Apparatus and method for closing an end effector of a surgical stapler to a buttress

Abstract

An apparatus for applying at least one adjunct element to at least one of opposing first and second jaws of an end effector of a surgical stapler, wherein each of the first and second jaws includes a stapling surface and an outer surface opposite the respective stapling surface. The apparatus includes: (a) a platform configured to be positioned between the first and second jaws of the end effector; (b) an adjunct element positioned on the platform; and (c) at least one closure surface opposite the platform, wherein the at least one closure surface is configured to mechanically engage the outer surface of at least one of the first or second jaws to transition the end effector from an open state toward a closed state for placing the respective stapling surface of the at least one of the first or second jaws in contact with the at least one adjunct element.

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 suture devices. Some of these suture devices are operable to clamp tissue layers, cut through the clamped tissue layers, and drive a staple through the tissue layers to substantially seal the cut tissue layers together near the cut ends. Exemplary surgical suture devices 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;

[0007] Figure 2 It shows Figure 1 A side front view of the instrument;

[0008] Figure 3 It shows that it is in the open state. Figure 1 A perspective view of the end effector of the instrument;

[0009] 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;

[0010] 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;

[0011] Figure 5 It shows Figure 3 end effector along Figure 3 The end cross-sectional view taken from line 5-5;

[0012] Figure 6 It shows Figure 3 Exploded perspective view of the end effector;

[0013] Figure 7 It shows Figure 3A perspective view of an end effector located at the tissue and already actuated once within the tissue;

[0014] 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;

[0015] 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;

[0016] 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;

[0017] 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;

[0018] 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;

[0019] Figure 11 It shows that it can be used for carrying and application Figure 8 A perspective view of an exemplary support applicator compartment of the support assembly;

[0020] Figure 12 It shows Figure 11 A top plan view of the support application device compartment;

[0021] Figure 13A It shows Figure 3 end effector and Figure 11 A perspective view of the support applicator compartment, showing the end effector and the support applicator compartment aligned with each other;

[0022] Figure 13B It shows Figure 3 end effector and Figure 11 A perspective view of the support applicator compartment, in which the end effector jaws are closed on the platform of the support applicator compartment;

[0023] Figure 14 It shows Figure 3 End effectors and can be used for carrying and applying Figure 8 A perspective view of another exemplary support applicator of the support assembly shows the support applicator positioned above the end effector, with the translational sleeve of the support applicator in a retracted position.

[0024] Figure 15A It shows the location at Figure 3 Above the end effector Figure 14 A side sectional view of the support applicator, showing the translational sleeve of the support applicator in the retracted position;

[0025] Figure 15B It shows the location at Figure 3 Above the end effector Figure 14 A side sectional view of the support applicator shows the translational sleeve of the support applicator in an extended position for changing the end actuator toward a closed state;

[0026] Figure 16 It shows that it can be used for carrying and application Figure 8 A perspective view of another exemplary support applicator for the support assembly;

[0027] Figure 17A It shows Figure 16 support applicator and Figure 3 A side sectional view of the end effector, showing the applicator and the end effector axially aligned;

[0028] Figure 17B It shows the location at Figure 3 Above the end effector Figure 16 A side sectional view of the support applicator shows the support applicator advancing proximally over the end effector to change the end effector toward a closed state;

[0029] Figure 18 It shows the positions that can be used for carrying and application. Figure 3 Above the end effector Figure 8 A side sectional view of another exemplary support applicator of the support assembly shows the rotatable sleeve of the support applicator in a first angle (e.g., "untimed") position;

[0030] Figure 19A It shows the location at Figure 3 Above the end effector Figure 18 The support applicator along Figure 18 The end section view taken by section line 19-19 shows the rotatable sleeve of the support applicator in the first angular position;

[0031] Figure 19BIt shows the location at Figure 3 Above the end effector Figure 18 The support applicator along Figure 18 The end section view taken by section line 19-19 shows the rotatable sleeve of the support applicator in a second angle (e.g., "timing") position for turning the end actuator toward a closed state;

[0032] Figure 20 It shows that it can be used for carrying and application Figure 8 A perspective view of another exemplary support applicator for the support assembly;

[0033] Figure 21A It shows the location at Figure 3 Above the end effector Figure 20 A side sectional view of the support applicator, showing the pivotable lever arm of the support applicator in the open position;

[0034] Figure 21B It shows the location at Figure 3 Above the end effector Figure 20 A side sectional view of the support applicator shows the pivotable lever arm of the support applicator in the closed position, used to change the end actuator toward the closed state;

[0035] Figure 22A It shows the positions that can be used for carrying and application. Figure 3 Above the end effector Figure 8 A side sectional view of another exemplary support applicator of the support assembly shows the pivotable lever arm of the support applicator in the unacted position; and

[0036] Figure 22B It shows the location at Figure 3 Above the end effector Figure 22A A side sectional view of the support applicator shows the pivotable lever arm of the support applicator in the actuated position for changing the end effector toward the closed state.

[0037] 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

[0038] 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.

[0039] 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.

[0040] 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.

[0041] I. Exemplary Surgical Stapler

[0042] 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).

[0043] 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).

[0044] 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.

[0045] 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 said 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).

[0046] 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).

[0047] 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 staple cartridge (37) together by entering the slot (49) within the staple cartridge (37), thereby driving the wedge-shaped slider (41) to make upward cam-action contact with the staple driver (43), which in turn drives the staple (47) outward through the staple hole (51) and causes the staple to form a staple 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).

[0048] 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.

[0049] 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,” published August 1, 2017. U.S. Patent No. 9,717,497, entitled “Cutting Member of 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 “StapleForming Features for Surgical Stapling Instrument”, published on October 9, 2018.

[0050] II. Exemplary support assembly and support applicator compartment

[0051] In some cases, it may be desirable to equip the end effector (12) of the surgical instrument (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 filling of gaps or spaces, administration of therapeutic agents, and / or other effects. In some cases, the support may be disposed 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 disposed on the surface of the anvil (18) facing the staple cartridge (37). It should also be understood that a first support may be disposed on the deck (72) of the staple cartridge (37), while a second support may be disposed on the anvil (18) of the same end effector (12).

[0052] 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 attached 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 support applicator cartridges 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.

[0053] A. Exemplary components of the support assembly

[0054] 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).

[0055] Each support body (114, 118) may include materials including, for example, hemostatic agents such as fibrin to aid in blood clotting and reduce bleeding at surgical sites along tissue (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.

[0056] 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.

[0057] B. Exemplary suturing of tissue and support components

[0058] Figures 9A to 9CAn exemplary sequence is shown in which a surgical suture end actuator (12), in which a support assembly (110, 112) is already loaded, is actuated to drive a staple (47) through two opposing tissue layers (T1, T2), wherein the support assembly (110, 112) is secured to the same tissue layer (T1, T2) by the staple (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 (124) 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 interposed 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).

[0059] 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 supports (110, 112) thus provide 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 tissue assembly (110, 112), thereby dividing each support assembly (110, 112) into a corresponding pair of segments, so that each segment remains fixed to the corresponding cut area of ​​the tissue (T1, T2).

[0060] C. An exemplary support applicator compartment with a movable retainer arm

[0061] Because the end effector (12) of the surgical instrument (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 end effector jaws (16, 18) during that single surgical procedure. Figures 11 to 13B An exemplary support applicator compartment (210) (also referred to as a "support applicator") 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 compartment (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 compartment (210) also includes a first housing (216a) and a second housing (216b), which together generally define a “U” shape to present the open end (212). A platform (218) and a slider retainer (220) are interposed between the first housing (216a) and the second housing (216b).

[0062] 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).

[0063] 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 resilient and is therefore configured to resiliently abut against the support assemblies (110, 112), thereby causing the support assemblies (110, 112) to retract against the platform (218). The support applicator compartment (210) includes a pair of tapered cam surfaces (232) 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 housing (210).

[0064] Figure 13A A compartment (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 A compartment (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 use the bin (210) to load the end effector (12), the operator will first position the bin (210) and the end effector (12) such that the end effector is aligned with the open end (212) of the bin (210), as shown. Figure 13A As shown. The operator then advances the distal end effector (12) and / or the proximal end chamber (210) to position the platform (218) and support assemblies (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 end effector jaws (16, 18) on the platform (218), thereby adhering the support assembly (110, 112) to the anvil (18) and the cartridge (37), and simultaneously pressing 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 end effector jaws (16, 18) can disengage from the platform (218), while the support assembly (110, 112) remains adhered to the anvil (18) and the cartridge (37).

[0065] III. Exemplary alternative application devices and related methods for applying the support to the surgical suture end actuator Law

[0066] In some cases, it may be desirable to provide an application device configured to apply a staple-reinforcing accessory to one or both jaws of a surgical stapler end effector without closing the jaws via an actuation of the end effector closure system of the stapler (such as via an actuation of the closure trigger (26) of the surgical stapler (10). The exemplary application devices described below provide such functionality, such that each application device is configured to be manipulated relative to the end effector to apply the accessory to one or both jaws without requiring the aforementioned... Figures 13A to 13B The jaws shown are actuated and closed. In addition, the exemplary application device described below is operable to apply minimal pressure to properly place the auxiliary material onto the desired jaws (e.g., the lower jaw (16) or the anvil (18)).

[0067] It should be understood that any of the exemplary application devices described below can be configured to apply the auxiliary element in the form of a support (such as the aforementioned supports (110, 112)) or a tissue thickness compensator (e.g., of the type disclosed in U.S. Patent Publication No. 2012 / 0080336 entitled “Staple Cartridge Comprising Staples Positioned Within A Compressible Portion Thereof,” published April 5, 2012 and now abandoned, the disclosure of which is incorporated herein by reference). Additionally, the application of the nail reinforcement element to the end effector jaws can 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, any of the exemplary application devices described below can be suitably configured for single or multiple use.

[0068] A. An exemplary support applicator with a translatable sleeve for use in reverse-drive end effector jaws.

[0069] Figures 14 to 15B An exemplary support applicator 310 is shown, which is configured to force the jaws of an end effector to close onto a portion of the support applicator 310 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 support applicator (310) is similar to the support applicator (210) described above, except as further described below.

[0070] The support applicator (310) of this example includes a frame (312) extending between a proximal end (not shown) and a distal end (314). The frame (312) includes a handle (316) positioned at or near the proximal end of the frame (312), a compression pad or platform (318) positioned at or near the distal end (314) of the frame (312), and an elongated track (320) extending longitudinally between the handle and the platform. In the example shown, the track (320) extends along the lateral sides of the handle (316) and the platform (318) such that the track (320) can be positioned side-by-side with the end effector (12). Although a single track (320) is shown, the frame (312) may include, for example, a pair of opposing tracks (320). The support applicator (310) also includes a movable member in the form of a translatable sleeve (322), which is attached to the frame (312) and configured to be longitudinally translatable relative to the platform (318) along the guide rail (320), 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.

[0071] The platform (318) of this example is configured to support at least one support assembly (110, 112) on at least one side of the platform (318). In the example shown, the platform (318) 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 (318) is shown as supporting the support assembly (110, 112) only on one side of the platform (318), the platform (318) can equally easily support the support assembly (110, 112) on both sides of the platform (318).

[0072] The translational sleeve (322) has a generally C-shaped cross-section and includes a generally C-shaped inner closure surface (324) 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 (318) is positioned between the jaws (16, 18). In this respect, the sleeve (322) may be sized and configured relative to the end effector (12) such that the closure surface (324) is capable of at least partially circumferentially surrounding or encircling the end effector (12) and contacting or nearly contacting 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 (324) 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 (322) and / or the guide rail (320) may also be configured to help provide proper alignment of the end effector (12) with the support applicator (310), such as by allowing the guide rail (320) to abut the lateral side of the end effector (12) when the support applicator (310) is positioned above the end effector (12) and the platform (318) is properly positioned between the jaws (16, 18).

[0073] Figure 15A The image shows an end effector (12) in the open state and a support applicator (310) configured such that the sleeve (322) is in a retracted position relative to the end effector (12), such that the closing surface (324) is mechanically disengaged from the outer surface of the upper jaw (18); while Figure 15B A support applicator (310) is shown in the following configuration: the sleeve (322) is in an extended position relative to the end effector (12), such that the closing surface (324) mechanically engages the outer surface of the jaws (18), thereby changing the end effector (12) from an open state to a closed state. To load the end effector (12) using the support applicator (310), the operator first positions the support applicator (310) and the end effector (12) such that the platform (318) and the support assembly (110, 112) are positioned between the anvil (18) and the staple cartridge (37), and the end effector (12) is aligned with the sleeve (322), wherein the sleeve (322) is retracted proximally from the jaws (16, 18), as... Figure 15A As shown. The operator then advances the sleeve (322) distally relative to the end actuator (12) so that the closing surface (324) mechanically engages with the outer surface of the anvil (18), as shown. Figure 15BAs 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 assembly (110, 112) to the anvil (18) (e.g., to its suture surface). The support assembly (110, 112) can be released from the platform (318) so that the end effector jaws (16, 18) can disengage from the platform (318) while the support assembly (110, 112) remains adhered to the anvil (18). In one example, the cannula (322) can be advanced and retracted sequentially in a back-and-forth or “pumping” manner to gradually transition the end effector (12) toward the closed state.

[0074] Although the support applicator (310) is shown to apply the support assembly (110, 112) to the anvil (18), the support applicator (310) 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).

[0075] B. An exemplary support with a tapered cam action surface for use in the jaws of a reverse-drive end effector. tools

[0076] Figures 16 to 17B Another exemplary support applicator 410 is shown, which is configured to force the jaws of an end effector to close onto a portion of the support applicator 410 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 support applicator (410) is similar to the support applicators (210, 310) described above, except as further described below.

[0077] The support applicator (410) of this example includes a housing (412) extending between an open proximal end (413) and a closed distal end (414). The housing (412) includes a generally truncated conical proximal portion (416) and a generally cylindrical distal portion (417), such that the housing (412) is generally funnel-shaped. A compression pad or platform (418) extends proximal from the closed distal end (414) within the proximal and distal portions (416, 417) of the housing (412) and is secured to resist movement relative to the housing. The housing (412) is configured to selectively receive an end actuator (12), as will be described in more detail below.

[0078] The platform (418) of this example is configured to support at least one support assembly (110, 112) on at least one side of the platform (418). In the example shown, the platform (418) 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 (418) is shown as supporting the support assembly (110, 112) only on one side of the platform (418), the platform (418) can be equally easily supported on both sides of the platform (418).

[0079] The proximal portion (416) and distal portion (417) of the housing (412) each include tapered inner closing surfaces and non-tapered inner closing surfaces (424, 426), which are configured to selectively and mechanically engage the outer 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 (418) is positioned between the jaws (16, 18). In this regard, the dimensions and configuration of the proximal portion (416) and distal portion (417) may be arranged relative to the end effector (12) such that the closing surfaces (424, 426) are able to at least partially circumferentially surround or encircle the end effector (12) and contact or nearly contact the outer outer surface of at least one of the jaws (16, 18) for retracting the end effector (12) in the closed state. For example, the non-tapered closing surface (426) 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. The tapered closing surface (424) 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 inward toward the non-tapered closing surface (426) in the distal direction. It should be understood that the tapered closing surface (424) may alternatively bend radially inward toward the non-tapered closing surface (426) in the distal direction. The dimensions and construction of the proximal and / or distal portions (416, 417) may also be configured to help provide proper alignment of the end effector (12) with the support applicator (410), such as by abutting one or more lateral sides of the end effector (12) when the support applicator (410) is positioned above the end effector (12) and the platform (418) is properly positioned between the jaws (16, 18).

[0080] Figure 17A The support applicator (410) is positioned relative to the end effector (12) such that the tapered closing surface (424) mechanically engages the outer surface of the jaws (18), thereby changing the end effector (12) from an open state to a closed state; while Figure 17B The support applicator (410) is positioned relative to the end effector (12) such that the non-retractable closure surface (326) 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 support applicator (410), the operator first positions the support applicator (410) and the end effector (12) such that the platform (418) 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 proximal portion (416) of the housing (412), as shown. Figure 17A As shown. Then, the operator advances the housing (412) proximally relative to the end effector (12) so that the tapered closing surface (424) mechanically engages with the outer surface of the anvil (18), as shown. Figure 17A As shown by the third arrow (A3) in the diagram, the anvil (18) is as follows: Figure 17A The fourth arrow (A4) indicates that the cam moves radially inward until the non-contracting closing surface (426) mechanically engages the outer surfaces of the two jaws (16, 18), as shown in the image. Figure 17B As shown. The end effector jaws (16, 18) can be reverse-driven closed on the platform (418) 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 (418) such that the end effector jaws (16, 18) can disengage from the platform (418) while the support assembly (110, 112) remains adhered to the anvil (18), such as by retracting the housing (412) distally relative to the end effector (12).

[0081] Although the support applicator (410) is shown to apply the support assembly (110, 112) to the anvil (18), the support applicator (410) 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).

[0082] In one example, the platform (418) may be omitted, and the housing (412) may be configured to selectively receive another support applicator or applicator compartment, such as compartment (210), in place of the platform (418). Thus, the support applicator (410) can be reused by selectively inserting the loaded compartment (210) into the housing (412) and removing the used compartment (210) from the housing (412).

[0083] C. An exemplary support applicator with a torsionable sleeve for use in reverse-drive end effector jaws.

[0084] Figures 18 to 19B Another exemplary support applicator 510 is shown, which is configured to force the jaws of an end effector to close onto a portion of the support applicator 510 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 support applicator (510) is similar to the support applicators (210, 310, 410) described above, except as further described below.

[0085] The support applicator (510) of this example includes a frame (512) that includes a compression pad or platform (518). The support applicator (510) also includes a movable member in the form of a rotatable sleeve (522) coupled to the frame (512) and configured to rotate relative to the platform (518) about a rotation axis (RA) parallel to the longitudinal axis of the platform (518), and selectively receive an end effector (12), as will be described in more detail below.

[0086] The platform (518) of this example is configured to support at least one support assembly (110, 112) on at least one side of the platform (518). In the example shown, the platform (518) 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 (518) is shown as supporting the support assembly (110, 112) only on one side of the platform (518), the platform (518) can equally easily support the support assembly (110, 112) on both sides of the platform (518).

[0087] The rotatable sleeve (522) includes a bore 523, the generally oval or elliptical cross-section of which defines a generally oval or elliptical inner closure surface (524), 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 (518) is positioned between the jaws (16, 18). In this respect, the sleeve (522) may be sized and configured relative to the end effector (12) such that the closure surface (524) 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 (524) 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 construction of the sleeve (522) may also be configured to aid in providing proper alignment of the end effector (12) with the support applicator (510), such as by abutting one or more lateral sides of the end effector (12) when the support applicator (510) is positioned above the end effector (12) and the platform (518) is properly positioned between the jaws (16, 18).

[0088] Figure 19A An end effector (12) in an open state is shown, and a support applicator (510) is configured such that a sleeve (522) is in a first angular (e.g., "untimed") position relative to the end effector (12), such that the closing surface (524) mechanically disengages from the outer surface of the jaws (16, 18); while Figure 19BA support applicator (510) is shown in a configuration such that a sleeve (522) is in a second angular (e.g., “timing”) position relative to the end effector (12), such that a closing surface (524) 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 support applicator (510), the operator first positions the support applicator (510) and the end effector (12) such that the platform (518) 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 (522), wherein the sleeve (522) 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 19A As shown. The operator then rotates the sleeve (522) about the axis of rotation (RA) relative to the end actuator (12) toward a second angular position so that the closing surface (524) mechanically engages with the outer surfaces of the two jaws (16, 18), as shown. Figure 19B 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 (524) mechanically engages the outer surfaces of the two jaws. The end effector jaws (16, 18) can be reverse-driven closed on the platform (518) 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 (518) such that the end effector jaws (16, 18) can disengage from the platform (518) while the support assembly (110, 112) remains adhered to the anvil (18), such as by rotating the sleeve (522) about the axis of rotation (RA) relative to the end effector (12) to a first angular position.

[0089] Although the support applicator (510) is shown to apply the support assembly (110, 112) to the anvil (18), the support applicator (510) 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).

[0090] D. An exemplary support applicator with a hinged lever arm for reverse-drive end effector jaws

[0091] Figures 20 to 21BAnother exemplary support applicator (610) is shown, configured to force the jaws of an end effector to close onto a portion of the support applicator (610) 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 support applicator (610) is similar to the support applicators (210, 310, 410, 510) described above, except as further described below.

[0092] The support applicator (610) of this example includes a frame (612) extending between a proximal end (613) and a distal end (614). The frame (612) includes a double-hinged steering knuckle (616) positioned at or near the distal end (614) of the frame (612) and a compression pad or platform (618) extending proximally from the steering knuckle (616) to the proximal end (613). The support applicator (610) also includes a pair of movable members in the form of opposing pivotable lever arms (622), which are coupled to the steering knuckle (616) via respective hinge pins (623) and configured to pivot relative to the platform (618) about a respective lateral pivot axis (PA) extending in a direction perpendicular to the longitudinal axis of the platform (618), and selectively receiving an end actuator (12), as will be described in more detail below.

[0093] The platform (618) of this example is configured to support at least one support assembly (110, 112) on at least one side of the platform (618). In the example shown, the platform (618) 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 (618) is shown as supporting the support assembly (110, 112) only on one side of the platform (618), the platform (618) can be equally easily supported on both sides of the platform (618).

[0094] Each lever arm (622) is generally flat and includes a correspondingly generally flat inner closing surface (624) 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 to a closed state when the platform (618) is positioned between the jaws (16, 18). In this respect, the lever arms (622) may be sized and configured relative to the end effector (12) such that the closing surfaces (624) 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 (624) 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. In one example, the hinge pins (623) may be spaced apart by a distance 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.

[0095] Figure 21A A support applicator (610) is shown in the following configuration: a lever arm (622) pivots about a corresponding pivot axis (PA) from an open position to a closed position, such that the closed surface (624) 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 21B A support applicator (610) is shown in the following configuration: the lever arm (622) is in the closed position such that the closed surface (624) 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 support applicator (610), the operator first positions the support applicator (610) and the end effector (12) such that the platform (618) 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 arm (622), wherein the lever arm (622) is positioned or close to the... Figure 21A The open position is shown. Then, the operator will place the support applicator (610) as shown. Figure 21B The sixth arrow (A6) indicates that the lever arm (622) is advanced proximally relative to the end effector (12), and / or causes the lever arm (622) to move as shown in the diagram. Figure 21BPivot toward the closed position as indicated by the seventh arrow (A7) (e.g., by pressing the lever arms (622) together) so that the closed surface (624) mechanically engages with the outer surfaces of the corresponding jaws (16, 18) until the closed surface (624) is substantially parallel to the corresponding outer surfaces, as shown in the image. Figure 21B As shown. The end effector jaws (16, 18) can be reverse-driven closed on the platform (618) by such mechanical engagement (e.g., while the closing trigger (26) of the instrument (10) remains unacted), as Figure 21B As indicated by the eighth arrow (A8), the support assemblies (110, 112) are adhesively attached to the anvil (18) (e.g., to its suture surface). The support assemblies (110, 112) can be released from the platform (618) such that the end effector jaws (16, 18) can disengage from the platform (618) while the support assemblies (110, 112) remain adhered to the anvil (18), such as by pivoting the lever arm (622) toward the open position. In one example, as the lever arm (622) pivots toward the closed position, the support applicator (610) can simultaneously advance proximally relative to the end effector (12).

[0096] Although the support applicator (610) is shown to apply the support assembly (110, 112) to the anvil (18), the support applicator (610) 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).

[0097] In one example, the support applicator (610) 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 (622) has applied a threshold force and / or pressure 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 (622) may include one or more notches configured to frictionally engage the corresponding jaws (16, 18) to inhibit the opening of the jaws (16, 18) until the lever arm (622) pivots toward the open position. In addition or alternatively, the support applicator (610) may include a threshold force notification or pressure notification feature configured to provide the user with visual, tactile and / or auditory indication that the lever arm (622) 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)).

[0098] E. An exemplary support for a cam-acting lever arm used in the reverse-drive end effector jaws. instrument

[0099] Figure 22 illustrates another exemplary support applicator (710) configured to force the jaws of an end effector to close onto a portion of the support applicator (710) 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 support applicator (710) is similar to the support applicators (210, 310, 410, 510, 610) described above, except as further described below.

[0100] The support applicator (710) of this example includes a frame (712) extending between a proximal end (not shown) and a distal end (714). The frame (712) includes a hinged steering knuckle (716) positioned at or near the distal end (714) of the frame (712), a compression pad or platform (718) extending proximally from the steering knuckle (716) to the proximal end of the frame (712), and a fixed arm (720) extending proximally from the steering knuckle (716). The support applicator (710) also includes a movable member in the form of a pivotable lever arm (722) coupled to the steering knuckle (716) via a hinge pin (723) and configured to pivot relative to the platform (718) about a lateral pivot axis (PA) extending in a direction perpendicular to the longitudinal axis of the platform (718), and selectively receiving an end actuator (12) against the fixed arm (720), as will be described in more detail below.

[0101] The platform (718) of this example is configured to support at least one support assembly (110, 112) on at least one side of the platform (718). In the example shown, the platform (718) 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 (718) is shown as supporting the support assembly (110, 112) only on one side of the platform (718), the platform (718) can equally easily support the support assembly (110, 112) on both sides of the platform (718).

[0102] The lever arm (722) is generally flat and includes a protruding tapered closing surface (724) configured to selectively mechanically engage one of the outer surfaces of the end effector jaws (16, 18), while the fixed arm (720) is generally flat and includes a generally flat non-tapered closing surface (726) configured to selectively mechanically engage the outer surface of 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 (718) is positioned between the jaws (16, 18). In this respect, the size and configuration of the arms (720, 722) may be arranged relative to the end effector (12) such that the closing surfaces (724, 726) can collectively 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 (724, 726) 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 tapered closing surface (724) may alternatively be curved.

[0103] Figure 22A A support applicator (710) is shown in the following configuration: a lever arm (722) pivots about a pivot axis (PA) from an open position to a closed position, such that a tapered closing surface (724) mechanically engages the outer surface of the anvil (18), while a non-tapered closing surface (726) 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 22B A support applicator (710) is shown in the following configuration: a lever arm (722) is in a closed position such that the closed surfaces (724, 726) 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 support applicator (710), the operator first positions the support applicator (710) and the end effector (12) such that the platform (718) 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 (720, 722), wherein the lever arm (722) is positioned or close to the following configuration: Figure 22A The open position is shown. Then, the operator will move the lever arm (722) as shown. Figure 22B Pivot toward the closed position as indicated by the ninth arrow (A9) to mechanically engage the closed surface (724) with the outer surface of the anvil (18), such that the anvil (18) is as... Figure 22B The tenth arrow (A10) indicates radial inward cam action. The end effector jaws (16, 18) can be accessed via... Figure 22B The mechanical engagement shown is reverse-driven closed on the platform (718) (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 (718) such that the end effector jaws (16, 18) can disengage from the platform (718) while the support assemblies (110, 112) remain adhered to the anvil (18). In one example, as the lever arm (722) pivots toward the closed position, the support applicator (710) can simultaneously advance proximally relative to the end effector (12).

[0104] Although the support applicator (710) is shown to apply the support assembly (110, 112) to the anvil (18), the support applicator (710) 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).

[0105] IV. Exemplary Combinations

[0106] The following examples illustrate various non-exhaustive ways in which the teachings herein can be combined or applied. It should be understood that the following examples are not intended to limit the scope of any claims that may be provided at any time in this patent application or a subsequent filing thereof. No disclaimer is intended. The following examples are provided merely for illustrative purposes. It is contemplated that the various teachings herein may be arranged and applied in a variety of other ways. It is also contemplated that some variations may omit certain features mentioned in the following examples. Therefore, none of the aspects or features mentioned below should be considered definitive unless otherwise expressly indicated, for example, by the inventor or a successor of the inventor of interest, at a later date. If any claim set forth in this patent application or a subsequent filing related to this patent application includes additional features beyond those mentioned below, such additional features should not be presumed to have been added for any reason related to patentability.

[0107] Example 1

[0108] An apparatus for applying at least one accessory element to at least one of a first jaw and a second jaw of an end effector of a surgical suture device, wherein each of the first jaw and the second jaw includes a suture surface and an outer surface opposite to the respective suture surface, the apparatus comprising: (a) a platform configured to be positioned between the first jaw and the second jaw of the end effector; (b) at least one accessory element positioned on the platform; and (c) at least one closed surface opposite the platform, wherein the at least one closed surface is configured to mechanically engage the outer surface of the first jaw or the second jaw, thereby changing the end effector from an open state to a closed state for positioning the respective suture surface of the at least one jaw of the first jaw or the second jaw into contact with the at least one accessory element.

[0109] Example 2

[0110] According to the device of Embodiment 1, the at least one closed surface is movable relative to the platform.

[0111] Example 3

[0112] The device according to Embodiment 2 further includes: (a) an elongated track fixedly connected to the platform; and (b) a sleeve capable of translating along the elongated track, wherein the at least one closed surface is presented by the sleeve.

[0113] Example 4

[0114] According to the device of embodiment 3, when the platform is positioned between the first jaw and the second jaw, the sleeve is translatable along the elongated track between a retracted position and an extended position. In the retracted position, the at least one closed surface is mechanically disengaged from the outer surface of the at least one of the first jaw or the second jaw. In the extended position, the at least one closed surface is mechanically engaged with the outer surface of the at least one of the first jaw or the second jaw, thereby causing the end effector to change from the open state to the closed state.

[0115] Example 5

[0116] The device according to any one or more of embodiments 3 to 4, wherein the sleeve has a generally C-shaped cross-section.

[0117] Example 6

[0118] The device according to Embodiment 2 further includes a sleeve capable of rotating about a rotation axis parallel to the longitudinal axis of the platform, wherein the at least one closed surface is presented by the sleeve.

[0119] Example 7

[0120] According to the device of Embodiment 6, when the platform is positioned between the first jaw and the second jaw, the sleeve is rotatable about the axis of rotation between a first angular position and a second angular position. In the first angular position, the at least one closed surface is mechanically disengaged from the outer surface of the first jaw or the second jaw, and in the second angular position, the at least one closed surface is mechanically engaged with the outer surface of the first jaw or the second jaw, thereby causing the end effector to change from the open state to the closed state.

[0121] Example 8

[0122] The device according to any one or more of embodiments 6 to 7, wherein the sleeve includes a hole defining the at least one closed surface, wherein the hole has a generally elliptical cross-section.

[0123] Example 9

[0124] The device according to Embodiment 2 further includes at least one lever arm capable of pivoting about a lateral axis extending in a direction perpendicular to the longitudinal axis of the platform, wherein the at least one closed surface is presented by the at least one lever arm.

[0125] Example 10

[0126] According to the device of embodiment 9, when the platform is positioned between the first jaw and the second jaw, the at least one lever arm is pivotable about the lateral axis between an open position and a closed position. In the open position, the at least one closing surface is mechanically disengaged from the outer surface of the at least one jaw of the first jaw or the second jaw, and in the closed position, the at least one closing surface is mechanically engaged with the outer surface of the at least one jaw of the first jaw or the second jaw, thereby causing the end effector to change from the open state to the closed state.

[0127] Example 11

[0128] The device according to any one or more of embodiments 9 to 10, wherein the at least one closed surface is substantially flat.

[0129] Example 12

[0130] According to any one or more of embodiments 9 to 11, the device comprises at least one lever arm, which includes opposing first and second lever arms, and the at least one closed surface comprises a first closed surface presented by the first lever arm and a second closed surface presented by the second lever arm.

[0131] Example 13

[0132] The device according to any one or more of embodiments 9 to 12, wherein the at least one closed surface includes at least one of a curved cam action surface or a tapered cam action surface.

[0133] Example 14

[0134] According to the device of embodiment 1, the at least one enclosed surface is fixed to resist movement relative to the platform.

[0135] Example 15

[0136] According to the device of embodiment 14, the at least one closed surface includes at least one of a curved cam action surface or a tapered cam action surface.

[0137] Example 16

[0138] A system comprising: (a) an end effector of a surgical suture device, wherein the end effector includes opposing first jaws and second jaws, wherein each of the first jaws and the second jaws includes a suture surface and an outer surface opposing the respective suture surface; and (b) a device according to any one or more of embodiments 1 to 15.

[0139] Example 17

[0140] According to the system of embodiment 16, the platform of the device is positioned between the first jaw and the second jaw of the end effector.

[0141] Example 18

[0142] An apparatus for applying at least one accessory element to at least one of opposing first and second jaws of an end effector of a surgical suture device, wherein each of the first and second jaws includes a suture surface and an outer surface opposite to the respective suture surface, the apparatus comprising: (a) a platform configured to be positioned between the first and second jaws of the end effector; (b) at least one accessory element positioned on the platform; and (c) at least one closed surface opposite the platform, wherein the at least one closed surface is configured to be movable relative to the outer surface of the first or second jaw when the platform is positioned between the first and second jaws, thereby changing the end effector from an open state to a closed state for positioning the respective suture surface of the at least one jaw of the first or second jaw into contact with the at least one accessory element.

[0143] Example 19

[0144] The device according to embodiment 18 further includes at least one movable member, wherein the at least one closed surface is presented by the at least one movable member, wherein the at least one closed surface is configured to cause the end effector to change from the open state to the closed state in response to movement of the movable member relative to the platform.

[0145] Example 20

[0146] According to the device of embodiment 18, the at least one closed surface is configured to cause the end effector to change from the open state to the closed state in response to translation of the end effector relative to the platform.

[0147] Example 21

[0148] A system comprising: (a) an end effector of a surgical suture device, wherein the end effector includes opposing first jaws and second jaws, wherein each of the first jaws and the second jaws includes a suture surface and an outer surface opposing the respective suture surface; and (b) a device according to any one or more of embodiments 18 to 20.

[0149] Example 22

[0150] According to the system of embodiment 21, the platform of the device is positioned between the first jaw and the second jaw of the end effector.

[0151] Example 23

[0152] A method for attaching an accessory element to an end effector of a surgical suture device, the end effector having opposing first jaws and second jaws, wherein each of the first jaws and the second jaws includes a suture surface and an outer surface opposite the corresponding suture surface, the method comprising: (a) positioning a platform of an accessory element applicator between the first jaws and the second jaws, wherein the accessory element is disposed on the platform; and (b) changing the end effector from an open state to a closed state by mechanically engaging at least one closed surface of the accessory element applicator with the outer surface of at least one of the first jaws or the second jaws, thereby placing the corresponding suture surface of the at least one jaw in the first jaw or the second jaws into contact with the at least one accessory element.

[0153] Example 24

[0154] According to the method of embodiment 23, the end effector includes a closing system configured to selectively change the end effector from the open state to the closed state, wherein the step of changing the end effector from the open state to the closed state is performed while keeping the closing system of the end effector in an unactuated state.

[0155] Example 25

[0156] According to one or more of the methods in embodiments 23 to 24, wherein changing the end effector from the open state to the closed state includes moving the at least one closed surface relative to the platform.

[0157] Example 26

[0158] According to the method of embodiment 25, the auxiliary element applicator includes: (a) an elongated track fixedly coupled to the platform, and (b) a sleeve, wherein the at least one closed surface is presented by the sleeve, and wherein changing the end effector from the open state to the closed state includes translating the sleeve along the elongated track.

[0159] Example 27

[0160] According to the method of embodiment 26, changing the end effector from the open state to the closed state includes translating the sleeve along the elongated guide between a retracted position and an extended position, wherein in the retracted position, the at least one closed surface is mechanically disengaged from the outer surface of the at least one of the first jaws or the second jaws, and in the extended position, the at least one closed surface is mechanically engaged with the outer surface of the at least one of the first jaws or the second jaws, thereby changing the end effector from the open state to the closed state.

[0161] Example 28

[0162] According to one or more of the methods in Examples 26 to 27, the sleeve has a generally C-shaped cross-section.

[0163] Example 29

[0164] According to the method of embodiment 25, the auxiliary element applicator includes a sleeve, wherein the at least one closed surface is presented by the sleeve, and wherein the transition of the end actuator from the open state to the closed state includes rotating the sleeve about a rotation axis parallel to the longitudinal axis of the platform.

[0165] Example 30

[0166] According to the method of embodiment 29, changing the end effector from the open state to the closed state includes translating the sleeve between a first angular position and a second angular position about the axis of rotation. In the first angular position, the at least one closed surface is mechanically disengaged from the outer surface of the at least one jaw of the first jaw or the second jaw. In the second angular position, the at least one closed surface is mechanically engaged with the outer surface of the at least one jaw of the first jaw or the second jaw, thereby changing the end effector from the open state to the closed state.

[0167] Example 31

[0168] According to one or more of the methods in embodiments 29 to 30, wherein the sleeve includes a hole defining the at least one closed surface, wherein the hole has a generally elliptical cross-section.

[0169] Example 32

[0170] According to the method of embodiment 25, the auxiliary element applicator includes at least one lever arm, wherein the at least one closed surface is presented by the at least one lever arm, and wherein changing the end actuator from the open state to the closed state includes pivoting the at least one lever arm about a lateral axis extending in a direction perpendicular to the longitudinal axis of the platform.

[0171] Example 33

[0172] According to the method of embodiment 32, changing the end effector from the open state to the closed state includes pivoting the at least one lever arm about the lateral axis between an open position and a closed position, wherein in the open position, the at least one closing surface is mechanically disengaged from the outer surface of the at least one of the first jaws or the second jaws, and in the closed position, the at least one closing surface is mechanically engaged with the outer surface of the at least one of the first jaws or the second jaws, thereby changing the end effector from the open state to the closed state.

[0173] Example 34

[0174] According to one or more of the methods described in Examples 32 to 33, wherein the at least one closed surface is substantially flat.

[0175] Example 35

[0176] According to any one or more of the methods in embodiments 32 to 34, wherein the at least one lever arm includes an opposing first lever arm and a second lever arm, wherein the at least one closed surface includes a first closed surface presented by the first lever arm and a second closed surface presented by the second lever arm.

[0177] Example 36

[0178] According to any one or more of the methods in Examples 32 to 35, wherein the at least one closed surface includes at least one of a curved cam action surface or a tapered cam action surface.

[0179] Example 37

[0180] According to one or more of the methods in embodiments 23 to 24, wherein changing the end effector from the open state to the closed state includes keeping the at least one closed surface fixed to resist movement relative to the platform.

[0181] Example 38

[0182] According to the device of embodiment 37, the at least one closed surface includes at least one of a curved cam action surface or a tapered cam action surface.

[0183] V. Miscellaneous

[0184] It should be understood that any one or more of the teachings, expressions, embodiments, examples, etc., described herein can be combined with any one or more of the other teachings, expressions, embodiments, examples, etc., described herein. Therefore, the foregoing 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.

[0185] Furthermore, any one or more of the teachings herein may be combined with any one or more of the teachings disclosed in the following patent applications: U.S. Patent Application No. END9286USNP1, filed on the same date as this application, entitled “Apparatus and Method to Apply Buttress to End Effector of Surgical Stapler via FixedBase”; U.S. Patent Application No. END9286USNP2, filed on the same date as this application, entitled “Apparatus and Method to Apply Buttresses Separately to Jaws of End Effector of Surgical Stapler”; U.S. Patent Application No. END9286USNP3, filed on the same date as this application, entitled “Apparatus and Method to Detect Full Seating of Buttress Applicator in End Effector of Surgical Stapler”; and U.S. Patent Application No. END9286USNP3, filed on the same date as this application, entitled “Apparatus and Method to Detect Full Seating of Buttress Applicator in End Effector of Surgical Stapler”. The following U.S. patent applications were filed on the same date as this application: “Apparatus and Method to Apply Buttress to End Effector of Surgical Stapler” [Attorney File No. END9286USNP5]; “Apparatus and Method to Apply Buttress to End Effector of Surgical Stapler” [Attorney File No. END9286USNP6]; and / or “Method of Applying Buttress to End Effector of Surgical Stapler” [Attorney File No. END9286USNP7], all of which are U.S. patent applications. The disclosure of each of these U.S. patent applications is incorporated herein by reference.

[0186] It should be understood that any patent, patent publication, or other public material allegedly incorporated herein by reference, whether in whole or in part, is incorporated only to the extent that the incorporated material does not conflict with any existing definitions, statements, or other public material set forth in this disclosure. Therefore, and to the extent necessary, the disclosures expressly listed herein replace any conflicting material incorporated herein by reference. Any material, or part thereof, allegedly incorporated herein by reference that conflicts with any existing definitions, statements, or other public material set forth herein will be incorporated only to the extent that the incorporated material does not conflict with any existing public material.

[0187] The aforementioned devices can be applied to both traditional medical treatments and surgeries performed by medical professionals and robot-assisted medical treatments and surgeries. By way of example only, the various teachings herein can be readily incorporated into robotic surgical systems, such as the DAVINCI system from Intuitive Surgical, Inc. (Sunnyvale, California). ™ system.

[0188] Devices of the types described above may be designed for single-use and disposal, or they may be designed for multiple uses. In either or both cases, these types may be repaired for reuse after at least one use. Repair may include any combination of the following steps: disassembling the device, then cleaning or replacing specific parts, and subsequently reassembling. Specifically, some types of devices may be disassembled, and any combination may be used to selectively replace or remove any number of specific parts or portions of the device. While cleaning and / or replacing specific components, some types of devices may be reassembled at a repair facility or by the user prior to surgery for subsequent use. Those skilled in the art will appreciate that device repair can utilize a variety of techniques for disassembly, cleaning / replacement, and reassembly. The use of such techniques and the resulting repaired devices are within the scope of this application.

[0189] By way of example only, the types described herein can be sterilized before and / or after surgery. In one sterilization technique, the device is placed in a closed and sealed container such as a plastic bag or a TYVEK bag. The container and device can then be placed in a radiation field that can penetrate the container, such as gamma radiation, X-rays, or high-energy electrons. The radiation kills bacteria on the device and in the container. The sterilized device can then be stored in a sterile container for later use. Any other techniques known in the art can also be used to sterilize the device, including but not limited to beta or gamma radiation, ethylene oxide, or vapor.

[0190] Various embodiments of the invention have been shown and described, and further improvements to the methods and systems described herein can be achieved by suitable modifications made by those skilled in the art without departing from the scope of the invention. Several such possible modifications have been mentioned, and other modifications will be apparent to those skilled in the art. For example, the embodiments, implementations, geometries, materials, dimensions, ratios, steps, etc., discussed above are illustrative and not essential. Therefore, the scope of the invention should be considered in accordance with the following claims and should be understood as not being limited to the details of the structures and operations shown and described in the specification and drawings.

Claims

1. An apparatus for applying at least one auxiliary element to at least one of the opposing first and second jaws of an end effector of a surgical suture device, wherein, Each of the first and second jaws includes a suture surface and an outer surface opposite the corresponding suture surface, and the device includes: (a) A platform configured to be positioned between the first jaw and the second jaw of the end effector; (b) Positioning at least one auxiliary element on the platform; and (c) At least one closed surface opposite the platform, wherein the at least one closed surface is configured to mechanically engage the outer surface of at least one of the first jaws or the second jaws, thereby changing the end effector from an open state to a closed state for placing the corresponding stitching surface of the at least one of the first jaws or the second jaws into contact with the at least one accessory element.

2. The device according to claim 1, wherein, The at least one closed surface is movable relative to the platform.

3. The device according to claim 2, further comprising: (a) A long, narrow track fixedly connected to the platform; and (b) A sleeve capable of translating along the elongated track, wherein the at least one closed surface is presented by the sleeve.

4. The device according to claim 3, wherein, When the platform is positioned between the first jaw and the second jaw, the sleeve is capable of translating along the elongated track between a retracted position and an extended position. In the retracted position, the at least one closed surface is mechanically disengaged from the outer surface of the first jaw or the second jaw. In the extended position, the at least one closed surface is mechanically engaged with the outer surface of the first jaw or the second jaw, thereby causing the end effector to change from the open state to the closed state.

5. The device according to claim 3, wherein, The sleeve has a generally C-shaped cross-section.

6. The device according to claim 2, further comprising a sleeve rotatable about a rotation axis parallel to the longitudinal axis of the platform, wherein, The at least one closed surface is presented by the sleeve.

7. The device according to claim 6, wherein, When the platform is positioned between the first jaw and the second jaw, the sleeve is able to rotate about the axis of rotation between a first angular position and a second angular position. In the first angular position, the at least one closed surface is mechanically disengaged from the outer surface of the first jaw or the second jaw, and in the second angular position, the at least one closed surface is mechanically engaged with the outer surface of the first jaw or the second jaw, thereby causing the end effector to change from the open state to the closed state.

8. The device according to claim 6, wherein, The sleeve includes a hole defining the at least one closed surface, wherein the hole has a generally elliptical cross-section.

9. The device of claim 2, further comprising at least one lever arm capable of pivoting about a lateral axis extending in a direction perpendicular to the longitudinal axis of the platform, wherein, The at least one closed surface is presented by the at least one lever arm.

10. The device according to claim 9, wherein, When the platform is positioned between the first jaw and the second jaw, the at least one lever arm is pivotable about the lateral axis between an open position and a closed position. In the open position, the at least one closing surface is mechanically disengaged from the outer surface of the first jaw or the second jaw, and in the closed position, the at least one closing surface is mechanically engaged with the outer surface of the first jaw or the second jaw, thereby causing the end effector to change from the open state to the closed state.

11. The device according to claim 9, wherein, The at least one closed surface is generally flat.

12. The device according to claim 9, wherein, The at least one lever arm includes a first lever arm and a second lever arm opposite to each other, wherein the at least one closed surface includes a first closed surface presented by the first lever arm and a second closed surface presented by the second lever arm.

13. The device according to claim 9, wherein, The at least one closed surface includes at least one of a curved cam action surface or a tapered cam action surface.

14. The device according to claim 1, wherein, The at least one enclosed surface is fixed to resist movement relative to the platform.

15. The device according to claim 14, wherein, The at least one closed surface includes at least one of a curved cam action surface or a tapered cam action surface.

16. An apparatus for applying at least one auxiliary element to at least one of the opposing first and second jaws of an end effector of a surgical suture device, wherein, Each of the first and second jaws includes a suture surface and an outer surface opposite the corresponding suture surface, and the device includes: (a) A platform configured to be positioned between the first jaw and the second jaw of the end effector; (b) Positioning at least one auxiliary element on the platform; and (c) At least one closed surface opposite the platform, wherein the at least one closed surface is configured to be movable relative to the outer surface of at least one of the first jaws or the second jaws when the platform is positioned between the first jaws and the second jaws, thereby changing the end effector from an open state to a closed state for placing the corresponding stitching surface of the at least one of the first jaws or the second jaws into contact with the at least one accessory element.

17. The device according to claim 16, further comprising at least one movable member, wherein, The at least one closed surface is presented by the at least one movable member, wherein the at least one closed surface is configured to cause the end effector to change from the open state to the closed state in response to movement of the movable member relative to the platform.

18. The device according to claim 16, wherein, The at least one closed surface is configured to allow the end effector to change from the open state to the closed state in response to translation of the end effector relative to the platform.

19. A method for attaching an accessory element to an end effector of a surgical suture device, the end effector having opposing first and second jaws, wherein, Each of the first and second jaws includes a suture surface and an outer surface opposite the corresponding suture surface, the method comprising: (a) Positioning the platform of the accessory component applicator between the first jaw and the second jaw, wherein the accessory component is disposed on the platform; and (b) The end effector is changed from an open state to a closed state by mechanically engaging at least one closed surface of the appendage applicator with the outer surface of at least one of the first jaws or the second jaws, thereby placing the corresponding stitching surface of at least one of the first jaws or the second jaws into contact with the at least one appendage element.

20. The method according to claim 19, wherein, The end effector includes a closing system configured to selectively change the end effector from the open state to the closed state, wherein the step of changing the end effector from the open state to the closed state is performed while keeping the closing system of the end effector in an unactuated state.

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