cartridge for surgical staples

Abstract

A cartridge (1) comprising compartments (2, 3, 4) for storing respective surgical staples, each surgical staple comprising two arms, one of the two arms being rotatable relative to the other arm about an axis of rotation to close the surgical staple, wherein all the compartments (2, 3, 4) of the cartridge are configured such that, when the surgical staples are respectively stored in all the compartments (2, 3, 4) of the cartridge (1), the surgical staples assume respective positions such that a plane (P) perpendicular to the axis of rotation (R) of each of the surgical staples intersects each of the surgical staples. Figure for the abbreviation: Figure 4

Description

Title of the invention: cartridge for surgical staples FIELD OF THE INVENTION

[0001] The present invention relates to a cartridge for surgical staples, also called surgical "clips" in the literature. STATE OF THE ART

[0002] A conventional surgical staple comprises two arms, one of the two arms being rotatable relative to the other arm about an axis of rotation to close the surgical staple. Such a surgical staple is typically used to be placed in a patient's body. For example, the surgical staple may be used to perform a ligation, i.e., to bring disjointed biological tissues together in order to stop bleeding.

[0003] Document US 2019 / 0133594 describes a cartridge comprising a row of housings for storing surgical staples of this type. The row of housings is configured so that, when the surgical staples are stored in the row of housings, the surgical staples adopt respective positions such that the axes of rotation of the surgical staples are coincident.

[0004] Such a cartridge thus forms a block having a length, a width and a height which are relatively balanced with respect to each other.

[0005] A user removes the staples stored in the cartridge one by one using an instrument, in order to place them on or in the body of a patient.

[0006] However, such a cartridge proves cumbersome in certain situations.

[0007] For example, it may be necessary to place several surgical staple cartridges in a bag having a substantially flat shape. Filling a bag with cartridges having the shape described in US 2019 / 0133594 is not optimal. This is because the two walls of a bag can only deform up to a certain point, leaving substantial void areas between them once cartridges have been inserted into the bag. Furthermore, it is not possible to fill these void areas without compromising the closure of the bag.

[0008] Furthermore, it has been proposed to insert a cartridge temporarily inside a patient's body, in the case where staples are to be placed at a site inside the patient's body. In this case, the cartridge is typically inserted into the patient's body via a first trocar, and an instrument for removing the staples is inserted into the body via a second trocar, the removal of the staples from the cartridge and their delivery to the placement site being carried out in the body, at using this instrument. This method avoids the user having to go back and forth between the inside and outside of the body to place different staples, and thus reduces the duration of the operation. However, the cartridge described in the document with cartridges having the shape described in document US 2019 / 0133594 is not suitable for such temporary intracorporeal insertion, due to its bulk.

[0009] Another solution to avoid going back and forth between the inside and outside of the patient's body is to use an applicator in which the staples are preloaded. However, such an applicator must necessarily include a complex mechanism to ensure the functions of storing and placing the staples. The manufacturing cost of this applicator is therefore high. Statement of the invention

[0010] An aim of the invention is to propose a cartridge more suited to certain uses, in particular packaging in a sachet and intracorporeal insertion.

[0011] This object is achieved by a cartridge comprising housings for storing respective surgical staples, each of the surgical staples comprising two arms, one of the two arms being rotatable relative to the other arm about an axis of rotation to close the surgical staple, wherein all of the housings of the cartridge are configured so that, when the surgical staples are respectively stored in all of the housings of the cartridge, the surgical staples adopt respective positions such that a plane perpendicular to the axis of rotation of each of the surgical staples intersects each of the surgical staples.

[0012] By orienting the housings in this way, the dimension of the cartridge, measured in a direction normal to the plane intersecting the staples, can be greatly reduced compared to the other two dimensions of the cartridge measured parallel to this plane. The proposed cartridge can thus have a much more flattened shape than the cartridge proposed in document US 2019 / 0133594. Cartridges of this flattened shape can be inserted into a bag in greater numbers than cartridges having the shape proposed in document US 2019 / 0133594.

[0013] Another advantage of the cartridge is that it can be more easily grasped by two jaws of a surgical clamp. This type of instrument is systematically available in an operating room.

[0014] Yet another advantage of the cartridge is that it can more easily be inserted into a trocar, which has an elongated shape. The cartridge can therefore be more easily inserted into a patient's body than the cartridge proposed in US 2019 / 0133594, for the purpose of extracting staples from the cartridge carried out in the body.

[0015] The cartridge described above constitutes a first aspect of the present disclosure.

[0016] The cartridge according to this first aspect may also comprise the following characteristics, taken alone or in combination whenever technically possible.

[0017] Preferably, the cartridge comprises the surgical staples respectively stored in all the housings.

[0018] Preferably, the housings comprise a first row of housings opening onto a first side of the cartridge, and a second row of housings opening onto a second side of the cartridge opposite the first side.

[0019] Preferably, the cartridge comprises: • a first wall and a second wall delimiting the housings between them, the first wall having a first external surface and the second wall having a second external surface opposite the first external surface, • two stops projecting from the first external surface so as to delimit a hollow between them, the two stops being arranged to allow the cartridge to be placed in a position gripped by an instrument, in which: • a first jaw of the instrument rests on the first external surface and a second jaw of the instrument rests on the second external surface, • each cartridge housing is accessible via a first side of the instrument or via a second side of the instrument opposite the first side, • the first jaw extends into the hollow between the two stops.

[0020] Preferably, the cartridge comprises two second stops projecting from the second external surface so as to delimit between them a second hollow, the two second stops being arranged so that, in the gripped position, the second jaw extends into the second hollow between the second stops.

[0021] Preferably, the cartridge comprises first locking means for limiting a movement of the cartridge relative to a first adjacent structure in a direction parallel to the plane, the first locking means comprising at least one of: • a first male element adapted to be engaged with a female element of the first adjacent structure, • a first female element adapted to be engaged with a male element of the first adjacent structure.

[0022] Preferably, the first locking means are adapted to limit a translational movement of the cartridge relative to the first adjacent structure in any direction parallel to the plane.

[0023] Preferably, the cartridge comprises a first wall having a first planar surface, wherein the first male element projects from the first planar surface and has a first slope extending the first planar surface, the first slope being inclined relative to the first planar surface at an obtuse angle.

[0024] Preferably, the cartridge comprises second locking means for limiting a movement of the cartridge relative to a second adjacent structure in a direction parallel to the plane, the second locking means being opposite the first locking means relative to the housings, the second locking means comprising at least one of: • a second male element adapted to be engaged with a female element of the second adjacent structure, • a second female element adapted to be engaged with a male element of the second adjacent structure.

[0025] Preferably, the second locking means are adapted to limit a translational movement of the cartridge relative to the second adjacent structure in any direction parallel to the plane.

[0026] Preferably, the second locking means are symmetrical to the first locking means with respect to an axis.

[0027] There is also provided, according to a second aspect, a set of cartridges comprising: • a first cartridge according to the first aspect, • a second cartridge according to the first aspect • in which the first locking means of the second cartridge are adapted for: • be engaged with the first locking means of the first cartridge, when the first cartridge is in a first orientation relative to the second cartridge, and • be engaged with the second locking means of the first cartridge, when the first cartridge is in a second orientation relative to the second cartridge, the second orientation being different from the first orientation.

[0028] There is also proposed, according to a third aspect, a system comprising: • a set of cartridges comprising a first cartridge and a second cartridge according to the first aspect, • a case including: • a first flap extending in a first plane and a second flap extending in a second plane, the first flap 52 and the second flap 54 defining between them a space for storing the set of cartridges in a stacked position in which the plane of the first cartridge and the plane of the second cartridge are parallel to the first plane and the second plane.

[0029] The system according to this third aspect may also comprise the following characteristics, taken alone or in combination whenever technically possible.

[0030] Preferably, the first flap is movable, when the set of cartridges is stored in the space in the stacked position, between: • a first position in which the first shutter is engaged with the first cartridge, so as to limit a translational movement of the first cartridge relative to the first shutter in a direction parallel to the first plane, • a second position, in which the first shutter is not engaged with the first cartridge.

[0031] Preferably: • the case defines an access to the space allowing insertion of the set of cartridges into the space, • the first slope is arranged so that, during insertion of the cartridge assembly into the space via the access, the first flap rests on the slope, and sliding of the first flap on the slope causes the first flap to move from the first position to the second position.

[0032] Preferably: • the first part includes a female element, • the first male element of the first cartridge engages with the female element of the first shutter in the first position.

[0033] Preferably, the second flap is movable, when the set of cartridges is stored in the space in the stacked position, between: • a first position in which the second flap is engaged with the second cartridge, so as to limit a translational movement of the second cartridge relative to the second flap in a direction parallel to the second plane, • a second position, in which the second shutter is not engaged with the second cartridge.

[0034] Preferably: • the case defines an access to the space allowing insertion of the set of cartridges into the space, • the case includes a base comprising: • a central part forming a bottom of the space opposite the access, • a first peripheral part extending the central part 76 beyond the first flap, and optionally a second peripheral part extending the central part beyond the second flap, the second peripheral part being opposite the first peripheral part with respect to the central part.

[0035] Preferably: • the case defines an access to the space allowing the cartridge assembly to be inserted into the space, • the case includes: • a base forming a bottom of the space opposite the access, the first flap being connected to the base by a first fold line, and the second flap being connected to the base by a second fold line, • a connecting flap connected to the first flap by a third fold line perpendicular to the first fold line, and further connected to the second flap by a fourth fold line perpendicular to the second fold line.

[0036] Preferably, the case is made of cardboard. DESCRIPTION OF FIGURES

[0037] Other characteristics, aims and advantages of the invention will emerge from the following description, which is purely illustrative and non-limiting, and which must be read in conjunction with the appended drawings in which:

[0038] [Fig.l] is a perspective view of a cartridge for surgical staples, according to one embodiment.

[0039] [Fig.2] is another perspective view of the cartridge shown in [Fig.l].

[0040] [Fig.3] is a sectional view of the cartridge shown in [Fig.l].

[0041] [Fig.4] is a top view of the cartridge shown in [Fig.l].

[0042] [Fig.5] is a top view of a set of cartridges according to a first embodiment of realization.

[0043] [Fig.6] is a perspective view of a set of cartridges according to a second embodiment, and of a case according to one embodiment.

[0044] [Fig.7] is a perspective view of the cartridge assembly and case of [Fig.6] arranged one inside the other.

[0045] [Fig.8] is a perspective view of a stack of cases, according to one embodiment.

[0046] [Fig.9] is a perspective view of a package containing a plurality of cartridges, according to one embodiment.

[0047] [Fig. 10] is a sectional view of a cartridge according to a second embodiment.

[0048] [Fig. 11] is a perspective view of the cartridge according to the second embodiment.

[0049] Throughout the figures, similar elements bear identical references. DETAILED DESCRIPTION OF THE INVENTION 1) Cartridge for surgical staples

[0050] Figures 1 to 4 show a cartridge 1 according to a first embodiment, for storing a plurality of surgical staples.

[0051] The cartridge 1 extends in a longitudinal direction indicated by an X axis, in a transverse direction indicated by a Y axis, and a vertical direction indicated by a Z axis, the X, Y and Z axes forming an orthogonal reference frame.

[0052] Generally, the cartridge 1 has an elongated shape in the longitudinal direction, in the sense that its length measured parallel to the X axis is greater than its width measured parallel to the Y axis and its height measured parallel to the Z axis.

[0053] The cartridge 1 comprises N housings 2, 3, 4 for storing N surgical staples (one staple per housing).

[0054] The N housings form a single row in the longitudinal direction. In other words, when traveling along the longitudinal direction, each housing in the row is successively traveled.

[0055] The single row of housings comprises two extreme housings 2, 4 (i.e. at the end of the row). The single row of housings may also comprise at least one intermediate housing (i.e. at least one housing between two other housings in the row). In the embodiment shown in [Fig. 1], N = 3, which implies that there is only one intermediate housing 3 in the cartridge 1 between the two extreme housings 2, 4 of the row. However, it is understood that N may be equal to 2 or strictly greater than 3.

[0056] The cartridge 1 comprises a first wall 6 and a second wall 8 between which the single row of housings, 2, 3, 4, is arranged.

[0057] The first wall 6 has a first internal surface 10, delimiting each of the housings 2, 3, 4 of the single row, and a first external surface 12 opposite the first internal surface 10. The first external surface 12 forms a first edge of the cartridge 1. The first inner surface 10 and the first outer surface 12 extend in the longitudinal direction and in the vertical direction. The first outer surface 12 is planar, and extends in a first plane parallel to the plane (X, Z).

[0058] With reference to [Fig.2], the second wall 8 has a second internal surface 14, delimiting each of the housings of the single row, and a second external surface 16 opposite the second internal surface 14. The second external surface 16 forms a second edge of the cartridge 1 opposite the first edge. The second internal surface 14 and the second external surface 16 extend in the longitudinal direction. The second external surface 16 is planar and extends in a second plane parallel to the plane (X, Z).

[0059] The first wall 6 and the second wall 8 comprise deformable portions 18, 20 by compression, serving as support points for the surgical staples when these are stored in the housings. The deformable portions 18, 20 are arranged to be mutually facing in each of the housings 2, 3, 4, such that a staple stored in any of the housings 2, 3, 4 presses simultaneously on the deformable portions 18, 20 to compress them, which allows the staple to be held by compression in the housing. The deformable parts 18, 20 are for example ribs projecting from the first internal surface 10 and from the second internal surface 14. Ultimately, the deformable parts 18, 20 therefore form retaining means for retaining surgical staples in the housings 2, 3, 4. However, it is understood that this retaining function can be ensured by retaining means having a different shape.

[0060] The cartridge 1 further comprises a third wall 22 and a fourth wall 24 between which the single row of housings 2, 3, 4 is arranged. The third wall 22 and the fourth wall 24 each connect the first wall 6 to the second wall 8.

[0061] The third wall 22 has a third internal surface 26, delimiting only the end housing 2, and a third external surface 28 opposite the third internal surface 26. The third external surface 28 forms a third edge of the cartridge 1. The third internal surface 26 and the third external surface 28 extend in the transverse direction, as well as in the vertical direction. The third external surface 28 is perpendicular to the first external surface 12 and to the second external surface 16.

[0062] The fourth wall 24 has a fourth internal surface 30, delimiting only the other end housing of the single row, and a fourth external surface 32 opposite the fourth internal surface 30. The fourth external surface 32 forms a fourth edge of the cartridge 1 opposite the third edge. The fourth internal surface 30 and the fourth external surface 32 extend in the direction transverse, as well as in the vertical direction. The fourth external surface 32 is perpendicular to the first external surface 12 and to the second external surface 16.

[0063] The cartridge 1 further comprises a plurality of partitions 34, 36. Each partition 34, 36 connects the first wall 6 to the second wall 8, extending from the first internal surface 10 to the second internal surface 14. Each partition 34, 36 separates two adjacent housings of the single row. The number of partitions is equal to N1, such that each housing can only store one surgical staple at a time. Thus, in the embodiment illustrated in Figures 1 to 4 in which N = 3, a first partition 34 separates the end housing 2 and the intermediate housing 3, and a second partition 36 separates the intermediate housing 3 and the other end housing 4.

[0064] The first wall 6, the second wall 8, the third wall 22, the fourth wall 24 delimit N openings giving access to the housings of the single row, in order to allow the insertion of surgical staples into these housings 2, 3, 4 by a translational movement in the vertical direction. The partitions 34, 36 also contribute to delimiting these openings.

[0065] With reference to [Fig. 3], the cartridge 1 further comprises a bottom wall 38 having an upper surface 40 and a lower surface 42 opposite the upper surface 40. The upper surface 40 forms the respective bottoms of the housings 2, 3, 4, these bottoms being opposite the openings giving access respectively to the housings 2, 3, 4.

[0066] The bottom wall 38 extends in a plane parallel to the longitudinal direction and to the transverse direction.

[0067] The cartridge 1 further comprises supports 44, each support 44 is arranged in a housing 2, 3, 4 to be overlapped by a surgical staple, when this surgical staple is stored in the housing 2, 3, 4. Each support 44 has a convex top intended to rest against a concave surface of a surgical staple, this concave surface being formed in a connecting part between two arms of the surgical staple.

[0068] The cartridge 1 forces surgical staples to adopt particular respective storage positions, when these staples are stored in the housings 2, 3, 4.

[0069] Each surgical staple comprises a first arm and a second arm that can rotate relative to the first arm about a rotation axis, between an open position and a closed position. The open position, visible in [Fig. 3], is a rest position of the surgical staple. In the closed position, the two arms are closer to each other than in the open position. The first arm and the second arm are connected by a connecting portion forming a pivot connection between the two arms. The relative mobility of the two arms is obtained by deformation of the connecting part.

[0070] With reference to [Fig. 4], when a staple is in the storage position in one of the housings 2, 3, 4, the surgical staple is oriented such that the axis of rotation R of the surgical staple is normal to the first internal surface 10 and to the second internal surface 14, in other words parallel to the transverse direction indicated by the axis Y.

[0071] In each housing 2, 3, 4, the transverse gap between the first wall 6 and the second wall 8, measured in the transverse direction, is chosen to constrain a surgical staple to adopt the preceding orientation. In particular, this transverse gap is chosen to prevent the storage of a staple in a housing in a position where the rotation axis R of the staple would be parallel to the transverse direction, as in the cartridge 1 described in document US 2019 / 0133594.

[0072] Furthermore, there is a reference plane P which is perpendicular to the axis of rotation R of each of the surgical staples, and which intersects each of the surgical staples, when these surgical staples are respectively stored in the housings 2, 3, 4. [Fig. 3] also shows a section of the cartridge 1 in this reference plane P. In this case, the reference plane P is a median plane equidistant from the first internal surface 10 and the second internal surface 14, and which intersects each housing 2, 3, 4 of the single row of housings, as well as the third wall 22, the fourth wall 24, and each partition 34, 36.

[0073] Furthermore, in its storage position, the connecting part of a surgical staple rests on one of the supports 44, and the two arms of the staple extend on either side of the support 44 (hence the overlap mentioned above), as can be seen in [Fig. 3].

[0074] By forming housings 2, 3, 4 which constrain the surgical staples to be arranged in the preceding positions, the width of the cartridge 1 measured along the Y axis can be greatly reduced. Moreover, the width of the cartridge 1 shown in the figures is significantly less than its length and its height.

[0075] Returning to [Fig.l], the cartridge 1 comprises first locking means 40, 41 for limiting a movement of the cartridge 1 relative to a first adjacent structure in a direction parallel to the reference plane P of the cartridge 1. It will be seen below that this adjacent structure can be another cartridge having the same characteristics as the cartridge 1, or else a flap of a case.

[0076] More precisely, the first locking means 40, 41 are adapted to limit a translational movement of the cartridge 1 relative to the first adjacent structure in any direction parallel to the reference plane P, in particular in the longitudinal direction and in the vertical direction.

[0077] The first locking means comprise a first male element 40 adapted to be engaged with a female element of the first adjacent structure.

[0078] The first male element 40 projects from the first external surface 12. The first male element 40 has a first slope extending the first flat surface, the first slope being inclined relative to the first flat surface at an obtuse angle. It will be seen below that this obtuse angle is advantageous for deflecting the trajectory of a shutter sliding along the first wall 6.

[0079] The first locking means further comprise a first female element 41 adapted to be engaged with a male element of the first adjacent structure. The first female element 41 is formed by a hole in the first external surface 12. This hole is blind; it therefore does not open into the first internal surface 10. The hole opens exclusively into the first external surface 12.

[0080] The first male element 40 is arranged between the first female element 41 and the edge of the cartridge formed by the fourth wall 24. In other words, the first male element 40 is closer to the fourth wall 24 than the first female element 4L. The first female element 41 is arranged between the first male element 40 and the edge formed by the third wall 22. In other words, the first female element 41 is closer to the third wall 22 than the first male element 40.

[0081] With reference to [Fig.2], the cartridge 1 further comprises second locking means 42, 43 for limiting a movement of the cartridge 1 relative to a second adjacent structure in a direction parallel to the reference plane of the cartridge 1.

[0082] More precisely, the second locking means are adapted to limit a translational movement of the cartridge 1 relative to the second adjacent structure in any direction parallel to the reference plane P, in particular in the longitudinal direction and in the vertical direction.

[0083] The second locking means 42, 43 are opposite the first locking means 40, 41 with respect to the single row of housings 2, 3, 4. Thus, the first locking means 40, 41 and the second locking means 42, 43 are intended to cooperate respectively with two different adjacent structures between which the cartridge 1 can be placed.

[0084] The second locking means comprise a second male element 42 adapted to be engaged with a female element of the second adjacent structure. The second male element 42 is opposite the first male element 40 with respect to the single row of housings.

[0085] The second male element 42 projects from the second external surface 16. The second male element 42 has a second slope extending the second flat surface, the second slope being inclined relative to the second flat surface at an obtuse angle. We will see later that this obtuse angle is advantageous for deflecting the trajectory of a shutter sliding along the second wall 8.

[0086] The second locking means further comprise a second female element 43 adapted to be engaged with a male element of the second adjacent structure. The second female element 43 is opposite the first female element 41 with respect to the single row of housings. The second female element 43 is formed by a hole in the second external surface 16. This hole is blind; it therefore does not open into the second internal surface 14. The hole opens exclusively into the second external surface 16.

[0087] The second male element 42 is arranged between the second female element 43 and the edge of the cartridge formed by the third wall 22. In other words, the second male element 42 is closer to the third wall 22 than the second female element 43. The second female element 43 is arranged between the second male element 42 and the edge formed by the fourth wall 24. In other words, the second female element 43 is closer to the fourth wall 24 than the second male element 42.

[0088] The second locking means 42, 43 are symmetrical to the first locking means 40, 41 with respect to a central axis of the cartridge 1 parallel to the vertical direction. In particular, the second male element 42 is symmetrical to the first male element 40 with respect to this central axis, and the second female element 43 is symmetrical to the first female element 41 with respect to this central axis. 2) Cartridge set

[0089] [Fig.5] shows a set of cartridges, including cartridge 1.

[0090] The set of cartridges further comprises a first adjacent cartridge 1' acting as a first adjacent structure for the cartridge 1. Thus, the first locking means 40, 41 of the cartridge 1 are adapted to limit a movement of the cartridge 1 relative to the first adjacent cartridge 1' in a direction parallel to the reference plane of the cartridge 1.

[0091] The first adjacent cartridge 1' has the same structure as the cartridge 1.

[0092] A limitation of movement of the cartridge 1 relative to the first adjacent cartridge 1' in a direction parallel to the reference plane of the cartridge (and parallel to the reference plane of the first adjacent cartridge 1') can be achieved by stacking the cartridge 1 and the first adjacent cartridge 1' in each of the following alternative positions: • In a first position shown in [Fig.5], in which the first wall 6 of the cartridge 1 is positioned against the second wall 8 of the first adjacent cartridge 1' and in which the first locking means 40, 41 of the cartridge 1 are engaged with the second locking means 42, 43 of the first adjacent cartridge 1'. • In a second position, in which the first wall 6 of the cartridge 1 is positioned against the first wall 6 of the first adjacent cartridge 1', and in which the first locking means 40, 41 of the cartridge 1 are engaged with the first locking means 40, 41 of the first adjacent cartridge 1'. • In a third position, in which the second wall 8 of the cartridge 1 is positioned against the first wall 6 of the first adjacent cartridge 1', and in which the second locking means 42, 43 of the cartridge 1 are engaged with the first locking means 40, 41 of the first adjacent cartridge 1', • In a fourth position, in which the second wall 8 of the cartridge 1 is positioned against the second wall 8 of the first adjacent cartridge 1', and in which the second locking means 42, 43 of the cartridge 1 are engaged with the second locking means 42, 43 of the first adjacent cartridge 1'.

[0093] In each of these positions, a male element (40 or 42) of the cartridge 1 is engaged with a female element (41 or 43) of the first adjacent cartridge 1', and a female element (41 or 43) of the cartridge 1 is engaged with a male element (40 or 42) of the first adjacent cartridge 1'.

[0094] It should be noted that the symmetrical nature of the first and second locking means described above contributes to making these multiple alternative positions possible. However, these alternative positions could also be obtained with locking means which are not perfectly symmetrical in the cartridge 1 and / or in the first adjacent cartridge 1'.

[0095] The cartridge assembly further comprises a second adjacent cartridge 1” acting as a second structure adjacent to the cartridge 1, such that the cartridge 1 is located between the first adjacent cartridge 1' and the second adjacent cartridge 1”.

[0096] The second adjacent cartridge 1” has a shape identical to that of the cartridge 1, which allows mutual locking between the cartridge and the second adjacent cartridge 1” by placing the cartridge and the second cartridge in four different alternative positions, as already described above for the cartridge and the first adjacent cartridge 1'. 3) Case for cartridge set

[0097] With reference to [Fig.6], a case 50 has the function of holding the cartridges of a set of stacked cartridges.

[0098] The case 50 extends in a longitudinal direction indicated by an axis X', in a transverse direction indicated by an axis Y', and a vertical direction indicated by an axis Z', the axes X', Y' and Z' forming an orthogonal reference frame.

[0099] Generally, the case has an elongated shape in the longitudinal direction, in the sense that its length measured parallel to the X' axis is greater than its width measured parallel to the Y' axis and its height measured parallel to the Z' axis.

[0100] The case comprises a first flap 52 and a second flap 54 at a distance from the first flap 52, so as to define between them a space 53 for storing a set of K identical cartridges. For this purpose, the distance between the flaps 52, 54 is substantially equal to K times the width of one of the cartridges. In the embodiment illustrated in [Fig.6], the set of cartridges consists of cartridges 1 and 1' (K = 2), but in other embodiments the set of cartridges may comprise a greater number of identical cartridges (for example the set formed by the three cartridges 1, 1' and 1" shown in [Fig.5], or a set comprising more cartridges).

[0101] The first flap 52 has a first internal surface 56 delimiting the space 53, and a first external surface 58 opposite the first internal surface 56. The first flap 52, in particular the first internal surface 56, extends in the longitudinal direction indicated by the axis X'.

[0102] The first flap 52 comprises a first female element 60. The first female element 60 is in the form of a hole opening into the first internal surface 56. The female element 60 also opens into the first external surface 58; in other words, the female element 60 is formed by a through hole.

[0103] The second flap 54 has a second internal surface 62 delimiting the space 53, and a second external surface 64 opposite the second internal surface 62. The second internal surface 62 faces the first internal surface 56. The second flap 54, in particular the second internal surface 62, extends in the longitudinal direction indicated by the axis X'.

[0104] The second flap 54 comprises a second female element 66. The second female element 66 is in the form of a hole opening into the second internal surface 62. The female element also opens into the second external surface 64; in other words, the female element 66 is formed by a through hole.

[0105] The case 50 further comprises a connecting flap 68 between the first flap 52 and the second flap 54. The connecting flap 68 is connected to the first flap 52 by a first vertical fold line, and is connected to the second flap 54 by a second vertical fold line. The first vertical fold line and the second vertical fold line are parallel to the vertical axis Z'.

[0106] The case 50 further comprises a base 70 intended to stabilize the case 50 when the case 50 is placed on a support.

[0107] The case 50 further defines an access to the space 53 via which the set of cartridges 1,1' can be inserted. The access comprises an upper opening opposite the base 70 with respect to the space 53, and a lateral opening opposite the connecting flap 68 with respect to the space 53. In this way, the set of cartridges can be inserted into the space 53 via the upper opening, or via the lateral opening, according to orthogonal translations.

[0108] The first flap 52, the second flap 54 and the connecting flap 68 extend transversely to the base 70.

[0109] The base 70 has an upper surface 72 and a lower surface 74 opposite the upper surface 72. The lower surface 74 is intended to rest on a support. The lower surface 72 is flat.

[0110] The base 70 comprises a central portion 76 forming a bottom of the space 53, and extending from the first flap 52 to the second flap 54.

[0111] The connecting flap 68 is connected to the central part 76 by a third fold line, perpendicular to the first fold line and the second fold line.

[0112] The base 70 further comprises a first peripheral portion 78, and a second peripheral portion 80 opposite the first peripheral portion 78 with respect to the central portion 76. In other words, the central portion 76 extends between the first peripheral portion 78 and the second peripheral portion 80. The first peripheral portion 78 extends the central portion 76 beyond the first flap 52, and the second peripheral portion 80 extends the central portion 76 beyond the second flap 54. The central portion 76, the first peripheral portion 78 and the second peripheral portion 80 are coplanar.

[0113] The two peripheral parts 78 and 80 have the advantage of giving the case 50 better stability. They prevent the case from tilting by rotation around an axis parallel to the X' axis.

[0114] The base 70 further comprises an additional connecting flap 82 connecting the first flap 52 to the first peripheral portion 78. The connecting flap 82 is connected to the first peripheral portion 78 by a third longitudinal fold line. The connecting flap 82 is folded against the upper surface 72 of the base 70, at the first peripheral portion 78. The connecting flap 82 is further connected to the first flap 52 by a fourth longitudinal fold line. The third longitudinal fold line and the fourth longitudinal fold line are parallel to the axis X'.

[0115] The base 70 further comprises another additional connecting flap 84 connecting the second flap 54 to the second peripheral part 80. The connecting flap 84 is connected to the second flap 54 by a fifth longitudinal fold line parallel to the axis X'. Furthermore, the connecting flap 84 is glued to the upper surface 72, against the second peripheral part 80.

[0116] The case 50 is formed from a single piece, made of a deformable material, typically cardboard. This piece of cardboard is folded on itself at the longitudinal and vertical fold lines mentioned above, and the flaps 82 and 84 are glued so as to form the case 50.

[0117] The first flap 52 is movable between several positions. A first position of the first flap 52, shown in [Fig. 6], constitutes a rest position of the first flap, that is to say the position that the first flap 52 naturally takes in the absence of external stress. When the first flap 52 is in its first position, the first internal surface 56 is flat, and extends in the vertical direction indicated by the axis Z', that is to say perpendicular to the base 70.

[0118] The first flap 52 can further be placed in a second position by pressing on the first inner surface 56, causing a deformation of the first flap 52 and partially separating the first flap 52 from the second flap 54. In the second position, the first inner surface 56 is convex, while the first outer surface 58 is concave. Furthermore, the female element 60 is further from the second flap 54 in the second position than in the first position. In the second position of the first flap 52, the first flap 52 remains connected to the flaps 68 and 82 via the first vertical fold line and the first longitudinal fold line, respectively.

[0119] Similarly, the second flap 54 is also movable between several positions.

[0120] A first position of the second flap 54, shown in [Fig. 6], constitutes a rest position of the second flap 54, that is to say the position that the second flap 54 naturally takes in the absence of external stress. When the second flap 54 is in its first position, the second internal surface 62 is flat, and extends in the vertical direction indicated by the axis Z', that is to say perpendicular to the base 70.

[0121] The second flap 54 may further be placed in a second position by pressing on the second inner surface 62, causing a deformation of the second flap 54 and partially separating the second flap 54 from the first flap 52. In the second position, the second inner surface 62 is convex, while the second outer surface 64 is concave. Furthermore, the female element 66 is further from the first flap 52 in the second position of the second flap 54 than in its first position. In the second position of the second flap 54, the second flap 54 remains connected to the flaps 68 and 84 via the second vertical fold line and the second longitudinal fold line, respectively. 4) Cartridge packaging process

[0122] A method of packaging surgical staples comprises the following steps.

[0123] A user places surgical staples in the housings 2, 3, 4 of the cartridge 1, and places surgical staples in the housings 2, 3, 4 of the cartridge 1', as illustrated in Figures 1 to 4.

[0124] Furthermore, the user stacks the cartridges 1 and 1' by pressing the second external surface 16 of the cartridge 1 against the first external surface 12 of the cartridge 1', so that the second locking means 42, 43 of the cartridge 1 are engaged with the first locking means 40, 41 of the cartridge 1'.

[0125] The first external surface 12 of the cartridge 1 (on the left in [Fig.6]) and the second external surface 16 of the cartridge 1' (on the right in [Fig.6]) form two opposite edges of the set of cartridges thus formed. It should be noted that the width of the set formed by the stacked cartridges 1, 1', measured between these two opposite edges, is substantially equal to the width of the space 53 defined by the case 50, that is to say the distance which separates the first flap 52 from the second flap 54 measured parallel to the axis Y'.

[0126] The case 50 is placed on a horizontal support, with the lower surface 76 of the base 70 facing downwards, in contact with the horizontal support.

[0127] A user grasps the cartridge assembly 1, 1' by its two opposite edges formed by the first external surface 12 of the cartridge 1 and by the second external surface 16 of the cartridge 1', so as to keep the cartridges 1 and 1' stacked. The user positions the cartridge assembly 1, 1' above the space 53, in an orientation such that the axes X and X' are parallel, the axes Y and Y' are parallel and the axes Z and Z' are parallel, as shown in [Fig. 6]. The openings of the housings 2, 3, 4 of the cartridges 1 and 1' are oriented upwards. Furthermore, the user substantially aligns the first external surface 12 of the cartridge 1 with the internal surface 56 of the first flap, and substantially aligns the second external surface 16 with the internal surface 62 of the second flap 54.

[0128] The user inserts the set of cartridges 1, 1' into the space 53 by moving it in translation in the vertical direction indicated by the axis Z', towards the bottom of the space 53 formed by the base 70.

[0129] During this insertion, the first external surface 12 of the cartridge 1 runs along the internal surface 56 of the first flap 52, or even slides against the latter. At a certain stage, the first flap 52 bears on the inclined slope of the male element 40 of the cartridge 1. However, the insertion can continue due to the obtuse nature of the angle of the inclined slope. The sliding of the first flap 52 against the inclined slope of the male element 40 causes a displacement of the first flap from its first position (rest position) to its second position discussed previously. When the cartridge assembly 1, 1' comes into abutment against the base 70, the first male element 40 of the cartridge 1 is aligned with the hole formed by the female element 60, so that the first male element 40 no longer presses on the first flap 52. At this stage, the first flap 52 returns to its first position by elastic return, and the first male element 40 of the cartridge 1 then engages in the hole formed by the female element 60. The first male element 40 of the cartridge 1 and the female element 60 are thus engaged, which has the effect of limiting or even preventing a translational movement of the cartridge 1 relative to the first flap 52 along the X' axis and along the Z' axis, and therefore an exit of the cartridge assembly from the space 53.

[0130] Furthermore, during insertion, the second external surface 16 of the cartridge 1' runs along the internal surface 62 of the second flap 54, or even slides against the latter. At a certain stage, the second flap 54 bears on the inclined slope of the male element 42 of the cartridge 1'. The sliding of the second flap 54 against the inclined slope of the male element 42 causes a movement of the second flap 54 from its first position (rest position) to its second position. When the set of cartridges 1, 1' comes into abutment against the base 70, the second male element 42 of the cartridge 1' is aligned with the hole formed by the female element 66, so that the second male element 42 of the cartridge 1' no longer presses on the second flap 54. At this stage, the second flap 54 returns to its first position by elastic return, and the second male element 42 of the cartridge 1' then engages in the hole formed by the female element 66.The second male element 42 of the cartridge 1 and the female element 66 are thus engaged, which has the effect of limiting or even preventing a translational movement of the cartridge 1' relative to the second flap 54 along the axis X' and along the axis Z', and therefore an exit of the set of cartridges from the space 53.

[0131] The set of cartridges is now stored in the space 53 of the case 50, in a position shown in [Fig.7] where the cartridges 1 and 1' are kept stacked and where the respective reference planes of the cartridges 1 and 1' extend parallel to the first flap 52 and the second flap 54.

[0132] It is also noted that the two flaps 52 and 54 limit or even prevent translational movement of the set of cartridges 1, 1' relative to the case 50 along the Y' axis.

[0133] The inclined slopes formed on the male elements 40 and 42 of the cartridges 1 and 1' have the advantage of facilitating the insertion of the set of cartridges 1, 1' into the space 53. Thanks to these slopes, the user does not need to manually separate the two flaps 52 and 54 from each other.

[0134] It is also possible to insert the set of cartridges 1, 1' into the space 53 via a translational movement along the axis X', after having placed the set of cartridges opposite the connecting flap 68. In this case, the user must manually separate the two flaps 52, 54.

[0135] With reference to [Fig.8], the preceding steps are repeated for other 50' and 50” cases having the same characteristics as the 50 case. Then, the 50, 50' and 50” cases can be stacked head to tail so as to optimize the storage space of the set of 50, 50', 50” cases.

[0136] The above method can be generalized to other embodiments in which the number K of cartridges in the set is greater than or equal to three. In these embodiments, there is at least one cartridge which is surrounded by two other cartridges in the cartridge set, as is the case of cartridge 1 in the set of three cartridges shown in [Fig. 5]. Each cartridge of this type is not intended to be engaged with the case 50, but to be engaged with the two adjacent cartridges which surround it, which makes it possible to maintain the set in the space 53 of the case 50.

[0137] Another type of packaging is shown in [Fig.9]. The packaging 90 such as a peelable bag contains a plurality of cartridges 1. The cartridges 1 are arranged in the packaging 90 so that their respective planes P coincide. Thanks to this arrangement, the packaging 90 can remain very flat.

[0138] 5) Use of the cartridge intracorporeally

[0139] The cartridge 1 is very advantageously suited to intracorporeal use. Such use typically comprises the following steps.

[0140] The cartridge 1 is placed between the jaws of a first instrument such as pliers, such that each housing of the cartridge remains accessible from the outside by one of the two opposite sides of the jaws. For this, the cartridge is oriented such that: one of the jaws rests on the first external surface 12 and the other jaw rests on the second external surface 16.

[0141] The jaws of the first instrument may be movable (such as the jaws of a clamp) or fixed and parallel to the external surfaces 12 and 16, so that the space between the two jaws is less than the distance between the first external surface 12 and the second external surface 16.

[0142] The first instrument is then moved through a first trocar introduced into the body of a patient, towards a site for placing at least one of the staples stored in the cartridge 1. The elongated shape of the cartridge 1 allows it to be inserted into a trocar of reduced diameter, which is very advantageous.

[0143] An applicator adapted for removing surgical staples, constituting a second instrument, is placed in a second trocar introduced into the patient's body.

[0144] From outside the patient's body, a user can move the applicator inside the body relative to the first instrument, so as to grasp and remove a staple from the cartridge 1 held between the jaws of the first instrument, and bring the grasped staple to the site where this staple is to be placed. These steps can be repeated to place several staples stored in the cartridge 1 on the placement site. As indicated in the introduction, this method avoids the user having to go back and forth between the inside and outside of the body to place different staples, and thus makes it possible to reduce the duration of the operation. 6) Other embodiments

[0145] [Fig. 10] shows a cartridge 100 according to a second embodiment. The cartridge 100 comprises all the walls, partitions and locking means of the cartridge 1 described above.

[0146] The cartridge 100 differs from the cartridge 1 in that it comprises not a single row of housings, but two rows of housings: a first row of N housings opening onto a first side of the cartridge 100 (corresponding to the single row of housings of the cartridge 1), and a second row of N housings 102, 103, 104 opening onto a second side of the cartridge opposite the first side of the cartridge 100.

[0147] Just as in the cartridge 1, there is a reference plane P which is perpendicular to the axis of rotation R of each of the surgical staples, and which intersects each of the surgical staples, when these surgical staples are respectively stored in the housings of the first row and the second row of the cartridge 100. [Fig. 10] also shows a section of the cartridge 100 in this reference plane P.

[0148] The bottom wall 38 forms not only the respective bottoms of the housings 2, 3, 4 of the first row, but also the respective bottoms of the housings 102, 103, 104 of the second row. In other words, the bottom wall 38 separates the first row of housings and the second row of housings.

[0149] With reference to [Fig. 11], the cartridge 100 further comprises two first stops 110, 112 projecting from the external surface 12 of the first wall 6, so as to delimit between them a first hollow for receiving a first jaw of the first instrument as mentioned previously. The stop 110 runs along the openings of the housings of the first row of housings, while the stop 112 runs along the openings of the housings of the second row of housings. The stops 110, 112 extend rectilinearly in the longitudinal direction parallel to the axis X.

[0150] The cartridge 100 further comprises two second stops 114, 116 projecting from the external surface 16 of the second wall 8, so as to delimit between them a second hollow for receiving a second jaw of the first instrument as mentioned previously. The stop 114 runs along the openings of the housings of the first row of housings, while the stop 116 runs along the openings of the housings of the second row of housings. The stops 114, 116 extend rectilinearly in the longitudinal direction parallel to the axis X.

[0151] The cartridge 100 can of course constitute an alternative to the cartridge 1, 1' or 1” in all the uses as described previously.

[0152] In particular, the cartridge 100 has the advantage of being even easier to use intracorporeally. The first jaw is received in the hollow formed between the first stops 110, 112, and the second jaw is received in the hollow formed between the second stops 114, 116. The first jaw bears on the first external surface 12 at the bottom of the first hollow, and the second jaw bears on the second external surface 16 at the bottom of the second hollow.

[0153] In this grasped position, the housings of the first row are accessible by a first lateral side of the first instrument and the housings of the second row are accessible by a second lateral side of the first instrument opposite the first lateral side.

[0154] In this grasped position, the stops 110, 112, 114, 116 limit or even prevent a displacement stroke of the cartridge 100 in a direction transverse to the jaws, thus preventing the cartridge from escaping through one of the two lateral sides of the first instrument.

[0155] A user wishing to remove a staple from the cartridge 100, while the latter is full, can choose to orient the first instrument in two different ways to allow the extraction of a staple contained in a housing of the first row, or of a staple contained in a housing of the second row.

Claims

1. Claims Cartridge (1) comprising: • housings (2, 3, 4) for storing respective surgical staples, each of the surgical staples comprising two arms, one of the two arms being rotatable relative to the other arm about an axis of rotation to close the surgical staple, wherein all the housings (2, 3, 4) of the cartridge are configured so that, when the surgical staples are respectively stored in all the housings (2, 3, 4) of the cartridge (1), the surgical staples adopt respective positions such that a plane (P) perpendicular to the axis of rotation (R) of each of the surgical staples intersects each of the surgical staples, • first locking means (40, 41) for limiting a movement of the cartridge (1) relative to a first adjacent structure in a direction parallel to the plane (P), the first locking means (40, 41) comprising at least one of: • a first male element (40) adapted to be engaged with a female element of the first adjacent structure, • a first female element (41) adapted to be engaged with a male element of the first adjacent structure, and • second locking means (42, 43) for limiting a movement of the cartridge (1) relative to a second adjacent structure in a direction parallel to the plane (P), the second locking means (42, 43) being opposite the first locking means (40, 41) relative to the housings (2, 3, 4) and being symmetrical to the first locking means relative to a vertical axis parallel to the plane (P) and perpendicular to the axis of rotation of each of the surgical staples when the surgical staples are respectively stored in all the housings (2, 3, 4) of the cartridge (1), the second locking means (42, 43) comprising at least one of: • a second male element (42) adapted to be engaged with a female element of the second adjacent structure, • a second female element (43) adapted to be engaged with a male element of the second adjacent structure.

2. Cartridge according to the preceding claim, comprising the surgical staples respectively stored in all the housings (2, 3, 4).

3. A cartridge according to any preceding claim, wherein the housings comprise a first row of housings opening onto a first side of the cartridge, and a second row of housings opening onto a second side of the cartridge opposite the first side.

4. Cartridge according to any one of the preceding claims, comprising: • a first wall (6) and a second wall (8) delimiting the housings between them, the first wall (6) having a first external surface (12) and the second wall having a second external surface (16) opposite the first external surface (12), • two stops (110, 112) projecting from the first external surface (12) so as to delimit a hollow between them, the two stops being arranged to allow the cartridge to be placed in a position gripped by an instrument, in which: • a first jaw of the instrument bears on the first external surface (12) and a second jaw of the instrument bears on the second external surface (16), • each housing of the cartridge is accessible via a first side of the instrument or via a second side of the instrument opposite the first side, • the first jaw extends into the hollow between the two stops.

5. Cartridge according to the preceding claim, comprising two second stops (114, 116) projecting from the second external surface (16) so as to delimit between them a second hollow, the two second stops (114, 116) being arranged so that, in the gripped position, the second jaw extends into the second hollow between the second stops (114, 116).

6. A cartridge according to any preceding claim, wherein the first locking means (40, 41) comprise the first male element (40) and the first female element (41).

7. Cartridge according to the preceding claim, in which the first locking means (40, 41) are adapted to limit a translational movement of the cartridge relative to the first adjacent structure in any direction parallel to the plane (P).

8. A cartridge according to any one of claims 6 and 7, comprising a first wall (6) having a first planar surface (12), wherein the first male element (40) projects from the first planar surface (12) and has a first slope extending the first planar surface (12), the first slope being inclined relative to the first planar surface at an obtuse angle.

9. A cartridge according to any one of claims 6 to 8, wherein the second locking means (42, 43) comprise the second male element (42) and the second female element (43).

10. Cartridge according to the preceding claim, in which the second locking means are adapted to limit a translational movement of the cartridge relative to the second adjacent structure in any direction parallel to the plane (P).

11. A cartridge assembly comprising a first cartridge and a second cartridge, wherein • the first cartridge and the second cartridge each comprise housings (2, 3, 4) for storing respective surgical staples, each of the surgical staples comprising two arms, one of the two arms being rotatable relative to the other arm about an axis of rotation to close the surgical staple, wherein all of the housings (2, 3, 4) of the cartridge are configured so that, when the surgical staples are respectively stored in all the housings (2, 3, 4) of the cartridge (1), the surgical staples adopt respective positions such that a plane (P) perpendicular to the axis of rotation (R) of each of the surgical staples intersects each of the surgical staples, the first cartridge and the second cartridge each comprise first locking means (40, 41) for limiting a movement of the cartridge (1) relative to a first adjacent structure in a direction parallel to the plane (P), the first locking means (40, 41) comprising at least one of: • a first male element (40) adapted to be engaged with a female element of the first adjacent structure, • a first female element (41) adapted to be engaged with a male element of the first adjacent structure, and the first cartridge comprises second locking means (42, 43) for limiting a movement of the cartridge (1) relative to a second adjacent structure in a direction parallel to the plane (P), the second locking means (42, 43) being opposite the first locking means (40, 41) relative to the housings (2, 3, 4), the second locking means (42, 43) comprising at least one of: • a second male element (42) adapted to be engaged with a female element of the second adjacent structure, a second female element (43) adapted to be engaged with a male element of the second adjacent structure, wherein the first locking means (40, 41) of the second cartridge (1) are adapted to: • be engaged with the first locking means (40, 41) of the first cartridge (1), when the first cartridge (1) is in a first orientation relative to the second cartridge (1'), and • be engaged with the second locking means (42, 43) of the first cartridge (1), when the first cartridge (1) is in a second orientation relative to the second cartridge (1'), the second orientation being different from the first orientation.

12. System comprising: • a set of cartridges (1, 1') comprising: • a first cartridge (1) according to any one of claims 1 to 10, • a second cartridge (1') according to any one of claims 1 to 10, • a case (50) comprising: • a first flap (52) extending in a first plane and a second flap (54) extending in a second plane, the first flap 52 and the second flap 54 defining between them a space (53) for storing the set of cartridges (1, 1') in a stacked position in which the plane (P) of the first cartridge (1) and the plane (P) of the second cartridge (1') are parallel to the first plane and the second plane.

13. System according to the preceding claim, in which the first flap (52) is movable, when the set of cartridges is stored in the space (53) in the stacked position, between: • a first position in which the first flap (52) is engaged with the first cartridge (1), so as to limit a translational movement of the first cartridge (1) relative to the first flap (52) in a direction parallel to the first plane, • a second position, in which the first flap (52) is not engaged with the first cartridge (1).

14. System according to the preceding claim, in which: • the case (50) defines an access to the space (53) allowing insertion of the set of cartridges (1, 1') into the space (53), • the first cartridge (1) is in accordance with claim 8, • the first slope is arranged so that, during insertion of the set of cartridges into the space (53) via the access, the first flap (52) bears on the slope, and sliding of the first flap (52) on the slope causes the first flap (52) to move from the first position to the second position.

15. System according to any one of claims 13 and 14, in which • the first flap (52) comprises a female element (60), • the first male element (40) of the first cartridge (1) engages with the female element (60) of the first flap (52) in the first position.

16. System according to any one of claims 12 to 15, in which the second flap (54) is movable, when the set of cartridges is stored in the space (53) in the stacked position, between: • a first position in which the second flap (54) is engaged with the second cartridge (1'), so as to limit a translational movement of the second cartridge (1') relative to the second flap (54) in a direction parallel to the second plane, • a second position, in which the second flap (54) is not engaged with the second cartridge (1').

17. System according to any one of claims 12 to 16, in which: • the case (50) defines an access to the space (53) allowing insertion of the set of cartridges (1, 1') into the space (53), • the case (50) comprises a base (70) comprising: • a central part (76) forming a bottom of the space (53) opposite the access, • a first peripheral part (78) extending the central part 76 beyond the first flap (52), and optionally a second peripheral part (80) extending the central part (76) beyond the second flap (54), the second peripheral part (80) being opposite the first peripheral part (78) relative to the central part (76).

18. A system according to any one of claims 12 to 17, wherein: • the case (50) defines an access to the space allowing the set of cartridges to be inserted into the space (53), • the case (50) includes: • a base (70) forming a bottom of the space opposite the access, the first flap (52) being connected to the base by a first fold line, and the second flap being connected to the base by a second fold line, • a connecting flap (68) connected to the first flap (52) by a third fold line perpendicular to the first fold line, and further connected to the second flap (54) by a fourth fold line perpendicular to the second fold line.

19. A system according to any one of claims 12 to 18, wherein the case (50) is made of cardboard.

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