for additive manufacturing techniques such as bottom-up and top-down stereolithography, (b) producing bioresorbable appendages, and / or (c) producing flexible or elastic appendages (e.g., at temperatures of about 25°C, about 37°C, and / or anywhere in between).

[0388] In some embodiments, the polymer may be formed from a photopolymerizable resin comprising an oligomeric prepolymer. The oligomeric prepolymer may be linear or branched (e.g., “star” oligomers, such as three-armed oligomers). Non-limiting examples of suitable end groups for such oligomeric prepolymers include acrylates, methacrylates, fumarates, vinyl carbonates, methyl esters, ethyl esters, etc. Non-limiting examples of suitable components for forming the polymer and thus the appendages provided herein are listed in Table 2 below. Components in each column of Table 2 may be combined with components in other columns in any combination.

[0389] Table 2. Exemplary Resin Compositions

[0390]

[0391] While various types of resins can be used to form polymers, in some embodiments, the polymer is formed from a resin based on a bioabsorbable polyester oligomer (e.g., an oligomer with methacrylate-terminated bioabsorbable polyester bonds). For example, the bioabsorbable polyester oligomer may be present in an amount of about 5% to 90%, 5% to 80%, about 10% to 90%, or about 10% to 80% by weight of the resin. Unlike conventional resins (e.g., resins based on polycaprolactone dimethacrylate and resins based on poly(D,L-lactide) dimethacrylate), this resin can form appendages with rubber-like elastic behavior, short-term retention of mechanical properties (e.g., 1 month or less), and / or long-term total absorption (e.g., over a period of approximately 4 to 6 months) at physiological temperatures.

[0392] In some embodiments, the oligomer may include a linear oligomer. Alternatively or otherwise, the oligomer may include a branched oligomer (e.g., a star-shaped oligomer, such as a three-armed oligomer).

[0393] In some embodiments, the bioabsorbable polyester oligomers described herein are bioabsorbable oligomers having methacrylate end groups. Such oligomers typically comprise biodegradable ester bonds between components such as caprolactone, lactide, glycolide-trimethylene carbonate, dioxane, and propylene glycol fumarate monomers in ABA blocks, BAB blocks, CBC blocks, BCB blocks, AB random compositions, BC random compositions, homopolymers, or any combination thereof, wherein: A = poly(lactide) (PLA), poly(glycolic acid) (PGA), poly(lactide-co-glycolic acid) (PLGA), or poly(poly(lactide-co-glycolic acid)) fumarate (PPF), B = polycaprolactone (PCL), poly(lactide-co-caprolactone) (PLACL), poly(glycolic acid-co-caprolactone) (PGACL), poly(trimethylene carbonate) (PTMC), or poly(caprolactone-co-lactide) (PCLLA), and C = polydioxane (PDO). The molecular weight (Mn) of the copolymer in a linear or star-shaped structure can be from about 2,000 Daltons to 6,000 Daltons, from about 2,000 Daltons to 10,000 Daltons, from about 2,000 Daltons to 15,000 Daltons, from about 2,000 Daltons to 20,000 Daltons, from about 2,000 Daltons to 50,000 Daltons, from about 5,000 Daltons to 6,000 Daltons, from about 5,000 Daltons to 10,000 Daltons, from about 5,000 Daltons to 15,000 Daltons, from about 5,000 Daltons to 20,000 Daltons, or from about 10,000 Daltons to 50,000 Daltons. The monomers used to prepare this oligomer may optionally be branched, for example to enhance elasticity; an example is γ-methyl-ε-caprolactone and γ-ethyl-ε-caprolactone.

[0394] In some embodiments, lactide may include L-lactide, D-lactide, or mixtures thereof (e.g., D,L-lactide). For example, in some embodiments having PLA blocks, L-lactide may be used for better regularity and higher crystallinity.

[0395] In some embodiments, the oligomer may include ABA blocks, BAB blocks, CBC blocks, or BCB blocks in the form of straight chains and / or branched chains (e.g., star-shaped or three-armed).

[0396] In some embodiments, A can be: (i) poly(lactide); (ii) poly(glycolic acid); (iii) poly(lactide-co-glycolic acid) comprising a lactide:glycolic acid molar ratio of 90:10 to 55:45 (e.g., lactide-rich ratio), 45:55 to 10:90 lactide:glycolic acid molar ratio (e.g., glycolide-rich ratio), or 50:50 lactide:glycolic acid; or any combination thereof. In such embodiments, the oligomer may be in linear and / or branched (e.g., star-shaped or three-armed) form. In some embodiments, D,L-lactide mixtures can be used to prepare PLGA random copolymers.

[0397] In some implementation schemes, B can be: ( i Polycaprolactone; ii (iii) Poly(caprolactone-co-lactide) comprising caprolactone:lactide in a molar ratio of 95:5 to 5:95; or any combination thereof.

[0398] In some embodiments, the molecular weight (Mn) of A (PLA, PGA, PLGA, PPF or any combination thereof) may be about 1,000 Daltons to 4,000 Daltons, about 1,000 Daltons to 6,000 Daltons, about 1,000 Daltons to 10,000 Daltons, about 2,000 Daltons to 4,000 Daltons, about 2,000 Daltons to 6,000 Daltons, or about 2,000 Daltons to 10,000 Daltons; and the molecular weight (Mn) of B (PCL, PLAC, PGC, PTMC, PCLLA or any combination thereof) may be about 1,000 Daltons to 4,000 Daltons, about 1,000 Daltons to 6,000 Daltons, about 1,000 Daltons to 10,000 Daltons, about 1,000 Daltons to 50,000 Daltons, about 1.6,000 Daltons to 4,000 Daltons, about 1.6,000 Daltons to 6,000 Daltons, about 1.6,000 Daltons to 10,000 Daltons, or about 1.6,000 Daltons to 50,000 Daltons.

[0399] The resin may also include additional components, such as additional crosslinking agents, non-reactive diluents, photoinitiators, reactive diluents, fillers, or any combination thereof.

[0400] In some embodiments, the resin may include an additional crosslinking agent. For example, the additional crosslinking agent may be present in an amount of about 1% to 5%, about 1% to 10%, about 2% to 5%, or about 2% to 10% by weight of the resin. Any suitable additional crosslinking agent may be used, including bioabsorbable crosslinking agents, non-absorbable crosslinking agents, or any combination thereof. Non-limiting examples of suitable bioabsorbable crosslinking agents include: divinyl adipate (DVA), poly(caprolactone) trimethacrylate (PCLDMA, e.g., at a molecular weight of about 950 to 2400 Daltons in MW), etc. Non-limiting examples of suitable non-absorbable crosslinking agents include: trimethylolpropane trimethacrylate (TMPTMA), poly(propylene glycol) dimethacrylate (PPGDMA), poly(ethylene glycol) dimethacrylate (PEGDMA), etc.

[0401] In some embodiments, the resin may include a non-reactive diluent. For example, the non-reactive diluent may be present in an amount of about 1% to 70%, about 1% to 50%, about 5% to 70%, or about 5% to 50% by weight of the resin. Non-limiting examples of non-reactive diluents include: dimethylformamide, dimethylacetamide, N-methylpyrrolidone (NMP), dimethyl sulfoxide, cyclic carbonates (e.g., propylene glycol carbonate), diethyl adipate, methyl ether ketone, ethanol, acetone, or any combination thereof.

[0402] In some embodiments, the resin may include a photoinitiator. For example, the photoinitiator may be present in an amount of about 0.1% to 4%, about 0.1% to 2%, about 0.2% to 4%, or about 0.2% to 2% by weight of the resin. The photoinitiator included in the resin can be any suitable photoinitiator. Non-limiting examples of suitable photoinitiators include: type I and type II photoinitiators, and UV photoinitiators (e.g., acetophenone (e.g., diethoxyacetophenone), phosphine oxides (e.g., diphenyl(2,4,6-trimethylbenzoyl)phosphine oxide, phenylbis(2,4,6-trimethylbenzoyl), phosphine oxide (PPO)), Irgacure... ® (369), etc. Additional exemplary photoinitiators can be found in U.S. Patent No. 9,453,142, the entire contents of which are incorporated herein by reference.

[0403] In one embodiment, the resin may include: a bioabsorbable polyester oligomer present in an amount of about 5% to 90%, 5% to 80%, about 10% to 90%, or about 10% to 80% by weight of the resin; a non-reactive diluent present in an amount of about 1% to 70%, about 1% to 50%, about 5% to 70%, or about 5% to 50% by weight of the resin; and a photoinitiator present in an amount of about 0.1% to 4%, about 0.1% to 2%, about 0.2% to 4%, or about 0.2% to 2% by weight of the resin.

[0404] In some embodiments, the resin may include a reactive diluent (including difunctional and trifunctional reactive diluents). For example, the reactive diluent may be present in an amount of about 1% to 50%, about 1% to 40%, about 5% to 50%, or about 5% to 40% by weight of the resin. Non-limiting examples of reactive diluents include: acrylates, methacrylates, styrene, vinylamides, vinyl ethers, vinyl esters, polymers containing any one or more of the foregoing or any combination thereof (e.g., acrylonitrile, styrene, divinylbenzene, vinyltoluene, methyl acrylate, ethyl acrylate, butyl acrylate, (meth)acrylate, isobornyl acrylate (IBOA), isobornyl methacrylate (IBOMA), alkyl ethers of mono-, di-, or tri-ethylene glycol acrylates or methacrylates, fatty alcohol acrylates or methacrylates (such as lauryl methacrylate) and mixtures thereof).

[0405] In one embodiment, the resin may include: a bioabsorbable polyester oligomer present in an amount of about 5% to 90%, about 5% to 80%, about 10% to 90%, or about 10% to 80% by weight of the resin; a non-reactive diluent present in an amount of about 1% to 70%, about 1% to 50%, about 5% to 70%, or about 5% to 50% by weight of the resin; a photoinitiator present in an amount of about 0.1% to 4%, about 0.1% to 2%, about 0.2% to 4%, or about 0.2% to 2% by weight of the resin; and a reactive diluent present in an amount of about 1% to 50%, about 1% to 40%, about 5% to 50%, or about 5% to 40% by weight of the resin.

[0406] In some embodiments, the resin may include fillers. For example, the filler may be present in an amount of about 1% to 50%, about 1% to 40%, about 2% to 50%, or about 2% to 40% by weight of the resin. Any suitable filler may be used in conjunction with the present invention, including but not limited to bioabsorbable polyester particles, sodium chloride particles, calcium triphosphate particles, sugar particles, etc.

[0407] In one embodiment, the resin may include: a bioabsorbable polyester oligomer present in an amount of about 5% to 90%, about 5% to 80%, about 10% to 90%, or about 10% to 80% by weight of the resin; a non-reactive diluent present in an amount of about 1% to 70%, about 1% to 50%, about 5% to 70%, or about 5% to 50% by weight of the resin; a photoinitiator present in an amount of about 0.1% to 4%, about 0.1% to 2%, about 0.2% to 4%, or about 0.2% to 2% by weight of the resin; a reactive diluent present in an amount of about 1% to 50%, about 1% to 40%, about 5% to 50%, or about 5% to 40% by weight of the resin; and a filler present in an amount of about 1% to 50%, about 1% to 40%, about 2% to 50%, or about 2% to 40% by weight of the resin.

[0408] Additionally, depending on the specific use of the appendage, in some embodiments the resin may have additional components. For example, in some embodiments, the resin may include one or more additional components, which may be present in amounts of about 0.1% to 10%, about 0.1% to 10%, about 1% to 20%, or about 1% to 10% by weight of the resin. Non-limiting examples of suitable additional components include: pigments, dyes, diluents, active or pharmaceutical compounds, detectable compounds (e.g., fluorescent, phosphorescent, radioactive), proteins, peptides, nucleic acids (DNA, RNA) such as siRNA, sugars, etc., including any combination thereof.

[0409] In some embodiments, the resin may include non-reactive pigments or dyes that absorb light (particularly UV light). Non-limiting examples of suitable non-reactive pigments or dyes include: (i) titanium dioxide (e.g., present in amounts of about 0.05% to 5%, about 0.05% to 1%, about 0.1% to 1%, or about 0.1% to 5% by weight of the resin), (ii) carbon black (e.g., present in amounts of about 0.05% to 5%, about 0.05% to 1%, about 0.1% to 1%, or about 0.1% to 5% by weight of the resin), and / or (iii) organic UV absorbers such as hydroxybenzophenone, hydroxyphenylbenzotriazole, oxyaniline, oxaloylaniline, thioxanthone, hydroxyphenyltriazine, and / or benzotriazole UV absorbers (e.g., Mayzo). BLS1326 (e.g., present in amounts of about 0.001% to 1%, 0.001% to 2%, about 0.001% to 4%, about 0.005% to 1%, about 0.005% to 2%, or about 0.005% to 4% by weight of the resin). Additional exemplary non-reactive pigments or dyes are disclosed in U.S. Patent Nos. 3,213,058, 6,916,867, 7,157,586, and 7,695,643, each of which is incorporated herein by reference in its entirety.

[0410] In some embodiments, the resin may include: (a) a (meth)acrylate-terminated bioresorbable polyester oligomer present in an amount of about 5% to 80%, about 5% to 90%, about 10% to 80%, or about 10% to 90% by weight of the resin; (b) a non-reactive diluent present in an amount of about 1% to 50%, about 1% to 70%, about 5% to 50%, or about 5% to 70% by weight of the resin; and (c) a photoinitiator present in an amount of about 0.1% to 2%, about 0.1% to 4%, about 0.2% to 2%, or about 0.2% to 4% by weight of the resin. In such embodiments, the resin may further include (d) a reactive diluent present in an amount of about 1% to 40%, about 1% to 50%, about 5% to 40%, or about 5% to 50% by weight of the resin; (e) a filler present in an amount of about 1% to 40%, about 1% to 50%, about 2% to 40%, or about 2% to 50% by weight of the resin; (f) additional components (e.g., surfactants, detectable groups, pigments or dyes, etc.) present in an amount of about 0.1% to 10%, about 0.1% to 20%, about 1% to 10%, or about 1% to 20% by weight of the resin; and / or (g) an additional crosslinking agent (e.g., trimethylolpropane trimethacrylate (TMPTMA)) present in an amount of about 1% to 5%, about 1% to 10%, about 2% to 5%, or about 2% to 10% by weight of the resin.

[0411] In some embodiments, the resin may include:

[0412] (a) A bioresorbable polyester oligomer of linear or branched (meth)acrylate-terminated form in ABA, BAB, CBC, or BCB blocks, comprising about 5% to 80%, about 5% to 90%, about 10% to 80%, or about 10% to 90% by weight of the resin, wherein: A is poly(lactide) (PLA), poly(glycolic acid) (PGA), poly(lactide-co-glycolic acid) (PLGA), or any combination thereof, wherein the PLGA contains a lactide:glycolic acid ratio of 90:10 to 60:40 or 40:60 to 10:90, and the molecular weight (Mn) of A is about 1,000 Daltons to 4,000 Daltons, about 1,000 Daltons to 10,000 Daltons, or about 2,000 Daltons to... 4,000 Daltons, or about 2,000 Daltons to 10,000 Daltons; B is polycaprolactone (PCL, PTMC, and PCLLA), poly(lactide-co-caprolactone) (PLACL), poly(glycolide-co-caprolactone) (PGACL), poly(trimethylene carbonate) (PTMC), and the molecular weight (Mn) of B is about 1,000 Daltons to 4,000 Daltons, about 1,000 Daltons to 10,000 Daltons, about 1.6,000 Daltons to 4,000 Daltons, or about 1.6,000 Daltons to 10,000 Daltons; and C is polydioxane (PDO), and the molecular weight (Mn) of C is about 1,000 Daltons to 4,000 Daltons, about 1,000 Daltons to 10,000 Daltons, about 2,000 Daltons to 4,000 Daltons, or about 2,000 Daltons to 10,000 Daltons;

[0413] (b) Propylene glycol carbonate, which is present in an amount of about 1% to 50%, about 1% to 70%, about 5% to 50% or about 5% to 70% by weight of the resin;

[0414] (c) A photoinitiator present in an amount of about 0.1% to 2%, about 0.1% to 4%, about 0.2% to 2%, or about 0.2% to 4% by weight of the resin;

[0415] (d) Optionally, a reactive diluent is present in an amount of about 1% to 40%, about 1% to 50%, about 5% to 40%, or about 5% to 50% by weight of the resin; and

[0416] (e) Optionally, filler is present in an amount of about 1% to 40%, about 1% to 50%, about 2% to 40% or about 2% to 50% by weight of the resin.

[0417] Manufacturing method

[0418] The non-fibrous appendages described herein can be formed from a matrix comprising at least one molten bioabsorbable polymer, and therefore can be formed using any additive manufacturing process. In some embodiments, the additive manufacturing process can be a continuous liquid interface generation (CLIP) involving the use of ultraviolet-cured liquid plastic resin. Details of the CLIP process are disclosed in, for example, U.S. Patent Nos. 9,211,678, 9,205,601, and 9,216,546; U.S. Patent Publications Nos. 2017 / 0129169, 2016 / 0288376, 2015 / 0360419, 2015 / 0331402, 2017 / 0129167, 2018 / 0243976, 2018 / 0126630, and 2018 / 0290374; J. Tumbleston et al., Continuous liquid interface production of 3D Objects Science 347, pp. 1349-1352 (2015); and R. Janusziewcz et al. Layerless fabrication with continuous liquid interface production , Proc. Natl. Acad. Sci. USA 113, pp. 11703-11708 (2016); the full text of each of the above is incorporated herein by reference. Non-limiting examples of other additive manufacturing apparatuses and methods that can be used to form the non-fibrous appendages described herein (and thus form a matrix comprising at least one molten bioabsorbable polymer) may include bottom-up and top-down additive manufacturing methods (e.g., in U.S. Patent Nos. 5,236,637, 5,391,072, 5,529,473, 7,438,846, 7,892,474 and 8,110,135 and U.S. Patent Publications 2013 / 0292862 and 2013 / 0295212, each of which is incorporated herein by reference in its entirety), as well as fused deposition modeling (e.g., heating thermoplastic filaments and extruding the molten filament layers one by one), material jetting, 2-photon polymerization, and holographic multifocus polymerization as understood by those skilled in the art.

[0419] In some embodiments, one or more post-processing steps may be performed after the additive manufacturing process. For example, in some embodiments, according to known techniques, one or more post-processing steps may include washing the appendages (e.g., in organic solvents such as acetone, isopropanol, glycol ethers such as dipropylene glycol methyl ether or DPM), wiping the appendages (e.g., with an absorbent material, by blowing with compressed gas or an air knife, etc.), centrifuging to separate residual resin, extracting residual solvent, additional curing such as by exposure to diffuse light such as ultraviolet light to further react, for example, the unpolymerized components of the appendages, drying the appendages (e.g., under vacuum) to remove the extracted solvent, or any combination thereof. One or more post-processing steps may cause the appendages to shrink, and therefore, in some embodiments, the appendages may be produced in a scaled-up form to counteract such shrinkage.

[0420] In other embodiments, the non-fibrous appendages may be partially or completely formed using any suitable non-additive manufacturing process, such as injection molding, foaming, and molding processes as understood by those skilled in the art.

[0421] The stitching assembly can be manufactured in various ways. For example, in some embodiments, as discussed above, a non-fibrous appendage can be placed by abutting the appendage's cartridge contact surface against the cartridge's surface (e.g., the surface facing the anvil, such as the top surface or platform surface) so that at least one attachment feature of the appendage is inserted into at least one surface feature (e.g., a recessed channel) of the cartridge (see example...). Figures 19A to 26C , Figures 37A to 39B and Figures 41A to 41C Alternatively or otherwise, as discussed above, non-fibrous appendages may be configured to receive one or more slot protrusions (e.g., nail pit protrusions) and / or nail legs (see example...). Figures 45A to 46B Additional details regarding surface features and other exemplary surface features can be found in U.S. Patent No. 2016 / 0106427, the entire contents of which are incorporated herein by reference. Alternatively or in addition, as discussed above, non-fibrous appendages may include an outer layer in the form of an adhesive film for releasably retaining the appendage on the staple cartridge (see, for example...). Figure 40 Additional details regarding adhesive films and other attachment methods can be found in U.S. Patent No. 10,349,939, the entire contents of which are incorporated herein by reference.

[0422] The appendages and methods can be further understood using the following non-limiting embodiments.

[0423] Example

[0424] Examples 1-3: Preparation of bifunctional methacrylate (MA)-terminated polyester oligomers

[0425] Examples 1-3 describe the preparation of bifunctional methacrylate-terminated polyester oligomers. The intermediate block is PLGA-PCL-PLGA with a molecular weight of 6 kilodaltons, and PCL accounts for 40 wt.% of the total molecular weight (MW). PLGA is a random copolymer of lactide (L) and glycolide (G), wherein the L:G weight ratio is 1:1.

[0426] Table 3 below provides the molar ratios and masses of each reagent used to synthesize 1 kg batches of HO-PLGA-b-PCL-b-PLGA-OH as discussed in Examples 1 and 2.

[0427] Table 3: Molar ratios and masses of reagents for Examples 1 and 2

[0428]

[0429] Example 1: Synthesis of HO-PCL-OH

[0430] The round-bottom flask was dried overnight in a drying oven and cooled to room temperature under N2 flow. Caprolactone and stannous octoate were added to the round-bottom flask via a glass syringe and syringe needle. The contents of the reaction flask were heated to 130°C. Simultaneously, diethylene glycol was heated to 130°C. After preheating, diethylene glycol was added to the reaction flask as an initiator, and the reaction was allowed to proceed until the monomer conversion was complete. H2 was used as the catalyst. 1 NMR was used to monitor monomer conversion. Once complete monomer conversion was achieved, the reaction was stopped, and the reaction mixture was cooled to room temperature. HO-PCL-OH was precipitated from chloroform into cold MeOH to obtain a white solid. 1 NMR, DSC, FTIR, and THF GPC were used to characterize HO-PCL-OH.

[0431] Example 2: Synthesis of HO-PLGA-b-PCL-b-PLGA-OH

[0432] The HO-PCL-OH prepared in Example 1, along with varying amounts of D,L-lactide and glycolide, were added to a round-bottom flask under N2 and heated to 140°C to melt the reaction contents. After melting, the temperature was lowered to 120°C and stannous octoate was added. The reaction was continued with stirring, while H2 was added. 1 NMR and THF GPC were used to monitor monomer conversion. Once the reaction reached the desired molecular weight, the reaction mixture was cooled to room temperature, dissolved in chloroform, and precipitated three times in cold diethyl ether. The precipitate was dried under vacuum.

[0433] Example 3: Synthesis of MA-PLGA-b-PCL-b-PLGA-MA

[0434] Table 4 below provides the molar ratios and masses of each reagent used to synthesize 1 kg batches of MA-PLGA-b-PCL-b-PLGA-MA.

[0435] Table 4: Molar ratios and masses of each reagent for Example 3

[0436]

[0437] Under N2 conditions, the HO-PLGA-b-PCL-b-PLGA-OH prepared in Example 2 was dissolved in anhydrous DCM in a round-bottom flask. Triethylamine and BHT were added to the reaction flask, and the flask was cooled to 0°C in an ice-water bath. The reaction flask was equipped with a pressure-equalizing feeding funnel containing methacryloyl chloride. Once the reaction flask reached 0°C, methacryloyl chloride was added dropwise over 2 hours. The reaction was carried out at 0°C for 12 hours and then at room temperature for 24 hours. Once the reaction was complete, the reaction contents were washed twice with distilled water to remove triethylamine hydrochloride, washed with saturated Na2CO3, and then dried with magnesium sulfate. The collected and dried DCM layer was dried by rotary evaporation. The solution was then dried with THF, GPC, and H2O. 1 The final product was characterized by NMR, FTIR, and DSC.

[0438] Examples 4-6: Preparation of three-arm MA-terminated polyester oligomers

[0439] Examples 4-6 describe the preparation of three-armed or star-shaped bioabsorbable polyester oligomers. Each arm is end-capped with methacrylate. Each arm has a molecular weight of 2 kDa and is a block copolymer of random poly(lactide-co-glycolic acid) (PLGA) and poly(caprolactone) (PCL) segments, wherein PCL is the core of the oligomer. PCL accounts for 40 wt.% of the total molecular weight (MW). The PLGA is a random copolymer of lactide (L) and glycolide (G), wherein the L:G weight ratio is 1:1.

[0440] Example 4: Synthesis of PCL-3oh

[0441] Table 5 below provides the molar ratios and masses of each reagent used to synthesize 1 kg batches of (PLGA-b-PCL)-3OH as discussed in Examples 4 and 5.

[0442] Table 5: Examples of molar ratios and masses for each reagent in Examples 4 and 5

[0443]

[0444] The round-bottom flask was dried overnight in a drying oven and cooled to room temperature under N2 flow. Caprolactone and stannous octoate were added to the round-bottom flask via a glass syringe and syringe needle. The contents of the reaction flask were heated to 130°C. Simultaneously, trimethylolpropane (TMP) was heated to 130°C. After preheating, TMP was added to the reaction flask as an initiator, and the reaction was allowed to proceed until the monomer conversion was complete. H2 was used as the initiator. 1NMR was used to monitor monomer conversion. Once complete monomer conversion was achieved, the reaction was stopped, and the reaction mixture was cooled to room temperature. (PCL)-3OH was precipitated from chloroform into cold MeOH to obtain a white solid. ¹H NMR, DSC, FTIR, and GPC were used to characterize (PCL)-3OH.

[0445] Example 5: Synthesis of (PCL-b-PLGA)-3OH

[0446] The (PCL)-3OH prepared in Example 4, along with varying amounts of D,L-lactide and glycolide, was added to a round-bottom flask under N2 and heated to 140°C to melt the reaction contents. After melting, the temperature was lowered to 120°C and stannous octoate was added. The reaction was continued with stirring, while H2 was added. 1 NMR and THF GPC were used to monitor monomer conversion. Once the reaction reached the desired molecular weight, the reaction mixture was cooled to room temperature, dissolved in chloroform, and precipitated three times in cold diethyl ether. The precipitate was dried under vacuum.

[0447] Example 6: Synthesis of (PCL-b-PLGA)-3MA

[0448] Table 6 below provides the molar ratios and masses of each reagent used to synthesize 1 kg batches of (PLGA-b-PCL)-3MA.

[0449] Table 6: Molar ratios and masses of each reagent for Example 6

[0450]

[0451] Under N2, (PCL-b-PLGA)-3OH prepared in Example 5 was dissolved in anhydrous DCM in a round-bottom flask. Triethylamine (TEA) and BHT were added to the reaction flask, and the flask was cooled to 0°C in an ice-water bath. The reaction flask was equipped with a pressure-equalizing feed funnel containing methacryloyl chloride. Once the reaction flask reached 0°C, methacryloyl chloride was added dropwise over 2 hours. The reaction was carried out at 0°C for 12 hours and then at room temperature for 24 hours. After the reaction was complete, the precipitate was removed by vacuum filtration. The filtrate was collected, and DCM was removed by rotary evaporation. The resulting viscous oil was dissolved in THF and precipitated in cold methanol. The precipitate was dissolved in DCM and washed with aqueous HCl (3%, twice), saturated aqueous sodium bicarbonate solution, and saturated aqueous sodium chloride solution, and then dried over magnesium sulfate. Magnesium sulfate was filtered through vacuum filtration, and the filtrate was collected. DCM was removed by rotary evaporation, the solid product was collected, and the product was dried over GPC and H2O. 1 The solid product was characterized by NMR, FTIR and DSC.

[0452] Example 7: Bifunctional oligomer resin formulation

[0453] The following components are mixed together in the following weight percentages (by weight of the resin) to provide an exemplary resin for additive manufacturing:

[0454] (1) 66.2% of the bifunctional oligomers prepared in Examples 1 to 3 above;

[0455] (2) 3.5% Trimethylolpropane Trimethacrylate (TMPTMA) reactive diluent;

[0456] (3) 28.4% N-methylpyrrolidone (NMP) non-reactive diluent; and

[0457] (4) 1.89% Irgacure ® 819 photoinitiator.

[0458] Example 8: Three-arm oligomer resin formulation

[0459] The following components are mixed together in the following weight percentages (by weight of the resin) to provide an exemplary resin for additive manufacturing:

[0460] (1) 68.6% of the three-armed oligomers prepared in Examples 4 to 6 above;

[0461] (2) 29.4% N-methylpyrrolidone (NMP) non-reactive diluent; and

[0462] (3) 1.96% Irgacure ® 819 photoinitiator.

[0463] Example 9: Additive Manufacturing and Post-processing

[0464] Five exemplary appendages were prepared. The first exemplary appendage (Appendix 1) is structurally similar to... Figures 8A to 8F The appendix 800, except that the first appendix is ​​formed by two vertically arranged 20 cells, is structurally similar to the appendix 800. Figures 31A to 31D The accessory 3100 shown (accessory 2), as Figures 32A to 32D The accessory 3200 shown (accessory 3), as Figures 33A to 33E The attached item 3300 (attachment 4) and as shown Figures 34A to 34EThe appendix 3400 (appendix 5) is shown. Five appendixes were prepared by additive manufacturing according to standard techniques on a Carbon Inc. M1 or M2 device available from Carbon Inc. (zip code: 94063), 1089 Mills Way, Redwood City, California. The resin formulation for each appendix is ​​provided in Table 7 below.

[0465] Table 7: Exemplary Appendage Resin Formulations

[0466]

[0467] When the resin contains a non-reactive diluent, the object may experience overall shrinkage to the extent of the non-reactive diluent loading during washing / extraction. Therefore, a size scaling factor is applied to the part stereolithography (.stl) file or 3D manufacturing format (3MF) file to enlarge the printed appendage and intentionally account for subsequent shrinkage during post-processing steps.

[0468] Post-treatment of each appendage is performed as follows: After removing the build platform from the equipment, wipe off excess resin from a flat surface around the appendage, leaving the platform on its sides to drain for approximately 10 minutes. Carefully remove the appendage from the platform. Wash the appendage three times in acetone, each time for 30 seconds at 280 rpm on a track-type shaker, followed by drying for 5 minutes between washes. After the third wash, allow the appendage to dry for 30 minutes, then proceed with PrimeCure. TM In the UV overflow curing equipment, each side is cured for 20 seconds.

[0469] Next, residual non-reactive diluents (e.g., N-methylpyrrolidone or propylene carbonate) were extracted from the appendix by immersing it in acetone and agitating it on an orbital oscillator at room temperature for approximately 18 hours, with the solvent being replaced every 12 hours. The appendix was then removed from the acetone and vacuum-dried overnight at 60°C. Residual solvent in the appendix was then examined using extraction methods for GCMS and FTIR. If no residual solvent was detected, the viscosity of the portion was checked. If the appendix remained viscous, it was flood-cured under nitrogen in an LED-based floodlight (e.g., a PCU LED N2 floodlight, available from Dreve Group of Unna, Germany).

[0470] Example 10: Stress-strain analysis of representative samples

[0471] Figure 56 The stress-strain curves for accessory 1 of Example 9 are shown, and Figure 57The stress-strain curves for appendices 2 to 5 of Example 9 are shown.

[0472] Figure 56 and Figure 57 The stress-strain curves shown are generated by the following procedure: The appendage is placed between a pair of 25 mm diameter circular stainless steel compression plates (available from TA Instruments, 159 Lukens Drive, New Castle, Delaware 19720 USA) on an RSA-G2 solids analyzer. The plates are lowered at a rate of 0.1 mm per step until the initial axial force reaches between 0.03 N and 0.05 N. The plate is then equilibrated at 37°C for 120 seconds, followed by a compression test (lowering the plates at 10 mm / min for 14 seconds until a gap height of 0.7 mm or an overload force of approximately 17 N is reached, whichever occurs first, while recording the real-time compressive stress) to produce the stress-strain curve for each appendage. Therefore, the stress-strain curves are generated by compressing each appendage from its corresponding uncompressed height of 3 mm (within manufacturing tolerances) to its corresponding compressed height. Table 8 below provides the compressed height and strain of each appendage under applied stress. These measurements are based on actual manufacturing accessories (including any measurement errors of the measurement system, such as a deviation of 50 µm to the uncompressed height and / or manufacturing tolerances, such as a deviation of 100 µm to the uncompressed height).

[0473] Table 8. Measurements of compression height and strain for accessories 1 to 5

[0474]

[0475] like Figure 56 As shown, attachments are formed by cells based on non-stretcher elements, for example... Figures 8A to 8F The appendage 800 described herein indicates that: (i) the cell structure is sufficiently stable such that even with a wall thickness of approximately 0.2 mm, the structure can be successfully printed and post-processed as described above; (ii) the appendage undergoes extensive buckling deformation and achieves a stress plateau between approximately 0.1 strain (approximately 10% deformation) and approximately 0.73 strain (73% deformation); and (iii) the appendage has bistable properties, thus the cell structure is deformable and achieves a new stable form that does not change until an additional force is applied, potentially providing the surgeon with tactile feedback on the deformable state of the appendage.

[0476] like Figure 57 As shown, an appendage formed by strut-based strut cells, for example Figures 31A to 31D 3100, an accessory Figures 32A to 32D 3200, an accessory Figures 33A to 33EThe appendages 3300 and Figures 34A to 34E The appendages exhibit a stress "plateau" between 5 kPa and 20 kPa within a strain range of 10% to 60%. This result is at least in part based on the structural configuration of the cells. Specifically, each cell is designed such that the spacer struts (e.g., struts of the internal structure) fold inward without contacting each other during compression of the appendages. Thus, densification of the appendages (e.g., reaching a solid height) can be delayed (e.g., occurring at higher strains).

[0477] Example 11: Stress-strain analysis of representative samples

[0478] Six exemplary appendages were prepared in a manner similar to that described in Example 9, referred to herein as Sample 1, Sample 2, Sample 3, Sample 4, Sample 5, and Sample 6, except that the resin formulation for each of Samples 1 to 6 was: a trifunctional oligomer (methacrylate end groups) having a PCL middle block and a PLGA end block (85:15 L:G weight ratio); with a target molecular weight of 6,000 Daltons. Sample 1 was formed from cells of a repeating interconnected Schwarz-P structure, and Samples 2 to 5 were formed from corresponding repeating interconnected modified Schwarz-P structures, wherein the top and / or bottom of the initial Schwarz-P structure were trimmed. Therefore, the geometric properties of the repeating cells for each sample are different. A list of geometric cell properties for each appendage based on ideal / expected dimensions is provided in Table 9 below.

[0479] Table 9. Exemplary Cell Geometric Properties

[0480]

[0481] use Figures 9A to 9B Using cell 810 as a reference, the height extends in the x direction, the width extends in the y direction, and the length extends in the z direction.

[0482] The total height reflects the uncompressed (untrimmed) cell height of Sample 1 and the uncompressed but trimmed heights of Samples 2 through 6.

[0483] The stress-strain curves for samples 1 to 6 were generated in a manner similar to that described in Example 10, and... Figure 58These curves are shown in the figure. As shown, although each cell is formed from the same resin, each sample has a different stress-strain curve. Therefore, these different stress-strain curves illustrate the relationship between the geometric properties of the cell (e.g., height, width, length, and wall thickness) and the stress-strain response of the resulting appendage when compressed from the corresponding uncompressed height (listed as total height in Table 9 above) to the corresponding compressed height. Therefore, in addition to the constituent components of the cell, its various geometric properties need to be considered, and thus the geometry is customized to achieve an appendage with a desired stress-strain response (such as the stress-strain response described herein). The compressed height and strain of each sample under an applied stress of 90 kPa are provided in Table 10 below. These measurements are based on the actual manufactured appendage (including any measurement errors of the measurement system, e.g., a deviation of 50 µm to the uncompressed height and / or manufacturing tolerances, e.g., a deviation of 100 µm to the uncompressed height).

[0484] Table 10. Compression height and strain measurements of samples 1 to 6 at 90 kPa

[0485]

[0486] Examples 12-14: Preparation of three-arm MA-terminated polyester oligomers

[0487] Examples 12-14 describe the preparation of three-armed or star-shaped bioabsorbable polyester oligomers. Each arm is end-capped with methacrylate. Each arm has a molecular weight of 2 kDa and is a block copolymer of poly(L-lactic acid) (PLLA) and poly(caprolactone-rL-lactic acid) (PCLLA), wherein PCLLA is the core of the oligomer. PCLLA accounts for 70 wt% of the total molecular weight (MW), and the CL:L ratio is 60:40.

[0488] Table 11 below provides the molar ratios and masses of each reagent used to synthesize 1 kg batches of (PLLA-b-PCLLA)-3OH as discussed in Examples 12 and 13.

[0489] Table 11: Examples of molar ratios and masses for each reagent in Examples 12 and 13

[0490]

[0491] Example 12: Synthesis of PCLLA-3OH

[0492] The round-bottom flask was dried overnight in a drying oven and then cooled to room temperature under N2. Caprolactone, L-lactide, and stannous octanoate were added to the round-bottom flask. The contents of the reaction flask were heated to 130°C. Simultaneously, trimethylolpropane (TMP) was heated to 130°C. After preheating, TMP was added to the reaction flask as an initiator, and the reaction was allowed to proceed until the monomer conversion was complete. H2 was used as the initiator. 1NMR was used to monitor monomer conversion. Once complete monomer conversion was achieved, the reaction was stopped, and the reaction mixture was cooled to room temperature. (PCLLA)-3OH was precipitated from chloroform into cold MeOH to obtain a white solid. 1 NMR, DSC, FTIR, and THF GPC were used to characterize (PCLLA)-3OH.

[0493] Example 13: Synthesis of (PLLA-b-PCLLA)-3OH

[0494] The (PCLLA)-3OH and L-lactide prepared in Example 12 were added to a round-bottom flask under N2 and heated to 140°C to melt the reaction contents. After melting, the temperature was lowered to 120°C and stannous octoate was added. The reaction was continued with stirring, while H2 was added. 1 NMR and THF GPC were used to monitor monomer conversion. Once the reaction reached the desired molecular weight, the reaction mixture was cooled to room temperature, dissolved in chloroform, and precipitated three times in cold diethyl ether. The precipitate was dried under vacuum.

[0495] Example 14: Synthesis of (PLLA-b-PCLLA)-3MA

[0496] Table 12 below provides the molar ratios and masses of each reagent used to synthesize 1 kg batches of (PLLA-b-PCLLA)-3MA.

[0497] Table 12: Molar ratios and masses of each reagent for Example 14

[0498]

[0499] Under N2, (PLLA-b-PCLLA)-3OH prepared in Example 13 was dissolved in anhydrous DCM in a round-bottom flask. Triethylamine (TEA) and 400 ppm BHT were added to the reaction flask, and the flask was cooled to 0°C in an ice-water bath. The reaction flask was equipped with a pressure-equalizing feed funnel containing methacryloyl chloride. Once the reaction flask reached 0°C, methacryloyl chloride was added dropwise over 2 hours. The reaction was carried out at 0°C for 12 hours and then at room temperature for 24 hours. After the reaction was complete, the precipitate was removed by vacuum filtration. The filtrate was collected, and DCM was removed by rotary evaporation. The resulting viscous oil was dissolved in THF and precipitated in cold methanol. The precipitate was dissolved in DCM and washed with aqueous HCl (3%, twice), saturated sodium bicarbonate aqueous solution, and saturated sodium chloride aqueous solution, and then dried over magnesium sulfate. Magnesium sulfate was filtered through vacuum filtration, and the filtrate was collected. DCM was removed by rotary evaporation, the solid product was collected, and the product was dried over THF, GPC, and H2O. 1 The solid product was characterized by NMR, FTIR and DSC.

[0500] Example 15: Bifunctional oligomer resin formulation

[0501] The following components are mixed together in the following weight percentages (by weight of the resin) to provide an exemplary photopolymerizable resin for additive manufacturing:

[0502] (1) 58.82% of the bifunctional oligomers prepared in Examples 12 to 13 above;

[0503] (2) 39.22% propylene carbonate (PC) non-reactive diluent; and

[0504] (3) 1.96% Irgacure ® 819 photoinitiator.

[0505] The device disclosed herein may be designed for single-use disposal or for multiple-use applications. However, in either case, the device can be repaired and reused after at least one use. Repair may include any combination of steps such as disassembling the device, subsequently cleaning or replacing specific parts, and subsequent reassembly. Specifically, the device is detachable, and any number of specific parts or components of the device can be selectively replaced or removed in any combination. After cleaning and / or replacing specific parts, the device can be reassembled for subsequent use at a repair facility or by a surgical team just before surgery. Those skilled in the art will understand that various techniques can be used to disassemble, clean / replace, and reassemble the repair device. The use of such techniques and the resulting repair device are within the scope of this application.

[0506] Furthermore, in this disclosure, components with similar names in various embodiments generally have similar features; therefore, in specific embodiments, not every feature of every component with a similar name is necessarily fully described. Additionally, the extent to which linear or circular dimensions are used in the description of the disclosed systems, devices, and methods is not intended to limit the types of shapes that can be used in conjunction with such systems, devices, and methods. Those skilled in the art will recognize that equivalent dimensions of such linear and circular dimensions can be readily determined for any geometry. The size and shape of systems and devices and their components may depend at least on the anatomy of the patient in which the system and device will be used, the size and shape of the components with which the system and device will be used, and the method and procedure in which the system and device will be used.

[0507] It should be understood that the terms "proximal" and "distal" are used in this article in relation to the user who grips the instrument handle, such as a clinician. Other spatial terms such as "anterior" and "posterior" similarly correspond to distal and proximal, respectively. It should also be understood that, for convenience and clarity, spatial terms such as "vertical" and "horizontal" are used in the diagrams. However, surgical instruments are used in many orientations and positions, and these spatial terms are not restrictive or absolute.

[0508] In this document, a value or range may be expressed as “about” and / or from “about” one specific value to another specific value. When such a value or range is expressed, other disclosed embodiments include the listed specific value and / or from one specific value to another. Similarly, when a value is expressed as an approximation using the antecedent “about,” it should be understood that many values ​​are disclosed herein, and a specific value forms another embodiment. It should also be understood that many values ​​are disclosed herein, and each value is also disclosed herein as “about” that specific value in addition to the value itself. In embodiments, “about” can be used to indicate, for example, within 10% of the listed values, within 5% of the listed values, or within 2% of the listed values.

[0509] In order to describe and define the content of this teaching, it is noted that, unless otherwise specified, the term "substantially" is used herein to mean the inherent uncertainty that characterizes any quantitative comparison, value, measurement, or other representation. The term "substantially" may also be used herein to mean the extent to which a quantitative representation can be changed relative to a stated reference without altering the essential function of the subject matter of interest.

[0510] Based on the above embodiments, those skilled in the art will recognize further features and advantages of the present invention. Therefore, the present invention should not be limited to what has been specifically shown and described, unless indicated by the appended claims. All publications and references cited herein are expressly incorporated in full. Any patent, publication, or information incorporated herein in whole or in part by reference is incorporated only to the extent that the incorporated material does not conflict with any existing definitions, statements, or other disclosures set forth herein. Similarly, the disclosures expressly set forth in this application supersede any conflicting material incorporated herein by reference.

Claims

1. An accessory system for a surgical suture device, the system comprising: A first appendage, configured to be releasably held on a first staple cartridge, the first appendage being formed of a first plurality of repeatedly interconnected cells, such that the first appendage experiences strain within a first range when subjected to an applied stress in the range of 30 kPa to 90 kPa; as well as A second appendage, different from the first appendage and configured to be releasably retained on a second staple cartridge, the second appendage being formed of a second plurality of repeating interconnected cells, such that the second appendage experiences strain within a second range when subjected to applied stress in the range of 30 kPa to 90 kPa; Wherein at least a portion of the first range overlaps with the second range, and wherein the combined range of the first range and the second range is at least 0.1 to 0.

9. Wherein, at least one of the first plurality of repeatedly interconnected cells and the second plurality of repeatedly interconnected cells includes a structure based on a strutless structure.

2. The system according to claim 1, wherein, The combined range of the first range and the second range is at least 0.1 to 0.

7.

3. The system according to claim 1, wherein, The first plurality of interconnected cells are formed of a first material, and the second plurality of interconnected cells are formed of a second material different from the first material.

4. The system according to claim 1, wherein, Each cell in the first plurality of interconnected repeating cells has a first geometry, and each cell in the second plurality of interconnected repeating repeating cells has a second geometry different from the first geometry.

5. The system according to claim 1, wherein, At least one of the first plurality of repeatedly interconnected cells and the second plurality of repeatedly interconnected cells includes a triple periodic minimal surface structure.

6. The system according to claim 1, wherein, At least one of the first plurality of repeatedly interconnected cells and the second plurality of repeatedly interconnected cells includes a Schwarz-P structure.

7. The system according to claim 1, wherein, Each cell in the first plurality of interconnected repeating cells is a first Schwarz-P structure, and each cell in the second plurality of interconnected repeating repeating cells is a second Schwarz-P structure different from the first Schwarz-P structure.

8. The system according to claim 1, wherein, Each of the first plurality of repeatedly interconnected cells includes: A first top portion, the first top portion being formed by a first plurality of support bars, the first plurality of support bars defining a first plurality of openings. A first bottom portion, the first bottom portion being formed by a second plurality of support bars, the second plurality of support bars defining a second plurality of openings, and A first spacer bar connects the first top portion and the first bottom portion.

9. The system according to claim 8, wherein, The second plurality of interconnected cells include a Schwarz-P structure.

10. The system according to claim 1, wherein, The first appendage is formed of a first bioabsorbable polymer, and the second appendage is formed of a second bioabsorbable polymer.

11. The system according to claim 10, wherein, The first bioabsorbable polymer and the second bioabsorbable polymer each comprise polylactide (PLA), polycaprolactone (PCL), polyglycolic acid (PGL), polydioxanone (PDO), polytrimethylene carbonate (PTMC), polyethylene glycol (PEG), polyethylene diethanolate (PEDG), polypropylene fumarate (PPF), poly(ethoxyethylene diglycol), poly(ether ester) (PEE), poly(amino acid), copolymers thereof, or any combination thereof.

12. The system according to claim 10, wherein, At least one of the first bioabsorbable polymer and the second bioabsorbable polymer is formed from a photopolymer resin.

13. The system according to claim 12, wherein, The photopolymer resin comprises: (Meth)acrylate-terminated bioabsorbable polyester oligomers, which are present in an amount of 5% to 90% by weight of the resin. One or more non-reactive diluents, present in an amount from 1% to 70% by weight of the resin; and One or more photoinitiators are present in an amount of 0.1% to 4% by weight of the resin.

14. The system according to claim 13, wherein, The photopolymer resin also includes one or more reactive diluents present in an amount ranging from 1% to 50% by weight of the resin.

15. The system according to claim 13, wherein, The photopolymer resin also includes one or more fillers present in an amount ranging from 1% to 50% by weight of the resin.

16. The system according to claim 13, wherein, The photopolymer resin also includes one or more additional crosslinking agents present in an amount of 1% to 10% by weight of the resin.

17. The system according to claim 1, wherein, The first appendage and the second appendage each have an average length of 20 mm to 100 mm.

18. The system according to claim 1, wherein, The first appendage and the second appendage each have an average width of 5 mm to 10 mm.

19. The system according to claim 1, wherein, The first appendage and the second appendage each have an average thickness of 1 mm to 8 mm.

20. The system according to claim 1, wherein, At least one of the first and second appendages includes a fragile label formed during its manufacture, the label having a unique identifier.

Images