DEVICE FOR APPLYING A BUTRESS TO AN END EFFECTOR OF A SURGICAL STAPLER THROUGH A FIXED BASE - Patent application

Abstract

The device includes a body having a first body portion, a second body portion opposing the first body portion, and a connecting portion connecting a proximal end of the first body portion to the proximal end of the second body portion. The connecting portion is configured to allow the first body portion and the second body portion to move toward and away from each other between a plurality of angular orientations. The first body portion and the second body portion define a distal opening angle. The first and second attachment elements are disposed on outwardly facing surfaces of the first and second body portions. The first and second body portions may be fixed in each of the angular orientations, allowing the first and second attachment elements to be simultaneously applied to the first and second jaws of a surgical stapler end effector, respectively.

Description

[Background technology]

[0001] In some surgical situations, endoscopic surgical instruments may be preferred over traditional open surgical devices because they allow for smaller incisions in the patient, reducing postoperative recovery time and complications. Some endoscopic surgical instruments are suitable for positioning a distal end effector at a desired surgical site through a trocar cannula. These distal end effectors can engage tissue in various ways to achieve diagnostic or therapeutic effects (e.g., endocutters, graspers, cutters, staplers, clip appliers, access devices, drug / gene therapy delivery devices, and energy delivery devices using ultrasound, RF, lasers, etc.). Endoscopic surgical instruments may include a shaft between the end effector and a handle portion that is manipulated by the clinician. Such a shaft may allow insertion to a desired depth and rotation about the shaft's longitudinal axis, thereby facilitating positioning of the end effector within the patient. Positioning of the end effector can be further facilitated by including one or more articulation joints or features that allow the end effector to be selectively articulated or otherwise deflected relative to the longitudinal axis of the shaft.

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

[0003] Surgical staplers may also be used in open procedures and / or other non-endoscopic procedures. By way of example only, in thoracic surgical procedures that do not use a trocar as a stapler conduit, a surgical stapler may be inserted between a patient's ribs through a thoracotomy to access one or more organs. For example, blood vessels leading to an organ may be cut and closed with the stapler before the organ is removed from the chest cavity. Of course, surgical staplers may be used in a variety of other settings and procedures.

[0004] While many different types of surgical stapling instruments and related components have been made and used, it is believed that no one prior to the present inventors has made or used the invention as set forth in the appended claims. [Brief explanation of the drawings]

[0005] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the invention and, together with the general description of the invention given above and the detailed description of the embodiments given below, serve to explain the principles of the invention. [Figure 1] 1 is a perspective view of an exemplary surgical stapling instrument; [Figure 2] 2 shows a side view of the device of FIG. 1. [Figure 3] 2 is a perspective view of the end effector of the instrument of FIG. 1 in an open state. [Figure 4A] 4 is a side cross-sectional view of the end effector of FIG. 3 taken along line 4-4 of FIG. 3 with the firing beam in a proximal position. [Figure 4B] 4 is a side cross-sectional view of the end effector of FIG. 3 taken along line 4-4 of FIG. 3 with the firing beam in a distal position. [Figure 5] 5 is a cross-sectional end view of the end effector of FIG. 3 taken along line 5-5 of FIG. 3. [Figure 6] FIG. 4 is an exploded perspective view of the end effector of FIG. 3. [Figure 7] 4 is a perspective view of the end effector of FIG. 3 after being placed in tissue and actuated once within the tissue. [Figure 8] FIG. 4 is a perspective view of an exemplary pair of buttress assemblies, each of which may be attached to the jaws of the end effector of FIG. 3. [Figure 9A] FIG. 9 is a cross-sectional end view of a portion of the end effector of FIG. 3 with the buttress assembly of FIG. 8 attached to the upper and lower jaws of the end effector, showing the jaws of the end effector in an open position and tissue positioned between the upper and lower jaws. [Figure 9B] FIG. 9B is a cross-sectional end view of the end effector and buttress assembly of FIG. 9A showing the jaws of the end effector in a closed position on tissue. [Figure 9C]9B is a cross-sectional view of the formed staple and buttress assembly of FIG. 9A after being secured to tissue by the end effector of FIG. 3. FIG. [Figure 10] 9B is a perspective view of the formed staple and buttress assembly of FIG. 9A after being secured to tissue by the end effector of FIG. 3; FIG. [Figure 11] FIG. 9 is a perspective view of an exemplary buttress applier cartridge that may be used to carry and apply the buttress assembly of FIG. [Figure 12] FIG. 12 is a top view of the buttress applier cartridge of FIG. [Figure 13A] FIG. 12 is a perspective view of the end effector of FIG. 3 and the buttress applier cartridge of FIG. 11 showing the end effector and buttress applier cartridge aligned with one another; [Figure 13B] FIG. 12 is a perspective view of the end effector of FIG. 3 and the buttress applier cartridge of FIG. 11 with the jaws of the end effector closed on the platform of the buttress applier cartridge. [Figure 14] FIG. 1 is a perspective view of an exemplary additive applicator coupled to a base in a folded configuration. [Figure 15] 15 is a perspective view of the add-on applicator of FIG. 14 positioned against a slot in the base in a folded configuration. [Figure 16] FIG. 15 is a plan view of the additive applicator of FIG. 14 in a deployed configuration. [Figure 17A] 15 is a perspective view of the jaws of the end effector of FIG. 3 in an open state engaging the additive applicator of FIG. 14, the applicator being in a first folded configuration defining a first angle. [Figure 17B] FIG. 15 is a perspective view of the jaws of the end effector of FIG. 3 engaged with the appendage applicator of FIG. 14 in an open state, the applicator in a second folded configuration defining a second angle, and showing the applicator coupled with the base via a pair of slots. [Figure 18] FIG. 10 is a plan view of a second exemplary additive applicator in a deployed configuration. [Figure 19] 19 is a perspective view of the addendum applicator of FIG. 18 in a first folded configuration defining a first angle. [Figure 20] 19 is a perspective view of the add-on applicator of FIG. 18 positioned against a pair of slots in the base in a first folded configuration. [Figure 21] 19 is a perspective view of the appendage applicator of FIG. 18 in a second folded configuration defining a second angle, showing the applicator coupled to the base via a pair of slots. [Figure 22] FIG. 10 is a side cross-sectional view of a third exemplary addendum applicator, showing the applicator in an unexpanded storage configuration. [Figure 23] 23 is a side cross-sectional view of the end effector of FIG. 3 engaging the adduct applicator of FIG. 22, the applicator being in a first, extended, angled configuration. [Figure 24] 23 is a side cross-sectional view of the end effector of FIG. 3 engaging the adduct applicator of FIG. 22, the applicator being in a second, expanded, angled configuration. [Figure 25] FIG. 10 is a perspective view of another exemplary additive applicator showing the wedge-shaped portion of the applicator in a first longitudinal position. [Figure 26A] 26A is a side cross-sectional view of the addendum applicator of FIG. 25 taken along line 26A-26A of FIG. 25, showing the wedge-shaped portion of the applicator in a proximal position engaged with the end effector of FIG. 3, shown in phantom. [Figure 26B] 26 is a side cross-sectional view of the add-on applicator cartridge of FIG. 25 showing the wedge-shaped portion of the applicator in a distal position engaged with the end effector of FIG. 3 shown in phantom.

[0006] The drawings are not intended to be limiting in any manner, and it is contemplated that various embodiments of the invention may be embodied in a variety of other ways, including those not necessarily depicted in the drawings. The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate several aspects of the invention and, together with the description, serve to explain the principles of the invention. It will be understood, however, that the invention is not limited to the precise arrangements shown. DETAILED DESCRIPTION OF THE INVENTION

[0007] The following description of specific examples of the present technology should not be used to limit its scope. Other examples, features, aspects, embodiments, and advantages of the present technology will become apparent to those skilled in the art from the following description, which is, by way of example, one of the best modes contemplated for carrying out the present technology. As will be understood, the technology described herein is capable of other different and obvious aspects, all without departing from the technology. Therefore, the drawings and descriptions should be regarded as illustrative in nature, and not as restrictive.

[0008] It will be further understood that any one or more of the teachings, expressions, embodiments, examples, etc. described herein can be combined with any one or more of the other teachings, expressions, embodiments, examples, etc. described herein. Therefore, the teachings, expressions, embodiments, examples, etc. described below should not be considered in isolation from one another. Various suitable ways in which the teachings herein can be combined will be readily apparent to those skilled in the art in light of the teachings herein. Such modifications and variations are intended to be within the scope of the claims.

[0009] For clarity of this disclosure, the terms "proximal" and "distal" are defined herein relative to a human or robotic surgical instrument operator. The term "proximal" refers to the location of an element closer to a human or robotic surgical instrument operator and further from the surgical end effector of the surgical instrument. The term "distal" refers to the location of an element closer to a surgical end effector of the surgical instrument and further from the human or robotic surgical instrument operator. Additionally, the terms "upper," "lower," "lateral," "transverse," "bottom," and "top" are relative terms to provide further clarity in the description of the figures provided below. The terms "upper," "lower," "lateral," "transverse," "bottom," and "top," therefore, are not intended to unnecessarily limit the invention(s) described herein.

[0010] I. Exemplary Surgical Stapler 1-7 illustrate an exemplary surgical stapling and severing instrument 10 sized for insertion into a surgical site on a patient through a trocar cannula or an incision (e.g., a thoracotomy) to perform a surgical procedure. The instrument 10 in this example includes a handle portion 20 connected to a shaft 22, which distally terminates in an articulation joint 11, which is further coupled to an end effector 12. Once the articulation joint 11 and end effector 12 are inserted through the trocar cannula passage, the articulation joint 11 may be remotely articulated by an articulation control 13, as depicted in phantom in FIG. 1, to deflect the end effector 12 at a desired angle α from the longitudinal axis (LA) of the shaft 22. The end effector (12) of this example includes a lower jaw (16) containing a staple cartridge (37) and an upper jaw in the form of a pivotable anvil (18).

[0011] The handle portion 20 includes a pistol grip 24 and a closure trigger 26. The closure trigger 26 is pivotable toward the pistol grip 24 to clamp or close the anvil 18 toward the lower jaw 16 of the end effector 12. Such closure of the anvil 18 is effected via a closure tube 32 and a closure ring 33, both of which translate longitudinally relative to the handle portion 20 in response to pivoting of the closure trigger 26 relative to the pistol grip 24. The closure tube 32 extends along the length of the shaft 22, and the closure ring 33 is positioned distal to the articulation joint 11. The articulation joint 11 is operable to transmit / transmit longitudinal movement from the closure tube 32 to the closure ring 33.

[0012] As shown in Figure 2, handle portion (20) also includes a firing trigger (28). An elongate member (not shown) extends longitudinally through shaft (22) and transfers longitudinal firing motion from handle portion (20) to firing beam (14) in response to actuation of firing trigger (28). As described in further detail below, this distal translation of firing beam (14) effects stapling and severing of tissue clamped within end effector (12).

[0013] As shown in Figures 3-6, the end effector (12) uses a firing beam (14) including a transversely disposed upper pin (38), a firing beam cap (44), a transversely disposed middle pin (46), and a distally directed cutting edge (48). The upper pin (38) is positioned within a longitudinal anvil slot (42) of the anvil (18) and is translatable within the longitudinal anvil slot (42). The firing beam cap (44) slidably engages the underside of the lower jaw (16) by having the firing beam (14) extend through a lower jaw slot (45) (shown in Figure 4B) formed through the lower jaw (16). The middle pin (46) slidably engages the upper side of the lower jaw (16) in cooperation with the firing beam cap (44).

[0014] Figure 3 shows the firing beam (14) of this example positioned proximally and the anvil (18) pivoted to an open configuration to removably load an unused staple cartridge (37) into a channel in the lower jaw (16). As best seen in Figures 5-6, the staple cartridge (37) of this example includes a cartridge body (70) that provides an upper deck (72) and is coupled to a lower cartridge tray (74). As best seen in Figure 3, a vertical slot (49) extends longitudinally through a portion of the staple cartridge body (70). Also best seen in Figure 3, three rows of staple openings (51) are formed through the upper deck (72) on either side of the vertical slot (49). As shown in Figures 4A-6, a wedge-shaped sled (41) and a plurality of staple drivers (43) are captured between a cartridge body (70) and a tray (74), with the wedge-shaped sled (41) positioned proximally relative to the staple drivers (43). The wedge-shaped sled (41) is longitudinally movable within the staple cartridge (37), while the staple drivers (43) are vertically movable within the staple cartridge (37). Staples (47) are also positioned within the cartridge body (70) above their corresponding staple drivers (43). Each staple (47) is driven vertically within the cartridge body (70) by the staple driver (43), causing the staple (47) to be driven out through an associated staple opening (51). As best seen in Figures 4A-4B and 6, wedge-shaped sled (41) presents an inclined cam surface that urges staple driver (43) upward as wedge-shaped sled (41) is driven distally through staple cartridge (37).

[0015] As shown in Figures 4A-4B, when the end effector 12 is closed by distally advancing the closure tube 32 and closure ring 33, the firing beam 14 advances distally, and the upper pin 38 enters the longitudinal anvil slot 42, thereby engaging the anvil 18. A pusher block 80 (shown in Figure 5) located at the distal end of the firing beam 14 pushes the wedge-shaped sled 41 distally as the firing beam 14 advances distally through the staple cartridge 37 when the firing trigger 28 is actuated. During such firing, the cutting edge 48 of the firing beam 14 enters the vertical slot 49 of the staple cartridge 37, severing the tissue clamped between the staple cartridge 37 and the anvil 18. As shown in FIGS. 4A-4B, the middle pin 46 and pusher block 80 together actuate the staple cartridge 37 by entering a vertical slot 49 within the staple cartridge 37, driving the wedge-shaped sled 41 into upward camming contact with the staple driver 43, which forces the staples 47 out of the staple openings 51 and into contact with and form the staple-forming pockets 53 (shown in FIG. 3) on the inner surface of the anvil 18. FIG. 4B shows the firing beam 14 fully translated distally after tissue cutting and stapling are complete. The staple-forming pockets 53 are intentionally omitted from the views of FIGS. 4A-4B, but are shown in FIG. 3. The anvil 18 is intentionally omitted from the view of FIG. 5.

[0016] Figure 7 shows the end effector 12 actuated by a single firing stroke through tissue 90. The cutting edge 48 (obscured in Figure 7) cuts the tissue 90 while the staple driver 43 drives three alternating rows of staples 47 through the tissue 90 on either side of the cut line formed by the cutting edge 48. After the first firing stroke is complete, the end effector 12 is withdrawn from the patient, the spent staple cartridge 37 is replaced with a new staple cartridge 37, and the end effector 12 is then reinserted into the patient to reach the stapling site and perform additional cutting and stapling. This process can be repeated until the desired number and pattern of firing strokes across the tissue 90 have been completed.

[0017] The instrument (10) may be further configured and operable in accordance with any of the teachings of the following references, the disclosures of which are incorporated herein by reference: U.S. Patent No. 8,210,411, entitled "Motor-Driven Surgical Instrument," issued July 3, 2012; U.S. Patent No. 9,186,142, entitled "Surgical Instrument End Effector Articulation Drive with Pinion and Opposing Racks," issued November 17, 2015; U.S. Patent No. 9,517,065, entitled "Integrated Tissue Positioning and Jaw Alignment Features for Surgical Stapler," issued December 13, 2016; U.S. Patent No. 9,622,746, entitled "Distal Tip Features for End Effector of Surgical Instrument," issued April 18, 2017; and U.S. Patent No. 9,622,746, entitled "Lockout No. 9,717,497, entitled "Feature for Movable Cutting Member of Surgical Instrument," issued on October 24, 2017; No. 9,795,379, entitled "Surgical Instrument with Multi-Diameter Shaft," issued on October 24, 2017; No. 9,808,248, entitled "Installation Features for Surgical Instrument End Effector Cartridge," issued on November 7, 2017; No. 9,839,421, entitled "Jaw Closure Feature for End Effector of Surgical Instrument," issued on December 12, 2017; and / or No. 10,092,292, entitled "Staple Forming Features for Surgical Stapling Instrument," issued on October 9, 2018.

[0018] II. Exemplary Buttress Assemblies and Buttress Applier Cartridges In some cases, it may be desirable to provide the end effector 12 of the surgical instrument 10 with additional material, such as a buttress, to reinforce the mechanical fastening of tissue provided by the staples 47. Such a buttress can prevent the applied staples 47 from backing out of the tissue, reducing the risk of tissue tearing that might otherwise occur at or near the application site of the staples 47. In addition to or instead of providing structural support and integrity to the line of staples 47, the buttress can provide various other types of benefits, such as filling voids or gaps, delivering therapeutic agents, and / or another benefit. In some cases, the buttress may be provided on the top deck 72 of the staple cartridge 37. As mentioned above, the deck 72 houses the staples 47 that are driven by the staple driver 43. In some other cases, the buttress may be provided on the surface of the anvil 18 that faces the staple cartridge 37. It should also be understood that a first buttress may be provided on the top deck (72) of the staple cartridge (37), while a second buttress is provided on the anvil (18) of the same end effector (12).

[0019] Examples of various shapes the buttress may take are described in more detail below. Various methods by which the buttress may be secured to the staple cartridge (37) or the anvil (18) are also described in more detail below. Exemplary buttress assemblies, exemplary materials and techniques for applying the buttress assemblies, and exemplary buttress applier cartridges may be constructed in accordance with at least some of the teachings of U.S. Patent No. 10,166,023, entitled "Method of Applying a Buttress to a Surgical Stapler End Effector," issued January 1, 2019, and / or U.S. Patent No. 10,349,939, entitled "Method of Applying a Buttress to a Surgical Stapler," issued July 16, 2019, the disclosures of which are incorporated herein by reference.

[0020] A. Exemplary Buttress Assembly Configurations FIG. 8 illustrates an exemplary pair of buttress assemblies (110, 112) (each individually referred to as a "buttress"). In this example, buttress assembly (110) comprises a buttress body (114) and an upper adhesive layer (116). Similarly, buttress assembly (112) comprises a buttress body (118) and a lower adhesive layer (120). In this example, each buttress body (114, 118) comprises a strong yet flexible material configured to provide structural support for a line of staples (47). By way of example only, each buttress body (114, 118) may comprise a mesh of polyglactin 910 material by Ethicon, Inc. (Somerville, New Jersey). Alternatively, any other suitable material or combination of materials may be used in addition to or in place of polyglactin 910 material to form each buttress body (114, 118).

[0021] Each buttress body (114, 118) may include a material including a hemostatic agent, such as fibrin, to assist in clotting blood and reducing bleeding at the cut and / or stapled surgical site along the tissue (T1, T2). As another merely illustrative example, each buttress body (114, 118) may include other additives or may include a hemostatic agent, such as thrombin, such that each buttress body (114, 118) may assist in clotting blood and reducing bleeding at the surgical site. Other additives or reagents that may be incorporated into each buttress body (114, 118) may further include, but are not limited to, medicinal solutions or matrix components.

[0022] In this embodiment, an adhesive layer 116 is provided on the buttress body 114 to adhere the buttress body 114 to the underside 124 of the anvil 18. Similarly, an adhesive layer 120 is provided on the buttress body 118 to adhere the buttress body 118 to the top deck 72 of the staple cartridge 37. Such adhesive material properly positions the buttress bodies 114, 118 before and during actuation of the end effector 12, and then allows the buttress bodies 114, 118 to separate from the end effector 12 after actuation of the end effector 12 without causing damage to the buttress bodies 114, 118 that would substantially impair the subsequent proper function of the buttress bodies 114, 118.

[0023] B. Stapling of tissue with an exemplary buttress assembly 9A-9C illustrate an exemplary sequence in which an end effector (12) loaded with buttress assemblies (110, 112) is actuated to drive staples (47) through two opposing tissue layers (T1, T2) such that the buttress assemblies (110, 112) are secured to the same tissue layers (T1, T2) by the staples (47). Specifically, FIG. 9A illustrates the tissue layers (T1, T2) positioned between an anvil (18) and a staple cartridge (37), with the anvil (18) in an open position. The buttress assembly (110) is adhered to the underside (424) of the anvil (18) via an adhesive layer (116), and the buttress assembly (112) is adhered to the top deck (72) of the staple cartridge (37) via an adhesive layer (120). The tissue layers T1, T2 are thus sandwiched between the buttress assemblies 110, 112. The closure trigger 26 is then pivoted toward the pistol grip 24, driving the closure tube 32 and closure ring 33 distally, which drives the anvil 18 to the closed position, as shown in FIG. 9B. At this stage, the tissue layers T1, T2 are compressed between the anvil 18 and the staple cartridge 37, and the buttress assemblies 110, 112 engage opposing surfaces of the tissue layers T1, T2. The end effector 12 is then actuated as described above, driving the staples 47 through the buttress assemblies 110, 112 and the tissue T1, T2. As shown in Figure 13C, the crowns (122) of the actuated staples (47) capture the buttress assembly (112) and hold it against the tissue layer (T2), and the legs (126) of the deformed staples (47) capture the buttress assembly (110) and hold it against the tissue layer (T1).

[0024] Similarly, a series of staples 47 capture and hold the buttress assemblies 110, 112 against the tissue layers T1, T2, thereby securing the buttress assemblies 110, 112 to the tissue T1, T2, as shown in Figure 10. After the staples 47 and buttress assemblies 110, 112 have been deployed, when the end effector 12 is pulled away from the tissue T1, T2, the buttress assemblies 110, 112 disengage from the end effector, thereby leaving the buttress assemblies 110, 112 secured to the tissue T1, T2 by the staples 47. In this manner, the buttress assemblies 110, 112 structurally reinforce the line of staples 47 formed in the tissue T1, T2. Additionally, as can be seen in FIG. 10 , the cutting edge (48) of the distally directed firing beam (14) further cuts through the buttress assemblies (110, 112) through their midlines, separating each buttress assembly (110, 112) into a corresponding pair of portions, whereby each portion remains fixed in the corresponding area of ​​severed tissue (T1, T2).

[0025] C. Exemplary buttress applier cartridge with active retainer arms Because the end effector 12 of the surgical instrument 10 may be actuated multiple times during a single surgical procedure, it may be desirable for the operator to repeatedly and easily load buttress assemblies 110, 112 into the lower jaw and anvil 16, 18 during that single surgical procedure. Figures 11-13B illustrate an exemplary cartridge 210 (also referred to as a "buttress applicator") that can be used to support, protect, and apply add-on material, such as buttress assemblies 110, 112, to the end effector 12. As best seen in Figures 11-12, the cartridge 210 in this example includes an open end 212 and a closed end 214. The open end 212 is configured to receive the end effector 12, as described in further detail below. The cartridge 210 further includes a first housing 216a and a second housing 216b, each generally defining a "U" shape and providing an open end 212. A platform 218 and a thread retainer 220 are positioned between the first housing 216a and the second housing 216b.

[0026] In this embodiment, platform 218 is configured to support a pair of buttress assemblies 110 on one side of platform 218 and another pair of buttress assemblies 112 on the other side of platform 218. Platform 218 is exposed in recesses formed between the prongs of the "U" configuration of first and second housings 216a, 216b. Although each buttress assembly 110, 112 is provided as a separate pair of sections so as not to span slots 42, 49 of anvil 18 and staple cartridge 37, respectively, platform 218 could easily support wider buttress assemblies 110, 112 that integrally span slots 42, 49 of anvil 18 and staple cartridge 37, respectively. More specifically, the outer edge of the platform (218) includes a retention feature (530) in the form of a ridge that further engages the first and second housings (216a, 216b) to prevent the platform (218) from sliding relative to the first and second housings (216a, 216b).

[0027] The first and second housings (216a, 216b) include integral gripping mechanisms (222) and indicator plates (224) positioned to correspond to windows (226) formed in the first and second housings (216a, 216b), through which the indicator plates (224) are viewable at any given time. The arms (228) in this example are configured to selectively secure the buttress assemblies (110, 112) to the platform (218). In this example, the arms (228) are resilient and, therefore, configured to resiliently support the buttress assemblies (110, 112), thereby sandwiching the buttress assemblies (110, 112) against the platform (218). The cartridge (210) includes a pair of tapered cam surfaces (232) and a pair of housing engagement features (234) positioned to engage corresponding surfaces of the first and second housings (216a, 216b), respectively. The first and second housings (216a, 216b) include proximal and distal guide features (236, 238) configured to help properly align the end effector (40) with the cartridge (210).

[0028] Figure 13A shows the cartridge (210) in a configuration in which the retainer arms (228) are positioned to hold the buttress assemblies (110, 112) against the platform (218), and Figure 13B shows the cartridge (210) in a configuration in which the retainer arms (228) are positioned to release the buttress assemblies (110, 112) from the platform (218). While Figures 13A-13B only show the buttress assembly (110) on the platform (218), the buttress assembly (112) is also retained on and released from the platform (218) in the same manner. To load the end effector (12) with the cartridge (210), the operator first positions the cartridge (210) and end effector (12) so that the end effector is aligned with the open end (212) of the cartridge (210), as shown in Figure 13A. The operator then advances end effector 12 distally and / or cartridge 210 proximally to position platform 218 and buttress assemblies 110, 112 between anvil 18 and staple cartridge 37, as shown in FIGURE 13B. The operator then pulls closure trigger 26 of instrument 10, causing the lower jaws and anvils 16, 18 to close on platform 218, thereby adhesively attaching buttress assemblies 110, 112 to anvil 18 and staple cartridge 37 and simultaneously depressing cam surface 232. When cam surface (232) is depressed, retainer arms (228) are actuated laterally outward, thereby releasing buttress assemblies (110, 112) from platform (218), thereby allowing lower jaws and anvils (16, 18) to disengage from platform (218) while buttress assemblies (110, 112) remain adhered to anvil (18) and staple cartridge (37).

[0029] III. Exemplary Static Wedge-Shaped Addendum Applicator and Method for Applying Addendums to an Open-Jaw Surgical Stapler End Effector In some cases, it may be desirable to provide an applicator device configured to apply a staple reinforcing affixation element to one or both jaws of a surgical stapler end effector while the jaws remain open, or without otherwise closing the jaws by actuation of the stapler's end effector closure system, such as by actuation of a closure trigger 26 of the surgical stapler 10. The exemplary applicator devices described below provide such functionality, with each applicator device configured to operate relative to an end effector that applies an affixation element to one or both jaws without requiring a closure actuation of the jaws, as shown in Figures 13A-13B above.

[0030] It will be understood that any of the exemplary applicator devices described below may be configured to apply additional elements in the form of buttresses, such as the buttress assemblies (110, 112) described above, or tissue thickness compensators, such as those of the type disclosed in U.S. Patent Application Publication No. 2012 / 0080336, entitled "Staple Cartridge Comprising Staples Positioned Within A Compressible Portion Thereof," published April 5, 2012, and now abandoned, the disclosure of which is incorporated herein by reference. Additionally, application of staple reinforcement elements to the jaws of the end effector may be achieved using adhesive mechanisms as described above and / or mechanical coupling mechanisms, such as those of the type disclosed in U.S. Patent No. 7,665,646, entitled "Interlocking Buttress Material Retention System," issued February 23, 2010, the disclosure of which is incorporated herein by reference. Furthermore, any of the exemplary applicator devices described below may be suitably configured for single use or multiple use.

[0031] A. Exemplary Static Wedge Addendum Applicator In some cases, it may be desirable to provide a compact applicator configured to apply a staple reinforcing affixing element to one or both jaws of a surgical stapler end effector while the jaws remain open or without otherwise closing the jaws by actuation of the stapler's end effector closure system, such as by actuation of the closure trigger (26) of the surgical stapler (10).

[0032] 14-16 illustrate an exemplary addendum applicator assembly (300) including a wedge-shaped applicator member (308) and a base (302). The wedge-shaped applicator member (308) includes a body (309), a first addendum element (304), and a second addendum element (306). The body (309) may be disposable or reusable. In disposable variations, the body (309) may be constructed from foam board, cardboard, plastic, or any other low-cost material known in the art that is sufficiently rigid, flat, and provides support. Such disposable body (309) variations may be discarded after a single use. In some variations, the body (309) may be constructed from cardboard, which may be treated with a surgically safe surface coating (334). Body (309) may include a corrugated or foam core with a rigid outer layer, such as plastic or any other low-cost material known in the art, to provide rigidity to the thin layer. In some reusable variations, body (309) may be constructed from a reusable material, such as stainless steel, or any other material known in the art that provides a sterilizable, sufficiently rigid surface that can be configured to assume different angles. In some variations, such reusable materials may be pre-formed into a folded configuration and sterilized using methods described further below.

[0033] In this embodiment, the body (309) of the wedge-shaped applicator member (308) has a first panel (313), a second panel (315) opposite the first panel (313), and a connecting panel (340) joining the proximal end of the first panel (313) to the proximal end of the second panel (315). The first panel (313) defines a first contact surface (314). The first contact surface (314) is generally rectangular and located on the outer surface of the first panel (313). The first panel (313) extends from the connecting panel (340) to the first tongue (320). The first tongue (320) has a trapezoidal shape, with a wider base adjacent to the first panel (313) and a narrower top extending distally from a central portion of the end opposite the connecting panel (340) away from the first panel (313). The second panel (315) is also generally rectangular and defines a second contact surface (316) located on the opposite outer surface of the second panel (315). The second panel (315) extends from the connecting panel (340) to the second tongue (322). The second tongue (322) has a trapezoidal shape, with a base adjacent to the second panel (315) and a top extending distally away from the second panel (315).

[0034] Each of the first and second attachment elements (304, 306) has a respective first surface (310) and a respective second surface (312). In this variation, the first surface (310) of each of the first and second attachment elements (304, 306) is configured to be removably attached to the respective first and second contact surfaces (314, 316) using a first attachment mechanism (342). The first attachment mechanism (342) may include, for example, an adhesive (not shown) and / or a mechanical attachment such as a retainer arm (228) (shown in FIG. 12 ). The first attachment mechanism (342) is configured to removably couple the first and second attachment elements (304, 306) to the first and second contact surfaces (314, 316). In some variations, the adhesive may be glue, cement, rubber cement, or paste. In some variations, the first attachment mechanism (342) may be of any type that would be readily apparent to one skilled in the art in view of the teachings herein for removably coupling an appendage to an applicator assembly.

[0035] The second surface (312) of each of the first and second attachment elements (304, 306) includes a second attachment mechanism (344) configured to attach to the open lower jaw and anvil (16, 18) of the end effector (12). The second attachment mechanism (344) has a stronger bond than the first attachment mechanism (342). The second attachment mechanism (344) may also include a bonding agent (not shown) similar to the first attachment mechanism (342) and / or a second mechanical attachment mechanism (not shown). Any combination of adhesive or mechanical attachment may be used for the first and second attachment mechanisms (342, 344), so long as the second attachment mechanism (344) has a stronger bond than the first attachment mechanism (342). The first and second attachment elements (304, 306) may be in the form of a buttress assembly, such as the buttress assemblies (110, 112) described above, or alternatively, a tissue thickness compensator (not shown). The second surfaces (312) of the first and second attachment elements (304, 306) may have a film (346) covering and protecting the second attachment mechanism (344). The film (346) may include a gripping portion (347) that extends proximally when the wedge-shaped applicator member (308) is in the folded configuration to allow a user to easily remove the film (346) without compromising the attachment of the first and second attachment elements (304, 306).

[0036] In some variations, the first and second attachment elements (304, 306) may be buttresses comprising a three-layer polymer structure including a core layer sandwiched between two outer layers so as to be generally strong but flexible enough to support a line of staples. In this example, the core layer is a polyglactin 910 material, and each outer layer is a polydioxanone or para-dioxanone (PDO) film material. The attachment elements (304, 306) in this example are formed by laminating the core layer between the outer layers for less than a predetermined time. The attachment elements (304, 306) are further mechanically cut to size to avoid abrasive edges, such as burrs and / or delaminations, that could damage sensitive tissue. It will be appreciated that alternative methods of cutting the attachment elements (304, 306), such as laser cutting or hot knife cutting, may also be used.

[0037] The base (302) may be constructed of foam, cardboard, plastic, or any other low-cost material known in the art to protect items from damage during transport and provide other structural support. The base (302) is configured to be placed on a work surface with the side (324) facing upward. The side (324) of the base (302) includes first, second, and third slots (328, 330, 332) configured to receive the first and second tangs (320, 322). The slots (328, 330, 332) are spaced apart and aligned with one another along the centerline of the side (324). The slots (328, 330, 332) extend transversely to the centerline (not shown) and are sized to receive the tangs (320, 322). In some variations, the base (302) may include a recess (not shown) configured to receive the additive applicator assembly (300) and the first and second additive elements (304, 306) within the base (302) to protect the additive applicator assembly (300) and the first and second additive elements (304, 306) during transport.

[0038] Figure 15 shows the add-on applicator assembly (300) after the wedge-shaped applicator member (308) has been transitioned from the deployed position (shown in Figure 16) to the folded position and aligned to fit within the base (302). In the folded position, the lateral distance between the first panel (313) and the second panel (315) gradually increases in the distal direction away from the connecting panel (340), thus providing the body (309) with a wedge-like shape that tapers proximally toward the connecting panel (340). To transition the add-on applicator assembly (300) from the deployed position to the folded position, the connecting panel (340) is folded such that the first panel (313) and the second panel (315) define a first angle (θ1) therebetween, which may be, for example, in the range of about 20 degrees to about 45 degrees. 15, the additive applicator assembly (300) is vertically aligned with the base (302) by aligning the first tang (320) with the first slot (328) and the second tang (322) with the second slot (330). In other variations, the base (302) may include one or more additional slots configured to set the first and second panels (313, 315) at one or more additional angles in the range of about 20 degrees to about 45 degrees.

[0039] In yet another variation, the base (302) may include one or more pairs of slots (not shown) similar to the slots (328, 330, 332) equally spaced apart from one another about a center point (not shown) along the centerline of the side (324) so ​​that the tongues (320, 322) may be inserted into the first pair of slots. Upon insertion of the tongues (320, 322) into the first pair of slots, a first angle (θ1) is formed between the first panel (313) and the second panel (315). The distance between the first panel (313) and the second panel (315) increases as the first and second panels (313, 315) extend distally away from the connecting panel (340). The second pair of slots are spaced further apart from the first pair of slots around the center point, and when the first and second tangs (320, 322) are inserted into the second pair of slots, which are spaced further apart from each other relative to the first pair of slots, the first panel (313) and the second panel (315) define a larger second angle (θ2).

[0040] 16 shows the wedge-shaped applicator member (308) in a flat, deployed configuration. In the deployed position, the wedge-shaped applicator member (308) is flat and extends longitudinally from the first tongue (320) to the first panel (313). The first panel (313) further extends distally to the connecting panel (340). The second panel (315) extends from the connecting panel (340) to the second tongue (322). The add-on applicator assembly (300) is configured to be contained within a sealed sterility barrier of product packaging (not shown) during shipping and storage so that the body (309), first and second add-on elements (304, 306), and base (302) remain sterile. By way of example only, such product packaging may be of the type disclosed in U.S. Patent Application Publication No. 2020 / 0205825, entitled "Method of Applying Buttresses to Surgically Cut and Stapled Sites," published July 2, 2020, the disclosure of which is incorporated herein by reference. To contain these components within a sterile barrier, it may be advantageous to minimize the size of or otherwise provide the additive applicator assembly (300) with the ability to be assembled from a collapsed state. It may also be advantageous to have a base (302) that serves as part of the packaging material to protect the additive applicator assembly (300) during transport.

[0041] The connecting panel 340 in this example is configured as a joint or hinge to facilitate folding of the wedge-shaped applicator member 308. The connecting panel 340 is flat in the deployed position and extends from a first fold line 336 to a second fold line 338. The first fold line 336 is adjacent to the first panel 313, and the second fold line 338 is adjacent to the second panel 315. The first and second fold lines 336, 338 include perforations or surface cutouts that traverse the length of the wedge-shaped applicator member 308. The perforations or surface cutouts are configured to facilitate bending of the connecting panel 340 relative to the first panel 313 and the second panel 315, respectively. As another merely illustrative example, the connecting panel (340) may include only the first fold (336), or may include multiple folds and multiple end panels used to join the first panel (313) with the second panel (315). In yet another merely illustrative example, the body (309) may be shipped in a partially folded configuration, in which the first fold (336) is folded 180 degrees and the second fold (338) remains straight, thereby folding the underside of the first panel (313) over and engaging the underside of the second panel (315), conserving longitudinal space within the sterile barrier.

[0042] 17A shows the wedge-shaped applicator member (308) coupled to the base (302), the longitudinally aligned end effector (12), and the resulting addendum applicator assembly (300). The base (302) is placed on a work surface with the side (324) facing upward, with the slots (328, 330, 332) facing upward. The wedge-shaped applicator member (308) is coupled to the base (302) by inserting the first tang (320) into the first slot (328) and the second tang (322) into the second slot (330) and pushing the wedge-shaped applicator member (308) downward. The first and second tangs (320, 322) coupled to the first and second slots (330, 332) thereby fix the angular relationship between the first panel (313) and the second panel (315) to define a first distal opening angle (θ1). As noted above, the base (302) may include one or more additional slots configured to allow the first distal opening angle (θ1) defined by the first and second panels (313, 315) to be set to any desired angle.

[0043] 17B shows the lower jaw and anvil (16, 18) of the end effector (12) in the open position engaging the wedge-shaped applicator member (308) of the addendum applicator assembly (300). The film (346) has been removed from the first and second addendum elements (304, 306) prior to engaging the addendum applicator assembly (300) with the lower jaw and anvil (16, 18) of the end effector (12). The lower jaw (16) of the end effector (12) engages the second surface (312) of the first addendum element (304), and the anvil (18) simultaneously engages the second surface (312) of the second addendum element (306). The above-described second attachment mechanisms (344) of the first and second attachment elements (304, 306) attach to the lower jaw and anvil (16, 18), respectively. The end effector (12) is then, while still in the open position, raised away from the add-on applicator assembly (300). The first attachment mechanism (342) allows the attachment elements (304, 306) to be removed from the first and second contact surfaces (314, 316) of the wedge-shaped applicator member (308), so that the second attachment mechanisms (344) of the first and second attachment elements (304, 306) remain attached to the lower jaw and anvil (16, 18). The first and second attachment elements (304, 306), now attached to the lower jaw and anvil (16, 18), are ready for use in a surgical procedure. It will be appreciated that by coupling the attachment elements (304, 306) to the lower jaws and anvils (16, 18) using the add-on applicator assembly (300) while the lower jaws and anvils (16, 18) are left open, an operator can control the force with which the attachment elements (304, 306) are secured to the lower jaws and anvils (16, 18) by selectively advancing the end effector (12) longitudinally toward the add-on applicator assembly (300), which may be stationary as shown in this embodiment.

[0044] B. Exemplary Stationary Wedge Addendum Applicator with Angled Wings In some cases, it may be desirable to modify the above-described addendum applicator assembly (300) to include additional structural support that provides additional rigidity to the first and second panels (313, 315) to prevent them from bending inward or outward so that the addendum elements (304, 306) uniformly adhere to the lower jaws and anvils (16, 18). Figures 18-21 show a second exemplary addendum applicator assembly (400) having first and second angled wing pairs (446, 448) that may provide such a functional benefit.

[0045] Figure 18 shows the wedge-shaped applicator member (408) of the add-on applicator assembly (400) in the deployed position. The add-on applicator assembly (400) is constructed similarly to the add-on applicator assembly (300) described above, except as otherwise described below. Like the add-on applicator assembly (300), the add-on applicator assembly (400) includes a wedge-shaped applicator member (408) and a base (302). The wedge-shaped applicator member (408) includes a body (409) and first and second add-on elements (304, 306). The wedge-shaped applicator member (408) and the base (302) are constructed of similar materials as the wedge-shaped applicator member (308) and the base (302) of the add-on applicator assembly (300). As shown in FIG. 18 , in the deployed position, the body (409) of the add-on applicator assembly (400) extends longitudinally from the first tongue (420) to the first panel (413). The first panel (413) extends toward the connecting panel (440). The second panel (415) extends from the connecting panel (440) toward the second tongue (422). The first and second panels (413, 415) define first and second contact surfaces (414, 416), respectively, similar to the first and second contact surfaces (314, 316) of the add-on applicator assembly (300). The first and second add-on elements (304, 306) are attached at their first surfaces (310) to the first and second contact surfaces (414, 416), respectively.

[0046] The body (409) of the wedge-shaped applicator member (408) differs from the body (309) of the wedge-shaped applicator member (308) in that the body (409) further includes first and second pairs of angled wings (446, 448) formed on the sides of the first and second panels (413, 415). Specifically, the first pair of angled wings (446) are formed on the sides of the first panel (413) and are configured as trapezoidally shaped planar panels extending laterally from a first panel edge (450). The first panel edge (450) extends along the outer edge of the first panel (413) and parallel to the length of the unfolded body (409). The first panel edge (450) may be perforated or surface-relieved to facilitate bending or breaking of the first angled wing (446) relative to the first panel (413). In this variation, the first pair of angled wings (446) form a trapezoidal planar panel pair. The right angle of the trapezoidal shape is located at the end proximate to the first tongue (420). Each of the first angled wings (446) defines a first outer edge (452) configured to abut the inner surface of the second panel (415), thereby defining a first predetermined angle (θ1) between the first panel (413) and the second panel (415) that may range from about 20 degrees to about 45 degrees, opening distally.

[0047] The second pair of angled wings (448) extend laterally from the second panel edge (454) of the second panel (415) to form trapezoidal planar panels each having a right angle. The right angle of each first angled wing (448) is located at the end closest to the first tongue (420). The second panel edge (454) extends along the edge of the second panel (415) parallel to the length of the unfolded body (409). Like the first panel edge (450), the second panel edge (454) may be perforated or surface-reduced to facilitate bending or breaking of the second pair of angled wings (448) relative to the second panel (315). The second pair of angled wings (448) are mirror images of the first pair of angled wings (446), and each second angled wing (448) defines a second outer edge (456) that defines a second predetermined angle (θ2) (see FIG. 21) between the first panel (413) and the second panel (415) of about 20 degrees to about 45 degrees. The second angle (θ2) may be the same as or different from the first angle (θ1).

[0048] In this embodiment, the second angled wing pair (448) is appropriately shaped so that the resulting second angle (θ2) is greater than the first angle (θ1) defined between the first panel (413) and the second panel (415) by the first wing (446), as shown in Figure 21 in comparison to Figure 19, for example. Thus, a user can selectively position the first wing (446) as described above to define a relatively small first angle (θ1) between the first panel (413) and the second panel (415) for use with an end effector (12) having a relatively small jaw opening (also referred to as an "aperture") between the anvil (18) in an open state and the deck (72) of the staple cartridge (37). Alternatively, the user can selectively position the second pair of angled wings (448) as described above to define a relatively large second angle (θ2) between the first panel (413) and the second panel (415) for use with an end effector (12) having a relatively large jaw opening in the open state.

[0049] Figure 19 shows the wedge-shaped applicator member (408) in a folded configuration after transitioning from the unfolded configuration. The wedge-shaped applicator member (408) is transitioned to the folded configuration by folding the first and second panels (413, 415) against the connecting panel (440) along the first and second fold lines (436, 438). To transition the wedge-shaped applicator member (408) from the unfolded configuration of Figure 16 to one of the folded configurations shown in Figures 19 and 20, either the first angled wing pair (446) or the second angled wing pair (448) is folded along the first or second panel edge (450, 454), respectively. The first or second outer edge (452, 456) engages the inside of the second panel (415) or the first panel (413), respectively. For example, if a user desires to set the additive applicator assembly 400 at a first angle (θ1), the user can fold the first pair of angled wings (446) inward along the first panel edge (450) to engage the inside of the second panel (415). The second pair of angled wings (448) can be folded out of the way, left unfolded, or cut away along the second panel edge (454) so ​​that they do not interfere with the first pair of angled wings (446) when the first pair of angled wings (446) is folded to engage the inside of the first panel (413).

[0050] To set the additive applicator assembly (400) at the second angle (θ2), the second pair of angled wings (448) are folded inward along the second panel edge (454) so ​​that the second outer edge (456) engages the inside of the first panel (413). The first pair of angled wings (446) may be folded out of the way, left unfolded, or cut away and discarded along the first panel edge (450) so that the first pair of angled wings (446) do not interfere with the second pair of angled wings (448) when the second pair of angled wings (448) is folded to engage the inside of the first panel (413).

[0051] 20 shows the additive applicator assembly (400) with the wedge-shaped applicator member (408) in a first folded configuration, the first and second panels (413, 415) defining a first angle (θ1) therebetween, and before the wedge-shaped applicator member (408) is coupled to the base (302). The base (302) is placed on a work surface with the side (324) facing upward. The first slot (328) is longitudinally spaced from the second slot (330) by a distance equal to the distance between the first tang (420) and the second tang (422) when the wedge-shaped applicator member (408) is set at the first angle (θ1). The first and second tongues (420, 422) are aligned with the first and second slots (428, 430) and then the wedge-shaped applicator member (408) is pushed downward to insert the first and second tongues (420, 422) into the first and second slots (428, 430).

[0052] 21 shows the add-on applicator assembly (400) with the wedge-shaped applicator member (408) in a second folded configuration, the first and second panels (413, 415) defining a second angle (θ2) therebetween, and the wedge-shaped applicator member (408) coupled to the base (302). The first slot (328) in the base (302) is spaced from the third slot (332) by a distance equal to the distance between the first tang (420) and the second tang (422) when the wedge-shaped applicator member (408) is set at the second angle (θ2). The wedge-shaped applicator member (408) is coupled to the base (302) by aligning the first tongue (420) with the first slot (328) and inserting the first tongue (420) into the first slot (328), aligning the second tongue (422) with the third slot (332) and inserting the second tongue (422) into the third slot (332), and pushing the wedge-shaped applicator member (408) downward.

[0053] As discussed above, it will be appreciated that the wedge-shaped applicator member (408) may be suitably configured to assume a variety of predetermined angular wedge configurations, and that the slots (328, 330, 332) in the base (302) may be suitably spaced from one another to receive the tangs (420, 422) of the wedge-shaped applicator member (408) in each of such predetermined configurations. Thus, a user may easily modify and adapt the wedge-shaped applicator member (408) for use with an end effector (12) having a fully open jaw opening between the anvil (18) and the deck (72) of the staple cartridge (37).

[0054] C. Exemplary Static Wedge Addendum Applicator with Adjustable Posts In some cases, it may be desirable to use a compact, sterile, disposable additive applicator assembly to attach an additive to the open lower jaw and anvil (16, 18) of an end effector (12). Additionally, it may be advantageous to set such additive applicator assemblies at different predetermined angles so that the additive applicator assembly can be used with different end effectors and / or at an optimal angle for a particular additive. It may also be desirable to have an additive applicator assembly that can be manipulated by a user to engage the open lower jaw and anvil (16, 18) of an end effector (12) without a base, such as the base (302) described above, that requires a work surface. Figures 22-24 illustrate a third exemplary additive applicator assembly (500) that may provide such functional benefits.

[0055] FIG. 22 shows the additive applicator assembly (500) in an unexpanded storage configuration. The additive applicator assembly (500) is similar to the additive applicator assembly (300) described above, except as otherwise described below. Like the additive applicator assembly (300), the additive applicator assembly (500) includes a wedge-shaped applicator member (508), a first additive element (304), and a second additive element (306). The additive applicator assembly (500) is also configured to be contained within a sealed sterility barrier of product packaging (not shown) during shipping and storage, such as being sealed within a sterile bag (not shown) during shipping and storage. The additive applicator assembly (500) may be constructed of materials similar to the additive applicator assembly (300). The additive applicator assembly (500) includes a body (509), which may be disposable or reusable. The addendum applicator assembly (500) is configured to move the first and second addendum elements (304, 306) into the open lower jaws and anvils (16, 18) of the end effector (12).

[0056] The additive applicator assembly (500) differs from the additive applicator assembly (300) in that the additive applicator assembly (500) is configured to be manually manipulated and inserted into the open lower jaw and anvil (16, 18) of the end effector (12) without being connected to the base (302), and the main body (509) can be folded into a storage configuration to minimize the space occupied by the main body (509) within the sterile barrier of the product packaging.

[0057] The body (509) includes a first panel (513), a second panel (515), a third panel (502), a first flex notch (504), a second flex notch (506), a connecting portion (518), and a support post (520). When in the unextended storage position, the body (509) extends proximally from the third panel (502) to the first flex notch (504). The third panel (502) may function as a handle configured for ergonomic grasping by a user's thumb and / or fingers. The third panel (502) is joined to the first panel (513) at the first flex notch (504). The first flexion notch (504) is a V-shaped notch located on the outer surface (522) of the main body (509) between the third panel (502) and the first panel (513). The outer surface (522) is the outward-facing surface of the main body (509). The first flexion notch (504) may include an adhesive (not shown) configured to hold the third panel (502) in a lateral position (shown in FIG. 23 ) relative to the longitudinally extending first panel (513).

[0058] The first panel (513) includes a first angular notch (544), a second angular notch (546), and a third angular notch (548) located at a distal portion of its inner surface (524). The inner surface (524) is the inward-facing surface of the body (509). The first panel (513) extends proximally from the first flexion notch (504) to a connecting portion (518). The connecting portion (518) joins the proximal end of the first panel (513) with the proximal end of the second panel (515). The connecting portion (518) may be in the form of a flexible U-bend or V-bend and is configured to allow the first and second panels (513, 515) to angularly deflect relative to one another between a plurality of angled configurations. The connecting portion (518) may include one or more bending features (538), which may be in the form of a fold or interconnected panels (not shown), similar to the first and second folds (336, 338) and connecting panel (340) of the additive applicator assembly (300). The second panel (515) extends distally from the connecting portion (518) to a second bending notch (506). The second bending notch (506) is located on the inner surface (554) of the second panel (515) and joins the post (520) to the second panel (515). The post (520) extends distally from the second bending notch (506) to the post end (540). The second bending notch (506) may be a V-shaped notch located on the inner surface (554) of the second panel (515). The post end (540) is configured to selectively engage one of the angled notches (544, 546, 548). The first and second attachment elements (304, 306) are removably attached to the first and second panels (513, 515) at their outer surfaces (522).

[0059] Figure 23 shows the additive applicator assembly (500) in a first, extended, angled configuration engaged with the open lower jaw and anvil (16, 18) of the end effector (12). The additive applicator assembly (500) has been transitioned from the storage configuration (shown in Figure 22) to the first angled configuration by bending the third panel (502) at the first bend notch (504) and bending the support post (520) at the second bend notch (506). The third panel (502) is bent laterally downward at the first bend notch (504) relative to the first panel (513) toward its outer surface (522). The support post (520) is bent laterally downward at the second bend notch (506) relative to the second panel (515) toward the inner surface (524) of the first panel (513). In the illustrated embodiment, the strut end (540) engages and is retained by the first angled notch (544). The first angled notch (544) is located distal to the second and third angled notches (546, 548). When the strut end (540) is retained by the first angled notch (544), the first panel (513) and the second panel (515) thereby define a first angle (θ1) therebetween, which may be, for example, in the range of about 20 degrees to about 45 degrees. In the first folded position, the lateral distance between the first panel (513) and the second panel (515) gradually increases distally away from the connecting portion (518), thus providing the wedge-shaped applicator member (508) with a wedge-like shape that tapers proximally toward the connecting portion (518).

[0060] The film 346 is removed from the second surfaces 312 of the first and second attachment elements 304, 306 before engaging the lower jaws and anvils 16, 18 of the end effector 12 with the wedge-shaped applicator member 508. A user can grasp or hold the third panel 502 between the fingers and thumb of one hand while using the other hand to push the wedge-shaped applicator member 508 into the open lower jaws and anvils 16, 18 of the end effector 12. The open lower jaws and anvils 16, 18 of the end effector 12 engage the first and second attachment elements 304, 306. The second surfaces 312 of the first and second attachment elements 304, 306 adhere to the open lower jaws and anvils 16, 18. The user then removes the end effector (12) from the wedge-shaped applicator member (508), and the first and second attachment elements (304, 306) separate from the applicator member (508) while remaining secured to the open lower jaw and anvil (16, 18).

[0061] Figure 24 shows the addendum applicator assembly (500) in a second, extended, angled position, engaged with the open lower jaw and anvil (16, 18) of the end effector (12). The wedge-shaped applicator member (508) has been transitioned from the storage position (shown in Figure 22) to the second angled configuration, similar to the first angled position (shown in Figure 23) described above. Specifically, the third panel (502) is bent about the first bend notch (504), and the support post (520) is bent about the second bend notch (506). The third panel (502) is bent laterally downward at the first bend notch (504) toward the outer surface (522) relative to the first panel (513). The struts (520) are bent laterally downward at the second bend notches (506) toward the inner surface (524) of the first panel (513) relative to the second panel (515). The strut ends (540) engage and are retained by the second angle notches (546). The second angle notches (546) are proximal to the first angle notches (544) and distal to the third angle notches (548). When the strut ends (540) are retained by the second angle notches (546), the first panel (513) and the second panel (515) define a second angle (θ2) therebetween, which may range from about 20 degrees to about 45 degrees. In this example, the second angle (θ2) is greater than the first angle (θ1) (shown in FIG. 23) in the second folded position, and therefore the lateral distance between the first panel (513) and the second panel (515) gradually increases in the distal direction at a greater rate than in the first folded position.

[0062] Although not shown, the support post (520) may be positioned in a third angle notch (548), such that the first panel (513) and the second panel (515) define a third angle between the first panel (513) and the second panel (515), which may be between about 20 degrees and about 45 degrees, greater than the second angle (θ2). As another merely illustrative example, the inner surface (524) of the first panel (513) may include one or more additional angle notches configured to define an additional predetermined angle between the first panel (513) and the second panel (515), in the range of about 20 degrees to about 45 degrees.

[0063] D. Exemplary Addendum Applicator Assembly with Force-Limiting Mechanism In some cases, it may be desirable to limit the amount of force used to attach an appendage to the open lower jaw and anvil (16, 18) of the end effector (12) to a predetermined amount of force to avoid excessive application of force that could otherwise damage the end effector (12) and / or the appendage elements (304, 306). Figures 25-26B show a fourth exemplary appendage applicator assembly (600) that may provide such a functional benefit.

[0064] As shown in FIG. 25 , the appendage applicator assembly (600) includes a wedge-shaped applicator member (608), which may be similar in structure and function to any of the exemplary wedge-shaped applicator members (308, 408, 508) described above. The applicator member (608) includes a body (610) and first and second appendages (304, 306) disposed on opposite sides of the body (610). The appendage applicator assembly (600) further includes a resilient member (602) in the form of a coil spring, a housing (604), and a coupling mechanism (606). The housing (604) may be configured similarly to the combination of the first and second housings (216A, 216B) of the buttress applier cartridge (210) described above, and in this example is configured as a chassis that provides a rigid support structure capable of supporting the wedge-shaped applicator member (608). Wedge-shaped applicator member 608 is slidably coupled to housing 604 by coupling mechanism 606. Coil spring 602 biases body 610 proximally to the proximal position shown in Figure 26A. Body 610 may be constructed from surgically safe plastic, stainless steel, or other materials known in the art that can be sterilized.

[0065] Similar to the wedge-shaped applicator member (308) of the add-on applicator assembly (300), the wedge-shaped applicator member (608) includes a first contact mechanism (613) including a first contact surface (614), a second contact mechanism (615) including a second contact surface (616), and a connection mechanism (640) interconnecting the first and second contact mechanisms (613, 615) at least at their proximal ends. The first add-on element (304) is attached to the first contact surface (614) of the first contact mechanism (613), and the second add-on element (306) is attached to the second contact surface (616) of the second contact mechanism (614). In some variations, the connection mechanism (640) may be suitably configured to allow the first and second contact mechanisms (613, 615) to move toward and away from each other about their proximal ends through a range of angled positions that define a distal opening angle for the body (610). In other variations, the body (610) may be a static structure in which the first and second contact mechanisms (613, 615) are fixed in angle relative to each other, thereby configuring the body (610) to define a single distal opening angle.

[0066] The wedge-shaped applicator member (608) is slidably coupled to the housing (604) by a plurality of support arms (642) and a movable member (644) in the form of a roller. Each support arm (642) is fixedly attached to the wedge-shaped applicator member (608) at a first end (646) and rotatably coupled to a roller (644) at a second end. This variation includes up to four support arms (642), with two support arms (642) attached to each side of the wedge-shaped applicator member (608). Various other numbers and arrangements of support arms (642) may be used in other variations. In still other variations, the movable member may be in the form of a slider, puck, ski, or any other structure known in the art that facilitates linear translation of a body relative to a chassis.

[0067] The housing (604) extends longitudinally from an open end (650) to a closed end (652) and has a "U" shape. The open end (650) is configured to receive the open lower jaw and anvil (16, 18) of the end effector (12). The housing (604) further includes first and second longitudinally extending housing sides (654, ​​658). The first housing side (654) has a first channel (656), and the second housing side (658) has a second channel (660) laterally opposed from the first channel (656). The first and second housing sides (654, ​​658) collectively define the "U" shape of the housing (604). Each channel (656, 660) houses one or more rollers (644). Each channel (656, 660) extends longitudinally along the corresponding first or second housing side (654, ​​658) and is configured to allow the roller (644) to rotate, thereby allowing the wedge-shaped applicator member (608) to translate proximally and distally relative to the housing (604).

[0068] A coil spring (602), shown in the form of an extension coil spring, is operably attached between the housing (604) and a coupling mechanism (606). In this variation, the coupling mechanism (606) couples to a proximal portion of the wedge-shaped applicator member (608) within the first housing side (654). In other variations, an additional coil spring (602) may be disposed within the second housing side (658) and attached between the additional coupling mechanism (606) and the proximal portion of the housing (604). In yet other variations, the coupling mechanism (606) may be attached between the coil spring (602) and a distal portion of the housing (604). In all of these variations, the coil spring (602) is in a contracted, relaxed state when the wedge-shaped applicator member (608) is in a proximal position relative to the housing (604).

[0069] 26A shows the open lower jaw and anvil (16, 18) of the end effector (12) engaging first and second attachment elements (304, 306) attached to first and second contact surfaces (614, 616), with the wedge-shaped applicator member (608) in a proximal position relative to the housing (604) and the coil spring (602) in a contracted state. In the proximal position, the coil spring (602) biases the wedge-shaped applicator member (608) proximally to the proximal position. The open lower jaw and anvil (16, 18) of the end effector (12) are pressed distally against the first and second attachment elements (304, 306), respectively, supported by the first and second contact mechanisms (613, 615).

[0070] Figure 26B shows the open lower jaw and anvil (16, 18) of the end effector (12) being pushed distally with a sufficient amount of force to overcome the resilient bias of the coil spring (602) and move the wedge-shaped applicator member (608) from the proximal position (shown in Figure 27A) to the distal position in which the coil spring (602) is extended. To transition the applicator member (608) to the distal position, the user applies a sufficient longitudinal input to overcome the predetermined biasing force that the coil spring (602) exerts on the wedge-shaped applicator member (608) in the proximal direction. When the distal input applied by the user to the applicator member (608) via the end effector (12) overcomes the proximal biasing force that the coil spring (602) exerts on the applicator member (608), the wedge-shaped applicator member (608) moves distally relative to the housing (604). This distal translational ability of the applicator member 608 relative to the housing 604 and the resilient bias of the extension spring 602 effectively limits the amount of force that the end effector 12 can apply to the applicator member 608 in response to user input. This configuration can ensure that the longitudinal compressive forces exerted mutually between the lower jaw and anvil 16, 18 and the applicator member 608 are sufficient to effectively secure the attachment elements 304, 306 to the lower jaw and anvil 16, 18, and can also limit such compressive forces to protect the lower jaw and anvil 16, 18 and the applicator member 608 from damage that might otherwise result from excessive compressive forces.

[0071] The rollers 644 facilitate distal translation of the wedge-shaped applicator member 608 and keep the wedge-shaped applicator member 608 longitudinally aligned to prevent misalignment during application of the first and second attachment elements 304, 306 to the lower jaw and anvil 16, 18 of the end effector 12. A portion of the end effector 12 may engage a stop mechanism on the housing 604 to prevent the coil spring 602 from overextending beyond its designed range of motion and applying more than a predetermined amount of force to the first and second attachment elements 304, 306. This allows the coil spring 602 to apply a predetermined amount of force proximally against the lower jaw and anvil 16, 18 of the end effector 12. As described above, this predetermined force is sufficient to attach the second surfaces (312) of the first and second attachment elements (304, 306) to the open lower jaws and anvils (16, 18) of the end effector (12). When a portion of the end effector (12) engages the stop feature of the housing (604), the end effector (12) moves proximally away from the add-on applicator assembly (600). The attachment force of the second attachment feature (344) is greater than the attachment force of the first attachment feature (342), thereby attaching the first and second attachment elements (304, 306) to the open lower jaws and anvils (16, 18) of the end effector (12).

[0072] IV. Exemplary Combinations The following examples illustrate various non-exhaustive ways in which the teachings herein may be combined or applied. It should be understood that the following examples are not intended to limit the scope of the claims that may be presented at any time in this application or any subsequent application related to this application. No disclaimer is intended. The following examples are provided merely for illustrative purposes. It is contemplated that the various teachings herein may be configured and applied in many other ways. It is also contemplated that certain features referred to in the following examples may be omitted in some variations. Accordingly, none of the aspects or features referred to below should be considered critical unless later expressly indicated as such by the inventors or their successors. If a claim presented in this application or any subsequent application related to this application includes additional features other than those referred to below, those additional features should not be considered added for any reasons of patentability. [Example]

[0073] 1. A device comprising: (a) a body including: (i) a first body portion; (ii) a second body portion opposite the first body portion; and (iii) a connecting portion coupling a proximal end of the first body portion to a proximal end of the second body portion, the connecting portion being configured to allow the first body portion and the second body portion to move toward and away from each other between a plurality of angular orientations that each define a distal opening angle; (b) a first attachment element disposed on an outwardly facing surface of the first body portion; and (c) a second attachment element disposed on an outwardly facing surface of the second body portion, the first body portion and the second body portion being securable relative to each other in each of the angular orientations such that the first body portion is configured to apply the first attachment element to a first jaw of a surgical stapler end effector, and the second body portion is configured to simultaneously apply the second attachment element to the second jaw of the surgical stapler end effector. [Example]

[0074] The device of example 1, wherein the distal opening angle defined by the body in the plurality of angular orientations ranges from about 20 degrees to about 45 degrees. [Example]

[0075] The device of any of Examples 1-2, further comprising a base removably coupled to the body, the base configured to support the body at multiple angular orientations. [Example]

[0076] The device of Example 3, wherein the body further includes a first tab extending from the first body portion and a second tab extending from the second body portion, the first tab and the second tab configured to mate with the multiple slots in the base. [Example]

[0077] The device of any of Examples 1 to 4, further comprising a first pair of wings coupled to the first body portion, the first pair of wings configured to engage and support the second body portion relative to the first body portion to define and maintain a distal opening angle. [Example]

[0078] The device of Example 5, further comprising a second pair of wings coupled to the second body portion, the second pair of wings configured to engage with the first body portion to define a distal opening angle. [Example]

[0079] A device described in any of Examples 3-4, wherein the base includes a first slot configured to set the angular orientation of the body to define a first distal opening angle. [Example]

[0080] The device of example 7, wherein the base includes a second slot configured to set an angular orientation of the body to define a second distal opening angle different from the first distal opening angle. [Example]

[0081] The device of any of Examples 1-8, wherein the first body portion comprises a first panel and the second body portion comprises a second panel. [Example]

[0082] The device of any one of Examples 1 to 9, wherein at least one of the first attachment element or the second attachment element includes a buttress. [Example]

[0083] The device of any one of Examples 1 to 10, wherein at least one of the first attachment element or the second attachment element includes a tissue thickness compensator. [Example]

[0084] The device of any one of Examples 1 to 11, wherein the first and second attachment elements are removably attached to the first and second body portions, respectively, using an adhesive. [Example]

[0085] 13. The device of any of Examples 1-12, wherein the body includes a third body portion configured to be gripped by a user. [Example]

[0086] The device of any of Examples 1 to 13, further comprising a base having a first pair of slots and a second pair of slots, the first pair of slots configured to define a first distal opening angle of the body, and the second pair of slots configured to define a second distal opening angle of the body. [Example]

[0087] 10. A surgical assembly comprising: (a) an end effector including a first jaw having a plurality of staple forming pockets and a second jaw having a plurality of openings configured to receive a plurality of staples; and (b) the apparatus of any of the preceding embodiments, wherein the first body portion is configured to apply a first attachment element to the first jaw and the second body portion is configured to apply a second attachment element to the second jaw. [Example]

[0088] 1. An assembly comprising: (a) a surgical stapler end effector including a first jaw and a second jaw; and (b) an applicator including: (i) a connecting portion; (ii) a first body portion extending distally from the connecting portion; (iii) a second body portion extending distally from the connecting portion opposite the first body portion, the first body portion and the second body portion being configured to define a distal opening angle; (iv) a first attachment element disposed on the first body portion; and (v) a second attachment element disposed on the second body portion, wherein the first body portion is configured to apply the first attachment element to the first jaw and the second body portion is configured to apply the second attachment element to the second jaw while the surgical stapler end effector is in an open state. [Example]

[0089] 17. The assembly of Example 16, wherein the device further includes a post hingedly connected to the second body portion, the first body portion including one or more retention notches disposed along a distal length of the first body portion, and the post configured to mate with a selected one of the retention notches to define a corresponding distal opening angle between the first body portion and the second body portion. [Example]

[0090] An assembly described in any of Examples 16-17, wherein the device further includes a third body portion hingedly connected to a distal end of the first body portion, the third body portion configured to deflect laterally relative to a longitudinal axis defined by the distal length of the first body portion, and the third body portion configured to be grasped by a user. [Example]

[0091] A method of applying an attachment element to a jaw of a surgical instrument end effector using an applicator, the applicator including a first body portion and a second body portion securable relative to one another in a non-parallel arrangement, whereby the first body portion and the second body portion define a distal opening angle, the attachment element being disposed on one of the first body portion or the second body portion, the method comprising: (a) providing the end effector in an open position configured to receive tissue between the first and second jaws of the end effector; (b) applying an attachment element to the first jaw of the end effector; (c) positioning an end effector in an open position about an applicator so that one jaw engages a first body portion and the second jaw simultaneously engages a second body portion; (d) moving the end effector and the applicator toward each other to apply an attachment element to one of the first jaw or the second jaw; and (d) moving the end effector and the applicator away from each other to separate the attachment element from the applicator while the attachment element remains attached to one of the first jaw or the second jaw. [Example]

[0092] 20. The method of example 19, further comprising moving the first body portion and the second body portion relative to each other to change a distal opening angle defined by the first body portion and the second body portion.

[0093] V. Other It should be understood that any one or more of the teachings, expressions, embodiments, examples, etc. described herein can be combined with any one or more of the other teachings, expressions, embodiments, examples, etc. described herein. Thus, the above teachings, expressions, embodiments, examples, etc. should not be considered in isolation from one another. Various suitable ways in which the teachings herein can be combined will be readily apparent to those skilled in the art in light of the teachings herein. Such modifications and variations are intended to be within the scope of the claims.

[0094] Additionally, any one or more of the teachings herein may be combined with any one or more of the teachings disclosed in the following patent applications: U.S. Patent Application No. [Attorney Docket No. END9286USNP2], entitled "Apparatus and Method to Apply Buttress to End Effector of Surgical Stapler via Driven Member" (filed on the same day as this application); U.S. Patent Application No. [Attorney Docket No. END9286USNP3], entitled "Apparatus and Method to Apply Buttresses Separately to Jaws of End Effector of Surgical Stapler" (filed on the same day as this application); U.S. Patent Application No. [Attorney Docket No. END9286USNP4], entitled "Apparatus and Method to Close End Effector of Surgical Stapler onto Buttress" (filed on the same day as this application); U.S. Patent Application No. [Attorney Docket No. END9286USNP5], entitled "Apparatus and Method to Detect Full Seating of Buttress Applicator in No. [Attorney Docket No. END9286USNP6], entitled "Apparatus and Method to Apply Buttress to End Effector of Surgical Stapler with Authentication," filed on the same day as this application, and / or U.S. Patent Application No. [Attorney Docket No. END9286USNP7], entitled "Method of Applying Buttress to End Effector of Surgical Stapler," filed on the same day as this application, the disclosures of each of which are incorporated herein by reference.

[0095] It should be understood that all or part of any patent, publication, or other disclosure referred to herein as being incorporated by reference is incorporated herein only to the extent that the incorporated material does not contradict existing definitions, opinions, or other disclosures set forth in this disclosure. As such, and to the extent necessary, the disclosures explicitly set forth herein shall supersede any conflicting statements incorporated herein by reference. Any material, or portions thereof, that is referred to herein as being incorporated by reference but that contradicts current definitions, opinions, or other disclosures set forth herein shall be incorporated only to the extent that no conflict arises between the incorporated material and the current disclosures.

[0096] Variations of the above-described devices can be applied not only to traditional medical procedures and surgeries performed by medical professionals, but also to robotic-assisted medical procedures and surgeries. By way of example only, the various teachings herein can be readily incorporated into robotic surgical systems such as the DAVINCI™ system by Intuitive Surgical, Inc. (Sunnyvale, California).

[0097] The device variations described above can be designed to be disposed of after a single use, or they can be designed to be used multiple times. In either or both cases, the variations can be reconditioned for reuse after at least one use. Reconditioning can include any combination of the steps of disassembly of the device, followed by cleaning or replacement of particular parts, and subsequent reassembly. In particular, some device variations can be disassembled and any number of particular portions or parts of the device can be selectively replaced or removed in any combination. Upon cleaning and / or replacement of particular parts, some device variations can be reassembled for subsequent use either at a reconditioning facility or by the user immediately prior to a procedure. Those skilled in the art will appreciate that reconditioning of a device can utilize a variety of techniques for disassembly, cleaning / replacement, and reassembly. The use of such techniques, and the resulting reconditioned device, are all within the scope of the present application.

[0098] By way of example only, the variations described herein may be sterilized before and / or after treatment. In one sterilization technique, the device is placed in a closed and sealed container, such as a plastic or TYVEK bag. The container and device may then be placed in a radiation field that can penetrate the container, such as gamma radiation, X-rays, or a high-energy electron beam. The radiation may kill bacteria on the device and in the container. The sterilized device may then be stored in the sterile container for later use. The device may also be sterilized using any other technique known in the art, including, but not limited to, beta or gamma radiation, ethylene oxide, or steam.

[0099] While various embodiments of the present invention have been shown and described, further adaptations of the methods and systems described herein may be realized by those skilled in the art through appropriate modifications without departing from the scope of the present invention. While some such possible modifications have been described, other modifications will be apparent to those skilled in the art. For example, the above examples, embodiments, geometries, materials, dimensions, proportions, steps, etc. are illustrative and not required. Accordingly, it will be understood that the scope of the present invention should be considered in terms of the following claims, and is not limited to the details of construction and operation shown and described in the specification and drawings.

[0100] [Embodiment] (1) A device comprising: (a) a body, (i) a first body portion; (ii) a second body portion opposite the first body portion; and (iii) a connecting portion coupling a proximal end of the first body portion to a proximal end of the second body portion, the connecting portion configured to allow the first body portion and the second body portion to move toward and away from each other between a plurality of angular orientations that each define a distal opening angle; (b) a first attachment element disposed on an outwardly facing surface of the first body portion; (c) a second attachment element disposed on an outwardly facing surface of the second body portion; the first body portion and the second body portion are securable relative to one another in each of the angular orientations such that the first body portion is configured to apply the first attachment element to a first jaw of a surgical stapler end effector and the second body portion is configured to simultaneously apply the second attachment element to a second jaw of the surgical stapler end effector. (2) The device described in embodiment 1, wherein the distal opening angle defined by the body in the multiple angular orientations ranges from about 20 degrees to about 45 degrees. (3) The device described in embodiment 1, further comprising a base removably connected to the body, the base configured to support the body at the plurality of angular orientations. (4) The device of embodiment 3, wherein the body further includes a first tab extending from the first body portion and a second tab extending from the second body portion, the first tab and the second tab configured to mate with a plurality of slots in the base. (5) The device of embodiment 4, further comprising a first pair of wings coupled to the first body portion, the first pair of wings configured to engage and support the second body portion relative to the first body portion to define and maintain the distal opening angle.

[0101] (6) The device of embodiment 5, further comprising a second pair of wings coupled to the second body portion, the second pair of wings configured to engage with the first body portion to define the distal opening angle. (7) The device of embodiment 4, wherein the base includes a first slot configured to set the angular orientation of the body to define a first distal opening angle. (8) The device of claim 7, wherein the base includes a second slot configured to set the angular orientation of the body to define a second distal opening angle different from the first distal opening angle. (9) The device of embodiment 1, wherein the first body portion includes a first panel and the second body portion includes a second panel. (10) The device of embodiment 1, wherein at least one of the first attachment element or the second attachment element includes a buttress.

[0102] (11) The device of embodiment 1, wherein at least one of the first attachment element or the second attachment element includes a tissue thickness compensator. (12) The device of embodiment 1, wherein the first attachment element and the second attachment element are removably attached to the first body portion and the second body portion, respectively, using an adhesive. (13) The device of embodiment 1, wherein the body includes a third body portion configured to be grasped by a user. (14) The device of embodiment 1, further comprising a base having a first pair of slots and a second pair of slots, the first pair of slots configured to define a first distal opening angle of the body, and the second pair of slots configured to define a second distal opening angle of the body. (15) A surgical assembly comprising: (a) an end effector including a first jaw having a plurality of staple forming pockets and a second jaw having a plurality of openings configured to receive a plurality of staples; (b) A surgical assembly comprising: an apparatus according to embodiment 1, wherein the first body portion is configured to apply the first attachment element to the first jaw, and the second body portion is configured to apply the second attachment element to the second jaw.

[0103] (16) An assembly comprising: (a) a surgical stapler end effector including a first jaw and a second jaw; (b) an additive applicator, (i) a connecting portion; (ii) a first body portion extending distally from the connecting portion; (iii) a second body portion opposite the first body portion and extending distally from the connecting portion, the first body portion and the second body portion configured to define a distal opening angle; (iv) a first attachment element disposed on the first body portion; and (v) a second application element disposed on the second body portion; an assembly, wherein the first body portion is configured to apply the first attachment element to the first jaw and the second body portion is configured to apply the second attachment element to the second jaw while the surgical stapler end effector is in an open state. (17) The assembly of embodiment 16, wherein the device further includes a post hingedly connected to the second body portion, the first body portion including one or more retention notches disposed along a distal length of the first body portion, and the post configured to mate with a selected one of the retention notches to define a corresponding distal opening angle between the first body portion and the second body portion. (18) The assembly of embodiment 16, wherein the device further includes a third body portion hingedly connected to a distal end of the first body portion, the third body portion configured to deflect laterally relative to a longitudinal axis defined by a distal length of the first body portion, and the third body portion configured to be grasped by a user. (19) A method of applying an attachment element to a jaw of a surgical instrument end effector using an applicator, the applicator including a first body portion and a second body portion securable relative to one another in a non-parallel arrangement, whereby the first body portion and the second body portion define a distal opening angle, the attachment element being disposed on one of the first body portion or the second body portion, the method comprising: (a) providing the end effector in an open position configured to receive tissue between a first jaw and a second jaw of the end effector; (b) positioning the end effector in the open position about the applicator such that the first jaw engages the first body portion and the second jaw simultaneously engages the second body portion; (c) moving the end effector and the applicator toward each other to apply the attachment element to one of the first jaw or the second jaw; (d) moving the end effector and the applicator away from each other to separate the attachment element from the applicator while the attachment element remains attached to the one of the first jaw or the second jaw. (20) The method of embodiment 19, further comprising moving the first body portion and the second body portion relative to one another to change the distal opening angle defined by the first body portion and the second body portion.

Claims

1. 1. An apparatus comprising: (a) a body, (i) a first body portion; (ii) a second body portion opposite the first body portion; and (iii) a connecting portion coupling a proximal end of the first body portion to a proximal end of the second body portion, the connecting portion configured to allow the first body portion and the second body portion to move toward and away from each other between a plurality of angular orientations that each define a distal opening angle; (b) a first attachment element disposed on an outwardly facing surface of the first body portion; (c) a second attachment element disposed on an outwardly facing surface of the second body portion; the first body portion and the second body portion are securable relative to one another in each of the angular orientations such that the first body portion is configured to apply the first application element to a first jaw of a surgical stapler end effector and the second body portion is configured to simultaneously apply the second application element to a second jaw of the surgical stapler end effector.

2. The device of claim 1 , wherein the distal opening angle defined by the body in the plurality of angular orientations ranges from about 20 degrees to about 45 degrees.

3. The device of claim 1 , further comprising a base removably coupled to the body, the base configured to support the body at the plurality of angular orientations.

4. 4. The device of claim 3, wherein the body further includes a first tab extending from the first body portion and a second tab extending from the second body portion, the first tab and the second tab configured to mate with a plurality of slots in the base.

5. 5. The device of claim 4, further comprising a first pair of wings coupled to the first body portion, the first pair of wings configured to engage and support the second body portion relative to the first body portion to define and maintain the distal opening angle.

6. 6. The device of claim 5, further comprising a second pair of wings coupled to the second body portion, the second pair of wings configured to engage the first body portion to define the distal opening angle.

7. The device of claim 4 , wherein the base includes a first slot configured to set the angular orientation of the body to define a first distal opening angle.

8. 8. The device of claim 7, wherein the base includes a second slot configured to set the angular orientation of the body to define a second distal opening angle different from the first distal opening angle.

9. The device of claim 1 , wherein the first body portion includes a first panel and the second body portion includes a second panel.

10. The device of claim 1 , wherein at least one of the first affixation element or the second affixation element comprises a buttress.

11. The device of claim 1 , wherein at least one of the first application element or the second application element comprises a tissue thickness compensator.

12. The device of claim 1 , wherein the first and second attachment elements are removably attached to the first and second body portions, respectively, using an adhesive.

13. The device of claim 1 , wherein the body includes a third body portion configured to be grasped by a user.

14. 10. The device of claim 1, further comprising a base having a first pair of slots and a second pair of slots configured to define a first distal opening angle of the body and a second pair of slots configured to define a second distal opening angle of the body.

15. 1. A surgical assembly comprising: (a) an end effector including a first jaw having a plurality of staple forming pockets and a second jaw having a plurality of openings configured to receive a plurality of staples; (b) the apparatus of claim 1, wherein the first body portion is configured to apply the first attachment element to the first jaw and the second body portion is configured to apply the second attachment element to the second jaw.

16. 1. An assembly comprising: (a) a surgical stapler end effector including a first jaw and a second jaw; (b) an additive applicator, (i) a connecting portion; (ii) a first body portion extending distally from the connecting portion; (iii) a second body portion opposite the first body portion and extending distally from the connecting portion, the first body portion and the second body portion configured to define a distal opening angle; (iv) a first attachment element disposed on the first body portion; and (v) a second application element disposed on the second body portion; the first body portion is configured to apply the first application element to the first jaw and the second body portion is configured to apply the second application element to the second jaw while the surgical stapler end effector is in an open state; an assembly wherein the addendum applicator further includes a post hingedly connected to the second body portion, the first body portion including one or more retention notches disposed along a distal length of the first body portion, the post configured to mate with a selected one of the retention notches to define a corresponding distal opening angle between the first body portion and the second body portion.

17. 1. An assembly comprising: (a) a surgical stapler end effector including a first jaw and a second jaw; (b) an additive applicator, (i) a connecting portion; (ii) a first body portion extending distally from the connecting portion; (iii) a second body portion opposite the first body portion and extending distally from the connecting portion, the first body portion and the second body portion configured to define a distal opening angle; (iv) a first attachment element disposed on the first body portion; and (v) a second application element disposed on the second body portion; the first body portion is configured to apply the first application element to the first jaw and the second body portion is configured to apply the second application element to the second jaw while the surgical stapler end effector is in an open state; the additive applicator further includes a third body portion hingedly connected to a distal end of the first body portion, the third body portion configured to deflect laterally relative to a longitudinal axis defined by a distal length of the first body portion, the third body portion configured to be grasped by a user.

Images