Attachment for use with surgical stapling instrument

Abstract

An appendage for use with a surgical stapler is disclosed. The adjunct includes a first layer comprising a first material. The adjunct includes a second film layer (70070 ') attached to the first layer. The second film layer defines a continuously textured device contact surface configured to establish a friction interface with a corresponding portion of the surgical stapler. The second film layer includes a second material different from the first material, and the adjunct includes a third film layer attached to the first layer. The third film layer includes a tissue contacting surface.

Description

Background Art

[0001] The present invention relates to surgical instruments and, in various arrangements, to appendages, end effectors, and staple cartridges for use with surgical stapling and severing instruments designed to staple and sever tissue.

[0002] The appendage material is used in combination with the surgical stapler end effector and the staple cartridge to provide various therapeutic advantages to the sutured tissue. Such materials are positioned between the cartridge and the anvil of the surgical stapler end effector and are sutured to the tissue when the tissue is cut and sutured. These appendage materials are configured to be absorbed by the body during the healing process. Depending on the application, one appendage may be positioned adjacent to the lower side of the anvil, and another appendage may be positioned on the platform surface of the staple cartridge. Then, the end effector is advantageously manipulated to position the target tissue between the appendages, and the jaws of the end effector are closed onto the target tissue. In other applications, only one appendage is used. In either case, after the jaws have been completely closed to clamp the target tissue between the jaws, the surgical stapler is fired. Firing requires driving the firing actuator or the slide driver toward the far side through the end effector in which the staple cartridge is supported. The nails are stored on the driver to be movably supported in the staple cartridge in a longitudinal row. The slide is movably supported in the cartridge and is configured to be able to sequentially cam the driver in the direction toward the closed anvil. As each driver moves toward the closed anvil, the staples supported thereon are driven through the appendages and the clamped target tissue, thereby contacting the underside of the anvil. The firing actuator or slide driver is also equipped with a knife or tissue cutting feature that cuts off the appendages and the clamped tissue. The knife is positioned to lag behind the slide so that the tissue is sutured before being cut.

[0003] During the firing process, when the slider driver or firing actuator is driven distally, the knife must initially contact the proximal end portion of the appendage to cut through the appendage material. During this initial contact period and before the nail is fired, the knife may cause the appendage to move and slide out of position, which may cause the nail to be deformed and the incorrect positioning of the appendage during suturing. This problem may be further aggravated when the appendage is used while firing multiple nail magazines sequentially along a single tissue cutting line. For example, when multiple firings are required to cut and suturing the target tissue, a first nail magazine is used to cut one or more first appendages and attach them to the first part of the target tissue. Thereafter, the used nail magazine is replaced with a new nail magazine, and the corresponding one or more second appendages are supported in the end effector. The end effector jaws are positioned so that the proximal ends of the one or more second appendages overlap with the distal ends of the one or more first appendages to be sutured, and then the jaws are closed to clamp the remaining portion of the target tissue between the one or more second appendages and the jaws. When the slide driver or firing actuator is driven distally, the knife on the firing actuator contacts the overlapping appendages. If the second appendages move during this process, they may bunch or "plow in", which may cause the second appendage to adversely affect the nail forming process. This undesirable plowing or bunching is more likely to occur when the knife of the firing actuator or slide driver initially contacts the overlapping second appendages. Therefore, it is desirable that the appendage and end effector be configured to prevent the appendage from moving out of position during the cutting and nail firing processes. The present disclosure provides improvements and modifications that minimize and prevent appendage sliding and movement during those operations. Summary of the invention

[0004] The present invention discloses an appendage for use with a surgical stapler. The appendage includes a first layer comprising a first material. The appendage includes a second film layer attached to the first layer. The second film layer defines a continuous textured device contact surface configured to establish a friction interface with a corresponding portion of the surgical stapler. The second film layer includes a second material different from the first material, and the appendage includes a third film layer attached to the first layer. The third film layer includes a tissue contact surface.

[0005] The present invention discloses a surgical stapler end effector. The surgical stapler end effector comprises a first jaw and an anvil. The anvil is movably supported relative to the first jaw. The anvil comprises a proximal end portion, a distal end portion, and a staple forming lower surface extending from the proximal end portion to the distal end portion. The surgical stapler end effector comprises an appendage, which is removably connected to the anvil adjacent to the staple forming lower surface. The appendage comprises an appendage retaining assembly, which comprises at least one hook formed on the proximal end of the appendage and configured to be able to releasably engage the corresponding hook portion of the proximal end of the anvil.

[0006] The present invention discloses a surgical stapler end effector. The surgical stapler end effector comprises a first jaw and an anvil. The anvil is movably supported between an open position and a closed position relative to the first jaw. The anvil comprises a proximal end portion, a distal end portion, a lower surface comprising a staple forming portion, and at least one tissue stopper on the proximal end, wherein each tissue stopper defines a distal tissue stop edge. The anvil also comprises at least one protrusion protruding from a portion of the lower surface proximal to each of the distal tissue stop edges. Each protrusion is configured to be able to pin the proximal end of an appendage positioned adjacent to the lower surface between the protrusion and a corresponding portion of the first jaw to prevent the appendage from moving relative to the first jaw when the anvil is in the closed position. BRIEF DESCRIPTION OF THE DRAWINGS

[0007] The various features of the embodiments described herein, together with their advantages, may be understood from the following description in conjunction with the following drawings:

[0008] Figure 1 is a perspective view of an end effector of a surgical stapler;

[0009] Figure 2 is a cross-sectional side view of an appendage for use with a staple cartridge and / or anvil of an end effector of a surgical stapler according to the present disclosure;

[0010] Figure 3 The invention is a device according to the present invention used in combination with an anvil and a staple cartridge of an end effector of a surgical stapler to clamp a portion of a target tissue therebetween. Figure 2 Side view of the two appendages of ;

[0011] Figure 4 is a cross-sectional side view of another appendage according to the present disclosure;

[0012] Figure 5 is a cross-sectional side view of another appendage according to the present disclosure;

[0013] Figure 6 is a cross-sectional side view of another appendage according to the present disclosure;

[0014] Figure 7 is a cross-sectional side view of another appendage for use in conjunction with a surgical staple cartridge of a surgical stapler end effector according to the present disclosure;

[0015] Figure 8 is a cross-sectional side view of another appendage for use in conjunction with a surgical staple cartridge of a surgical stapler end effector according to the present disclosure;

[0016] Fig. 9 is a cross-sectional side view of another appendage for use in conjunction with an anvil of a surgical stapler end effector according to the present disclosure;

[0017] Fig.10 is a partial perspective view of a surgical stapler end effector according to the present disclosure;

[0018] Fig.11 According to the present disclosure Fig.10 A cross-sectional end view of a surgical stapler end effector;

[0019] Fig.12 According to the present disclosure Fig. 9 A partial cross-sectional side view of a surgical stapler end effector;

[0020] Fig.13 According to the present disclosure Fig. 9 Another partial perspective view of a surgical stapler end effector of , wherein the appendage is supported on the staple cartridge of the end effector;

[0021] Fig.14 is a perspective view of an anvil and appendages of a surgical stapler end effector according to the present disclosure;

[0022] Fig.15 According to the present disclosure Fig.14 A partial cross-sectional perspective view of a proximal end portion of an anvil and appendage of FIG.

[0023] Fig.16 A surgical stapler according to the present disclosure is used in combination with an end effector of a surgical stapler. Fig.14 A top partial cross-sectional view of a portion of an appendage and anvil of the end effector with the knife of the end effector in an initial position before the cutting and firing process begins;

[0024] Fig.17 According to the present disclosure Fig.16 Another top partial cross-sectional view of the appendage, anvil, and end effector of the present invention, wherein the knife is in an intermediate position; and

[0025] Fig.18 According to the present disclosure Fig.16 and Fig.17 Another top partial cross-sectional view of an appendage, anvil, and end effector showing the appendage attachment assembly of the appendage partially torn from the appendage. DETAILED DESCRIPTION

[0026] The applicant of the present application owns the following U.S. patent applications filed on the same date as the present application and each of which is incorporated herein by reference in its entirety:

[0027] U.S. Patent Application Titled “METHOD OF OPERATING A SURGICAL STAPLING INSTRUMENT”; Attorney Docket No. END9484USNP2 / 220491-2M;

[0028] U.S. Patent Application Titled “SURGICAL STAPLING SYSTEMS WITH ADAPTIVESTAPLE FIRING ALGORITHMS”; Attorney Docket No. END9484USNP3 / 220491-3;

[0029] U.S. Patent Application Titled “LEARNED TRIGGERS FOR ADAPTIVE CONTROL OF SURGICAL STAPLING SYSTEMS”; Attorney Docket No. END9484USNP4 / 220491-4;

[0030] U.S. Patent Application Titled “CONTROL CIRCUIT FOR ACTUATING MOTORIZED FUNCTION OF SURGICALSTAPLING INSTRUMENT UTILIZINGINERTIAL DRIVE TRAIN PROPERTIES”; Attorney Docket No. END9484USNP5 / 220491-5;

[0031] U.S. Patent Application Titled “PROPORTIONATE BALANCING OF THE FUNCTION IMPACT MAGNITUDE OF BATTERY OUTPUT TO PEAKMOTOR CURRENT”; Attorney Docket No. END9484USNP6 / 220491-6;

[0032] U.S. Patent Application Titled “MOTOR OPTIMIZATION BY MINIMIZATION OF PARASITIC LOSSES AND TUNING MOTOR DRIVE CONFIGURATION”; Attorney Docket No. END9484USNP7 / 220491-7;

[0033] U.S. Patent Application Titled “APPARATUS AND METHOD TO REDUCE PARASITICLOSSES OF THE ELECTRICAL SYSTEM OF A SURGICALIN STRUMENT”; Attorney Docket No. END9484USNP8 / 220491-8;

[0034] U.S. Patent Application Titled “SURGICAL TOOL WITH RELAXED FLEX CIRCUITARTICULATION”; Attorney Docket No. END9484USNP9 / 220491-9;

[0035] U.S. Patent Application Titled “WIRING HARNESS FOR SMART STAPLER WITH MULTI AXIS ISARTICULATION”; Attorney Docket No. END9484USNP10 / 220491-10;

[0036] U.S. Patent Application Titled “SURGICAL SYSTEM WITH WIRELESS ARRAY FOR POWER AND DATATRANSFER”; Attorney Docket No. END9484USNP11 / 220491-11; and

[0037] U.S. patent application titled “SURGICAL STAPLE CARTRIDGE COMPRISING REPLACEABLE ELECTRONICS PACKAGE”;

[0038] Attorney Docket No. END9484USNP12 / 220491-12.

[0039] The applicant of the present application owns the following U.S. patent applications filed on the same date as the present application and each of which is incorporated herein by reference in its entirety:

[0040] U.S. Patent Application Titled “METHOD OF ASSEMBLING A STAPLE CARTRIDGE”; Attorney Docket No. END9484USNP13 / 220491-13M;

[0041] U.S. Patent Application Titled “CONTROL SURFACES ON A STAPLE DRIVER OF ASURGICAL STAPLE CARTRIDGE”; Attorney Docket No. END9484USNP14 / 220491-14;

[0042] U.S. Patent Application Titled “INTEGRAL CARTRIDGE STIFFENING FEATURES TOREDUCE CARTRIDGE DEFLECTION”; Attorney Docket No. END9484USNP15 / 220491-15;

[0043] U.S. Patent Application Titled “STAPLE CARTRIDGE COMPRISING WALLSTRUCTURES TO REDUCE CARTRIDGE DEFLECTION”; Attorney Docket No. END9484USNP16 / 220491-16;

[0044] U.S. Patent Application Titled “PAN-LESS STAPLE CARTRIDGE ASSEMBLY COMPRISING RETENTION FEATURES FOR HOLDING STAPLED RIVERS AND SLED”; Attorney Docket No. END9484USNP17 / 220491-17;

[0045] U.S. Patent Application Titled “STAPLE CARTRIDGE COMPRISING A SLED HAVING A DRIVER LIFT CAM”; Attorney Docket No. END9484USNP18 / 220491-18;

[0046] U.S. Patent Application Titled “SURGICAL STAPLE CARTRIDGES WITH SLEDSCONFIGURED TO BECOUPLED TO A FIRING DRIVER OF A COMPATIBLE SURGICAL STAPLER”; Attorney Docket No. END9484USNP19 / 220491-19;

[0047] U.S. Patent Application Titled “STAPLE CARTRIDGE COMPRISING A COMPOSITESLED”; Attorney Docket No. END9484USNP20 / 220491-20;

[0048] U.S. Patent Application Titled “SURGICAL INSTRUMENTS WITH JAW AND FIRING ACTUATOR LOCKOUTARRANGEMENTS LOCATED PROXIMAL TO A JAW PIVOT LOCATION”; Attorney Docket No. END9484USNP21 / 220491-21;

[0049] U.S. Patent Application Titled “SURGICAL INSTRUMENTS WITH LATERALLY ENGAGEABLE LOCKING ARRANGEMENTS FOR LOCKING AFIRING ACTUATOR”; Attorney Docket No. END9484USNP22 / 220491-22;

[0050] U.S. Patent Application Titled “DUAL INDEPENDENT KEYED LOCKING MEMBERSACTING ON THE SAMEDRIVE MEMBER”; Attorney Docket No. END9484USNP23 / 220491-23;

[0051] U.S. Patent Application Titled “ADJUNCTS FOR USE WITH SURGICAL STAPLING INSTRUMENTS”; Attorney Docket No. END9484USNP24 / 220491-24;

[0052] U.S. Patent Application Titled “JAW CONTROL SURFACES ON A SURGICALINSTRUMENT JAW”; Attorney Docket No. END9484USNP26 / 220491-26;

[0053] U.S. Patent Application Titled “ZONED ALGORITHM ADAPTIVE CHANGES BASED ON CORRELATION OF COOPERATIVE COMPRESSION CONTRIBUTIONS OF TISSUE”; Attorney Docket No. END9484USNP27 / 220491-27;

[0054] U.S. Patent Application Titled “STAPLE CARTRIDGES COMPRISING TRACERETENTION FEATURES”; Attorney Docket No. END9484USNP29 / 220491-29; and

[0055] U.S. Patent Application Titled “STAPLE CARTRIDGES COMPRISING STAPLERETENTION FEATURES”; Attorney Docket No. END9484USNP30 / 220491-30.

[0056] The entire disclosures of the following patents are incorporated herein by reference: U.S. Patent No. 11,589,865, issued on February 28, 2023, entitled “METHODS FOR CONTROLLING A POWERED SURGICAL STAPLER THAT HAS SEPARATE ROTARYCLOSURE AND FIRING SYSTEMS”, U.S. Patent No. 6,978,921, issued on December 27, 2005, entitled “SURGICAL STAPLING INSTRUMENT INCORPORATING AN E-BEAM FIRING MECHANISM”, U.S. Patent No. 10,213,203, issued on February 26, 2019, entitled “STAPLE CARTRIDGE ASSEMBLY WITHOUTA BOTTOM COVER”, U.S. Patent No. 10,213,203, issued on March 16, 2021, entitled “STAPLE CARTRIDGE WITH DEFORMABLE DRIVER RETENTION No. 10,945,727, entitled “STAPLING SYSTEM COMPRISING A CLAMP LOCKOUT AND AFIRING LOCKOUT”, issued on February 1, 2022, U.S. Patent No. 11,234,698, entitled “STAPLING SYSTEM COMPRISING A CLAMP LOCKOUT AND AFIRING LOCKOUT”, issued on January 3, 2023, U.S. Patent No. 11,540,826, entitled “SURGICALSTAPLER END EFFECTOR SLED HAVING CARTRIDGE WALL SUPPORT FEATURE”, issued on May 28, 2019, U.S. Patent No. 10,299,792, entitled “FASTENER CARTRIDGE COMPRISING NON-UNIFORM FASTENERS”, issued on September 24, 2013, U.S. Patent No. 8,540,133, entitled “STAPLECARTRIDGE”, issued on October 17, 2017, U.S. Patent No. 1 No. 9,788,835 entitled "AND METHODS FOR FACILITATING EJECTION OF SURGICAL FASTENERS FROM CARTRIDGES", and No. 10,105,142 entitled "SURGICAL STAPLER WITH PLURALITY OF CUTTING ELEMENTS" issued on October 23, 2018.U.S. Patent No. 10,537,324, issued on January 21, 2020, entitled “STEPPED STAPLE CARTRIDGE WITH ASYMMETRICAL STAPLES”, U.S. Patent No. 7,669,746, issued on March 2, 2010, entitled “STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS”, U.S. Patent No. 8,123,100, issued on February 28, 2012, entitled “SURGICAL STAPLING INSTRUMENTS INCLUDING A CARTRIDGE HAVING MULTIPLESTAPLE SIZES”, U.S. Patent No. 8,123,100, issued on August 5, 2008, entitled “STAPLE CARTRIDGE HAVING MULTIPLE STAPLE SIZES FOR A SURGICAL STAPLING No. 7,407,075, entitled “SURGICAL APPARATUS WITH CONDUCTOR STRAIN RELIEF”, U.S. Patent No. 10,085,749, issued on October 2, 2018, entitled “SURGICAL APPARATUS WITH CONDUCTOR STRAIN RELIEF”, U.S. Patent No. 10,765,427, issued on September 8, 2020, entitled “METHOD FOR ARTICULATING A SURGICAL INSTRUMENT”, U.S. Patent No. 11,291,445, issued on April 5, 2022, entitled “SURGICAL STAPLE CARTRIDGES WITH INTEGRAL AUTHENTICATION KEYS”, U.S. Patent No. 10,194,866, issued on October 21, 2014, entitled “IMPLANTABLE FASTENER CARTRIDGE HAVING A NON-UNIFORM No. 8,864,007 entitled “COMPRESSIBLE NON-FIBROUS ADJUNCTS”, No. 11,490,890 issued on November 8, 2022, entitled “THREE DIMENSIONAL ADJUNCTS”, No. 10,952,724 issued on March 23, 2021, entitled “LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES”, No. 9,770,245 issued on September 26, 2017, entitled “LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES”,No. 10,123,798, issued on November 13, 2018, entitled “TISSUE THICKNESSCOMPENSATOR COMPRISING CONTROLLED RELEASE AND EXPANSION”, No. 10,166,023, issued on January 1, 2019, entitled “METHOD OF APPLYING A BUTTRESS TO A SURGICALSTAPLER END EFFECTOR”, No. 11,207,065, issued on December 28, 2021, entitled “METHOD FOR FABRICATING SURGICAL STAPLER ANVILS”, No. 8,141,762, issued on March 27, 2012, entitled “SURGICAL STAPLER COMPRISING A STAPLE POCKET”, No. 8,141,762, issued on November 4, 2014, entitled “END EFFECTOR WITH REDUNDANT No. 8,876,857, entitled “COMPOSITE DRIVEBEAM FOR SURGICAL STAPLING,” U.S. Patent No. 9,629,631, published on April 25, 2017, entitled “METHOD FOR OPERATING A SURGICAL INSTRUMENT INCLUDING SEGMENTED ELECTRODES,” U.S. Patent Application Publication No. 2022 / 0346858, published on November 3, 2022, entitled “DRIVERS FOR FASTENER CARTRIDGE ASSEMBLIES HAVING ROTARY DRIVE SCREWS,” U.S. Patent Application Publication No. 2022 / 0304680, published on September 29, 2022, entitled “METHOD OF USING A POWERED ELECTRICAL SYSTEM WITH A SURGICAL SYSTEM WITH A SURGICAL SYSTEM WITH A SURGICAL SYSTEM WITH A SURGICAL SYSTEM WITH A SURGICAL SYSTEM STAPLING DEVICE”, U.S. Patent Application Publication No. 2022 / 0304679, entitled “METHODSFOR CONTROLLING A POWERED SURGICAL STAPLER THAT HAS SEPARATE ROTARY CLOSURE AND FIRING SYSTEMS” published on October 3, 2019,U.S. Patent Application Publication No. 2017 / 0367695, published on December 28, 2017, entitled “STAPLE CARTRIDGE COMPRISING WIRE STAPLES AND STAMPED STAPLES,” U.S. Patent Application Publication No. 2015 / 0134077, published on May 14, 2015, entitled “SEALING MATERIALS FOR USE INSURGICAL STAPLING,” U.S. Patent Application Publication No. 2018 / 0168615, published on June 21, 2018, entitled “METHOD OF DEFORMING STAPLES FROM TWO DIFFERENT TYPES OF STAPLE CARTRIDGESWITH THE SAME SURGICAL STAPLING INSTRUMENT,” and U.S. Patent Application Publication No. 2018 / 0168615, published on May 17, 2018, entitled “STAPLE FORMING POCKET CONFIGURATIONS FOR CIRCULAR SURGICAL STAPLER and U.S. Patent Application Publication No. 2018 / 0132849, entitled “SURGICAL INSTRUMENTS WITH JAWS THAT ARE PIVOTABLE ABOUT A FIXED AXISAND INCLUDE SEPARATE AND DISTINCT CLOSURE AND FIRING SYSTEMS,” published on June 21, 2018, and U.S. Patent Application Publication No. 2018 / 0168613, entitled “SURGICAL INSTRUMENTS WITH JAWS THAT ARE PIVOTABLE ABOUT A FIXED AXISAND INCLUDE SEPARATE AND DISTINCT CLOSURE AND FIRING SYSTEMS,” published on November 9, 2017, and U.S. Patent Application Publication No. 2017 / 0319205, entitled “POWERED END EFFECTOR ASSEMBLYWITH PIVOTABLE CHANNEL,” published on January 2, 2014, and U.S. Patent Application Publication No. 2014 / 0001231, entitled “FIRING SYSTEM LOCKOUT ARRANGEMENTS FOR SURGICAL INSTRUMENTS,” published on April 7, 2016, and U.S. Patent Application Publication No. 2018 / 0132849, entitled “SURGICAL INSTRUMENTS WITH JAWS THAT ARE PIVOTABLE ABOUT A FIXED AXISAND INCLUDE SEPARATE AND DISTINCT CLOSURE AND FIRING SYSTEMS,” published on June 21, 2018, and U.S. Patent Application Publication No. 2018 / 0168613, entitled “SURGICAL INSTRUMENTS WITH JAWS THAT ARE PIVOTABLE ABOUT A FIXED AXISAND FOR ENDOSCOPIC PROCEDURES” U.S. Patent Application Publication No. 2016 / 0095596,U.S. Patent Application Publication No. 2015 / 0297199, published on October 22, 2015, entitled “ADAPTER ASSEMBLY WITH GIMBAL FOR INTERCONNECTING ELECTROMECHANICAL SURGICALDEVICES AND SURGICAL LOADING UNITS, AND SURGICAL SYSTEMS THEREOF,” U.S. Patent Application Publication No. 2022 / 0031351, published on February 3, 2022, entitled “SURGICAL INSTRUMENTS WITH DIFFERENT ARTICULATION JOINT ARRANGEMENTS FOR ACCOMMODATING FLEXIBLE ACTUATORS,” and U.S. Patent Application Publication No. 2022 / 0031351, published on February 3, 2022, entitled “SURGICAL INSTRUMENTS WITH FLEXIBLE FIRING MEMBER ACTUATOR and U.S. Patent Application Publication No. 2022 / 0031320, entitled “CONSTRAINTARRANGEMENTS”, U.S. Patent Application Publication No. 2023 / 0119119, entitled “CABLE-DRIVEN ACTUATION SYSTEM FOR ROBOTIC SURGICAL TOOL ATTACHMENT”, published on April 20, 2023, International Patent Publication No. WO2018 / 071497, entitled “STAPLER CARTRIDGE WITH AN INTEGRAL KNIFE”, published on March 15, 2018, International Patent Publication No. WO2018 / 049211, entitled “WRIST ARCHITECTURE”, published on April 12, 2022, entitled “METHOD FOR PROVIDING AN AUTHENTICATION LOCKOUT IN A SURGICAL STAPLER WITH AREPLACEABLE No. 11,298,129 entitled “ROBOTIC SURGICAL INSTRUMENT WITH CLOSED LOOP FEEDBACK TECHNIQUES FOR ADVANCEMENT OF CLOSURE MEMBER DURING FIRING” issued on January 26, 2021,U.S. Patent No. 5,485,947, published on January 23, 1996, entitled “LINEAR STAPLING MECHANISM WITH CUTTING MEANS”, International Patent Publication No. WO2018 / 049206, published on March 15, 2018, entitled “STAPLER RELOAD DETECTION AND IDENTIFICATION”, U.S. Patent Application Publication No. 2016 / 0249920, published on September 1, 2016, entitled “Surgical fastener applying apparatus”, U.S. Design Patent No. D974,560, published on January 3, 2023, entitled “STAPLE CARTRIDGE”, U.S. Design Patent No. D967,421, published on October 18, 2022, entitled “STAPLE CARTRIDGE”, and U.S. Design Patent No. D967,421, published on October 12, 2021, entitled “BUTTRESS ASSEMBLY FOR A SURGICAL FASTENER APPLYING APPARATUS” No. D933,220, entitled “TISSUE THICKNESS COMPENSATOR COMPRISING AT LEASTONE MEDICAMENT,” U.S. Patent No. 9,839,420, issued on Dec. 12, 2017, entitled “TISSUE THICKNESS COMPENSATOR COMPRISING AT LEASTONE MEDICAMENT,” U.S. Patent No. 10,588,623, issued on Mar. 17, 2020, entitled “ADHESIVE FILM LAMINATE,” U.S. Patent No. 8,499,992, issued on Aug. 6, 2013, entitled “DEVICE AND METHOD FOR CONTROLLING COMPRESSION OF TISSUE,” U.S. Patent Application Publication No. 2022 / 0378427, issued on Dec. 1, 2022, entitled “STAPLING INSTRUMENT COMPRISING JAW MOUNTS,” and U.S. Patent Application Publication No. 2022 / 0378427, issued on Dec. 1, 2022, entitled “METHOD OF APPLYING A BUTTRESS TO A No. 10,349,939 entitled "SURGICAL STAPLER" and No. 9,386,988 entitled "RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR" issued on July 12, 2016.U.S. Patent No. 9,072,535, issued on July 7, 2015, entitled “SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS”, and U.S. Patent No. 9,844,369, issued on December 19, 2017, entitled “SURGICAL END EFFECTORS WITH FIRING ELEMENT MONITORING ARRANGEMENTS”.

[0057] Many specific details are listed herein to provide a thorough understanding of the overall structure, function, manufacture, and use of the embodiments described in the specification and shown in the drawings. Well-known operations, parts, and elements are not described in detail to avoid obscuring the embodiments described in the specification. The reader will understand that the embodiments described and shown herein are non-limiting examples, so that it can be recognized that the specific structural and functional details disclosed herein can be representative and illustrative. These embodiments can be modified and changed without departing from the scope of the claims.

[0058] The terms "proximal" and "distal" are used herein relative to a clinician manipulating the handle portion of a surgical instrument. The term "proximal" refers to the portion closest to the clinician, and the term "distal" refers to the portion positioned away from the clinician. It should also be understood that for brevity and clarity, spatial terms such as "vertical," "horizontal," "upper," and "lower" may be used herein in conjunction with the accompanying drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and / or absolute.

[0059] Various exemplary devices and methods are provided for performing laparoscopic and minimally invasive surgical procedures. However, the reader will readily appreciate that the various methods and devices disclosed herein can be used in a variety of surgical procedures and applications, including, for example, in conjunction with open surgical procedures. Continuing to refer to this detailed description, the reader will further appreciate that the various instruments disclosed herein can be inserted into the body in any manner, such as through a natural cavity, through an incision or puncture formed in the tissue, etc. The working portion or end effector portion of the instrument can be inserted directly into the patient's body or can be inserted through an access device having a working channel through which the end effector and elongated shaft of the surgical instrument can be advanced.

[0060] The surgical stapling system may include an axis and an end effector extending from the axis. The end effector includes a first jaw and a second jaw. The first jaw includes a staple cartridge. The staple cartridge can be inserted into the first jaw and can be removed from the first jaw; however, the staple cartridge may not be removed from the first jaw or at least cannot be easily replaced from the first jaw. The second jaw includes an anvil configured to deform the staples ejected from the staple cartridge. The second jaw can pivot relative to the first jaw about a closed axis; however, the first jaw can pivot relative to the second jaw. The surgical stapling system also includes an articulated joint configured to allow the end effector to rotate or articulate relative to the axis. The end effector can rotate around an articulated axis extending through the articulated joint. Alternatively, the surgical stapling system may not include an articulated joint.

[0061] The staple cartridge comprises a cartridge body. The cartridge body comprises a proximal end, a distal end and a platform extending between the proximal end and the distal end. In use, the staple cartridge is positioned on a first side of a tissue to be sutured, and the anvil is positioned on a second side of the tissue. The anvil moves toward the staple cartridge to compress the tissue and clamp it against the platform. The staples removably stored in the cartridge body can then be deployed into the tissue. The cartridge body comprises a staple cavity defined in the cartridge body, wherein the staples are removably stored in the staple cavity. The staple cavities are arranged in six longitudinal rows. Three rows of staple cavities are positioned on a first side of the longitudinal slot and three rows of staple cavities are positioned on a second side of the longitudinal slot. Other arrangements of staple cavities and staples are also possible.

[0062] The nail is supported by a nail driver in the magazine body. The driver can move between a first or non-firing position and a second or firing position to eject the nail from the nail cavity. The driver is retained in the magazine body by a retainer, which extends around the bottom of the magazine body and includes a resilient member configured to grip the magazine body and retain the retainer to the magazine body. The driver can move between its non-firing position and its firing position by a slide. The slide can move between a proximal position adjacent to the proximal end and a distal position adjacent to the distal end. The slide includes a plurality of ramp surfaces that are configured to slide under the driver toward the anvil and lift the driver, and the nail is supported on the driver.

[0063] In addition to the above, the slider can also be moved distally by the firing driver. The firing driver is configured to contact the slider and push the slider toward the distal end. The longitudinal slot defined in the magazine body is configured to receive the firing driver. The anvil also includes a slot configured to receive the firing driver. The firing driver also includes a first cam engaging the first jaw and a second cam engaging the second jaw. As the firing driver advances distally, the first cam and the second cam can control the distance or tissue gap between the platform of the nail magazine and the anvil. The firing driver also includes a knife configured to cut into the tissue captured between the nail magazine and the anvil. It is desired that the knife is positioned at least partially close to the ramp surface so that the nail is ejected before the knife.

[0064] Figure 1 A surgical stapler 70000 comprising a shaft 70002 is depicted, the surgical stapler comprising an end effector 70004 extending from the shaft 70002. The end effector 70004 comprises a first jaw 70006 and a second jaw 70008. The first jaw 70006 comprises an elongated channel 70010. A staple cartridge 70020 can be inserted into and removed from the elongated channel 70010. However, the staple cartridge 70020 may not be removed from the first jaw 70006 or at least not easily replaced from the first jaw. The second jaw 70008 comprises an anvil 70030 configured to form a staple ejected from the staple cartridge 70020. The second jaw 70008 can pivot relative to the first jaw 70006 between an open position and a closed position; however, the first jaw 70006 may pivot relative to the second jaw 70008.

[0065] The staple cartridge 70020 includes a cartridge body 70022 including a proximal end 70024 and a distal end 70026. The cartridge body 70022 also includes a deck surface 70028 extending between the proximal end 70024 and the distal end 70026 and configured to be opposed to the anvil 70030. A longitudinal slot 70029 extends from the proximal end 70024 of the cartridge body 70022 toward the distal end 70026 and is sized to receive a slide driver or firing actuator configured to eject staples from the cartridge body 70022 during a cutting and staple firing stroke. Various aspects of the staple cartridge are described in more detail in U.S. Pat. No. 9,844,369, the disclosure of which is incorporated herein by reference in its entirety.

[0066] Many surgical applications require the use of buttresses or tissue thickness compensators, which are generally referred to as appendages used in conjunction with the suture end effectors described herein, to strengthen the staple line and provide support to the tissue surrounding the staple line. Various appendages are disclosed herein and may include materials characterized by one or more of the following properties: for example, biocompatible, bioabsorbable, bioresorbable, biodurable, biodegradable, compressible, fluid-absorbable, swellable, self-expanding, bioactive, pharmaceutical, pharmaceutically active, anti-adhesion, hemostatic, antibiotic, antimicrobial, antiviral, nutritional, adhesive, permeable, hydrophilic, and / or hydrophobic. Any appendage disclosed herein may include at least one of a hemostatic agent (such as fibrin and thrombin), an antibiotic (such as doxycycline), and a drug (such as a matrix metalloproteinase (MMP)).

[0067] Various appendages disclosed herein may include synthetic and / or non-synthetic materials.Appendages may include polymer compositions containing one or more synthetic polymers and / or one or more non-synthetic polymers.Synthetic polymers may include synthetic absorbable polymers and / or synthetic non-absorbable polymers.For example, polymer compositions may include biocompatible foams.For example, biocompatible foams may include porous open-cell foams and / or porous closed-cell foams.The biocompatible foam may have uniform pore morphology or may have a gradient pore morphology (i.e., the size of the small pores through the thickness of the foam gradually increases to macropores in one direction).The polymer composition may include porous scaffolds, porous matrices, gel matrices, hydrogel matrices, solution matrices, filamentous matrices, tubular matrices, composite matrices, membrane matrices, biostable polymers and biodegradable polymers, and one or more of their combinations.For example, an appendage may include foams enhanced by filamentous matrices or may include foams with additional hydrogel layers, which expand in the presence of body fluids to further provide compression of the tissue. Any appendage disclosed herein may also consist of a coating and / or a second or third layer on a material that swells in the presence of body fluids to further provide compression of the tissue. Such layers may be hydrogels, which may be synthetic and / or naturally derived materials, and may be, for example, biodurable and / or biodegradable. The appendage may include a microgel or a nanogel. The hydrogel may include a carbohydrate-derived microgel and / or nanogel. The appendage may be enhanced with a fiber nonwoven material or a fiber mesh element, for example, which may provide additional flexibility, hardness and / or strength. The appendage may have a porous morphology presenting a gradient structure, such as small holes on one surface and large holes on another surface. Such morphology may be more optimized for tissue ingrowth or hemostatic behavior. In addition, this gradient may also be composed of a varying bioabsorption curve. A short-term absorption curve may be preferred for solving hemostasis, while a long-term absorption curve may solve better tissue healing without leakage.

[0068] Examples of non-synthetic materials that may constitute the appendages disclosed herein include, but are not limited to, lyophilized polysaccharides, glycoproteins, bovine pericardium, collagen, gelatin, fibrin, fibrinogen, elastin, proteoglycans, keratin, albumin, hydroxyethyl cellulose, cellulose, oxidized cellulose, oxidized regenerated cellulose (ORC), hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose, chitin, deacetylated chitosan, casein, alginate, and combinations thereof.

[0069] Examples of synthetic absorbable materials include, but are not limited to, poly(lactic acid) (PLA), poly(L-lactic acid) (PLLA), polycaprolactone (PCL), polyglycolic acid (PGA), poly(trimethylene carbonate) (TMC), polyethylene terephthalate (PET), polyhydroxyalkanoates (PHA), copolymers of glycolide and ε-caprolactone (PGCL), copolymers of glycolide and trimethylene carbonate, poly(glycerol sebacate) (PGS), poly(dioxanone) (PDS), polyesters, poly(orthoesters), polyoxyesters, polyetheresters, polycarbonates, polyamide esters, polyanhydrides, polysaccharides, poly(ester-amides), tyrosine-based polyarylates, polyamine-based Polyiminocarbonate of tyrosine, polycarbonate based on tyrosine, poly(D,L-lactide-carbamate), poly(hydroxybutyrate), poly(B-hydroxybutyrate), poly(ε-caprolactone), polyethylene glycol (PEG), poly[di(carboxyphenoxy)phosphazene], poly(amino acid), pseudo-poly(amino acid), absorbable polyurethane, poly(phosphazene), polyphosphazene, polyoxyalkylene, polyacrylamide, polyhydroxyethyl methacrylate, polyvinyl pyrrolidone, polyvinyl alcohol, poly(caprolactone), polyacrylic acid, polyacetate, polypropylene, aliphatic polyester, glycerol, copoly(ether-ester), polyalkylene oxalate, polyamide, poly(iminocarbonate), polyalkylene oxalate, and combinations thereof. The polyester may be selected from polylactide, polyglycolide, trimethylene carbonate, polydioxanone, polycaprolactone, polybutene ester, and combinations thereof.

[0070] The appendage may include a surfactant. Examples of surfactants may include, but are not limited to, polyacrylic acid, methylcellulose, methylcellulose, ethylcellulose, propylcellulose, hydroxyethylcellulose, carboxymethylcellulose, polyoxyethylene cetyl ether, polyoxyethylene lauryl ether, polyoxyethylene octyl ether, polyoxyethylene octylphenyl ether, polyoxyethylene oleyl ether, polyoxyethylene sorbitan monolaurate, polyoxyethylene stearyl ether, polyoxyethylene nonylphenyl ether, dialkylphenoxy poly(ethyleneoxy)ethanol, and poloxamer.

[0071] The polymer composition may contain a pharmaceutically active agent. The polymer composition may release a therapeutically effective amount of the pharmaceutically active agent. The pharmaceutically active agent may be released as the polymer composition is desorbed / absorbed. The pharmaceutically active agent may be released into a fluid such as blood that passes through or through the polymer composition. Examples of pharmaceutically active agents may include, but are not limited to, hemostatic agents and drugs such as fibrin, thrombin, and oxidized regenerated cellulose (ORC); anti-inflammatory drugs such as diclofenac, aspirin, naproxen, sulindac, and hydrocortisone; antibiotics and antimicrobial drugs or agents such as triclosan, ionic silver, ampicillin, gentamicin, polymyxin B, chloramphenicol; and anticancer agents such as cisplatin, mitomycin, doxorubicin.

[0072] The polymer composition may include a hemostatic material. The appendage may include a hemostatic material including polylactic acid, polyglycolic acid, polyhydroxybutyrate, polycaprolactone, polydioxanone, polyoxyalkylene, copoly(ether-ester), collagen, gelatin, thrombin, fibrin, fibrinogen, fibronectin, elastin, albumin, hemoglobin, ovalbumin, polysaccharides, hyaluronic acid, chondroitin sulfate, hydroxyethyl starch, hydroxyethyl cellulose, cellulose, oxidized cellulose, hydroxypropyl cellulose, carboxyethyl cellulose, carboxy Methylcellulose, chitosan, chitosan, agarose, maltose, maltodextrin, alginate, coagulation factors, methacrylates, polyurethanes, cyanoacrylates, platelet agonists, vasoconstrictors, alum, calcium, RGD peptides, proteins, protamine sulfate, ε-aminocaproic acid, ferrous sulfate, ferric basic sulfate, ferric chloride, zinc, zinc chloride, aluminum chloride, aluminum sulfate, aluminum acetate, permanganate, tannins, bone wax, polyethylene glycol, fucoidan, and combinations thereof. The appendage may be characterized by hemostatic properties.

[0073] Figure 2 An appendage 70050 according to the present disclosure is illustrated. The appendage 70050 includes a first material layer 70060, which may include Mesh Material-70062. The mesh material provides a woven support structure for supporting surgical staples and severed tissue when fastened thereto. The first material layer 70060 may alternatively include other mesh or woven materials described herein. In the illustrated arrangement, the first material layer 70060 defines a first device contact surface 70064. The appendage 70050 also includes a second film layer 70070 that is adhered to the side of the first material layer 70060 opposite the device contact surface 70064. The second film layer 70070 may be formed of a second material 70072 that is different from the first material 70062 and includes a polydioxanone (PDO) film that helps further stabilize the first mesh material 70062. In the illustrated arrangement, the second film layer 70070 defines a planar or substantially planar tissue contact surface 70074. The tissue contact surface 70074 is smooth compared to the mesh, woven or mesh device contact surface 70064. Alternatively, the second film layer 70070 can be formed from an alternative synthetic polymer material described herein.

[0074] like Figure 3 As can be seen in the figure, in use, the appendage 70050 can be positioned between the jaws 70006, 70008 of the surgical stapler end effector 70004, which respectively include the surgical staple cartridge 70020 and the anvil 70030. In applications where only one appendage 70050 is employed, the device contact surface 70064 is placed in contact with the staple forming lower surface 70032 of the anvil 70030 or with the platform surface 70028 on the staple cartridge 70020. It will be understood by those of ordinary skill in the art that the mesh, woven or mesh construction of the device contact surface 70064 will be used to establish a friction interface with the staple forming lower surface 70032 of the anvil 70030 or the platform surface 70028 of the staple cartridge 70020 to prevent the appendage 70050 from sliding or otherwise moving laterally and / or longitudinally when initially contacted by the knife of the firing actuator or sled driver of the surgical stapler. Figure 3 An application in which two appendages 70050 are used is illustrated. Figure 3 As shown, when two appendages 70050 are used, the device contact surface 70064 of one appendage 70050 contacts the staple forming lower surface 70032 of the anvil 70030, while the device contact surface 70064 of the other appendage 70050 contacts the platform surface 70028 of the staple cartridge 70020. The target tissue T is then clamped between the tissue contact surfaces 70074 of each of the appendages 70050.

[0075] Figure 4 Another appendage 70050' is depicted which is somewhat similar to appendage 70050. Figure 470050' also includes a third film layer 70080 that defines a tissue contacting surface 70082. The third film layer includes a third material 70084, which can be the same as the second material 70072. That is, the third material 70084 also includes a polydioxanone (PDO) film. The first film layer 70060 and the third film layer 70080 can be applied to the second material layer in one operation, such that the second material layer is completely encapsulated in the polydioxanone (PDO) film. Thus, the second film layer 70070' defines a planar or substantially planar textured or roughened device contacting surface 70074'.

[0076] In use, the appendage 70050' can be positioned between the jaws of the surgical stapler end effector including an anvil and a surgical staple cartridge. In applications where only one appendage 70050' is used, the device contact surface 70074' is placed in contact with the nail forming lower surface of the anvil or the platform surface of the staple cartridge. It will be appreciated by those of ordinary skill in the art that the textured or roughened surface 70074' will be used to establish a friction interface with the anvil or the staple cartridge to prevent the appendage 70050' from sliding or moving when initially contacted by the firing actuator of the surgical stapler or the knife of the slider driver. In applications where two appendages 70050' are used, the device contact surface 70074' of one appendage 70050' contacts the nail forming surface of the anvil, while the device contact surface 70074' of the other appendage 70050' contacts the platform surface of the staple cartridge. The target tissue is then clamped between the tissue contact surfaces 70074' of each of the appendages 70050'. The layered appendage 70050' enjoys the advantages provided by the woven material 70062 and the advantages provided by the nonwoven materials 70072, 70084, while also minimizing the likelihood that the appendage 70050' will shift, plow, or bunch during cutting and firing.

[0077] Figure 5 Another appendage 71050 similar to the appendage 70050' described above is illustrated, except that the device contact surface 71074 of the second film layer 70070' is contoured to frictionally engage the staple forming lower surface 70032 of the anvil 70030. For example, the device contact surface 71074 includes a plurality of convex friction bumps 71076 corresponding to the staple forming recesses 70034 in the anvil 70030. In use, the appendage 71050 is placed adjacent to the anvil so that the friction bumps 71076 frictionally engage the corresponding staple forming recesses 70034 in the anvil 70030. Such an arrangement is used to prevent the appendage 71050 from sliding or moving when initially contacted by the knife of the firing actuator or sled driver of the surgical stapler. Alternatively, the contoured device contact surface may also include a continuously roughened or textured surface 70078 to further enhance the frictional engagement between the appendage 71050 and the anvil 70030. See FIG. Figure 6 .

[0078] Figure 7 An appendage 72050 is depicted that is similar to appendage 70050', except that a device contacting surface 70082' of a third film layer 70080' is contoured to frictionally engage a platform 70028 of a surgical staple cartridge 70020. Figure 7 As can be seen in the figure, the platform surface 70028 of the staple cartridge 70020 also includes a plurality of feature structures or protrusions 70029 corresponding to the staple pits in the staple cartridge 70020. In the illustrated arrangement, the device contact surface 70082' has a plurality of concave cavities 70086 corresponding to the protrusions 70029 on the staple cartridge 70020. Such an arrangement is used to prevent the appendage 72050 from sliding or moving when initially contacted by the firing actuator of the surgical stapler or the knife of the sled driver. Alternatively, the contoured device contact surface 70082' may also include a roughened or textured surface to further enhance the frictional engagement between the appendage 72050 and the platform 70028 of the staple cartridge 70020.

[0079] The attachment 72050' and the nail magazine 70020 are Figure 8 . The staple cartridge 70020 includes a cartridge platform 70028 and a cartridge platform feature 70029. The appendage 72050' includes a first material layer 72060 that includes a pattern of traction bumps 71100. The first material 72060 may include any of the various appendage materials disclosed herein. The first layer may include polydioxanone (PDO) or other synthetic polymer materials disclosed herein. The traction bumps 71100 are made of a second material 71102 that is embedded in the first material 72060 and has a coefficient of friction that is greater than the coefficient of friction of the first material 72060. For example, the second material may include The traction tabs 71100 are configured to contact the cartridge deck feature 71220. The traction tabs 71100 of the appendage 71000 are configured to reduce sliding or slipping of the appendage 72050' relative to the staple cartridge 70020 and the staple cartridge deck 70028.

[0080] Fig. 9Another appendage 72000 formed of a single material 72002 is illustrated. For example, the material 72002 may include polydioxanone (PDO) or other synthetic polymer materials disclosed herein. The appendage 72000 defines a device contact surface 72074, which includes a plurality of convex friction bumps 72076 corresponding to the staple forming recesses 70034 in the anvil 70030. In use, the appendage 72000 is placed adjacent to the anvil 70030 so that the friction bumps 72076 frictionally engage the corresponding staple forming recesses 70034 in the anvil 70030. Such an arrangement is used to prevent the appendage 72000 from sliding or moving when initially contacted by the knife of the firing actuator or slider driver of the surgical stapler. Alternatively, the contoured device contact surface may also include a roughened or textured surface to further increase the frictional engagement between the appendage 72000 and the anvil 70030.

[0081] The surgical stapler end effector 74000 according to the present disclosure is Figures 10 to 13 . The end effector 74000 includes a first jaw 74100 and a second jaw 74200. The first jaw 74100 includes an elongated channel 74102 configured to support a surgical staple cartridge 74120 therein. The staple cartridge 74120 is insertable into and removable from the elongated channel 74102; however, the staple cartridge 74120 may not be removable from the elongated channel 74102 or at least not easily replaceable from the elongated channel. The staple cartridge 74120 includes a cartridge body 74122 having a proximal end portion 74124 and a distal end portion (not shown). The cartridge body 74122 defines a platform surface 74126 extending from the proximal end portion 74124 of the cartridge body 74122 to the distal end portion. The elongated slot 74128 extends from the proximal end portion 74214 to the distal end portion to accommodate the sled 74140 (and the sled driver or firing actuator of the surgical stapling instrument) therethrough. Fig.11 . Three longitudinal lines of staple cavities 74130 can be disposed on each side of the elongated slot 74128. A corresponding staple driver 74132 is movably supported in each staple cavity 74130. One or more surgical staples 74134 or fasteners are removably supported on each driver 74132. See FIG. Fig.12 Other staple cartridge arrangements and fastener arrangements are contemplated, wherein each fastener has an integral driver formed therewith. In any event, when the sled 74140 is driven distally by a sled driver or firing actuator of the surgical stapling instrument, the sled 74140 sequentially contacts the drivers 74132 in each longitudinal row and drives the drivers and the staples 74134 or fasteners supported thereon out of the corresponding staple cavities.

[0082] The second jaw 74200 includes an anvil 74210 configured to deform the nails 74134 ejected from the nail magazine 74120. The anvil 74210 includes an anvil body 74212 having a proximal end portion 74214 and a distal end portion (not shown). The nail forming surface 74216 extends from the proximal end portion 74214 to the distal end portion and defines a plurality of nail forming recesses 74218 therein. The elongated anvil slot 74213 extends from the proximal end portion 74214 to the distal end portion to accommodate the passage of a slide driver or a firing actuator. The anvil 74210 also includes a pair of tissue stops 74220 protruding downward on each side of the proximal end portion 74214. The tissue stops 74220 each define a distal edge 74222 which is configured to be contacted by the target tissue when the target tissue is positioned between the anvil and the staple cartridge so as to prevent the target tissue from being positioned proximally beyond the nearest-most staple in the staple cartridge 74120 .

[0083] The anvil 74210 also includes at least one appendage retainer in the form of a protrusion, tooth, or recess 74230 formed on the proximal end portion 74214 and projecting downwardly toward the staple cartridge 74120. Fig.11 As can be seen in FIG. 74, one protrusion 74230 is formed on one side of the anvil slot 74213, and another protrusion 74230 is formed on the other side of the anvil slot 74213. Fig.12 As can be seen in the drawings, each protrusion 74230 includes a rounded surface 74232 that corresponds to a concave cavity, opening or hole 74136 disposed in the proximal end 74124 of the staple cartridge 74120. The rounded surface 74232 reduces the chance of tissue damage or trauma if tissue is accidentally captured between the proximal end portion 74214 of the anvil 74210 and the proximal end 74122 of the staple cartridge 74120. However, as Fig.12 , the projections 74230 can be proximal to the distal edge 74222 of the tissue stop 74220 and proximal to the proximal-most staple cavities 74130 and staples 74132 in the staple cartridge 74120. Thus, as the anvil 74210 is closed, the tissue stop 74120 will prevent tissue from accidentally migrating proximally to a position where tissue could be accidentally captured or clamped between the projections 74230 and their corresponding cavities 74136 in the staple cartridge 74120.

[0084] Fig.13The use of an end effector 74000 and an appendage 74300 is illustrated. The appendage 74300 may include any of the appendages disclosed herein. The appendage 74300 may include a single layer of any of the woven or nonwoven appendage materials disclosed herein. In one application, the appendage 74300 is positioned on the platform surface 74126 of the staple cartridge 74120 so that the proximal end 74302 of the appendage extends proximally beyond the cavity 74136 in the proximal end 74124 of the staple cartridge 74120. Thereafter, the end effector 74000 may be manipulated to position the target tissue between the staple forming surface 74216 of the anvil 74210 and the appendage 74300. Once the target tissue has been appropriately positioned, the anvil 74210 is closed to clamp the target tissue between the anvil and the appendage 74300. As the anvil is closed, the tabs 74230 clamp portions of the appendage 74300 within their respective cavities 74136 to hold the appendage 74300 in place and prevent any movement (lateral or longitudinal) of the appendage 74300 when the knife of the slide driver or firing actuator initially contacts and cuts through the appendage 74300. Alternatively, the appendage 74300 may additionally include cavities, detents, openings or holes 74304 corresponding to each tab 74230 and adapted to receive the tabs 74230 therein when the anvil 74210 is closed, thereby holding and preventing movement of the appendage 4300 during the cutting and firing procedures.

[0085] Fig.14 and Fig.15 An anvil 76000 that can be advantageously used with any of the surgical stapler end effectors disclosed herein is illustrated. As will be discussed in further detail below, the anvil 76000 is configured to be used with the appendage 76026. Fig.14 and Fig.15 As can be seen in the figure, the anvil 76000 includes an anvil body 76002, which includes a proximal end portion 76004 and a distal end portion 76006. The anvil body 76002 also includes a staple forming lower surface 76008, which extends from the proximal end portion 76004 to the distal end portion 76006 and defines an elongated slot 76010, which is configured to accommodate the passage of a firing actuator or a slide driver of a surgical stapler. Tissue stops 76012 are formed on each side of the proximal end portion 76004 of the anvil 76000.

[0086] Appendage 76020 may include any of the appendages disclosed herein with the additional features or properties discussed below. Fig.14As shown, the appendage 76020 includes a proximal end 76022 that is configured to extend proximally beyond the distal edge 76014 of the tissue stop 76012. In the illustrated arrangement, the proximal end 76022 includes a tapered end portion 76024. Also in the illustrated arrangement, the appendage 76020 also includes a proximal slot segment 76026 that extends partially into the appendage 76020 and coincides with the longitudinal anvil slot 76010. Additionally, in the illustrated arrangement, the appendage 76020 also includes a distal slot segment 76030 that extends partially inwardly from the distal end 76028 of the appendage 76020 and also coincides with the anvil slot 76010. It should be understood that the proximal slot segment 76026 and the distal slot segment 76030 facilitate the passage of the slider driver or firing actuator of the surgical stapler without contacting the appendage 76020 during the length of the corresponding slot segment, which may otherwise cause undesirable movement of the appendage 76020 during the cutting and firing process. Other appendages may lack one or both of the proximal slot segment 76026 and the distal slot segment 86030.

[0087] The appendage 76020 further includes an appendage attachment assembly 76040 that is attached to or otherwise formed on the proximal end 76022 of the appendage 76020 and that is configured to releasably engage the proximal end portion 76004 of the anvil 76000 . Fig.16 , Fig.17 and Fig.18 The portion of the surgical stapler end effector 76400 including the anvil 76000 and the appendage 76020 is illustrated. Figures 16 to 18 As shown, the appendage attachment assembly 76040 includes a severable attachment ring 76042 that is releasably attached to the proximal end 76022 of the appendage 76020. The severable attachment ring 76042 is made of the same material as the material that constitutes the appendage 76020. However, several of the attachment rings 76042 can be made of one of the appendage materials disclosed herein that is different from the appendage material that constitutes the appendage 76020.

[0088] like Fig.14 , Fig.16 , Fig.17 and Fig.18, the severable attachment ring 76042 is attached to the proximal end portion 76022 by a plurality of tearable links 76044 such that the severable ring 76042 spans the tapered end portion 76024 and the proximal slot segment 76026 therein. The links 76044 may be formed by forming holes or openings 76046 in the appendage material between the links 76044. In addition, the severable attachment ring includes a first hook or loop portion and a second hook or loop portion 76048 formed therein that are configured to hook-engage a corresponding slotted portion, protrusion, detent, hook or retaining feature 76016 formed on each tissue stop 76012 or other portion of the proximal end portion 76004 of the anvil 76000.

[0089] Fig.16 The appendage 76020 is illustrated in its position prior to initiating the cutting and firing process. Fig.16 As can be seen in FIG. 7 , the knife 76410 of the slide driver or firing actuator of the surgical stapler is positioned proximal to the severable attachment ring 76042 on the appendage 76020 . Fig.17 The position of the proximal end portion 76022 of the appendage 76020 relative to the proximal-most staple cavity 76444 supported in the staple cartridge 76440 in the end effector 76400 is illustrated. Fig.17 As can be seen in the figure, the proximal end portion 76022 of the appendage 76020 and more specifically at least a portion of the tapered end portion 76024 is proximal to the proximal-most staple cavity 76444.

[0090] Fig.17 The beginning of the cutting and firing process is illustrated. Fig.17 As can be seen, as the knife 76410 is advanced distally through the end actuator 76400, the knife has severed the severable attachment ring 76042. Fig.18The knife 76410 is further advanced distally and some of the links 76042 are broken. Once the firing and cutting process has been completed and the appendage 76020 has been severed and sutured to the severed target tissue clamped in the end effector 76400, the end effector jaws can be opened to release the target tissue and appendage 76020 from the end effector. As the clinician removes the end effector from the sutured target tissue and appendage, the remaining tearable links 76042 will break to release the appendage attachment assembly 76040 from the appendage 76020. Thus, the appendage attachment assembly 76040 will be withdrawn from the patient's body together with the end effector. The severable hook can be formed in the appendage material and can be configured to be releasably engaged with a hook or protrusion on the anvil 76000 in other ways. When the end effector is withdrawn from the target tissue and appendage being stapled, such hooks will be torn or severed to release the appendage from the anvil, leaving the remainder of the appendage hook with the staple piece of the appendage to be absorbed into the patient's body. In either case, it will be understood by those skilled in the art that the appendage attachment assembly and hook arrangement are used to prevent longitudinal and lateral displacement of the appendage material as the knife passes through the appendage material.

[0091] In addition to any of the appendage retention arrangements and configurations disclosed herein, a temporary form of pressure-sensitive adhesive 75000 may be applied to the contact device surface of the appendage. The pressure-sensitive adhesive may be characterized by one or more of the following properties: (1) aggressive and persistent tack; (2) adhesion at no more than finger pressure; (3) sufficient ability to remain on an adherend; and (4) sufficient cohesive strength to be cleanly removed from an adherend. These temporary pressure-sensitive adhesives may be advantageously applied to certain portions of each appendage to further enhance the adhesion of the appendage to the anvil or staple cartridge, thereby preventing the appendage from sliding, moving, or bunching during firing. For example, these pressure-sensitive adhesives may be applied only to the proximal portion of the device contact surface and / or they may also be applied along the length of the appendage. Examples of such adhesives 75000 include, but are not limited to, polyvinyl pyrrolidone (PVP), polyvinyl acetate (PVA), acrylic-based adhesives, and cyanoacrylate adhesives, among others. A more aggressive (more viscous) form of adhesive 75000 may be applied only to the device contact surface of the appendage that protrudes proximally beyond the distal edge of the tissue stop. For example, a small amount of PVP-based adhesive may be applied to the device contact surface adjacent to the proximal end of the appendage (and proximal to the distal edge of the tissue stop) to further enhance the retention of the proximal end of the appendage to the device (anvil or staple cartridge). The properties of the adhesive may be further adjusted by reducing the amount of plasticizer added to the adhesive to increase the adhesive's resistance to moisture intrusion / softening. However, some adhesives such as PVP become lubricated when wet, making the portion of the device to which the adhesive is applied difficult to dry between uses. Therefore, in at least some applications, it may be desirable to avoid applying those adhesives to the portion of the anvil proximal to the distal edge of the tissue stop.

[0092] Figure 2 An amount of temporary pressure sensitive adhesive 75000 is illustrated that may be applied to a proximal end portion of the first device contacting surface 70064 . Figure 4 Illustrated is an amount of temporary pressure sensitive adhesive 75000 that may be applied to a proximal end portion of the first device contacting surface 70074'.

[0093] Various aspects of the subject matter described herein are illustrated in the following examples.

[0094] Example 1 - An appendage (70050', 71050, 71050', 72050, 74300, 76020) for use with a surgical stapler (70000). The appendage includes: a first layer (70060), the first layer comprising a first material (70062); and a second film layer (70070'), the second film layer attached to the first layer and defining a continuous textured device contact surface (70074', 70078), the continuous textured device contact surface being configured to establish a friction interface with a corresponding portion of the surgical stapler. The second film layer comprises a second material (70072) different from the first material. The appendage includes a third film layer (70080) attached to the first layer and defining a tissue contact surface (70082).

[0095] Embodiment 2 - The appendage (70050') of Embodiment 1, wherein the continuous texturing device contact surface (70074') is planar.

[0096] Example 3 - The appendage (70050', 71050') according to Example 1 or 2, wherein the continuously textured device contact surface (70074', 70078) is configured to establish a friction interface with the staple forming lower surface (70032) of the anvil (70030) of the surgical stapler.

[0097] Example 4 - An appendage (71050') according to Example 1, 2 or 3, wherein the continuously textured device contact surface (70078) includes a plurality of contoured feature structures (70076), wherein each contoured feature structure corresponds to a nail forming pit (70034) in the nail forming lower surface (70032) of the anvil (70030).

[0098] Example 5 - The appendage (74300, 76020) of Example 1, 2, 3 or 4, further comprising at least one anvil attachment feature (74222, 76040) configured to releasably engage a corresponding appendage retainer (74230, 76016) on the anvil (74210, 76400).

[0099] Example 6 - An appendage (74300) according to Example 5, wherein the at least one anvil attachment feature structure (74222) includes an opening through the proximal end of the appendage (74300), and the opening is configured to receive a corresponding appendage retainer in the appendage retainer (74230) on the anvil (74210).

[0100] Example 7 - An appendage (76020) according to Example 5, wherein the at least one anvil attachment feature structure (76040) includes a hook (76042) on the proximal end (76022) of the appendage (76020), and the hook is configured to be able to hook-engage a corresponding appendage retainer (76016) on the proximal end (76004) of the anvil (76000).

[0101] Example 8 - An appendage (76020) according to Example 7, wherein the hook (76042) includes: a first ring (76048), which is configured to be able to hook-engage a first hook portion (76016) on the proximal end (76004) of the anvil (76000); a second ring (76048), which is configured to be able to hook-engage a second hook portion (76016) on the proximal end (76004) of the anvil (76000); and a severable attachment ring (76042), which is connected to the first ring (76048) and the second ring (76048) and extends between the first ring and the second ring, wherein the severable attachment ring (76042) is configured to be able to be cut by the knife (76410) of the surgical stapler and separated from the appendage (76020).

[0102] Example 9 - The appendage (76020) of Example 8, wherein the severable attachment ring (76042) is removably attached to the proximal end (70624) of the appendage (76020) via a plurality of tearable links (76044).

[0103] Example 10 - An appendage according to Examples 1, 2, 3, 4, 5, 6, 7, 8 or 9, wherein the appendage further comprises an adhesive material (75000) on a proximal portion of the appendage, the adhesive material extending proximally beyond a distal-most portion of a tissue stop formed on the anvil.

[0104] Example 11 - An appendage according to Example 1 or 2, wherein the continuously textured device contact surface (70074', 70082') is configured to establish a friction interface with a platform surface (70028) of a surgical stapler cartridge (70020) of the surgical stapler.

[0105] Example 12 - An appendage according to Example 11, wherein the continuously textured device contact surface (70082') includes a plurality of concave contoured feature structures (70086), wherein each concave contoured feature structure corresponds to a pit extension (70029) protruding from the platform surface (70028) of the surgical nail magazine (70020).

[0106] Example 13 - The appendage of Example 11 or 12 further comprising at least one cartridge retaining feature (74304) configured to releasably engage a corresponding appendage retainer on the anvil.

[0107] Example 14 - An appendage according to Example 13, wherein the at least one magazine retaining attachment feature structure includes an opening through the proximal end of the appendage, and the opening is configured to receive a corresponding one of the appendage retainers on the anvil when the anvil is in a closed position.

[0108] Example 15 - An appendage according to Example 11, 12, 13 or 14, wherein the appendage also includes an adhesive material (75000) on a proximal portion of the appendage, wherein the adhesive material extends proximally beyond the distal-most portion of the tissue stop formed on the anvil.

[0109] Example 16 - An appendage for use with a surgical stapler. The appendage comprises: a first layer comprising a first material; a second film layer attached to the first layer and defining a continuously textured device contact surface, the continuously textured device contact surface being configured to establish a friction interface with a corresponding portion of the surgical stapler. The second film layer comprises a second material different from the first material. The appendage comprises a third film layer attached to the first layer and defining a tissue contact surface.

[0110] Embodiment 17 - An appendage according to Embodiment 16, wherein the continuous texturing device contact surface is planar.

[0111] Example 18 - An appendage according to Example 16 or 17, wherein the continuously textured device contact surface is configured to establish a friction interface with the staple forming lower surface of the anvil of the surgical stapler.

[0112] Embodiment 19 - An appendage according to Embodiment 18, wherein the continuously textured device contact surface includes a plurality of contoured features, wherein each contoured feature corresponds to a staple forming recess in the staple forming lower surface of the anvil.

[0113] Example 20 - The appendage of Example 16, 17, 18 or 19 further comprising at least one anvil attachment feature structure configured to releasably engage a corresponding appendage retainer on the anvil.

[0114] Example 21 - An appendage according to Example 20, wherein the at least one anvil attachment feature structure includes an opening through a proximal end of the appendage, and the opening is configured to receive a corresponding one of the appendage retainers on the anvil.

[0115] Example 22 - An appendage according to Example 20, wherein the at least one anvil attachment feature structure includes a hook on the proximal end of the appendage, and the hook is configured to hook-engage a corresponding appendage retainer on the proximal end of the anvil.

[0116] Example 23 - An accessory according to Example 22, wherein the hook includes: a first hook, which is configured to be able to hook-engage a first hook portion on the proximal end of the anvil; a second hook, which is configured to be able to hook-engage a second hook portion on the proximal end of the anvil; and a severable attachment ring, which is connected to the first hook and the second hook and extends between the first ring and the second ring, wherein the severable attachment ring is configured to be able to be cut by the knife of the surgical stapler and separated from the accessory.

[0117] Example 24 - An appendage as described in Example 23, wherein the severable attachment ring is removably attached to the proximal end of the appendage by a plurality of tearable links.

[0118] Example 25 - An appendage according to Examples 16, 17, 18, 19, 20, 21, 22, 23 or 24, wherein the appendage further comprises an adhesive material on a proximal portion of the appendage, wherein the adhesive material extends proximally beyond a distal-most portion of a tissue stop formed on the anvil.

[0119] Example 26 - An appendage according to Examples 16, 17, 18, 19, 20, 21, 22, 23 or 24, wherein the continuously textured device contact surface is configured to establish a friction interface with a platform surface of a surgical stapler of the surgical stapler.

[0120] Example 27 - An appendage according to Example 26, wherein the continuously textured device contact surface includes a plurality of concave contoured features, wherein each concave contoured feature corresponds to a pit extension protruding from the deck surface of the surgical staple cartridge.

[0121] Example 28 - The appendage of Example 26 further comprising at least one cartridge retaining feature structure configured to releasably engage a corresponding appendage retainer on the anvil.

[0122] Example 29 - An appendage according to Example 28, wherein the at least one magazine retaining attachment feature structure includes an opening through the proximal end of the appendage, and the opening is configured to receive a corresponding appendage retainer in the appendage retainer on the anvil when the anvil is in a closed position.

[0123] Embodiment 30 - A surgical stapler end effector. The surgical stapler end effector comprises a first jaw, an anvil movably supported relative to the first jaw, wherein the anvil comprises a proximal end portion, a distal end portion, and a staple forming lower surface extending from the proximal end portion to the distal end portion. The surgical stapler end effector comprises an appendage, the appendage being removably connected to the anvil adjacent to the staple forming lower surface, wherein the appendage comprises an appendage retaining assembly, the appendage retaining assembly comprising at least one hook formed on the proximal end of the appendage and configured to releasably engage a corresponding hook portion of the proximal end of the anvil.

[0124] Example 31 - A surgical stapler end actuator according to Example 30, wherein the appendage retaining assembly comprises: a first ring, the first ring being configured to be capable of hooking into a first hook portion on the proximal end of the anvil; a second ring, the second ring being configured to be capable of hooking into a second hook portion on the proximal end of the anvil; and a severable attachment ring, the severable attachment ring being connected to the first ring and the second ring and extending between the first ring and the second ring, wherein the severable attachment ring is configured to be capable of being cut by a knife of the surgical stapler end actuator and separated from the appendage.

[0125] Example 32 - A surgical stapler end effector according to Example 31, wherein the severable attachment ring is removably attached to the proximal end of the appendage by a plurality of tearable links.

[0126] Example 33 - A surgical stapler end actuator according to Example 30, 31 or 32, wherein the anvil further comprises at least one tissue stop, the tissue stop comprising at least one distal tissue stop edge, and wherein the at least one hook of the appendage retaining assembly is proximal to the at least one distal tissue stop edge.

[0127] Example 34 - A surgical stapler end effector. The surgical stapler end effector includes a first jaw and an anvil, the anvil being movably supported between an open position and a closed position relative to the first jaw. The anvil includes a proximal end portion, a distal end portion, and a lower surface including a staple forming portion. The anvil includes: at least one tissue stop on the proximal end, wherein each tissue stop defines a distal tissue stop edge; and at least one protrusion protruding from a portion of the lower surface proximal to each of the distal tissue stop edges, wherein each protrusion is configured to be able to pin the proximal end of an appendage positioned adjacent to the lower surface between the protrusion and a corresponding portion of the first jaw to prevent the appendage from moving relative to the first jaw when the anvil is in the closed position.

[0128] Example 35 - A surgical stapler end effector according to Example 34, wherein the first jaw comprises: a surgical staple cartridge, the surgical staple cartridge comprising a cartridge proximal end, a cartridge distal end, a cartridge platform surface extending between the cartridge proximal end and the cartridge distal end; a cavity in the cartridge platform surface, the cavity corresponding to each of the at least one protrusion and configured to receive a portion of the corresponding protrusion therein when the anvil is in the closed position. The surgical stapler end effector further comprises an appendage, the appendage comprising an appendage proximal end and an opening therethrough, the opening corresponding to each protrusion of the anvil and configured to receive a corresponding protrusion therethrough when the anvil is in the closed position, and wherein the appendage is positioned on the cartridge platform surface.

[0129] Many of the surgical instrument systems described herein are actuated by electric motors; however, the surgical instrument systems described herein may be actuated in any suitable manner. For example, the surgical instrument systems described herein may be actuated by a manually operated trigger. The motors disclosed herein may include a portion or portions of a robotic control system. In addition, any end effector and / or tool assembly disclosed herein may be used with a robotic surgical instrument system. For example, U.S. patent application serial number 13 / 118,241 (now U.S. Patent No. 9,072,535), entitled "SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS," discloses several examples of robotic surgical instrument systems in more detail.

[0130] The surgical instrument systems described herein have been described in conjunction with the deployment and deformation of staples; however, the present disclosure may not be limited thereto. The present disclosure contemplates that fasteners other than staples, such as clamps or tacks, may be deployed. Furthermore, the present disclosure contemplates utilizing any suitable means for sealing tissue. An end effector according to the present disclosure may include an electrode configured to heat and seal tissue. Additionally, an end effector according to the present disclosure may apply vibration energy to seal tissue.

[0131] The entire disclosures of the following patents are hereby incorporated herein by reference:

[0132] - U.S. Patent No. 5,403,312, issued on April 4, 1995, entitled "ELECTROSURGICALHEMOSTATIC DEVICE";

[0133] - U.S. Patent 7,000,818, issued on February 21, 2006, entitled "SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS";

[0134] - U.S. Patent 7,422,139, issued on September 9, 2008, entitled "MOTOR-DRIVEN SURGICALCUTTING AND FASTENING INSTRUMENT WITH TACTILEPOSITION FEEDBACK";

[0135] - U.S. Patent 7,464,849, issued on December 16, 2008, entitled "ELECTRO-MECHANICAL SURGICAL INSTRUMENT WITH CLOSURE SYSTEM AND ANVIL ALIGNMENT COMPONENTS";

[0136] - U.S. Patent 7,670,334, issued on March 2, 2010, entitled “SURGICAL INSTRUMENT HAVING AN ARTICULATING END EFFECTOR”;

[0137] - U.S. Patent 7,753,245, entitled “SURGICAL STAPLING INSTRUMENTS,” issued on July 13, 2010;

[0138] - U.S. Patent 8,393,514, issued on March 12, 2013, entitled "SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE";

[0139] - U.S. Patent Application Serial No. 11 / 343,803, entitled “SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES,” now U.S. Patent No. 7,845,537;

[0140] - U.S. Patent Application Serial No. 12 / 031,573, filed February 14, 2008, entitled “SURGICAL CUTTING AND FASTENING INSTRUMENT HAVING RF ELECTRODES”;

[0141] - U.S. Patent Application Serial No. 12 / 031,873, filed on February 15, 2008, entitled “END EFFECTORS FOR ASURGICAL CUTTING AND STAPLING INSTRUMENT,” now U.S. Patent No. 7,980,443;

[0142] - U.S. Patent Application Serial No. 12 / 235,782, entitled “MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT,” now U.S. Patent No. 8,210,411;

[0143] - U.S. Patent Application Serial No. 12 / 235,972, entitled “MOTORIZED SURGICAL INSTRUMENT,” now U.S. Patent No. 9,050,083.

[0144] - U.S. Patent Application Serial No. 12 / 249,117, entitled “POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLY RETRACTABLE FIRING SYSTEM,” now U.S. Patent No. 8,608,045;

[0145] - U.S. Patent Application Serial No. 12 / 647,100, filed December 24, 2009, entitled "MOTOR-DRIVENSURGICAL CUTTING INSTRUMENTWITH ELECTRICACTUATOR DIRECTIONAL CONTROL ASSEMBLY," now U.S. Patent No. 8,220,688;

[0146] - The US entry "STAPLE CARTRIDGE" submitted on September 29, 2012

[0147] US patent application serial number 12 / 893,461, now US patent 8,733,613;

[0148] - U.S. Patent Application Serial No. 13 / 036,647, filed on February 28, 2011, entitled “SURGICAL STAPLING INSTRUMENT,” now U.S. Patent No. 8,561,870;

[0149] - U.S. Patent Application Serial No. 13 / 118,241, entitled “SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENTARRANGEMENTS,” now U.S. Patent No. 9,072,535;

[0150] - U.S. Patent Application Serial No. 13 / 524,049, filed on June 15, 2012, entitled “ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE,” now U.S. Patent No. 9,101,358;

[0151] - U.S. Patent Application Serial No. 13 / 800,025, filed on March 13, 2013, entitled "STAPLE CARTRIDGETISSUE THICKNESS SENSOR SYSTEM," now U.S. Patent No. 9,345,481;

[0152] U.S. Patent Application Serial No. 13 / 800,067, filed on March 13, 2013, and entitled “STAPLE CARTRIDGETISSUE THICKNESS SENSOR SYSTEM,” now U.S. Patent Application Publication No. 2014 / 0263552;

[0153] - U.S. Patent Application Publication No. 2007 / 0175955, filed January 31, 2006, entitled "SURGICAL CUTTING AND FASTENING INSTRUMENTWITH CLOSURE TRIGGERLOCKING MECHANISM"; and

[0154] - U.S. Patent Application Publication No. 2010 / 0264194, filed on April 22, 2010, entitled "SURGICAL STAPLING INSTRUMENT WITH ANARTICULATABLE END EFFECTOR," now U.S. Patent No. 8,308,040.

[0155] Although various devices have been described herein in conjunction with certain embodiments, many modifications and variations of these embodiments may also be implemented. In one or more embodiments, specific features, structures, or characteristics may be combined in any suitable manner. Therefore, without limitation, specific features, structures, or characteristics shown or described in conjunction with one embodiment may be combined in whole or in part with features, structures, or characteristics of one or more other embodiments. In addition, where materials for certain components are disclosed, other materials may also be used. In addition, according to various embodiments, a single component may be replaced with multiple components, and multiple components may also be replaced with a single component to perform a given one or more functions. The above-described specific embodiments and the following claims are intended to cover all such modifications and variations.

[0156] The device disclosed herein can be designed to be discarded after a single use, or it can be designed to be used multiple times. However, in either case, the device can be used again after being conditioned after at least one use. Conditioning may include any combination of the following steps, including but not limited to disassembling the device, cleaning or replacing specific parts of the device, and then reassembling the device. Specifically, the conditioning facility and / or surgical team can disassemble the device, and after cleaning and / or replacing specific parts of the device, the device can be reassembled for subsequent use. Those skilled in the art will understand that conditioning the device can utilize various techniques for disassembly, cleaning / replacement, and reassembly. The use of such techniques and the resulting repair device are within the scope of this application.

[0157] The devices disclosed herein can be processed before surgery. First, new or used instruments can be obtained and cleaned as needed. Then, the instruments can be sterilized. In one sterilization technique, the instrument is placed in a closed and sealed container (such as a plastic or TYVEK bag). The container and the instrument can then be placed in a radiation field that can penetrate the container, such as gamma radiation, X-rays and / or high-energy electrons. Radiation can kill bacteria on the instrument and in the container. The sterilized instrument can then be stored in a sterile container. The sealed container can keep the instrument sterile until the container is opened in a medical facility. The device can also be sterilized using any other technology known in the art, including but not limited to beta radiation, gamma radiation, ethylene oxide, plasma peroxide and / or steam.

[0158] It is noted that any reference signs included in the appended claims are used to reference exemplary embodiments / elements described in the present disclosure. Therefore, any such reference signs are not meant to limit the scope of the subject matter recited in the appended claims.

[0159] While the present invention has been described as having an exemplary design, the present invention can be further modified within the spirit and scope of this disclosure. Therefore, this application is intended to cover any variations, uses or adaptations of the invention using its general principles.

Claims

1. An accessory (70050', 71050, 71050', 72050, 74300, 76020) for use with a surgical stapler (70000), wherein: The appendages include: a first layer (70060), the first layer comprising a first material (70062); a second film layer (70070') attached to the first layer and defining a continuously textured device contacting surface (70074', 70078) configured to establish a friction interface with a corresponding portion of the surgical stapler, wherein the second film layer comprises a second material (70072) different from the first material; and A third film layer (70080) is attached to the first layer and defines a tissue contacting surface (70082).

2. The appendage (70050') according to claim 1, wherein: The continuous texturing device contact surface (70074') is planar.

3. The appendage (70050', 71050') according to claim 1 or 2, wherein: The continuously textured device contacting surfaces (70074', 70078) are configured to establish a friction interface with the staple forming lower surface (70032) of the anvil (70030) of the surgical stapler.

4. The appendage (71050') according to claim 3, wherein: The continuously textured device contact surface (70078) comprises a plurality of contoured features (70076), wherein each contoured feature corresponds to a staple forming recess (70034) in the staple forming lower surface (70032) of the anvil (70030).

5. The appendage (74300, 76020) of claim 1, further comprising at least one anvil attachment feature (74222, 76040) configured to releasably engage a corresponding appendage retainer (74230, 76016) on an anvil (74210, 76400).

6. The appendage (74300) of claim 5, wherein: The at least one anvil attachment feature structure (74222) includes an opening through the proximal end of the appendage (74300), and the opening is configured to receive a corresponding one of the appendage retainers (74230) on the anvil (74210).

7. The appendage (76020) according to claim 5, wherein: The at least one anvil attachment feature structure (76040) includes a hook (76042) on the proximal end (76022) of the appendage (76020), and the hook is configured to hook-engage a corresponding appendage retainer (76016) on the proximal end (76004) of the anvil (76000).

8. The appendage (76020) of claim 7, wherein: The hook (76042) comprises: a first ring (76048) configured to hook-engage a first hook portion (76016) on the proximal end (76004) of the anvil (76000); a second ring (76048) configured to hook-engage a second hook portion (76016) on the proximal end (76004) of the anvil (76000); A severable attachment ring (76042) is connected to the first ring (76048) and the second ring (76048) and extends between the first ring and the second ring, wherein the severable attachment ring (76042) is configured to be severed by the knife (76410) of the surgical stapler and separated from the appendage (76020).

9. The appendage (76020) of claim 8, wherein: The severable attachment ring (76042) is removably attached to the proximal end (70624) of the appendage (76020) via a plurality of tearable links (76044).

10. The appendage of claims 1, 2, 3, 4, 5, 6, 7, 8 or 9, further comprising an adhesive material (75000) on a proximal portion of the appendage, the adhesive material extending proximally beyond a distal-most portion of a tissue stop formed on the anvil.

11. The appendage according to claim 1 or 2, wherein: The continuously textured device contact surface (70074', 70082') is configured to establish a friction interface with a platform surface (70028) of a surgical stapler cartridge (70020) of the surgical stapler.

12. The appendage according to claim 11, wherein: The continuously textured device contacting surface (70082') comprises a plurality of concavely contoured features (70086), wherein each concavely contoured feature corresponds to a dimple extension (70029) protruding from the deck surface (70028) of the surgical staple cartridge (70020).

13. The appendage of claim 11 or 12, further comprising at least one cartridge retaining feature (74304) configured to releasably engage a corresponding appendage retainer on the anvil.

14. The appendage according to claim 13, wherein: The at least one cartridge retaining attachment feature includes an aperture through a proximal end of the appendage, the aperture being configured to receive a corresponding one of the appendage retainers on the anvil when the anvil is in a closed position.

15. The appendage of claim 11, 12, 13 or 14, further comprising an adhesive material (75000) on a proximal portion of the appendage, the adhesive material extending proximally beyond a distal-most portion of a tissue stop formed on the anvil.

Images