Methods of applying buttress to end effectors of surgical staplers

Abstract

A method for applying an adjunct element to a surgical stapler end effector having a first stapling surface and a second stapling surface using an applicator device is provided. The method includes providing the end effector in an open state in which the first stapling surface and the second stapling surface are spaced apart. With the end effector in the open state, at least a portion of the applicator device is positioned between the first stapling surface and the second stapling surface. Without engaging a closure system input feature of the surgical stapler, a portion of the end effector is compressively engaged by the applicator device, thereby securing the adjunct element to one of the first stapling surface or the second stapling surface. The applicator device and the end effector are withdrawn relatively away from each other such that the adjunct element remains attached to one of the first stapling surface or the second stapling surface of the end effector.

Description

Background Technology

[0001] In some surgical settings, endoscopic surgical instruments may be superior to traditional open surgical devices in creating smaller incisions within the patient, which can reduce postoperative recovery time and complications. Some endoscopic surgical instruments are adapted to place distal end-effectors at desired surgical sites via cannulation of a trocar. These distal end-effectors (e.g., internal cutters, grippers, scalpels, suture devices, clamps, entry devices, drug / gene therapy delivery devices, and energy delivery devices using ultrasound, RF, lasers, etc.) can engage tissue in various ways to achieve diagnostic or therapeutic effects. Endoscopic surgical instruments may include an axis located between the end-effector and a handle portion manipulated by the clinician. This axis allows insertion to the desired depth and rotation about the longitudinal axis of the axis, thereby facilitating the positioning of the end-effector within the patient. Positioning of the end-effector can be further facilitated by including one or more articulation joints or features that allow the end-effector to selectively articulate or otherwise deflect relative to the longitudinal axis of the axis.

[0002] Examples of endoscopic surgical instruments include surgical staplers. Some of these staplers are operable to clamp tissue layers, cut through the clamped tissue layers, and drive staples through the tissue layers to substantially seal the cut tissue layers together near the cut ends. Exemplary surgical staplers are disclosed only in U.S. Patent No. 7,380,696, published June 3, 2008, entitled “Articulating Surgical Stapling Instrument Incorporating a Two-Piece E-BeamFiring Mechanism”; U.S. Patent No. 8,408,439, published April 2, 2013, entitled “Surgical Stapling Instrument with An Articulatable End Effector”; and U.S. Patent No. 8,453,914, published June 4, 2013, entitled “Motor-Driven Surgical Cutting Instrument with Electric Actuator Directional Control Assembly”. The disclosure of each of the above-cited U.S. patents and U.S. patent publications is incorporated herein by reference.

[0003] Surgical staplers can also be used in open abdominal surgeries and / or other non-endoscopic procedures. By way of example only, in thoracic surgery, a surgical stapler can be inserted via a thoracotomy and thus positioned between the patient's ribs to reach one or more organs, in which a trocar is not used as the catheter for the stapler. For example, blood vessels leading to an organ can be severed and closed using a stapler before it is removed from the thoracic cavity. Of course, surgical staplers can be used in a variety of other situations and procedures.

[0004] Although various surgical suturing instruments and associated components have been manufactured and used, it is believed that no one had manufactured or used the invention described in the appended claims prior to the inventors. Attached Figure Description

[0005] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the invention and, together with the general description of the invention given above and the detailed description of the embodiments given below, serve to explain the principles of the invention.

[0006] Figure 1 A perspective view of an exemplary surgical suturing instrument is shown; Figure 2 It shows Figure 1 A side front view of the instrument; Figure 3 It shows that it is in the open state. Figure 1 A perspective view of the end effector of the instrument; Figure 4A It shows Figure 3 end effector along Figure 3 The side section view taken from line 4-4, with the firing beam in a near-side position; Figure 4B It shows Figure 3 end effector along Figure 3 The side section view taken from line 4-4, with the firing beam in the far side position; Figure 5 It shows Figure 3 end effector along Figure 3 The end cross-sectional view taken from line 5-5; Figure 6 It shows Figure 3 Exploded perspective view of the end effector; Figure 7 It shows Figure 3 A perspective view of an end effector located at the tissue and already actuated once within the tissue; Figure 8 A perspective view of an exemplary pair of support components is shown, wherein each support component can be applied to Figure 3 The jaws of the end effector; Figure 9A It shows Figure 3 A cross-sectional end view of a portion of the end effector, wherein Figure 8 The support assembly is applied to the upper and lower jaws of the end effector, showing the end effector jaws in the open state, with tissue positioned between the upper and lower jaws; Figure 9B It shows Figure 9A A cross-sectional end view of the end effector and support assembly, showing the end effector jaws in a tissue-closed state; Figure 9C The formed nail and the nail that has been passed are shown. Figure 3 The end effector is fixed to the tissue afterward. Figure 9A A cross-sectional view of the support assembly; Figure 10 The formed nail and the nail that has been passed are shown. Figure 3 The end effector is fixed to the tissue afterward. Figure 9A A perspective view of the support components; Figure 11 It shows that it can be used for carrying and application Figure 8 A perspective view of an exemplary accessory application device for a support assembly; Figure 12 It shows Figure 11 Top plan view of the auxiliary application device; Figure 13A It shows Figure 3 end effector and Figure 11 A perspective view of the auxiliary application device, showing the end effector and the auxiliary application device aligned with each other; Figure 13B It shows Figure 3 end effector and Figure 11 A perspective view of the auxiliary application device, in which the end effector jaws are closed on the platform of the auxiliary application device; Figure 14 A perspective view of another exemplary auxiliary application device is shown, which is in a folded configuration and connected to the base; Figure 15 The slot is shown in a folded configuration and positioned relative to the base. Figure 14 A perspective view of the auxiliary application device; Figure 16 It shows an unfolded configuration Figure 14 A plan view of the auxiliary application device; Figure 17A It shows Figure 3 A perspective view of the jaws of an end effector, the jaws being in the open and engaged position. Figure 14The auxiliary application device is in a first folded configuration that defines a first angle; Figure 17B It shows Figure 3 A perspective view of the jaws of an end effector, the jaws being in the open and engaged position. Figure 14 The auxiliary application device, while the auxiliary application device is in a second folded configuration defining a second angle, shows the auxiliary application device connected to the base via a pair of slots; Figure 18 A plan view of another exemplary auxiliary application device in an unfolded configuration is shown; Figure 19 The first fold configuration at a defined first angle is shown. Figure 18 A perspective view of the auxiliary application device; Figure 20 This shows a pair of slots positioned in the first fold configuration and relative to the base. Figure 18 A perspective view of the auxiliary application device; Figure 21 The second fold configuration at the defined second angle is shown. Figure 18 A perspective view of the auxiliary application device, showing the auxiliary application device connected to the base via a pair of slots; Figure 22 A side sectional view of another exemplary auxiliary application device is shown, illustrating the auxiliary application device in a non-expanded storage configuration; Figure 23 It shows Figure 3 A side sectional view of the end effector, which is engaged. Figure 22 The auxiliary application device is in a first expanded angle configuration; Figure 24 It shows Figure 3 A side sectional view of the end effector, which is engaged. Figure 22 The auxiliary application device is in a second expanded angular configuration; Figure 25 A perspective view of another exemplary auxiliary application device is shown, which illustrates the wedge-shaped portion of the auxiliary application device in a first longitudinal position; Figure 26A It shows along Figure 25 The line 26A-26A cut Figure 25 A side sectional view of the auxiliary application device, showing the engagement. Figure 3 The wedge-shaped portion of the auxiliary application device of the end actuator in the proximal position (shown in dashed lines); Figure 26B It shows Figure 25 A side sectional view of the auxiliary application device, showing the engagement. Figure 3 The wedge-shaped portion of the auxiliary application device of the end effector in the distal position (shown in dashed lines); Figure 27A Another exemplary auxiliary application device is shown, and the application is made to the auxiliary application device. Figure 8 support components and Figure 3 A side sectional view of the end effector, showing the auxiliary application device in a non-expanded state; Figure 27B It shows Figure 27A Auxiliary application device, Figure 8 support components and Figure 3 A side sectional view of the end effector, wherein the auxiliary application device is in an expanded state to secure the support assembly to the end effector; Figure 28A Another exemplary auxiliary application device is shown, and the application is made to the auxiliary application device. Figure 8 support components and Figure 3 A side sectional view of the end effector, showing the auxiliary application device in a non-expanded state; Figure 28B It shows Figure 28A Auxiliary application device, Figure 8 support components and Figure 3 A side sectional view of the end effector, wherein the auxiliary application device is in an expanded state to secure the support assembly to the end effector; Figure 29A A partial side sectional view of another exemplary accessory application device is shown, in which Figure 8 The support assembly is applied to the auxiliary application device, which is shown in a non-expanded state. Figure 29B It shows Figure 29A Auxiliary application device, Figure 8 support components and Figure 3 A side sectional view of the end effector, wherein the air pump is connected to the auxiliary application device and is in the first state; Figure 29C It shows Figure 29A Auxiliary application device, Figure 8 support components and Figure 3 A partial side sectional view of the end effector, wherein the air pump is connected to the auxiliary application device and is in a second state, thereby causing the auxiliary application device to expand to secure the support assembly to the end effector; Figure 30 A partial side sectional view of another exemplary accessory application device is shown, in which Figure 8 The support assembly is applied to the auxiliary application device and therein Figure 3The end effector is positioned for applying the support assembly, wherein the fluid injector is coupled to the auxiliary application device, which is shown in a non-expanded state. Figure 31A A partial side sectional view of another exemplary accessory application device is shown, in which Figure 8 The support assembly is applied to the auxiliary application device, which is shown in a non-expanded state. Figure 31B It shows Figure 31A Auxiliary application device, Figure 8 support components and Figure 3 A partial side sectional view of the end effector, wherein the compressed air injector is connected to the auxiliary application device and the compressed air is in a first state, wherein the auxiliary application device is in a non-expanded state; Figure 31C It shows Figure 31A Auxiliary application device, Figure 8 support components and Figure 3 A partial side sectional view of the end effector, wherein a compressed air injector is connected to an auxiliary application device and the compressed air is in a second state, thereby causing the auxiliary application device to expand to secure the support assembly to the end effector; Figure 32A A side view of another exemplary accessory application device is shown, in which Figure 8 The support assembly is applied to the auxiliary application device and the auxiliary application device is in a first non-expanded state; Figure 32B It shows Figure 32A A side front view of the auxiliary application device, wherein the auxiliary application device is in a second expanded state, thereby securing the support assembly to the end actuator; Figure 33A A partial side sectional view of another exemplary accessory application device is shown, in which Figure 8 The support assembly is applied to the coating pad of the auxiliary application device, wherein the auxiliary application device is in a first non-expanded state; Figure 33B It shows Figure 33A Auxiliary application device, Figure 8 support components and Figure 3 A partial side sectional view of the end effector, wherein the coating pad is in a first non-expanded state; Figure 33C It shows Figure 33A Auxiliary application device, Figure 8 support components and Figure 3 A partial side sectional view of the end effector, wherein the coating pad is in a second expanded state, thereby securing the support assembly to the end effector; Figure 34A A perspective view of another exemplary auxiliary application device is shown, which is in a first non-expanded state; Figure 34B It shows Figure 34A A perspective view of the auxiliary application device in the second expanded state; Figure 35A It shows along Figure 34A The line cut at 35A-35A Figure 34A A partial side sectional view of the auxiliary application device, wherein Figure 8 The support assembly is applied to the auxiliary application device, which is in a first non-expanded state; Figure 35B It shows along Figure 34B The line cut from 35B-35B Figure 34A A partial side sectional view of the auxiliary application device, wherein Figure 8 The support assembly is applied to the auxiliary application device, which is in a second expanded state, thereby securing the support assembly to the end effector; Figure 36A A partial side sectional view of another exemplary accessory application device is shown, in which Figure 8 The support assembly is applied to the auxiliary application device, which is in a first non-expanded state; Figure 36B It shows Figure 36A A partial side sectional view of the auxiliary application device, wherein Figure 8 The support assembly is applied to the auxiliary application device, which is in a second expanded state, thereby securing the support assembly to the end effector; Figure 37A A perspective view of another exemplary auxiliary application device is shown, which is in a first non-expanded state; Figure 37B It shows Figure 37A A perspective view of the auxiliary application device in a second expanded state, thereby securing the support assembly to the end effector; Figure 38A It shows along Figure 37A The line cut from 38A-38A Figure 37A A top sectional view of the auxiliary application device in a first non-expanded state; Figure 38B It shows along Figure 37A The line cut from 38A-38A Figure 37A Another top sectional view of the auxiliary application device in a second expanded state, thereby securing the support assembly to the end effector; Figure 39A A perspective view of another exemplary auxiliary application device is shown, which is in a first non-expanded state; Figure 39B It shows Figure 39A A perspective view of the auxiliary application device in a second expanded state, thereby securing the support assembly to the end effector; Figure 40A It shows along Figure 39A The line cut from 40A-40A Figure 39A A partial cross-sectional view of the auxiliary application device in a first non-expanded state; Figure 40B It shows along Figure 39B The line cut from 40B-40B Figure 39A Another partial cross-sectional view of the auxiliary application device in a second expanded state, thereby securing the support assembly to the end effector; Figure 41A A side sectional view of another exemplary auxiliary application device is shown, in which Figure 8 The support assembly is applied to the auxiliary application device, which is in a first non-expanded state; Figure 41B It shows Figure 41A The auxiliary application device and Figure 3 A side sectional view of the end effector, wherein Figure 8 The support assembly is applied to the auxiliary application device, which is in a second expanded state, thereby securing the support assembly to the end effector.

[0007] Figure 42 A perspective view of another exemplary accessory application device is shown; Figure 43A Show Figure 42 Auxiliary application device, Figure 8 support components and Figure 3 A cross-sectional view of an end effector, wherein an auxiliary application device secures the applied support assembly to the distal portion of the upper jaw of the end effector; Figure 43B It shows Figure 43A A cross-sectional view of the auxiliary application device, support assembly, and end effector, wherein the auxiliary application device secures the applied support assembly to the proximal portion of the upper jaw; Figure 43C It shows Figure 43B A cross-sectional view of the end effector, wherein the support assembly is fixed to the upper jaw of the end effector and Figure 8 The second support assembly is fixed to the lower jaw of the end effector; Figure 44 A perspective view of another exemplary auxiliary application device is shown, in which selected internal components are schematically shown in dashed lines; Figure 45A It shows Figure 44 The auxiliary application device and Figure 3 A cross-sectional view of the end effector, wherein the auxiliary application device applies and secures the continuous support assembly from the material dispenser to the proximal portion of the upper jaw of the end effector; Figure 45B It shows Figure 45A A cross-sectional view of the auxiliary application device and end effector, wherein the auxiliary application device applies the continuous support assembly from the material dispenser and secures it to the distal portion of the upper jaw; Figure 46 A perspective view of another exemplary accessory application device is shown; Figure 47A It shows Figure 46 Auxiliary application device, Figure 8 support components and Figure 3 A cross-sectional view of the end effector, wherein the arm of the auxiliary application device pivots toward the upper jaw; Figure 47B It shows Figure 47A A cross-sectional view of the auxiliary application device, support assembly, and end effector, wherein the lateral weak portion of the arm is disconnected to release the support assembly from the auxiliary application device and to apply and secure the support assembly to the upper jaw. Figure 47C It shows Figure 47A A cross-sectional view of the auxiliary application device, support assembly, and end effector, wherein the support assembly is fixed to the upper jaw and the auxiliary application device is removed from the upper jaw; Figure 48 Another exemplary accessory application device is shown. Figure 8 support components and Figure 3 A cross-sectional view of the end effector, wherein the arm of the auxiliary application device pivots toward the lower jaw of the end effector; Figure 49 A perspective view of another exemplary accessory application device is shown; Figure 50A It shows Figure 49 Auxiliary application device, Figure 8 support components and Figure 3 A cross-sectional view of the end effector, wherein the auxiliary application device moves proximally along the upper jaw of the end effector; Figure 50B It shows Figure 50A A cross-sectional view of the auxiliary application device, support assembly, and end effector, wherein the auxiliary application device rotates via a tab to apply and secure the support assembly to the upper jaw; Figure 51 A perspective view of another exemplary accessory application device is shown; Figure 52A It shows Figure 51 Auxiliary application device, Figure 8 support components and Figure 3 A cross-sectional view of an end effector, wherein the auxiliary application device and support assembly move proximally along the upper jaw of the end effector; Figure 52B It shows Figure 52A A cross-sectional view of the auxiliary application device, support assembly, and end effector, wherein the arm of the auxiliary application device rotates to apply and secure the support assembly to the upper jaw; Figure 53 An exemplary method for applying the support assembly is shown.

[0008] Figure 54 It shows Figure 3 End effectors and can be used for carrying and applying Figure 8 Another exemplary auxiliary application device of the support assembly is shown in a perspective view, which shows the support application device positioned above the end effector, with the translational sleeve of the auxiliary application device in a retracted position; Figure 55A It shows the location at Figure 3 Above the end effector Figure 54 A side sectional view of the auxiliary application device, showing the translational sleeve of the auxiliary application device in the retracted position; Figure 55B It shows the location at Figure 3 Above the end effector Figure 54 A side sectional view of the auxiliary application device, showing the translational sleeve of the auxiliary application device in an extended position for changing the end effector toward a closed state; Figure 56 It shows that it can be used for carrying and application Figure 8 A perspective view of another exemplary accessory application device for the support assembly; Figure 57A It shows Figure 56 The auxiliary application device and Figure 3 A side sectional view of the end effector, showing the application device aligned axially with the end effector; Figure 57B It shows the location at Figure 3 Above the end effector Figure 56 A side sectional view of the auxiliary application device, showing the auxiliary application device advancing proximally on the end effector to change the end effector toward a closed state; Figure 58It shows the positions that can be used for carrying and applying. Figure 3 Above the end effector Figure 8 Another exemplary auxiliary application device of the support assembly is shown in a side sectional view, which shows the rotatable sleeve of the auxiliary application device in a first angle (e.g., "untimed") position; Figure 59A It shows the location at Figure 3 Above the end effector Figure 58 The auxiliary application device along Figure 58 The end section view taken by section line 59-59 shows the rotatable sleeve of the auxiliary application device in the first angular position; Figure 59B It shows the location at Figure 3 Above the end effector Figure 58 The auxiliary application device along Figure 58 Another end section view taken by section line 59-59 shows the rotatable sleeve of the auxiliary application device in a second angle (e.g., "timing") position for turning the end actuator toward a closed state; Figure 60 It shows that it can be used for carrying and application Figure 8 A perspective view of another exemplary accessory application device for the support assembly; Figure 61A It shows the location at Figure 3 Above the end effector Figure 60 A side sectional view of the auxiliary application device, showing the pivotable lever arm of the auxiliary application device in the open position; Figure 61B It shows the location at Figure 3 Above the end effector Figure 60 A side sectional view of the auxiliary application device, showing the pivotable lever arm of the auxiliary application device in the closed position for changing the end actuator toward the closed state; Figure 62A It shows the positions that can be used for carrying and application. Figure 3 Above the end effector Figure 8 Another exemplary auxiliary application device of the support assembly is shown in a side sectional view, which shows the pivotable lever arm of the auxiliary application device in the unacted position; Figure 62B It shows the location at Figure 3 Above the end effector Figure 62A A side sectional view of the auxiliary application device, showing the pivotable lever arm of the auxiliary application device in the actuated position for changing the end effector toward the closed state.

[0009] Figure 63 The bearing is shown Figure 8A schematic side sectional view of another exemplary accessory application device for the support assembly; Figure 64 It shows Figure 63 A schematic diagram of an auxiliary application device, showing components configured to detect... Figure 3 Various electrical components of the electrical switch for the organization stop of the end actuator; Figure 65A It shows the location at Figure 63 Above the auxiliary application device Figure 3 A side sectional view of the end effector, showing the expandable platform of the auxiliary application device in a collapsed state; Figure 65B It shows the location at Figure 63 Above the auxiliary application device Figure 3 A side sectional view of the end effector, showing an expandable platform of the auxiliary application device in a deployed state for applying the support assembly to the jaws of the end effector in response to an electrical switch of the tissue stop of the end effector contacting the auxiliary application device. Figure 66A The bearing is shown Figure 8 One of the support components and positioned in Figure 3 A side sectional view of another exemplary auxiliary application device above the lower jaw of the end effector, showing the movable platform of the auxiliary application device in a retracted state; Figure 66B It shows the location at Figure 3 The end effector above the lower jaw Figure 66A A side sectional view of the auxiliary application device, showing a movable platform of the auxiliary application device in a deployed state for applying the support assembly to the lower jaw of the end effector in response to contact of the distal tip of the lower jaw with a translational slider of the auxiliary application device; Figure 67A It shows that it can be used for carrying and application Figure 8 Another exemplary auxiliary application device of the support assembly is shown in a top cross-sectional view, wherein the auxiliary application device is in a locked configuration; Figure 67B It shows Figure 67A Another top cross-sectional view of the auxiliary application device, showing the auxiliary application device in the unlocked configuration; Figure 68A It shows Figure 67A A partial sectional view of the side of the auxiliary application device, wherein Figure 3 The end effector is inserted into the auxiliary application device; Figure 68B It shows Figure 67A Another partial cross-sectional view of the auxiliary application device, in which Figure 3 The end effector is fully inserted into the auxiliary application device, and the platform of the auxiliary application device is in an expanded configuration; Figure 69 It shows that it can be used for carrying and application Figure 8 A side cross-sectional view of another exemplary accessory application device for the support assembly; Figure 70A It shows Figure 69 A top-detail plan view of the auxiliary application device, in which the end effector is inserted into the auxiliary application device and selected parts are omitted from the view; Figure 70B It shows Figure 69 Another detailed plan view of the auxiliary application device, in which Figure 70A The end effector is fully inserted into the auxiliary application device and the selected component is omitted from the view; Figure 71 It shows Figure 69 Another side cross-sectional view of the auxiliary application device, in which the platform of the auxiliary application device is in an expanded configuration; Figure 72A It shows that it can be used for carrying and application Figure 8 Another exemplary auxiliary application device of the support assembly is shown in a partial sectional view of the side, which shows the end actuator being inserted into the auxiliary application device; Figure 72B It shows Figure 72A Another partial cross-sectional view of the auxiliary application device on one side, which shows Figure 72A The end effector is fully inserted into the auxiliary application device; Figure 73A It shows Figure 72A A schematic diagram of the interior of the auxiliary application device and the switch in an open-circuit configuration; Figure 73B It shows Figure 72A Another schematic diagram of the interior of the auxiliary application device shows a switch in a closed-loop configuration; Figure 74A It shows that it can be used for carrying and application Figure 8 Another exemplary auxiliary application device of the support assembly is shown in a partial sectional view of the side, which shows the end actuator being inserted into the auxiliary application device; Figure 74B It shows Figure 74A Another partial cross-sectional view of the auxiliary application device on one side, which shows Figure 74A The end effector is fully inserted into the auxiliary application device; Figure 75 They are shown respectively Figure 74A The auxiliary application device and Figure 74ADetailed perspective view of the power input and power output of the end effector; Figure 76 It shows that it can be used for carrying and application Figure 8 Another exemplary perspective view of the auxiliary application device of the support assembly, showing the auxiliary application device positioned to... Figure 3 On the pin cartridge of the end effector; Figure 77A It shows Figure 76 The auxiliary application device and staple cartridge and Figure 3 A side sectional view of the end effector, showing the auxiliary application device and staple cartridge inserted into the lower jaw of the end effector; Figure 77B It shows Figure 76 The auxiliary application device and staple cartridge and Figure 3 Another side sectional view of the end effector shows the auxiliary application device and the staple cartridge fully inserted into the lower jaw of the end effector and the platform of the auxiliary application device in an expanded configuration; Figure 77C It shows in Figure 76 The auxiliary application device has been removed from the end effector. Figure 3 A side sectional view of the end effector; Figure 78 It shows that it can be used for carrying and application Figure 8 A partial side cross-sectional view of another exemplary accessory application device for the support assembly; Figure 79A It shows Figure 76 Another side sectional view of the auxiliary application device and staple cartridge, showing the auxiliary application device and staple cartridge inserted into... Figure 3 In the end effector, the pad is positioned on the auxiliary application device; and Figure 79B It shows Figure 76 Another side sectional view of the auxiliary application device and staple cartridge, showing the auxiliary application device fully inserted into... Figure 3 In the end effector and Figure 79A The liner engages with the end effector.

[0010] The accompanying drawings are not intended to be limiting in any way, and various embodiments of the invention can be conceived to be implemented in many other ways, including those not necessarily shown in the drawings. The drawings, which are incorporated in and constitute a part of this specification, illustrate several aspects of the invention and, together with the description, serve to explain the principles of the invention; however, it should be understood that the invention is not limited to the explicit arrangements shown. Detailed Implementation

[0011] The following description of certain examples of the present technology is not intended to limit the scope of the present technology. Other examples, features, aspects, embodiments, and advantages of the present technology will become apparent to those skilled in the art from the following description, which is given by way of example, representing one of the best ways contemplated for implementing the present technology. As will be appreciated, the technology described herein can have other different and obvious aspects, all of which are not departing from the present technology. Therefore, the accompanying drawings and descriptions should be considered substantially illustrative rather than restrictive.

[0012] Furthermore, it should be understood that any one or more of the teachings, expressions, embodiments, examples, etc., described herein may be combined with any one or more of the other teachings, expressions, embodiments, examples, etc., described herein. Therefore, the following teachings, expressions, embodiments, examples, etc., should not be considered in isolation from each other. Various suitable ways in which the teachings herein can be combined will be apparent to those skilled in the art. Such modifications and variations are intended to be included within the scope of the claims.

[0013] For clarity of disclosure, the terms "proximal" and "distal" are defined herein with respect to a human or robotic operator of the surgical instrument. The term "proximal" refers to the element location of the surgical end effector that is closer to the human or robotic operator of the surgical instrument and further away from the surgical instrument. The term "distal" refers to the element location of the surgical end effector that is closer to the surgical instrument and further away from the human or robotic operator of the surgical instrument. Furthermore, the terms "upper," "lower," "lateral," "transverse," "bottom," and "top" are relative terms to provide additional clarity to the figures provided below. Therefore, the terms "upper," "lower," "lateral," "transverse," "bottom," and "top" are not intended to unnecessarily limit the invention described herein.

[0014] I. Exemplary Surgical Stapler Figures 1 to 7 An exemplary surgical suturing and cutting instrument (10) is shown, sized to be inserted through a trocar cannula or incision (e.g., thoracotomy, etc.) into a patient's surgical site to perform surgery. The instrument (10) of this example includes a shank portion (20) connected to a shaft (22) that terminates distally in an articulation joint (11), which is further coupled to an end effector (12). Once the articulation joint (11) and the end effector (12) are inserted through the cannula's insertion channel, the articulation joint (11) can be remotely articulated via articulation controls (13), such as... Figure 1The end effector (12) is depicted as a virtual image, such that the end effector (12) can be deflected from the longitudinal axis (LA) of the shaft (22) at a desired angle (α). The end effector (12) of this example includes a lower jaw (16) and an upper jaw in the form of a pivotable anvil (18), the lower jaw including a staple cartridge (37).

[0015] The handle portion (20) includes a pistol grip (24) and a closing trigger (26). The closing trigger (26) is pivotable toward the pistol grip (24) so ​​that the anvil (18) clamps or closes toward the lower jaws (16) of the end effector (12). Such closure of the anvil (18) is provided by a closing tube (32) and a closing ring (33), both of which translate longitudinally relative to the handle portion (20) in response to the pivoting of the closing trigger (26) relative to the pistol grip (24). The closing tube (32) extends along the length of the shaft (22); and the closing ring (33) is positioned distal to the articulated joint (11). The articulated joint (11) is operable to transfer / transmit longitudinal motion from the closing tube (32) to the closing ring (33).

[0016] like Figure 2 As shown, the handle portion (20) also includes a firing trigger (28). An elongated member (not shown) extends longitudinally through the shaft (22) and, in response to actuation of the firing trigger (28), transmits longitudinal firing motion from the handle portion (20) to the firing beam (14). This distal translation of the firing beam (14) causes the tissue clamped in the end effector (12) to be sutured and cut, as will be described in more detail below.

[0017] like Figures 3 to 6 As shown, the end effector (12) employs a firing beam (14) comprising a laterally oriented upper pin (38), a firing beam top cap (44), a laterally oriented middle pin (46), and a distal cutting edge (48). The upper pin (38) is positioned within a longitudinal anvil slot (42) of the anvil (18) and is translatable within this longitudinal anvil slot. The firing beam top cap (44) extends the firing beam (14) through a lower jaw slot (45). Figure 4B (As shown) The lower surface of the lower jaw (16) is slidably engaged, and the lower jaw groove (45) is formed through the lower jaw (16). The central pin (46) slidably engages the top surface of the lower jaw (16), thereby cooperating with the firing beam top cover (44).

[0018] Figure 3 This example illustrates the proximal-positioned firing beam (14) and the anvil (18) pivoting to an open configuration, allowing the unexploded cartridge (37) to be removably inserted into the channel of the lower jaws (16). Figures 5 to 6As best seen in this example, the staple cartridge (37) includes a cartridge body (70) that presents an upper deck (72) and is coupled to a lower cartridge tray (74). Figure 3 As best seen, a vertical slot (49) extends longitudinally through a portion of the staple cartridge body (70). Similarly... Figure 3 As best seen, three rows of nail holes (51) are formed through the upper deck (72) on each transverse side of the vertical slot (49). Figures 4A to 6 As shown, a wedge-shaped slider (41) and multiple nail actuators (43) are held between the cartridge (70) and the tray (74), wherein the wedge-shaped slider (41) is positioned close to the nail actuators (43). The wedge-shaped slider (41) is capable of longitudinal movement within the nail cartridge (37); while the nail actuators (43) are capable of vertical movement within the nail cartridge (37). The nails (47) are also positioned within the cartridge (70), above the corresponding nail actuators (43). Each nail (47) is vertically driven within the cartridge (70) by the nail actuator (43) to drive the nail (47) outward through the associated nail hole (51). Figures 4A to 4B and Figure 6 As is best seen, the wedge slider (41) has an inclined cam surface that pushes the nail driver (43) upward as the wedge slider (41) is driven toward the distal end through the nail cartridge (37).

[0019] By advancing the closed tube (32) and closed ring (33) to the distal end of the actuator (12) as... Figures 4A to 4B In the closed configuration shown, by engaging the upper pin (38) into the longitudinal anvil slot (42), the firing beam (14) is pushed distally until it engages with the anvil (18). Push block (80) Figure 5 Located at the distal end of the firing beam (14), when the firing trigger (28) is actuated, the wedge-shaped slider (41) is pushed distally as the firing beam (14) advances distally through the staple cartridge (37). During this firing, the cutting edge (48) of the firing beam (14) enters the vertical slot (49) of the staple cartridge (37), thereby severing the tissue clamped between the staple cartridge (37) and the anvil (18). Figures 4A to 4B As shown, the intermediate pin (46) and the pusher (80) actuate the nail cartridge (37) together by entering the slot (49) within the nail cartridge (37), thereby driving the wedge-shaped slider (41) into an upward-pushing contact with the nail actuator (43), which in turn drives the nail (47) outward through the nail hole (51) and causes the nail to contact the nail forming recess (53) on the inner surface of the anvil (18). Figure 3 (As shown in the diagram) to form a contact. Figure 4B The firing beam (14) is shown after the tissue has been cut and sutured, and then completely translated distally. From Figures 4A to 4BThe nail-shaped recess (53) is intentionally omitted in the view, but... Figure 3 As shown in [the image]. Figure 5 The anvil is intentionally omitted in the view (18).

[0020] Figure 7 An end effector (12) is shown, actuated through tissue (90) by a single firing stroke. Cutting blade (48) Figure 7 The tissue (90) has been cut through (the obscured area), and the staple driver (43) has driven three rows of alternating staples (47) through the tissue (90) on each side of the cut line created by the cutting edge (48). After the first firing stroke is completed, the end effector (12) is withdrawn from the patient and the empty staple cartridge (37) is replaced with a new staple cartridge (37). The end effector (12) is then reinserted into the patient to reach the suture site for further cutting and suturing. This process can be repeated until the desired number and pattern of firing strokes across the tissue (90) have been completed.

[0021] The device (10) may be further constructed and operated based on any of the teachings of the following references, the disclosures of which are incorporated herein by reference: U.S. Patent No. 8,210,411, entitled “Motor-Driven Surgical Instrument,” published July 3, 2012; U.S. Patent No. 9,186,142, entitled “Surgical Instrument End Effector Articulation Drive with Pinion and Opposing Racks,” published November 17, 2015; U.S. Patent No. 9,517,065, entitled “Integrated Tissue Positioning and Jaw Alignment Features for Surgical Stapler,” published December 13, 2016; U.S. Patent No. 9,622,746, entitled “Distal Tip Features for End Effector of Surgical Instrument,” published April 18, 2017; and U.S. Patent No. 9,622,746, entitled “Lockout Feature for Movable Cutting Member of…”, published August 1, 2017. U.S. Patent No. 9,717,497, entitled “Surgical Instrument”; U.S. Patent No. 9,795,379, entitled “Surgical Instrument with Multi-Diameter Shaft”, published on October 24, 2017; U.S. Patent No. 9,808,248, entitled “Installation Features for Surgical Instrument End Effector Cartridge”, published on November 7, 2017; U.S. Patent No. 9,839,421, entitled “Jaw Closure Feature for End Effector of Surgical Instrument”, published on December 12, 2017; and / or U.S. Patent No. 10,092,292, entitled “Staple Forming Features for Surgical Stapling Instrument”, published on October 9, 2018.

[0022] II. Exemplary support assembly and application device In some cases, it may be desirable to equip the end effector (12) of the surgical stapler (10) with an adjunct material (such as a support) to reinforce the tissue mechanical fastening provided by the staples (47). This support prevents the applied staples (47) from being pulled through the tissue and may otherwise reduce the risk of tissue tearing at or near the site of the applied staples (47). In addition to providing structural support and integrity for a row of staples (47) or as an alternative, the support may provide a variety of other effects, such as gap or interstitial filling, administration of therapeutic agents, and / or other effects. In some cases, the support may be located on the upper deck (72) of the staple cartridge (37). As described above, the deck (72) houses the staples (47) driven by the staple actuator (43). In some other cases, the support may be located on the surface of the anvil (18) facing the staple cartridge (37). It should also be understood that a first support may be located on the deck (72) of the staple cartridge (37), while a second support may be located on the anvil (18) of the same end effector (12).

[0023] Various examples of the forms in which the support may take will be described in more detail below. Various ways in which the support may be secured to the staple cartridge (37) or the anvil (18) will also be described in more detail below. Exemplary support assemblies, exemplary materials and techniques for applying the support assembly, and exemplary application devices may be constructed in accordance with at least some of the teachings of the following patents, the disclosures of which are incorporated herein by reference: U.S. Patent No. 10,166,023, entitled “Method of Applying a Buttress to a Surgical Stapler End Effector,” published January 1, 2019, and / or U.S. Patent No. 10,349,939, entitled “Method of Applying a Buttress to a Surgical Stapler,” published July 16, 2019.

[0024] A. Exemplary components of the support assembly Figure 8An exemplary pair of support assemblies (110, 112) (each also individually referred to as a “support”) are shown. The support assembly (110) of this example includes a support body (114) and an upper adhesive layer (116). Similarly, the support assembly (112) includes a support body (118) and a lower adhesive layer (120). In this example, each support body (114, 118) includes a strong yet flexible material configured to structurally support a row of nails (47). By way of example only, each support body (114, 118) may include a mesh of polyglactin 910 material from Ethicon Ltd. (Somerville, New Jersey). Alternatively, in addition to polyglactin 910 material, or as an alternative, any other suitable material or combination of materials may be used to form each support body (114, 118).

[0025] Each support body (114, 118) may include materials such as hemostatic agents like fibrin to aid in blood clotting and reduce bleeding at surgical sites along tissue cuts and / or sutures (T1, T2). As another illustrative example only, each support body (114, 118) may include other adjuvants or hemostatic agents such as thrombin, which may be used to enable each support body (114, 118) to aid in blood clotting and reduce bleeding at surgical sites. Other adjuvants or agents that may be incorporated into each support body (114, 118) may also include, but are not limited to, medical fluids or matrix components.

[0026] In this example, an adhesive layer (116) is applied to the support body (114) to adhere the support body (114) to the underside (124) of the anvil (18). Similarly, an adhesive layer (120) is applied to the support body (118) to adhere the support body (118) to the upper deck (72) of the staple cartridge (37). Such adhesive material provides proper positioning of the support bodies (114, 118) before and during actuation of the end effector (12); and then allows the support bodies (114, 118) to separate from the end effector (12) after the end effector (12) has been actuated without damaging the support bodies (114, 118) to a degree sufficient to impair their proper subsequent function.

[0027] B. Exemplary suturing of tissue and support components Figures 9A to 9CAn exemplary sequence is shown in which an end effector (12) already loaded with support assemblies (110, 112) is actuated to drive a nail (47) through two opposing tissue layers (T1, T2), wherein the support assemblies (110, 112) are secured to the same tissue layers (T1, T2) by the nail (47). Specifically, Figure 9A Tissue layers (T1, T2) positioned between the anvil (18) and the cartridge (37) are shown, with the anvil (18) in the open position. A support assembly (110) is adhered to the underside (424) of the anvil (18) via an adhesive layer (116); while a support assembly (112) is adhered to the upper deck (72) of the cartridge (37) via an adhesive layer (120). Thus, tissue layers (T1, T2) are inserted between the support assemblies (110, 112). Next, a closing trigger (26) pivots toward the pistol grip (24) to drive the closing tube (32) and closing ring (33) distally. This drives the anvil (18) to... Figure 9B The closed position is shown. At this stage, the tissue layers (T1, T2) are compressed between the anvil (18) and the staple cartridge (37), where the support assemblies (110, 112) engage the opposing surfaces of the tissue layers (T1, T2). The end effector (12) is then actuated as described above, thereby driving the staple (47) through the support assemblies (110, 112) and the tissue (T1, T2). Figure 9C As shown, the crown (122) of the driven nail (47) abuts against the tissue layer (T2) to capture and retain the support assembly (112). The deformable leg (126) of the nail (47) abuts against the tissue layer (T1) to capture and retain the support assembly (110).

[0028] Similarly, a series of pins (47) abut against the tissue layers (T1, T2) to capture and retain the support assembly (110, 112), thereby securing the support assembly (110, 112) to the tissue (T1, T2), as... Figure 10 As shown. Because the end effector (12) is pulled away from the tissue (T1, T2) after the deployment of the pins (47) and the support assembly (110, 112), the support assembly (110, 112) disengages from the end effector, so that the support assembly (110, 112) is held fixed to the tissue (T1, T2) by the pins (47). The support assembly (110, 112) thus provides structural reinforcement for the rows of pins (47) formed in the tissue (T1, T2). Additionally, as... Figure 10It can be seen that the cutting edge (48) of the firing beam (14) on the far side also cuts through the centerline of the support assembly (110, 112), thereby dividing each support assembly (110, 112) into a corresponding pair of segments, such that each segment remains fixed to the corresponding cut area of ​​the tissue (T1, T2).

[0029] C. An exemplary auxiliary application device with a movable retainer arm Because the end effector (12) of the surgical stapler (10) can be actuated multiple times during a single surgical procedure, it may be desirable to enable the operator to repeatedly and easily load the support assembly (110, 112) onto the lower jaws and anvil (16, 18) during that single surgical procedure. Figures 11 to 13B An exemplary auxiliary application device (210) (also referred to as a “support application device” or “support applicator compartment”) is shown, which can be used to support, protect, and apply auxiliary materials, such as support assemblies (110, 112), to an end effector (12). Figures 11 to 12 As best seen in the present example, the application device (210) includes an open end (212) and a closed end (214). The open end (212) is configured to receive an end actuator (12), as will be described in more detail below. The application device (210) also includes a first housing (216a) and a second housing (216b), each of which together generally defines a “U” shape to present the open end (212). A platform (218) and a slider holder (220) are interposed between the first housing (216a) and the second housing (216b).

[0030] The platform (218) of this example is configured to support a pair of support assemblies (110) on one side of the platform (218) and another pair of support assemblies (112) on the other side of the platform (218). The platform (218) is exposed in a recess formed between the forks of the “U” configuration of the first housing (216a) and the second housing (216b). Each support assembly (110, 112) is respectively disposed in a separate corresponding pair of portions to avoid crossing the slots (42, 49) of the anvil (18) and the staple cartridge (37), but the platform (218) can equally easily support a wide-type support assembly (110, 112) that crosses the slots (42, 49) of the anvil (18) and the staple cartridge (37) individually, respectively. More specifically, the outer edge of the platform (218) includes a ridge-shaped retaining feature (530) that further engages the first housing (216a) and the second housing (216b) to prevent the platform (218) from sliding relative to the first housing (216a) and the second housing (216b).

[0031] The first housing (216a) and the second housing (216b) include an integral gripping feature (222) and an indicator plate (224) positioned to correspond to a window (226) formed in the first housing (216a) and the second housing (216b), such that the indicator plate (224) is visible through the window (226) at different times. The arm (228) of this example is configured to selectively secure the support assemblies (110, 112) to the platform (218). The arm (228) of this example is elastic and is therefore configured to elastically abut against the support assemblies (110, 112), thereby causing the support assemblies (110, 112) to contract against the platform (218). The application device (210) includes a pair of cam surfaces (232) with gradually changing cross-sections and a corresponding pair of housing engagement features (234) positioned to engage corresponding surfaces of the first housing (216a) and the second housing (216b). The first housing (216a) and the second housing (216b) include a proximal guide feature (236) and a distal guide feature (238) configured to assist in providing proper alignment of the end effector (40) with the application device (210).

[0032] Figure 13A An application device (210) is shown in which the retainer arm (228) is positioned against the platform (218) to hold the support assembly (110, 112); while Figure 13B An application device (210) is shown in which the retainer arm (228) is positioned to release the support assembly (110, 112) from the platform (218). Figures 13A to 13B Only the support assembly (110) on the platform (218) is shown; the support assembly (112) is held on and released from the platform (218) in the same manner. To load the end effector (12) using the application device (210), the operator will first position the application device (210) and the end effector (12) such that the end effector is aligned with the open end (212) of the application device (210), as shown. Figure 13A As shown. The operator then advances the distal end effector (12) and / or the proximal adjuvant (210) to position the platform (218) and support assembly (110, 112) between the anvil (18) and the staple cartridge (37), as shown. Figure 13BAs shown. Then, the operator squeezes the closing trigger (26) of the instrument (10) to close the lower jaws and anvil (16, 18) on the platform (218), thereby adhering the support assembly (110, 112) to the anvil (18) and the cartridge (37), and simultaneously presses the cam surface (232). The pressing of the cam surface (232) laterally actuates the retainer arm (228), thereby releasing the support assembly (110, 112) from the platform (218), so that the lower jaws and anvil (16, 18) can disengage from the platform (218), while the support assembly (110, 112) remains adhered to the anvil (18) and the cartridge (37).

[0033] III. Exemplary auxiliary application device with a static wedge configuration In some cases, it may be desirable to provide an auxiliary application device configured to apply the staple reinforcement auxiliary element to one or both jaws (e.g., the lower jaw (16) and / or the anvil (18)) of the surgical stapler end actuator while the jaws remain open, or otherwise prevent the jaws from closing via actuation of the end actuator closure system of the stapler (such as actuation via the closure trigger (26) input feature of the surgical stapler (10)). Figures 14 to 79B The exemplary application devices described provide such functionality that each application device is configured to be maneuverable relative to the end effector to apply the auxiliary element to one or both jaws, without requiring the features described above. Figures 13A to 13B The jaws shown are triggered-actuated to close. Additionally, each of these exemplary accessory application devices is operable to apply minimal pressure to properly place the accessory material onto one or more desired jaws.

[0034] It should be understood that the following is combined with Figures 14 to 79BAny of the exemplary accessory application devices described may be configured to apply accessory elements in the form of a support (such as the support assembly (110, 112) described above) or a tissue thickness compensator (e.g., of the type disclosed in U.S. Patent Publication No. 2012 / 0080336 entitled “Staple Cartridge Comprising Staples PositionedWithin A Compressible Portion Thereof,” published April 5, 2012 and now abandoned, the disclosure of which is incorporated herein by reference). Alternatively, the application of accessory elements to the end effector jaws may be achieved using adhesive features as described above and / or mechanically connected features (e.g., of the type disclosed in U.S. Patent No. 7,665,646 entitled “Interlocking Buttress Material Retention System,” published February 23, 2010, the disclosure of which is incorporated herein by reference). Furthermore, the following... Figures 14 to 79B Any of the exemplary application devices described may be suitably configured for single or multiple use.

[0035] A. Exemplary static wedge-shaped auxiliary application device In some cases, it may be desirable to provide a compact attachment application device configured to apply the staple reinforcement attachment element to one or both jaws of the surgical stapler end actuator while the jaws remain open, or otherwise prevent the jaws from closing via actuation of the end actuator closure system of the stapler (such as via actuation of the closure trigger (26) of the surgical stapler (10)).

[0036] Figures 14 to 16An exemplary accessory application device assembly (300) is shown, comprising a wedge-shaped application device component (308) and a base (302). The wedge-shaped application device component (308) includes a body (309), a first accessory element (304), and a second accessory element (306). The body (309) may be disposable or reusable. In a disposable type, the body (309) may be constructed from foam board, cardboard, plastic, or any other low-cost material known in the art that is sufficiently rigid, planar, and provides support. This type of body (309) intended for disposal may be discarded after a single use. In some types, the body (309) may be constructed from cardboard that can be treated with a surgically safe surface coating (334). The body (309) may include a rigid outer layer (such as plastic or any other low-cost material known in the art) to provide a rigid corrugated or foamed center within a thin layer. In some reusable forms, the body (309) may be constructed of a reusable material (such as stainless steel) or any other material known in the art to provide a sufficiently rigid surface that can be configured to present sterilizable surfaces at different angles. In some forms, such reusable materials may be pre-formed into a folded configuration and can be sterilized using methods further described below.

[0037] In this example, the body (309) of the wedge-shaped application device component (308) has a first panel (313), a second panel (315) opposite to the first panel (313), and a connecting panel (340) that engages the proximal end of the first panel (313) with the proximal end of the second panel (315). The first panel (313) defines a first contact surface (314). The first contact surface (314) is generally rectangular and is located on the outside of the first panel (313). The first panel (313) extends from the connecting panel (340) to a first foot (320). The first foot (320) has a trapezoidal shape, the wider base of which abuts the first panel (313), and the narrower apex of which extends distally from the center portion of the end opposite to the connecting panel (340) away from the first panel (313). The second panel (315) is also generally rectangular and defines a second contact surface (316) located on the outer surface opposite to the second panel (315). The second panel (315) extends from the connecting panel (340) to the second foot (322). The second foot (322) has a trapezoidal shape with a base adjacent to the second panel (315) and a top extending distally away from the second panel (315).

[0038] Each first and second accessory element (304, 306) has a corresponding first side (310) and a corresponding second side (312). In this embodiment, the first side (310) of each first and second accessory element (304, 306) is configured to be releasably attached to the first and second contact surfaces (314, 316) respectively via a first attachment feature (342). For example, the first attachment feature (342) includes an adhesive (not shown) and / or a mechanical attachment such as a retainer arm 228 (in Figure 12 (As shown in the diagram). The first attachment feature (342) is configured to removably attach the first and second attachment elements (304, 306) to the first and second contact surfaces (314, 316). In some forms, the adhesive may be a glue, cement, viscous liquid, or paste. In some forms, in view of the teachings herein, the first attachment feature (342) may be of any type readily apparent to a person skilled in the art for removably attaching attachments to an application device assembly.

[0039] The second side (312) of each of the first and second auxiliary elements (304, 306) includes a second attachment feature (344) configured to attach to the open lower jaws and anvils (16, 18) of the end effector (12). The second attachment feature (344) has stronger adhesive properties than the first attachment feature (342). Similar to the first attachment feature (342), the second attachment feature (344) may also include an adhesive (not shown) and / or a second mechanical attachment feature (not shown). Any combination of adhesive or mechanical attachment may be used for the first and second attachment features (342, 344), provided that the second attachment feature (344) has stronger adhesive properties than the first attachment feature (342). The first and second auxiliary elements (304, 306) may be in the form of a support assembly, such as the support assembly (110, 112) described above; or alternatively, a thickness compensator (not shown). The second side (312) of the first and second auxiliary elements (304, 306) may have a membrane (346) covering and protecting the second attachment feature (344). The membrane (346) may include a gripping portion (347) that extends proximally when the wedge-shaped application device member (308) is in a folded configuration, allowing the user to easily remove the membrane (346) without interfering with the attachment characteristics of the first and second auxiliary elements (304, 306).

[0040] In some forms, the first and second auxiliary elements (304, 306) may be supports comprising a three-layer polymer structure including a core layer sandwiched between two outer layers to provide a robust yet flexible support for a row of studs. In this example, the core layer is polyglactin 910, while each outer layer is a poly(p-dioxanone) or p-dioxanone (PDO) film material. The auxiliary elements (304, 306) of this example are formed by laminating the core layer between the outer layers over a predetermined time. The auxiliary elements (304, 306) are further mechanically cut to a specific size to suppress rough edges, such as burrs and / or delamination, that could damage sensitive tissue. It should be understood that alternative methods for cutting the auxiliary elements (304, 306), such as laser cutting or hot knife cutting, may be used similarly.

[0041] The base (302) may be constructed of foam, cardboard, plastic, or any other low-cost material known in the art to protect the article from damage during transport and to provide additional structural support. The base (302) is configured to be placed on a working surface such that the sides (324) face upward. The sides (324) of the base (302) include a first slot, a second slot, and a third slot (328, 330, 332) configured to receive a first foot and a second foot (320, 322). The slots (328, 330, 332) are spaced apart along the centerline of the sides (324) and aligned with each other. The slots (328, 330, 332) extend laterally relative to the centerline (not shown) and are sized to receive the feet (320, 322). In some configurations, the base (302) may include a recess (not shown) configured to receive the auxiliary application device assembly (300) and the first and second auxiliary elements (304, 306) within the base (302) to protect the auxiliary application device assembly (300) and the first and second auxiliary elements (304, 306) during transport.

[0042] Figure 15 This shows that the wedge-shaped application device component (308) has been deployed from its unfolded position. Figure 16The auxiliary application device assembly (300) is transformed into a folded position and aligned for assembly with the base (302). In the folded position, the lateral distance between the first panel (313) and the second panel (315) gradually increases in the direction away from the connecting panel (340), thus providing a body (309) with a wedge shape that tapers in the direction towards the connecting panel (340). To transform the auxiliary application device assembly (300) from the unfolded position to the folded position, the connecting panel (340) is folded such that the first panel (313) and the second panel (315) define a first angle (θ1) between them, which may range, for example, from about 20 degrees to about 45 degrees. Figure 15 As shown, the auxiliary application device assembly (300) is vertically aligned with the base (302) by aligning the first handle (320) with the first slot (328) and the second handle (322) with the second slot (330). In other embodiments, the base (302) may include one or more additional slots configured to set the first and second panels (313, 315) at one or more additional angles ranging from about 20 degrees to about 45 degrees.

[0043] In other configurations, the base (302) may include one or more pairs of slots (not shown) similar to slots (328, 330, 332), which are equidistant from each other around a center point (not shown) along a centerline on the side (324) such that the feet (320, 322) can be inserted into the first pair of slots. When the feet (320, 322) are inserted into the first pair of slots, a first angle (θ1) is formed between the first panel and the second panel (313, 315). The distance between the first panel (313) and the second panel (315) increases as the first panel (313) and the second panel (315) extend distally away from the connecting panel (340). The second pair of slots is further spaced apart from the first pair of slots around the center point, such that when the first and second shanks (320, 322) are inserted into the second pair of slots which are further spaced apart from each other relative to the first pair of slots, the first panel (313) and the second panel (315) define a larger second angle (θ2).

[0044] Figure 16A wedge-shaped application device component (308) in a planar unfolded configuration is shown. In the unfolded position, the wedge-shaped application device component (308) lies flat and extends longitudinally from a first handle (320) to a first panel (313). The first panel (313) extends further distally to a connecting panel (340). A second panel (315) extends from the connecting panel (340) to a second handle (322). The auxiliary application device assembly (300) is configured to be contained within a sealed sterile barrier (not shown) of the product packaging during transport and storage, such that the body (309), the first and second auxiliary elements (304, 306), and the base (302) remain sterile. By way of example only, such product packaging may be of the type disclosed in U.S. Patent Publication No. 2020 / 0205825, entitled “Method of Applying Buttresses to Surgically Cut and Stapled Sites,” published July 2, 2020, the disclosure of which is incorporated herein by reference. To house these components within a sterile barrier, it may be advantageous to minimize the size of the adjunct application device assembly (300) or otherwise provide the adjunct application device assembly (300) with the ability to assemble from a collapsed state. It may also be advantageous to use the base (302) as part of the packaging material to protect the adjunct application device assembly (300) during transport.

[0045] The connecting panel (340) of this example is configured as a joint or hinge to facilitate folding of the wedge-shaped application device member (308). The connecting panel (340) is flat in the unfolded position and extends from a first crease (336) to a second crease (338). The first crease (336) abuts a first panel (313), and the second crease (338) abuts a second panel (315). The first and second creases (336, 338) include perforations or release portions transverse to the length of the wedge-shaped application device member (308). The perforations or release portions are configured to facilitate flexure of the connecting panel (340) relative to each of the first panel (313) and the second panel (315). As another example, the connecting panel (340) may include only the first crease (336) or may include multiple creases and multiple end plates for engaging the first panel (313) and the second panel (315). In yet another example, the body (309) can be transported in a partially folded configuration. In the partially folded configuration, the first crease (336) is folded to 180 degrees and the second crease (338) remains straight, such that the rear side of the first panel (313) is folded and engages the rear side of the second panel (315) to preserve longitudinal space within the sterile barrier.

[0046] Figure 17AA wedge-shaped applicator component (308) is shown attached to a base (302), wherein the end actuator (12) is longitudinally aligned with the resulting auxiliary applicator assembly (300). The base (302) is positioned on a working surface with the side face (324) facing upwards such that the slots (328, 330, 332) face upwards. The wedge-shaped applicator component (308) is attached to the base (302) by inserting a first foot (320) into the first slot (328) and a second foot (322) into the second slot (330) and by pressing the wedge-shaped applicator component (308) downwards. The first foot and the second foot (320, 322) attached to the first slot and the second slot (330, 332) thereby fix the angular relationship between the first panel and the second panel (313, 315) to define a first angle (θ1) opening to the distal side. As described above, the base (302) may include one or more additional slots configured such that the first angle (θ1) of the distal opening defined by the first panel and the second panel (313, 315) can be set to any desired angle.

[0047] Figure 17BThe lower jaws and anvils (16, 18) of the end effector (12) in the open position are shown, engaging the wedge-shaped application device member (308) of the auxiliary application device assembly (300). Before engaging the auxiliary application device assembly (300) with the lower jaws and anvils (16, 18) of the end effector (12), the membrane (346) has been removed from the first and second auxiliary elements (304, 306). The lower jaws (16) of the end effector (12) engage the second side (312) of the first auxiliary element (304) while the anvil (18) simultaneously engages the second side (312) of the second auxiliary element (306). The aforementioned second attachment features (344) of the first and second auxiliary elements (304, 306) are attached to the lower jaws and anvils (16, 18), respectively. When held in the open position, the end effector (12) is then pulled upwards away from the auxiliary application device assembly (300). The second attachment feature (344) of the first and second auxiliary elements (304, 306) remains attached to the lower jaw and anvil (16, 18) because the first attachment feature (342) allows the auxiliary elements (304, 306) to be released from the first and second contact surfaces (314, 316) of the wedge-shaped application device member (308). The first and second auxiliary elements (304, 306) attached to the lower jaw and anvil (16, 18) are prepared for use in surgical procedures. It should be understood that by keeping the lower jaws and anvil (16, 18) in the open state, while attaching the auxiliary elements (304, 306) to the lower jaws and anvil (16, 18) via the auxiliary application device assembly (300), the operator can control the force used to place the auxiliary elements (304, 306) onto the lower jaws and anvil (16, 18) by selectively advancing the end actuator (12) longitudinally toward the auxiliary application device assembly (300) which can be kept stationary as shown in this example.

[0048] B. An exemplary static wedge-shaped auxiliary application device with corner wings In some cases, it may be desirable to modify the above-described auxiliary application device assembly (300) to include additional structural supports to provide additional rigidity to the first and second panels (313, 315), thereby preventing the first and second panels (313, 315) from bending inward or outward, so that the auxiliary elements (304, 306) adhere uniformly to the lower jaws and anvil (16, 18). Figures 18 to 21 A second exemplary accessory application device assembly (400) is shown, which has a pair of first and second corner wings (446, 448) that can provide the beneficial effects of such functionality.

[0049] Figure 18A wedge-shaped application device member (408) of the auxiliary application device assembly (400) in the deployed position is shown. The auxiliary application device assembly (400) is constructed similarly to the auxiliary application device assembly (300) described above, except as further described below. Similar to the auxiliary application device assembly (300), the auxiliary application device assembly (400) includes a wedge-shaped application device member (408) and a base (302). The wedge-shaped application device member (408) includes a body (409) and a first auxiliary element and a second auxiliary element (304, 306). The wedge-shaped application device member (408) and the base (302) are constructed of a material similar to that of the wedge-shaped application device member (308) and the base (302) of the auxiliary application device assembly (300). Figure 18 As shown, the main body (409) of the auxiliary application device assembly (400) in the unfolded position extends longitudinally from the first handle (420) to the first panel (413). The first panel (413) extends toward the connecting panel (440). The second panel (415) extends from the connecting panel (440) toward the second handle (422). The first panel and the second panel (413, 415) define a first contact surface and a second contact surface (414, 416), respectively, similar to the first contact surface and the second contact surface (314, 316) of the auxiliary application device assembly (300). A first auxiliary element and a second auxiliary element (304, 306) are attached to the first contact surface and the second contact surface (414, 416) on their first side (310), respectively.

[0050] The body (409) of the wedge-shaped application device component (308) differs from the body (309) of the wedge-shaped application device component (408) in that the body (409) also includes a first diagonal wing and a second diagonal wing (446, 448) formed on the side portions of the first panel and the second panel (413, 415). Specifically, the first diagonal wing (446) is formed on the side portion of the first panel (413) and is configured as a trapezoidal planar panel extending laterally from the edge (450) of the first panel. The edge (450) of the first panel extends parallel to the length of the unfolding body (409) along the outer edge of the first panel (413). The edge (450) of the first panel can be perforated or released to facilitate bending or tearing of the first wing (446) relative to the first panel (413). In this embodiment, the first diagonal wing (446) forms a pair of trapezoidal planar panels. The right angle of the trapezoidal shape is located at the end near the first foot (420). Each of the first corner wings (446) defines a first outer edge (452) configured to abut the inner surface of the second panel (415) to define a first predetermined angle (θ1) between the first panel and the second panel (413, 415), the first predetermined angle opening to the distal side and being within the range of approximately 20 degrees to approximately 45 degrees.

[0051] The second diagonal wing (448) extends laterally from the second panel edge (454) of the second panel (415) to form a trapezoidal planar panel with a right angle. The right angle of each first wing (448) is located at the end near the first foot (420). The second panel edge (454) extends parallel to the length of the unfolding body (409) along the edge of the second panel (415). Similar to the first panel edge (450), the second panel edge (454) may be perforated or released to facilitate bending or tearing of the second diagonal wing (448) relative to the second panel (315). The second diagonal wing (448) is a mirror version of the first diagonal wing (446), and each second wing (448) defines a second outer edge (456) to define a second predetermined angle (θ2) between the first panel and the second panel (413, 415) from approximately 20 degrees to approximately 45 degrees (see See Figure 21 The second angle (θ2) can be the same as or different from the first angle (θ1).

[0052] In this example, the second diagonal wing (448) is suitably shaped such that the resulting second angle (θ2) is greater than the first angle (θ1) defined by the first wing (446) between the first panel and the second panel (413, 415), for example as Figure 21 and Figure 19 As shown above, the user can selectively deploy the first wing (446) in the manner described above to define a relatively small first angle (θ1) between the first panel and the second panel (413, 415) for use with an end actuator (12) having a relatively small jaw opening (also referred to as an "orifice") between the anvil (18) and the deck (72) of the staple cartridge (37) in the open state. Alternatively, the user can selectively deploy the second diagonal wing (448) in the manner described above to define a relatively large second angle (θ2) between the first panel and the second panel (413, 415) for use with an end actuator (12) having a relatively large jaw opening in the open state.

[0053] Figure 19 The wedge-shaped applicator component (408) is shown in a folded configuration after being transformed from an unfolded configuration. The wedge-shaped applicator component (408) is transformed into a folded configuration by folding the first and second panels (413, 415) relative to the connecting panel (440) along the first and second creases (436, 438). Figure 16 The unfolded configuration transforms into Figure 19 and Figure 20In one of the folding configurations shown, the first diagonal wing (446) or the second diagonal wing (448) folds along the edge of the first panel or the edge of the second panel (450, 454), respectively. The first outer edge or the second outer edge (452, 456) engages the inside of the second panel (415) or the first panel (413), respectively. For example, if the user wishes to set the auxiliary application device assembly (400) to a first angle (θ1), the user can fold the first diagonal wing (446) inward along the edge of the first panel (450) to engage the inside of the second panel (415). The second diagonal wing (448) can be folded away, remaining unfolded, or torn off along the edge of the second panel (454) such that when the first diagonal wing (448) is folded to engage the inside of the first panel (413), the second diagonal wing (446) does not interfere with the first diagonal wing (446).

[0054] In order to set the auxiliary application device assembly (400) at the second angle (θ2), the second diagonal wing (448) is folded inward along the edge (454) of the second panel so that the second outer edge (456) engages the inside of the first panel (413). The first diagonal wing (446) can be folded away and left unfolded, or torn open and discarded along the edge (450) of the first panel, such that the first diagonal wing (448) does not interfere with the second diagonal wing (448) when the second diagonal wing (446) is folded to engage the inside of the first panel (413).

[0055] Figure 20 A subordinate applicator assembly (400) is shown prior to the connection of the wedge applicator member (408) to the base (302), wherein the wedge applicator member (408) is in a first folded configuration, in which a first panel and a second panel (413, 415) define a first angle (θ1) therebetween. The base (302) rests on a working surface, wherein the side (324) faces upward. When the wedge applicator member (408) is set to the first angle (θ1), the first slot (328) and the second slot (330) are longitudinally spaced apart by a distance equal to the distance between the first foot and the second foot (420, 422). The first and second handles (420, 422) are aligned with the first and second slots (428, 430), and then the wedge-shaped application device member is pressed down (408), thereby inserting the first and second handles (420, 422) into the first and second slots (428, 430).

[0056] Figure 21The diagram shows a wedge-shaped applicator component (408) in a second folded configuration, wherein the wedge-shaped applicator component (408) is coupled to an auxiliary applicator assembly (400) of a base (302), in which a first panel and a second panel (413, 415) define a second angle (θ2) therebetween. When the wedge-shaped applicator component (408) is set to the second angle (θ2), a first slot (328) and a third slot (332) in the base (302) are spaced apart by a distance equal to the distance between the first foot and the second foot (420, 422). The wedge applicator component (408) is attached to the base (302) by aligning the first handle (420) with the first slot (328) and inserting the first handle (420) into the first slot (328), while aligning the second handle (422) with the third slot (332) and inserting the second handle (422) into the third slot (332) by pressing the wedge applicator component (408) downward in the direction of downward.

[0057] As described above, it should be understood that the wedge-shaped application device component (408) can be suitably configured to present a wedge shape at various predetermined angles, and in each of such predetermined configurations, the slots (328, 330, 332) of the base (302) can be suitably spaced apart to receive the shank (420, 422) of the wedge-shaped application device component (408). Thus, the user can easily modify and adapt the wedge-shaped application device component (408) for use with an end effector (12) having a jaw opening between the platform (72) of the anvil (18) and the cartridge (37) in the fully open state.

[0058] C. An exemplary static wedge-shaped auxiliary application device with an adjustable support column In some cases, it may be desirable to attach the appendage to the open lower jaws and anvil (16, 18) of the end effector (12) via a compact, sterile, disposable appendage application device assembly. Additionally, it may be advantageous to configure such appendage application device assemblies at different predetermined angles, allowing them to be used with different end effectors and / or at an optimal angle for a particular appendage. It may also be desirable to have an appendage application device assembly that can be manipulated by the user to engage the open lower jaws and anvil (16, 18) of the end effector (12) without requiring a base of working surface, such as the base (302) described above. Figures 22 to 24 A third exemplary accessory application device assembly (500) is shown that can provide the beneficial effects of such functionality.

[0059] Figure 22An accessory application device assembly (500) in a non-expandable storage configuration is shown. The accessory application device assembly (500) is similar to the accessory application device assembly (300) described above, except as further described below. Similar to the accessory application device assembly (300), the accessory application device assembly (500) includes a wedge-shaped application device member (508), a first accessory element (304), and a second accessory element (306). The accessory application device assembly (500) is also configured to be contained within a sealed sterile barrier (not shown) of the product packaging during transport and storage, such that it is sealed within a sterile bag (not shown) during transport and storage. The accessory application device assembly (500) may be constructed from a material similar to that of the accessory application device assembly (300). The accessory application device assembly (500) includes a body (509) that may be disposable or reusable. The auxiliary application device assembly (500) is configured to transfer the first auxiliary element and the second auxiliary element (304, 306) to the open lower jaw and anvil (16, 18) of the end effector (12).

[0060] The difference between the auxiliary application device assembly (500) and the auxiliary application device assembly (300) is that the auxiliary application device assembly (500) is configured to be manually operated and inserted into the open lower jaws and anvils (16, 18) of the end effector (12) without being coupled to the base (302), and the body (509) can be folded into a storage configuration to minimize the space occupied by the body (509) within the sterile barrier of the product packaging.

[0061] The body (509) includes a first panel (513), a second panel (515), a third panel (502), a first curved notch (504), a second curved notch (506), a connecting portion (518), and a support (520). In the non-expanded storage position, the body (509) extends proximally from the third panel (502) to the first curved notch (504). The third panel (502) serves as a handle configured to be ergonomically gripped by a user with their thumb and / or fingers. The third panel (502) engages with the first panel (513) at the first curved notch (504). The first curved notch (504) is a V-shaped notch located on the outer surface (522) of the body (509) between the third panel (502) and the first panel (513). The outer surface (522) is the outward-facing surface of the body (509). The first curved notch (504) may include an adhesive (not shown) configured to hold the third panel (502) in a lateral position relative to the longitudinally extending first panel (513). Figure 23 (As shown).

[0062] The first panel (513) includes a first angular notch (544), a second angular notch (546), and a third angular notch (548) located on the distal portion of the inner surface (524). The inner surface (524) is the inward-facing surface of the body (509). The first panel (513) extends proximally from the first curved notch (504) to the connecting portion (518). The connecting portion (518) engages the proximally end of the first panel (513) with the proximally end of the second panel (515). The connecting portion (518) may be in the form of a flexible U-bend or a V-bend and is configured to allow the first panel and the second panel (513, 515) to be angularly deflected relative to each other between a plurality of angular configurations. The connecting portion (518) may include one or more flexural features (538), which may be in the form of creases or interconnecting plates (not shown) similar to the first and second creases (336, 338) and the connecting panel (340) of the auxiliary application device assembly (300). A second panel (515) extends distally from the connecting portion (518) to a second curved notch (506). The second curved notch (506) is located on the inner surface (554) of the second panel (515) and engages a support (520) to the second panel (515). The support (520) extends distally from the second curved notch (506) to a support end (540). The second curved notch (506) may be a V-shaped notch located on the inner surface (554) of the second panel (515). The support end (540) is configured to selectively engage one of the angled notches (544, 546, 548). The first and second auxiliary elements (304, 306) are releasably attached to the first and second panels (513, 515) on the outer surface (522).

[0063] Figure 23 The attached application device assembly (500) is shown in a first expanded angle configuration with the open lower jaws and anvils (16, 18) of the engaging end actuator (12). The attached application device assembly (500) has been moved from the storage configuration by bending the third panel (502) at the first curved notch (504) and the support column (520) at the second curved notch (506). Figure 22The third panel (502) is laterally bent downward relative to the first panel (513) toward the outer surface (522) at the first curved notch (504). The pillar (520) is laterally bent downward relative to the second panel (515) toward the inner surface (524) of the first panel (513) at the second curved notch (506). In the example shown, the end of the pillar (540) engages with and is held by the first angle notch (544). The first angle notch (544) is positioned distally relative to the second and third angle notches (546, 548). The end of the pillar (540) is held by the first angle notch (544) such that the first panel (513) and the second panel (515) define a first angle (θ1) between them, which may range, for example, from about 20 degrees to about 45 degrees. In the first folded position, the lateral distance between the first panel (513) and the second panel (515) gradually increases in the direction away from the connecting portion (518), thus providing a wedge-shaped application device member (508) with a wedge shape that tapers in the direction toward the connecting portion (518).

[0064] Before the lower jaws and anvils (16, 18) of the end effector (12) engage the wedge-shaped applicator component (508), the membrane (346) is removed from the second side (312) of the first and second auxiliary elements (304, 306). The user can grasp or hold the third panel (502) between the fingers and thumb of one hand while using the other hand to press the wedge-shaped applicator component (508) into the open lower jaws and anvils (16, 18) of the end effector (12). The open lower jaws and anvils (16, 18) of the end effector (12) will engage the first and second auxiliary elements (304, 306). The second side (312) of the first and second auxiliary elements (304, 306) is attached to the open lower jaws and anvils (16, 18). The user then removes the end effector (12) from the wedge-shaped application device component (508), which causes the first and second auxiliary elements (304, 306) to detach from the application device component (508) while remaining fixed to the open lower jaws and anvil (16, 18).

[0065] Figure 24 The attached application device assembly (500) is shown with the open lower jaws of the engagement end actuator (12) and the anvil (16, 18) in a second expanded angular position. The wedge-shaped application device component (508) is positioned similarly to the first angular position described above. Figure 23 (as shown) from the storage location ( Figure 22(As shown) it transforms into a second angle configuration. Specifically, the third panel (502) bends around the first curved notch (504) and the support (520) bends around the second curved notch (506). The third panel (502) bends laterally downward relative to the first panel (513) toward the outer surface (522) at the first curved notch (504). The support (520) bends laterally downward relative to the second panel (515) toward the inner surface (524) of the first panel (513) at the second curved notch (506). The end of the support (540) engages with and is held by the second angle notch (546). The second angle notch (546) is proximal to the first angle notch (544) and distal to the third angle notch (548). Once the support end (540) is held by the second angle notch (546), the first panel (513) and the second panel (515) define a second angle (θ2) between them, which can range from approximately 20 degrees to approximately 45 degrees. In this example, in the second folded position, the second angle (θ2) is greater than the first angle (θ1). Figure 23 As shown), and therefore the lateral distance between the first panel (513) and the second panel (515) gradually increases toward the far side at a greater rate than in the first folded position.

[0066] Although not shown, the support (520) may also be placed in a third angle notch (548) such that the first panel (513) and the second panel (515) define a third angle between the first panel (513) and the second panel (515), which is greater than the second angle (θ2) and may be approximately 20 degrees to approximately 45 degrees. As another example, which is merely illustrative, the inner surface (524) of the first panel (513) may include one or more additional angle notches configured to define an additional predetermined angle between the first panel and the second panel (513, 515) ranging from approximately 20 degrees to approximately 45 degrees.

[0067] D. An exemplary static wedge-shaped auxiliary application device with a force-limiting feature. In some cases, it may be desirable to limit the force of the open lower jaws and anvils (16, 18) used to attach the accessory to the end effector (12) to a predetermined force, thereby avoiding excessive force that could otherwise damage the end effector (12) and / or the accessory (304, 306). Figures 25 to 26B A fourth exemplary accessory application device component (600) is shown that can provide the beneficial effects of such functionality.

[0068] like Figure 25As shown, the auxiliary application device assembly (600) includes a wedge-shaped application device member (608), which may be structurally and functionally similar to any of the exemplary wedge-shaped application device members (308, 408, 508) described above. The application device member (608) includes a body (610) and first and second auxiliary elements (304, 306) disposed on opposite sides of the body (610). The auxiliary application device assembly (600) also includes an elastic member in the form of a helical spring (602), a housing (604), and a linking feature (606). The housing (604) may be configured as a combination of the first and second housings (216A, 216B) of the auxiliary application device (210) described above, and in this example is configured as a chassis that provides a rigid support structure capable of supporting the wedge-shaped application device member (608). The wedge-shaped application device member (608) is slidably connected to the housing (604) via the linking feature (606). The helical spring (602) biases the body (610) toward the proximal side. Figure 26A The proximal position is shown. The body (610) may be made of surgically safe plastic, stainless steel, or other materials known in the art that can be sterilized.

[0069] Similar to the auxiliary application device assembly (300), the wedge-shaped application device member (608) includes: a first contact feature (613) including a first contact surface (614), a second contact feature (615) including a second contact surface (616), and a connecting feature (640) interconnecting the first contact feature and the second contact feature (613, 615) at least at their proximal ends. A first auxiliary element (304) is mounted to the first contact surface (614) of the first contact feature (613), and a second auxiliary element (306) is mounted to the second contact surface (616) of the second contact feature (615). In some embodiments, the connecting feature (640) may be suitably configured to allow the first contact feature and the second contact feature (613, 615) to move toward and away from each other about their proximal ends via a range of angular positions in which the body (610) defines a distal opening angle. In other forms, the body (610) may be a static structure in which the first contact feature and the second contact feature (613, 615) are fixed at an angle relative to each other so that the body (610) is configured to define a single distal opening angle.

[0070] The wedge-shaped application device component (608) is slidably coupled to the housing (604) via a movable member in the form of a plurality of support arms (642) and a roller (644). Each support arm (642) is fixedly attached to the wedge-shaped application device component (608) at a first end (646) and rotatably coupled to the roller (644) at a second end. This type includes up to four support arms (642), with two support arms (642) attached to each lateral side of the wedge-shaped application device component (608). In other types, a variety of other numbers and arrangements of support arms (642) may be employed. In still other types, the movable member may take the form of a slider, a disc, a slide, or any other structure known in the art that facilitates linear translation of the body relative to the chassis.

[0071] The housing (604) extends longitudinally from an open end (650) to a closed end (652) and has a “U” shape. The open end (650) is configured to receive the open lower jaws and anvils (16, 18) of the end effector (12). The housing (604) also includes a longitudinally extending first housing side portion and a second housing side portion (654, ​​658). The first housing side portion (654) has a first channel (656) and the second housing side portion (658) has a second channel (660) laterally opposite to the first channel (656). The first housing side portion and the second housing side portion (654, ​​658) together define the “U” shape of the housing (604). Each channel (656, 660) accommodates one or more rollers (644). Each channel (656, 660) extends longitudinally along the corresponding first or second housing side portion (654, ​​658) and is configured to allow the roller (644) to rotate, thereby enabling the wedge-shaped application device member (608) to translate proximally and distally relative to the housing (604).

[0072] A coil spring (602), shown as a tension coil spring, is operatively attached between a housing (604) and a linking feature (606). In this embodiment, the linking feature (606) is connected to the proximal portion of the wedge-shaped applicator member (608) within the first housing side portion (654). In other embodiments, an additional coil spring (602) may be located within a second housing side portion (658) and attached between the additional linking feature (606) and the proximal portion of the housing (604). In still other embodiments, the linking feature (606) may be fitted between the coil spring (602) and the distal portion of the housing (604). In all such embodiments, the coil spring (602) is in a contracted, relaxed state when the wedge-shaped applicator member (608) is in a proximal position relative to the housing (604).

[0073] Figure 26AThe open lower jaws and anvil (16, 18) of the end effector (12) are shown, engaging with first and second accessory elements (304, 306) on first and second contact surfaces (614, 616), with the wedge-shaped applicator member (608) in a proximal position relative to the housing (604) and the coil spring (602) in a retracted state. In the proximal position, the coil spring (602) biases the wedge-shaped applicator member (608) in a proximal direction. The open lower jaws and anvil (16, 18) of the end effector (12) are forced distally against the first and second accessory elements (304, 306), which are supported by first and second contact features (613, 615), respectively.

[0074] Figure 26B This demonstrates how the elastic bias of the helical spring (602) is sufficient to overcome and how the wedge-shaped application device component (608) is moved from a proximal position ( Figure 27A The force actuated to the distal position where the helical spring (602) extends presses the open lower jaws and anvil (16, 18) of the end effector (12) distally. To move the application device member (608) to the distal position, the user applies sufficient longitudinal input force to overcome the predetermined biasing force applied proximally to the wedge-shaped application device member (608) by the helical spring (602). Once the distal input force applied by the user to the application device member (608) via the end effector (12) overcomes the proximal biasing force applied by the helical spring (602), the wedge-shaped application device member (608) moves distally relative to the housing (604). This distal translational capability of the application device member (608) relative to the housing (604) and the elastic biasing of the extended helical spring (602) effectively limit the magnitude of the force that the end effector (12) can apply to the application device member (608) in response to the user's input force. This configuration ensures that the longitudinal compressive force applied between the lower jaws and anvil (16, 18) and the application device component (608) is sufficient to effectively position the auxiliary elements (304, 306) on the lower jaws and anvil (16, 18), while also limiting this compressive force to protect the lower jaws and anvil (16, 18) and the application device component (608) from damage caused by additional excessive compressive force.

[0075] Roller (644) facilitates distal translation of the wedge-shaped applicator component (608) and maintains longitudinal alignment of the wedge-shaped applicator component (608) so that the first and second appendages (304, 306) do not become misaligned when applied to the lower jaws and anvils (16, 18) of the end effector (12). A portion of the end effector (12) engages a stop feature of the housing 604 to prevent the helical spring (602) from overextending beyond its designed range of motion and applying a force greater than predetermined to the first and second appendages (304, 306). This allows the helical spring (602) to apply a predetermined force proximally against the lower jaws and anvils (16, 18) of the end effector (12). As described above, this predetermined force is sufficient to attach the second side (312) of the first and second appendages (304, 306) to the open lower jaws and anvils (16, 18) of the end effector (12). Once a portion of the end effector (12) engages the stop feature of the housing (604), the end effector (12) moves proximally away from the auxiliary application device assembly (600). The attachment force of the second attachment feature (344) being greater than that of the first attachment feature (342) causes the first and second auxiliary elements (304, 306) to attach to the open lower jaws and anvils (16, 18) of the end effector (12).

[0076] IV. Exemplary auxiliary application device with selective scalability In some cases, it may be desirable to provide an adjunct application device operable to selectively switch between a non-expanded state and an expanded state for applying adjunct elements (e.g., support assemblies or tissue thickness compensators) to one or both jaws of a surgical suture end effector while the jaws remain open. (See below for details.) Figures 27A to 41B Each of the exemplary application devices described provides such functionality.

[0077] A. First selectively expandable auxiliary application device Figures 27A to 27B Another exemplary application device (700) is shown, configured to apply adjunct materials (e.g., support assemblies (110, 112) or tissue thickness compensators) to the jaws (e.g., lower jaw (16) or anvil (18)) of the end effector (12) of a surgical stapler (10). The application device (700) adjusts the thickness of the anvil (18) or lower jaw (16) to allow the application device (700) to properly apply the adjunct materials to the anvil (18) or lower jaw (16), respectively. Figure 27AAs shown, the application device (700) includes an expansion mechanism (701) and a contact structure shown as an expandable wedge (714). The expansion mechanism (701) of this example includes a handle (702, 704), a compression spring (706), and an application device arm (708, 710).

[0078] The wedge (714) in this example is configured to support a pair of support assemblies (110) on one side of the wedge (714) and another pair of support assemblies (112) on the opposite side of the wedge (714). Each support assembly (110, 112) is respectively disposed in a separate corresponding pair of portions to avoid crossing the slots (42, 49) of the anvil (18) and the staple cartridge (37) (see...). Figure 3 However, the wedge (714) can equally easily support the wide-type support assembly (110, 112) that spans the slots (42, 49) of the anvil (18) and the cartridge (37) individually. The application arms (708, 710) are separated by a pivot member (shown as a pin (712)) configured to be rotatably connected to the application arms (708, 710). Thus, the application device (700) can resemble a reverse clamp, i.e., a compression spring (706) is configured to provide a force that biases the handles (702, 704) away from each other, thereby biasing the distal portions (709, 711) of the application arms (708, 710) toward each other via pivoting rotation about the axis (720) provided by the pin (712). The wedge (714) is configured to contact the application device arm (708, 710) via contact members (722, 724); however, the contact members (722, 724) are merely optional and may be omitted in some versions. Furthermore, the wedge (714) includes a first application device surface (716) and a second application device surface (718) joined together at an elastic pivot point (726).

[0079] The first and second application device surfaces (716, 718) are each configured to apply auxiliary material to the end actuator (12) of the suturing instrument (10). More specifically, the first application device surface (716) is configured to receive a support assembly (110) thereon for application to a pivotable anvil (18), and the second application device surface (718) is configured to receive a support assembly (112) thereon for application to a lower jaw (16). Specifically, the support assembly (110) is placed on the surface (716) of the first application device such that the upper adhesive layer (116) faces outward away from the first application device surface (716), and the support assembly (112) is placed on the surface (718) of the second application device such that the lower adhesive layer (120) faces outward away from the second application device surface (718), thereby allowing the lower adhesive layer and the upper adhesive layer (116, 120) to adhere to the pivotable anvil (18) and the lower jaw (16) respectively when the support assembly (110, 112) is applied by the application device (700). In some embodiments, the first and second application device surfaces (716, 718) and the support assemblies (110, 112) include corresponding features, such as clamping arms and clamping arm fingers (not shown), to hold the support assemblies (110, 112) in place and to ensure proper and secure alignment and positioning of the support assemblies (110, 112) on the application device surfaces (716, 718) before they are applied to the pivotable anvil (18) and lower jaws (16), respectively. However, various suitable methods and structures are also contemplated for securely and removably positioning the support assemblies (110, 112) on the application device surfaces (716, 718). In some embodiments, a user using a separate device (not shown) may initially apply one or both support assemblies (110, 112) to the application device surfaces (716, 718).

[0080] Figure 27B The diagram shows the attachment of auxiliary material to the suture surface of the pivotable anvil (18) and lower jaw (16) of the end effector (12). As described above, the auxiliary material may include support assemblies (110, 112), tissue thickness compensation elements, or other suitable materials. The suture surface is intended to include the upper plate (72) of the staple cartridge (37) including staple holes (50) or the contact surface (52) of the anvil (18) including staple forming recesses (53), such as Figure 3 As shown. It is also envisioned that the anvil (18) can be set on the lower jaw and the nail cartridge (37) can be set on the upper jaw.

[0081] like Figure 27BAs shown, once the support assemblies (110, 112) are positioned on the application device surfaces (716, 718), the handles (702, 704) of the application device (700) are pressed together, thereby compressing the spring (706) and causing the application device arms (708, 710) to pivot about the axis (720). As the handles (702, 704) come closer together, the distal portions (709, 711) of the application device arms (708, 710) move away from each other and contact the inward-facing surfaces (728, 730) of the application device arms (708, 710) so that the application device arms (708, 710) unfold (i.e., separate) in opposite directions via the elastic pivot point (726) until the support assemblies (110, 112) adhere to the pivotable anvil (18) and the lower jaw (16), respectively. More specifically, the wedge (714) defines a distal opening angle that increases as the application arms (708, 710) of the wedge (714) unfold, thus causing each application arm (708, 710) to advance toward the corresponding jaw of the end effector (12).

[0082] Subsequently, the handle (702, 704) can be released by the user, thereby reversing the pivoting motion of the application device arms (708, 710) and disengaging them from the support assemblies (110, 112) while they remain adhered to the pivotable anvil (18) and lower jaws (16). The application device (700) can then be removed.

[0083] In some configurations, it may be desirable to include a fracture feature to ensure that the application device (700) does not apply excessive pressure to the end effector (12) when applying the support assembly (110, 112). For example, one or more fracture features, such as notches (732, 734), may be included on the application device arm (708, 710). In the illustrated example, the notches (732, 734) are included between the handle (702, 704) and the pin (712), and the arm (708, 710) is configured to fracture at the notches (732, 734) respectively if the arm (708, 710) is subjected to a force exceeding a predetermined limit when applying the support assembly (110, 112).

[0084] B. Second selectively expandable auxiliary application device Figures 28A to 28BAnother exemplary application device (800) is shown, configured to apply adjunct material to the jaws (e.g., lower jaw (16) or anvil (18)) of the end effector (12) of a surgical stapler (10). The application device (810) adjusts the thickness of the anvil (18) or lower jaw (16) to allow the application device (810) to properly apply adjunct material to the anvil (18) and lower jaw (16). Thus, applying a support assembly (112) to the lower jaw (16) including the staple cartridge (37) using the application device (810) is similar to the application of the application device (700) described above. Figure 28A As shown, the application device (800) includes an expansion mechanism (801) and a contact structure shown as an expandable wedge (814). The expansion mechanism (801) of this example includes a handle (802, 804), a compression spring (806), and an application device arm (808, 810).

[0085] The application arms (808, 810) are joined together at the first and second pivot members (shown as pins (815, 812)). A compression spring (806) is configured to provide a force that biases the handles (802, 804) away from each other, thereby biasing the flexible central portions (809, 811) of the application arms (808, 810) toward each other via pivoting rotation about pivot axes (820, 821) provided by the pins (815, 812). The wedge (814) of this example is configured to support a pair of support assemblies (110) on one side of the wedge (814) and another pair of support assemblies (112) on the opposite side of the wedge (814). Each support assembly (110, 112) is respectively positioned in a separate pair of corresponding sections to avoid crossing the slots (42, 49) of the anvil (18) and the staple cartridge (37) (see...) Figure 3 However, the wedge (814) can equally easily support wide-type support assemblies (110, 112) that each span a slot (42, 49) across the anvil (18) and the cartridge (37), respectively. The wedge (814) is configured to contact the application device arm (808, 810) along the flexible central portion (809, 811). Furthermore, the wedge (814) includes a first application device surface (816) and a second application device surface (818) joined together at a resilient pivot point (826). In some versions, the flexible central portion (809, 811) may be fixed to the application device arm (808, 810).

[0086] The first and second application device surfaces (816, 818) are each configured to apply auxiliary material to the end actuator (12) of the suturing instrument (10). More specifically, the first application device surface (816) is configured to receive a support assembly (110) thereon for application to a pivotable anvil (18), and the second application device surface (818) is configured to receive a support assembly (112) thereon for application to a lower jaw (16). Specifically, the support assembly (110) is placed on the surface of the first application device (816) such that the upper adhesive layer (116) faces outward away from the first application device surface (816), and the support assembly (112) is placed on the surface of the second application device (818) such that the lower adhesive layer (120) faces outward away from the second application device surface (818), thereby allowing the upper adhesive layer and the lower adhesive layer (116, 120) to adhere to the pivotable anvil (18) and the lower jaw (16), respectively, when the support assembly (110, 112) is applied by the application device (800). In some embodiments, the first and second application device surfaces (816, 818) and the support assemblies (110, 112) include corresponding features, such as clamping arms and clamping arm fingers (not shown), to hold the support assemblies (110, 112) in place and to ensure proper and secure alignment and positioning of the support assemblies (110, 112) on the application device surfaces (816, 818) before they are applied to the pivotable anvil (18) and lower jaws (16), respectively. However, various suitable methods and structures are also contemplated for securely and removably positioning the support assemblies (110, 112) on the application device surfaces (816, 818). In some embodiments, a user using a separate device (not shown) may initially apply one or both support assemblies (110, 112) to the application device surfaces (816, 818).

[0087] Figure 28BThe attached material is shown attached to the stitching surface of the pivotable anvil (18) and lower jaw (16) of the end effector (12). Once the support assembly (110, 112) is positioned on the application device surface (816, 818), the handle (802, 804) of the application device (800) is pressed together, thereby compressing the spring (806) and causing the application device arm (808, 810) to pivot about the axis (820, 821). As the handles (802, 804) come closer together, the flexible central portions (809, 811) of the application arms (808, 810) deflect away from each other and become more convex to contact the inward-facing surfaces (828, 830) of the application arms (808, 810) and cause the application arms (808, 810) to unfold in opposite directions via the elastic pivot point (426) until the support assemblies (110, 112) adhere to the pivotable anvil (18) and the lower jaw (16), respectively. Thereafter, the handles (802, 804) can be released by the user, thereby reversing the pivoting motion of the application arms (808, 810) and disengaging them from the support assemblies (110, 112) while they remain adhered to the pivotable anvil (18) and the lower jaw (16). The end effector (12) can then be removed from the application device (800).

[0088] In some configurations, it may be desirable to include a fracture feature to ensure that the application device (800) does not apply excessive pressure to the end effector (12) when applying the support assembly (110, 112). For example, one or more fracture features, such as notches (832, 834), may be included on the application device arm (808, 810). In the illustrated example, the notches (832, 834) are included between the handle (802, 804) and the pin (812), and the arm (808, 810) is configured to fracture at the notches (832, 834) respectively if the arm (808, 810) is subjected to forces exceeding a certain limit when applying the support assembly (110, 112).

[0089] C. Third selectively expandable auxiliary application device Figures 29A to 29C Another exemplary application device (900) is shown, configured to apply adjunct material to the jaws (e.g., lower jaws (16)) of the end effector (12) of the surgical suture device (10). Figure 29A As is best seen, apart from the differences described below, the application device (900) of this example may be similar to the auxiliary application device (210) (see below). Figure 11Specifically, the application device (900) includes a body (902) defining an open end (904) and a closed end (906). The open end (904) is configured to receive an end effector (12), as will be described in more detail below. The application device (900) also includes a first housing (908a) and a second housing (908b), each of which together generally defines a “U” shape to present the open end (904). A contact structure in the form of an expandable wedge (910) is inserted between the first housing (908a) and the second housing (908b). The wedge (910) of this example is configured to support a pair of support assemblies (110) on one side (911a) of the wedge (910) and another pair of support assemblies (112) on the other side (911b) of the wedge (910). The wedge (910) is exposed in a recess formed between the forks of the “U” configuration of the first housing (908a) and the second housing (908b). Each support assembly (110, 112) is respectively disposed in a separate pair of corresponding portions to avoid crossing the slots (42, 49) of the anvil (18) and the staple cartridge (37) (see... Figure 3 However, the wedge (910) can equally easily support the wide-type support assembly (110, 112) that spans the slots (42, 49) of the anvil (18) and the nail cartridge (37) individually.

[0090] like Figure 29B As shown, the application device (900) also includes a fluid connector (912) and a fluid conduit (914) fluidly connected to the wedge (910). The fluid connector (912) is positioned at the closed end (906) of the housing (902) and is configured to connect with an application device expansion mechanism in the form of a pump (918). In some types, the pump (918) may be an expandable flexible bladder filled with air, while in other types, the pump (918) may be a similar pumping device pre-filled with liquid (such as water or brine) that can be actuated by a user to discharge the liquid. The fluid connector (912) may be any suitable fluid-sealed connector known in the art, such as a Luer interface or snap-fit ​​connector, configured to connect with the complementary connector (920) of the pump (918). When connected, the fluid connectors (912, 920) define a lumen configured to deliver fluid (e.g., air, water, brine, etc.) from the pump (918) through the fluid conduit (914) in a direction toward the open end (904) of the chamber (902). As will be described in more detail below, the fluid conduit (914) is configured to engage with the wedge (910) such that when fluid is received from the fluid conduit (914), the wedge (910) is in a first state (see...) Figure 29B ) transition to the second state (see Figure 29CThis causes the opposing sides (911a, 911b) of the wedge (910) to expand in a relatively outward direction, each away from the longitudinal axis (934), thereby applying the support assembly (110, 112) to the pivotable anvil (18) and the lower jaw (16). In some types, the fluid connector (920) or fluid conduit (914) includes a check valve (928) to ensure that the fluid pressure remains constant within the fluid conduit (914) until the user disengages the pump (918) from the housing (902).

[0091] The wedge (910) includes first and second contact members in the form of first and second application device surfaces (922, 924), each configured to apply auxiliary material to the end actuator (12) of the suture instrument (10). Specifically, a first side (911a) of the wedge (910) includes a first application device surface (922), and a second side (911b) of the wedge (910) includes a second application device surface (924). The first and second application device surfaces (922, 924) engage at a point (926) on the wedge (910) such that the surfaces (922, 924) are movably coupled to each other. The wedge (910) may be made of any one or more materials that provide sufficient stiffness at each application device surface (922, 924) to receive and apply the support assembly (110, 112), while also providing sufficient flexibility to repeatedly expand and contract as pressure is applied from the pump (918) to cause each application device surface (922, 924) to expand outward to apply the support assembly (110, 112). In some examples, the wedge (910) may be made of an elastomeric material (e.g., silicone) having a hollow interior, the wedge facing as... Figure 29A and Figure 29B The collapsed or flattened configuration shown is biased and is configured to expand when it is filled with fluid.

[0092] As described above, the first application device surface (922) is configured to receive the support assembly (110) thereon for application to the pivotable anvil (18), and the second application device surface (924) is configured to receive the support assembly (112) thereon for application to the lower jaw (16). The support assembly (110) is placed on the first application device surface (922) such that the upper adhesive layer (116) faces outwards away from the first application device surface (922), and the support assembly (112) is placed on the second application device surface (924) such that the lower adhesive layer (120) faces outwards away from the second application device surface (924), thereby allowing the upper adhesive layer and the lower adhesive layer (116, 120) to adhere to the pivotable anvil (18) and the lower jaw (16), respectively, when the support assembly (110, 112) is applied by the application device (900). In some embodiments, the first and second application device surfaces (922, 924) and the support assemblies (110, 112) include corresponding features, such as clamping arms and clamping arm fingers (not shown), to hold the support assemblies (110, 112) in place and to ensure proper and secure alignment and positioning of the support assemblies (110, 112) on the application device surfaces (922, 924) before they are applied to the pivotable anvil (18) and lower jaws (16), respectively. However, various suitable methods and structures are also contemplated for securely and removably positioning the support assemblies (110, 112) on the application device surfaces (922, 924). In some embodiments, a user using a separate device (not shown) may initially apply one or both support assemblies (110, 112) to the application device surfaces (922, 924).

[0093] Figure 29CThe attachment material is shown to be fixed to the sutured surfaces of the pivotable anvil (18) and lower jaw (16) of the end effector (12). Once the support assembly (110, 112) is positioned on the application device surfaces (922, 924), the end effector (12) is placed in place to apply the support assembly (110, 112), and the pump (918) is coupled to the chamber (902). The user can then grasp and squeeze the pump (918) once or multiple times to expel fluid (e.g., air, water, brine, etc.) from the pump (918) through the fluid conduit (914). The fluid delivered through the fluid conduit (914) is pressurized to expand the wedge (910), thereby causing the application device surfaces (922, 924) to expand and unfold in the opposite outward direction. When the application device surfaces (922, 924) are deployed in the opposite outward direction, the support assembly (110, 112) can be applied to the end effector (12) without any actuation of the pivotable anvil (18) or lower jaw (16).

[0094] The fluid pressure applied to the wedge (910) within the fluid conduit (914) can then be released by the user by disengaging the pump (918), thereby releasing fluid from the fluid conduit (914). Releasing fluid from the fluid conduit (914) reverses the unfolding of the application device surfaces (922, 924), thereby disengaging the support assemblies (110, 112) from their engagement while they remain adhered to the pivotable anvil (18) and lower jaw (16). The end actuator (12) can then be removed from the application device (900).

[0095] D. Fourth selectively expandable auxiliary application device Figure 30Another exemplary application device (1000) is shown, configured to apply adjunct material to the jaws (e.g., lower jaws (16)) of the end effector (12) of a surgical suture device (10). Except for the differences described below, the application device (1000) is configured to have the same structure and function as the application device (900). As an alternative to the pump (918) of the application device (1000), the application device (900) is configured to accept fluids (1002) (e.g., air, water, saline, etc.) injected using an application device expansion mechanism in the form of a syringe (1004) or other similar fluid injection devices known and used in the art. To operate the application device (1000) to apply the support (110, 112), i.e., to expand the expandable wedge (1014) and extend the application device surfaces (1022, 1024) outward, the user can connect the syringe (1004) to the fluid connector (1006) of the housing (1008) and actuate the plunger (1010) in the distal longitudinal direction along the axis (1012). To retract the application device surfaces (1022, 1024) inward, the user can retract the plunger (1010) proximally along the longitudinal axis (1012), thereby drawing fluid (1002) from the wedge (1014) and back into the syringe (1004) via the fluid conduit (1020).

[0096] E. Fifth selectively expandable auxiliary application device Figures 31A to 31CAnother exemplary application device (1100) is shown, configured to apply adjunct material to the jaws (e.g., lower jaws (16)) of the end effector (12) of a surgical suture device (10). Except for the differences described below, the application device (1100) is configured to have the same structure and function as the application devices (900, 1000). As an alternative to the pump (918) of the application device (1100) and the syringe (1004) of the application device (900), the application device (1000) is configured to accept compressed gas (1102) (e.g., air, CO2, etc.) injected using an application device expansion mechanism in the form of a canister (1104) or other similar injection devices known and used in the art. In order to operate the application device (1100) to apply the support (110, 112), that is, to expand the wedge (1114) and extend the application device surfaces (1122, 1124) of the wedge (1114) outward, the user can connect the canister (1104) to the fluid conduit (1106) of the chamber (1108) via the fluid connector (1110). Thus, the canister (1104) may include a connector (shown as a thread (1112)) configured to engage with the fluid connector (1110), and a thin seal (1116) configured to be pierced by a sharp tip (1130) formed by the proximal end (1128) of the fluid conduit (1106) to release compressed gas (1102) from the canister outlet (1118).

[0097] In the illustrated example, the user connects the can (1104) to the container (1108) by screwing the connector (1112) of the can (1104) into the fluid connector (1110), thereby translating the can (1104) along the axis (1120) in the distal longitudinal direction. Once the can (1104) is fully connected to the container (1108) and the support assemblies (110, 112) have been applied to the application device surfaces (1122, 1124) of the wedge (1114), the end effector (12) can be positioned for application, as follows. Figure 31B As shown. At this stage, the seal (1116) is positioned adjacent to the sharp tip (1130) of the rigid piercing mechanism (1140), whereby the proximal end of the fluid conduit (1106) is positioned within the hollow portion (1144) defined at the proximal end of the rigid piercing mechanism (1140). The seal (1142) prevents fluid leakage in the event that the fluid conduit (1106) is inserted into the hollow portion (1144) of the rigid piercing mechanism (1140). To expel the compressed gas (1102) from the canister (1104), the anvil portions (90a, 90b) (see...) Figure 3 , Figure 6 , Figure 31B and Figure 31CThe device is configured to push against the distal end (1146) of the rigid piercing mechanism (1140) near the distal tip (1126) of the wedge (1114), thereby causing the rigid piercing mechanism (1140) to translate proximally (i.e., toward the can (1104)). As the rigid piercing mechanism (1140) translates proximally, the sharp tip (1130) pierces the seal (1116) and allows compressed gas (1102) to flow distally through the lumen defined by the fluid conduit (1106).

[0098] In an alternative configuration, the wedge (1114) can be slidably fixed relative to the housing (1108) along the longitudinal axis (1120), and the sharp tip (1130) can be integrally formed as the proximal portion of the fluid conduit (1106). Thus, the seal (1116) can be pierced by the fluid conduit (1106), and therefore the support assembly (110, 112) can be applied by the user simply screwing the can (1104) into the fluid connector (1110).

[0099] The pressure applied to the rod (1132) within the fluid conduit (1106) can then be released by the user by disengaging the canister (1104), thereby releasing gas from the fluid conduit (1106). Releasing gas from the fluid conduit (1106) reverses the unfolding or pivoting motion of the application device surfaces (1122, 1124), thereby disengaging the support assemblies (110, 112) from their engagement while they remain adhered to the pivotable anvil (18) and lower jaw (16). The end actuator (12) can then be removed from the application device (1100).

[0100] F. Sixth selectively expandable auxiliary application device Figures 32A to 32B Another exemplary application device (1200) is shown, configured to apply adjunct material to the jaws (e.g., lower jaws (16)) of the end effector (12) of a surgical suture device (10). The application device (1200) includes a contact structure having first and second application device arms (1202, 1204) configured to engage with an application device expansion mechanism in the form of a rotary actuator (1206). The application device arms (1202, 1204) of this example are configured to support a pair of support assemblies (110) on the first application device arm (1202) and another pair of support assemblies (112) on the second application device arm (1204) (the first and second application device arms (1202, 1204) together define a wedge). Each support assembly (110, 112) is respectively positioned in a separate pair of corresponding sections to avoid crossing the slots (42, 49) of the anvil (18) and the staple cartridge (37) (see...) Figure 3 However, the application arms (1202, 1204) can equally easily support wide-type support assemblies (110, 112) that span the slots (42, 49) of the anvil (18) and the staple cartridge (37) individually, respectively. The application arms (1202, 1204) are connected together using a pivoting member (shown as a pin (1208)).

[0101] The first and second application arms (1202, 1204) are each configured to apply auxiliary material to the end effector (12) of the suturing instrument (10). More specifically, the first application arm (1202) is configured to receive a support assembly (110) thereon for application to a pivotable anvil (18), and the second application arm (1204) is configured to receive a support assembly (112) thereon for application to a lower jaw (16). Specifically, the support assembly (110) is placed on the first application device arm (1202) such that the upper adhesive layer (116) faces outward away from the first application device arm (1202), and the support assembly (112) is placed on the second application device arm (1204) such that the lower adhesive layer (120) faces outward away from the second application device arm (1204), thereby allowing the upper adhesive layer and the lower adhesive layer (116, 120) to adhere to the pivotable anvil (18) and the lower jaw (16) respectively when the support assembly (110, 112) is applied by the application device (1200). In some embodiments, the first and second application arms (1202, 1204) and the support assemblies (110, 112) include corresponding features, such as clamping arms and clamping arm fingers (not shown), to hold the support assemblies (110, 112) in place and to ensure proper and secure alignment and positioning of the support assemblies (110, 112) on the application arms (1202, 1204) before they are applied to the pivotable anvil (18) and lower jaws (16), respectively. However, various suitable methods and structures are also contemplated for securely and removably positioning the support assemblies (110, 112) on the application arms (1202, 1204). In some embodiments, a user using a separate device (not shown) may initially apply one or both support assemblies (110, 112) to the application arms (1202, 1204).

[0102] As from Figure 32A Transform to Figure 32BAs shown, the application arms (1202, 1204) can be expanded by the user in the opposite outward direction to apply the support assembly (110, 112) to the end effector (12). To expand the application arms ((1202, 1204)) outward, the user grasps the rotary actuator (1206) and rotates it in the first direction. The rotary actuator (1206) is coupled to a screw (1210), and the screw (1210) is rotatably coupled to each application arm (1202, 1204) via a hinge connector (1212) (shown as a hinge pin) and a translational leg (1214, 1216). The first translational leg (1214) is rotatably coupled to the underside (1218) of the first application arm (1202) via a hinge connector (shown as a hinge pin (1222)). The second translatable leg (1216) is rotatably connected to the underside (1220) of the second application arm (1204) via a hinge connector (shown as a hinge pin (1224)). When the rotary actuator (1206) rotates in the first direction, the hinge connector (1212) translates distally away from the rotary actuator (1206) toward the distal end (1226) of the screw (1210). Thus, as Figure 32B As shown, the translational legs (1214, 1216) push the application device arms (1202, 1204) in opposite directions relative to each other to apply the support assembly (110, 112) to the end effector (12). The rotary actuator (1206) can then rotate in the opposite second direction, which reverses the unfolding or pivoting motion of the application device arms (1202, 1204), thereby disengaging the support assembly (110, 112) from the support assembly (110, 112) while it remains adhered to the pivotable anvil (18) and lower jaw (16). The end effector (12) can then be removed from the application device (1200).

[0103] G. Seventh selectively expandable auxiliary application device Figures 33A to 33CAnother exemplary application device (1300) is shown, configured to apply adjunct material to the jaws (e.g., lower jaws (16)) of the end effector (12) of a surgical suture device (10). Except for the differences described below, the application device (1300) is configured to have the same structure and function as the application devices (900, 1000, 1100). As an alternative to the pump (918) of the application device (1300), the syringe (1004) of the application device (900), and the canister (1104) of the application device (1000), the application device (1100) includes a contact structure in the form of a selectively expandable application device (1302) and an application device expansion mechanism in the form of a removable clip (1304). The application device (1300) includes a housing (1316) defining a closed end (1318) and an open end (1320) and a pair of retaining members (1306, 1308) operable to compress the upper surface (1310) and lower surface (1312) of the expandable application device (1302), such as Figure 33A and Figure 33B As shown. The expandable application device (1302) may be made of compressible foam material biased to an expanded state. In addition, the expandable application device (1302) may be formed as a V-shaped wedge that provides a shape complementary to the pivotable anvil (18) and the lower jaw (16), which is operable to securely attach the support assembly (110, 112) to the pivotable anvil (18) and the lower jaw (16) when the expandable application device (1302) expands between the pivotable anvil (18) and the lower jaw (16).

[0104] The upper and lower application device surfaces (1310, 1312) are each configured to apply the auxiliary material to the end actuator (12) of the suturing instrument (10). More specifically, the upper application device surface (1310) is configured to receive a support assembly (110) thereon for application to a pivotable anvil (18), and the lower application device surface (1312) is configured to receive a support assembly (112) thereon for application to a lower jaw (16). Specifically, the support assembly (110) is placed on the upper application device surface (1310) such that the upper adhesive layer (116) faces outward away from the upper application device surface (1310), and the support assembly (112) is placed on the lower application device surface (1312) such that the lower adhesive layer (120) faces outward away from the lower application device surface (1312), thereby allowing the upper adhesive layer and the lower adhesive layer (116, 120) to adhere to the pivotable anvil (18) and the lower jaw (16), respectively, when the support assembly (110, 112) is applied by the application device (1300). In some models, the upper and lower application device surfaces (1310, 1312) and the support assemblies (110, 112) include corresponding features, such as clamping arms and clamping arm fingers (not shown), to hold the support assemblies (110, 112) in place and to ensure proper and secure alignment and positioning of the support assemblies (110, 112) on the application device surfaces (1310, 1312) before they are applied to the pivotable anvil (18) and lower jaws (16), respectively. However, various suitable methods and structures are also contemplated for securely and removably positioning the support assemblies (110, 112) on the application device surfaces (1310, 1312). In some models, a user using a separate device (not shown) may initially apply one or both support assemblies (110, 112) to the application device surfaces (1310, 1312).

[0105] Figure 33A An expandable application device (1302) in an initial compressed state is shown, with support assemblies (110, 112) mounted thereon. Furthermore, retaining members (1306, 1308) of the clamp (1304) ensure that the expandable application device (1302) remains in the compressed state until the end actuator (12) is positioned to apply the support assemblies (110, 112). Figure 33BThe end effector (12) is shown translated into position to apply the support assembly (110, 112). When the end effector (12) is translated into position, the tip (1322) of the pivotable anvil (18) is configured to contact a portion (1314) of the clamp (1304), thereby translating the clamp (1304) toward the closed end (1318) of the housing (1316). As the clamp (1304) translates (e.g., by sliding along the surface of the housing (1316), the retaining members (1306, 1308) are released from their position holding the expandable application device (1302) in a compressed state. Figure 33C An expandable application device (1302) is shown after the clamp (1304) has been removed and is in its expanded state, whereby the application device surfaces (1310, 1312) expand in opposite directions relative to each other to apply the support assembly (110, 112) to the end effector (12). The end effector (12) can then be removed from the application device (1300).

[0106] H. Eighth selectively expandable auxiliary application device Figures 34A to 35B Another exemplary application device (1400) is shown, configured to apply adjunct material to the jaws (e.g., lower jaws (16)) of the end effector (12) of the surgical suture device (10). Figure 34A As best seen, except for the differences described below, the application device (1400) of this example may be similar to the auxiliary application devices (210, 900, 1000, 1100, 1300). Specifically, the application device (1400) includes a housing (1402) defining an open end (1404) and a closed end (1406). The open end (1404) is configured to receive an end effector (12), as will be described in more detail below. The application device (1400) also includes a first housing (1408a) and a second housing (1408b), each of which together generally defines a “U” shape to present the open end (1404). A contact structure in the form of an expandable wedge (1410) is inserted between the first housing (1408a) and the second housing (1408b). The wedge (1410) in this example is configured to support a pair of support assemblies (110) on the first application arm (1420) and another pair of support assemblies (112) on the second application arm (1422). The wedge (1410) is exposed in a recess formed between the forks of the “U” configuration of the first housing (1408a) and the second housing (1408b). Each support assembly (110, 112) is respectively disposed in a separate pair of portions to avoid crossing the slots (42, 49) of the anvil (18) and the staple cartridge (37) (see...). Figure 3However, the wedge (1410) can equally easily support the wide-type support assembly (110, 112) that spans the slots (42, 49) of the anvil (18) and the nail cartridge (37) individually.

[0107] The application device (1400) also includes an expansion mechanism defined by an actuator member (1412), an application device actuation mechanism (1418), a rod (1416), a guide rod (1434), and application device arms (1420, 1422), which is selectively operable to switch the wedge (1410) between a non-expanded state and an expanded state, as explained in more detail below. The actuator member (1412) is capable of longitudinal translation parallel to the guide rod (1434). The actuator member (1412) includes one or more user gripping portions (1414a, 1414b) internally coupled together via the rod (1416) through the housing (1402) and the wedge (1410). The actuator member (1412) is also configured to slide distally and proximally relative to the closed end (1406) of the housing (1402). As will be described in more detail below, the actuator component (1412) or more specifically the rod (1416) is configured to actuate the application device actuation mechanism (1418) (see below). Figure 35A and Figure 35B The connection is such that when the actuator member (1412) slides distally relative to the closed end (1406) of the housing (1402), the application device actuation mechanism (1418) slides distally above the guide rod (1434) to move the application device arms (1420, 1422) from the first non-expanded position (see...). Figure 35A ) shifted to the second expansion position (see Figure 35B As will be described in more detail below, the application device actuation mechanism (1418) is also connected to the first and second application device arms (1420, 1422) of the wedge (1410).

[0108] The wedge (1410) includes first and second application arms (1420, 1422), each configured to apply auxiliary material to the end actuator (12) of the suture instrument (10). The first and second application arms (1420, 1422) are joined together at an elastic pivot point (1426) of the wedge (1410). The wedge (1410) may be made of any one or more materials that provide sufficient stiffness at each application arm (1420, 1422) to receive and apply the support assembly (110, 112), while also providing sufficient flexibility to repeatedly flex at the pivot point (1426) when pressure is applied from the application device actuation mechanism (1418) to cause each application arm (1420, 1422) to expand outward to apply the support assembly (110, 112). In some examples, the wedge (1410) may be made of a resilient metal or metal alloy and is biased into a "closed" configuration, such as... Figure 34A and Figure 35A As shown.

[0109] A first application arm (1420) is configured to receive a support assembly (110) thereon for application to a pivotable anvil (18), and a second application arm (1422) is configured to receive a support assembly (112) thereon for application to a lower jaw (16). The support assembly (110) is placed on the first application arm (1420) such that the upper adhesive layer (116) faces outwards away from the first application arm (1420), and the support assembly (112) is placed on the second application arm (1422) such that the lower adhesive layer (120) faces outwards away from the second application arm (1422), thereby allowing the upper adhesive layer and the lower adhesive layer (116, 120) to adhere to the pivotable anvil (18) and the lower jaw (16), respectively, when the support assembly (110, 112) is applied by the application device (1000). In some embodiments, the first and second application arms (1422, 1424) and the support assembly (110, 112) include corresponding features, such as clamping arms and clamping arm fingers (not shown), to hold the support assembly (110, 112) in place before it is applied to the pivotable anvil (18) and lower jaw (16), respectively, and to ensure proper and secure alignment and positioning of the support assembly (110, 112) on the application arms (1420, 1422). However, various suitable methods and structures are also contemplated for securely and removably positioning the support assembly (110, 112) on the application arms (1420, 1422). In some models, a user using a separate device (not shown) may initially apply one or two support assemblies (110, 112) to the application device arm (1420, 1422).

[0110] Figure 34B and Figure 35BThe stitching surface of the pivotable anvil (18) and lower jaw (16) of the end effector (12) is shown, with the auxiliary material secured to it. Once the support assembly (110, 112) is positioned on the application arm (1420, 1422), the end effector (12) is positioned to apply the support assembly (110, 112), and the user can then grasp the gripper (1414a, 1414b) and slide the actuator member (1412) distally relative to the closed end (1406) of the housing (1402) to shift the application device actuation mechanism (1418) of the wedge (1410) to the distal position. The distal end (1440) of the application device actuation mechanism (1418) is adjacent to a compression spring (1432) disposed above the distal end (1442) of the guide rod (1434). The spring (1432) is configured to apply proximal pressure to the application device actuation mechanism (1418) to counteract the distal pressure provided by the application device actuation mechanism (1418). Therefore, when pressure is removed from the application device actuation mechanism (1418), such as when the user slides the actuator member (1412) proximal relative to the closed end (1406), the application device actuation mechanism (1418) translates proximal back to its initial position, as... Figure 34A and Figure 35A As shown.

[0111] like Figure 35A and Figure 35BAs shown, the application device actuation mechanism (1418) is movably coupled to one end (1446) of one or more actuator arms (1444), and the opposite ends (1448) of the one or more actuator arms (1444) are coupled to the wedge (1410). Specifically, each actuator arm (1444) is rotatably coupled to the interior or underside of the first application device arm (1420) or the second application device arm (1422). Thus, the application device actuation mechanism (1418), the actuator arms (1444), and the wedge (1410) are configured to operate in a manner similar to that of an umbrella. That is, when the application device actuation mechanism (1418) translates in the distal direction above the guide rod (1434), the actuator arm (1444) is hinged to the application device actuation mechanism (1418) at the first end (1446) of the actuator arm (1444) and also hinged to the internal connection of the wedge (1410) at the second end (1448) of the actuator arm (1444), thereby pushing the first and second application device arms (1420, 1422) to unfold in opposite outward directions. The distal translation of the application device actuation mechanism (1418) also compresses the spring (1432). When the application device arms (1420, 1422) unfold in opposite outward directions, the support assembly (110, 112) can be applied to the end effector (12) without any actuation of the pivotable anvil (18) or the lower jaw (16).

[0112] The user pressure applied to the actuation mechanism (1418) of the application device via the actuator member (1412) can then be released by the user by sliding the actuator member (1412) proximally, thereby disengaging from the support assembly (110, 112) while it remains adhered to the pivotable anvil (18) and the lower jaw (16). The end effector (12) can then be removed from the application device (1400).

[0113] I. Ninth Selectively Expandable Auxiliary Application Device Figures 36A to 36BAnother exemplary application device (1500) is shown, configured to apply adjunct material to the jaws (e.g., lower jaws (16)) of the end effector (12) of a surgical suture device (10). Except for the differences described below, the application device (1500) is configured to have the same structure and function as the application devices (900, 1000, 1100, 1400). Similarly, the application device (1500) includes an application device actuation mechanism (1502) configured to translate longitudinally relative to the housing (1504) to spread the application device arms (1506, 1508) apart and apply one or more support assemblies (110, 112) to the end effector (12). This example application device (1500) includes an expansion mechanism in the form of a user-activated motor (1510). To operate the motor (1510) to apply the supports (110, 112), i.e., to extend the application arms (1506, 1508) of the wedge (1512) outward, the user can actuate an actuator, such as a button (1514) located on the housing (1504). To retract the application arms (1506, 1508), the user can actuate the button (1514) again. Alternatively, an additional actuator, such as a button (1516), may be included on the housing (1504) to operate the motor (1510) in the reverse direction.

[0114] J. Tenth Selectively Expandable Auxiliary Application Device Figures 37A to 37B Another exemplary application device (1600) is shown, configured to apply adjunct material to the jaws (e.g., lower jaws (16)) of the end effector (12) of a surgical suture device (10). Except for the differences described below, the application device (1600) is configured to have the same structure and function as the application devices (900, 1000, 1100, 1400, 1500). Similarly, the application device (1600) includes an application device actuation mechanism (1602) coupled to a platform (1620), configured to translate longitudinally relative to the housing (1604) to deploy the application device arms (1606, 1608) and apply one or more support assemblies (110, 112) to the end effector (12).

[0115] The application device (1600) of this example includes an expansion mechanism in the form of a user-actuable actuation component (1610). To cause the application device actuation mechanism (1610) to translate distally to apply the supports (110, 112), i.e., to extend the application device arms (1606, 1608) of the wedge-shaped member (1612) (i.e., the contact structure) outward, the user can operate an actuator, such as a squeeze button (1614a, 1614b) located on the housing (1604). Figure 37A and Figure 37B As shown, each squeeze button (1614a, 1614b) includes a distal retaining flange (1616a, 1616b) that contacts the tabs (1618a, 1618b) of the platform (1620). Furthermore, the proximal end (1622) of the platform (1620) contacts a compression spring (1624), whereby the compression spring (1624) biases the platform (1620) in a distal direction (i.e., toward the opening end (1626) of the compartment). Therefore, when the proximal ends (1628a, 1628b) of the actuators (1614a, 1614b) are pressed together, the distal ends (1630a, 1630b) of the actuators (1614a, 1614b) translate apart, thereby releasing the tabs (1618a, 1618b) from the retaining flanges (1616a, 1616b). Then, the spring (1624) pushes the platform (1620) and the application device actuation mechanism (1602) distally. When the application device actuation mechanism (1602) and wedge (1612) include the same features as the application device (1400, 1500) described herein, the application device arms (1606, 1608) extend in the opposite outward direction to apply the support assembly (110, 112) to the end effector (12) without any actuation of the pivotable anvil (18) or lower jaw (16). To retract the application device arms (1606, 1608), the user may squeeze the distal ends (1630a, 1630b) of the actuators (1614a, 1614b) to return the actuators (1614a, 1614b) and the application device arms (1606, 1608) to their initial positions, such as... Figure 37A and Figure 38A As shown.

[0116] K. Eleventh Selectively Expandable Auxiliary Application Device Figures 39A to 40BAnother exemplary application device (1700) is shown, configured to apply adjunct material to the jaws (e.g., lower jaws (16)) of the end effector (12) of a surgical suture device (10). Apart from the differences described below, the application device (1700) is configured to have the same structure and function as the application devices (900, 1000, 1100, 1400, 1500, 1600). Similarly, the application device (1700) includes an application device actuation mechanism (1702) that can be selectively actuated by a user to deploy the application device arms (1706, 1708) of the wedge (1712) (i.e., the contact structure of this type) and apply one or more support assemblies (110, 112) to the end effector (12). The application device (1700) also includes an expansion mechanism defined by the actuator component (1710), the application device actuation mechanism (1702), and the application device arms (1706, 1708), which is selectively operable to switch the wedge (1712) between a non-expanded state and an expanded state, as explained in more detail below. The actuation component (1710) is configured to be selectively rotated by the user about a longitudinal axis (1704) and is also configured to be coupled to the application device actuation mechanism (1702), thereby causing the application device actuation mechanism (1702) to rotate about the longitudinal axis (1704). The application device actuation mechanism (1702) is formed in an elongated shape, for example, as Figures 40A to 40B The elliptical shape is shown. The application device actuation mechanism (1702) is disposed between the application device arms (1706, 1708) and is configured to contact the application device arms (1706, 1708) and apply a radially outward force relative to the longitudinal axis (1704) to them when the application device actuation mechanism (1702) rotates about the longitudinal axis (1704). Although an elliptical shape is shown, various alternative elongated application device actuation mechanism (1702) shapes are envisioned.

[0117] like Figure 39A and Figure 40A As shown, the elongated sides (1716a, 1716b) of the application device actuation mechanism (1702) rotate to the initial position (i.e., the position before extending the application device arms (1706, 1708)) to contact the application device arms (1706, 1708). Figure 39B and Figure 40BAs shown, the user can grasp the actuation assembly (1710) located on the chamber (1714) and rotate it 90 degrees about the longitudinal axis (1704), thereby extending the application device arms (1706, 1708) to apply the support (110, 112). When the application device actuation mechanism (1702) rotates, the opposite ends (1718a, 1718b) of the application device actuation mechanism (1702) rotate to contact the application device arms (1706, 1708) of the wedge (1712) to push the application device arms (1706, 1708) apart. In some configurations, the elongated sides (1716a, 1716b) of the application device actuation mechanism (1702) can be shortened or lengthened depending on the separation distance between the pivotable anvil (18) and the lower jaw (16) of the end effector (12), thereby reducing or increasing the separation distance of the application device arms (1706, 1708) in the expanded state, respectively. To retract the application device arms (1706, 1708), the user can rotate the actuation assembly (1710) 90 degrees in the same or opposite direction as before, so that the application device arms (1706, 1708) return to their initial positions, such as... Figure 39A and Figure 40A As shown.

[0118] L. Twelfth Selectively Expandable Auxiliary Application Device Figures 41A to 41B Another exemplary application device (1800) is shown, configured to apply adjunct material to the jaws (e.g., lower jaws (16)) of the end effector (12) of a surgical suture device (10). Except for the differences described below, the application device (1800) is configured to have the same structure and function as the application devices (900, 1000, 1100, 1400, 1500, 1600, 1700). This example application device (1800) includes a torsion spring (1802), a damper (1804), a latch (1806), and application device arms (1808, 1810). The application arms (1808, 1810) may be formed as a V-shaped wedge, which provides a shape complementary to the pivotable anvil (18) and lower jaw (16). When the application arms (1808, 1810) are open and positioned between the pivotable anvil (18) and lower jaw (16), the V-shaped wedge is operable to securely attach the support assembly (110, 112) to the pivotable anvil (18) and lower jaw (16). The application arms (1808, 1810) are pivotally coupled together at their proximal ends (1820, 1822), and a torsion spring (1802) is pivotally coupled adjacent to the proximal ends (1820, 1822).

[0119] The application arms (1808, 1810) cooperate to define the contact structure and are each configured to apply the auxiliary material to the end actuator (12) of the suturing instrument (10). More specifically, the upper application arm (1808) is configured to receive a support assembly (110) thereon for applying it to a pivotable anvil (18), and the lower application arm (1810) is configured to receive a support assembly (112) thereon for applying it to a lower jaw (16). Specifically, the support assembly (110) is placed on the upper application device arm (1808) with the upper adhesive layer (116) facing outward away from the upper application device arm (1808), and the support assembly (112) is placed on the lower application device arm (1810) with the lower adhesive layer (120) facing outward away from the lower application device arm (1810), thereby allowing the upper adhesive layer and the lower adhesive layer (116, 120) to adhere to the pivotable anvil (18) and the lower jaw (16), respectively, when the support assembly (110, 112) is applied by the application device (1800).

[0120] Figure 41A The application device arms (1808, 1810) in their unexpanded, pre-application state are shown, with support assemblies (110, 112) mounted thereon. The application device arms (1808, 1810) are biased to expand in the opposite direction by a torsion spring (1802). The torsion spring (1802) is disposed at the base of the “V” shape defined by the application device arms (1808, 1810) and includes spring arms (1812, 1814) extending across the inner surfaces (1816, 1818) of the application device arms (1808, 1810), respectively. The application device arms (1808, 1810) are also connected to a latch (1806). The latch (1806) is configured to be pivotally connected to the application device arm (1810) at one end and includes a hook (1821) at the opposite end. In some examples, the latch (1806) may alternatively be configured to be pivotally coupled to the application arm (1808) at one end. The hook (1821) of the latch (1806) is also configured to be releasably coupled to another of the first application arm (1808) or the second application arm (1810) to prevent the application arm (1808, 1810) from unfolding due to the unfolding force provided by the torsion spring (1802). The torsion spring (1802) and the latch (1806) cooperate to define an expansion mechanism configured to be actuated by the user to move the application device (1810) from a non-expanded state (see...). Figure 41A ) transitions to an expanded state (see Figure 41BAdditionally, a damper (1804) or alternatively another similar energy damping device is attached to the inner surface (1816, 1818) of the application device arm (1808, 1810).

[0121] like Figure 41B As shown, the user can pivot the hook (1821) of the latch (1806) away from the application arm (1808), thereby allowing the torsion spring (1802) to push the application arm (1808, 1810) in the opposite direction. As described above, the application arm (1808, 1810) unfolded in the opposite direction is operable to apply the support assembly (110, 112) to the end effector (12). When the hook (1821) is removed and the application arm (1808, 1810) unfolds, the damper (1804) is configured to reduce the rate of unfolding movement of the application arm (1808, 1810). Therefore, when the support assembly (110, 112) is applied, the damper (1804) ensures that the application arm (1808, 1810) does not unfold too quickly, causing damage to the end effector (12). Then, the end effector (12) can be removed from the application device (1300).

[0122] V. An exemplary accessory application device for individually applying accessory elements to the jaws of a surgical stapler. In some cases, it may be desirable to provide an adjunct application device operable to independently and individually apply adjunct elements (e.g., support assemblies or tissue thickness compensators) to each jaw of the surgical stapler end effector while the jaws remain open. (See below for details.) Figures 42 to 53 Each of the exemplary application devices described provides such functionality.

[0123] A. A first application device for separate adjunctive application Figures 42 to 43C Another exemplary application device (1910) is shown, configured to apply adjunct materials (e.g., support assemblies (110, 112) or tissue thickness compensators) to the jaws (e.g., lower jaws (16) or anvil (18)) of the end effector (12) of a surgical stapler (10). The application device (1910) adjusts the thickness of the anvil (18) or lower jaws (16), thereby allowing the application device (1910) to properly apply the adjunct materials to the anvil (18) or lower jaws (16), respectively. Figure 42As shown, the application device (1910) includes a housing (1912), an arm (1914), an elastic feature (1916), and a connecting feature (shown as a pin (1918)). The housing (1912) includes a main body member (1920), a protrusion (1922) extending from the main body member (1920), and a first contact feature (1924). The first contact feature (1924) extends from the main body member (1920) and is translatably fixed relative to the main body member (1920). The arm (1914) can be connected to the housing (1912) using a pin (1918) that extends through a cavity (not shown) provided in the main body member (1920) of the housing (1912). However, other suitable structures for connecting the housing (1912) and the arm (1914) are also conceivable. The arm (1914) includes a proximal end (1926) and a distal end (1928), wherein a second contact feature (1930) is provided at the distal end (1928) of the arm (1914).

[0124] like Figure 42 As shown, the resilient feature (1916) can be connected to the main body member (1920) of the housing (1912) and the proximal end (1926) of the arm (1914). The arm (1914) can be rotatably biased toward the housing (1912) using the resilient feature (1916) and the pin (1918). The resilient feature (1916) is configured to bias the arm (1914), including the second contact feature (1930), relative to the first contact feature (1924), as... Figures 43A to 43B The application of compressive force secures the auxiliary material to the desired jaws. The resilient feature (1916) may include at least one spring operatively coupled to the housing (1912). Figure 42 As shown, the elastic feature (1916) includes a tension spring (1932). A first end (1942) of the tension spring (1932) is connectable to the main body member (1920), and a second end (1944) of the tension spring (1932) is connectable to the proximal end (1926) of the arm (1914). The tension spring (1932) can bias the arm (1914) including the second contact feature (1930) relative to the first contact feature (1924) by applying a compressive force. Figure 42 The first contact feature (1924) and the second contact feature (1930) are shown separated from each other by a certain distance in a neutral configuration (i.e., a stationary configuration). Alternatively, it is envisioned that the second contact feature (1930) can contact the first contact feature (1924) in the neutral configuration so as to apply a predetermined contact force to the first contact feature (1924) before the auxiliary material is secured to the jaws of the end effector (12) using the application device (1910).

[0125] The first contact feature (1924) and / or the second contact feature (1930) may include a roller. For example... Figure 42 As shown, the first contact feature (1924) includes a roller (1934) connected to the main body member (1920) via a connecting feature (1936). Similarly, the second contact feature (1930) includes a roller (1938) connected to the arm (1914) via a connecting feature (1940). The rollers (1934, 1938) are configured to apply a compressive force as they move along the jaws. Specifically, the roller (1938) applies a compressive force to the jaws of the end effector (12), while the roller (1934) applies a reaction force. Therefore, the roller (1934) can be stationary and not deflected relative to the main body member (1920). Although the rollers (1934, 1938) are in Figure 42 The roller is shown as a single elongated roller, but other suitable rollers are also contemplated, including rollers with discontinuous contact surfaces. The connecting features (1936, 1940) may include, for example, a pin or another suitable connecting element along a feature that allows the roller (1934) to rotate relative to the body member (1920) and allows the roller (1938) to rotate relative to the arm (1914). While the first contact feature (1924) and the second contact feature (1930) are shown as including rollers (1934, 1938), it is also contemplated that the first contact feature (1924) and the second contact feature (1930) may include low-friction elements that can slide along the outer surface of the auxiliary material or jaws.

[0126] Figures 43A to 43C The diagram shows the attachment of auxiliary material to the suture surface of the jaws of the end effector (12). As described above, the auxiliary material may include support assemblies (110, 112), tissue thickness compensation elements, or other suitable materials. The suture surface is intended to include the upper plate (72) of the staple cartridge (37) including staple holes (50) or the contact surface (52) of the anvil (18) including staple forming recesses (53), such as Figure 3 As shown. It is also envisioned that the anvil (18) may be disposed on the lower jaws and the staple cartridge (37) may be disposed on the upper jaws. The application device (1910) is shown as securing the support assembly (110) to the anvil (18), wherein the support assembly (110) is already at least partially disposed on the anvil (18). In some models, a user using a separate device (not shown) may first apply the support assembly (110) to the anvil (18), such that the application device (1910) presses the support assembly (110) more firmly against the anvil (18) to secure the support assembly (110) in place with the desired pressure. In other models, the application device (1910) may include or be coupled to a material dispenser for supplying auxiliary materials, which is similar to the one referenced below. Figures 44 to 45B Detailed description of the material dispenser (2030).

[0127] Figure 43A It shows Figure 42 The application device (1910) and Figure 3 A cross-sectional view of the end effector (12), wherein the application device (1910) secures the support assembly (110) to the distal portion (54) of the anvil (18) of the end effector (12). As described above, the support assembly (110) includes an upper adhesive layer (116) configured to adhere the support assembly (110), including the support body (114), to the contact surface (52) of the anvil (18). Figure 43A As shown, the anvil (18) includes an outer surface (58) disposed at a 180-degree angle to the contact surface (52). The roller (1938) of the second contact feature (1930) is configured to apply a compressive force to compress the support assembly (110) against the distal portion (54) of the anvil (18), thereby securing the upper adhesive layer (116) of the support assembly (110) to the contact surface (52), thus fixing the upper adhesive layer (116) to the contact surface (52). Figures 43A to 43B As shown, rollers (1934, 1938) are arranged opposite to each other along the compression plane (CP). Roller (1934) can rotate in the opposite direction relative to roller (1938). Roller (1938) applies a compressive force when roller (1938) moves along the outer surface (58) of anvil (18) and roller (1934) moves along the contact surface (52) of anvil (18). In some types, roller (1938) may apply a compressive force when roller (1938) moves along the contact surface (52) of anvil (18) and roller (1934) moves along the outer surface (58) of anvil (18).

[0128] Figure 43B It shows Figure 43A A cross-sectional view of the application device (1910) and end actuator (12), wherein after the roller (1934) rolls along the outer surface (58) of the anvil (18), the application device (1910) applies the support assembly (110) to the proximal portion (56) of the anvil (18), and the roller (1938) rolls along the support body (114) to adhere the upper adhesive layer (116) to the contact surface (52). While the user may typically attach the support assembly (110) to the distal portion (54) of the anvil (18) and then to the proximal portion (56) of the anvil (18), it is also envisioned that the user may attach the support assembly (110) to the proximal portion (56) of the anvil (18) and then to the distal portion (54) of the anvil (18).

[0129] Figure 43C It shows Figure 43B A cross-sectional view of the end effector (12) is shown, wherein the support assembly (110) is fixed to the contact surface (52) of the anvil (18), and the support assembly (112) is fixed to the upper deck (72) of the lower jaw (16) of the end effector (12). As shown, the support assembly (112) includes a lower adhesive layer (120) configured to adhere the support assembly (112), including the support body (118), to the upper deck (72) of the lower jaw (16). The application of the support assembly (112) can be similar to the application of the support assembly (110) described above. For example, as the roller (1934) moves along the outer surface (60) of the lower jaw (16), the roller (1938) can apply a compressive force, and the roller (1938) moves the support body (118) to adhere the lower adhesive layer (120) to the upper deck (72) of the lower jaw (16). However, it is also envisioned that as the roller (1934) moves along the support body (114), the roller (1938) can apply a compressive force to adhere the lower adhesive layer (120) to the upper deck (72) of the lower jaw (16), and the roller (1938) moves along the outer surface (60) of the lower jaw (16). Since the lower jaw (16) is shown to be thicker than the anvil (18), the tension spring (1932) can be further stretched to further separate the rollers (1934, 1938). Stretching the tension spring (1932) can result in a greater spring force, causing the lower jaw (16) to be inserted between the rollers (1934, 1938).

[0130] B. A second application device for separate adjunctive application Figure 44 To the diagram Figure 45B Another exemplary application device (2010) is shown, configured to apply adjunct material to the jaws (e.g., lower jaw (16) or anvil (18)) of the end effector (12) of a surgical stapler (10). The application device (2010) adjusts the thickness of the anvil (18) or lower jaw (16) to allow the application device (2010) to properly apply adjunct material to the anvil (18) and lower jaw (16). Thus, applying a support assembly (112) to a lower jaw (16) including a staple cartridge (37) using the application device (2010) is similar to the application of the support assembly (110) described above. Figure 44As shown, the application device (2010) includes a housing (2012), an arm (2014), and an elastic feature (2016). The housing (2012) includes a base (2018), a first post (2020), a second post (2022), and a first contact feature (2024). The first post (2020) and the second post (2022) extend outward from the base (2018). The first post (2020) and the second post (2022) are shown as parallel to each other. Optionally, the arm (2014) can translate along a slot (2026) provided in the first post (2020) and the second post (2022). The arm (2014) includes a second contact feature (2028).

[0131] The housing (2012) may include an accessory material dispenser (2030) that dispenses accessory material from a reel (2032) using a first contact feature (2024). As shown, the accessory material is a continuous support assembly (2033). The support assembly (2033) may include an adhesive surface that engages with the stitching surface. It should be understood that the material dispenser (2030) may also be constructed and operated in accordance with the teachings of U.S. Patent Publication No. 2015 / 0076212, entitled “Surgical End Effector Having Buttress Retention Features,” published March 19, 2015, the disclosure of which is incorporated herein by reference. The continuous support assembly (2033) may be dispensed at the first contact feature (2024). The first contact feature (2024) applies the support assembly (2033) to the contact surface (52). As shown in the figure, the first contact feature (2024) includes a roller (2034) fixed to the first column (2020), the second column (2022), and the material dispenser (2030) using a connecting feature (2036). Optionally, the reel (2032) can be removed from the housing (2012) by removing the connecting feature (2036) that connects the first contact feature (2024) to the material dispenser (2030). The material dispenser (2030) can deliver multiple support materials without reloading. Furthermore, the material dispenser (2030) using a single product code can dispense supports of different lengths. This can reduce the number of different support sizes that the user already has in stock or on hand.

[0132] The application device (2010) can control the force applied to the jaws from the material dispenser (2030) using an elastic feature (2016). The elastic feature (2016) can be disposed between the base (2018) of the housing (2012) and the arm (2014). The elastic feature (2016) is configured to bias the arm (2014), including the second contact feature (2028), relative to the first contact feature (2024) to apply a compressive force, such as... Figures 45A to 45B As shown. The arm (2014) is configured to translate relative to the base (2018) using an elastic feature (2016). For example, the elastic feature (2016) may include at least one spring. Figure 44 As shown, the elastic feature (2016) includes a pair of compression springs (2038). However, it is also envisioned that there may be more or fewer compression springs (2038), such as a single compression spring.

[0133] like Figures 45A to 45B As shown, a first end (2040) of the compression spring (2038) can be connected to the base (2018), and a second end (2042) of the compression spring (2038) can be connected to the arm (2014). The compression spring (2038) is configured to bias the arm (2014), including the second contact feature (2028), relative to the first contact feature (2024) by applying a compressive force. In other words, the compression spring (2038) pushes the arm (2014) upward against the outer surface (58) of the anvil (18). The compression spring (2038) disposed between the arm (2014) and the base (2018) can provide the desired applied pressure to secure the auxiliary material to the sewing surface of the jaws. Figure 44 The first contact feature (2024) and the second contact feature (2028) are shown separated from each other by a certain distance in a neutral configuration (i.e., a static configuration). Alternatively, it is envisioned that the second contact feature (2028) can contact the first contact feature (2024) in the neutral configuration so as to apply a predetermined contact force to the first contact feature (2024) before the application device (2010) secures the auxiliary material to the contact surface (52) of the upper deck (72) of the lower jaw (16) or the anvil (18).

[0134] The first contact feature (2024) and / or the second contact feature (2028) may include a roller. For example... Figure 44As shown, the second contact feature (2028) includes a pair of rollers (2044) configured to apply compressive force as the rollers (2044) move along the outer surface of the jaws. While a pair of rollers (2044) is shown, more or fewer rollers (2044) are also envisioned. The rollers (2044) of the arm (2014) allow for the smooth application of adjunct material along the length of the jaws. The arm (2014) including the rollers (2044) is configured to translate relative to the base (2018) to simultaneously contact the outer surface as the adjunct material is applied to the contact surface (52) of the upper deck (72) of the lower jaw (16) or the anvil (18) from the reel (2032). The rollers (2044) can be coupled to the arm (2014) using a coupling feature (2046). Specifically, roller (2044) is configured to apply a compressive force to the jaws of the end effector (12), while roller (2034) is configured to apply a reaction force. Therefore, roller (2034) can be stationary and not deflected relative to the base (2018). Figure 44 As shown, rollers (2034, 2044) are arranged opposite each other along the compression plane (CP). Although roller (2034) is in Figure 44 The roller is shown as a single elongated roller, but other rollers are also envisioned, including rollers with discontinuous contact surfaces or multiple discrete rollers. The connecting features (2036, 2046) may include, for example, a pin or another suitable coupling along a feature that allows the roller (2034) to rotate relative to the material dispenser (2030) and allows the roller (2044) to rotate relative to the arm (2014). While the second contact feature (2028) is shown as including the roller (2044), it is also envisioned that the second contact feature (2028) may include a low-friction element that can slide along the jaws.

[0135] Figures 45A to 45B The application and attachment of the auxiliary material to the suture surface of the jaws of the end effector (12) is shown. Specifically, Figure 45A It shows Figure 44 The application device (2010) and Figure 3 A cross-sectional view of the end effector (12), wherein the application device (2010) secures the support assembly (110) to the proximal portion (56) of the anvil (18). As shown, the support assembly (110) includes an upper adhesive layer (116) configured to adhere the support assembly (110), including the support body (114), to the contact surface (52) of the anvil (18). The outer surface (58) of the anvil (18) is disposed 180 degrees opposite to the contact surface (52). Figure 45AAs shown, the roller (2044) of the second contact feature (2028) applies a compressive force to compress the support assembly (110) against the proximal portion (56) of the anvil (18), thereby securing the upper adhesive layer (116) of the support assembly (110) to the contact surface (52). The roller (2034) can rotate in the opposite direction relative to the roller (2044). As the roller (2034) moves along the outer surface (58) of the anvil (18), the roller (2044) applies a compressive force, and the roller (2034) moves along the support body (114) to adhere the upper adhesive layer (116) to the contact surface (52) of the anvil (18). The application device (2010) applies a clamping force on the anvil (18) between the proximal tip of the roller (2034) and the center point of the roller (2044) of the arm (2014), which acts as a bottom force limiting and return device.

[0136] Figure 45B It shows Figure 45A A cross-sectional view of the application device (2010) and end actuator (12), wherein after the roller (2034) rolls along the support body (114) to adhere the upper adhesive layer (116) to the contact surface (52), the application device (2010) applies and secures the support assembly (110) to the distal portion (54) of the anvil (18), and the roller (2044) rolls along the outer surface (58) of the anvil (18). While a user may typically secure the support assembly (110) to the proximal portion (56) of the anvil (18) and then to the distal portion (54) of the anvil (18), it is envisioned that a user may secure the support assembly (110) to the distal portion (54) of the anvil (18) and then to the proximal portion (56) of the anvil (18). Applying the support assembly (112) to the lower jaw (16) including the staple cartridge (37) can be similar to the application of the support assembly (110) described above.

[0137] C. A third application device for separate adjunctive application Figures 46 to 47C Another exemplary application device (2110) is shown, configured to apply adjunct material to the jaws (e.g., anvil (18)) of the end effector (12) of the surgical suture device (10). Figure 46As shown, the application device (2110) includes a housing (2112), an arm (2114), and a hinge (2116). The hinge (2116) pivotally connects the arm (2114) to the housing (2112) at a hinge point HP, such that the arm (2114) can pivot relative to the housing (2112) to apply and secure the auxiliary material (shown as a support assembly (110)) to the anvil (18). The housing (2112) includes a first contact feature (2118) shown as a generally planar base. The first contact feature (2118) includes an inner surface (2120) and an outer surface (2122), wherein the inner surface (2120) faces the arm (2114). The arm (2114) includes a connecting portion (2124) and a second contact feature (2126) shown as a generally planar platform. The connecting portion (2124) has a first thickness (D1) to accommodate the thickness of the anvil (18). The connecting portion (2124) may include a hole (2127) to allow the jaws to extend through it, such as Figures 47A to 47C As shown. The second contact feature (2126) includes an inner surface (2128) and an outer surface (2130), wherein the inner surface (2128) faces the inner surface (2120) of the first contact feature (2118). Figures 47A to 47B As shown, the cavity (2132) is disposed between the inner surfaces (2120, 2128) of the first contact feature (2118) and the second contact feature (2126).

[0138] The second contact feature (2126) is configured to be able to open relative to the first contact feature (2118) in an open configuration (e.g., Figure 47A (as shown) and closed configurations (such as) Figure 47B Pivoting between (as shown), wherein the second contact feature (2126) pushes the support assembly (110) into contact with the suture surface. Figure 46 As shown, the second contact feature (2126) includes an inner portion (2134), an outer portion (2136), and a retaining portion (2138). The inner and outer portions (2134, 2136) are connected together by transversely brittle portions (2140, 2142). The transversely brittle portions (2140, 2142) are configured to detach when a predetermined pressure is applied to release the auxiliary material from the application device (2110). The retaining portion (2138) is located at the end of the second contact feature (2126) opposite to the hinge (2116). The transversely brittle portions (2140, 2142) are configured to break to separate the inner and outer portions (2134, 2136), except for the retaining portion (2138) that holds the inner and outer portions (2134, 2136) together.

[0139] Figures 47A to 47BAn accessory material (shown as a support assembly (110)) is attached to the upper jaw (shown as an anvil (18)) of the end effector (12). As shown, the application device (2110) can load and attach the support assembly (110) to the anvil (18). Specifically, Figure 47A It shows Figure 46 The application device (2110) and Figure 3 A cross-sectional view of the end effector (12), wherein the arm (2114) of the application device (2110) pivots toward the upper jaw (shown as an anvil (18)). The outer surface (58) of the anvil (18) is disposed 180 degrees opposite to the contact surface (52). As shown, the support assembly (110) includes an upper adhesive layer (116) configured to adhere the support assembly (110), including the support body (114), to the contact surface (52) of the anvil (18). Figure 47A As shown, the second contact feature (2126) of the arm (2114) provides an elongated platform to which the first side of the support assembly (110) is releasably attached (e.g., via adhesive). In other words, the support body (114) can be temporarily attached to the inner surface (2128) of the second contact feature (2126) using an adhesive or mechanical connection feature. The inner portion (2134) of the second contact feature (2126) can be perforated along the side except for the retaining portion (2138).

[0140] Figure 47B It shows Figure 47A A cross-sectional view of the application device (2110) and end effector (12), wherein the transversely fragile portions (2140, 2142) break to release the application device (2110) from the anvil (18). A second contact feature (2126) applies compressive force to compress the support assembly (110) against the proximal portion (56) of the anvil (18), thereby applying and securing the support assembly (110) to the contact surface (52). The transversely fragile portions (2140, 2142) break off when the arm (2114) rotates toward the jaws of the end effector (12) with sufficient force and compresses against the jaws of the end effector. This transforms the inner portion (2134) into a flap (2144) with a free end, which is hingedly attached to the retaining portion (2138), such that the remaining portion of the arm (2114), such as the flap (2144), is not a completely loose piece that could fall onto the patient or the floor. Figure 47BAs shown, the retaining portion (2138) may include a flexible portion configured to bend but not break when the support assembly (110) is released from the application device (2110). The support assembly (110) separates from the inner portion (2134) of the second contact feature (2126) in response to the closing of the jaw upper arm (2114) of the end effector (12). Thus, the application device (2110) may use the laterally fragile portions (2140, 2142) to control the force applied to the contact surface (52) of the anvil (18) of the support assembly (110).

[0141] The transversely vulnerable portions (2140, 2142) are shown as spaced perforations along the corresponding sides of the inner portion (2134) but not at the distal end. For ease of application, the transversely vulnerable portions (2140, 2142) may be positioned around an area adjacent to the support assembly (110) such that when the support assembly (110) is applied, the transversely vulnerable portions (2140, 2142) tear and secure the support assembly (110) to the anvil (18). The transversely vulnerable portions (2140, 2142) may be modified to increase or decrease the force applied to the support assembly (110) to the anvil (18) before the transversely vulnerable portions (2140, 2142) are cut. For example, the spacing between adjacent perforations and / or the material-to-gap ratio may be varied. The transversely vulnerable portions (2140, 2142) on the application device (2110) prevent reuse after the application of the auxiliary material. The application device (2110) prevents the dislodged transverse vulnerable parts (2140, 2142) from being reused. In some models, once the arm (2114) is opened, the arm (2114) can destroy itself or lock into a non-closable state, allowing the pawl to be overcome but difficult to reset.

[0142] Figure 47C It shows Figure 47B A cross-sectional view of the application device (2110) and end effector (12), wherein the support assembly (110) is applied to the anvil (18) and the application device (2110) is actively removed. For example, the application device (2110) can slide distally relative to the end effector (12) using a hole provided in the arm (2114).

[0143] D. A fourth application device for separate adjunctive application Figure 48Another exemplary alternative application device (2210) configured to apply adjunct material to the jaws (e.g., the lower jaw (16)) of the end effector (12) of a surgical suture device (10) is shown. As shown, the application device (2210) includes a housing (2212), an arm (2214), and a hinge (2216). The hinge (2216) pivotally connects the arm (2214) to the housing (2212) at a hinge point, such that the arm (2214) can pivot relative to the housing (2212) to apply and secure adjunct material (shown as a support assembly (112)) to the lower jaw (16). The housing (2212) includes a first contact feature (2218) shown as a generally planar base. The first contact feature (2218) includes an inner surface (2220) and an outer surface (2222), wherein the inner surface (2220) faces the arm (2214).

[0144] The arm (2214) includes a connecting portion (2224) and a second contact feature (2226) shown as a generally planar platform. The connecting portion (2224) has a second thickness (D2) to accommodate the thickness of the lower jaw (16). Therefore, the connecting portion (2224) may be longer than the connecting portion (2124) to account for the increased thickness (i.e., height) of the lower jaw (16) compared to the anvil (18). The connecting portion (2224) may include a hole (2227) to allow the jaw to extend through it, such as Figures 47A to 47C As shown. The second contact feature (2226) includes an inner surface (2228) and an outer surface (2230), wherein the inner surface (2228) faces the inner surface (2220) of the first contact feature (2218). As shown, a cavity (2232) is disposed between the inner surfaces (2220, 2228) of the first contact feature (2218) and the second contact feature (2226). The second contact feature (2226) is configured to be able to open relative to the first contact feature (2218) in an open configuration (similar to... Figure 47A Regarding the application device (2110) shown) and the closed configuration (as shown) Figure 48 The support assembly (110) pivots between the two portions (shown), wherein a second contact feature (2226) is provided to push the support assembly (110) into contact with the suture surface. The second contact feature (2226) includes an inner portion (2234) and an outer portion (not shown), the outer portion being similar to the outer portion (2136), and a retaining portion (2238). The inner portion (2234) is connected to the outer portion via a transversely fragile portion (not shown), the transversely fragile portion being similar to the transversely fragile portions (2140, 2142) described above.

[0145] Figure 48An auxiliary material (shown as a support assembly (112)) is shown attached to the lower jaw (16) of the end effector (12). As shown, the application device (2210) can load and secure the support assembly (110) to the lower jaw (16). Specifically, Figure 48 It shows Figure 3 A cross-sectional view of the application device (2210) and end effector (12), wherein the arm (2214) of the application device pivots toward the lower jaw (16) of the staple cartridge (37) including the end effector (12). The outer surface (60) of the lower jaw (16) is positioned 180 degrees opposite to the upper deck (72). As shown, the support assembly (110) includes a lower adhesive layer (120) configured to adhere the support assembly (112) including the support body (118) to the upper deck (72) of the staple cartridge (37) of the lower jaw (16). As shown, when the arm (2214) rotates toward the jaw of the end effector (12) with sufficient force and compresses against the jaw of the end effector, the laterally fragile portion breaks off. This transforms the inner portion (2234) into a flap (not shown) with a free end, which is hingedly attached to the retaining portion (2238).

[0146] Applying the support assembly (112) to the lower jaw (16) including the staple cartridge (37) can be similar to applying the support assembly (110) to the anvil (18) as described above. It may be desirable to package the application devices (2110, 2210) together or to package the application devices (2110, 2210) and the support assemblies (110, 112) together. For example, a kit may include an application device (2210) and an accompanying support assembly (110), and an application device (2210) and an accompanying support assembly (112). As shown, the application devices (2110, 2210) are configured to apply the support assemblies (110, 112) to the desired jaws of the end effector. The application devices (2110, 2210) may include support assemblies (110, 112) to be applied, and the application devices are individually fitted onto each jaw, closed, and then removed to create force limitation. The application devices (2110, 2210) may close to different thicknesses to accommodate the different thicknesses of each end effector jaw. Optionally, markings (not shown) may be provided on the application devices (2110, 2210) to indicate the jaws to be used.

[0147] E. A fifth application device for separate adjunctive application Figures 49 to 50B Another exemplary application device (2310) is shown, configured to apply adjunct material to the jaws (e.g., anvil (18)) of the end effector (12) of a surgical suture device (10). Figure 49As shown, the application device (2310) includes a housing (2312) and an arm (2314). The arm (2314) includes a connecting portion (2316) that connects to the housing (2312). The housing (2312) includes a first contact feature (2318) shown as a U-shaped channel. The first contact feature (2318) includes an inner surface (2320) and opposing upward-facing walls (2322, 2324). The upward-facing walls (2322, 2324) include corresponding cutouts (2326). The connecting portion (2316) allows the arm (2314) to function as a pivot element to apply and secure the auxiliary material (shown as a support assembly (110)) to the anvil (18). The arm (2314) includes a second contact feature (2328). The second contact feature (2328) includes an inner surface (2330) and an outer surface (2332), wherein the inner surface (2330) faces the inner surface (2320) of the first contact feature (2318). Figures 50A to 50B As shown, a channel (2334) is disposed between the inner surfaces (2320, 2330) of the first contact feature (2318) and the second contact feature (2328). The housing (2312) includes a downward-facing tab (2336) for securing the support assembly (110) to the anvil (18).

[0148] Figures 50A to 50B The support assembly (110) is shown being applied to and secured to the upper jaw (shown as an anvil (18)) of the end effector (12). However, it is also envisioned that the application device (2310) could be modified to apply the support assembly (112) to the upper deck (72) of the lower jaw (16). As shown, the application device (2310) can load and secure the support assembly (110) to the anvil (18). Specifically, Figure 50A It shows Figure 49 The application device (2310) and Figure 3 A cross-sectional view of the end effector (12), wherein the application device (2310) moves proximally along the anvil (18). Figure 50A As shown, the second contact feature (2328) of the arm (2314) provides an elongated platform to which the first side of the support assembly (110) is releasably attached (e.g., via adhesion). The outer surface (78) of the anvil (18) is disposed 180 degrees opposite to the contact surface (52). When the second contact feature (2328) pushes the support assembly (110) into contact with the stitching surface, the second contact feature (2328) is configured to function as a lever against the first contact feature (2318).

[0149] Figure 50B It shows Figure 50AA cross-sectional view of the application device (2310) and the end effector (12), wherein the distal end (2338) of the application device (2310) is rotated to the contact anvil (18) to apply the support assembly (110) to the anvil (18). Figure 50B The end effector (12) is shown rotating downwards so that the anvil (18) is fully received within the channel (2334) to compressively contact the support assembly (110), and adhesion is caused by the leverage provided by the contact between the outer surface (58) of the anvil (18) and the inner surface (2330) of the second contact feature (2328). Applying the support assembly (112) to the lower jaw (16) including the staple cartridge (37) can be similar to the application of the support assembly (110) described above, except that the modified form of the application device (2310) takes into account the additional thickness of the lower jaw (16).

[0150] F. A sixth application device for separate adjunctive application Figures 51 to 52B Another exemplary application device (2410) is shown, configured to apply adjunct material to the jaws (e.g., anvil (18)) of the end effector (12) of a surgical suture device (10). Figure 51 As shown, the application device (2410) includes a housing (2412), an arm (2414), and a connection feature (2416) that pivotally connects the arm (2414) to the housing (2412). The housing (2412) includes a first contact feature (2418), shown as a U-shaped channel. The first contact feature (2418) includes an inner surface (2420) and opposing upward-facing walls (2422, 2424). The upward-facing walls (2422, 2424) include a hole (2426) configured to receive the connection feature (2416). The connection feature (2416) allows the arm (2414) to pivot to apply and secure the auxiliary material (shown as a support assembly (110)) to the anvil (18). The arm (2414) includes a body portion (2428). The main body portion (2428) includes a shank portion (2430) disposed opposite to a second contact feature portion (2432) shown as a cam feature portion. The second contact feature portion (2432) includes a first cam surface (2434) and a second cam surface portion (2436). Figure 52AAs shown, the first cam surface (2434) is separable from the connecting feature (2416) by a first distance (D1). A channel (2438) is provided between the inner surface (2420) of the first contact feature (2418) and the first cam surface (2434) and the second cam surface (2436) of the second contact feature (2432). When the application device (2410) is loaded onto the anvil (18), the first cam surface (2434) of the second contact feature (2432) is provided across the channel (2438) from the inner surface (2420) of the first contact feature (2418).

[0151] Figures 52A to 52B The support assembly (110) is shown attached to the upper jaw of the end effector (12). As shown, the application device (2410) can load and secure the support assembly (110) to the contact surface (52) of the anvil (18). However, it is also envisioned that the application device (2410) can be modified to apply the support assembly (112) to the upper deck (72) of the lower jaw (16). Specifically, Figure 52A It shows Figure 23 The application device (2410) and Figure 3 A cross-sectional view of the end effector (12), wherein the application device (2410) moves proximally along the anvil (18). Figure 52A As shown, the second contact feature (2432) of the arm (2414) provides an elongated platform to which the first side of the support assembly (110) is releasably attached (e.g., via adhesion). When the second contact feature (2432) pushes the support assembly (110) into contact with the contact surface (52) of the anvil (18), the second contact feature (2432) is configured to function as a lever against the first contact feature (2418).

[0152] Figure 52B It shows Figure 52A A cross-sectional view of the application device (2410) and the end effector (12), wherein the handle portion (2430) of the arm (2414) of the application device (2410) rotates to the distal portion (54) of the contact anvil (18) to apply the support assembly (110) to the anvil (18). Figure 52B The end effector (12) is shown to rotate downwards, causing the anvil (18) to be fully received within the channel (2438) to compressively contact the support assembly (110), and adhesion is caused by the leverage provided by the contact between the outer surface (58) of the anvil (18) and the second cam surface (2436) of the second contact feature (2432). Figure 52BAs shown, the second cam surface (2436) can be separated from the connecting feature (2416) by a second distance (D2). Applying the support assembly (112) to the lower jaw (16) including the staple cartridge (37) can be similar to the application of the support assembly (110) described above, except that the modified form of the application device (810) takes into account the additional thickness of the lower jaw (16).

[0153] G. An exemplary method for applying auxiliary material separately to the end effector jaws. Figure 53 A method (2510) is shown for applying an adjunct material (e.g., a support assembly (110, 112) or a tissue thickness compensator) to the suture surface (upper plate (72) or contact surface (52)) of the first or second jaw (e.g., the lower jaw (16) or anvil (18)) of the end effector (12) of a surgical suturer (10) using an application device (1910, 2010, 2110, 2210, 2310, 2410). At step (2512), the method (2510) may include opening the jaws of the end effector (12) such that the lower jaw (16) and the anvil (18) are spaced apart. At step (2514), the method (2510) may include, with the lower jaw (16) or anvil (18) in an open configuration, compressing the accessory material between the first contact feature (1924, 2024, 2118, 2218, 2318, 2418) and the second contact feature (1930, 2028, 2126, 2226, 2328, 2432) to attach the accessory material to the stitching surface (e.g., upper deck (72) or contact surface (52)) of one of the lower jaws (16) or anvil (18) of the end effector (12). The auxiliary material can be attached to the sewing surface of one of the first or second jaws by applying local compressive force between the rollers (1934, 1938, 2034, 2044) using the application device (1910, 2010) to compress the support assembly (110, 112).

[0154] VI. An exemplary auxiliary application device for reverse-driving the end effector jaws closed onto the auxiliary element. In some cases, it may be desirable to provide an adjunct application device operable to apply an adjunct element (e.g., a support assembly or tissue thickness compensator) to one or both jaws of a surgical suture end actuator in an open state by directly contacting the jaws and forcibly closing (or “reverse-driving”) the jaws onto a portion of the application device. (See below for further details.) Figures 54 to 62B Each of the exemplary application devices described provides such functionality.

[0155] A. An exemplary auxiliary application device with a translatable sleeve for reverse-drive end effector jaws. Figures 54 to 55B An exemplary auxiliary application device (2610) is shown, which is configured to force the jaws of an end effector to close onto a portion of the auxiliary application device (2610) supporting one or more support assemblies (110, 112), or otherwise “reverse drive” the jaws of the end effector to apply the support assemblies (110, 112) thereon. The auxiliary application device (2610) is similar to the auxiliary application device (210) described above, except as further described below.

[0156] The accompanying application device (2610) of this example includes a frame (2612) extending between a proximal end (not shown) and a distal end (2614). The frame (2612) includes a handle (2616) positioned at or near the proximal end of the frame (2612), a compression pad or platform (2618) positioned at or near the distal end (2614) of the frame (2612), and an elongated track (2620) extending longitudinally between the handle and the platform. In the example shown, the track (2620) extends along the lateral sides of the handle (2616) and the platform (2618), such that the track (2620) can be positioned side-by-side with the end effector (12). Although a single track (2620) is shown, the frame (2612) may include, for example, a pair of opposing tracks (2620). The auxiliary application device (2610) also includes a movable member in the form of a translatable sleeve (2622), which is connected to the frame (2612) and configured to be longitudinally translatable relative to the platform (2618) along the guide rail (2620), such as Figure 14 As indicated by the first arrow (A1) in the diagram, and the selective acceptance of the end effector (12), as will be described in more detail below.

[0157] The platform (2618) of this example is configured to support at least one support assembly (110, 112) on at least one side of the platform (2618). In the example shown, the platform (2618) supports a wide support assembly (110, 112) integrally spanning the slots (42, 49) of the anvil (18) or the staple cartridge (37), but the support assembly (110, 112) may alternatively be arranged in separate corresponding pairs of portions to avoid spanning the slots (42, 49) of the anvil (18) and the staple cartridge (37) respectively. Although the platform (2618) is shown as supporting the support assembly (110, 112) only on one side of the platform (2618), the platform (2618) can equally easily support the support assembly (110, 112) on both sides of the platform (2618).

[0158] The translational sleeve (2622) has a generally C-shaped cross-section and includes a generally C-shaped inner closure surface (2624) configured to selectively and mechanically engage the outer surface of at least one of the end effector jaws (16, 18) to change the end effector (12) from an open state to a closed state when the platform (2618) is positioned between the jaws (16, 18). In this respect, the sleeve (2622) may be sized and configured relative to the end effector (12) such that the closure surface (2624) is able to at least partially circumferentially surround or encircle the end effector (12) and contact or nearly contact the outer surface of at least one of the jaws (16, 18) for retracting the end effector (12) in the closed state. For example, the closing surface (2624) may define a lateral dimension (e.g., diameter) that is substantially equal to or slightly larger than the distance between the outer surfaces of the jaws (16, 18) when the end effector (12) is in the closed position. The dimensions and configuration of the sleeve (2622) and / or the guide rail (2620) may also be configured to aid in providing proper alignment of the end effector (12) with the auxiliary application device (2610), such as by allowing the guide rail (2620) to abut the lateral side of the end effector (12) when the auxiliary application device (2610) is positioned above the end effector (12) and the platform (2618) is properly positioned between the jaws (16, 18).

[0159] Figure 55A The end effector (12) is shown in the open state, and the auxiliary application device (2610) is configured such that the sleeve (2622) is in the retracted position relative to the end effector (12), such that the closing surface (2624) is mechanically disengaged from the outer surface of the anvil (18); while Figure 55B An auxiliary application device (2610) is shown in the following configuration: a sleeve (2622) is in an extended position relative to the end effector (12), such that a closing surface (2624) mechanically engages the outer surface of the anvil (18), thereby changing the end effector (12) from an open state to a closed state. To load the end effector (12) using the auxiliary application device (2610), the operator first positions the auxiliary application device (2610) and the end effector (12) such that the platform (2618) and support assemblies (110, 112) are positioned between the anvil (18) and the cartridge (37), and the end effector (12) is aligned with the sleeve (2622), wherein the sleeve (2622) is retracted proximally from the jaws (16, 18), as... Figure 55A As shown. The operator then advances the sleeve (2622) distally relative to the end effector (12) to mechanically engage the closing surface (2624) with the outer surface of the anvil (18), as shown. Figure 55B As indicated by the second arrow (A2) in the diagram. The end effector jaws (16, 18) can be reverse-driven closed on the platform (318) via this mechanical engagement (e.g., while the closing trigger (26) of the instrument (10) remains unacted), thereby adhesively attaching the support assemblies (110, 112) to the anvil (18) (e.g., to its suture surface). The support assemblies (110, 112) can be released from the platform (2618) such that the end effector jaws (16, 18) can disengage from the platform (2618) while the support assemblies (110, 112) remain adhered to the anvil (18). In one example, the cannula (2622) can be advanced and retracted sequentially in a back-and-forth or “pumping” manner to gradually transition the end effector (12) towards the closed state.

[0160] Although the auxiliary application device (2610) is shown to apply the support assembly (110, 112) to the anvil (18), the auxiliary application device (2610) may additionally or alternatively apply the support assembly (110, 112) to the lower jaw (16), such as to the staple cartridge (37) (e.g., to its suture surface).

[0161] B. An exemplary application of a cam surface with a gradient cross-section for use in a reverse-drive end effector jaw. Device Figures 56 to 57B Another exemplary auxiliary application device (2710) is shown, which is configured to force the jaws of an end effector to close onto a portion of the auxiliary application device (2710) supporting one or more support assemblies (110, 112), or otherwise “reverse drive” the jaws of the end effector to apply the support assemblies (110, 112) thereon. The auxiliary application device (2710) is similar to the auxiliary application devices (210, 2610) described above, except as further described below.

[0162] The example accessory application device (2710) includes a housing (2712) extending between an open proximal end (2713) and a closed distal end (2714). The housing (2712) includes a generally truncated conical proximal portion (2716) and a generally cylindrical distal portion (2717), such that the housing (2712) is generally funnel-shaped. A compression pad or platform (2718) extends proximal from the closed distal end (2714) within the proximal and distal portions (2716, 2717) of the housing (2712) and is secured to resist movement relative to the housing. The housing (2712) is configured to selectively receive an end effector (12), as will be described in more detail below.

[0163] The platform (2718) of this example is configured to support at least one support assembly (110, 112) on at least one side of the platform (2718). In the example shown, the platform (2718) supports a wide support assembly (110, 112) integrally spanning the slots (42, 49) of the anvil (18) or the staple cartridge (37), but the support assembly (110, 112) may alternatively be arranged in separate corresponding pairs of portions to avoid spanning the slots (42, 49) of the anvil (18) and the staple cartridge (37), respectively. Although the platform (2718) is shown as supporting the support assembly (110, 112) only on one side of the platform (2718), the platform (2718) can equally easily support the support assembly (110, 112) on both sides of the platform (2718).

[0164] The proximal portion (2716) and distal portion (2717) of the housing (2712) respectively include an inner closing surface with a gradually changing cross section and an inner closing surface (2724, 2726) with a non-gradient cross section, which are configured to selectively and mechanically engage the outer surface of at least one of the jaws (16, 18) of the end effector, thereby causing the end effector (12) to change from an open state to a closed state when the platform (2718) is positioned between the jaws (16, 18). In this regard, the dimensions and configuration of the proximal portion (2716) and distal portion (2717) may be arranged relative to the end effector (12) such that the closing surfaces (2724, 2726) are able to at least partially circumferentially surround or encircle the end effector (12) and contact or nearly contact the outer surface of at least one of the jaws (16, 18) for retracting the end effector (12) in the closed state. For example, a non-section-gradient closed surface (2726) may define a secondary lateral dimension (e.g., diameter) that is substantially equal to or slightly greater than the distance between the outer surfaces of the jaws (16, 18) when the end effector (12) is closed. A section-gradient closed surface (2724) may define a primary lateral dimension (e.g., diameter) that is substantially equal to or greater than the distance between the outer surfaces of the jaws (16, 18) when the end effector (12) is closed, and may be radially inwardly tapered toward the non-section-gradient closed surface (2726) in the distal direction. It should be understood that the section-gradient closed surface (2724) may alternatively be radially inwardly curved toward the non-section-gradient closed surface (2726) in the distal direction. The dimensions and construction of the proximal and / or distal portions (2716, 2717) may also be configured to help provide proper alignment of the end effector (12) with the auxiliary application device (2710), such as by abutting one or more lateral sides of the end effector (12) when the auxiliary application device (2710) is positioned above the end effector (12) and the platform (2718) is properly positioned between the jaws (16, 18).

[0165] Figure 57A The auxiliary application device (2710) is positioned relative to the end effector (12) such that a closed surface (2724) with a gradually changing cross section mechanically engages the outer surface of the anvil (18), thereby changing the end effector (12) from an open state to a closed state; while Figure 57BThe auxiliary application device (2710) is positioned relative to the end effector (12) such that a non-section-gradient closed surface (2626) mechanically engages the outer surfaces of the two jaws (16, 18), thereby keeping the end effector (12) in a closed state. To load the end effector (12) using the auxiliary application device (2710), the operator will first position the auxiliary application device (2710) and the end effector (12) such that the platform (2718) and support assembly (110, 112) are positioned between the anvil (18) and the staple cartridge (37), and the end effector (12) is received by the proximal portion (2716) of the housing (2712), as shown. Figure 57A As shown. Then, the operator advances the housing (2712) proximally relative to the end effector (12) so that the tapered closed surface (2724) mechanically engages with the outer surface of the anvil (18), as shown. Figure 57A As shown by the third arrow (A3) in the diagram, the anvil (18) is as follows: Figure 57A As indicated by the fourth arrow (A4), the cam moves radially inward until the non-section-gradient closed surface (2726) mechanically engages the outer surfaces of the two jaws (16, 18), as shown. Figure 57B As shown. The end effector jaws (16, 18) can be reverse-driven closed on the platform (2718) via this mechanical engagement (e.g., while the closing trigger (26) of the instrument (10) remains unacted), thereby adhesively attaching the support assembly (110, 112) to the anvil (18) (e.g., to its suture surface). The support assembly (110, 112) can be released from the platform (2718) such that the end effector jaws (16, 18) can disengage from the platform (2718) while the support assembly (110, 112) remains adhered to the anvil (18), such as by retracting the housing (2712) distally relative to the end effector (12).

[0166] Although the auxiliary application device (2710) is shown to apply the support assembly (110, 112) to the anvil (18), the auxiliary application device (2710) may additionally or alternatively apply the support assembly (110, 112) to the lower jaw (16), such as to the staple cartridge (37) (e.g., to its suture surface).

[0167] In one example, the platform (2718) may be omitted, and the housing (2712) may be configured to selectively receive another application device, such as the application device (210) described above, in place of the platform (2718). In this way, the auxiliary application device (2710) can be reused by selectively inserting the loaded application device (210) into the housing (2712) and later removing the used application device (210) from the housing (2712).

[0168] C. An exemplary auxiliary application device with a torsionable sleeve for reverse-drive end effector jaws Figures 58 to 59B Another exemplary auxiliary application device (2810) is shown, which is configured to force the jaws of an end effector to close onto a portion of the auxiliary application device (2810) supporting one or more support assemblies (110, 112), or otherwise “reverse drive” the jaws of the end effector to apply the support assemblies (110, 112) thereon. The auxiliary application device (2810) is similar to the auxiliary application devices (210, 2610, 2710) described above, except as further described below.

[0169] The auxiliary application device (2810) of this example includes a frame (2812) that includes a compression pad or platform (2818). The auxiliary application device (2810) also includes a movable member in the form of a rotatable sleeve (2822) coupled to the frame (2812) and configured to rotate relative to the platform (2818) about a rotation axis (RA) parallel to the longitudinal axis of the platform (2818), and to selectively receive an end effector (12), as will be described in more detail below.

[0170] The platform (2818) of this example is configured to support at least one support assembly (110, 112) on at least one side of the platform (2818). In the example shown, the platform (2818) supports a wide support assembly (110, 112) integrally spanning the slots (42, 49) of the anvil (18) or the staple cartridge (37), but the support assembly (110, 112) may alternatively be arranged in separate corresponding pairs of portions to avoid spanning the slots (42, 49) of the anvil (18) and the staple cartridge (37) respectively. Although the platform (2818) is shown as supporting the support assembly (110, 112) on only one side of the platform (2818), the platform (2818) can equally easily support the support assembly (110, 112) on both sides of the platform (2818).

[0171] The rotatable sleeve (2822) includes a bore 2823, the generally oval or elliptical cross-section of which defines a generally oval or elliptical inner closure surface (2824), which is configured to selectively and mechanically engage the outer surface of at least one of the end effector jaws (16, 18) to change the end effector (12) from an open state to a closed state when the platform (2818) is positioned between the jaws (16, 18). In this respect, the sleeve (2822) may be sized and configured relative to the end effector (12) such that the closure surface (2824) is able to at least partially circumferentially surround or encircle the end effector (12) and contact or nearly contact the outer surface of at least one of the jaws (16, 18) for retracting the end effector (12) in the closed state. For example, the closing surface (2824) may define a secondary lateral dimension (e.g., diameter) substantially equal to or slightly greater than the distance between the outer surfaces of the jaws (16, 18) when the end effector (12) is closed, and may also define a primary cross-sectional dimension (e.g., diameter) substantially equal to or greater than the distance between the outer surfaces of the jaws (16, 18) when the end effector (12) is closed. The size and configuration of the sleeve (2822) may also be configured to aid in providing proper alignment of the end effector (12) with the auxiliary application device (2810), such as by abutting one or more lateral sides of the end effector (12) when the auxiliary application device (2810) is positioned above the end effector (12) and the platform (2818) is properly positioned between the jaws (16, 18).

[0172] Figure 59A An end effector (12) in an open state is shown, and an auxiliary application device (2810) configured such that a sleeve (2822) is in a first angular (e.g., "untimed") position relative to the end effector (12), such that the closing surface (2824) mechanically disengages from the outer surface of the jaws (16, 18); while Figure 59BAn auxiliary application device (2810) is shown in a configuration such that a sleeve (2822) is in a second angular (e.g., “timing”) position relative to the end effector (12), such that a closing surface (2824) mechanically engages the outer surface of the jaws (16, 18), thereby changing the end effector (12) from an open state to a closed state. To load the end effector (12) using the auxiliary application device (2810), the operator first positions the auxiliary application device (2810) and the end effector (12) such that the platform (2818) and the support assembly (110, 112) are positioned between the anvil (18) and the staple cartridge (37), and the end effector (12) is received by the sleeve (2822), wherein the sleeve (2822) is oriented in a first angular position relative to the end effector (12) about the axis of rotation (RA), as shown in the figure. Figure 59A As shown. The operator then rotates the sleeve (2822) about the axis of rotation (RA) relative to the end actuator (12) toward a second angular position, so that the closing surface (2824) mechanically engages with the outer surfaces of the two jaws (16, 18), as shown. Figure 59B As indicated by the fifth arrow (A5), the two jaws (16, 18) are mechanically engaged until the narrow or sublateral dimension of the closing surface (2824) mechanically engages the outer surfaces of the two jaws. The end effector jaws (16, 18) can be reverse-driven closed on the platform (2818) by such mechanical engagement (e.g., while the closing trigger (26) of the instrument (10) remains unacted), thereby adhesively attaching the support assembly (110, 112) to the anvil (18) (e.g., to its suture surface). The support assembly (110, 112) can be released from the platform (2818) such that the end effector jaws (16, 18) can disengage from the platform (2818) while the support assembly (110, 112) remains adhered to the anvil (18), such as by rotating the sleeve (2822) about the axis of rotation (RA) relative to the end effector (12) to a first angular position.

[0173] Although the auxiliary application device (2810) is shown to apply the support assembly (110, 112) to the anvil (18), the auxiliary application device (2810) may additionally or alternatively apply the support assembly (110, 112) to the lower jaw (16), such as to the staple cartridge (37) (e.g., to its suture surface).

[0174] D. An exemplary auxiliary application device with a hinged lever arm for reverse-drive end effector jaws Figures 60 to 61BAnother exemplary auxiliary application device (2910) is shown, which is configured to force the jaws of an end effector to close onto a portion of the auxiliary application device (2910) supporting one or more support assemblies (110, 112), or otherwise “reverse drive” the jaws of the end effector to apply the support assemblies (110, 112) thereon. The auxiliary application device (2910) is similar to the auxiliary application devices (210, 2610, 2710, 2810) described above, except as further described below.

[0175] The auxiliary application device (2910) of this example includes a frame (2912) extending between a proximal end (2913) and a distal end (2914). The frame (2912) includes a double-hinged steering knuckle (2916) positioned at or near the distal end (2914) of the frame (2912) and a compression pad or platform (2918) extending proximally from the steering knuckle (2916) to the proximal end (2913). The auxiliary application device (2910) also includes a pair of movable members in the form of opposing pivotable lever arms (2922), which are coupled to the steering knuckle (2916) via corresponding hinge pins (2923) and configured to pivot relative to the platform (2918) about a corresponding lateral pivot axis (PA) extending in a direction perpendicular to the longitudinal axis of the platform (2918), and selectively receive an end actuator (12), as will be described in more detail below.

[0176] The platform (2918) of this example is configured to support at least one support assembly (110, 112) on at least one side of the platform (2918). In the example shown, the platform (2918) supports a wide support assembly (110, 112) integrally spanning the slots (42, 49) of the anvil (18) or the staple cartridge (37), but the support assembly (110, 112) may alternatively be arranged in separate corresponding pairs of portions to avoid spanning the slots (42, 49) of the anvil (18) and the staple cartridge (37) respectively. Although the platform (2918) is shown as supporting the support assembly (110, 112) on only one side of the platform (2918), the platform (2918) can equally easily support the support assembly (110, 112) on both sides of the platform (2918).

[0177] Each lever arm (2922) is generally flat and includes a corresponding generally flat inner closing surface (2924) configured to selectively and mechanically engage the corresponding outer surfaces of the end effector jaws (16, 18) to change the end effector (12) from an open state to a closed state when the platform (2918) is positioned between the jaws (16, 18). In this respect, the lever arms (2922) may be sized and configured relative to the end effector (12) such that the closing surfaces (2924) can collectively and at least partially circumferentially surround or encircle the end effector (12) and contact or nearly contact the corresponding outer surfaces of the jaws (16, 18) for retracting the end effector (12) in the closed state. For example, the closing surfaces (2924) may collectively define a variable lateral dimension that is substantially equal to or slightly greater than the distance between the outer surfaces of the jaws (16, 18) when the end effector (12) is closed. In one example, the hinge pins (2923) may be spaced apart from each other by a distance substantially equal to or slightly greater than the distance between the outer surfaces of the jaws (16, 18) when the end effector (12) is closed.

[0178] Figure 61A An auxiliary application device (2910) is shown in the following configuration: a lever arm (2922) pivots about a corresponding pivot axis (PA) from an open position to a closed position, such that the closing surface (2924) mechanically engages the outer surface of the corresponding jaws (16, 18), thereby changing the end effector (12) from an open state to a closed state; and Figure 61B An auxiliary application device (2910) is shown in the following configuration: a lever arm (2922) is in the closed position such that a closing surface (2924) mechanically engages the outer surface of the corresponding jaws (16, 18), thereby keeping the end effector (12) in the closed state. To load the end effector (12) using the auxiliary application device (2910), the operator first positions the auxiliary application device (2910) and the end effector (12) such that the platform (2918) and the support assembly (110, 112) are positioned between the anvil (18) and the staple cartridge (37), and the end effector (12) is received between the lever arms (2922), wherein the lever arms (2922) are positioned or close to the... Figure 61A The operator will then place the auxiliary application device (2910) as shown in the open position. Figure 61B The sixth arrow (A6) indicates that the lever arm (2922) is advanced proximally relative to the end effector (12), and / or causes the lever arm (2922) to move as shown in the diagram. Figure 61BPivot toward the closed position as indicated by the seventh arrow (A7) (e.g., by pressing the lever arms (2922) together) so that the closed surface (2924) mechanically engages with the outer surfaces of the corresponding jaws (16, 18) until the closed surface (2924) is substantially parallel to the corresponding outer surfaces, as shown in the image. Figure 61B As shown. The end effector jaws (16, 18) can be reverse-driven closed on the platform (2918) by such mechanical engagement (e.g., while the closing trigger (26) of the instrument (10) remains unacted), as Figure 61B As indicated by the eighth arrow (A8), the support assemblies (110, 112) are thus adhesively attached to the anvil (18) (e.g., to its suture surface). The support assemblies (110, 112) can be released from the platform (2918) such that the end effector jaws (16, 18) can disengage from the platform (2918) while the support assemblies (110, 112) remain adhered to the anvil (18), such as by pivoting the lever arm (2922) toward the open position. In one example, as the lever arm (2922) pivots toward the closed position, the auxiliary application device (2910) can simultaneously advance proximally relative to the end effector (12).

[0179] Although the auxiliary application device (2910) is shown to apply the support assembly (110, 112) to the anvil (18), the auxiliary application device (2910) may additionally or alternatively apply the support assembly (110, 112) to the lower jaw (16), such as to the staple cartridge (37) (e.g., to its suture surface).

[0180] In one example, the auxiliary application device (2910) may include a threshold force application or pressure application feature configured to prevent the end effector jaws (16, 18) from pivoting toward the open position until the lever arm (2922) has applied a threshold force and / or pressure to the respective jaws (16, 18) sufficient to ensure that the support assembly (110, 112) is properly positioned on the anvil (18) (or lower jaw (16)). For example, each lever arm (2922) may include one or more notches configured to frictionally engage the respective jaws (16, 18) to inhibit the opening of the jaws (16, 18) until the lever arm (2922) pivots toward the open position. Alternatively or in addition, the auxiliary application device (2910) may include a threshold force notification or pressure notification feature configured to provide the user with visual, tactile and / or auditory indications that the lever arm (2922) has applied a threshold force and / or pressure to the corresponding jaws (16, 18) sufficient to ensure that the support assembly (110, 112) is properly positioned on the anvil (18) (or the lower jaw (16)).

[0181] E. An exemplary auxiliary application device with a cam lever arm for reverse-drive end effector jaws Figures 62A to 62B Another exemplary auxiliary application device (3010) is shown, which is configured to force the jaws of an end effector to close onto a portion of the auxiliary application device (3010) supporting one or more support assemblies (110, 112), or otherwise “reverse drive” the jaws of the end effector to apply the support assemblies (110, 112) thereon. The application device (700) is similar to the auxiliary application devices (210, 2610, 2710, 2810, 2910) described above, differing from those further described below.

[0182] The example of the auxiliary application device (3010) includes a frame (3012) extending between a proximal end (not shown) and a distal end (3014). The frame (3012) includes a hinged steering knuckle (3016) positioned at or near the distal end (3014) of the frame (3012), a compression pad or platform (3018) extending proximally from the steering knuckle (3016) to the proximal end of the frame (3012), and a retaining arm (3020) extending proximally from the steering knuckle (3016). The auxiliary application device (3010) also includes a movable member in the form of a pivotable lever arm (3022), which is connected to the steering knuckle (3016) via a hinge pin (3023) and is configured to pivot relative to the platform (3018) about a lateral pivot axis (PA) extending in a direction perpendicular to the longitudinal axis of the platform (3018), and abutment fixed arm (3020) selectively receiving end actuator (12), as will be described in more detail below.

[0183] The platform (3018) of this example is configured to support at least one support assembly (110, 112) on at least one side of the platform (3018). In the example shown, the platform (3018) supports a wide-type support assembly (110, 112) integrally spanning the slots (42, 49) of the anvil (18) or the staple cartridge (37), but the support assembly (110, 112) may alternatively be arranged in separate corresponding pairs of portions to avoid spanning the slots (42, 49) of the anvil (18) and the staple cartridge (37) respectively. Although the platform (3018) is shown as supporting the support assembly (110, 112) on only one side of the platform (3018), the platform (3018) can equally easily support the support assembly (110, 112) on both sides of the platform (3018).

[0184] The lever arm (3022) is a generally flat closed surface (3024) with a protruding, tapered cross section and an outer surface configured to selectively mechanically engage one of the end effector jaws (16, 18), while the fixed arm (3020) is a generally flat closed surface (3026) with a generally flat, non-tapered cross section and an outer surface configured to selectively mechanically engage the other of the end effector jaws (16, 18), thereby causing the end effector (12) to change from an open state to a closed state when the platform (3018) is positioned between the jaws (16, 18). In this respect, the dimensions and configuration of the arms (3020, 3022) may be configured relative to the end effector (12) such that the closing surfaces (3024, 3026) can collectively and at least partially circumferentially surround or encircle the end effector (12) and contact or nearly contact the respective outer surfaces of the jaws (16, 18) for retracting the end effector (12) in the closed state. For example, the closing surfaces (3024, 3026) may collectively define a variable lateral dimension that is substantially equal to or slightly greater than the distance between the outer surfaces of the jaws (16, 18) when the end effector (12) is in the closed state. It should be understood that the closure surface (3024) with a gradually changing cross-section may alternatively be curved.

[0185] Figure 62A An auxiliary application device (3010) is shown in the following configuration: a lever arm (3022) pivots about a pivot axis (PA) from an open position to a closed position, such that a closed surface with a gradually changing cross-section (3024) mechanically engages the outer surface of the anvil (18), while a closed surface without a gradually changing cross-section (3026) mechanically engages the outer surface of the lower jaw (16), thereby changing the end effector (12) from an open state to a closed state; and Figure 62B An auxiliary application device (3010) is shown in the following configuration: a lever arm (3022) is in a closed position such that the closed surfaces (3024, 3026) mechanically engage the corresponding outer surfaces of the jaws (16, 18), thereby keeping the end effector (12) in a closed state. To load the end effector (12) using the auxiliary application device (3010), the operator first positions the auxiliary application device (3010) and the end effector (12) such that the platform (3018) and the support assembly (110, 112) are positioned between the anvil (18) and the staple cartridge (37), and the end effector (12) is received between the arms (3020, 3022), wherein the lever arm (3022) is positioned or close to the arm (3024, 3026). Figure 62A The open position is shown. Then, the operator will move the lever arm (3022) as shown. Figure 62BPivot toward the closed position as indicated by the ninth arrow (A9) to mechanically engage the closed surface (3024) with the outer surface of the anvil (18), such that the anvil (18) is as... Figure 62B The cam moves radially inward as indicated by the tenth arrow (A10). The end effector jaws (16, 18) can be accessed via... Figure 62B The mechanical engagement shown is reverse-driven closed on the platform (3018) (e.g., while the closing trigger (26) of the instrument (10) remains unacted), thereby adhesively attaching the support assemblies (110, 112) to the anvil (18) (e.g., to its suture surface). The support assemblies (110, 112) can be released from the platform (3018) such that the end effector jaws (16, 18) can disengage from the platform (3018) while the support assemblies (110, 112) remain adhered to the anvil (18). In one example, as the lever arm (3022) pivots toward the closed position, the auxiliary application device (3010) can simultaneously advance proximally relative to the end effector (12).

[0186] Although the auxiliary application device (3010) is shown to apply the support assembly (110, 112) to the anvil (18), the auxiliary application device (3010) may additionally or alternatively apply the support assembly (110, 112) to the lower jaw (16), such as to the staple cartridge (37) (e.g., to its suture surface).

[0187] VII. An exemplary auxiliary application device for detecting complete placement of the application device in the surgical suture end actuator. In some cases, it may be desirable to provide an adjunct application device comprising one or more features operable to ensure that, prior to the application of an adjunct element (e.g., a support assembly or tissue thickness compensator) to one or both jaws of the end effector, the application device is fully housed within and properly aligned with the surgical suture end effector in its open position. (See below for further details.) Figures 63 to 66B Each of the exemplary application devices described provides such functionality.

[0188] A. An exemplary device with an organizational stop-engagement feature for detecting proper placement in an end effector. Application device Figures 63 to 65B An exemplary auxiliary application device (3100) is shown, which is configured to prevent improper loading of the support assembly (110, 112) onto the jaws of the end effector when the auxiliary application device (3100) is not longitudinally aligned with the jaws via a tissue stop-engagement feature. The auxiliary application device (3100) is similar to the auxiliary application device (210) described above, except as further described below.

[0189] The auxiliary application device (3100) of this example includes a housing (3112) extending between a proximal end (3113) and a distal end (3114). The housing (3112) includes an integral gripping feature defining a handle (3116) positioned at or near the distal end (3114) of the housing (3112). The auxiliary application device (3110) also includes an expandable compression pad or platform (3118) configured to selectively transition between a collapsed or non-expanded state and a deployed or expanded state, in which the collapsed or non-expanded state the platform (3118) presents a generally flat configuration. Figure 63 and Figure 65A In this deployment or expansion state, the platform (3118) presents a roughly wedge-shaped configuration. Figure 65B In this respect, the auxiliary application device (3110) also includes: a platform driver in the form of a screw (3120) rotatably coupled to the housing (3112) and extending between opposing folded halves of the platform (3118); and a plurality of extendable arms or links (3122) positioned between the screw (3120) and the opposing folded halves of the platform (3118) such that rotation of the screw (3120) in a predetermined direction causes the links (3122) to extend radially outward from the screw (3120) for deploying the platform (3118). In the example shown, the auxiliary application device (3110) also includes an energy storage device in the form of a motor (3124) having a power source, such as a battery (3126), selectively electrically connected thereto and configured to selectively supply torque to the screw (3120) for deploying the platform (3118). In this respect, the auxiliary application device (3110) also includes a detector in the form of an electrical probe or switch (3128) that is electrically connected to the motor (3124) and the battery (3126) for controllable activation of the motor (3124), as will be described in more detail below.

[0190] The platform (3118) of this example is configured to support a support assembly (110) on one opposite folded side of the platform (3118) and another support assembly (112) on the other opposite folded side of the platform (3118). In the example shown, the platform (3118) supports a wide-type support assembly (110, 112) that integrally spans the slots (42, 49) of the anvil (18) and the staple cartridge (37), respectively. However, the support assemblies (110, 112) may alternatively be arranged in separate corresponding pairs of portions to avoid spanning the slots (42, 49) of the anvil (18) and the staple cartridge (37), respectively.

[0191] An electrical switch (3128) is positioned at or near the proximal end (3113) of the housing (3112) and is configured to detect a predetermined portion of the end actuator (12), such as a tissue stop (12a) defined by the side flange of the anvil (18), when the end actuator (12) is properly positioned relative to the auxiliary application device (3110) to load the support assembly (110, 112) onto the end actuator (12). For example, and referring to Figure 64 The electrical switch (3128) can be configured to move from an open state to a closed state in response to contact with the tissue stop (12a). The motor (3124) can be configured to be activated in response to the movement of the electrical switch (3128) to the closed state to deploy the platform (3118). For example, the movement of the electrical switch (3128) to the closed state can selectively place the motor (3124) in electrical communication with the battery (3126), such that power is selectively supplied from the battery (3126) to the motor (3124) via the electrical switch (3128). Therefore, the motor (3124) can be configured to selectively supply torque to the screw (3120) for deploying the platform (3118) in response to the detection of the tissue stop (12a) by the electrical switch (3128). In this way, the electrical switches (3128) can assist in providing proper longitudinal and lateral alignment of the end effector (12) with the auxiliary application device (3110) during the deployment of the platform (3118). In one example, the auxiliary application device (3110) may include a pair of electrical switches (3128) configured to detect corresponding tissue stops (12a) defined by the lateral opposing side flanges of the anvil (18), and a motor (3124) may be configured to selectively supply torque to the screw (3120) for deploying the platform (3118) in response to the detection of both tissue stops (12a) by the corresponding electrical switches (3128) (e.g., simultaneously). The pair of electrical switches (3128) can assist in providing proper angular alignment (e.g., relative to the longitudinal axis of the end effector (12)) of the end effector (12) with the auxiliary application device (3110) during the deployment of the platform (3118). Alternatively, the auxiliary application device (3110) may include a pair of laterally opposed angled ramps or cam surfaces at or near the proximal end (3113) of the housing (3112) for capturing tissue stop (12a) and aligning the end actuator (12) at an angle with the auxiliary application device (3110) during distal advance of the end actuator (12) relative to the auxiliary application device (3110).

[0192] Figure 65AAn end effector (12) is shown, which is in the open state and positioned relative to the auxiliary application device (3110) such that the electrical switch (3128) is spaced apart from the tissue stop (12a), thereby preventing the platform (3118) from changing into a collapsed state; and Figure 65B An end effector (12) is shown positioned relative to the auxiliary application device (3110) such that an electric switch (3128) contacts the tissue stop (12a), thereby activating the motor (3124) and thus transforming the platform (3118) from a collapsed state to a deployed state. To load the end effector (12) using the auxiliary application device (3110), the operator first positions the auxiliary application device (3110) and the end effector (12) such that the platform (3118) and the support assembly (110, 112) are positioned between the anvil (18) and the staple cartridge (37), with the platform (3118) in a collapsed state, as shown... Figure 65A As shown. The operator then advances the end effector (12) distally relative to the auxiliary application device (3110) to bring the electrical switch (3128) into contact with the tissue stop (12a), as... Figure 65B As indicated by the first arrow (A1) in the diagram. The platform (3118) can respond to, as Figure 65B The contact indicated by the second arrow (A2) is achieved by the motor (3124) deploying the end effector jaws (16, 18) toward the end effector jaws, thereby adhesively attaching the support assemblies (110, 112) to the respective jaws (16, 18). The support assemblies (110, 112) can be released from the platform (3118) so that the end effector jaws (16, 18) can disengage from the platform (3118) while the support assemblies (110, 112) remain adhered to the respective jaws (16, 18).

[0193] While the deployment of the platform (3118) has been described as automated via a motor (3124) and a battery (3126), an auxiliary application device (3110) may be configured such that the deployment of the platform (3118) is performed manually via user input, such as by allowing the user to apply torque to the screw (3120). In such a case, the auxiliary application device (3110) may include a locking mechanism configured to transition between a locked state and an unlocked state, in which the locking mechanism inhibits rotation of the screw (3120), thereby preventing the deployment of the platform (3118), and in which the locking mechanism allows rotation of the screw (3120), thereby allowing the deployment of the platform (3118) (e.g., when the user applies torque to the screw (3120)). In one example, the motor (3124) may be configured to selectively transition the locking mechanism from a locked state to an unlocked state in response to detection of a tissue stop (12a) via an electrical switch (3128). Alternatively, the motor (3124), battery (3126), and electrical switch (3128) may be omitted, and the auxiliary application device (3110) may include a detector in the form of a mechanical switch, such as a cam-type feature configured to selectively change the locking mechanism from a locked state to an unlocked state in response to contact with one or more tissue stops (12a). For example, such a cam-type feature may be configured to rotate in response to contact with the tissue stop (12a), and such rotation of the cam-type feature may allow rotation of the screw (3120), thereby allowing deployment of the platform (3118) (e.g., when torque is applied to the screw (3120) by the user).

[0194] Although the auxiliary application device (3110) has been described as including an expandable platform (3118) and a platform driver in the form of a screw (3120) and a link (3122) for deploying the platform (3118), it should be understood that the auxiliary application device (3110) may include any other suitable type of platform and / or platform driver for deploying such a platform to attach the support assembly (110, 112) to the end effector jaws (16, 18). Similarly, although the auxiliary application device (3110) has been described as including a detector in the form of an electrical switch (3128), it should be understood that the auxiliary application device (3110) may include any other suitable type of electrical and / or mechanical detector for detecting a predetermined portion of the end effector (12) when the auxiliary application device (3110) is properly aligned with it, such that the platform drive may be configured to selectively deploy the platform only when the detector detects the predetermined portion of the end effector (12) (e.g., by automatically deploying the platform in response to such detection, or by switching the locking mechanism of the drive to an unlocked state in response to such detection to allow the deployment of the platform). For example, the detector may be a non-contact mechanism, such as a proximity sensor (e.g., optical, magnetic, etc.), which is configured to detect the presence of the predetermined portion of the end effector (12) without actually contacting the predetermined portion of the end effector (12).

[0195] B. An exemplary actuator with a distal tip-engagement feature for detecting proper placement in an end effector Device Figures 66A to 66B An exemplary auxiliary application device (3210) is shown, which is configured to prevent improper loading of the support assembly (110, 112) onto the jaws of the end effector when the auxiliary application device (3210) is not longitudinally aligned with the jaws, via a distal tip-engagement feature. The auxiliary application device (3210) is similar to the auxiliary application devices (210, 3110) described above, except as further described below.

[0196] The auxiliary application device (3210) of this example includes a housing (3212) extending between a proximal end (3213) and a distal end (3214). The housing (3212) includes a viewing window (3216) positioned at or near the distal end (3214) of the housing (3212) to allow visual observation of internal components positioned within the housing (3212), as will be described in more detail below. The auxiliary application device (3210) also includes a generally flat floating compression pad or platform (3218) having a pair of slots (3220) and configured to selectively retract into a retracted state ( Figure 66A ) and deployment status ( Figure 66BThe auxiliary application device (3210) also includes a platform driver in the form of multiple energy storage devices, comprising an elastic member positioned between the platform (3218) and the housing (3212), and more specifically, a compression leaf spring (3224). The leaf spring (3224) is configured to selectively switch between a compressed state and a compressed state. Figure 66A ) transforms into an expansion state ( Figure 66B This pushes the platform (3218) in the application direction, the surface of which is configured to support the support assembly (110, 112) facing the application direction (e.g., perpendicular to the longitudinal axis of the platform (3218)) for deployment of the platform (3218). The auxiliary application device (3210) also includes a detector in the form of a mechanical switch, and more specifically, includes a longitudinally translatable slider (3228) positioned on the side of the platform (3218) opposite the leaf spring (3224) to limit the movement of the platform (3218) in the application direction, as will be described in more detail below.

[0197] The platform (3218) of this example is configured to support at least one support assembly (110, 112) on at least one side of the platform (3218). In the example shown, the platform (3218) supports a wide support assembly (110, 112) integrally spanning the slots (42, 49) of the anvil (18) or the staple cartridge (37), but the support assembly (110, 112) may alternatively be arranged in separate corresponding pairs of portions to avoid spanning the slots (42, 49) of the anvil (18) and the staple cartridge (37) respectively.

[0198] The translatable slider (3228) includes an activation rod (3230) positioned at or near the distal end (3214) of the housing (3212) and a generally elongated support (3232) extending proximally from the activation rod (3230) and parallel to the platform (3218). The translatable slider (3228) also includes a pair of tabs (3234) projecting from the support (3232) toward the platform (3218) and configured to selectively abut the platform (3218) to prevent expansion of the leaf spring (3224), and further configured to selectively be received by a corresponding slot (3220) to allow expansion of the leaf spring (3224) for deployment of the platform (3218). The activation lever (3230) is configured to detect a predetermined portion of the end effector (12), such as the distal tip (12b) defined by the pin cartridge (37) of the lower jaw (16), when the end effector (12) is properly positioned relative to the auxiliary application device (3210) to load the support assembly (110, 112) onto the end effector (12). For example, a translational slider (3228) may be configured to move from a proximal unactuated state to a distal actuated state in response to the activation lever (3230) being pushed distally from the distal tip (12b) or otherwise contacting the distal tip. A leaf spring (3224) may be configured to expand in response to the movement of the translational slider (3228) to the actuated state to deploy the platform (3218). For example, the movement of the translational slider (3228) to the actuated state can selectively align the tab (3234) of the support (3232) longitudinally with the slot (3220) of the platform (3218), allowing the leaf spring (3224) to selectively push the platform (3218) in the application direction. Thus, the leaf spring (3224) can be configured to selectively push the platform (3218) in the application direction to deploy the platform (3218) in response to detection of the distal tip (12b) by the activation lever (3230) of the translational slider (3228). In this way, the translational slider (3228) can assist in providing proper longitudinal and lateral alignment of the end effector (12) with the auxiliary application device (3210) during the deployment of the platform (3218). In one example, the movement of a panning slider (3228) to an actuated state can be observed through a viewing window (3216), thereby providing a visual indication of the deployment of the platform (3218).

[0199] Figure 66A An end effector (12) in the open state is shown, wherein an auxiliary application device (3210) is positioned above the lower jaw (16) such that the activation lever (3230) of the translational slider (3228) is spaced apart from the distal tip (12b), thereby allowing the tab (3234) to abut the platform (3218) to prevent the platform (3218) from changing out of the retracted state; while Figure 66B An end effector (12) is shown positioned relative to the auxiliary application device (3210) such that the distal tip (12b) pushes distally or otherwise contacts the activation lever (3230) to thereby translate the slider (3228) distally, thereby causing the tab (3234) to longitudinally align with the slot (3220) and thus stop the abutment platform (3218) to allow the leaf spring (3224) to change the platform (3218) from a retracted state to a deployed state. To load the end effector (12) using the auxiliary application device (3210), the operator will first position the auxiliary application device (3210) and the end effector (12) such that the lower jaw (16) is received within the housing (3212), wherein the platform (3218) and the support assembly (110, 112) are positioned between the anvil (18) and the staple cartridge (37) and wherein the platform (3218) is in the retracted state, as Figure 66A As shown. The operator then advances the end effector (12) distally relative to the auxiliary application device (3210) to push or otherwise contact the activation lever (3230) of the translational slider (3228) distally via the distal tip (12b), as... Figure 66B As indicated by the third arrow (A3) in the diagram. The platform (3218) can respond to, as Figure 66B The contact indicated by the fourth arrow (A4) is deployed by the leaf spring (3224) toward the lower jaw (16), thereby adhesively attaching the support assembly (110, 112) to the lower jaw (16). The support assembly (110, 112) can be released from the platform (3218) so that the lower jaw (16) can disengage from the platform (3218) while the support assembly (110, 112) remains adhered to the lower jaw (16).

[0200] VIII. Exemplary Auxiliary Application Devices with Authentication Features In some cases, it may be desirable to provide an auxiliary application device having certain features that facilitate alignment between the jaws of the application device and the end effector; prevent the reuse of the application device, the end effector, or both; and / or authenticate an application device with a given end effector to facilitate the use of application devices having only a specific, predetermined type of end effector with a specific, predetermined configuration. (The following is in conjunction with...) Figures 67A to 79B Each of the exemplary application devices described provides such functionality.

[0201] A. An exemplary application device with a locking element Figure 67AAn exemplary alternative auxiliary application device (3310) (also referred to as a “support application device”) is shown, which can be used to support, protect, and apply auxiliary materials, such as support assemblies (110, 112), to an end effector (12). Except where explicitly described elsewhere herein, the auxiliary application device (3310) of this example is substantially similar to the application device (210) described above. For example, like the application device (210), the application device (3310) of this example includes an open end (3312) and a closed end (3314). Like the open end (212) described above, the open end (3312) of this example is configured to receive the end effector (12), as will be described in more detail below. Similarly, the application device (3310) of this example also includes a first housing (416a) and a second housing (3316b), each of which together generally defines a “U” shape to present the open end (3312). Similarly, the platform (3318) is inserted between the first housing (3316a) and the second housing (3316b).

[0202] Similar to the platform (218) described above, the platform (3318) of this example is configured to support a pair of support assemblies (110) on one side of the platform (3318) and another pair of support assemblies (112) on the other side of the platform (3318). The platform (3318) is exposed in a recess formed between the forks of the “U” configuration of the first housing (3316a) and the second housing (3316b). Each support assembly (110, 112) is disposed in a separate corresponding pair of portions to avoid crossing the slots (42, 49) of the anvil (18) and the staple cartridge (37), but the platform (3318) can equally easily support a wide-type support assembly (110, 112) that crosses the slots (42, 49) of the anvil (18) and the staple cartridge (37) individually, respectively.

[0203] Unlike the platform (218) described above, the platform (3318) of this example is generally configured to expand in one or more directions to apply the support assembly (110, 112). As will be described in more detail below, this functionality can be achieved by the platform (3318) operating as an expandable wedge. By way of example only, in some examples, this functionality can be achieved by constructing other suitable features of the platform (3318) or application device (3310) in accordance with at least some of the teachings of the following U.S. patent application filed on the same date as this application, entitled “Apparatus and Method to Apply Buttress to End Effector of Surgical Stapler via DrivenMember” [Attorney’s File No. END9286USNP2], the disclosure of which is incorporated herein by reference.

[0204] Similar to the application device (210) described above, the first housing (3316a) and the second housing (3316b) include a gripping feature (3322). However, unlike the gripping feature (222) described above, the gripping feature (3322) in this example is movable to selectively expand the platform (3318). As will be described in more detail below, the gripping feature (3322) is generally configured to translate relative to the housings (3316a, 3316b) to activate the expansion of the platform (3318). Also as will be described in more detail below, it should be understood that in some configurations, the gripping feature (3322) may be locked to prevent platform expansion or otherwise deactivate the application support assembly (110, 112) of the application device (3310).

[0205] Unlike the application device (210) described above, the application device (3310) of this example includes a locking assembly (3340) disposed within the housing (3316a, 3316b). The locking assembly (3340) is generally configured to prevent the platform (3218) from expanding until the application device (3310) is properly positioned within the end effector (12), thereby preventing improper application of the support assemblies (110, 112). In other words, the locking assembly (3340) is generally configured to allow deployment of the support assemblies (110, 112) only when the locking assembly (3340) is engaged at a predetermined portion of the end effector (12). Such engagement can then be used to allow movement of the gripping feature (3322) to activate expansion or other movement of the platform (3318).

[0206] The locking assembly (3340) of this example is positioned near the opening end (3312) and includes two actuators (3342) extending inwardly from either side of its application device (3310) into the opening end (3312). Each actuator (3342) includes an engagement portion (3344), a spring collar (3346), a release opening (3348), and a locking end (3349). Although not shown, it should be understood that each actuator (3342) in this example is constructed as an elongated rod, I-beam, or other elongated structure. Of course, various other suitable cross-sectional shapes that can be used for each actuator (3342) will be apparent to those skilled in the art in light of the teachings herein.

[0207] The engagement portion (3344) of each actuator (3342) defines a length suitable for extending from the housing (3316a, 3316b) into the opening end (3312). In this example, this extension length of each engagement portion (3344) is approximately equal to half the lateral length of the opening end (3312). Thus, the engagement portions (3344) of each actuator (3342) extend toward each other to collectively occupy the entire lateral length of the opening end (3312). Alternatively, the engagement portions (3344) of each actuator (3342) may collectively occupy a large portion of the lateral length of the opening end (3312) to define a small gap at the end of each engagement portion (3344). As will be described in more detail below, such gaps between the engagement portions (3344) may be expected to facilitate movement of each actuator (3342) by engaging with a portion of the end actuator (12).

[0208] A spring collar (3346) is positioned along the length of each actuator (3342) between a corresponding engagement portion (3344) and a release opening (3348). The spring collar (3346) is typically configured to engage a spring (3350) disposed within one or more housings in the housings (3316a, 3316b) to bias each actuator (3342) toward a predetermined position. In this example, the combination of the spring collar (3346) and the spring (3350) is configured to bias each actuator (3342) toward a corresponding... Figure 67A The locking position is biased in the configuration shown. As will be described in more detail below, each actuator (3342) is positioned to prevent movement of the corresponding gripping feature (3322) when in the locked position.

[0209] A release opening (3348) is defined within each actuator (3342) near the locking end (3349). As will be described in more detail below, the release opening (3348) is generally configured to receive a portion of the corresponding gripping feature (3322). To facilitate this configuration, each release opening (3348) corresponding to each actuator (3342) extends from one side through the actuator (3342) to the other side. Thus, each release opening (3348) is configured as a through-hole that extends through the corresponding actuator (3342).

[0210] Adjacent to the release opening (3348), a locking end (3349) of each actuator (3342) is positioned on its outermost end. Each locking end (3349) is generally configured to prevent movement of a portion of the corresponding gripping feature (3322). Thus, it should be understood that the locking end (3349) has a generally solid configuration. As will be described in more detail below, each actuator (3342) is generally configured to be laterally slew within the application device (3310) to switch between engaging a portion of the gripping feature (3322) with the locking end (3349) or engaging a portion of the gripping feature (3322) with the release opening (3348).

[0211] To facilitate engagement between the gripping feature (3322) and the locking assembly (3340), each gripping feature (3322) includes a locking arm (3324). Specifically, each locking arm extends axially or proximally from the body of each gripping feature (3322) toward each actuator (3342) through the application device (3310). Each locking arm (3324) is generally configured as an elongated rod or beam having a cross-section corresponding to the shape of a respective release opening (3348). As will be described in more detail below, each locking arm (3324) is configured to be received within the respective release opening (3348) to allow movement of the gripping feature (3322).

[0212] like Figure 67A and Figure 67B As best viewed, the locking assembly (3340) generally responds to a predetermined portion of the end effector (12) to lock and unlock the movement of the gripping feature (3322). Figure 68A and Figure 68B As seen, the unlocking movement of the gripping feature (3322) allows activation of the application device (3310) via the gripping feature (3322) to expand the platform (3318). Therefore, the locking assembly (3340) is configured to be able to... Figure 67A The locking configuration shown transforms into Figure 67BThe unlocking configuration is shown. This change allows the gripping feature (3322) to be used to activate the expansion of the platform (3318), such as... Figure 68B As seen in the text.

[0213] like Figure 67A As seen, in the locking configuration, each actuator (3342) of the locking assembly (3340) is positioned inward such that each engaging portion (3344) is in near contact (or alternatively in contact) with the opposite engaging portion (3344). Correspondingly, each locking end (3349) is positioned adjacent to the proximal end of the corresponding locking arm (3324). Thus, when the locking assembly (3340) is in the locking configuration, each locking end (3349) prevents movement of each gripping feature (3322) via the locking arm (3324). Additionally, it should be understood that the locking assembly (3340) is biased toward the locking configuration by a spring (3350) and a spring collar (3246).

[0214] The transition of the locking assembly (3340) from a locking configuration to an unlocking configuration is in Figure 67B As shown in the figure, the transition of the locking assembly (3340) is driven by a predetermined portion of the end effector (12). In this example, this transition is driven by the cutting edge (48) of the end effector (12). The use of the cutting edge (48) in this example is generally desirable because the specific shape, size, and position of the cutting edge (48) can be unique to the end effector (12). Therefore, the use of the cutting edge (48) as described herein serves as a locking feature to facilitate the use of the application device (3310) only with certain specific end effectors corresponding to the end effector (12) described above. In other words, end effectors with configurations different from those of the end effector (12) described above may not be usable with the application device (3310). It is also desirable to use the cutting edge (48) as described herein to prevent the deployment of the support assemblies (110, 112) until the application device (3310) is properly positioned within the end effector (12). Although the cutting edge (48) is shown and described herein as being usable for driving the locking assembly (3340), it should be understood that in other examples, various alternative portions of the end effector (12) may be used to drive the transformation of the locking assembly (3340). It should be understood that suitable portions of the end effector (12) may include any part of the end effector (12) that is unique or different from other end effector configurations or styles.

[0215] Returning to this example, the locking assembly (3340) is transformed by engagement between the engagement portion (3344) of each actuator (3342) and the cutting edge (48) of the end effector (12). Specifically, the application device (3310) is inserted into / on the end effector (12) (or the end effector (12) is inserted into / on the application device (3310)) to bring the cutting edge (48) into contact with each engagement portion (3344). This contact pushes each actuator (3342) outward away from the opposite actuator (3342) by a predetermined distance. Once this predetermined distance is reached, as Figure 67B As shown, each release opening (3348) is positioned adjacent to the proximal end of the corresponding locking arm (3324). This allows each locking arm (3324) to be received within the corresponding release opening (3348). Therefore, each gripping feature can be translated proximally relative to the housing (3316a, 3316b).

[0216] like Figure 68B As shown, once the locking assembly (3340) transitions to the unlocked configuration, each gripping feature (3322) can move proximally to activate the expansion of the platform (3318). This expansion pushes the platform (3318) toward the upper deck (72) and the anvil (18) of the end effector (12) to deploy the support assemblies (110, 112) thereon. Although not shown, it should be understood that the gripping features (3322) can communicate with one or more features adapted to activate the expansion of the platform (3318). In this example, the gripping features (3322) are used to drive the linkage assembly to expand the platform (3318). As discussed above, the expansion of the platform (3318) can be achieved using a variety of mechanical and / or electrical configurations.

[0217] B. An exemplary application device with keyed release Figure 69 Another exemplary auxiliary application device (3410) (also referred to as a “support application device”) is shown, which can be used to support, protect, and apply auxiliary materials, such as support assemblies (110, 112), to an end effector. Except where explicitly described elsewhere herein, the auxiliary application device (3410) of this example is substantially similar to the auxiliary application devices (210, 3310) described above. For example, like the application device (3310), the application device (3410) of this example includes a housing (not shown) defining an open end (not shown) and a closed end (not shown). Similarly, a platform (3418) is inserted between one or more portions of the housing.

[0218] Similar to the platform (3318) described above, the platform (3418) of this example is configured to support a pair of support assemblies (110) on one side of the platform (3418) and another pair of support assemblies (112) on the other side of the platform (3418). Also similar to the platform (3318), the platform (3418) of this example is generally configured to expand to accommodate the support assemblies (110, 112). To support this expandability, the platform (3418) includes an upper support (3420) and a lower support (3422) connected to a hinge (3426). The upper support (3420) includes an elongated, flat surface configured to support the support assemblies (110). Similarly, the lower support (3422) also includes an elongated, flat surface configured to support the support assemblies (112).

[0219] The upper support (3420) is connected to the lower support (3422) at a hinge (3426). The hinge (3426) is positioned at the proximal end of each support (3420, 3422) such that the hinge (3426) is generally configured for insertion into an end effector (3512), as will be described in more detail below. The hinge (3426) is generally configured to allow pivoting of the upper support (3420) relative to the lower support (3422).

[0220] The platform (3418) of this example is configured to expand automatically (e.g., without the operator pushing or pulling any part of the platform (3418)). To facilitate such automatic expansion, the platform (3418) of this example also includes an elastic member or torsion spring (3430) and a damper (3432). The torsion spring (3430) is configured to provide an outward force against the upper support (3420) and the lower support (3422) to bias the platform (3418) toward the expansion configuration. Meanwhile, the damper (3432) is generally configured to provide a controlled force opposite to that of the torsion spring (3430) (e.g., an inwardly oriented force). It should be understood that the damper (3432) is generally configured to act as a damper to prevent the torsion spring (3430) from expanding the platform (3418) at an undesirable rate. By way of example only, in some instances, this functionality may be implemented by constructing a platform (3418) or an application device (3410) in accordance with at least some of the teachings of the following U.S. patent application filed on the same date as this application, entitled “Apparatus and Method to Apply Buttress to EndEffector of Surgical Stapler via Driven Member” [Attorney’s File No. END9286USNP2], the disclosure of which is incorporated herein by reference.

[0221] To activate the expansion of the platform (3418), the application device (3410) of this example also includes a release component (3440). The release component (3440) is typically configured to engage a predetermined portion of the end effector (3512) to activate the expansion of the platform (3418) upon such engagement. Thus, the release component (3440) is similar to the locking component (3340) described above, because the release component (3440) facilitates the use of the application device (3410) only with certain end effectors and also facilitates the activation of the application device (3410) only when the application device (3410) is properly positioned within such end effectors.

[0222] The release assembly (3440) of this example includes a probe (3442) and a latch (3448). The probe (3442) includes a keyed end (3444) and an elongated pusher (3446) extending from the keyed end (3444). A portion of the probe (3442) extends proximally from a hinge (3426) such that the keyed end (3444) protrudes from the proximal end of the application device (3410). As will be described in more detail below, a particular position of the probe (3442) is configured to allow engagement between the keyed end (3444) and a predetermined portion of the end actuator (3510) when the lower support (3422) is properly positioned within the end actuator (3512).

[0223] An elongated actuator (3446) extends distally from the hinge (3426) and the key end (3444) toward the torsion spring (3430) and the latch (3448). The elongated actuator (3446) is generally responsive to movement of the key end (3444), such that movement of the key end (3444) causes a corresponding movement of the elongated actuator (3446). As will be described in more detail below, the movement of the elongated actuator (3446) is configured to actuate the latch (3448), which releases the torsion spring (3430) and thereby expands the platform (3418).

[0224] A latch (3448) is typically configured to selectively engage a torsion spring (3430) to retain the torsion spring (3430) in a compression configuration. In this example, the latch (3448) comprises an elongated rod or wire including a connector (3450) and a release member (3452). The connector (3450) is pivotally coupled to a lower support member (3422) to allow the latch (3448) to pivot relative to the lower support member (3422). The release member (3452) is positioned opposite the connector (3450) and is configured to releasably engage a portion of the torsion spring (3430) and / or the upper support member (3420) to retain the torsion spring (3430) in a compression configuration. As will be described in more detail below, the elongated pusher (3446) is generally configured to engage the latch (3448) to pivot the latch (3448) about the connector (3450), thereby disengaging the release member (3452) from a portion of the torsion spring (3430) and / or the upper support member (3420).

[0225] Although the release assembly (3440) is shown in a particular configuration, it should be understood that a variety of alternative configurations may be used in other examples. For example, in some examples, other mechanical release mechanisms may be used to allow the platform (3418) to expand selectively via a torsion spring (3430) or other mechanisms configured to store potential energy. In other examples, the release assembly (3440) may use a variety of electrical / mechanical components, such as solenoids, motors, buttons, sensors, etc. Of course, various other suitable configurations of the release assembly (3440) will be apparent to those skilled in the art in light of the teachings herein.

[0226] like Figure 70A As seen herein, the application device (3410) of this example is configured to be used with an end effector (3512). Except where otherwise explicitly stated herein, the end effector (3512) of this example is substantially similar to the end effector (12) described above. For example, similar to the end effector (12) described above, the end effector (3512) of this example employs a firing beam (3514) which can be used to cut and suture tissue in a single stroke. Like the firing beam (14) described above, the firing beam (3514) of this example can be driven relative to an anvil (not shown) (similar to anvil (18)) and an unexploded staple cartridge (not shown) (similar to staple cartridge (37)) to cut and suture tissue. Like the staple cartridge (37), the staple cartridge of the end effector (3512) is removably mounted into a channel of the lower jaw (3516).

[0227] Unlike the end effector (12) described above, the end effector (3512) of this example includes a cartridge closure (3530) integrated into the end effector (3512). The closure (3530) is typically configured to engage with certain corresponding parts of the cartridge. Such an engagement arrangement moves the closure (3530) to a predetermined position and unlocks certain operations of the end effector (3512), such as the movement of the firing beam (3514) and the closure of the anvil. Therefore, it should be understood that the closure (3530) is configured to prevent the use of the end effector (3512) when the cartridge is not installed, an improperly installed (e.g., lacking a mating feature) cartridge is installed, or the cartridge is improperly installed. In some examples, the end effector (3512) and the locking element (3530) of the staple cartridge, and other associated features may be constructed in accordance with at least some of the teachings of the following patent: U.S. Patent Application No. 16 / 453,273, filed June 26, 2019, entitled “Method for Providing an Authentication Lockout in a Surgical Stapler with a Replaceable Cartridge,” the disclosure of which is incorporated herein by reference.

[0228] exist Figures 70A to 71 The use of an auxiliary application device (3410) with an end effector (3512) is shown in the figure. Figure 70A As is best viewed, the application device (3410) can first be inserted into the end effector (3512) to position the lower support (3422) aligned with the lower jaw (3516) of the end effector (3512). The insertion direction is such that the hinge (3426) and the key end (3444) are inserted into the end effector (3512) first toward the locking member (3530).

[0229] Once the application device (3410) is fully inserted into the end effector (3512), the keyed end (3444) engages a portion of the locking element (3530), as... Figure 70B As seen in the example. In some examples, the specific geometry of the key end (3444) may be configured to correspond to specific geometric features of the locking element (3530) to further facilitate precise positioning of the application device (3410) relative to the end effector (3512). In any case, when the key end (3444) engages with the locking element (3530), the key end (3444) pushes the probe (3442) distally.

[0230] like Figure 71As the probe (3442) moves distally, the elongated pusher (3446) engages the latch (3448). The latch (3448) is correspondingly pushed by the elongated pusher (3446) to pivot about the connector (3450), thereby disengaging the release member (3452) from the torsion spring (3430) and / or the upper support member (3420). With the torsion spring (3430) released, the platform (3418) can expand at a controlled speed using the force applied by the torsion spring (3430) and the buffer (3432) to apply the support assembly (110, 112) to the end effector (3512).

[0231] C. Exemplary application device with RFID certification Figure 72A and Figure 73A Another exemplary alternative application device (3610) (also referred to as a “support application device”) is shown, which can be used to support, protect, and apply auxiliary materials, such as support assemblies (110, 112), to an end effector. Except where explicitly described elsewhere herein, the application device (3610) of this example is substantially similar to the application devices (210, 3310, 3410) described above. For example, like the application device (3310), the application device (3610) of this example includes a housing (3616) defining an open end (3612) and a closed end (3614). Similarly, a platform (3618) is inserted between one or more portions of the housing.

[0232] Similar to the platform (3318) described above, the platform (3618) of this example is configured to support a pair of support assemblies (110) on one side of the platform (3618) and another pair of support assemblies (112) on the other side of the platform (3618). Also similar to the platform (3318), the platform (3618) of this example is generally configured to expand to apply the support assemblies (110, 112). To support this expandability, the platform (3618) includes certain mechanisms generally configured to facilitate its expansion. By way of example only, the platform (3618) of this example includes an expandable wedge driven by a linkage mechanism similar to that of the platform (3318) described above. However, it should be understood that other suitable mechanisms, such as expandable airbags, spring-loaded wedges, lead screw drives, etc., may be used in other examples. In other examples, the platform (3618) may be constructed based on at least some of the teachings of the following patent: U.S. patent application entitled “Apparatus and Method to Apply Buttress to End Effector of Surgical Staplervia Driven Member” [Attorney’s File No. END9286USNP2], filed on the same date as this application, the disclosure of which is incorporated herein by reference.

[0233] Unlike the platform (3318) described above, the scalability of the platform (3618) in this example is motor-driven rather than manually operated. Specifically, as Figure 73A As best seen, the internal components of the application device (3610) include a motor (3630), a power source (3634), and a switch (3638), all integrated into a circuit. Although not shown, it should be understood that the motor (3630) of this example can communicate with one or more features of the platform (3618) to drive the expansion of the platform (3618). For example, as described above, the platform (3618) of this example can use a linkage mechanism to provide its expansion. Thus, in such examples, the motor (3630) can be configured to rotate a lead screw or other drive mechanism to move the platform (3618) from a flat configuration to an expanded configuration. Of course, in other configurations using alternative expansion mechanisms, the motor (3630) can vary as needed. For example, in some examples, the motor (3630) can include a vacuum pump, a linear actuator, etc.

[0234] The switch (3638) communicates with the motor (3630) and the power source (3634) to selectively activate and deactivate the power supplied to the motor (3630) via the power source (3634). The power source (3634) in this example is shown as a battery, but any other suitable power source, including DC and / or AC power sources, can be used. Although not shown, it should be understood that the motor (3630), power source (3634), and switch (3638) can be connected to other circuits, such as microcontrollers, controllers, relays, diodes, capacitors, inductors, resistors, inverters, etc.

[0235] return Figure 72A The application device (3610) also includes an RFID module (3640). As will be described in more detail below, the RFID module (3640) is generally configured to respond to one or more corresponding RFID components of the end effector (3712). This relationship is generally desired to provide confirmation of the use of the application device (3610) with a suitable end effector similar to the end effector (3712), and confirmation of the proper positioning of the application device (3610) prior to deployment of the support assembly (110, 112) via the platform (3618).

[0236] As shown in the figure, the RFID module (3640) communicates with the switch (3638). In this example, the RFID module (3640) is configured to trip or otherwise actuate switching between open and closed configurations. It should be understood that this configuration allows the RFID module (3640) to activate the motor (3630) and thereby expand the platform (3618) to deploy the support assembly (110, 112) only when the RFID module (3640) is close to certain corresponding features of the end effector (3712).

[0237] In this example, the RFID module (3640) is positioned near the proximal end of the application device (3610) adjacent to the open end (3612). Although only a single RFID module (3640) is visible, it should be understood that additional RFID modules (3640) may be provided on each side of the application device (3610) (e.g., one on each side). Figure 72A On the side outside the page, and one in Figure 72A(On one side of the page). As will be described in more detail below, this proximal positioning is generally desirable to confirm the proper positioning of the application device (3610) within the end effector (3712). In other examples, any suitable number of RFID modules (3640) may be used. For example, in some examples, four RFID modules (3640) may be used, with two on the proximal end of the application device (3610) and two on the distal end of the application device (3610). Such a configuration may be desirable for providing improved position confirmation. Therefore, in other examples, even more RFID modules (3640) may be used, as will be apparent to those skilled in the art given the teachings herein. Additionally, it should be understood that in examples using multiple RFID modules (3640), all such RFID modules (3370) may communicate with the switch (3638) such that all RFID modules (3640) may be used to switch the switch (3638) between an open-circuit configuration and a closed-circuit configuration.

[0238] like Figure 72A As seen, the application device (3610) can be used with the end effector (3712). Except where otherwise explicitly stated herein, the end effector (3712) of this example is substantially similar to the end effector (12) described above. For example, similar to the end effector (12) described above, the end effector (3712) of this example employs a firing beam (3714) which can be used to cut and suture tissue in a single stroke. Like the firing beam (14) described above, the firing beam (3714) of this example can be driven relative to the anvil (3718) and the unexploded staple cartridge (3737) to cut and suture tissue. Like the staple cartridge (37), the staple cartridge (3737) is removably mounted into a channel of the lower jaw (3716).

[0239] Unlike the end effector (12) described above, the end effector (3712) of this example includes an RFID module (3740) positioned adjacent to the fork formed by the anvil (3718) and the lower jaw (3716). The RFID module (3740) of the end effector (3712) is typically configured to communicate with the RFID module (3640) of the application device (3610). By way of example only, the RFID module (3740) of the end effector (3712) is configured as an RFID sensor or antenna. Meanwhile, the RFID module (3640) of the application device (3610) is configured as an RFID chip or transmitter for transmitting radio frequency signals to the RFID module (3740) of the end effector (3712). Of course, in other examples, this configuration is reversed, and the RFID module (3740) may be configured as a chip or transmitter, while the RFID module (3640) may be configured as a sensor or antenna.

[0240] Although the end effector (3712) in this example is shown as having a single RFID module (3740), it should be understood that in other examples, the end effector (3712) may include any suitable number of RFID modules (3740). For example, in some examples, an array of RFID modules (3740) may be used in the end effector (3712), wherein a group of RFID modules (3740) is configured to be used for certain specific purposes. In such a configuration, one set of RFID modules (3740) may be used to detect and authenticate the presence of a specific staple cartridge, similar to a staple cartridge (3737). Simultaneously, another set of RFID modules (3740) may be used to detect and authenticate the presence of a specific auxiliary application device, similar to an auxiliary application device (3610). Yet another set of RFID modules (3740) may be used to detect other auxiliary components, such as staple cartridge retainers, and authenticate the presence (or absence) of these other auxiliary components. In some examples, a suitable configuration of the RFID module (3740) may be based on at least some of the teachings of the following patent: U.S. Patent Application No. 16 / 458,108, filed June 30, 2019, entitled “Surgical Instrument System Comprising an RFID System,” the disclosure of which is incorporated herein by reference.

[0241] exist Figures 72A to 73B An exemplary use of this example is shown in the figure. As can be seen, the end effector (3712) is initially moved relative to the application device (3610) to insert the application device (3610) into the end effector (3712). Figure 73A The switch (3638) of the application device (3610) is shown in an open configuration during insertion. This open configuration corresponds to the platform (3618) being in a non-expanded configuration. Although not shown, it should be understood that in some applications, the end effector (3712) may be electronically locked before and during insertion of the application device (3610). For example, an RFID module (3740) may generate a signal corresponding to the absence of detection of the application device (3610). This signal may then communicate with electronic circuitry within the end effector (3712) or other parts of the instrument (not shown) to physically or electronically lock parts of the instrument or the end effector (3712) to prevent movement (e.g., to prevent the firing beam (3714) from advancing distally).

[0242] Once the application device (3610) is fully inserted into the end effector (3712), the RFID module (3640) of the application device (3610) is adjacent to the RFID module (3740) of the end effector (3712), as... Figure 72BAs seen in the image. Then, the RFID module (3640) responds to the presence of the RFID module (3740) by changing the switch (3638) from an open configuration to a closed configuration, as... Figure 73B As shown. This switching of the switch (3638) activates the motor (3630) and thereby expands the platform (3618), which results in the application of the support assembly (110, 112) to the anvil (3718) and the staple cartridge (3737) of the end effector (3712).

[0243] In some applications, the RFID module (3740) may also respond to the presence of the RFID module (3640). For example, the RFID module (3740) may generate one or more signals upon detecting the presence of the RFID module (3640). Such signals may then be transmitted to the end effector (3712) or other parts of the instrument to release or otherwise disengage certain locking features. Alternatively, such locking features may remain active but may disengage after a predetermined amount of time or until the presence of the RFID module (3640) is no longer detected.

[0244] D. An exemplary application device with an external power input Figure 74A Another exemplary alternative application device (3810) (also referred to as a “support application device”) is shown, which can be used to support, protect, and apply auxiliary materials, such as support assemblies (110, 112), to an end effector. Except where explicitly described herein, the auxiliary application device (3710) of this example is substantially similar to the auxiliary application devices (210, 3310, 3410, 3610) described above. For example, like the application device (3310), the application device (3810) of this example includes a housing (916) defining an open end (3812) and a closed end (3814). Similarly, a platform (3818) is inserted between one or more portions of the housing (3816).

[0245] Similar to the platform (3318) described above, the platform (3818) of this example is configured to support a pair of support assemblies (110) on one side of the platform (3818) and another pair of support assemblies (112) on the other side of the platform (3818). Also similar to the platform (3318), the platform (3818) of this example is generally configured to expand to apply the support assemblies (110, 112). To support this expandability, the platform (3818) includes certain mechanisms generally configured to facilitate its expansion. By way of example only, the platform (3818) of this example includes an expandable wedge driven by a linkage mechanism similar to that of the platform (3318) described above. However, it should be understood that other suitable mechanisms, such as expandable airbags, spring-loaded wedges, lead screw drives, etc., may be used in other examples. In other examples, the platform (3818) may be constructed based on at least some of the teachings of the following patent: U.S. patent application entitled “Apparatus and Method to Apply Buttress to End Effector of Surgical Staplervia Driven Member” [Attorney’s File No. END9286USNP2], filed on the same date as this application, the disclosure of which is incorporated herein by reference.

[0246] Unlike the platform (3318) described above, the scalability of the platform (3818) in this example is motor-driven rather than manually operated. Specifically, as Figure 74A As best seen, the application device (3810) includes a power input or key-type actuator (3830). The power input (3830) is shown communicating with one or more features of the platform (3818) to drive the expansion of the platform (3818). Such features of the platform (3818) can be driven by the power input (3830) in a variety of ways. For example, as described above, the platform (3818) of this example can use a linkage mechanism to provide its expansion. Thus, in such an example, the power input (3830) can be configured to rotate a lead screw or other drive mechanism to move the platform (3818) from a flat configuration to an expanded configuration. Of course, in other configurations using alternative expansion mechanisms, the power input (3830) can vary as needed. For example, in some examples, the power input (3830) can include a vacuum pump, a linear actuator, etc.

[0247] The power input (3830) is configured to communicate with certain features of the end effector (3912). As will be described in more detail below, in some examples, the end effector (39...

Claims

1. A method for applying an adjunct element to the end effector of a surgical suture device using an application device, wherein, The end effector includes a first suture surface having a plurality of staple openings and a second suture surface having a plurality of staple forming recesses, the method comprising: (a) The end effector is provided in an open state, wherein the first suture surface and the second suture surface are provided by the end effector, spaced apart from each other, and away from the application device; (b) With the end effector in the open state, at least a portion of the application device is positioned between the first suture surface and the second suture surface; (c) Expanding a portion of the application device by means of fluid to change the application device from a non-expanded state to an expanded state, thereby advancing the auxiliary element in a direction toward one of the first suture surface or the second suture surface, wherein the application device defines a distal opening angle in the expanded state; (d) Without engaging the closure system input feature of the surgical suture device, compressively engaging a portion of the end effector with the application device, thereby securing the accessory element to one of the first suture surface or the second suture surface; and (e) The application device and the end effector are retracted relative to each other, such that the accessory element remains attached to one of the first suture surface or the second suture surface of the end effector.

2. The method according to claim 1, wherein, The accessory element can be releasably attached to the application device.

3. The method according to claim 2, wherein, The accessory element includes a first accessory element, wherein the application device further includes a second accessory element, wherein the method further includes securing the first accessory element to the first suture surface and securing the second accessory element to the second suture surface.

4. The method according to claim 1, wherein, The application device is configured to switch between multiple angular orientations, in each of which the application device defines a distal opening angle.

5. The method according to claim 4, wherein, The application device includes a base and a body, the body being configured to be releasably coupled to the base in each of the angular orientations.

6. The method according to claim 1, wherein, The application device includes a first contact feature and a second contact feature that are movable relative to each other between the non-expanded state and the expanded state, wherein the first contact feature is configured to engage the first suture surface and the second contact feature is configured to engage the second suture surface.

7. The method according to claim 1, wherein, The end effector includes a first jaw defining the first suture surface and a second jaw defining the second suture surface, wherein the application device includes a first contact feature and a second contact feature movable relative to each other, wherein compressively engaging a portion of the end effector with the application device includes engaging one of the first suture surface or the second suture surface with the first contact feature and simultaneously engaging an outer jaw surface disposed opposite to one of the first suture surface or the second suture surface with the second contact feature.

8. The method according to claim 7, wherein, The first contact feature and the second contact feature are elastically biased toward each other.

9. The method of claim 1, further comprising engaging a first predetermined portion of the end effector with a second predetermined portion of the application device, wherein, The action of engaging the first predetermined portion and the second predetermined portion with each other allows the application device to transition from the non-expanded state to the expanded state, wherein the application device remains in the non-expanded state before the first predetermined portion and the second predetermined portion engage with each other.

10. The method according to claim 9, wherein, The application device further includes an actuator, wherein the method further includes switching the application device from the non-expanded state to the expanded state in response to the engagement of the first predetermined portion and the second predetermined portion with each other.

11. The method according to claim 1, wherein, The end effector includes a first jaw defining the first suture surface and a second jaw defining the second suture surface, wherein compressively engaging a portion of the end effector includes engaging the outer jaw surface of one of the first jaws or the second jaws with the application device to push the end effector toward a closed state, in which the accessory element is compressed against one of the first suture surface or the second suture surface.

12. A method for applying an adjunct element to the end effector of a surgical suture using an application device having a flexible body with a hollow interior, wherein, The end effector includes a first suture surface having a plurality of staple openings and a second suture surface having a plurality of staple forming recesses, the method comprising: (a) The end effector is provided in an open state, wherein the first suture surface and the second suture surface are provided by the end effector, spaced apart from each other, and away from the application device; (b) With the end effector in the open state, at least a portion of the application device is positioned between the first suture surface and the second suture surface; (c) Inflate the hollow interior to change the application device from a non-expanded state to an expanded state to advance the accessory element in a direction toward one of the first suture surface or the second suture surface, wherein the application device in the expanded state defines a distal opening angle. (d) With the end effector in the open state and the application device in the expanded state, engaging one of the first suture surface or the second suture surface with the accessory element and thereby securing the accessory element to one of the first suture surface or the second suture surface; and (e) With the end effector in the open state, the application device and the end effector are retracted relative to each other, such that the auxiliary element is separated from the application device while remaining attached to the end effector.

13. The method of claim 12, further comprising engaging a first predetermined portion of the end effector with a second predetermined portion of the application device, wherein, The action of engaging the first predetermined portion and the second predetermined portion with each other allows the application device to transition from the non-expanded state to the expanded state.

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