Attachment for use with surgical stapling instrument

Abstract

An adjunct for use with a surgical stapling system is disclosed. The adjunct includes a first region. The first region includes a first composition. The adjunct includes a second region. The second region is distal to the first region and comprises a second composition. The adjunct includes a third region. The third region is distal to the second region. The third region comprises a third composition. The second composition is different from the first composition and the third composition.

Description

Background Art

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

[0002] Typically, when using surgical stapling and cutting instruments, it is advantageous to use an appendage in conjunction with a staple cartridge, an anvil, or both to provide support for tissue around the cut line. However, if an appendage is used while firing multiple staple cartridges sequentially along a single tissue cut line, various problems may arise. For example, during the first firing motion in more than one firing motion, during the deployment of a first appendage associated with a first staple cartridge, the first appendage and the staples from the first staple cartridge provide sufficient reinforcement along the tissue cut line at a particular location. As the staples are released from a second staple cartridge including a second appendage immediately after the first firing motion, typically, the second appendage overlaps the first appendage. The overlap of the second appendage with the first appendage provides an increased level of reinforcement along the tissue cut line at a given location.

[0003] During the suturing of the second appendage, this increased level of reinforcement can cause the knife of the suturing instrument to drive the second appendage distally, which is sometimes referred to as plowing. When the knife drives the second appendage distally, the nails being fired from the second nail magazine may deform during forming. Therefore, the fired nails are not formed correctly, which may cause bleeding and other complications during the suturing and cutting process. The present disclosure provides improvements and modifications that minimize the deformation of the nails during deployment and improve efficiency and ease of use when cutting overlapping appendages. Summary of the invention

[0004] The present invention discloses an appendage for use with a surgical suturing system. The appendage includes a first region. The first region includes a first composition. The appendage includes a second region. The second region is distal to the first region and includes a second composition. The appendage includes a third region. The third region is distal to the second region. The third region includes a third composition. The second composition is different from the first composition and the third composition.

[0005] The present invention discloses an appendage for use with a surgical suturing system. The appendage includes an elongated body including a proximal end, a distal end, and two lateral sides extending between the proximal end and the distal end. The elongated body also includes a first material extending longitudinally through a central portion of the elongated body between the proximal end and the distal end. The first material includes a first composition. The elongated body also includes a section of a second material extending longitudinally from the proximal end to the distal end between the first material and one of the lateral sides. The second material includes a second composition different from the first composition. The elongated body also includes another section of a second material extending longitudinally from the proximal end to the distal end between the first material and the other of the lateral sides.

[0006] The present invention discloses a surgical suturing system. The surgical suturing system includes a nail magazine. The nail magazine includes a magazine body defining a proximal end and a distal end and an elongated slot extending from the proximal end toward the distal end, wherein the elongated slot defines a slot axis. The nail magazine also includes a plurality of first nail cavities, which are arranged into three rows of first nail cavities on each side of the elongated slot. Each row of first nail cavities is aligned on a corresponding first cavity axis parallel to the slot axis. Each row of first nail cavities extends from the proximal end of the magazine body to a position proximal to the distal end of the magazine body. Each first nail cavity stores a corresponding first nail therein removably. The nail magazine also includes a plurality of second nail cavities, which are formed on each side of the elongated slot in the distal portion of the magazine body, between a position proximal to the distal end and the distal end. Each second nail cavity is oriented on a second cavity axis arranged at an angle relative to the slot axis. Each second nail cavity stores a corresponding second nail therein removably. 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 partial perspective view of a surgical stapling system including an end effector;

[0009] Figure 2 yes Figure 1 An exploded perspective view of an end effector;

[0010] Figure 3 is a perspective view of the appendage supported on a platform of a nail magazine;

[0011] Figure 4 is a perspective view of an appendage supported by a staple-forming lower surface adjacent to an anvil of a surgical stapler;

[0012] Figure 5 is a top view of a staple cartridge for use with a surgical instrument according to the present disclosure;

[0013] Figure 5A The second nail cavity is relative to Figure 5 A schematic diagram of a portion of a longitudinal slot of a staple cartridge;

[0014] Figure 6 is corresponding to Figure 5 A top view of a slide, a staple driver, and staples of a second staple chamber of a staple cartridge;

[0015] Figure 7 yes Figure 6 A perspective view of a slide, a staple driver, and a staple;

[0016] Figure 8 is a perspective view of the reinforced nail line during subsequent nail firing;

[0017] Fig. 9 is a top view of an appendage for use with a staple cartridge and / or anvil according to the present disclosure;

[0018] Fig.10 yes Fig. 9 A cross-sectional side view of an appendage;

[0019] Fig.11 is a cross-sectional side of an appendage according to the present disclosure;

[0020] Fig.12 is a top view of another appendage for use with a staple cartridge and / or anvil in accordance with the present disclosure;

[0021] Fig.13 yes Fig.12 A cross-sectional side view of an appendage;

[0022] Fig.14 is a cross-sectional side view of an appendage according to the present disclosure;

[0023] Fig.15 is a top view of an appendage for use with a staple cartridge and / or anvil according to the disclosure;

[0024] Fig.16 is another top view of the appendage of FIG. K15 relative to the tissue stop of the surgical staple anvil;

[0025] Fig.17 is a top view of another appendage for use with a staple cartridge and / or anvil according to the present disclosure, wherein staple pockets of the staple cartridge are shown in phantom for reference;

[0026] Fig.18 is a top view of another appendage for use with a staple cartridge and / or anvil in accordance with the present disclosure, showing some formed staples from the staple cartridge for reference;

[0027] Fig.19is a top view of another appendage for use with a staple cartridge and / or anvil in accordance with the present disclosure;

[0028] Fig. 20 is a top view of another appendage for use with a staple cartridge and / or anvil in accordance with the present disclosure;

[0029] Fig.21 is a top view of another appendage for use with a staple cartridge and / or anvil in accordance with the present disclosure;

[0030] Fig. 22 is a schematic diagram of a control system according to the present disclosure; and

[0031] Fig.23 is configured according to the present disclosure Fig. 22 An algorithm used in conjunction with a control system.

[0032] Corresponding reference characters indicate corresponding parts throughout the several views. DETAILED DESCRIPTION

[0033] 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:

[0034] U.S. Patent Application Titled “METHOD OF OPERATING A SURGICAL STAPLING INSTRUMENT”; Attorney Docket No. END9484USNP2 / 220491-2M;

[0035] U.S. Patent Application Titled “SURGICAL STAPLING SYSTEMS WITH ADAPTIVESTAPLE FIRING ALGORITHMS”; Attorney Docket No. END9484USNP3 / 220491-3;

[0036] U.S. Patent Application Titled “LEARNED TRIGGERS FOR ADAPTIVE CONTROL OF SURGICAL STAPLING SYSTEMS”; Attorney Docket No. END9484USNP4 / 220491-4;

[0037] U.S. Patent Application Titled “CONTROL CIRCUIT FOR ACTUATING MOTORIZED FUNCTION OF SURGICALSTAPLING INSTRUMENT UTILIZINGINERTIAL DRIVE TRAIN PROPERTIES”; Attorney Docket No. END9484USNP5 / 220491-5;

[0038] U.S. Patent Application Titled “PROPORTIONATE BALANCING OF THE FUNCTION IMPACT MAGNITUDE OF BATTERY OUTPUT TO PEAKMOTOR CURRENT”; Attorney Docket No. END9484USNP6 / 220491-6;

[0039] U.S. Patent Application Titled “MOTOR OPTIMIZATION BY MINIMIZATION OF PARASITIC LOSSES AND TUNING MOTOR DRIVE CONFIGURATION”; Attorney Docket No. END9484USNP7 / 220491-7;

[0040] 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;

[0041] U.S. Patent Application Titled “SURGICAL TOOL WITH RELAXED FLEX CIRCUITARTICULATION”; Attorney Docket No. END9484USNP9 / 220491-9;

[0042] U.S. Patent Application Titled “WIRING HARNESS FOR SMART STAPLER WITH MULTI AXIS ISARTICULATION”; Attorney Docket No. END9484USNP10 / 220491-10;

[0043] U.S. Patent Application Titled “SURGICAL SYSTEM WITH WIRELESS ARRAY FOR POWER AND DATATRANSFER”; Attorney Docket No. END9484USNP11 / 220491-11; and

[0044] U.S. Patent Application Titled “SURGICAL STAPLE CARTRIDGE COMPRISING REPLACEABLE ELECTRONICS PACKAGE”; Attorney Docket No. END9484USNP12 / 220491-12.

[0045] 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:

[0046] U.S. Patent Application Titled “METHOD OF ASSEMBLING A STAPLE CARTRIDGE”; Attorney Docket No. END9484USNP13 / 220491-13M;

[0047] U.S. Patent Application Titled “CONTROL SURFACES ON A STAPLE DRIVER OF ASURGICAL STAPLE CARTRIDGE”; Attorney Docket No. END9484USNP14 / 220491-14;

[0048] U.S. Patent Application Titled “INTEGRAL CARTRIDGE STIFFENING FEATURES TOREDUCE CARTRIDGE DEFLECTION”; Attorney Docket No. END9484USNP15 / 220491-15;

[0049] U.S. Patent Application Titled “STAPLE CARTRIDGE COMPRISING WALLSTRUCTURES TO REDUCE CARTRIDGE DEFLECTION”; Attorney Docket No. END9484USNP16 / 220491-16;

[0050] 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;

[0051] U.S. Patent Application Titled “STAPLE CARTRIDGE COMPRISING A SLED HAVING A DRIVER LIFT CAM”; Attorney Docket No. END9484USNP18 / 220491-18;

[0052] 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;

[0053] U.S. Patent Application Titled “STAPLE CARTRIDGE COMPRISING A COMPOSITESLED”; Attorney Docket No. END9484USNP20 / 220491-20;

[0054] 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;

[0055] U.S. Patent Application Titled “SURGICAL INSTRUMENTS WITH LATERALLY ENGAGEABLE LOCKING ARRANGEMENTS FOR LOCKING AFIRING ACTUATOR”; Attorney Docket No. END9484USNP22 / 220491-22;

[0056] U.S. Patent Application Titled “DUAL INDEPENDENT KEYED LOCKING MEMBERSACTING ON THE SAMEDRIVE MEMBER”; Attorney Docket No. END9484USNP23 / 220491-23;

[0057] U.S. Patent Application Titled “ADJUNCTS FOR USE WITH SURGICAL STAPLING INSTRUMENTS”; Attorney Docket No. END9484USNP25 / 220491-25;

[0058] U.S. Patent Application Titled “JAW CONTROL SURFACES ON A SURGICALINSTRUMENT JAW”; Attorney Docket No. END9484USNP26 / 220491-26;

[0059] U.S. Patent Application Titled “ZONED ALGORITHM ADAPTIVE CHANGES BASED ON CORRELATION OF COOPERATIVE COMPRESSION CONTRIBUTIONS OF TISSUE”; Attorney Docket No. END9484USNP27 / 220491-27;

[0060] U.S. Patent Application Titled “STAPLE CARTRIDGES COMPRISING TRACERETENTION FEATURES”; Attorney Docket No. END9484USNP29 / 220491-29; and

[0061] U.S. Patent Application Titled “STAPLE CARTRIDGES COMPRISING STAPLERETENTION FEATURES”; Attorney Docket No. END9484USNP30 / 220491-30.

[0062] 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 ACARTRIDGE 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”.

[0063] 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.

[0064] 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.

[0065] 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.

[0066] 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.

[0067] 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.

[0068] 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.

[0069] 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.

[0070] See also Figure 1 , a surgical stapling system 60000 is shown. The surgical stapling system 60000 includes a shaft 60002 and an end effector 60004 extending from the shaft 60002. The end effector 60004 includes a first jaw 60006 and a second jaw 60008. The first jaw 60006 includes an elongated channel 61007 and a staple cartridge 60020. The staple cartridge is configured to be replaceable during a surgical procedure. Alternatively, the staple cartridge 60020 may not be removable from the first jaw 60006 or at least not easily replaceable from the first jaw.

[0071] The second jaw 60008 includes an anvil configured to deform the nails ejected from the nail magazine 60020. The second jaw 60008 can pivot or otherwise move between an open position and a closed position relative to the first jaw 60006 around the closed axis CA. The surgical stapling system 60000 also includes an articulation joint 60013, which is configured to allow the end effector 60004 to rotate or articulate relative to the shaft 60002. The end effector 60004 can rotate around the articulation axis extending through the articulation joint. Alternatively, the surgical stapling system 60000 may not include an articulation joint.

[0072] The staple cartridge 60020 includes a cartridge body 60022. The cartridge body includes a proximal end 60024, a distal end 60026, and a platform 60028 extending between the proximal end and the distal end. In use, the staple cartridge 60020 is positioned on a first side of a tissue to be sutured and the anvil 60008 is positioned on a second side of the tissue. The anvil 60008 moves toward the staple cartridge 60020 to compress and clamp the tissue against the platform 60028. Then, a plurality of staples 60034 removably stored in the cartridge body 60022 are deployed into the tissue. The staples 60034 are removably stored in corresponding staple cavities 60030 formed in the cartridge body 60022. The staple cavities 60030 are arranged in six longitudinal rows. Three rows of staple cavities 60030 are positioned on a first side of the longitudinal slot 60032 and three rows of staple cavities 60030 are positioned on a second side of the longitudinal slot 60032. Other arrangements of staple cavities and staples are possible.

[0073] The nail 60034 is supported by a nail driver 60036 supported in the cartridge body 60030. The nail supported on the nail driver can be seen in U.S. Patent No. 9,844,369 entitled "SURGICAL END EFFECTORS WITH FIRING ELEMENT MONITORING ARRANGEMENTS", the entire disclosure of which is incorporated herein by reference. The driver 60036 is movable between a first position or non-firing position and a second position or firing position to eject the nail 60034 from the nail cartridge 60030. The driver 60036 is retained in the cartridge body by a retainer 60023, which extends around the bottom of the cartridge body 60022 and includes a resilient member configured to grip the cartridge body and retain the retainer to the cartridge body. The driver 60036 is movable between its non-firing position and its firing position by a slide 60038. The slide 60038 is movable between a proximal position adjacent to the proximal end 60024 of the cartridge body 60022 and a distal position adjacent to the distal end 60026 of the cartridge body 60022. The slide 60038 includes a plurality of ramp surfaces configured to slide beneath and lift the driver 60036 toward the anvil 60008, with the staples 60034 supported thereon.

[0074] In addition to the above, the slider 60038 is also moved distally by the firing actuator or firing member 60040. The firing actuator 60040 is configured to contact the slider 60038 and push the slider 60038 toward the distal end 60026. The longitudinal slot 60032 defined in the cartridge body 60022 is configured to receive the firing actuator 60040. The anvil 60008 also includes a slot 60009 configured to receive the firing actuator 60040. The firing actuator 60040 also includes a knife 60046 that is configured to cut into tissue captured between the staple cartridge 60020 and the anvil 60008.

[0075] The support, tissue thickness compensator and / or appendage (collectively referred to herein as "appendage") 60050 is generally used to strengthen the staple line and provide support for the tissue around the staple line. For example, the appendage 60050 can be supported on the magazine platform 60028. The appendage can be referred to herein as, for example, a "replaceable staple assembly" when used in conjunction with a replaceable staple cartridge. In use, the end effector is positioned to facilitate capturing the tissue to be sutured between the appendage material and the underside of the anvil or magazine platform. Once the end effector is properly positioned, the anvil is closed. The suturing instrument is then fired, causing the firing actuator to move distally through the end effector. As the firing actuator moves distally, the firing actuator drives the slide or other cam arrangement to contact the driver in the staple cartridge, and the staple cartridge supports the staple thereon. As the slide contacts the driver, the driver is driven toward the closed anvil, thereby driving the staple through the appendage material and the clamped target tissue to form contact with the underside of the anvil. The rear knife on the firing actuator cuts through the sutured accessory materials and tissue until the firing actuator reaches the distal end of the staple cartridge and all the staples stored therein have been fired. The anvil of the end effector is then opened and the sutured tissue is released from the end effector. The accessory materials remain in the sutured tissue and are eventually absorbed by the patient's body.

[0076] As described above, when a surgical procedure involves a long tissue cutting line requiring the use of multiple staple cartridges and corresponding multiple appendages, subsequent appendages overlap previously installed appendages to form a continuous line of appendage material on each side of the cut tissue over the entire length of the tissue cutting line. When the knife of the firing actuator contacts the overlapping conventional appendages, the resistance created by the overlapping material may cause the appendages to bunch, move or skew undesirably, which may cause the staples to misalign with the forming pockets in the anvil during firing, and may also cause previously formed staples to be cut through or otherwise damaged by the knife.

[0077] Figure 5A staple cartridge 62000 configured to address the above-described issues is shown. The staple cartridge 62000 is configured to be seated in a first jaw and removable from the first jaw as described above; however, the staple cartridge may not be removable from the first jaw or at least not easily replaceable from the first jaw. The staple cartridge 62000 includes a cartridge body 62001 and a nose 62008. The cartridge body 62001 includes a proximal end portion 62002, a distal end portion 62004, and a cartridge platform 62005 extending between the proximal end portion 62002 and the distal end portion 62004. The cartridge body 62001 also includes a longitudinal slot 62006 extending from the proximal end portion 62002 through the cartridge body 62001 to the distal end portion 62004. The cartridge body 62001 includes a plurality of first staple cavities 62010 and a plurality of second staple cavities 62012. Each nail cavity 62010, 62012 movably supports a corresponding nail driver therein. The corresponding nail can be removably stored on the driver and is configured to be ejected from the nail cavity 62010, 62012 by the driver during the firing stroke of the firing actuator.

[0078] As in Figure 5 As can be seen in the figure, the first nail cavities 62010 are arranged in six longitudinal rows extending from a position in the proximal end portion 62002 of the platform surface 62005 and extending distally to the distal end portion 62106 of the platform surface 62005. Three rows of first nail cavities 62010 are positioned on a first side of the longitudinal slot 62006 and three rows of first nail cavities 62010 are positioned on a second side of the longitudinal slot 62006. As shown in FIG. Figure 5 62006. As can be seen in the drawings, each first staple cavity 62010 is parallel or substantially parallel to the slot 62006. The first staple cavities 62010 in the second row 62015 are staggered relative to the first staple cavities 62010 in the first row 62013 of the first staple cavities 62010 that are adjacent to the slot 62006. The first staple cavities 62010 in the third row 62017 are staggered relative to the first staple cavities 62010 in the second row 62015. Such an arrangement creates overlapping staple lines.

[0079] Still see Figure 5 , the second nail cavity 62012 is opened through the distal portion 62016 of the platform surface 62005. Figure 5 As shown, the second nail cavities 62012 are arranged in a different pattern than the first nail cavities 62010. The first nail cavities 62010 are positioned substantially parallel to the longitudinal slots 62006, while the second nail cavities 62012 are positioned at an angle relative to the longitudinal slots 62006. The nail cavities 62012 can be positioned at an angle less than 90° relative to the longitudinal slots 62006. For example, as shown in FIG. Figure 5AAs shown, the longitudinal slot 62006 can define a slot axis SA, and each second cavity 62012 can define a second cavity axis SPA. The second nail cavities 62012 can be arranged in a row of two second nail cavities 62012, wherein each row is positioned so that the angle SCA between the slot axis SA and the second cavity axis SPA can be between 90° and 20°. This inclination of the second cavity 62012 relative to the longitudinal slot 62006 provides only two second nail cavities 62012 in each row of second nail cavities. In the illustrated arrangement, four lines 62018A, 62018B, 62018C, and 62018D are employed on each side of the longitudinal slot 62006. Other rows of second cavities 62012 are envisioned.

[0080] See also Figure 6 and Figure 7 , a pair of angled nail drivers 60037 are shown for supporting nails 60035 thereon in the second nail cavities 62012. As can be seen in these figures, the nails 60035 are supported at an angle SCA relative to the slot axis SA. As the slide 60038 is driven distally during the firing stroke, the nail drivers 60037 are driven upward in their respective second nail cavities 62012.

[0081] The staple cartridge 62000 is different from other staple cartridges that may employ a full row of staple cavities and staples that are angled offset relative to the longitudinal slot axis SA. The staple cartridge 62000 maintains the advantages provided by the three rows of parallel staples on each side of the longitudinal slot, but also obtains the improved advantages provided by the several rows of second staple cavities and staples that are angled offset relative to the longitudinal slot and the travel axis of the firing actuator. As described above, when multiple sequential firings are completed, it occurs that the appendages of the second firing stroke overlap with the appendages of the first firing stroke. Therefore, the overlap of the appendages creates a certain thickness, making cutting more difficult. This increased cutting resistance may cause the second appendages to bunch and skew, which may cause the knife to turn through some of the formed staples that secure the distal end of the first appendage material to the tissue. The angled pattern of staples 60035 provides some relief by providing a turning path for the knife during subsequent firings. For example, the angled pattern of staples 60035 allows the knife to more easily pass through the enhanced staple line during subsequent firings. The subsequently fired knife can impact the angled staple 60035 at a shallow angle, which increases the likelihood that the knife will rebound from and pass through the angled staple 60035 during the firing stroke rather than getting stuck and distorting the shape and formation of the angled staple 60035. In this way, the position of the staple cavities 62012 and staples 60035 reduces the likelihood that the force of the knife passing through the previously fired staple line will apply damaging forces to the staples 60035 within the previously fired staple line. Additionally, by providing the staples 60035 at an angle to the direction of travel of the firing actuator, the staples 60035 can provide increased resistance to the movement of the second accessory material as the knife of the firing actuator initially contacts the second accessory material to cut and drive therethrough.

[0082] Figure 8The staple cartridge 62000 is shown to sequentially cut through tissue "T" when a pair of first appendages 60050F and a pair of second appendages 60050S are used. The first appendages 60050F are sutured on both sides of the tissue T using the first staple cartridge 62000 in the manner described herein. In this way, one first appendage 60050F is positioned on the cartridge platform and the other first appendage 60050F is placed adjacent to the underside of the anvil. The target tissue "T" is then positioned between the first appendages 60050F, and then the anvil is closed and the firing actuator is fired. Once the first staple cartridge 62000 is fully fired and exhausted, it is removed from the end effector and replaced with another new staple cartridge 62000 and a pair of second appendages 60050S. The end effector is then positioned so that the proximal end portion 60051 of the second appendage 60050S overlaps the distal end portion 60053 of the first appendage 60050F. The distal end portion 60053 of the first appendage 60050F is sutured with the staples 60035 supported in the angled second cavity 62012 in the first staple cartridge 62000. The anvil of the end effector is then closed to capture the uncut tissue between the second appendage 60050S and fire the firing actuator. As the firing actuator moves distally, the firing actuator contacts the four overlapping appendages 60050F, 60050S, which increases the amount of resistance experienced by the knife of the firing actuator. In the event that the appendages become skewed or bunched, the angled orientation of the staples 60035 will increase the likelihood that the knife will rebound from the staples 60035 and thereby pass through but not cut through those previously formed staples. Alternative cartridge arrangements are contemplated in which the second nail cavity 62012 (and the nail 60035 supported thereon) is disposed only in the proximal portion of the cartridge, and in other arrangements, the second nail cavity 62012 (and the nail 60035 supported thereon) is disposed only in the distal portion and the proximal portion. However, these angled cavities do not extend the entire length of the cartridge. The central segment of the cavity includes three rows of nail cavities parallel to each other, and the slot axis can separate the proximal segment of the angled cavity from the distal segment of the angled cavity on both sides of the longitudinal slot.

[0083] The various appendages disclosed herein can be used in combination with the above-mentioned suturing system and other known suturing devices and systems to strengthen the nail line and provide support for the tissue around the nail line. The appendage arrangement discussed below can also solve the problems outlined above by adopting changes in the cross-section, pattern or integrity of the appendage material at the predetermined position, wherein the appendage material is configured to be able to tear or separate advantageously. In this way, the appendage includes one or more predefined and specific weakened portions of the appendage material to prevent the first appendage from affecting the performance of the second appendage during multiple sequential nail firings. Such weakened portions include intermittent openings, and / or interruptions, and / or thinned tearable portions that are configured to tear during multiple sequential nail firings. The tearable portion is configured to enable the appendage to be sheared in a predetermined manner. The tearable portion is also configured to be able to separate a specific nail from the appendage when a drag force occurs. By reducing the strength of certain portions of the appendage, during multiple sequential nail firings, during the second cutting movement of the knife, the nail fixing force or retention force is reduced.

[0084] Go to Fig. 9 and Fig.10 , an appendage 69200 of the present invention includes a first region 69210, a second region 69212, and a third region 69214. The first region 69210 of the appendage 69200 is located at the proximal end 69202 of the appendage 69200. The third region 69214 is located at the distal end 69208 of the appendage 69200. The second region 69212 is located between the first region 69210 and the third region 69214. Fig. 9 As can be seen in the figure, the first area 69210 includes a woven mesh 69211. The second area 69212 includes a woven mesh 69213, and the third area 69214 includes a woven mesh 69215. Although the woven meshes 69211, 69213, 69215 may be formed of the same material (or different materials that are otherwise layered or woven together), the meshes 69211 and 69215 have properties and strength characteristics that are different from the properties of the woven mesh 69213. For example, all of the woven meshes 69211, 69213, and 69215 may include material or other woven materials disclosed herein. However, the material constituting woven meshes 69211 and 69215 may have a knot density, strand diameter, weave, and / or denier that is different from the knot density, strand diameter, weave, and / or denier of woven mesh 69213. The denier and / or number of strands forming woven mesh 69213 may be higher than the denier and / or number of strands forming woven meshes 69211 and 69215. For example, woven mesh 69213 may have strands of 2×28 denier, and woven meshes 69211 and 69215 may have strands of 1×28 denier, but still have the same weave pattern. The weave of mesh materials 69211 and 69215 may be looser than the weave of mesh material 69213. As in Fig.10 , while the compositions of the first region 69210 and the third region 69214 are the same, they are different from the composition of the second region 69212. However, in the illustrated example, the cross-sectional thicknesses of the regions 69210, 69212, and 69214 are the same. Thus, the first region 69210 and the third region 69214 can be further weakened by exposing those portions (but not the second portion 69212) to one or more of moisture, ultraviolet light, and radiation (gamma, X-rays, electron beams, etc.) during manufacturing and prior to use.

[0085] According to the present disclosure, woven mesh 69213 includes greater strength than woven meshes 69211 and 69215. This means that woven meshes 69211 and woven meshes 69215 are easier to cut through and provide less resistance to the knife than woven mesh 69213. In addition, if the accessory material begins to bunch or plow during firing, woven meshes 69211 and 69215 may be more easily disengaged from the nails fired therethrough. Therefore, in applications where the first area 69210 of the second appendage 69200 overlaps the third area 69214 of the first appendage 69200 that was previously pinned, the second appendage 69200 is less likely to plow or bunch when initially contacted by the knife. In addition, with the second appendage 69220 still beginning to bunch or plow, the woven mesh 69215 forming the third region 69214 of the first appendage 69200 is more likely to break away from the staples formed therein, leaving those staples secured to the tissue. Likewise, the woven mesh 69211 forming the first region 69210 in the second appendage 69200 is more likely to break away from any of the staples initially formed therein, leaving those staples secured to the underlying tissue. Thus, various forms of the appendage 69200 are used to address the above-described issues when conventional appendages are used in sequential suturing and cutting applications.

[0086] Fig.11Another appendage 69200' is shown. The appendage 69200' includes a first region 69210', a second region 69212', and a third region 69214'. The first region 69210', the second region 69212', and the third region 69214' may be similar to the first region 69210, the second region 69212, and the third region 69214 described above, respectively. However, as in Fig.11 As can be seen in the appendage 69200', the first region 69210' and the third region 69214' include equal thicknesses 69211' and 69215', respectively, while the second region 69212' includes a thickness 69213' that is different from or greater than the thicknesses 69211' and 69215'. Alternatively, the appendage 69200' may include further weakening of the first region 69210' and the third region 69214' (but not the second region 69212) by exposing these portions to one or more of moisture, ultraviolet light, and radiation (gamma, x-rays, electron beams, etc.) during manufacturing and prior to use. The appendage 69200' is configured to provide similar benefits to the appendage 69200 disclosed above.

[0087] Go to Fig.12 and Fig.13 , discloses another appendage 69300 of the present invention. Fig.13 69300. The appendage 69300 includes a first region 69310, a second region 69312, and a third region 69314. The first region 69310 of the appendage 69300 is located at the proximal end 69302 of the appendage 69300. The third region 69314 is located at the distal end 69308 of the appendage 69300. The second region 69312 is located between the first region 69310 and the third region 69314. Fig.12 As can be seen, the third region 69312 includes a woven mesh 69313, such as a woven The first region 69310 and the second region 69314 include a nonwoven material 69311, which may include any of the nonwoven materials described below. The nonwoven material 69311 is weaker than the woven material 69313 and provides less reinforcement to the nails formed therein. The material 69311 also provides less resistance to the knife as the knife is driven through it, thereby reducing the possibility of plowing and bunching during firing. Therefore, in use, if the appendage 69300 begins to bunch or plow during cutting, the weaker first region 69310 and the weaker third region 69314 will be more likely to break away from the nails formed therein, which can prevent those nails from being pulled out and / or damaged as the firing actuator passes through it. Alternatively, the appendage 69300 may include further weakening of the first region 69310 and the third region 69314 (but not the second region 69312) by exposing these portions to one or more of moisture, ultraviolet light, and radiation (gamma, X-rays, electron beams, etc.) during manufacturing and prior to use.

[0088] Fig.14 An appendage 69300' is shown which is similar in many respects to the appendage 69300 described above. Fig.14 As can be seen in the appendage 69300', the appendage 69300' includes a first region 69310', a second region 69312', and a third region 69314'. The first region 69310' and the third region 69314' include a cross-sectional thickness that is different from the cross-sectional thickness of the second region 69312'. In the illustrated arrangement, the cross-sectional thickness of the second region 69312' is greater than the cross-sectional thickness of the first region 69310' and the cross-sectional thickness of the third region 69314'. The second region 69312' may include a woven mesh 69313', such as a woven Or other woven materials disclosed herein. The first region 69310' and the third region 69314' include nonwoven mesh 69311', such as PDO, ORC, etc. as described below. The nonwoven material 69311' is weaker than the woven material 69313 and provides less reinforcement for the nails formed therein. In the illustrated arrangement, the layer 69317' of the nonwoven material 69313' is laminated on both sides of the woven material 69311'. In this way, the second region 69312' includes two materials 69313' and 69311'. However, the first region 69310' and the third region 69314' are only composed of the laminated layer of the nonwoven material 69311'. The woven material 69313' does not extend into the first region 69310' and the third region 69314'. The appendage 69300' is configured to provide similar benefits as the appendage 69300 disclosed above. Alternatively, the appendage 69300' may include further weakening of the first region 69310' and the third region 69314' (but not the second region 69312') by exposing these portions to one or more of moisture, ultraviolet light, and radiation (gamma, X-ray, electron beam, etc.) during manufacturing and prior to use.

[0089] As described above, the difference in material composition can be achieved by reducing or increasing the knot density of the material, increasing or decreasing the strand diameter, denier of the material, or using different materials in combination with each other. The first material may include, for example, The first material may be exposed to one or more of moisture, ultraviolet light, and radiation (gamma, X-rays, electron beams, etc.) prior to the lamination process. Alternatively, the entire appendage may be exposed to one or more of moisture, ultraviolet light, and radiation (gamma, X-rays, electron beams, etc.) after the lamination process. In either case, the appendage is weakened to enable the knife to pass through the material without causing bunching or plowing, and if such bunching or plowing occurs accidentally during firing, the appendage is enabled to detach from the formed nail.

[0090] Fig.15 Another appendage 69400 is shown comprising a woven material 69410 of various types and compositions disclosed herein. However, the appendage 69400 may be made of any of the other nonwoven materials and compositions described herein. The appendage includes a proximal end 69402 and a distal end 69408. As in Fig.1569400 and extend a distance L1 into the appendage 69400. As described above, when two appendages 69400 are used during a sequential firing motion, the proximal end 69402 of the second appendage 69400 will overlap the distal end 69408 of the first appendage 69400. The slot 69450 provides a unique benefit of allowing a knife to pass through the slot 69450 in the second appendage 69400 where the two appendages 69400 overlap but do not encounter two layers of material, thereby reducing the amount of resistance encountered by the knife in this area that could otherwise cause the second appendage 69400 to move, bunch, or plow. Thus, the length L1 of the slot 69450 can be at least as long as the amount that the second appendage 69400 overlaps the previously sutured appendage to allow the knife to travel through the second appendage 69400 unimpeded in the appendage overlap area. The slot 69450 may be wide enough so that the knife and firing actuator of the surgical stapler can pass through the slot without contacting the accessory material on the side of the slot. In the illustrated arrangement, the slot 69450 extends completely through the thickness of the accessory material 69410 by a distance L1. The slot 69450 may only partially extend through the cross-sectional thickness of the accessory material 69410 by a distance L1. Alternatively, the slot 69450 may include a slit. The slit may extend completely through the cross-sectional thickness of the accessory material 69410 by a distance L1, or it may only partially extend through the cross-sectional thickness of the accessory material 69410 by a distance L1. The slot 69450 is intended to eliminate or reduce the amount of resistance encountered by the knife as it passes through the proximal end of the appendage 69400 (in the appendage overlap region).

[0091] In various surgical procedures, in order to ensure that all tissue clamped between the jaws of the stapling instrument is stapled before being cut by the knife, the anvil of the stapler is usually formed with a "tissue stopper" that prevents the tissue from extending proximally in the jaws beyond the most proximal staple. Figure 4 An anvil 60008' is shown with a pair of tissue stops 60009' formed on its proximal end portion. Thus, when the anvil 60008' is in the open position and the target tissue is positioned between the anvil and the staple cartridge, the tissue contacts the distal edge 60011' of the tissue stop 60009' and is thereby prevented from being positioned any closer to the staple cartridge. However, the staple line extends proximally beyond this position so that those staples are fired before the knife contacts the tissue clamped in the jaws to ensure that the cut tissue is stapled. Fig.16The appendage 69400 is shown positioned relative to the tissue stop 60009' of the surgical stapler. In such applications, in order to reduce the amount of resistance encountered by the knife as it passes through the appendage 69400 and initially encounters the clamped tissue, it is desirable that the slot 69450 extends distally past the tissue stop by at least 5 mm (L2). This allows the knife to pass through the tissue without being hindered by the proximal end of the appendage material 69450, and allows several staples to be fired through the proximal end of the appendage material 69400 before the knife begins to cut the appendage material.

[0092] Fig.17 An appendage 69500 ​​is shown in accordance with the present disclosure. The appendage 69500 ​​includes a material 69510, which may include any of the appendage compositions and materials described herein. The appendage 69500 ​​includes a proximal end 69502 and a distal end 69508. A slot 69550 is offset from the proximal end 69502 of the appendage. Alternatively, the slot 69550 may extend through the proximal end 69502. The slot 69550 extends completely through the thickness of the appendage material 69510. The slot 69550 may extend only partially through the cross-sectional thickness of the appendage material 69510. Alternatively, the slot 69550 may include a slit. The slit may extend completely through the cross-sectional thickness of the appendage material 69510, or it may extend only partially through the cross-sectional thickness of the appendage material 69510. The slot 6950 is intended to reduce the amount of resistance encountered by the knife as it passes through the proximal end of the appendage 69500 ​​(in the area of ​​possible appendage overlap). Fig.17 The relationship of the appendage 69500 ​​relative to the staple pockets 69518 of the staple cartridge during use is shown. Fig.17 As can be seen in FIG. 6 , several staple pockets 69518 are located proximal to the distal end 60011 ' of the tissue stop 60009 '. As described above, the distance L3 may be at least 5 mm.

[0093] Fig.18 Another appendage 69600 arrangement is shown that can be made from an appendage material 69610 that can include any of the appendage materials and arrangements described herein. The appendage 69600 includes a proximal end 69602 and a distal end 69608. As such, the slot 69650 extends a distance L3 from the proximal end of the appendage 69600, but the proximal portion 69652 of the slot 69650 is filled with another appendage nonwoven material 69654 disclosed herein that will provide less resistance to the knife than other materials that make up the appendage 69600. For example, the appendage material 69610 includes a woven material, wherein the proximal portion 69652 of the narrow groove 69650 is filled with oxidized regenerated cellulose (ORC) or a similar material 69554. Fig.18The position of the slot 69650 is shown relative to some of the formed staples 69618 formed by the anvil using the tissue stop 60009'. The slot 69650 extends a distance L4 from the proximal end 69602. The distal end of the slot 69650 can be at least 5 mm from the end 60011' of the tissue stop 60009'. The length L4 of the slot 69650 can be at least as long as the amount by which the second appendage 69600 overlaps the previously sutured appendage to reduce the resistance encountered by the knife as the knife advances through the appendage overlap area. It will be understood by those of ordinary skill in the art that any of the aforementioned slot / slit arrangements can be used with any of the appendage configurations.

[0094] Fig.19 An appendage 69800 is shown that is similar to appendages 69200, 69200', 69300, and 69300'. Appendage 69800 includes woven material 69816 of various types and configurations described herein, however, appendage 69800 may include any of the non-woven appendage materials and arrangements described herein. Fig.19 As can be seen in the appendage 69800, the appendage 69800 includes a series of proximal end perforations or cutouts 69820 disposed adjacent to the proximal end 69802 to define a proximal weakened portion 69810, and a series of distal end perforations or cutouts 69822 disposed adjacent to the proximal distal end 69606 to define a distal weakened portion 69814. No perforations are provided in the central portion 69812 extending between the proximal weakened portion 69810 and the distal weakened portion 69814. In use, if the appendage 69800 begins to bunch or plow during cutting, the proximal weakened portion 69810 and the distal weakened portion 69814 enable those portions to disengage from the nails formed therein, which can prevent those nails from being pulled out and / or damaged as the firing actuator passes therethrough. One of ordinary skill in the art will appreciate that any of the aforementioned perforation / cutout arrangements can be used with any of the appendage configurations, including those appendages that employ slots or slits. In addition to the perforations and cut-out portions, the weakened proximal portion 69810 and the weakened distal portion 69814 (but not the central portion 69812) may be exposed to one or more of moisture, ultraviolet light, and radiation (gamma, X-rays, electron beams, etc.) during manufacturing and prior to use.

[0095] Fig. 20Another appendage 69900 is shown that includes a woven material 69916. The appendage 69900 may include a weakened proximal portion 69910 and a weakened distal portion 69914 that provide the advantages described above. The weakened portions 69910 and 69914 are formed by exposing those portions (but not the central portion 69912) to one or more of moisture, ultraviolet light, and radiation (gamma, X-rays, electron beams, etc.) during manufacturing and prior to use. Alternatively, the appendage 69900 may include any of the various appendage materials described herein, wherein the weakened proximal portion 69910 and the weakened distal portion 69914 are formed by exposing those portions of the appendage to one or more of moisture, ultraviolet light, and radiation (gamma, X-rays, electron beams, etc.) during manufacturing and prior to use.

[0096] Fig.21 Another appendage 69900' is shown including a central region 69920 corresponding to two central rows 69930 of staple pockets 69932 (shown in phantom) on each side of the longitudinal slots of the respective staple cartridges. The appendage 69900' also includes two lateral regions 69922 and 69924 corresponding to the two outer rows 69934 of staple pockets 69932 in the staple cartridge. In the illustrated arrangement, the central region 69920 comprises a first material 69921 and the two lateral regions 69922 comprise a second material 69923 that is different from the first material 69921. The first material 69921 comprises oxidized regenerated cellulose (ORC) or a similar material, and the second material comprises a polyester such as polyester. Or a woven material of similar material. The first material 69921 provides less resistance to cutting than the second material 69923, thereby providing increased strength to the outer row of staples. Other materials described herein may be used, where the first material 69921 is weaker than the second material (providing less resistance to knife travel and / or being more likely to break away from the formed staples if the accessory material begins to bunch or plow).

[0097] The entire appendage 69900' may be degraded during manufacture by exposing the appendage 69000' to one or more of moisture, ultraviolet light, and radiation (gamma, X-rays, electron beams, etc.) during manufacture and prior to use. This will further weaken the appendage 69900' and reduce resistance to cutting (and plowing) as well as increase the ability to break away from the formed staple when plowing occurs during firing. The first material 69921 and / or the second material 69923 may be degraded by exposure to one or more of moisture, ultraviolet light, and radiation (gamma, X-rays, electron beams, etc.) and then laminated or otherwise attached together to form the appendage 69900'.

[0098] In addition to the various properties described above, for example, any of the appendages described herein may include materials characterized by one or more of the following properties: biocompatible, bioabsorbable, bioresorbable, biodurable, biodegradable, compressible, fluid-absorbable, swellable, self-expandable, bioactive, pharmaceutical, pharmaceutically active, anti-adhesive, hemostatic, antibiotic, antimicrobial, antiviral, nutritional, adhesive, permeable, hydrophilic, and / or hydrophobic. In other configurations, the appendage may include at least one of a hemostatic agent (such as fibrin and thrombin), an antibiotic (such as doxycpl), and a drug (such as a matrix metalloproteinase (MMP)).

[0099] The appendages described herein may include synthetic and / or non-synthetic materials. For example, the appendage may include a polymer composition 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. The polymer composition includes, for example, biocompatible foams. The biocompatible foam may include, for example, porous open-cell foams and / or porous closed-cell foams. The biocompatible foam may have a uniform pore morphology or may have a gradient pore morphology (i.e., the pore size gradually increases to macropores through the thickness of the foam in one direction). The polymer composition may include one or more of a porous scaffold, a porous matrix, a gel matrix, a hydrogel matrix, a solution matrix, a filamentous matrix, a tubular matrix, a composite matrix, a membrane matrix, a biostable polymer, and a biodegradable polymer and a combination thereof. For example, the appendage may include a foam enhanced by a filamentous matrix or may include a foam having an additional hydrogel layer that expands in the presence of body fluids to further provide compression of the tissue. The appendages described herein may also be composed of a coating on the material and / or a second or third layer that expands in the presence of body fluids to further provide compression of the tissue. Such layers can be hydrogels, which can be synthetic materials and / or natural source materials and can be, for example, biodurable and / or biodegradable. The appendages can include microgels or nanogels. The hydrogels can include carbohydrate-derived microgels and / or nanogels. The appendages described herein can be enhanced with, for example, fiber nonwoven materials or fiber mesh-type elements that can provide additional flexibility, rigidity and / or strength. Appendages with porous morphologies that present gradient structures can be used, such as having macropores on one surface and macropores on another surface. Such morphologies may be more optimal for tissue ingrowth or hemostatic behavior. In addition, gradients can also be combined with varying bioabsorption profiles. For example, short-term absorption profiles may be preferred for addressing hemostasis, while long-term absorption profiles can achieve better tissue healing without leakage.

[0100] Examples of non-synthetic materials that may comprise any of the appendages described 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, chitan, chitosan, casein, alginate, and combinations thereof.

[0101] Examples of synthetic absorbable materials that may comprise any of the appendages described herein 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, polyamines, tyrosine-based polyiminocarbonates, tyrosine-based polycarbonates, poly(D,L-lactide-carbamate), poly(hydroxybutyrate), poly(B-hydroxybutyrate), poly(ε-caprolactone), polyethylene glycol (PEG), poly[di(carboxyphenoxy)phosphazene], poly(amino acids), pseudo-poly(amino acids), absorbable polyurethanes, poly(phosphazenes), polyphosphazenes, polyoxyalkylenes, polyacrylamide, polyhydroxyethyl methacrylate, polyvinyl pyrrolidone, polyvinyl alcohol, poly(caprolactone), polyacrylic acid, polyacetate, polypropylene, aliphatic polyesters, glycerol, copoly(ether-esters), polyalkylene oxalates, polyamides, poly(iminocarbonates), polyalkylene oxalates, and combinations thereof. The polyester may be selected from polylactide, polyglycolide, trimethylene carbonate, polydioxanone, polycaprolactone, polybutylene esters, and combinations thereof.

[0102] Any of the appendages described herein may include a surfactant. Examples of surfactants may include, but are not limited to, polyacrylic acid, cellulose methyl ether (methalose), methyl cellulose, ethyl cellulose, propyl cellulose, hydroxyethyl cellulose, carboxymethyl cellulose, 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.

[0103] 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 flows through or passes 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.

[0104] The polymer composition may comprise a hemostatic material. Hemostatic materials may include poly(lactic acid), poly(glycolic acid), poly(hydroxybutyrate), poly(caprolactone), poly(dioxanone), polyalkylene oxide, copoly(ether esters), 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, carboxymethyl cellulose, chitin, chitosan, agarose, maltose, maltodextrin, alginate, coagulation factors, methacrylate, polyurethane, cyanoacrylate, platelet agonists, vasoconstrictors, alum, calcium, RGD peptide, protein, protamine sulfate, ε-aminocaproic acid, iron sulfate, basic iron sulfate, iron chloride, zinc, zinc chloride, aluminum chloride, aluminum sulfate, aluminum acetate, permanganate, tannic acid, bone wax, polyethylene glycol, fucoidan, and combinations thereof. In one form, the appendage is characterized by hemostatic properties.

[0105] As described herein, various surgical instruments include a motor control system 67000 configured to execute an intelligent algorithm. The intelligent algorithm includes a sequence optimized to interact with the physical features of the appendage. The motor control system 67000 can detect changes in the thickness and / or properties of the appendage and adjust the firing stroke in response to the detected changes. If different thicknesses and / or different properties are detected based on a predetermined initial threshold, the motor control system 67000 can change the firing speed and / or pause at a certain position in the appendage.

[0106] The motor control system 67000 includes a control circuit 67010. The control circuit 67010 includes a processor 67011 and a memory device 67012. The processor 67011 communicates with the motor 67002 of the surgical instrument. The motor control system 67000 may include and / or receive data 67020 about the appendages loaded in the instrument and adjust the firing stroke in response to the data 67020. The data 67020 may include a predetermined appendage thickness threshold 67022. The data 67020 may be stored on a memory device 67030 within the control circuit 67010. The data 67020 may also be stored in or on the cartridge itself. The cartridge 60026 may include an RFID tag 67040 attached thereto.

[0107] The surgical instruments described herein may include a control board, such as a printed control board (PCB), which includes, for example, hardware and software for a motor control system 67000 for the surgical instrument. When the clinician initiates a firing motion, the firing member begins to travel distally through the cartridge, which the motor control system 67000 will detect. At this point, the motor control system 67000 follows an algorithm 67100 for deciding when or whether to adjust the firing speed. The algorithm 67100 is used to determine when or whether to adjust the firing speed. Fig.23 It is shown in , which can control this, but any suitable algorithm may be used.

[0108] As described above, the motor control system of the surgical instrument may include an intelligent algorithm 67100 that can change the firing speed or pause the firing motion of the surgical instrument based on predetermined criteria (e.g., physical characteristics of the appendage). Also as described above, the algorithm can be configured to modify aspects of the firing motion of the surgical instrument based on a predetermined appendage thickness threshold. Fig.23 As shown, the algorithm 67100 includes step 67101, in which the motor control system 67000 evaluates whether the physical features of the appendage attached to the staple cartridge are aligned with a predetermined initial threshold. If it is determined in step 67101 that the physical features of the appendage are aligned with the predetermined initial threshold, the algorithm 67100 follows a logic path 67110. In the logic path 67110, the motor control system 67000 operates the surgical instrument at a consistent firing speed. Alternatively, if the motor control system 67000 determines in step 67101 that the physical features of the appendage are not aligned with the predetermined initial threshold, the algorithm follows a logic path 67120. In the logic path 67120, the motor control system 67000 increases or decreases the speed of the firing motion in step 67122, for example to accommodate an appendage that is thicker or thinner than the predetermined initial threshold.

[0109] In addition to the above, the motor control system 67000 of the surgical instrument 60000 includes a pulse width modulation (PWM) control circuit that is configured to control the speed of the firing drive electric motor. The PWM control circuit applies voltage pulses to the firing drive electric motor to perform the nail firing stroke. The PWM control circuit can increase the duration of the voltage pulses it applies to the firing drive electric motor so as to increase the speed of the firing drive electric motor and correspondingly increase the speed of the nail firing stroke. The PWM control circuit can reduce the duration of the voltage pulses it applies to the firing drive electric motor so as to reduce the speed of the firing drive electric motor and correspondingly reduce the speed of the nail firing stroke. In either case, the PWM control circuit can make these pulse length adjustments without substantially increasing or reducing the magnitude of the voltage pulses applied to the motor. That is, the magnitude of the voltage pulses or certain voltage pulses can be changed. In any case, as described in more detail below, the control system is configured to drive the nail firing drive at a constant or near-constant speed by adjusting the duration of the pulses via the PWM circuit. The entire disclosure of U.S. Patent 8,499,992, entitled “DEVICE AND METHOD FOR CONTROLLING COMPRESSION OF TISSUE,” issued on August 6, 2013, is incorporated herein by reference.

[0110] The ratio of the time that the PWM circuit applies voltage to the electric motor (on time) divided by the total time (on time + off time) is the duty cycle of the nail firing drive motor. Therefore, the duty cycle can range between 0% (completely off) and 100% (completely on), that is, a constant voltage without periodic interruptions. The terms on and off represent non-zero voltage and zero voltage; however, the terms on and off include high voltage and low voltage, respectively. The term low or off includes zero voltage and a non-zero voltage whose magnitude is less than the high voltage or on voltage. In view of the above, another way to express the duty cycle of the electric motor of the firing drive device is the ratio of the time that the PWM circuit applies voltage to the electric motor (high time) divided by the total time (high time + low time).

[0111] The PWM control circuit applies voltage pulses to the firing drive motor at regular intervals; however, the control system may include a frequency modulation (FM) control circuit to vary the frequency of the voltage pulse intervals. The FM control circuit may reduce the intervals between the voltage pulses to increase the speed of the firing drive motor and the nail firing stroke. Correspondingly, the FM control circuit increases the intervals between the voltage pulses to decrease the speed of the firing drive motor and the nail firing stroke. In addition to or in lieu of the foregoing, the control system may increase the magnitude of the voltage it applies to the firing drive motor to increase the speed of the firing drive motor and the nail firing stroke, and / or decrease the magnitude of the voltage it applies to the firing drive motor to decrease the speed of the firing drive motor and the nail firing stroke.

[0112] The control system of the surgical instrument 60000 includes an algorithm for controlling the speed of the nail firing member. The motor control system 67000 may include another algorithm configured to drive the nail firing member at a low speed, a medium speed, and a high speed. The low speed is 6 mm / s, or about 6 mm / s. The medium speed is 12 mm / s, or about 12 mm / s. The high speed is 20 mm / s, or about 20 mm / s. That is, the motor control system 67000 can be configured to operate the surgical instrument at a plurality of any suitable speeds and / or at any suitable speed. The control system is configured to monitor the speed of the nail firing drive via a motor speed sensor, and adjust the length of the voltage pulse applied to the electric motor of the nail firing drive to make the speed of the nail firing drive reach the target speed. For example, if the target speed of the nail firing drive at a given point in the nail firing stroke is 12 mm / s and the actual speed is 11 mm / s, the control system increases the length of the voltage pulse applied to the electric motor to increase the speed of the nail firing drive. In other words, the control system increases the duty cycle of the firing drive electric motor to increase the speed of the nail firing drive. Correspondingly, the motor control system 67000 is configured to shorten the length of the voltage pulse applied to the firing drive electric motor when the speed of the nail firing drive exceeds the target speed until the speed of the nail firing drive reaches the target speed. In other words, the control system is configured to reduce the duty cycle of the firing drive electric motor to reduce the speed of the nail firing drive. It is worth noting that the target speed of the nail firing drive can be changed during the nail firing stroke. The entire disclosure of U.S. Patent Application No. 17 / 728,089, entitled "STAPLING INSTRUMENT COMPRISING JAW MOUNTS", is incorporated herein by reference.

[0113] Various aspects of the subject matter described herein are illustrated in the following examples.

[0114] Embodiment 1 - An appendage (69200, 69200', 69300, 69300', 69800, 69900) for use with a surgical stapling system (60000). The appendage includes: a first region (69210, 69210', 69310, 69310', 69810, 69910) comprising a first composition; a second region (69212, 69212', 69312, 69312', 69812, 69912) distal to the first region, wherein the second region comprises a second composition; and a third region (69214, 69214', 69314, 69314', 69814, 69914) distal to the second region, wherein the third region comprises a third composition, and wherein the second composition is different from the first composition and the third composition.

[0115] Embodiment 2 - The appendage of embodiment 1, further comprising a woven material (69816, 69916) spanning the first region, the second region, and the third region.

[0116] Example 3 - An accessory according to Example 1 or 2, wherein the first region comprises a first woven material (69211, 69211') having a first weaving density, wherein the second region comprises a second woven material (69213, 69213') having a second weaving density that is tighter than the first weaving density, and wherein the third region comprises a third woven material (69215, 69215') having the first weaving density.

[0117] Example 4 - An accessory according to Example 3, wherein the first woven material (69211, 69211') has a first denier, wherein the second woven material (69213, 69213') has a second denier different from the first denier, and wherein the third woven material (69215, 69215') includes a first denier.

[0118] Embodiment 5 - An accessory according to Embodiment 3 or 4, wherein the first woven material (69211, 69211') has a first number of strands, wherein the second woven material (69213, 69213') has a second number of strands, and wherein the third woven material (69215, 69215') has the first number of strands.

[0119] Embodiment 6 - The appendage of Embodiment 5, wherein the second number of strands is greater than the first number of strands.

[0120] Example 7 - An appendage according to Example 1, wherein the first region (69210, 69210', 69310, 69310') comprises a first material (69211, 69211'69311, 69311'), wherein the second region (69212, 69212', 69312, 69312') comprises a second material (69213, 69213', 69313, 69313') different from the first material, and wherein the third region (69214, 69214', 69314, 69314') comprises the first material.

[0121] Embodiment 8 - The appendage of Embodiment 7, wherein the first material comprises a nonwoven material, and wherein the second material comprises a woven material.

[0122] Example 9 - An appendage according to any of Examples 1 to 8, wherein the first region extends from a proximal end of the appendage, and wherein the appendage includes a narrow groove (69450, 69550, 69650) extending longitudinally from the proximal end through at least a portion of the first region.

[0123] Embodiment 10 - An appendage according to Embodiment 9, wherein the narrow groove extends only partially through the cross-sectional thickness of the first region.

[0124] Example 11 - An appendage according to Example 9 or 10, wherein the narrow groove comprises a slit.

[0125] Example 12 - An appendage according to any one of Examples 1 to 8, further comprising a plurality of perforations (6982) passing through the first region and another plurality of other perforations (69822) passing through the third region.

[0126] Embodiment 13 - An appendage according to any one of Embodiments 1 to 13, wherein the first region has a first cross-sectional thickness, wherein the second region includes a second cross-sectional thickness different from the first cross-sectional thickness, and wherein the third region has the first cross-sectional thickness.

[0127] Embodiment 14 - An appendage as described in Embodiment 13, wherein the second cross-sectional thickness is greater than the first cross-sectional thickness.

[0128] Embodiment 15 - The appendage of any one of Embodiments 1 to 14, wherein the first region and the third region are exposed to at least one of moisture, ultraviolet light, and radiation prior to use.

[0129] Example 16 - An appendage for use with a surgical stapling system. The appendage comprises: a first region comprising a first composition; a second region distal to the first region, wherein the second region comprises a second composition; and a third region distal to the second region, wherein the third region comprises a third composition, and wherein the second composition is different from the first composition and the third composition.

[0130] Embodiment 17 - The appendage of Embodiment 16, further comprising a woven material spanning the first region, the second region, and the third region.

[0131] Example 18 - An accessory according to Example 17, wherein a first portion of the woven material spanning the first area has a first weave density, wherein a second portion of the woven material spanning the second area has a second weave density that is tighter than the first weave density, and wherein a third portion of the woven material spanning the third area has a third weave density that is the same as the first weave density.

[0132] Example 19 - An accessory according to Example 18, wherein the first portion of the woven material has a first denier, wherein the second portion of the woven material has a second denier different from the first denier, and wherein the third portion of the woven material has a third denier the same as the first denier.

[0133] Example 20 - An accessory according to Example 18, wherein the first portion of the woven material includes a first number of strands of the woven material, wherein the second portion of the woven material includes a second number of strands of the woven material that is different from the first number of strands of the woven material, and wherein the third portion of the woven material includes a third number of strands of the woven material that is the same as the first number of strands of the woven material.

[0134] Embodiment 21 - An accessory according to Embodiment 20, wherein the woven material of the second number of strands is greater than the woven material of the first number of strands.

[0135] Embodiment 22 - An appendage according to Embodiment 16, wherein the first region comprises a first material, wherein the second region comprises a second material different from the first material, and wherein the third region comprises a third material that is the same as the first material.

[0136] Embodiment 23 - An appendage according to Embodiment 22, wherein the first material comprises a nonwoven material and wherein the second material comprises a woven material.

[0137] Example 24 - An appendage according to Example 16, wherein the first region extends from a proximal end of the appendage, and wherein the appendage includes a narrow slot extending longitudinally from the proximal end through at least a portion of the first region.

[0138] Embodiment 25 - An appendage according to Embodiment 24, wherein the narrow groove extends only partially through the cross-sectional thickness of the first region.

[0139] Example 26 - An appendage as described in Example 24, wherein the narrow groove comprises a slit.

[0140] Embodiment 27 - The appendage of Embodiment 16 further comprising a plurality of perforations through the first region and another plurality of other perforations through the third region.

[0141] Example 28 - An appendage according to Example 16, wherein the first region has a first cross-sectional thickness, wherein the second region has a second cross-sectional thickness different from the first cross-sectional thickness, and wherein the third region has a third cross-sectional thickness the same as the first cross-sectional thickness.

[0142] Embodiment 29 - An appendage according to Embodiment 28, wherein the second cross-sectional thickness is greater than the first cross-sectional thickness.

[0143] Embodiment 30 - The appendage of Embodiment 16, wherein the first region and the third region are exposed to at least one of moisture, ultraviolet light, and radiation prior to use.

[0144] Example 31 - An appendage for use with a surgical suturing system. The appendage includes an elongated body including a proximal end, a distal end, and two lateral sides extending between the proximal end and the distal end. The elongated body also includes: a first material extending longitudinally through a central portion of the elongated body between the proximal end and the distal end, wherein the first material includes a first composition; a section of a second material extending longitudinally from the proximal end to the distal end between the first material and one of the lateral sides, wherein the second material includes a second composition different from the first composition; and another section of the second material extending longitudinally from the proximal end to the distal end between the first material and the other of the lateral sides.

[0145] Embodiment 32 - An appendage according to Embodiment 31, wherein the first material comprises a nonwoven material and wherein the second material comprises a woven material.

[0146] Embodiment 33 - A surgical suturing system including a staple cartridge. The staple cartridge includes: a cartridge body, the cartridge body defining a proximal end and a distal end; an elongated slot, the elongated slot extending from the proximal end toward the distal end, wherein the elongated slot defines a slot axis; a plurality of first staple cavities, the plurality of first staple cavities being arranged in three rows of first staple cavities on each side of the elongated slot, wherein each row of first staple cavities is aligned on a corresponding first cavity axis parallel to the slot axis, and wherein each row of first staple cavities extends from the proximal end of the cartridge body to a position proximal to the distal end of the cartridge body, wherein each first staple cavity removably stores a corresponding first staple therein; and a plurality of second staple cavities, the plurality of second staple cavities being formed on each side of the elongated slot in the distal portion of the cartridge body, between the position proximal to the distal end and the distal end, wherein each second staple cavity is oriented on a second cavity axis arranged at an angle relative to the slot axis, and wherein each second staple cavity removably stores a corresponding second staple therein.

[0147] Example 34 - A surgical suturing system according to Example 33, wherein the angle is between twenty degrees and ninety degrees.

[0148] Example 35 - According to the surgical suturing system of Example 33, the surgical suturing system also includes an appendage supported on the platform surface of the cartridge body, wherein the appendage includes: a first region containing a first composition; a second region distal to the first region, wherein the second region contains a second composition; and a third region distal to the second region, wherein the third region contains a third composition, and wherein the second composition is different from the first composition and the third composition.

[0149] The entire disclosures of the following patents are hereby incorporated herein by reference:

[0150] - U.S. Patent No. 5,403,312, issued on April 4, 1995, entitled "ELECTROSURGICALHEMOSTATIC DEVICE";

[0151] - U.S. Patent 7,000,818, issued on February 21, 2006, entitled "SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS";

[0152] - U.S. Patent 7,422,139, issued on September 9, 2008, entitled "MOTOR-DRIVEN SURGICALCUTTING AND FASTENING INSTRUMENT WITH TACTILEPOSITION FEEDBACK";

[0153] - U.S. Patent 7,464,849, issued on December 16, 2008, entitled "ELECTRO-MECHANICAL SURGICAL INSTRUMENT WITH CLOSURE SYSTEM AND ANVIL ALIGNMENT COMPONENTS";

[0154] - U.S. Patent 7,670,334, issued on March 2, 2010, entitled “SURGICAL INSTRUMENT HAVING AN ARTICULATING END EFFECTOR”;

[0155] - U.S. Patent 7,753,245, entitled “SURGICAL STAPLING INSTRUMENTS,” issued on July 13, 2010;

[0156] - U.S. Patent 8,393,514, issued on March 12, 2013, entitled "SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE";

[0157] - U.S. Patent Application Serial No. 11 / 343,803, entitled “SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES,” now U.S. Patent No. 7,845,537;

[0158] - U.S. Patent Application Serial No. 12 / 031,573, filed on February 14, 2008, entitled “SURGICAL CUTTING AND FASTENING INSTRUMENT HAVING RF ELECTRODES”;

[0159] - 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;

[0160] - U.S. Patent Application Serial No. 12 / 235,782, entitled “MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT,” now U.S. Patent No. 8,210,411;

[0161] - U.S. Patent Application Serial No. 12 / 235,972, entitled “MOTORIZED SURGICAL INSTRUMENT,” now U.S. Patent No. 9,050,083.

[0162] - 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;

[0163] - 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;

[0164] - The US application titled "STAPLE CARTRIDGE" was submitted on September 29, 2012

[0165] US patent application serial number 12 / 893,461, now US patent 8,733,613;

[0166] - 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;

[0167] - 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;

[0168] - 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;

[0169] - 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;

[0170] - 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;

[0171] - U.S. Patent Application Publication No. 2007 / 0175955, filed January 31, 2006, entitled "SURGICAL CUTTING AND FASTENING INSTRUMENTWITH CLOSURE TRIGGERLOCKING MECHANISM"; and

[0172] - 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.

[0173] 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.

[0174] 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.

[0175] 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.

[0176] 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.

[0177] 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 (69200, 69200', 69300, 69300', 69800, 69900) for use with a surgical stapling system (60000), wherein: The appendages include: A first region (69210, 69210', 69310, 69310', 69810, 69910) comprising a first composition; a second region (69212, 69212', 69312, 69312', 69812, 69912) distal to the first region, wherein the second region comprises a second composition; and A third region (69214, 69214', 69314, 69314', 69814, 69914) distal to the second region, wherein the third region comprises a third composition, and wherein the second composition is different from the first composition and the third composition.

2. The appendage of claim 1, further comprising a woven material (69816, 69916) spanning the first region, the second region, and the third region.

3. The appendage according to claim 1, wherein: The first region comprises a first woven material (69211, 69211') having a first weaving density, wherein the second region comprises a second woven material (69213, 69213') having a second weaving density that is tighter than the first weaving density, and wherein the third region comprises a third woven material (69215, 69215') having the first weaving density.

4. The appendage according to claim 3, wherein: The first woven material (69211, 69211') has a first denier, wherein the second woven material (69213, 69213') has a second denier different from the first denier, and wherein the third woven material (69215, 69215') has the first denier.

5. The appendage according to claim 3 or 4, wherein: The first woven material (69211, 69211') has a first number of strands, wherein the second woven material (69213, 69213') has a second number of strands, and wherein the third woven material (69215, 69215') has the first number of strands.

6. The appendage according to claim 5, wherein: The second strand quantity is greater than the first strand quantity.

7. The appendage according to claim 1, wherein: The first region (69210, 69210', 69310, 69310') comprises a first material (69211, 69211'69311, 69311'), wherein the second region (69212, 69212', 69312, 69312') comprises a second material (69213, 69213', 69313, 69313') different from the first material, and wherein the third region (69214, 69214', 69314, 69314') comprises the first material.

8. The appendage according to claim 7, wherein: The first material comprises a nonwoven material, and wherein the second material comprises a woven material.

9. The appendage according to any one of claims 1 to 8, wherein: The first region extends from a proximal end of the appendage, and wherein the appendage includes a slot (69450, 69550, 69650) extending longitudinally from the proximal end through at least a portion of the first region.

10. The appendage according to claim 9, wherein: The slot extends only partially through the cross-sectional thickness of the first region.

11. An appendage according to claim 9 or 10, wherein: The slot comprises a slit.

12. The appendage according to any one of claims 1 to 8, further comprising a plurality of perforations (6982) passing through the first region and a further plurality of other perforations (69822) passing through the third region.

13. An appendage according to any one of claims 1 to 12, wherein: The first region has a first cross-sectional thickness, wherein the second region has a second cross-sectional thickness different from the first cross-sectional thickness, and wherein the third region has the first cross-sectional thickness.

14. The appendage according to claim 13, wherein: The second cross-sectional thickness is greater than the first cross-sectional thickness.

15. An appendage according to any one of claims 1 to 14, wherein: The first region and the third region are exposed to at least one of moisture, ultraviolet light, and radiation prior to use.

Images