CN103140182B - 包括多个层的可植入紧固件仓 - Google Patents

包括多个层的可植入紧固件仓 Download PDF

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Publication number
CN103140182B
CN103140182B CN201180047613.5A CN201180047613A CN103140182B CN 103140182 B CN103140182 B CN 103140182B CN 201180047613 A CN201180047613 A CN 201180047613A CN 103140182 B CN103140182 B CN 103140182B
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staple
nail bin
end effector
anvil block
percussion
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CN103140182A (zh
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F·E·谢尔顿四世
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Ethicon Endo Surgery Inc
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Ethicon Endo Surgery Inc
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Abstract

本发明提供了一种紧固件仓,所述紧固件仓可包括可压缩、可塌缩和/或可压溃的仓体以及嵌入所述仓体内的紧固件,所述紧固件可用于紧固组织。在使用中,所述紧固件仓可被定位在外科紧固装置的第一钳口中,其中所述第一钳口可与第二钳口或砧座相对地定位。所述砧座可与所述紧固件仓接合以压缩、塌缩和/或压溃所述仓体,并且使包含在仓体中的紧固件变形或换句话讲对所述紧固件进行部署。当紧固件变形或被部署时,紧固件可将仓体的至少一部分连同被紧固组织的至少一部分捕获在其中。在各种实施例中,所述仓体可包括由不同材料构成的多个层,所述多个层可对组织施加压力。这些不同的材料可具有不同的刚度和/或弹簧比率。

Description

包括多个层的可植入紧固件仓
背景技术
技术领域
本发明涉及一种外科器械,并且在各种实施例中,本发明涉及被设计成用于切割和缝合组织的外科切割和缝合器械及其钉仓。
背景技术
内窥镜式外科器械常常优于传统的开放式外科器件,因为较小的切口往往会降低术后恢复时间和并发症。因此,已对适用于将端部执行器穿过套管针的套管精确地设置在所需外科手术部位处的内窥镜式外科器械进行了显著的开发。这些远侧端部执行器以多种方式接合组织以实现诊断或治疗效果(例如腔内切割缝合器、抓紧器、切割器、缝合器、施夹器、进入装置、药物/基因治疗递送装置以及利用超声波、RF、激光等的能量装置)。
在许多内窥镜式外科应用中,希望采用仅具有完成特定外科手术所需大小的端部执行器。端部执行器越小,手术部位的可视化就越好。较小的端部执行器也能够在紧密空间中更顺利地进入及操纵。这种端部执行器的设计者在试图开发小的端部执行器时面临许多挑战。制造小的端部执行器并且更具体地讲制造被设计成用于切割和缝合组织的小的腔内切割缝合器的能力受到致动力大小的限制,所述致动力通常是使成行的缝钉成形所必需的。这种致动力也可随着被处理的组织的厚度及组成而改变。例如,切割及缝合厚的组织通常需要更大的致动力。然而,切割及缝合较薄的组织期望的致动力较小。因此,许多现有的腔内切割缝合器通常采用强健的砧座闭合系统及缝钉驱动系统,所述砧座闭合系统及所述缝钉驱动系统能够适应特定范围的组织厚度。然而,这种装置常常并不适用于处理较薄的组织。
先前的腔内切割缝合器装置通常也在缝钉被驱动并在切口每一侧上的组织中成形时切割组织。尽管这种装置对于需要切割并紧固组织的手术而言非常有效,然而其无法令外科医生在不切割组织的情况下安装紧固件。同样,尽管已开发出各种形式的铰接式腔内切割缝合器来改善进入,然而这种装置中所通常采用的元件必须基本上足够容纳可从装置的柄部产生并传送足够的击发及闭合力至端部执行器的结构。因此,这种端部执行器常常过大而无法有效进入体内的紧密空间。
因此,需要提供能够解决上述许多挑战的外科切割和缝合器械和钉仓装置。
上述讨论仅仅为了举例说明本技术领域内目前存在的一些不足之处,而不应看作是对权利要求范围的否定。
发明内容
在至少一种形式中,一种钉仓可包括多个缝钉、以及可植入的钉仓本体,所述可植入的钉仓本体包括:由第一材料构成的第一可压缩层,其中缝钉被嵌入所述第一可压缩层中;以及由第二材料构成的第二可压缩层,其中所述第一可压缩层包含第一刚度,其中所述第二可压缩层包含第二刚度,并且其中所述第一刚度不同于所述第二刚度。
在至少一种形式中,一种紧固件仓可包括多个紧固件以及可植入的仓体,所述可植入的仓体包括:由第一材料构成的第一可压缩层合物,其中缝钉被嵌入所述第一可压缩层合物中;以及由第二材料构成的第二可压缩层合物,其中所述第一可压缩层合物包含第一刚度,其中所述第二可压缩层合物包含第二刚度,并且其中所述第一刚度不同于所述第二刚度。
在至少一种形式中,一种紧固件仓可包括多个紧固件以及可植入的仓体,所述可植入的仓体包括用于存储所述多个紧固件的装置以及可压缩层,其中所述装置包含第一刚度,其中所述可压缩层包含第二刚度,并且其中所述第一刚度不同于所述第二刚度。
附图说明
通过结合附图参考本发明实施例的以下说明,本发明的上述和其它特征和优点和其实现方法将会变得更加明显,并可更好地理解发明本身,其中:
图1是本发明的外科器械实施例的剖视图;
图1A是本发明的可植入钉仓的一个实施例的透视图;
图1B-1E示出本发明各种实施例的端部执行器的用于夹紧和缝合组织的部分以及本发明的可植入钉仓实施例;
图2是本发明的端部执行器实施例和外科缝合器械实施例的一部分的分解组装剖视图;
图3是本发明的砧座实施例的侧正视图;
图4是图1所示柄部组件的一部分的剖视图;
图5是沿图1中的线5-5截取的图1所示柄部组件的局部剖视图;
图6是本发明的击发传递实施例的一部分的透视图;
图7是沿图1中的线7-7截取的图1所示柄部组件的局部剖视图;
图8是沿图7中的线8-8截取的图7所示柄部组件的一部分的局部剖视图;
图9是本发明的外科器械实施例在端部执行器已联接到外科器械的脊部之后且在所述端部执行器被锁定至所述脊部之前的剖视图;
图9A是图10所示的端部执行器与外科器械的一部分的放大视图;
图10是图9所示外科器械在端部执行器已被锁定至外科器械的脊部之后的剖视图;
图10A是图10所示的端部执行器与外科器械的一部分的放大视图;
图11是图9和图10所示的外科器械在第一击发衔接子已被推进至砧座的夹紧滑道部的起点之后的剖视图;
图11A是图11所示的端部执行器与外科器械的一部分的放大视图,其中其砧座与钉仓之间容纳有组织;
图12是图9至图11所示的外科器械在第一击发衔接子已在砧座的夹紧滑道部上推进之后的剖视图;
图12A是图12所示的端部执行器与外科器械的一部分的放大视图;
图13是图9至图12所示的外科器械在第一击发衔接子已在缝钉成形滑道上推进从而在可植入钉仓内使缝钉完全成形之后的剖视图;
图13A是图13所示的端部执行器与外科器械的一部分的放大视图;
图14是图9至图13所示的外科器械在第一击发衔接子已在缝钉成形滑道上推进从而在可植入钉仓内使缝钉完全成形之后以及在刀杆沿纵向推进穿过端部执行器之后的剖视图;
图14A是图14所示的端部执行器与外科器械的一部分的放大视图;
图15是本发明的另一端部执行器实施例与本发明外科器械实施例的脊构件的一部分的分解剖视图;
图16是图15所示的端部执行器实施例处于打开位置并附接到外科器械实施例的局部剖视图;
图17是图15和图16所示的端部执行器实施例处于完全夹紧位置的另一局部剖视图;
图18是图15至图17所示的端部执行器实施例处于完全击发位置且在远端刀具构件推进之前的另一局部剖视图;
图19是图15至图18所示的端部执行器实施例处于完全击发位置且在远端刀具构件完全推进之后的另一局部剖视图;
图20是本发明的另一柄部组件实施例的一部分的剖视图;
图21是沿图20中的线21-21截取的图20所示柄部组件的一部分的局部剖视图;
图22是沿图20中的线22-22截取的图20所示柄部组件的一部分的局部剖视图;
图23是沿图20中的线23-23截取的图20所示柄部组件的一部分的局部剖视图;
图24是本发明的另一柄部组件实施例的一部分的剖视图;
图25是本发明的另一端部执行器实施例联接到本发明外科器械实施例的一部分的局部剖面侧视图,其中端部执行器支撑本发明的外科钉仓实施例,并且端部执行器的砧座处于打开位置;
图26是图25所示的端部执行器处于闭合位置的另一局部剖面侧视图;
图27是图25和图26所示的端部执行器在刀杆开始穿过端部执行器而被推进时的另一局部剖面侧视图;
图28是图25至图27所示的端部执行器在刀杆被部分地推进穿过其中时的另一局部剖面侧视图;
图29是本发明的另一端部执行器实施例联接到本发明外科器械实施例的一部分的局部剖面侧视图,其中端部执行器支撑本发明的另一外科钉仓实施例,并且端部执行器的砧座处于打开位置;
图30是图29所示的端部执行器在刀杆被部分地推进穿过其中时的另一局部剖面侧视图;
图31是本发明的另一外科器械实施例的剖视图,其端部执行器的砧座处于打开位置;
图32是图31所示的端部执行器实施例和外科缝合器械实施例的一部分的分解组装剖视图;
图33是图31所示的端部执行器和外科器械的细长轴组件的一部分的俯视图,其中某些部分显示于沿线图31中的33-33截取的横截面中;
图34是图31所示外科器械的端部执行器和细长轴组件的一部分的俯视图,其中某些部分显示于横截面中;
图35是图31所示外科器械的端部执行器和细长轴组件的一部分的另一俯视图,其中端部执行器处于铰接式取向且端部执行器处于打开位置;
图36是图35所示端部执行器的另一俯视图,其中端部执行器处于闭合或夹紧位置;
图37是图36所示端部执行器和外科器械实施例的一部分的放大视图;
图38是图31所示外科器械的柄部组件的一部分的剖视图;
图39是沿图38中的线39-39截取的图38所示柄部组件的一部分的另一剖视图;
图40是本发明各实施例的关节球和承窝结构的局部分解透视图;
图41是本发明的处于非铰接式取向的另一外科器械实施例的端部执行器和细长轴组件的一部分的俯视图;
图42是图41所示端部执行器和细长轴组件的部分处于铰接位置时的另一俯视图;
图43是本发明另一外科器械实施例的剖视图;
图44是图43所示外科器械实施例的铰接式轴组件的一部分的局部剖视图;
图44A是图44所示铰接式轴组件的一部分的剖视图;
图44B是图44所示铰接式轴组件的另一部分的另一剖视图;
图44C是图44所示铰接式轴组件的另一部分的另一剖视图;
图44D是图44所示铰接式轴组件的另一部分的另一剖视图;
图44E是图44所示铰接式轴组件的另一部分的另一剖视图;
图44F是图44所示铰接式轴组件的另一部分的另一剖视图;
图45是沿图44中的线45-45截取的图44所示铰接式轴组件的局部剖视图;
图46是沿图44中的线46-46截取的图44所示铰接式轴组件的局部剖视图;
图47是图43所示外科器械的另一剖视图,其中所述外科器械的端部执行器显示于完全铰接位置中;
图48是图47所示端部执行器的剖视图,其中波纹管状覆盖件延伸越过铰接接头;
图49是本发明另一外科器械实施例的柄部组件的剖视图;
图50是图49所示端部执行器与细长轴组件的远端的分解组装剖视图;
图51是图50所示端部执行器和细长轴组件的部分的另一剖视图,其中端部执行器处于打开位置;
图52是端部执行器和细长轴组件的部分的另一剖视图,其中端部执行器处于闭合位置;
图53是图49至图52所示端部执行器和细长轴的另一剖视图,其中刀构件处于完全击发位置;
图54是图51至图53所示的端部执行器处于打开位置的透视图;
图55是沿图51中的线55-55截取的图51至图54所示端部执行器的剖视图;
图56是本发明另一实施例的细长轴组件的局部透视图,所述细长轴组件附接到本发明的端部执行器实施例;
图57是本发明另一外科器械实施例的柄部组件的局部剖视图;
图58是沿图57中的线58-58截取的图56和图57所示细长轴组件的一部分的剖视图;
图59是图57所示柄部组件的一部分的放大视图;
图60是图56至图59所示细长轴组件的远端部分的剖视图;
图61是本发明另一实施例的细长轴组件的局部透视图,所述细长轴组件附接到本发明的端部执行器实施例;
图62是图61所示细长轴的可重构的轴区段的一部分的剖视图;
图63是本发明另一实施例的细长轴组件的局部透视图,所述细长轴组件附接到本发明的端部执行器实施例;
图64是本发明另一外科器械实施例的柄部组件的剖视图;
图65是沿图64中的线65-65截取的图63和图64所示细长轴组件的一部分的剖视图;
图66是图64所示柄部组件的一部分的放大视图;
图67是图63所示可重构的轴区段的一部分的剖视图,其中所述部分的各管状链节部基本上沿直线对齐;
图68是图63和图67所示可重构的轴区段的一部分的剖视图,其中所述部分的各管状链节部以基本上弯曲(非同轴)的取向对齐;
图69是本发明的替代钉仓实施例的透视图,所述钉仓安装在本发明的外科切割和缝合装置实施例中;
图70是图69所示装置的外科钉仓和细长通道的俯视图;
图71是本发明的另一外科钉仓实施例的俯视图,所述外科钉仓安装在本发明的端部执行器实施例的细长通道中;
图72是本发明的砧座实施例的仰视图;
图73是用于形成本发明缝钉线实施例的一部分的多个缝钉的局部透视图;
图74是图73所示缝钉线实施例在其缝钉通过与外科切割和缝合装置的砧座相接触而成形后的另一局部透视图;
图75是用于形成本发明另一缝钉线实施例的一部分的替代缝钉的局部透视图;
图76是用于形成本发明另一缝钉线实施例的一部分的替代缝钉的局部透视图;
图77是用于形成本发明另一缝钉线实施例的一部分的替代缝钉的局部透视图;
图78是本发明的端部执行器实施例的剖视图,所述端部执行器实施例支撑本发明的钉仓实施例;
图79是图78所示端部执行器的细长通道部在移除可植入钉仓本体部和缝钉之后的剖视图;
图80是本发明的端部执行器实施例的剖视图,所述端部执行器支撑本发明的另一钉仓实施例;
图81是本发明的外科缝合器械实施例的局部剖视图,其中在所述外科缝合器械的端部执行器中支撑钉仓,以使钉仓锁定系统运动至解锁位置;
图82是图81所示外科缝合器械的另一局部剖视图,其中钉仓自端部执行器移除且钉仓锁定系统处于锁定位置;
图83A-83D根据至少一个实施例描绘位于可塌缩钉仓本体内的外科缝钉的变形;
图84A是示出位于可压溃钉仓本体中的缝钉的图;
图84B是示出图84A所示的可压溃钉仓本体被砧座压溃的图;
图84C是示出图84A所示的可压溃钉仓本体被砧座进一步压溃的图;
图84D是示出图84A所示的缝钉处于完全成形构型且图84A所示的可压溃钉仓处于完全压溃状态的图;
图85是绘示抵靠钉仓支撑表面而定位的缝钉和示出缝钉与钉仓支撑表面之间的潜在相对运动的图;
图86是钉仓支撑表面的剖视图,所述钉仓支撑表面包括狭槽或槽,以用于稳定图85所示的缝钉;
图87是根据至少一个可供选择的实施例的缝钉的剖视图,所述缝钉包括重叠注塑的冠部和能够容纳所述冠部的一部分的狭槽或槽;
图88是根据至少一个实施例的钉仓的俯视图,所述钉仓包括嵌入可塌缩钉仓本体中的缝钉;
图89是图88所示钉仓的正视图;
图90是根据至少一个实施例的钉仓的正视图,所述钉仓包括围绕位于可塌缩钉仓本体内的缝钉的保护层;
图91是沿图90中的线91-91截取的图90所示钉仓的剖视图;
图92是根据至少一个实施例的钉仓的正视图,所述钉仓包括至少部分地延伸于可塌缩钉仓本体外的缝钉和围绕所述钉仓本体的保护层;
图93是沿图92中的线93-93截取的图92所示钉仓的剖视图;
图94是根据至少一个实施例的钉仓的局部切除视图,所述钉仓包括至少部分地嵌入可塌缩钉仓本体中的缝钉,所述缝钉至少部分地位于所述钉仓本体中的缝钉腔隙中;
图95是沿图94中的线95-95截取的图94所示钉仓的剖视图;
图96是根据至少一个实施例的钉仓的局部切除视图;
图97是根据至少一个实施例的钉仓的局部切除视图,所述钉仓包括至少部分地嵌入可塌缩钉仓本体内的缝钉以及连接所述缝钉并使所述缝钉相对于彼此对齐的对齐矩阵;
图98是沿图97中的线98-98截取的图97所示钉仓的剖视图;
图99是可压缩钉仓本体的内层的局部切除视图;
图100是示出图99所示的内层被压缩于转移板与支撑板之间的图;
图101是示出缝钉被插入图100所示的经压缩的内层中的图;
图102是示出图100所示支撑板被自内层移除的图;
图103是示出包括图99所示内层和被插入外层中的图101所示缝钉的子组件的图;
图104是示出图103所示外层被密封以形成密封钉仓的图;
图105是图104所示密封钉仓的剖视图;
图106是根据至少一个实施例的钉仓和钉仓通道的剖视图;
图107是示出图106所示钉仓的一部分处于变形状态的图;
图108是外科缝合器的端部执行器的正视图,所述端部执行器包括处于打开位置的砧座和位于钉仓通道内的钉仓;
图109是图108所示端部执行器的正视图,其示出处于闭合位置的砧座和被压缩于砧座与钉仓通道之间的钉仓;
图110是图108所示端部执行器的正视图,其示出图108所示的钉仓以替代方式位于钉仓通道内;
图111是外科缝合器的端部执行器的剖视图,所述端部执行器包括位于钉仓通道内的可压缩钉仓和附接到砧座的一块支撑材料;
图112是图111所示端部执行器的剖视图,其示出处于闭合位置的砧座;
图113是外科缝合器的端部执行器的可供选择的实施例的剖视图,所述端部执行器包括具有不透水层的钉仓;
图114是外科缝合器的端部执行器的另一可供选择的实施例的剖视图;
图115是外科缝合器的端部执行器的可供选择的实施例的剖视图,所述端部执行器包括阶梯式砧座以及包括阶梯式仓体的钉仓;
图116是外科缝合器的端部执行器的另一可供选择的实施例的剖视图;
图117是外科缝合器的端部执行器的可供选择的实施例的剖视图,所述端部执行器包括倾斜的组织接触表面;
图118是外科缝合器的端部执行器的另一可供选择的实施例的剖视图,所述端部执行器包括倾斜的组织接触表面;
图119是外科缝合器的端部执行器的可供选择的实施例的剖视图,所述端部执行器包括用于支撑钉仓的支撑插入件;
图120是外科缝合器的端部执行器的可供选择的实施例的剖视图,所述端部执行器包括具有多个可压缩层的钉仓;
图121是外科缝合器的端部执行器的可供选择的实施例的剖视图,所述端部执行器包括具有阶梯式可压缩仓体的钉仓;
图122是外科缝合器的端部执行器的另一可供选择的实施例的剖视图,所述端部执行器包括具有阶梯式可压缩仓体的钉仓;
图123是外科缝合器的端部执行器的可供选择的实施例的剖视图,所述端部执行器包括具有弯曲的组织接触表面的钉仓;
图124是外科缝合器的端部执行器的可供选择的实施例的剖视图,所述端部执行器包括具有倾斜的组织接触表面的钉仓;
图125是可压缩钉仓的剖视图,所述可压缩钉仓包括缝钉且其中存储有至少一种药剂;
图126是示出图125所示的可压缩钉仓被压缩且其中所容纳的缝钉变形之后的图;
图127是根据至少一个实施例的钉仓的局部切除视图;
图128是图127所示钉仓的剖视图;
图129是根据至少一个可供选择的实施例的所植入钉仓的透视图;
图130是图129所示所植入钉仓的剖视图;
图131是钉仓的可供选择的实施例的透视图,所述钉仓包括自钉仓的外层延伸的可变形构件;
图132是钉仓的可供选择的实施例的透视图,所述钉仓包括组装至内层的钉仓外层;
图133是钉仓的可供选择的实施例的剖视图,所述钉仓包括多个缝钉、可压缩层、和脱脂棉层;
图134是图133所示脱脂棉层的透视图;
图135是自图133所示的脱脂棉层分割出的脱脂棉以及与脱脂棉中的沟槽对齐的缝钉的透视图;
图136是来自图133所示脱脂棉层的两个相连脱脂棉的透视图;
图137是图133所示脱脂棉层的脱脂棉支撑框架被自所分割出的脱脂棉移除的透视图;
图138是可压缩钉仓的可供选择的实施例的分解透视图,所述可压缩钉仓中包括缝钉和用于抵靠砧座而驱动缝钉的系统;
图138A是图138所示钉仓的可供选择的实施例的局部切除视图;
图139是图138所示钉仓的剖视图;
图140是能够横贯图138所示的钉仓并使缝钉朝砧座行进的橇的正视图;
图141是示出缝钉驱动器的图,所述缝钉驱动器可由图140所示的橇朝砧座提升;
图142是根据至少一个可供选择的实施例的钉仓的切除视图,所述钉仓包括位于缝钉驱动器内的缝钉;
图143是图142所示的钉仓位于钉仓通道内时的剖视图;
图144是图142所示钉仓的剖视图,其示出运动到闭合位置的砧座和通过砧座而变形的容纳于钉仓内的缝钉;
图145是图142所示钉仓的剖视图,其示出朝砧座向上行进的缝钉;
图146是钉仓的可供选择的实施例的透视图,所述钉仓包括连接钉仓的各挠性侧的带;
图147是橇和切割构件组件的透视图;
图148是示出使用图147所示的橇和切割构件组件来提升图142所示钉仓的缝钉的图;
图149是示出能够接合缝钉并朝砧座提升缝钉的橇和能够选择性地使橇向远端行进的闭锁系统的图;
图150A-150C示出将缝钉插入缝钉冠部中的过程;
图151是包括支撑盘或保持器的钉仓的剖视图;
图152是根据至少一个可供选择的实施例的可压缩钉仓的局部剖视图;
图153是示出图152所示的钉仓处于植入状态时的图;
图154是根据至少一个可供选择的实施例的可压缩钉仓的局部切除视图;
图155是图154所示钉仓的局部剖视图;
图156是示出图154所示的钉仓处于植入状态时的图;
图157是根据至少一个可供选择的实施例的可压溃钉仓的局部剖视图;
图158是根据至少一个实施例的包括多个可塌缩元件的可塌缩钉仓的局部切除视图;
图159是图158所示的可塌缩元件处于非塌缩状态时的透视图;
图160是图159所示的可塌缩元件处于塌缩状态时的透视图;
图161A是外科缝合器械的端部执行器的局部剖视图,所述端部执行器包括钳口、与所述钳口相对地定位的钉仓通道、以及位于所述钉仓通道内的钉仓,其中所述钳口包括附接到钳口的保留矩阵;
图161B是图161A所示端部执行器的局部剖视图,其示出朝钉仓通道行进的钳口、被砧座和保留矩阵压缩的钉仓、以及缝钉,所述缝钉至少部分地延伸穿过位于保留矩阵与钉仓之间的组织;
图161C是图161A所示端部执行器的局部剖视图,其示出处于最终位置的钳口和与图161B所示的缝钉接合的保留矩阵;
图161D是图161A所示端部执行器的局部剖视图,其示出钳口和钉仓通道远离所植入的钉仓和保留矩阵而行进;
图162是根据至少一个可供选择的实施例的保留矩阵的保留孔的透视图,所述保留孔包括多个保留构件,以用于接合延伸穿过所述保留孔的紧固件支腿;
图163是根据至少一个可供选择的实施例的保留矩阵的保留孔的透视图,所述保留孔包括六个保留构件;
图164是根据至少一个可供选择的实施例的保留矩阵的保留孔的透视图,所述保留孔包括八个保留构件;
图165是根据至少一个可供选择的实施例的保留矩阵的保留孔的透视图,所述保留孔包括多个保留构件,以用于接合延伸穿过所述保留孔的紧固件支腿;
图166是根据至少一个可供选择的实施例的保留矩阵的保留孔的透视图,所述保留孔包括六个保留构件;
图167是根据至少一个可供选择的实施例的保留矩阵的保留孔的透视图,所述保留孔包括八个保留构件;
图168是根据至少一个可供选择的实施例的保留矩阵的保留孔的透视图,所述保留孔包括由金属片冲压而成的多个保留构件;
图169是根据至少一个可供选择的实施例的保留矩阵的保留孔的透视图,所述保留矩阵包括沿所述保留孔的周边延伸的多个孔;
图170是根据至少一个可供选择的实施例的保留矩阵的保留孔的俯视图;
图171是根据至少一个可供选择的实施例的保留矩阵的保留孔的俯视图;
图172是根据至少一个可供选择的实施例的保留矩阵的保留孔的俯视图;
图173是根据至少一个可供选择的实施例的保留矩阵的保留孔的俯视图;
图174是根据至少一个可供选择的实施例的保留矩阵的保留孔的俯视图;
图175是根据至少一个实施例的保留矩阵的保留孔的俯视图,所述保留孔包括延伸至所述保留孔中的保留凸片;
图176是根据至少一个可供选择的实施例的保留矩阵的保留孔的俯视图,所述保留孔包括延伸至所述保留孔中的保留凸片;
图177是紧固系统的透视图,所述紧固系统包括多个缝钉、与所述缝钉接合的保留矩阵、以及能够对齐所述缝钉的对齐矩阵;
图178是图177所示保留矩阵的透视图;
图179是图177所示对齐矩阵的透视图;
图180是图177所示的保留矩阵与图177所示的缝钉接合时的局部俯视图;
图181是图177所示的保留矩阵与图177所示的缝钉接合时的局部仰视图;
图182是图177所示紧固系统的局部正视图;
图183是图177所示紧固系统的局部透视图;
图184是图177所示的保留矩阵与图177所示的缝钉接合时的局部剖视图;
图185是图177所示紧固系统的局部剖视图;
图186是图177所示紧固系统的透视图,所述紧固系统还包括组装至缝钉腿的保护性帽;
图187是图186所示紧固系统结构的底部透视图;
图188是图186所示紧固系统结构的局部透视图;
图189是图186所示紧固系统结构的局部剖视图;
图190是根据至少一个实施例的端部执行器的正视图,所述端部执行器包括处于打开位置的钳口、位于钳口中的保留矩阵和多个保护性帽、以及位于钉仓通道中的钉仓;
图191是图190所示的端部执行器处于闭合位置时的正视图;
图192是图190所示的端部执行器处于击发位置时的正视图;
图193是图190所示的保留矩阵和保护性帽组装至图190所示的钉仓时的正视图;
图194是图193所示结构的细部图;
图195是图190所示端部执行器的正视图,其示出处于打开位置的钳口和位于保留矩阵与钉仓之间的较薄组织;
图196是图190所示端部执行器的正视图,其示出抵靠图195所示的组织而处于闭合位置的钳口;
图197是图190所示端部执行器的正视图,其示出处于击发位置以在保留矩阵与钉仓之间捕获图195所示较薄组织的钳口;
图198是图190所示保留矩阵和保护性帽组装至图190所示的钉仓并使图195所示的薄组织位于其间时的正视图;
图199是图198所示结构的细部图;
图200是根据至少一个可供选择的实施例的位于缝钉腿顶端上的保护性帽的剖视图;
图201是嵌于材料片内的多个保护性帽的透视图;
图202是钳口的透视图,所述钳口包括多个凹陷部以用于将多个保护性帽容纳于其中;
图203是钳口的一部分的细部图,所述一部分包括用于覆盖位于图202所示钳口内的保护性帽的薄片;
图204是根据至少一个可供选择的实施例的位于缝钉腿顶端上的保护性帽的剖视图,其中所述保护性帽包括内部成形表面;
图205是图204所示保护性帽的另一剖视图,其示出抵靠成形表面而变形的缝钉腿;
图206是保留矩阵的可供选择的实施例的俯视图,所述保留矩阵包括多个相连的矩阵元件;
图207是保留矩阵的可供选择的实施例的俯视图,所述保留矩阵包括多个相连的矩阵元件;
图208是保留矩阵的可供选择的实施例的俯视图,所述保留矩阵包括多个相连的矩阵元件;
图209是保留矩阵阵列的可供选择的实施例的俯视图,所述保留矩阵阵列包括多个相连的矩阵元件;
图210是保留矩阵的可供选择的实施例的俯视图,所述保留矩阵包括多个相连的矩阵元件;
图211是包括保留矩阵的钳口的局部分解视图,所述保留矩阵包括可压缩覆盖件;
图212是图211所示保留矩阵的细部图;
图213是包括保留矩阵的紧固系统的局部剖视图,所述保留矩阵包括可压缩层和包封一种或多种药物的多个单元;
图214是示出缝钉腿在与保留矩阵接合时刺穿图213所示单元的图;
图215是包括保留矩阵的紧固系统的局部剖视图,所述保留矩阵包括可压缩层;
图216是紧固件仓插入组件的正视图,所述紧固件仓插入组件包括夹持器、第一紧固件仓和第二紧固件仓;
图217是外科缝合器的端部执行器的正视图,所述外科缝合器包括第一钳口和第二钳口,所述第二钳口被示为处于开口构型;
图218是图217所示端部执行器的正视图,其示出处于闭合构型的第二钳口以及用于为第一钳口加载第一仓且为第二钳口加载第二仓的图216所示的紧固件仓插入组件;
图219是已加载的图218所示端部执行器的正视图,其示出自端部执行器移除的仓插入组件、再次处于开口构型的第二钳口、以及位于第一钳口与第二钳口之间的组织;
图220是图219所示已加载的端部执行器处于击发构型的正视图;
图221是处于植入状态的第一仓和第二仓的正视图;
图222是图217所示端部执行器的正视图,其根据至少一个实施例示出仍与第一钳口接合的第一仓的一部分;
图223是紧固件仓插入组件的可供选择的实施例的正视图,所述紧固件仓插入组件包括夹持器、第一紧固件仓和第二紧固件仓;
图224是用于为端部执行器的第一钳口加载第一仓且为第二钳口加载第二仓的图223所示紧固件仓插入组件的正视图;
图225是图224所示已加载端部执行器的剖视图;
图226是根据至少一个实施例的包括底部钳口和顶部钳口的外科缝合器的透视图,其中外科缝合器的某些部分已被移除;
图227是已移除顶部钳口的图226所示外科缝合器的透视图;
图228是图226所示外科缝合器的顶部钳口的可滑动砧座系统的透视图,所述可滑动砧座系统包括第一可滑动砧座和第二可滑动砧座;
图229是图228所示可滑动砧座系统的端视图;
图230是图228所示可滑动砧座系统的俯视图;
图231是示出图228所示的可滑动砧座系统处于未击发状态的图;
图232是示出图228所示可滑动砧座系统的第一可滑动砧座处于未击发位置且位于底部钳口内的缝钉处于未部署位置的图;
图233是示出位于底部钳口中的缝钉处于已部署构型且图232所示第一可滑动砧座被拉向近侧以使第一组缝钉的缝钉腿变形的图;
图234是示出图233所示第一组缝钉变形至完全变形状态的图;
图235是示出图228所示可滑动砧座系统的第二可滑动砧座被推向远侧以使第二组缝钉腿变形的图;
图236是根据至少一个实施例的包括多个成形凹坑的砧座的局部透视图;
图237是图236所示砧座的横截面端视图;
图238是示出制造图236所示成形凹坑的第一步骤的图;
图239是示出制造图236所示成形凹坑的第二步骤的图;
图240是图236所示砧座的成形凹坑结构的俯视图;
图241是示出用于制造砧座的制造工艺的第一步骤的图;
图242是示出图241所示制造工艺的第二步骤的图;并且
图243是示出图241所示制造工艺的第三步骤的图。
在所述这些图式中,对应的参考符号均表示对应的部件。本文示出的范例以一种形式示出本发明的优选实施例,不应将这种范例理解为是以任何方式限制本发明的范围。
具体实施方式
本申请的申请人还拥有以下的美国专利申请,这些专利申请与本申请同一天提交,并且每个都以引用方式各自整体并入本文:
美国专利申请序列号_________,名称为“Surgical Stapling InstrumentWith a Variable Staple Forming System”,代理人案卷号END6848USNP/100533;
美国专利申请序列号_________,名称为“Surgical Stapling InstrumentWith Interchangeable Staple Cartridge Arrangements”,代理人案卷号END6849USNP/100534;
美国专利申请序列号_________,名称为“Surgical Cutting andFastening Instruments With Separate and Distinct Fastener Deployment andTissue Cutting Systems”,代理人案卷号END6839USNP/100524;
美国专利申请序列号_________,名称为“Surgical Stapling InstrumentWith Compact Articulation Control Arrangement”,代理人案卷号END6847USNP/100532;
美国专利申请序列号_________,名称为“Jaw Closure ArrangementsFor Surgical Instruments”,代理人案卷号END6736USNP/100060;
美国专利申请序列号_________,名称为“Surgical Instruments WithReconfigurable Shaft Segments”,代理人案卷号END6734USNP/100058;
美国专利申请序列号_________,名称为“Surgical Staple CartridgesSupporting Non-Linearly Arranged Staples and Surgical Stapling InstrumentsWith Common Staple-Forming Pockets”,代理人案卷号END6735USNP/100059;
美国专利申请序列号_________,名称为“Surgical Staple CartridgesWith Detachable Support Structures and Surgical Stapling Instruments WithSystems For Preventing Actuation Motions When a Cartridge is Not Present”,代理人案卷号END6855USNP/100540;
美国专利申请序列号_________,名称为“Implantable FastenerCartridge Having a Non-Uniform Arrangement”,代理人案卷号END6840USNP/100525;
美国专利申请序列号_________,名称为“Implantable FastenerCartridge Comprising a Support Retainer”,代理人案卷号END6841USNP/100526;
美国专利申请序列号_________,名称为“Selectively OrientableImplantable Fastener Cartridge”,代理人案卷号END6843USNP/100528;
美国专利申请序列号_________,名称为“Implantable FastenerCartridge Comprising Bioabsorbable Layers”,代理人案卷号END6856USNP/100541;
美国专利申请序列号_________,名称为“Compressible FastenerCartridge”,代理人案卷号END6857USNP/100542;
美国专利申请序列号_________,名称为“Fasteners Supported By aFastener Cartridge Support”,代理人案卷号END6858USNP/100543;
美国专利申请序列号_________,名称为“Collapsible FastenerCartridge”,代理人案卷号END6859USNP/100544;
美国专利申请序列号_________,名称为“Fastener System Comprising aPlurality of Connected Retention Matrix Elements”,代理人案卷号END6860USNP/100546;
美国专利申请序列号_________,名称为“Fastener System Comprising aRetention Matrix and an Alignment Matrix”,代理人案卷号END6861USNP/100547;
美国专利申请序列号_________,名称为“Fastener System Comprising aRetention Matrix”,代理人案卷号END6862USNP/100548;
美国专利申请序列号_________,名称为“Fastening Instrument ForDeploying a Fastener System Comprising a Retention Matrix”,代理人案卷号END6863USNP/100549;
美国专利申请序列号_________,名称为“Fastener System Comprising aRetention Matrix and a Cover”,代理人案卷号END6864USNP/100550;以及
美国专利申请序列号_________,名称为“Fastener System Comprising aPlurality of Fastener Cartridges”,代理人案卷号END6865USNP/100551。
现在将描述某些示例性实施例,以从整体上理解本文所公开的装置和方法的结构、功能、制造和用途。这些实施例的一个或多个实例示出于附图中。本领域的普通技术人员将会理解,在本文中具体描述并示出于附图中的装置和方法为非限制性的示例性实施例,并且本发明的多个实施例的范围仅由权利要求书限定。就一个示例性实施例进行图解说明或描述的特征,可与其它实施例的特征进行组合。这种修改形式和变化形式旨在包括在本发明的范围之内。
本说明书通篇引用的“各种实施例”、“一些实施例”、“一个实施例”或“实施例”等,是指结合所述实施例描述的具体特征、结构或特性包括在至少一个实施例中。因此,本说明书通篇出现的短语“在各种实施例中”、“在一些实施例中”、“在一个实施例中”或“在实施例中”等并不一定都指相同的实施例。此外,在一个或多个实施例中,具体特征、结构或特性可按任何合适的方式结合。因此,在没有限制的情况下,结合一个实施例示出或描述的具体特征、结构或特性可全部或部分地与一个或多个其它实施例的特征、结构或特性结合。这种修改形式和变化形式旨在包括在本发明的范围之内。
本文所用术语“近侧”和“远侧”是相对于操纵外科器械柄部的临床医生而言的。术语“近侧”是指最靠近临床医生的部分,并且术语“远侧”是指远离临床医生的部分。还应当理解,为简洁和清楚起见,本文可以结合附图使用例如“竖直”、“水平”、“上”和“下”之类的空间术语。然而,外科器械在许多方向和位置中使用,并且这些术语并非限制性的和/或绝对的。
提供各种示例性装置和方法以执行腹腔镜式和微创外科手术操作。然而,本领域中的普通技术人员将容易理解,本文所公开的各种方法及装置可用于许多外科手术操作及应用(包括例如与开放式外科手术操作相结合的应用)中。继续参阅本具体实施方式,本领域中的普通技术人员将进一步理解,本文所公开的各种器械可以任何方式插入体内,例如通过自然腔道、通过形成于组织中的切口或穿刺孔等。器械的工作部分或端部执行器部分可被直接插入患者体内或可通过具有工作通道的进入装置插入,外科器械的端部执行器及细长轴可通过所述工作通道而推进。
参见附图,其中在所有视图中,类似的数字代表类似的元件,图1绘示能够实践本发明所特有的多种有益效果的外科器械10。外科缝合器械10被设计成用于操纵和/或致动可操作地附接到外科缝合器械10的各种形式及尺寸的端部执行器12。在图1和图2所示的实施例中,例如端部执行器12包括细长通道14,该细长通道14形成端部执行器12的下钳口13。细长通道14能够支撑“可植入的”钉仓30并且还可动地支撑用作端部执行器12的上钳口15的砧座20。
在各种实施例中,细长通道14例如可由300&400系列17-4&17-7不锈钢、钛等加工而成,并可形成有间隔侧壁16。砧座20例如可由300&400系列17-4&17-7不锈钢、钛等加工而成,并可具有缝钉成形下表面,所述缝钉成形下表面总体被标示为22且其中形成有多个缝钉成形凹坑23。参见图1B-1E。另外,砧座20具有从砧座20向近侧突起的分为两部分的滑道组件24。砧座销26从滑道组件24的每一横侧突起,以容纳在细长通道14的侧壁16中的对应狭槽或开口18中,从而有利于将砧座销26可动地或枢转地附接到所述对应狭槽或开口18。
各种形式的可植入钉仓可与本文所公开的外科器械的各种实施例一起使用。以下将更详细地论述特定的钉仓构型及构造。然而,在图1A和图9-14所示的实施例中示出可植入钉仓30。在至少一个实施例中,钉仓30具有本体部31,本体部31中支撑有多排未成形的金属缝钉32,本体部31由可压缩的止血材料(例如氧化再生纤维素(ORC)或可生物吸收的泡沫)组成。在至少某些实施例中,为了防止缝钉受影响并防止止血材料在引入及定位过程期间被活化,整个仓可涂覆有或包裹有可生物降解的膜38,例如以商标出售的六环酮膜或以聚甘油癸二酸酯(PGS)膜、或以由PGA(聚乙醇酸,以商标Vicryl出售)、PCL(聚己内酯)、PLA或PLLA(聚乳酸)、PHA(聚羟基链烷酸酯)、PGCL(聚卡普隆25,以商标Monocryl出售)或由PGA、PCL、PLA、PDS的复合物形成的其它可生物降解的膜,所述膜只有在破裂时才可渗透。钉仓30的本体31的尺寸被设定成可移除地支撑在如图所示的细长通道14内,使得当砧座20被驱动至与钉仓30形成接触时,其中的每一缝钉32均与对应的缝钉成形凹坑23对齐。
在使用中,一旦端部执行器12邻近靶组织而定位,端部执行器12便被操纵成将靶组织捕获或夹紧于钉仓30的顶面36与砧座20的缝钉成形表面22之间。缝钉32通过如下方式成形:在基本上平行于细长通道14的路径中运动砧座20,以使缝钉成形表面22及更尤其是其中的缝钉成形凹坑23基本上同时接触钉仓30的顶面36。随着砧座20继续运动至钉仓30中,缝钉32的腿部34在砧座20中接触对应的缝钉成形凹坑23,缝钉成形凹坑23用于使缝钉腿34弯曲以使缝钉32成形为“B形”。砧座20朝细长通道14的进一步行进将会进一步压缩缝钉32并使缝钉32成形为所需的最终成形高度“FH”。
上述缝钉成形过程大体绘示于图1B-1E中。例如,图1B示出端部执行器12,其中靶组织“T”位于砧座20与可植入钉仓30的顶面36之间。图1C示出砧座20的初始夹紧位置,其中砧座20已被合拢至靶组织“T”上,以将靶组织“T”夹紧于砧座20与钉仓30的顶面36之间。图1D示出初始缝钉成形,其中砧座20已开始压缩钉仓30,使得缝钉32的腿部34开始通过砧座20中的缝钉成形凹坑23而成形。图1E示出穿过靶组织“T”而处于最终成形状态的缝钉32,为清晰起见已移除砧座20。一旦缝钉32成形并紧固至靶组织“T”,外科医生便将砧座20运动至打开位置,以在自患者撤出端部执行器12时使仓体31及缝钉32能够保持附连到靶组织。当两个钳口13、15共同夹紧时,端部执行器12使所有的缝钉同时成形。其余“被压溃的”本体材料31用作止血剂(ORC)及缝钉线加固剂(PGA、PDS、或任何上述其它膜组合物38)。此外,由于缝钉32在成形期间从不需要离开仓体31,因此缝钉32在成形期间变为畸形的可能性被最小化。如本文所用,术语“可植入的”是指除缝钉之外,用于支撑缝钉的仓体材料也将被保持在患者体内并最终被患者身体吸收。这种可植入的钉仓可区别于现有技术中与端部执行器保持在一起并与其一起移除的仓结构。这些“可移除的”钉仓通常包括缝钉驱动器组件,因此其可比本发明的端部执行器大得多,本发明的端部执行器被设计成结合本发明的某些独特且新型的可植入钉仓实施例使用。
在各种具体实施中,端部执行器12能够联接到自柄部组件100突出的细长轴组件40。端部执行器12(在闭合时)及细长轴组件40可具有相似的横截面形状,并且其尺寸被设定成可操作地穿过套管针管或呈另一进入器械形式的工作通道。如本文所用,术语“可操作地穿过”是指端部执行器及细长轴组件的至少一部分可通过通道或管开口插入或可穿过通道或管开口,并可视需要在通道或管开口中对其进行操纵以完成外科缝合手术。在一些实施例中,当处于闭合位置时,端部执行器12的钳口13及15可为端部执行器提供大致圆形的横截面形状以利于其穿过圆形的通道/开口。然而,可设想本发明的各种实施例的端部执行器以及细长轴组件实施例具有其它横截面形状,从而可穿过具有非圆形横截面形状的进入通道及开口。因此,闭合的端部执行器的横截面的总体尺寸将与端部执行器将穿过的通道或开口的尺寸相关。因此,一个端部执行器例如可被称为“5mm”端部执行器,此是指其能够可操作地穿过直径至少为大约5mm的开口。
在本发明的各种实施例中,细长轴组件40的外径可与处于闭合位置的端部执行器12的外径基本上相同。例如,5mm端部执行器可联接到具有5mm横截面直径的细长轴组件40。然而,继续参阅本具体实施方式,将显而易见的是,本发明的各种实施例可有效地结合不同尺寸的端部执行器使用。例如,10mm端部执行器可附接到具有5mm横截面直径的细长轴。相反,对于其中提供10mm或更大的进入开口或通道的应用而言,细长轴组件40可具有10mm(或更大)的横截面直径,但也能够致动5mm或10mm端部执行器。因此,外轴40的外径可与附接到外轴40的闭合的端部执行器12的外径相同或不同。
如图所示,细长轴组件40自柄部组件100大体上沿直线向远侧延伸,以限定纵向轴线A-A。在各种实施例中,例如细长轴组件40可为大约9-16英寸(229-406mm)长。然而,细长轴组件40可设置为其它长度,并且在其它实施例中,细长轴组件40中可具有接头或换句话讲能够有利于端部执行器12相对于轴或柄部组件的其它部分进行铰接,以下将更详细地论述之。在各种实施例中,细长轴组件40包括脊构件50,该脊构件从柄部组件100延伸至端部执行器12。端部执行器12的细长通道14的近端具有从其突起的一对保留凸耳17,该一对保留凸耳17的尺寸被设定成被容纳在对应的凸耳开口或支架52中,所述凸耳开口或支架52设置于脊构件50的远端中,以使端部执行器12能够可移除地联接细长轴组件40。脊构件50可由例如6061或7075铝、不锈钢、钛等制成。
在各种实施例中,柄部组件100包括手枪抓握型壳体,所述手枪抓握型壳体可被加工成两个或更多个部分以便于组装。例如,如图所示的柄部组件100包括右手壳体构件102和左手壳体构件104(图5、7和8),所述右手壳体构件和左手壳体构件是由聚合物或塑性材料模制而成或换句话讲加工而成,并被设计成彼此配合在一起。这种壳体构件102及104可通过在其中模制而成的或换句话讲形成的按扣结构、钉和承窝和/或通过粘合剂、螺钉而附接到一起。脊构件50具有近端54,在该近端上形成有凸缘56。凸缘56能够被旋转地支撑在沟槽106中,该沟槽由从壳体构件102、104中的每一者向内突起的配合肋108形成。这种结构有利于脊构件50附接到柄部组件100,同时使脊构件50能够相对于柄部组件100沿360°路径绕纵向轴线A-A旋转。
如在图1和图4中可进一步看出,脊构件50穿过安装轴衬60并由安装轴衬60支撑,该安装轴衬可旋转地附连到柄部组件100。安装轴衬60具有近侧凸缘62和远侧凸缘64,该近侧凸缘和远侧凸缘限定旋转沟槽65,该旋转沟槽能够将柄部组件100的前缘部分101可旋转地容纳在其间。这种结构使安装轴衬60能够相对于柄部组件100绕纵向轴线A-A旋转。脊构件50通过脊销66不可旋转地销接至安装轴衬60。另外,旋转旋钮70附接到安装轴衬60。在一实施例中,旋转旋钮70具有中空安装凸缘部72,该中空安装凸缘部72的尺寸被设定成将安装轴衬60的一部分容纳在其中。在各种实施例中,旋转旋钮70可由例如玻璃或碳填充尼龙、聚碳酸酯、等加工而成,并且也通过脊销66附连到安装轴衬60。另外,向内突起的保留凸缘74形成于安装凸缘部72上并能够延伸至形成于安装轴衬60中的径向沟槽68中。因此,外科医生可通过抓紧旋转旋钮70并使其相对于柄部组件100旋转,而使脊构件50(及附接到脊构件50的端部执行器12)围绕纵向轴线A-A沿360°路径旋转。
在各种实施例中,砧座20由砧座弹簧21或其它偏置结构保持于打开位置,如图1、图9A、图10A、和图11A所示。砧座20可通过击发系统从打开位置选择性地运动至各种闭合或夹紧位置以及击发位置,所述击发系统被总体上标记为109。击发系统109包括“击发构件”110,在各种实施例中,“击发构件”110包括中空击发管110。中空击发管110可在脊构件50上轴向地运动,因此形成细长轴组件40的外部。击发管110可由聚合物或其它适宜的材料加工而成,并具有附接到击发系统109的击发轭114的近端112。参见图4。在各种实施例中,例如击发轭114可被重叠注塑至击发管110的近端112。然而,也可采用其它紧固件结构。
如在图1和图4中可看出,击发轭114可以可旋转地支撑在支撑衬圈120中,该支撑衬圈能够在柄部组件100内轴向地运动。在各种实施例中,支撑衬圈120具有一对侧向延伸的翅片122,所述一对翅片的尺寸设定成被可滑动地容纳在翅片狭槽103及105中,所述翅片狭槽103和105分别形成于左手壳体构件102及右手壳体构件104中。参见图7。因此,支撑衬圈120可在柄部壳体100中轴向地滑动,同时使击发轭114及击发管110能够相对于支撑衬圈120而围绕纵向轴线A-A旋转。如在图4中可看出,穿过击发管110设置有纵向狭槽111,以使脊销66能够穿过纵向狭槽111延伸至脊构件50中,同时有利于击发管110在脊构件50上轴向地行进。
击发系统109还包括击发触发器130,该击发触发器用于控制击发管110在脊构件50上的轴向行进。参见图1。击发管110的此种沿远侧方向运动至与砧座20进行击发相互作用的轴向运动在本文中被称为“击发运动”。如在图1中可看出,击发触发器130通过枢轴销132而可动地或枢转地联接到柄部组件100。采用扭转弹簧135来偏置击发触发器130远离柄部组件100的手枪式握把部107而到达未致动的“打开”或起始位置。如在图1和图4中可看出,击发触发器130具有上部134,该上部可动地附接(销接)到击发链节136,该击发链节可动地附接(销接)到支撑衬圈120。因此,击发触发器130从起始位置(图1和图9)朝与柄部组件100的手枪式握把部107相邻的结束位置(图14)的运动将使击发轭114和击发管110沿远侧方向“DD”运动。击发触发器130远离柄部组件100的手枪式握把部107的运动(在扭转弹簧135的偏置下)将使击发轭114和击发管110在脊构件50上沿近侧方向“PD”运动。
本发明的各种实施例可与不同尺寸和构型的可植入钉仓一起使用。例如,当与第一击发衔接子140结合使用时,外科器械10可与用于支撑可植入钉仓30的大约20mm长(或具有其它长度)的5mm端部执行器12一起使用。这种端部执行器尺寸可尤其非常适用于例如实现相对精细的解剖及血管处理。然而,如以下所更详细地论述,例如也可通过将第一击发衔接子140更换为第二击发衔接子150而将外科器械10与其它尺寸的端部执行器及钉仓结合使用。在另一些实施例中,细长轴组件40能够附接到仅一种形式或尺寸的端部执行器。在此类实施例中,例如压力表面146或158(通常分别设置于击发衔接子140、150上)将整体地形成于击发管110的远端中—根据与其一起使用的端部执行器的特定尺寸而定。
如在图2中可看出,第一击发衔接子140是基本上中空的并具有第一弹簧部142,该第一弹簧部能够延伸至击发管110的开口的远端116中。第一保持器按钮144形成于第一弹簧部142上,并且其尺寸设定成被容纳在保留孔117中,该保留孔设置在击发管110的远端部分中。参见图1和图2。因此,为从击发管110上拆卸第一击发衔接子140,使用者仅需压下保持器按钮144使其离开保留孔117并将第一击发衔接子140撤出击发管110。在图2中也可看出,第一击发衔接子140具有内部压力表面146,该内部压力表面能够与砧座20的分为两部分的滑道组件24交接。
在各种具体实施中,砧座20上的分为两部分的滑道组件24包括一对尖齿45,所述一对尖齿被刀片容纳沟槽(未示出)间隔开。每一尖齿45均具有近侧表面27,当砧座20处于闭合位置时,近侧表面27基本上平行于细长通道14的底部。随后,近侧表面27过渡至远离近侧表面27的夹紧滑道28。参见图3。夹紧滑道28被取向成相对于近侧表面27成夹紧角“A”。在各种实施例中,例如夹紧角“A”可为大约15度至30度。如以下所更详细地论述,当第一击发衔接子140的第一压力表面146接触夹紧滑道28时,砧座20将朝细长通道14运动,更具体地讲,朝细长通道14中的钉仓30运动。随着第一击发衔接子140进一步向远侧运动,第一压力表面146接触每一砧座尖齿45上的缝钉成形滑道29,以将砧座20进一步驱动至钉仓30中,从而使钉仓30中的缝钉32成形。同样如图3所示,缝钉成形滑道29相对于夹紧滑道27以成形角“B”取向。在各种实施例中,例如成形角“B”可为大约5度至20度。砧座20的滑道组件24上还可具有倾斜的下表面25(例如角“C”为大约5至40度),使得当砧座20处于打开位置时,倾斜的下表面25的表面使砧座20能够枢转至15度的打开极限(图11A中的角“β”)。
现在将阐释一种用于将端部执行器12可移除地联接到脊构件50的方法。通过将细长通道14上的保留凸耳17插入脊构件50中的凸耳支架52中来开始联接过程。随后,外科医生朝壳体组件100的手枪式握把107行进击发触发器130,以使击发管110和第一击发衔接子140向远侧推进超过细长通道14的近端部分47,从而将凸耳17保持在其各自的支架52中。参见图10和图10A。第一击发衔接子140相对于凸耳17的此种位置在本文中被称为“联接位置”。本发明的各种实施例也可具有端部执行器锁定组件160,以用于在端部执行器12附接到脊构件50之后将击发触发器130锁定就位。
更具体地讲,参照图5、图7、和图8,端部执行器锁定组件160的一个实施例包括保留销162,该保留销被可动地支撑在击发触发器130的上部134中。保留弹簧166将保留销162朝左手壳体构件104进行弹簧偏置。当击发触发器130处于非致动(起始)位置时,保留销162被偏置至与起始棘爪163进行邻接接触,该起始棘爪从左手壳体构件104向内突起。参见图7和图8。如上所述,击发管110必须首先向远侧推进至联接位置,在联接位置中,第一击发衔接子140将端部执行器12的保留凸耳17保持在脊构件50中的凸耳支架52中。外科医生通过自起始位置朝手枪式握把107牵拉击发触发器130而使击发衔接子140向远侧推进至联接位置。当击发触发器130被开始致动时,保留销162在与起始棘爪163进行邻接接触的同时进行滑动,直至击发管110使第一击发衔接子140推进至联接位置为止,此时保留销162被偏置到形成于左手壳体构件104中的锁定腔164中。参见图8。在各种实施例中,当保留销162进入锁定腔164中时,销162可发出可听见的“咔嗒”声或其它声音,并会为外科医生提供端部执行器12已被“锁定”到脊构件50上的触觉指示。另外,只要不有意地将保留销162偏置出锁定腔164,外科医生便不会无意间致动击发触发器130以开始使端部执行器12中的缝钉32成形。相似地,如果外科医生释放处于联接位置的击发触发器130,则保留销162会使击发触发器130保持在该位置,以防止击发触发器130返回至起始位置并因此从脊构件50释放端部执行器12。
在各种具体实施中,击发触发器释放按钮167安装在柄部组件100的左侧壳体构件104中,以使外科医生能够有意地释放保留销162,从而使击发触发器130能够被进一步致动或返回至起始位置。参见图5、图7、和图8。击发触发器释放按钮167被可动地安装在锁定腔164中并被弹簧偏置至非激活位置(图8)。当击发触发器释放按钮167被向内按压时,其会接触保留销162并使保留销162运动出锁定腔163外,以使击发触发器130能够被进一步激活。
如到目前为止所述,外科器械10可用作用于操纵/定位组织的抓紧装置。在触发器130被解锁(通过压下保持释放按钮167)之后,击发触发器130朝手枪式握把部107的进一步运动将使击发衔接子140接触砧座20上的夹紧滑道28。随着第一击发衔接子的压力表面部146滑动到夹紧滑道28上,砧座将在细长通道14中朝钉仓30运动。因此,外科医生可朝钉仓30或远离钉仓30而操纵砧座20,以在其间抓紧及释放组织而不使缝钉成形。
本发明的各种实施例还可包括击发系统锁定按钮137,击发系统锁定按钮137枢转地附接到柄部组件100。参见图1和图4。在一种形式中,击发系统锁定按钮137具有在其远端上形成的闩锁138,该闩锁被取向成当击发释放按钮处于第一闩锁位置时闩锁138接合击发轭114。如在图1和图4中可看出,闩锁弹簧139用于将击发系统锁定按钮137偏置到第一闩锁位置(图11和图12)。如以下将更详细地解释,闩锁138用于在以下时刻接合击发轭114:此时脊构件50上的击发轭114的位置对应于其中第一击发衔接子140的压力表面146将朝远侧向砧座20的夹紧滑道28推进的点。应当理解,随着第一击发衔接子140轴向地向夹紧滑道28上推进,砧座20将沿路径运动,使得缝钉成形表面部22基本上平行于钉仓30的顶面36。
在端部执行器12联接到脊构件50之后,通过首先压下击发系统锁定按钮137而开始缝钉成形过程,以使击发轭114能够在脊构件50上进一步向远侧运动并最终将砧座20压缩至钉仓30中。参见图13。在压下击发系统锁定按钮137之后,外科医生继续朝手枪式握把107致动击发触发器130,从而将第一缝钉衬圈140的压力表面146驱动于对应的缝钉成形滑道29上,以迫使砧座20与钉仓30中的缝钉32进行成形接触。击发系统锁定按钮137防止在外科医生准备好开始缝钉成形过程之前无意地使缝钉32成形。在此类实施例中,外科医生必须在击发触发器130可被进一步致动之前压下击发系统锁定按钮137以开始缝钉成形过程。
外科器械10可视需要而仅用作组织缝合装置。然而,本发明的各种实施例也可包括组织切割系统,该组织切割系统被总体上标记为170。在至少一种形式中,组织切割系统170包括刀构件172;可通过致动刀推进触发器200使刀构件172从与端部执行器12的近端相邻的未致动位置(图1和图9-13)选择性地推进至致动位置(图14)。刀构件172被可动地支撑在脊构件50中并附接到刀杆180或换句话讲从刀杆180突起。刀构件172可由例如具有大于38HRC(以C分度表示的洛氏硬度)的硬度的420或440不锈钢加工而成并可具有形成于其远端174上的组织切割刀刃176,并能够可滑动地延伸穿过砧座20中的狭槽31及在钉仓30中居中设置的狭槽33,以切穿夹紧于端部执行器12中的组织。参见图14A。如在图4中可看出,刀杆180延伸穿过脊构件50并具有近端部分182。近端部分182以驱动方式与刀传送装置190相互作用,该刀传送装置可操作地附接到刀推进触发器200。在各种实施例中,刀推进触发器200附接到枢轴销132,使得刀推进触发器200可在无需致动击发触发器130的情况下进行枢转或换句话讲被致动。在各种实施例中,第一刀齿轮192也附接到枢轴销132,使得刀推进触发器200的致动也使第一刀齿轮192枢转。第一刀齿轮192与柄部壳体100之间附接有击发返回弹簧202,以将刀推进触发器200偏置到起始位置或未致动位置。参见图1和图4。
参见图5和图6,刀传送装置190的各种实施例也包括第二刀齿轮194,该第二刀齿轮可旋转地支撑在第二齿轮轴193上并与第一刀齿轮192啮接。第二刀齿轮194与第三刀齿轮196啮接,该第三刀齿轮被支撑在第三齿轮轴195上。第四刀齿轮198也被支撑在第三齿轮轴195上。第四刀齿轮198能够以驱动方式接合位于刀杆180的近端上的一系列环形齿轮齿或环184。因此,这种结构使第四刀齿轮198能够沿远侧方向“DD”或近侧方向“PD”轴向地驱动刀杆180,同时使击发杆180相对于第四刀齿轮198绕纵向轴线A-A旋转。因此,外科医生可通过朝柄部组件100的手枪式握把107牵拉刀推进触发器200而使击发杆180轴向地推进且最终向远侧推动刀构件172。
本发明的各种实施例还包括刀锁定系统210,刀锁定系统210防止刀构件72的推进,除非击发触发器130已被拉动至完全击发位置(图13和图14)。因此,这种结构将防止刀推进系统170的激活,除非缝钉已首先被击发或成形于组织中。如在图1中可看出,刀锁定系统210的各种具体实施包括刀锁定杆211,该刀锁定杆211被枢转地支撑在柄部组件100的手枪式握把部107中。刀锁定杆211具有激活端212,当击发触发器130处于完全击发位置时,激活端212能够被击发触发器130接合。另外,刀锁定杆211在其另一端上具有保持吊钩214,该保持吊钩能够以吊钩方式接合第一切割齿轮192上的闩锁杆216。采用刀锁定弹簧218来将刀锁定杆211偏置到“锁定”位置。在该“锁定”位置中,保持吊钩214保持与闩锁杆216相接合,从而防止刀推进触发器200的致动,除非击发触发器130处于完全击发位置。参见图9。
现在将结合图9、9A、10、10A、11、11A、12、12A、13、13A、14、和14A来解释用于操作本发明的至少一个外科器械实施例的各种方法。结合图1、图9、和图9A可理解,当刀杆172处于所示的“起始”位置或未致动位置时,组织切割刀刃176邻近第一击发衔接子140的远端,使得锋利的组织切割刀刃176不会暴露于使用者。在细长轴组件被制造成与单一形式或尺寸的端部执行器一起使用(例如其中未采用击发衔接子140、150)的可供选择的实施例中,刀杆172的切割刀刃176将邻近击发管的远端定位,以同样在这些实施例中防止组织切割刀刃176暴露于使用者。
图9和9A示出通过将端部执行器12上的保留凸耳17插入脊构件50中的凸耳支架52中而被附接到脊构件50之后的端部执行器12。如图9所示,击发触发器130处于未致动位置或起始位置,并且端部执行器12尚未被第一击发衔接子140锁定至脊构件50。“PO”表示在第一击发衔接子140开始向砧座20的夹紧滑道部28上行进之前击发触发器130可行进的距离。刀推进触发器200也处于锁定的未致动位置。
图10及图10A示出击发触发器130在被推进至其中端部执行器12被第一击发衔接子140锁定至脊构件50的位置之后的位置。这种位置在本文中被称为“联接”位置。当处于联接位置时,保留销162已被按扣至锁定腔164(图8)中,从而为外科医生提供端部执行器12现在已被锁定至脊构件50的听觉及触觉指示。直到外科医生有意地压下击发触发器释放按钮167(图5、图7和图8)以将保留销62偏置出锁定腔164外,击发触发器130才能被进一步致动。第一击发衔接子140的远端141已行进的距离被表示为距离“l”(图10A),并且击发轭114在脊构件50上已行进的对应距离被表示为距离“l’”。图11及图11A示出在释放按钮(未示出)被压下且外科医生已激活击发触发器130以将第一击发衔接子140运动至砧座20上的夹紧滑道28的起点之后击发触发器130的位置。如在这些图中可看出,砧座弹簧21已将砧座20偏置到打开位置。第一击发衔接子140的远端的行进被表示为距离“l1”,并且击发轭114在脊构件50上已行进的对应距离被表示为距离“l’1”。图12及图12A示出第一击发衔接子140在被推进至砧座20的缝钉成形滑道29的起点之后的位置。此位置表示在缝钉成形开始之前可获得的最大夹紧量。此位置在本文中被称为“最大夹紧位置”。如在图12中可看出,击发轭114已接触击发触发器释放按钮137上的闩锁138,因此直到击发触发器释放按钮137被压下时,击发轭114才能被进一步向远侧推进。如在图12A中可看出,砧座20的缝钉成形表面22基本上平行于钉仓30的顶面31。砧座20的缝钉成形部22与细长通道14的顶部保持表面之间的距离被表示为“Cmax”。在各种实施例中,对于具有基本上相等厚度的本体部31的各钉仓30而言,Cmax可例如为0.085英寸至0.144英寸(大约2.15mm至3.65mm)。在至少一个实施例中,例如仓厚度可大于缝钉尺寸大约0.01英寸至0.03英寸(大约0.25mm至0.76mm)。第一击发衔接子140从起始位置到此最大夹紧位置所行进的总距离被表示为“l2”,并且击发轭114在脊构件50上已行进的对应距离被表示为“l’2”。图13及图13A示出击发轭114处于完全击发位置时的位置,在完全击发位置中,钉仓30中的缝钉32被完全成形。当处于该位置时,砧座20的缝钉成形部22与细长通道14的顶部保持表面之间的距离被表示为“Cmin”。在各种实施例中,对于用于支撑未成形时腿部为大约0.075英寸至0.134英寸(大约1.90mm至3.40mm)长(图1A中的距离“UF”)且完全成形时的完全成型高度例如为大约0.025英寸至0.04英寸(大约0.63mm至1.01mm)(包括图1D中的距离“FF”)的缝钉的钉仓而言,“Cmin”可为例如大约0.015英寸至0.030英寸(大约0.38mm至0.76mm)。第一击发衔接子140从起始位置到此完全击发位置所行进的总距离被表示为“l3”,并且击发轭114在脊构件50上已行进的对应距离被表示为“l’3”。同样在图13中可看出,击发触发器130处于完全击发位置并已接触刀锁定杆211的激活端212,以偏置保持吊钩214而使其与第一切割齿轮192上的闩锁杆216脱离。
横切,尤其是血管的横切可为任何外科手术中难度最大的步骤之一。在腹腔镜式环境中,横切的难度更大,这是因为如果出现任何失败,则整个手术可能需要几乎立即转换成开放式手术,以防止发生灾难性事件。因此,期望采用一种能够在部署缝钉之后任选地切割组织的外科缝合器械。本发明的各种实施例能够满足这种需求。
在缝钉被“击发”(成形)至靶组织中之后,外科医生可压下击发触发器释放按钮167,以使击发触发器130能够在扭转弹簧135的偏置作用下返回至起始位置,从而使砧座20能够在弹簧21的偏置作用下偏置到打开位置。当处于打开位置时,外科医生可撤出端部执行器12而留下可植入的钉仓30和缝钉32。在其中端部执行器穿过通道、工作通道等而被插入的应用中,外科医生将通过激活击发触发器130而使砧座20返回至闭合位置,以使端部执行器12能够通过所述通道或工作通道被撤出。然而,如果外科医生想要在击发缝钉之后切割靶组织,则外科医生以上述方式激活刀推进触发器200,以驱动刀杆72穿过靶组织而到达端部执行器的末端,如图14、14A所示。图14示出在针对不同长度的端部执行器/钉仓的各种实施例中刀推进触发器200的运动量,其中刀杆72已推进至端部执行器12中的完全击发位置。随后,外科医生可释放刀推进触发器200,以使击发返回弹簧202能够使击发传送装置将刀杆72返回至起始(非致动)位置(图13、13A)。一旦刀杆72返回至起始位置,外科医生便可打开端部执行器钳口13、15,以将可植入的仓30释放于患者体内并随后从患者体内撤出端部执行器12。因此,本发明的这种外科器械有利于使用可通过相对较小的工作通道及通道而被插入的小的可植入钉仓,同时为外科医生提供击发缝钉而不切割组织或视需要在击发缝钉之后也切割组织的选择。
如上所述,外科器械10可与支持其它尺寸的钉仓的其它端部执行器结合使用,所述其它尺寸的钉仓容纳有其它尺寸及数目的缝钉。图15-19示出端部执行器12’的使用,端部执行器12’可操作地支撑钉仓30’,该钉仓所具有的缝钉32’大于钉仓30中的缝钉32。例如,钉仓30中的缝钉32可为大约0.080英寸至0.085英寸(大约2.03mm至2.15mm)的缝钉,而钉仓30’中的缝钉32’可为大约0.075英寸(大约1.90mm)。在各种实施例中,钉仓30’长于钉仓30。例如,钉仓30可为大约0.78英寸(大约20mm)长;而钉仓30’可为大约1.57英寸(大约40mm)长。图15是端部执行器12’、第二击发衔接子150、及脊构件50的远端55的分解视图。如在图15中可看出,细长通道14’具有一对间隔开的侧壁16’,每一侧壁16’中具有狭槽或开口18’,该狭槽或开口的尺寸被设定成容纳对应的砧座销26’。砧座20’与细长通道14’可共同形成端部执行器12’,该端部执行器的总直径将容许端部执行器12’穿过具有至少大约0.20英寸(大约5.0mm)直径的开口。砧座20’也具有缝钉成形部22’及分为两部分的滑道组件24’,所述缝钉成形部22’中形成有多个缝钉成形凹坑,并且分为两部分的滑道组件24’从砧座20’朝近侧突起。细长通道14’的近端15’具有从其突起的一对保留凸耳17’,该一对保留凸耳的尺寸设定成被容纳在脊构件50中所设置的对应的凸耳支架52中。
如在图15中可看出,第二击发衔接子150具有基本上中空的本体部151以及近侧衬圈部152,近侧衬圈部152中具有向内延伸的保持突起154。本体部151与近侧衬圈部152之间设置有狭槽156,以使衬圈部152能够相对于本体部151被偏置,以利于将保持突起154插入击发管110中的保留孔117中。为从击发管110上拆卸第二击发衔接子150,外科医生需压下近侧衬圈部152以将保持突起154移出保留孔117外,从而使第二击发衔接子150能够朝远侧被拉离击发管110。
在各种实施例中,砧座20’具有分为两部分的滑道组件24’,分为两部分的滑道组件24’具有一对尖齿45’,所述一对尖齿45’中的每一者均具有近侧表面27’,近侧表面27’过渡至远离近侧表面27’的夹紧滑道28’。参见图15。夹紧滑道28’被取向成相对于近侧表面27’成角度“A’”。在各种实施例中,例如角度“A’”可为大约50至30度。如以下所更详细地论述,当第二击发衔接子150的第二压力表面158接触夹紧滑道28’时,砧座20’将朝细长通道14’运动,更具体地讲,朝细长通道14中的钉仓30’运动。参见图17。当第二击发衔接子150进一步向远侧运动时,第二压力表面158接触砧座尖齿45上的缝钉成形滑道29’,以进一步朝钉仓30’驱动砧座20’,从而使钉仓30中的缝钉32成形。参见图18。缝钉成形滑道29’被取向成相对于夹紧滑道27’成角度“B’”。在各种实施例中,例如角度“B’”可为大约5至20度。滑道组件24’与细长通道14’的底部之间可设置有弹簧(未示出),以将砧座20’偏置到打开位置。
图16示出在外科医生已将第二击发衔接子150朝远侧推进至夹紧滑道部28’的起点之后第二击发衔接子150的位置。击发触发器130以上文中关于第一击发衔接子140所述的方式来控制第二击发衔接子150的操作。图17示出第二击发衔接子150处于完全夹紧位置时的位置。图18示出第二击发衔接子150处于完全击发位置时的位置;在所述完全击发位置中,钉仓30’中的缝钉32’已穿过所夹紧的组织(未示出)而成形。
如上所述,可植入钉仓30’比可植入钉仓30长。因此,如图15所示,端部执行器12’也包括远侧刀构件124,该远侧刀构件被可动地支撑在细长通道14’中。远侧刀构件124具有组织切割刀刃125和近侧部分126,该近侧部分能够由刀杆72进行接合。因此,如果外科医生想要在缝钉已被击发之后切割组织,则外科医生需如上所述激活击发触发器200,以朝远侧驱动刀杆172使其接触远侧刀构件124,从而驱动远侧刀构件124穿过组织,如图19所示。远侧刀构件124上可具有至少一个保持器部,该保持器部能够穿过细长通道14’中的对应成型的狭槽(未示出)而滑动。这种结构使端部执行器12’能够在缝钉成形且组织被切割之后打开。远侧刀构件124保持在砧座20’中并在从患者体内被撤出时与端部执行器12’一起被移除。
因此,外科器械10的各种实施例具有单独的缝合机构和组织切割机构,使得外科医生可在不切割组织的条件下缝合组织。本发明缝合器械的各种实施例可顺利地与能够击发不同尺寸和数目的缝钉的不同尺寸的端部执行器一起使用。外科器械可按包括器械10和第一击发衔接子140和第二击发衔接子150的套件形式来提供,第二击发衔接子150使器械能够用于击发不同尺寸的可植入钉仓。
本发明的各种独特和新型实施例采用可压缩的钉仓,所述可压缩的钉仓支撑处于基本上固定位置以用于被砧座成形接触的缝钉。与现有技术中采用缝钉驱动元件的外科缝合结构不同,本发明各种实施例的钉仓中的缝钉不被驱动至砧座中。在本发明的各种实施例中,砧座被驱动至未成形的缝钉中。所获得的缝钉成形程度取决于砧座被驱动至缝钉中的程度。这种结构使得外科医生能够调整施加至缝钉的成形或击发压力的大小,从而改变缝钉的最终成形高度。
在各种实施例中,施加至可行进砧座的击发运动的量取决于击发触发器的致动程度。例如,如果外科医生想要获得仅部分成形的缝钉,则仅需朝手枪式握把107部分地向内压下击发触发器。要想获得更多的缝钉成形,外科医生仅需进一步压紧击发触发器,使得砧座被进一步驱动以与缝钉进行成形接触。如本文所用,术语“成形接触”是指缝钉成形表面或缝钉成形凹坑已接触缝钉腿的末端并已开始将腿部成形或弯曲至成形位置。缝钉成形的程度是指缝钉腿被折叠的程度且最终是指上文所提及的缝钉的成形高度。本领域中的普通技术人员将进一步理解,因为在对砧座20施加击发运动时,砧座20是以与钉仓基本上平行的关系进行运动,所以缝钉基本上同时成形并具有基本上相同的成形高度。
图20-23示出采用缝钉高度指示器组件220的可供选择的外科器械10。在各种实施例中,缝钉高度指示器组件220包括指示器棒222,指示器棒222附接到击发触发器130的上部134,以与上部134一起枢转地行进。当击发触发器130朝柄部组件100的手枪式握把107枢转以如上所述将砧座20压紧至钉仓30中时,可透过左手壳体构件104中的视窗223观察到指示器棒222。在此类实施例中,缝钉高度指示器组件220也包括形成于左手壳体构件104中且对应于缝钉成形的三个阶段的一系列棘爪24、26、28。具体地讲,一旦击发触发器130被初始地致动,保留销162便在与起始棘爪163邻接接触的同时进行滑动,直至击发管110将击发衔接子140或150推进至上述锁定位置为止,此时保留销162被偏置到形成于左手壳体构件104中的锁定腔164中。当外科医生想要开始闭合端部执行器12的钳口13、35时,需压下保持释放按钮167,以使击发触发器130能够被进一步致动。当击发触发器释放按钮167被向内按压时,其会接触保留销162并使保留销162运动出锁定腔163外,以使击发触发器130能够被激活。如上所述,外科医生现在可使用端部执行器12的底部钳口13及顶部钳口15来抓紧并操纵组织。当外科医生想要开始缝钉成形过程时,需将击发触发器释放按钮167压下,从而在外科医生继续压下击发触发器130时使击发轭114能够朝远侧推进。
击发触发器130的进一步推进会使砧座20运动至与钉仓30中的缝钉32进行成形接触。随着击发触发器130被进一步按下,保留销162的平端165将滑动离开起始棘爪163并接触对应于第一缝钉成形量的第一棘爪224,所述第一缝钉成形量由左手壳体构件104上的第一缝钉高度符号230表示。参见图20。如图所示,第一缝钉高度符号230包括缝钉刚开始成形的图片。可使用其它符号/标记来标识缝钉成形的此阶段。当保留销162接合第一棘爪224时,外科医生可听见咔嗒声。保留销162与第一棘爪224的接合也可通过击发触发器130对外科医生提供某种触觉反馈。另外,可透过与第一高度缝钉符号230相邻的观察窗口223观察到缝钉高度指示器棒222。如果外科医生想要使钉仓中的缝钉32进一步成形,则通过形成于第二侧壳体构件104中的释放按钮240来按压保留销162以使其与第一棘爪224脱离。在各种实施例中,例如释放按钮240可利用铰链部242而整体地形成于左手壳体构件104中,铰链部240是左手壳体构件104的一部分。这种结构使释放按钮240能够被按压到保留销162的末端165中,以使末端165运动而与第一棘爪224、第二棘爪226和第三棘爪228中的任一者脱离。一旦保留销162被按压至第一棘爪224外,击发触发器130便可被进一步压下,直至保留销162接合第二缝钉成形棘爪226为止。击发触发器130的这种位置使得砧座20进一步运动,以与钉仓30中的缝钉32进行缝钉成形接触。同样,保留销162按扣至第二缝钉成形棘爪226中,并为外科医生提供击发触发器130处于第二缝钉成形位置的听觉及触觉反馈。当处于该位置时,缝钉高度指示器棒222可透过观察窗口223而被观察到且邻近第二缝钉高度符号232。如果外科医生想要使钉仓30中的缝钉32进一步成形,则通过压下释放按钮240来按压保留销162使其与第二棘爪226脱离。随后,可进一步压下击发触发器130,直至保留销162接合与缝钉成形的最后阶段相对应的第三缝钉成形棘爪228为止。同样,保留销162按扣至第三缝钉成形棘爪228中,并为外科医生提供击发触发器130处于第三缝钉成形位置的听觉及触觉反馈。当处于该位置时,缝钉高度指示器棒222可透过观察窗口223而被观察到且邻近缝钉高度符号234。在缝钉成形为期望的量之后,外科医生可偏置保留销162使其离开第三缝钉高度棘爪228,以使击发触发器130能够返回至起始位置。或者,如果需要,外科医生随后可在将击发触发器130返回至起始位置之前开始上述组织切割手术。
图24示出其中被总体上标识为220’的缝钉高度指示器组件不包括与各种缝钉成形对应的一系列棘爪的可供选择的实施例。然而,此实施例包括缝钉高度指示器棒222和观察窗口223。因此,外科医生可通过透过观察窗口223监视缝钉高度指示器棒222的位置来监视所达到的缝钉成形量。此实施例不包括上述缝钉高度指示器符号230、232和234。另外,此实施例也可包括与起始位置相对应的未成形缝钉符号229,在所述起始位置中,缝钉32尚未开始通过砧座20而成形。另外,此实施例将以与上述相同的方式操作。
图25和26示出可供选择的端部执行器12”,除以下能够容纳刀杆172’的不同点之外,端部执行器12”类似于上述端部执行器12’。刀杆172’联接到刀杆180或自刀杆180突起,并且除此之外以上文中关于刀杆172所述的方式进行操作。然而,在此实施例中,刀杆172’足够长以横贯端部执行器12”的整个长度,因此端部执行器12”中未采用单独的远侧刀构件。刀杆172’上形成有上横切构件173’及下横切构件175’。上横切构件173’被取向成可滑动地横切砧座20”中对应的细长狭槽250,并且下横切构件175’被取向成横贯端部执行器12”的细长通道14”中的细长狭槽252。砧座20”中也设置有脱离狭槽(未示出),使得当刀杆172’被驱动至端部执行器12”内的结束位置时,上横切构件173’穿过对应的狭槽而下落,以使砧座20”能够运动至打开位置,从而与所缝合和切割的组织脱离。砧座20”可除此之外与上述砧座20相同,并且细长通道14”可除此之外与上述细长通道14相同。
在这些实施例中,砧座20”被弹簧或其它打开结构(未示出)偏置到完全打开位置(图25)。砧座20”通过击发衔接子150以上述方式进行的轴向行进而在打开位置与完全夹紧位置之间运动。一旦击发衔接子150推进至完全夹紧位置(图26),外科医生便可随后以上述方式朝远侧推进刀杆172”。如果外科医生想要将端部执行器用作抓紧装置来操纵组织,则可将击发衔接子朝近侧运动,以容许砧座20”远离细长通道14”而运动,如图27中的虚线所示。在此实施例中,当刀杆172”朝远侧运动时,上横切构件173’和下横切构件175’同时拉动砧座20”和细长通道14”,以在刀杆172”穿过端部执行器12”朝远侧推进时达到期望的缝钉成形。参见图28。因此,在此实施例中,缝钉成形是与组织切割同时发生,但缝钉本身可在刀杆172”朝远侧被驱动时依序成形。
图29和30示出具有砧座20”的端部执行器12”的使用,砧座20”例如由不锈钢、钛、PGA(聚乙醇酸)或其它可吸收的塑料加工而成,并且在某种程度上是挠性的。这些图也示出保留矩阵6250及对齐矩阵6206的使用,以下将更详细地说明。如在图29中可看出,当刀杆172”穿过砧座20”朝远侧被驱动时,砧座20”屈曲至完全成形位置。
在许多外科应用中,可取的或有利的是采用如下外科切割和缝合器械,所述外科切割和缝合器械具有可相对于细长轴组件进行铰接的端部执行器。然而,现有技术中的可铰接器械进入紧密区域的能力常常由于用于对端部执行器进行铰接的构件的尺寸及构造而受限。图31-40示出本发明的另一外科器械实施例,所述外科器械能够使端部执行器相对于细长轴进行铰接,并且所述外科器械在柄部组件中采用相对紧凑的铰接控制结构。
此实施例的外科器械310基本上类似于上述各种外科器械实施例10,不同之处在于,此实施例采用铰接式轴组件312,以利于相对于细长的纵向轴线A-A而选择性地定位端部执行器12。尽管本文将描述外科器械310是与上述类型的端部执行器12结合使用,然而本领域中的普通技术人员应理解,外科器械310也可与第二击发衔接子150结合使用以致动端部执行器12’或其它端部执行器结构。如在图31和图32中可看出,铰接式轴组件312包括远侧轴组件部314,该远侧轴组件部枢转地联接到近侧轴组件部316,该近侧轴组件部可操作地联接到柄部组件100。在各种实施例中,例如远侧轴组件314包括远侧脊构件320,该远侧脊构件中具有一对凸耳支架322以用于将凸耳17容纳在其中。参见图32。远侧脊构件320具有近端324,该近端包括枢轴基座326,该枢轴基座具有从其突起的枢轴销328。
如在图32中可看出,近侧轴组件部316包括近侧脊区段330,近侧脊区段330具有近侧枢轴基座和附接到所述近侧枢轴基座的刀导轨332。刀导轨332可例如使用粘合剂或其它紧固件结构而焊接或附接到近侧脊段330。近侧枢轴基座刀导轨332中设置有枢轴孔334以将枢轴销328可旋转地容纳在其中,从而使远侧脊段320能够相对于近侧脊段330绕第一枢轴线FA-FA枢转,所述第一枢轴线FA-FA基本上横切纵向轴线A-A。外科器械310还包括远侧击发管段370,该远侧击发管段枢转地联接到一对击发管链节380、382,以围绕第二轴线SA-SA枢转地行进。远侧击发管段370具有保持器孔372,以用于将第一击发衔接子140的保持器按钮144容纳在其中。所述一对击发管链节380、382枢转地联接到近侧击发管390,以相对于近侧击发管390绕第三枢转轴线TA-TA枢转运动。参见图32。
在各种实施例中,近侧击发管390附接到旋转旋钮400,旋转旋钮400可旋转地附接到柄部组件100。参见图31、图38、和图39。旋转旋钮400可由聚合物或塑性材料模制而成,并可包括中心部402及与中心部402间隔开的凸缘部404。柄部组件100的前缘部分101被容纳在中心部402与凸缘部404之间,以使旋转旋钮400能够相对于柄部组件100绕纵向轴线A-A旋转。在其它实施例中,旋转旋钮400可由其它适宜的材料加工而成。在所示实施例中,近侧击发管390和近侧脊段330分别非可动地附接到旋转旋钮400。如在图38和图39中可看出,近侧脊段330和近侧击发管390通过销406销接至旋转旋钮400。因此,外科医生可通过对旋转旋钮400进行旋转而相对于柄部组件100沿360度路径绕纵向轴线A-A旋转端部执行器12。
参见图37、图38及图40,在各种实施例中,端部执行器12可通过一对铰接构件420、430及铰接球440而相对于纵向轴线A-A选择性地进行铰接,所述一对铰接构件420、430附接到远侧枢轴基座326,并且铰接球440可旋转地支撑在旋转旋钮400中的承窝408内。在各种实施例中,铰接构件420、430例如可包括由多线缆线、镍钛诺、钛等加工成的缆线。第一或右侧铰接构件420具有远端422,该远端上形成有耳状物424,该耳状物的尺寸被设定成能够压配到远侧枢轴基座326中所设置的第一缆线附接孔327中。同样,第二或左侧铰接构件430具有远端432,该远端上形成有耳状物434,该耳状物434的尺寸被设定成能够压配到远侧枢轴基座326中所设置的第二缆线附接孔329中。参见图37。因此,可通过牵拉第一或右侧铰接构件420来使端部执行器12绕第一轴线FA-FA(图35和图36)枢转到右侧,并可通过牵拉第二或左侧铰接构件430来使端部执行器12绕第一轴线FA-FA枢转到左侧。在各种实施例中,右侧铰接构件420可被滑动地容纳于在近侧脊段330中形成的右侧缆线槽336中,并且左侧铰接构件430可被滑动地容纳在近侧脊段330中的左侧缆线槽338中。
参照图38-40,第一铰接构件420具有近端426,近端426上锻造有或换句话讲附接有保持球428,保持球428能够容纳于铰接球440中的第一保留狭槽442内,铰接球440可旋转地支撑在旋转旋钮400中的承窝401内。同样,第二铰接构件430具有近端436,该近端上锻造有或换句话讲附接有保持球438,该保持球能够被容纳在铰接球440中的第二保留狭槽444内。如在图40中可最尤其看出,铰接球440还具有穿过铰接球440的致动器狭槽446,该致动器狭槽有利于在其中为近侧击发管段390形成畅通无阻的通道。如图38所示,致动器狭槽446可从较宽的开口部448、450到铰接球440的中心中的通道452逐渐变细,该通道容许近侧击发管段390以滑动方式通过。如以下所进一步论述,铰接球440可旋转地或被枢转地支撑在承窝401内,并且从中性位置(在图38中以实线示出)选择性地运动至第一铰接控制位置和第二铰接控制位置(在图38中以虚线示出)。铰接球440也在承窝401内轴向地运动。
如在图40中可看出,外科器械310可包括被总体上标识为453的锁定装置,以用于将铰接球440锁定在中性位置、第一铰接控制位置、及第二铰接控制位置中的任一者。在各种实施例中,锁定装置453包括一系列锁定棘爪段454,所述一系列锁定棘爪段454设置于铰接球440上并能够与形成于凹陷部408内的锁定肋410相配合,所述凹陷部形成于中心部402中,所述中心部被取向于旋转旋钮400的承窝区域401中。致动器通道412延伸穿过中心部402并与铰接球440中的致动器狭槽446对齐,以容纳穿过致动器通道412的近侧击发管段390。如在图38和图39中可看出,致动器球弹簧456在旋转旋钮400的弹簧保持中心部414上推进以朝近侧偏置铰接球440,使得锁定棘爪454与中心部402中的锁定肋410以保持方式进行接合。
为利于对铰接球440施加铰接运动,一对横向延伸的铰接柄458、460从铰接球440沿径向相对的方向突起。在各种实施例中,铰接球440可例如由无填充的、玻璃填充的、碳填充的、矿物填充等的聚碳酸酯、尼龙、加工而成,并且铰接球440上可机加工或模制有锁定棘爪454。铰接柄458、460可通过压配合、焊接等方式附接到铰接球440。这种锁定装置使铰接球440能够被锁定至中性位置、或第一铰接位置或第二铰接位置中的任一者。一旦外科医生将铰接球440运动至达到端部执行器期望的铰接位置,外科医生便可释放铰接球440,以使致动器球弹簧456能够朝近侧偏置铰接球440,使得锁定棘爪454与中心部402中的锁定肋410以保持方式接合。在各种实施例中,致动器球弹簧456的尺寸可被设定成当铰接的端部执行器通过套管针或相似的开口而被强制拉回时,铰接球440可弹回至中性位置。此外,铰接柄458、460的使用使得能够根据特定的外科应用来“微调”铰接程度。
如在图38中可看出,第一铰接柄或右侧铰接柄458穿过旋转旋钮400中的右侧狭槽416突起,并且第二铰接柄或左侧铰接柄460穿过旋转旋钮400中的左侧狭槽418突起。为使端部执行器12相对于纵向轴线A-A进行铰接,外科医生需首先沿远侧方向“DD”轴向地运动右侧铰接柄458和左侧铰接柄460,以使锁定棘爪454从旋转旋钮400的中心部402中的锁定肋410脱离。随后,外科医生可通过沿期望方向运动铰接柄458、460以对铰接构件420、430施加铰接运动而使铰接球440进行枢转。例如,可通过以下方式使端部执行器12枢转至右侧:沿近侧方向“PD”运动右侧铰接柄458,并沿远侧方向“DD”运动左侧铰接柄460,以对右侧铰接构件420施加牵拉运动(铰接运动)且对左侧铰接构件430施加推动运动。相似地,可通过以下方式使端部执行器12枢转至左侧:沿近侧方向“PD”运动左侧铰接柄460,并沿远侧方向“DD”运动右侧铰接柄458,以对左侧铰接构件430施加牵拉运动(铰接运动)且对右侧铰接构件420施加推动运动。右侧铰接柄458和左侧铰接柄460的各种运动范围以虚线示于图38中。如此一来,端部执行器12可例如通过顺时针或逆时针调整角度而最佳地定位在各种成角度的位置中,而无需使细长轴组件40进行旋转或其它运动。图35示出角α,在各种实施例中,角α可为0°至45°。
外科器械310的各种实施例包括穿过刀支撑狭槽333并被可动地支撑在中空的近侧脊区段330中的刀杆472,刀支撑狭槽333从窄的近侧部分335到宽的远侧部分337呈锥形,以使刀杆472能够围绕刀支撑狭槽333而屈曲,从而适应端部执行器12绕纵向轴线A-A的铰接。参见图37。在各种实施例中,刀杆472可由例如300或400系列的不锈钢加工而成,并可具有形成于其远端上的组织切割刀刃476。如在图37中可进一步看出,刀杆472可滑动地穿过远侧枢轴基座326中的刀狭槽473。刀杆472的近端478附接到延伸穿过近侧脊段330的刀杆480,从而如上所述以驱动方式接合击发传送装置190。参见图31。保留销406延伸至近侧击发管段390中的纵向狭槽392(图38)中并穿过近侧脊段330中的孔339(图39)而进入刀杆480中的纵向狭槽482中,以使近侧击发管段390及刀杆480能够相对于近侧脊段330及柄部组件100轴向地运动。因此,外科医生可通过以上述方式操作刀推进触发器200来选择性地操作刀杆472以切割组织。
各种铰接结构公开于2010年5月7日提出申请的、授予Frederick E.Shelton IV且名称为“Laparoscopic Devices With Articulating End Effectors”的美国专利申请No.12/775,809(代理人案卷号END6755USNP)及2010年5月7日提出申请的、授予Frederick E.Shelton IV等人且名称为“BendableShaft For Handle Positioning”的美国专利申请No.12/775,699(代理人案卷号END6756USNP)中,上述美国专利申请中的每一者的公开内容相应全文以引用方式并入本文中。图41和图42示出可供选择的铰接式轴组件490,该铰接式轴组件490与铰接式轴组件340基本上相同并以基本上相同的方式进行操作,不同之处在于中间击发管段492取代了铰接式轴组件340中所采用的击发管链节380。如在图41和图42中可看出,中间击发管段492从远侧击发管段370延伸至近侧击发管段390。在各种实施例中,中间击发管段492可由尼龙、或其它挠性塑料加工而成。在各种实施例中,中间击发管段492具有两个纵向延伸的压缩脊部494,由空间498间隔开的多个间隔开的肋段496从压缩脊部494延伸以形成基本上中空的管段,所述脊组件的其它元件及刀杆可操作地穿过所述基本上中空的管段。脊部494能够从近侧击发管段390向远侧击发管段370传递压缩运动,所述压缩运动的大小足以将砧座20致动至完全击发位置,同时使端部执行器12能够相对于纵向轴线A-A选择性地铰接。中间击发管段492具有远端部分491和近侧部分493,所述远端部分491通过例如销、开槽的套筒、按扣结构等附接到远侧击发管段,所述近侧部分493通过相同或相似的装置附接到近侧击发管段390。在此实施例中,端部执行器12可例如通过顺时针或逆时针调整角度而最佳地定位在各种成角度的位置中,而无需使细长轴组件490进行旋转或其它运动。图42示出角度α,在各种实施例中,角度α可为0°至45°。
图43-47示出本发明的另一外科器械实施例。除以下所述各种不同点之外,此实施例的外科器械510基本上类似于上述外科器械实施例310。尽管本文将描述外科器械510是与上述类型的端部执行器12结合使用,然而本领域中的普通技术人员将理解,外科器械也可与第二击发衔接子150结合使用以致动端部执行器12’或可与其它端部执行器结构结合使用。外科器械510的各种实施例包括铰接式轴组件512,以利于相对于纵向轴线A-A选择性地定位端部执行器12。如在图43和图44中可看出,铰接式轴组件512包括远侧脊构件520,该远侧脊构件中具有一对凸耳支架522以用于将凸耳17容纳在其中。远侧脊构件520具有近端521,该近端枢转地联接到近侧脊段530的远端531。具体地讲,远侧脊段520的近端521具有用于支撑铰接销524的一对间隔开的远侧脊尖齿523,所述铰接销524延伸穿过近侧脊段530的远端531,以限定基本上横切纵向轴线A-A的铰接轴线AA-AA。参见图46。
在本发明的各种实施例中,端部执行器12可绕纵向轴线A-A铰接成各种不同的取向。例如,图47中的角度α’可介于180°到90°的范围内。端部执行器12通过至少一个联接到铰接链节540的铰接构件550而进行铰接。铰接链节540通过远侧销542而枢转地联接到远侧脊段520的远端521。参见图43。铰接链节540通过铰接杆销554而枢转地联接到铰接杆550的远端552,如图46所示。如在图43中可看出,铰接构件550延伸穿过铰接式轴组件512并具有近端556,该近端556延伸至旋转旋钮560中,该旋转旋钮560可旋转地联接到柄部组件100。铰接构件550的近端556联接到铰接控制构件或按钮558,所述铰接控制构件或按钮558可滑动地联接到旋转旋钮560以相对于旋转旋钮560进行选择性的轴向行进。因此,沿远侧方向“DD”轴向滑动铰接按钮558将使端部执行器12以图47中所示的方法绕纵向轴线A-A进行枢转。为使端部执行器返回至其中端部执行器以同轴方式对齐于纵向轴线A-A上的起始非铰接位置,外科医生仅需在旋转旋钮560上沿近侧方向“PD”滑动致动器按钮558。
与上述实施例中的某些实施例一样,旋转旋钮560不可旋转地联接到安装轴衬570,安装轴衬570可旋转地附连到柄部组件100。参见图43和图47。安装轴衬570具有近侧凸缘572和远侧凸缘574,该近侧凸缘572和远侧凸缘574之间限定有旋转沟槽575,以将柄部组件100的前缘部分101可旋转地容纳在其间。这种结构使安装轴衬570能够相对于柄部组件100绕纵向轴线A-A旋转。近侧脊段530不可旋转地销接或换句话讲(焊接、利用粘合剂等)附接到安装轴衬570,使得旋转旋钮560绕纵向轴线A-A的旋转能够使端部执行器12绕纵向轴线A-A旋转。应当理解,这种结构可有利于端部执行器12沿360°路径绕纵向轴线A-A旋转。
此实施例也具有远侧击发管区段580,远侧击发管区段580联接到第一击发衔接子140并可在远侧脊段520上轴向地行进。具体地讲,第一击发衔接子140上的保持器按钮144以上述方式被容纳在远侧击发管段580中的保持器孔581内。远侧击发管段580由附接到远侧击发管段580的至少一个击发构件致动。在一个优选的实施例中,远侧击发管段580由附接到远侧击发管段580的一对击发带582、584致动。击发带582、584附接到带底座585,该带底座联接到近侧击发管段590,该近侧击发管段590以上述方式附接到击发轭114。覆盖管592也在近侧脊段530上推进并联接到旋转旋钮560以与旋转旋钮560一起旋转。近侧击发管590及带底座585可相对于覆盖管592轴向地运动。击发带582、584可滑动地容纳在远侧脊构件520中的侧向带通道526内,如图44C所示。在各种实施例中,击发带582、584各自包括可由例如不锈钢加工而成的薄的挠性构件,并且分别能够推动远侧击发管段580,从而以上述方式致动或闭合砧座20以使可植入钉仓30中的缝钉32成形。通过以上述方式牵拉击发触发器130而实现击发缆线582、584的致动。击发触发器130返回至起始位置时会牵拉击发缆线582、584并使第一击发衔接子140将砧座20牵拉至打开位置或使第一击发衔接子140运动至其中弹簧(未示出)将砧座20偏置到打开位置的位置处。
外科器械510还可包括刀534,刀534被可动地支撑在远侧脊段520中的刀支撑狭槽528内。参见图44B。在各种实施例中,刀杆534可由例如300或400不锈钢等加工而成,并可具有形成于其远端上的组织切割刀刃535。刀杆534附接到可由300或400系列的不锈钢加工而成的刀带536。刀带可例如包括0.007英寸至0.012英寸厚的不锈钢带材料,所述不锈钢带材料比杆更为坚硬。刀缆线536延伸穿过远侧脊构件520,并且近侧脊段530附接到刀杆480,该刀杆如上所述以驱动方式接合击发传送装置190。因此,外科医生可通过以上述方式操作刀推进触发器200来选择性地操作刀杆534以切割组织。各种实施例也可采用波纹管状的覆盖构件594以防止灰尘、组织、碎屑等对铰接接头造成污染。参见图48。
图49-53示出本发明的另一外科器械实施例。除以下所解释的不同点之外,此实施例的外科器械610基本上类似于上述外科器械实施例10。外科器械610能够致动具有两个可运动钳口613、615的端部执行器612。在各种实施例中,端部执行器612联接到从柄部组合件100突起的细长轴组合件655。参见图49。细长轴组件655包括细长的脊组件658及细长的闭合管组件680,细长的闭合管组件680可在脊组件658上沿近侧方向及远侧方向轴向地运动。如图所示,细长轴组件655沿纵向轴线A-A从柄部组件100大体上成直线地朝远侧延伸。在各种实施例中,细长轴组件655可为大约9英寸到16英寸(大约228.8mm至406.4mm)长。然而,细长轴组件655也可被设置成其它长度。
参见图50和图51,在各种实施例中,端部执行器612的下钳口613包括细长通道614,并且上钳口615包括砧座620。细长通道614具有一对间隔开的侧壁616,所述一对间隔开的侧壁616分别终止于向上突起的闭合末端或末端618中。细长通道614可由例如17-4或400系列的不锈钢加工而成,并且其尺寸可被设定成能够在其中可操作地支撑钉仓630或其它形式的钉仓。砧座620可由416、17-4、17-7不锈钢等加工而成。在至少一个实施例中,例如端部执行器612(当处于闭合位置时)及细长轴组件655各自具有最大外径以容许装置可操作地穿过具有至少大约8mm至12mm(大约0.31英寸至0.47英寸)直径的开口。然而,端部执行器612及细长轴组件655可具有其它直径及形状。端部执行器612还包括远侧脊段660,远侧脊段660能够可移除地联接到近侧脊段670的远端,下文将进一步说明。
砧座620具有缝钉成形部622,缝钉成形部622中形成有多个缝钉成形凹坑。另外,砧座620具有分为两部分的闭合部624,该闭合部包括至少一个且优选地包括一对向下延伸的闭合末端625。如在图50-53中可看出,在至少一个实施例中,闭合末端625及细长通道614的对应的闭合末端或末端618通过枢轴销626枢转地销接至脊组件658的远侧脊段660的分为两部分的远端662的脊耳633(图55),使得当从侧面观察时,闭合末端625和闭合末端618形成被总体上标识为628的可运动的“剪刀状”闭合结构。在其它实施例中,砧座620可动地联接到细长通道614。
端部执行器612的各种实施例也包括可轴向地行进的刀组件640,刀组件640包括刀板642,刀板642包括从刀板642朝远侧突起的一对间隔开的刀杆644,所述一对间隔开的刀杆644能够在远侧脊段660的脊耳663之间轴向地滑动。参见图55。刀构件646附接到或换句话讲形成于刀杆644的远端上。在各种实施例中,刀杆644及刀构件646可由例如300或400系列的不锈钢加工而成。刀构件646的远端上形成有组织切割刀刃648。刀构件646的下部649能够接合缝钉驱动橇650,该缝钉驱动橇被可动地支撑在细长轴614内。缝钉驱动橇650可保持在细长通道614内的狭槽或狭槽结构(未示出)中,以利于缝钉驱动橇650从起始位置(图50-52)轴向地运动至结束位置(图53),同时保持连接至细长通道614。缝钉驱动橇650上具有一个或多个缝钉驱动表面652,所述缝钉驱动表面被取向成以驱动方式接合钉仓630中的缝钉632,并在刀构件646穿过端部执行器612而朝远侧推进时朝砧座620的缝钉成形部622向上驱动缝钉632。
此外,在各种实施例中,远侧脊螺母668可旋转地联接到远侧脊段660的近端664,以相对于近端664绕纵向轴线A-A可旋转地行进。远侧脊螺母668具有一对向内延伸的凸耳669,所述一对向内延伸的凸耳669的尺寸被设定成能够容纳于近侧脊区段670的自柄部组件100突起的远端672中的对应凸耳狭槽674中,以使远侧脊段660能够相对于近侧脊区段670旋转。如在图49中可看出,近侧脊段670销接至旋转旋钮70(通过销66),该旋转旋钮70以上述方式可旋转地安装至柄部组件100,以利于端部执行器612绕纵向轴线A-A沿360°路径进行旋转。
如在图49中可看出,近侧脊区段670的近端671上形成有凸缘676。凸缘676能够旋转地支撑在沟槽106中,该沟槽由自壳体构件102、104中的每一者向内突起的配合肋108形成。这种结构有利于将近侧脊段670附接到柄部组件100,同时使近侧脊段670能够相对于柄部组件100沿360°路径绕纵向轴线A-A旋转。近侧闭合管段682可由聚合物或其它适宜的材料加工而成并可具有近端683,该近端683附接到击发轭114,所述击发轭114以上述各种方式构造并被可动地安装在柄部组件100内。在各种实施例中,例如击发轭114可被重叠注塑至近侧闭合管段682的近端683。然而,也可采用其它紧固件结构。如上所述,击发轭114可被旋转地支撑在支撑衬圈120中,该支撑衬圈120能够在柄部组件100中轴向地运动。如在图49中可看出,穿过近侧闭合管段682设置有纵向狭槽681,以使脊销66能够穿过纵向狭槽681而延伸至近侧脊段670中,同时有利于近侧闭合管段682在远侧脊段670上进行轴向行进。
如在图49中可看出,击发触发器130具有相对于击发链节636、638可枢转(销接)的上部134,击发链节636、638相对于支撑衬圈120可枢转(销接)。因此,击发触发器130朝柄部组件100的手枪式握把部107的运动将使击发轭114和近侧闭合管段682沿近侧方向“PD”(在图49中以虚线示出)运动。夹具和击发触发器130远离柄部组件100的手枪式握把部107的运动将使击发轭114和击发管110在近侧脊段670上沿近侧方向“DD”运动。
如在图50-53中可看出,近侧闭合管段682具有远端684,远端684能够附接到远侧闭合管段690的近端692。在所示实施例中,远侧闭合管段690能够通过螺纹附接到近侧闭合管段682的远端684。远侧闭合管段690的远端694中具有逐渐变细的驱动构件696,该逐渐变细的驱动构件696能够与剪刀状的闭合结构628交接,使得当远侧闭合管段690处于图51所示的位置时,位于细长通道614与砧座620之间的一个或多个端部执行器弹簧617用于将砧座620偏置到该图所示的打开位置。然而,当沿近侧方向“PD”牵拉远侧闭合管段690时,逐渐变细的驱动构件696会接触剪刀状的闭合结构628,以使钳口613(细长通道614)与615(砧座620)朝彼此枢转。参见图52和图53。
外科器械610还可包括刀推进系统639,刀推进系统639包括延伸穿过近侧脊区段670的刀杆700并具有以驱动方式与击发传送装置190交接的近端部分702,击发传送装置190以上述方式可操作地附接到刀推进触发器200。因此,外科医生可通过以上述方式牵拉刀推进触发器200而使刀杆700朝远侧推进。如在图52和图53中可看出,刀杆700具有分为两部分的远端704,该分为两部分的远端包括上刀杆段706和下刀杆段708,所述上刀杆段706和下刀杆段708能够接合刀板642。如在图51-54中可看出,上刀杆段706能够穿过脊螺母668中的上狭槽773而滑动,并且下刀杆段708能够穿过脊螺母668中的下狭槽775而滑动。
为使用外科器械610,通过将脊螺母668上的凸耳669插入近侧脊区段670中与其对应的凸耳支架674中而将端部执行器612附接到近侧脊区段670的远端672。参见图50。随后,外科医生或临床医生可相对于细长轴组件655旋转端部执行器612,以将远侧闭合管段690螺接到近侧闭合管段682上,从而形成闭合管组件680。端部执行器612中可具有钉仓630,或者临床医生可在此时或稍后将钉仓安装至细长通道614中。一旦端部执行器612附接到外科器械610的细长轴组件655,外科医生可通过延伸至患者体内的进入通道(例如通过套管针或内窥镜等,或通过切口—在开放式手术的情形中)插入端部执行器612及细长轴组件655,以抓紧端部执行器钳口613、615之间的靶组织。与上述各种实施例一样,通过相对于柄部组件100的手枪式握把107操纵击发触发器130来闭合钳口613、615。一旦靶组织被抓紧于端部执行器钳口613、615之间,外科医生便可通过以上述方式将砧座620压紧至钉仓630中而将缝钉632“击发”或成形到靶组织中。如果手术无需切割靶组织,则外科医生可随后释放击发触发器130,以容许砧座620运动至打开位置(在来自弹簧617的偏置运动下),从而从端部执行器612释放可植入钉仓630。随后,外科医生可再次闭合端部执行器钳口613、615,以容许端部执行器612通过进入通道或工作通道被撤出。然而,如果外科医生想要切割缝钉线632之间的靶组织,则外科医生可通过以上述方式操作刀推进触发器200来击发刀组件640,以朝远侧驱动刀构件648穿过靶组织。随着刀构件648穿过端部执行器612朝远侧运动,刀构件648会接触缝钉驱动橇650,该缝钉驱动橇用于进一步驱动缝钉632以使其与砧座620的缝钉成形表面622进行成形接触,从而使缝钉632进一步成形。参见图53。随后,外科医生可打开端部执行器612以从端部执行器612释放切割/缝合的靶组织和可植入钉仓630。
因此,通过朝远侧运动闭合管来闭合端部执行器钳口的独特且新型的闭合管结构使得能够采用更小的闭合结构,同时仍保持产生使缝钉成形所需的大的闭合力的能力。另外,本发明的此类实施例为外科医生提供在无需切割组织的应用中缝合而不切割组织的灵活性。
图56-60示出可供选择的外科器械实施例810,除以下所论述的不同点之外,外科器械实施例810与外科器械610基本上相同。外科器械810例如包括挠性脊组件820,该挠性脊组件具有近端,所述近端上具有凸缘822,该凸缘可旋转地容纳在沟槽106内,所述沟槽106由自形成柄部组件100的壳体构件102、104中的每一者向内突起的配合肋108形成。参见图57和图58。这种安装结构有利于挠性脊组件820相对于柄部组件100可旋转地运动。在各种实施例中,挠性脊组件820可由例如尼龙、丙烯腈丁二烯苯乙烯(ABS)、聚碳酸酯、液晶聚合物、不锈钢、钛等加工而成,并能够与上述类型的端部执行器612一起使用。
外科器械810还包括被总体上表示为830的细长轴组件。在各种实施例中,例如细长轴组件830包括可重构轴段840和近侧轴段844。如在图56中可看出,例如可重构轴段840可具有远侧安装衬圈842,该远侧安装衬圈例如通过粘合剂、焊接、紧固件等非可动地附接到挠性脊组件820的一部分。可重构轴段840可在其中可重构的段840的所有部分均基本上以同轴方式相互对齐(即,其形成基本上直的中空管状结构)的线性构型与其中可重构的段840的所述部分中的至少一部分不以同轴方式或线性方式与另一部分对齐的构型之间选择性地重构。在图56所示的实施例中,例如可重构轴段840可由尼龙、丙烯腈丁二烯苯乙烯(ABS)、聚碳酸酯等加工而成,并可具有多个肋846,所述多个肋846有利于段840从线性或同轴对齐的取向重构至非线性或非同轴的(例如蜿蜒的、弯曲的等)取向并保持这种取向,直至使用者用手或通过使用其它外科器械(例如抓紧装置等)来重构轴段840。因此,可重构轴段840是“可被动铰接的”,这是指该装置未配备有用于主动控制段840的铰接的铰接装置。
在各种实施例中,近侧轴区段844例如通过互锁结构或销而联接到可重构的轴区段840,并用于有利于可重构的轴区段840可旋转地附接到柄部组件100。在至少一个实施例中,例如近侧轴段844联接到安装轴衬60,该安装轴衬以上述方式可旋转地附连到柄部组件100。参见图57和图59。
此外,在各种实施例中,闭合管段832被可动地安装在挠性脊组件820上,以在挠性脊组件820上选择性地行进。参见图56和图60。如在图60中可看出,在至少一个实施例中,闭合管段832及脊组件820分别形成有相对的凸缘部833、821,使得能够防止闭合管段832从脊组件820上滑脱,同时保持被可动地安装在脊组件820上。在各种实施例中,挠性闭合构件848联接到击发轭114或包括击发轭114的一部分。参见图57和图59。挠性闭合构件848可由例如不锈钢等加工而成并可具有延伸穿过脊组件820中的细长狭槽834以联接到闭合管段832的远端部分849。这种结构有利于通过以上述方式致动击发触发器130而使闭合管段832在脊组件820上沿远侧方向“DD”及近侧方向“PD”运动。
如在图56中可看出,外科器械810可与上文中所详细描述的端部执行器612一起使用。具体地讲,可通过将脊螺母668上的凸耳669插入脊组件820的远端825中对应的凸耳狭槽825中而将端部执行器612可移除地联接到挠性脊组件820。参见图60。闭合管段832的远端835能够以上述方式通过螺纹附接到远侧闭合管段690的近端692。
在至少一个实施例中,外科器械810还包括刀推进系统639,刀推进系统639包括延伸穿过脊组件820的刀杆700并具有以驱动方式与击发传送装置190交接的近端部分702,击发传送装置190以上述方式可操作地附接到刀推进触发器200。因此,外科医生可通过以上述方式牵拉刀推进触发器200而使刀杆700朝远侧推进。刀杆700具有分为两部分的远端704,该分为两部分的远端704包括上刀杆段706和下刀杆段708,所述上刀杆段706和下刀杆段708能够接合端部执行器612中的刀板642。参见图60。
为使用外科器械810,通过将脊螺母668上的凸耳669插入与其对应的凸耳支架825中而将端部执行器612附接到脊组件820的远端823。随后,外科医生或临床医生可旋转端部执行器612以将远侧闭合管段690螺接到闭合管段832上。端部执行器612中可具有钉仓630,或者临床医生可在此时将钉仓安装至细长通道614中。一旦端部执行器612附接到外科器械810的细长闭合管组件830,外科医生便可将可重构轴段840构造成使得各细长轴组件部分以同轴方式对齐,以通过延伸至患者体内的开口或工作通道(例如通过套管针或内窥镜等,或通过切口—在开放式手术的情形中)插入。随后,外科医生可将可重构轴段840重构,使得其各部分不以同轴方式相互对齐,以相对于靶组织将附接到可重构轴段840的端部执行器612取向于期望的位置中。与上述各种实施例一样,通过相对于柄部组件100的手枪式握把107操纵击发触发器130来闭合钳口613、615。一旦靶组织被抓紧于端部执行器钳口613、615之间,外科医生便可通过以上述方式将砧座620压紧至钉仓630中而将缝钉632“击发”或成形到靶组织中。如果手术无需切割靶组织,则外科医生可随后释放击发触发器130,以容许砧座620运动至打开位置(在来自弹簧617的偏置运动下),从而从端部执行器612释放可植入钉仓630。随后,外科医生可再次闭合端部执行器钳口613、615并对可重构轴段840进行重构,以容许端部执行器612通过进入通道或工作通道而被撤出。然而,如果外科医生想要切割缝钉线632之间的靶组织,则外科医生可通过以上述方式操作刀推进触发器200来击发刀组件640,以朝远侧驱动刀构件648穿过靶组织。随着刀构件648穿过端部执行器612朝远侧运动,刀构件648会接触缝钉驱动橇650,该缝钉驱动橇用于进一步驱动缝钉632以使其与砧座620的缝钉成形表面622进行成形接触,从而使缝钉632进一步成形。随后,外科医生可打开端部执行器612以从端部执行器612释放切割/缝合的靶组织和可植入钉仓630。
图61和62示出另一外科器械实施例810’,外科器械实施例810’与上述外科器械810实施例基本上相同,不同之处在于,可重构的轴区段850包括细长轴组件830’的可操作地联接到柄部组件100的一部分,以用于操作端部执行器612。在各种实施例中,可重构轴段850包括可动地互连的多个管状链节852。每一管状链节852可例如由具有或不具有玻璃或碳填充的尼龙、丙烯腈丁二烯苯乙烯(ABS)、聚碳酸酯等加工而成,并可具有管状本体部854。管状本体部854上可形成有球形或球状联接器部856,该球形或球状联接器部具有穿过其中的脊容纳通道858。另外,管状脊容纳通道858延伸至形成于管状本体部854中的中空承窝860中,该中空承窝的尺寸被设定成可动地容纳相邻管状链节852的球状联接器部856。球状联接器部856的尺寸相对于承窝860被设定成容许球状联接器部856按扣于其中并保持在其中轴段基本上成直线的期望构型至其中轴850可具有弯曲构型(图62)或蜿蜒状构型(图61)的构型。
尽管球状联接器部856及承窝860的尺寸可相对于彼此设定成在其间形成小的摩擦力,以将区段850保持在期望取向中直至对其施加外力为止,然而图60和图61所示的实施例采用锁定系统862,以将各管状链节852一起可释放地保持或非可动地锁定在期望构型中。如在这些图中可看出,锁定装置862包括在其一端853附近形成于管状链节852的周边上至少一个、优选地多个挠性闩锁结节或构件864。在一个优选的实施例中,采用4个闩锁结节864。其它实施例可具有1、2、3个或多于4个闩锁结节864。每一管状链节852还包括与邻近链节852另一端865的每一闩锁结节864相对应的锁定构件866。每一锁定构件866中具有闩锁容纳凹口868,该闩锁容纳凹口能够在其中可释放地容纳形成于相邻管状链节852上的对应闩锁结节864的一部分。
为使用外科器械810’,需以上述方式将端部执行器612附接到脊组件820的远端823。端部执行器612的远侧闭合管段690螺接至闭合管段832上。一旦端部执行器612附接到外科器械810’的细长闭合管组件830,则外科医生可将可重构轴段850构造成使得各细长轴组件部分以同轴方式对齐,以通过延伸至患者体内的开口或工作通道(例如通过套管针或内窥镜等,或通过切口—在开放式手术的情形中)插入。随后,外科医生可例如采用抓紧器械869来将可重构轴段850的可运动的链节852构造至期望取向,并随后将每一链节852上的适当锁定结节864按压至其对应的闩锁容纳凹口868中,以将各链节852锁定在期望取向中。参见图62。与上述各种实施例一样,通过相对于柄部组件100的手枪式握把107操纵击发触发器130来闭合钳口613、615。一旦靶组织被抓紧于端部执行器钳口613、615之间,外科医生便可通过以上述方式将砧座620压紧至钉仓630中而将缝钉632“击发”或成形到靶组织中。如果手术无需切割靶组织,则外科医生可随后释放击发触发器130,以容许砧座620运动至打开位置(在来自弹簧617的偏置运动下),从而从端部执行器612释放可植入钉仓630。随后,外科医生可再次闭合端部执行器钳口613、615并使用抓紧器械869将各锁定结节864从其对应的闩锁容纳凹口868中移除,以容许各链节852对齐,从而容许装置能够通过进入通道或工作通道而被撤出。然而,如果外科医生想要切割缝钉线632之间的靶组织,则外科医生可通过以上述方式操作刀推进触发器200来击发刀组件640,以朝远侧驱动刀构件648穿过靶组织。随着刀构件648穿过端部执行器612朝远侧运动,刀构件648会接触缝钉驱动橇650,该缝钉驱动橇用于进一步驱动缝钉632以使其与砧座620的缝钉成形表面622进行成形接触,从而使缝钉632进一步成形。随后,外科医生可打开端部执行器612以从端部执行器612释放切割/缝合的靶组织及可植入钉仓630。
图63-68示出另一外科器械实施例810”,除细长轴组件的可重构的轴区段870及相关的锁定系统882之外,外科器械实施例810”与上述外科器械实施例810、810’基本上相同。在各种实施例中,可重构轴段870包括可动地互连的多个管状链节872并联接到近侧轴段871,该近侧轴段联接到安装轴衬60,该安装轴衬60如上文详细所述被旋转地支撑在柄部组件100中。每一管状链节872可例如由尼龙、丙烯腈丁二烯苯乙烯(ABS)、聚碳酸酯等加工而成,并可具有管状本体部874。参见图67。管状本体部874上可形成有球形或球状联接器部876,球形或球状联接器部876具有穿过其中而延伸的脊容纳通道878。另外,管状脊容纳通道878延伸至形成于管状本体部854中的中空承窝880中,该中空承窝的尺寸被设定成可动地容纳相邻管状链节872的球状联接器部876。球状联接器部876的尺寸相对于承窝880被设定成容许球状联接器部876按扣于其中并保持在其中可重构轴段870基本上成直线(图67)的期望构型至其中轴870可具有弯曲的(图68)或蜿蜒状构型的构型。
尽管在至少一个实施例中,球状联接器部876及承窝880的尺寸可相对于彼此被设定成在其间形成小的摩擦力,以将可重构的轴区段870的管状链节872保持在期望取向中直至对其施加外力为止,然而图63-68所示的实施例采用锁定系统882,以将各管状链节872一起可释放地保持或非可动地锁定在期望构型中。如在图67和图68中可看出,锁定装置882包括延伸穿过处于直径相对位置的管状链节872的至少一个、且优选地两个能选择性膨胀的锁囊884。在各种实施例中,锁囊884可例如由尼龙膜等加工而成并能够容纳来自加压流体源886的加压流体。在图64所示的实施例中,加压流体源886包括流体泵结构888,该流体泵结构888能够在压力作用下将空气供给至锁囊884中。具体地讲,在至少一个实施例中,流体泵结构888包括其中具有活塞890的汽缸889。活塞890具有围绕于其周边的O形环或其它密封结构891并附接到螺纹泵柄部892,该螺纹泵柄部892螺纹接合柄部组件100的一部分。因此,通过将泵柄部892旋入柄部组件100中,汽缸890中的空气会在压力作用下通过自汽缸890延伸至歧管组件894的供给管道893而被泵送,该歧管组件被容纳在脊组件820上。可通过沿相反方向旋动泵柄部894而将气压释放于锁囊884中。
如在图65中可看出,歧管组件894包括由O形环或其它密封件896密封于每一侧上的环形歧管区域895。环形歧管区域895与供给管线897连通,该供给管线延伸穿过近侧轴段871并联接到锁囊884或在锁囊884中卸料。这种结构用于将加压空气供给至锁囊884中,同时有利于脊组件820相对于柄部组件100绕纵向轴线A-A可旋转地运动。如本文所用,术语“加压流体”可包括例如空气、盐溶液、或优选地为甘油。在可供选择的实施例中,管状构件可填充有硬度非常低的橡胶或弹性体。当对橡胶材料施加压力时,橡胶材料会变形以填充空隙并以与流体实施例差不多的方式锁定轴。
为使用外科器械810”,需以上述方式将端部执行器612附接到脊组件820’的远端823。端部执行器612的远侧闭合管段690螺接至闭合管段832上。一旦端部执行器612附接到外科器械810”的细长轴组件830”,则外科医生可将可重构轴段870构造成使得各细长轴组件部分830”以同轴方式对齐,以通过延伸至患者体内的开口或工作通道(例如通过套管针或内窥镜等,或通过切口—在开放式手术的情形中)插入。随后,外科医生可采用例如抓紧器械来将可重构轴段870的可运动链节872构造至期望取向。一旦可重构轴段870取向在期望取向中,则外科医生可随后将泵柄部892旋至柄部壳体100中以对锁囊884加压,从而将可运动的链节872锁定在如图68所示的位置。与上述各种实施例一样,通过相对于柄部组件100的手枪式握把107操纵击发触发器130来闭合钳口613、615。一旦靶组织被抓紧于端部执行器钳口613、615之间,外科医生便可通过以上述方式将砧座620压紧至钉仓630中而将缝钉632“击发”或成形到靶组织中。如果手术无需切割靶组织,则外科医生可随后释放击发触发器130,以容许砧座620运动至打开位置(在来自弹簧617的偏置运动下),从而从端部执行器612释放可植入钉仓630。随后,外科医生可再次闭合端部执行器钳口613、615并通过沿相反的方向旋动泵柄部892而释放锁囊884中的压力。可采用抓紧器械来将可运动的链节872调控至基本上同轴对齐的取向(图67)或使装置能够从患者体内被撤出期望的其它方向。然而,如果外科医生想要切割缝钉线632之间的靶组织,则外科医生可通过以上述方式操作刀推进触发器200来击发刀组件640,以朝远侧驱动刀构件648穿过靶组织。随着刀构件648穿过端部执行器612朝远侧运动,刀构件648会接触缝钉驱动橇650,该缝钉驱动橇用于进一步驱动缝钉632以使其与砧座620的缝钉成形表面622进行成形接触,从而使缝钉632进一步成形。随后,外科医生可打开端部执行器612以从端部执行器612释放切割/缝合的靶组织及可植入钉仓630。
本文所公开的包括可重构的轴区段的各种实施例大大改良了采用可锁定铰接接头的传统的可铰接外科器械结构。这种外科器械的端部执行器在横切部位的放置通常被限制到1或2个自由度。本发明的各种实施例使得端部执行器的可能位置范围更宽并因此使外科医生在通过单个入口使用装置时具有更大的灵活性。
本发明的各种外科钉仓及外科器械的独特且新型的结构使所述钉仓中的缝钉能够排列成一条或多条线性或非线性的线。细长狭槽的每一侧上可设置有多条这种缝钉线,所述细长狭槽居中地设置于钉仓内,以用于穿过所述细长狭槽而容纳组织切割构件。在一种排列方式中,例如成一条线的缝钉可大体上平行于位于相邻缝钉线中的缝钉但与其偏离。在另一些实施例中,一条或多条缝钉线可本质上为非线性的。换言之,缝钉线中的至少一个缝钉的基部可沿基本上与同一缝钉线中的其它缝钉的基部横切的轴线延伸。例如,如以下将更详细地论述,在可供选择的实施例中,细长狭槽的每一侧上的缝钉线可具有锯齿形外观。这种非线性的缝钉排列方式可行的原因在于,缝钉不被向上驱动至砧座中。相反,在这些各种实施例中,砧座与不运动的缝钉的末端进行成形接触。与其中缝钉实际被向上驱动以与砧座进行成形接触的现有技术的钉仓中所采用的各种线性缝钉排列方式相比,这种非线性的缝钉排列方式可使用更少的缝钉获得更好的组织紧固结果。
图69示出本发明的端部执行器实施例612’中的外科钉仓实施例900的使用。端部执行器612’可以上述各种方式与外科器械610结合使用。除以下所述不同点之外,端部执行器612’可与上述端部执行器612相同。如在图69和图70中可看出,外科钉仓900的实施例具有仓体902,该仓体具有居中设置的细长狭槽904,该细长狭槽穿过近端903而延伸至与远端605相邻的区域。细长狭槽904能够在以上述方式进行组织切割操作期间容许外科器械610的刀本体646穿过细长狭槽904轴向地运动。在至少一个实施例中,仓体902由例如氧化再生纤维素(ORC)或例如由PGA(聚乙醇酸,以商标Vicryl出售)、PCL(聚己内酯)、PLA或PLLA(聚乳酸)、PDS(聚对二氧环己酮)、PHA(聚羟基链烷酸酯)、PGCL(聚卡普隆25,以商标Monocryl出售)或PGA、PCL、PLA及PDS的复合物加工而成的可生物吸收的泡沫等可压缩的止血材料组成,在所述可压缩的止血材料中支撑有未成形缝钉922形成的线920、930。然而,仓体902也可由用于将未成形的缝钉922支撑在期望取向以使砧座910与成形的缝钉922接触时未成形的缝钉922可被压缩的其它材料加工而成。与上述各种其它实施例一样,钉仓900是可植入的且在缝合手术完成之后被留下并附接到被缝合的组织。在至少某些实施例中,为防止缝钉922受影响并防止止血材料在引入及定位过程期间被活化,整个仓900可涂覆有或包裹于可生物降解的膜906中,例如以商标出售的六环酮膜或聚甘油癸二酸酯(PGS)膜、或例如由PGA(聚乙醇酸,以商标Vicryl出售)、PCL(聚己内酯)、PLA或PLLA(聚乳酸)、PHA(聚羟基链烷酸酯)、PGCL(聚卡普隆25,以商标Monocryl出售)或PGA、PCL、PLA、PDS的复合物形成的膜,所述膜只有在破裂时才可渗透。钉仓900的仓体902的尺寸设定成被可移除地支撑在端部执行器612’的细长通道614内。
在图69、图73、及图74所示的实施例中,外科钉仓900可操作地在细长狭槽904的一个横向侧907上支撑缝钉922形成的第一线920,并在细长狭槽904的另一横向侧909上支撑缝钉922形成的第二线930。在各种实施例中,缝钉922可由例如钛、钛合金(例如6Al-4V钛、3al-2.5V钛)、不锈钢等金属材料加工而成并具有缝钉基部924和从缝钉基部924突起的两个直立的缝钉腿926。每一缝钉腿926上可形成有组织刺穿末端928。在缝钉922形成的第一线920中,至少一个缝钉922的缝钉基部924与另一缝钉922的缝钉基部交搭。在一个优选的实施例中,除位于第一缝钉线920每一末端上的最后缝钉922的基部924之外,每一缝钉922的缝钉基部924均与两个相邻缝钉922的缝钉基部924交搭。参见图73。因此,第一缝钉线920具有基本上非线性的形状。更具体地讲,当从上方观察时,第一缝钉线920具有基本上锯齿形的外观。
如在图72中可看出,砧座90具有两个相继形成的纵向缝钉成形凹坑912,每一纵向缝钉成形凹坑912具有与缝钉922形成的第一线920的形状对应的基本上锯齿形的形状,使得当砧座910与缝钉922进行成形接触时,缝钉922的腿部926如图74所示成形。因此,一个缝钉的远侧腿部与在纵向上的下一缝钉的近侧腿部共享同一凹坑。这种结构能够形成更密集的凹坑图案,甚至达到缝钉自身进行相互作用(例如跨过彼此而折叠)的程度。在现有技术的缝钉凹坑结构中,一般来讲,一组凹坑与下一组凹坑之间必须具有0.005英寸至0.015英寸之间的金属/空间。然而,例如本发明的此类实施例具有0至0.02英寸的干涉/交搭间隔结构(本质上,a-0.020"),这是因为一个缝钉与下一个缝钉相配合。这种结构使得能够在相同的空间中包括多出15%至30%的缝钉。此外,当各缝钉互锁时,对多个侧向缝钉排的需求减少。现有的结构通常在组织切割线的每一侧上采用三排缝钉,以防止存在血液可流过的开放路径。互锁缝钉线形成血液可流过的路径的可能性更小。本发明的各种互锁缝钉结构所提供的另一明显的优点涉及与撕开缝钉线开口所需力的大小相关的改良“破裂强度”。
本发明的另一缝钉成形凹坑结构可包括共用的缝钉成形凹坑。如本文所用,术语“共用的缝钉成形凹坑”是指,与其中针对每一预成形缝钉的每一腿部来设置独立形成凹坑的现有技术的砧座设计不同,一个成形凹坑可使单个缝钉线中的所有缝钉成形。
图75示出另一个缝钉实施例922’,其中基部924’具有偏移部928,以利于各基部924’进行更紧密的交搭。如上所述,钉仓900具有支撑在细长狭槽904的第二横侧909上的缝钉922的第二线930。缝钉922的第二线930与缝钉922的第一线920基本上相同。因此,砧座910具有对应于第二缝钉线930的第二共用缝钉成形凹坑912,以与第二缝钉线930成形接触。然而,在可供选择的实施例中,缝钉922的第二线930可在形状上并可能在缝钉数目上不同于第一缝钉线920。
图71示出外科钉仓900’,除支撑在其中的缝钉922形成的线920’、930’之外,外科钉仓900’与上述钉仓900基本上相同。例如,在此实施例中,缝钉922的线920’相对于彼此被设定成使得至少一个缝钉基部924的基部轴线S-S基本上横切至少一个另一相邻缝钉922的缝钉基部924的基部轴线S-S。当从上方观察时,这种预定的缝钉图案包括基本上锯齿形的排列。在图76所示的实施例中,缝钉922的各基部924上可另外重叠注塑有基部支撑构件927,如图所示。在各种实施例中,基部支撑构件927可由例如不可吸收的塑料(例如聚醚醚酮“PEEK”)或可吸收的塑料(例如聚乙醇酸“PGA”、聚乳酸“PLA”或“PLLA”、聚对二氧环己酮“PDS”、PCL(聚己内酯)、PHA(聚羟基链烷酸酯)、PGCL(聚卡普隆25,以商标Monocryl出售)或PGS、PDS、PLA、PGA和PCL的各种复合混合物)加工而成。基部支撑构件927有利于在不使缝钉自身交搭的情况下使各缝钉之间进行互锁。因此,这种结构可在不使缝钉自身的腿部交搭的情况下使缝钉成形为“B”形或倒“W”形。然而,由于冠部通过基部支撑构件相连,因此冠部像交搭的缝钉一样起作用。这种结构容许相结合的凹坑针对每一腿部具有两个独立的路径。
图77所示的实施例采用缝钉线920”,在缝钉线920”中,相邻缝钉922的腿部926通过以模制或其它方式附接到腿部926的联接器部929联接在一起。每一联接器部929可由例如聚醚醚酮“PEEK”或可吸收的塑料(例如聚乙醇酸“PGA”、聚乳酸“PLA”或“PLLA”、聚对二氧环己酮“PDS”、PCL(聚己内酯)、PHA(聚羟基链烷酸酯)、PGCL(聚卡普隆25,以商标Monocryl出售)或PGS、PDS、PLA、PGA、和PCL的各种复合混合物)加工而成。当从上方观察时,这种缝钉线920”具有基本上锯齿形的外观。尽管结合与端部执行器612’及外科缝合器械610一起使用来解释各种外科缝钉实施例900、900’,然而应当理解,钉仓900、900’可有效地与上文所述的各种其它端部执行器及外科器械一起使用,其中这些器械的砧座中设置有适当的缝钉成形凹坑,以便在砧座运动至与缝钉进行成形接触时达到期望的缝钉成形量。
图78和79示出支撑在本发明外科器械10的细长通道14中的另一外科钉仓940实施例。在至少一个实施例中,外科钉仓940包括仓体942,该仓体具有居中设置的细长狭槽944,该细长狭槽至少部分地穿过仓体942延伸。细长狭槽944能够在以上述方式进行组织切割操作期间容许外科器械10的刀本体穿过细长狭槽944轴向地运动。在各种实施例中,仓体942由例如氧化再生纤维素(ORC)或上述或下述类型的可生物吸收的泡沫等可压缩的止血材料组成,所述止血材料中支撑有未成形缝钉922形成的线946、948、950和952。在至少某些实施例中,为防止缝钉922受影响并防止止血材料在引入及定位过程期间被活化,整个仓940可涂覆有或包裹于可生物降解的膜954中,例如以商标出售的六环酮膜或聚甘油癸二酸酯(PGS)膜、或例如由PGA(聚乙醇酸,以商标Vicryl出售)、PCL(聚己内酯)、PLA或PLLA(聚乳酸)、PHA(聚羟基链烷酸酯)、PGCL(聚卡普隆25,以商标Monocryl出售)或PGA、PCL、PLA、PDS的复合物形成的膜,所述膜只有在破裂时才可渗透。
在图78所示的实施例中,仓940还包括联接到仓体942的仓支撑构件960。在各种实施例中,仓支撑构件960可由例如钛、不锈钢、铝、上述材料形成的任何合金等刚性金属加工而成,并可部分地嵌入仓体942中。在各种实施例中,仓支撑构件960可由例如膜954保持就位。在需要限制性结合的另一些实施例中,可零星地使用氰基丙烯酸盐粘合剂来将两个元件“胶合”在一起。在另一些实施例中,可将仓体942加热并“焊接”或“熔融”至仓支撑构件960。在各种实施例中,仓支撑构件960形成仓体942的底部表面的至少一部分以与细长通道14相配合。在一个优选的实施例中,仓支撑构件960具有从其突起的一个或多个按扣结构962,以用于将仓支撑构件960可释放地联接到细长通道14。可采用其它形式的按扣结构/紧固件结构将仓支撑构件960可释放地联接到细长通道14。
在各种实施例中,仓支撑构件960上形成有一系列支撑脊964、966、968、970、972、974、及976,以对缝钉线946、948、950、及952中的缝钉922的基部924提供某种程度的横向支撑。因此,在至少某些实施例中,支撑脊与缝钉线是基本上同延的。图80示出可供选择的钉仓实施例940’,钉仓实施例940’与仓940基本上相同,不同之处在于,钉仓实施例940’包括分别自支撑脊964、966、968、970、972、和976突起以对缝钉922提供额外侧向支撑的直立翅片部978、979、980、981、982、和983。在各种实施例中,翅片部可与仓支撑构件960形成为一体,并且其高度可为仓高度的大约1/2或以下。因此,在优选的实施例中,例如任何用于支撑泡沫的直立结构皆无法延伸至泡沫的最大压缩高度以上。因此,如果仓被设计成例如在被击发时压缩至其原始高度的1/3,则翅片将在未压缩高度的66%一路下降到未压缩高度的10%之间。
在使用中,一旦缝钉922通过以上述方式接触砧座20而成形,则将砧座20打开并将端部执行器12拉离经缝合的组织。当将端部执行器12拉离经缝合的组织时,仓体942保持紧固至经缝合的组织并随后与保持联接到细长通道14的仓支撑构件960分离。在各种实施例中,仓支撑构件960的颜色不同于包括仓体942的材料的颜色以及细长通道14的颜色。这种布置为外科医生提供端部执行器中不存在钉仓的可容易识别的指示。因此,外科医生不会无意地试图在未在端部执行器中安装新的钉仓的情况下再次插入/使用端部执行器。为此,外科医生仅需将仓支撑构件960的按扣结构从细长通道14脱离,以使新的钉仓940的仓支撑构件960能够被放置于细长通道14中。尽管结合外科器械10解释钉仓940、940’,然而应当理解,在不背离本发明的实质和范围的条件下,这些仓可有效地与本文所公开的许多其它外科器械实施例一起使用。
图81和82示出外科器械实施例10结合端部执行器990的使用,除可动地联接到细长通道14或换句话讲支撑在细长通道14中的闭合锁定装置991之外,端部执行器990与上述端部执行器12基本上相同。在各种实施例中,闭合锁定装置991包括具有远端993和近端994的锁定臂992。锁定臂992绕枢轴构件或凸耳995枢转地联接到细长通道。远端部分具有附接到远端部分的片簧996或其它偏置构件以将锁定臂992偏置到致动或锁定位置;在致动或锁定位置中,近端994接合第一击发衬圈141的远端141以防止第一击发衬圈140朝远侧推进至“击发”位置。然而,当细长通道14中安装有钉仓30时,钉仓30会使锁定臂992运动至非致动或非锁定位置中,使得击发衬圈140可朝远侧推进超过锁定臂992,以完成缝钉击发过程。参见图81。
当处于锁定位置时,击发衬圈140无法朝远侧被推进而完成击发过程。另外,击发触发器130无法推进至完全击发位置,在完全击发位置中,刀锁定杆210运动至解锁位置,从而使外科医生能够使刀杆172推进。因此,当端部执行器990中不存在仓时,闭合锁定装置991处于锁定位置,这最终会防止刀杆172推进。因此,除非端部执行器990中存在仓30,否则外科医生无法使刀杆172推进来切割组织。应当理解,在不背离本发明的实质和范围的条件下,上述闭合锁定装置991可有效地合并于本文所公开的许多外科器械实施例中。
在各种实施例中,钉仓可包括仓体及存储在仓体中的多个缝钉。在使用中,可将钉仓引入手术部位中并将其定位在所处理的组织的侧上。另外,可将缝钉成形砧座定位在组织的相对侧上。在各种实施例中,砧座可由第一钳口携载且钉仓可由第二钳口携载,其中第一钳口和/或第二钳口可朝另一钳口运动。一旦钉仓及砧座相对于组织被定位,则可从钉仓本体中射出缝钉,使得缝钉可刺穿组织并接触缝钉成形砧座。一旦从钉仓本体中部署缝钉,则可从手术部位移除钉仓本体。在本文所公开的各种实施例中,钉仓或钉仓的至少一部分中可植入有缝钉。在至少一个此类实施例中,如以下所更详细地描述,钉仓可包括仓体,当砧座从打开位置运动到闭合位置时,所述仓体可被所述砧座压缩、压溃、和/或塌缩。当仓体被压缩、压溃、和/或塌缩时,位于仓体中的缝钉可通过砧座而变形。作为另外一种选择,用于支撑钉仓的钳口可朝砧座运动至闭合位置。在两种情形的任一种中,在各种实施例中,当缝钉至少部分地位于仓体中时,缝钉可被变形。在某些实施例中,缝钉可不从钉仓中被射出,而在一些实施例中,缝钉可与仓体的一部分一起从钉仓中被射出。
现在参见图83A-83D,可压缩的钉仓(例如钉仓1000)例如可包括可压缩、可植入的仓体1010,另外,位于可压缩仓体1010中的多个缝钉1020绘示于图83A-83D中(然而图中仅示出一个缝钉1020)。图83A示出由钉仓支撑件或钉仓通道1030支撑的钉仓1000,其中钉仓1000被示出处于未压缩状态。在这种未压缩状态中,砧座1040可接触或不接触组织T。在使用中,砧座1040可从打开位置运动至接触组织T(如图83B所示)以及组织T抵靠仓体1010的位置。即使砧座1040可将组织T定位成抵靠钉仓本体1010的组织接触表面1019,然而再次参见图83B,钉仓本体1010可受到小的(如果有的话)压缩力或压力,使得缝钉1020可保持在未成形或未击发状态。如图83A和图83B所示,钉仓本体1010可包括一个或多个层,并且缝钉1020的缝钉腿1021可穿过这些层向上延伸。在各种实施例中,仓体1010可包括第一层1011、第二层1012、第三层1013、和第四层1014,其中第二层1012可定位在第一层1011与第三层1013之间,其中第三层1013可定位在第二层1012和第四层1014之间。在至少一个实施例中,例如缝钉1020的基部1022可定位在第四层1014中的腔1015中,并且缝钉腿1021可从基部1022向上延伸并穿过第四层1014、第三层1013和第二层1012。在各种实施例中,每一可变形腿部1021可包括末端,例如锋利的末端1023,例如当钉仓1000处于未压缩状态时,锋利的末端1023例如可定位在第二层1012中。在至少一个此类实施例中,末端1023可不延伸至和/或穿过第一层1011,其中在至少一个实施例中,当钉仓1000处于未压缩状态时,末端1023可不突起穿过组织接触表面1019。在某些实施例中,当钉仓处于未压缩状态时,锋利的末端1023可定位在第三层1013和/或任何其它适宜的层中。在各种可供选择的实施例中,钉仓的仓体可具有任何适宜数目的层,例如少于四层或多于四层。
在各种实施例中,如以下所更详细地描述,第一层1011可由支撑材料和/或塑性材料(例如聚对二氧环己酮(PDS)和/或聚乙醇酸(PGA))构成,并且第二层1012可由可生物吸收的泡沫材料和/或可压缩的止血材料(例如氧化再生纤维素(ORC))构成。在各种实施例中,第一层1011、第二层1012、第三层1013、和第四层1014中的一者或多者可将缝钉1020保持在钉仓本体1010中,并且另外可使缝钉1020保持相互对齐。在各种实施例中,第三层1013可由支撑材料或相当不可压缩的或非弹性材料构成,所述材料能够将缝钉1020的缝钉腿1021相对于彼此保持就位。此外,即使能够由可压缩的泡沫或弹性材料构成,位于第三层1013的相对两侧上的第二层1012和第四层1014也可稳定或减少缝钉1020的运动。在某些实施例中,缝钉腿1021的缝钉末端1023可至少部分地嵌入第一层1011中。在至少一个此类实施例中,第一层1011和第三层1013能够可协作地且稳固地将缝钉腿1021保持就位。在至少一个实施例中,第一层1011和第三层1013可分别由可生物吸收材料(例如以商品名Vicryl出售的聚乙醇酸(PGA)、聚乳酸(PLA、PLLA)、聚对二氧环己酮(PDS)、聚羟基链烷酸酯(PHA)、以商品名Monocryl出售的聚卡普隆25(PGCL)、聚己内酯(PCL)、和/或PGA、PLA、PDS、PHA、PGCL、和/或PCL的复合物)形成的薄片构成,并且第二层1012和第四层1014可分别由至少一种止血材料或剂构成。
尽管第一层1011可为可压缩的,然而第二层1012可基本上比第一层1011更可压缩。例如,第二层1012的可压缩性可为第一层1011的约两倍、约三倍、约四倍、约五倍、和/或约十倍。换言之,针对给定的力,第二层1012的压缩程度可为第一层1011的约两倍、约三倍、约四倍、约五倍、和/或约十倍。在某些实施例中,第二层1012的可压缩性可在第一层1011的约两倍与约十倍之间。在至少一个实施例中,第二层1012中可限定有多个气隙,其中第二层1012中的气隙的量和/或尺寸可被控制以提供第二层1012的期望压缩。与上文相似,尽管第三层1013能够为可压缩的,然而第四层1014能够比第三层1013基本上更可压缩。例如,第四层1014的可压缩性可为第三层1013的约两倍、约三倍、约四倍、约五倍、和/或约十倍。换言之,针对给定的力,第四层1014的压缩程度可为第三层1013的约两倍、约三倍、约四倍、约五倍、和/或约十倍。在某些实施例中,第四层1014的可压缩性可在第三层1013的约两倍与约十倍之间。在至少一个实施例中,第四层1014中可限定有多个气隙,其中第四层1014中的气隙的量和/或尺寸可被控制以便提供第四层1014的期望压缩。在各种情形中,可通过压缩率(即,层针对给定大小的力所压缩的距离)来表达仓体或仓体层的可压缩性。例如,与具有较低压缩率的层相比,具有高压缩率的层针对施加至该层的给定大小的压缩力将压缩更大的距离。如此而言,第二层1012可比第一层1011具有更高的压缩率;相似地,第四层1014可比第三层1013具有更高的压缩率。在各种实施例中,第二层1012和第四层1014可由相同的材料构成并可具有相同的压缩率。在各种实施例中,第二层1012和第四层1014可由具有不同压缩率的材料构成。相似地,第一层1011和第三层1013可由相同的材料构成并可具有相同的压缩率。在某些实施例中,第一层1011和第三层1013可由具有不同压缩率的材料构成。
当砧座1040朝其闭合位置行进时,砧座1040可接触组织T并对组织T和钉仓1000施加压缩力,如图83C所示。在这种情形中,砧座1040可朝钉仓支撑件1030向下推动仓体1010的顶面或组织接触表面1019。在各种实施例中,钉仓支撑件1030可包括仓支撑表面1031,仓支撑表面1031能够当钉仓1000被压缩于仓支撑表面1031与砧座1040的组织接触表面1041之间时支撑钉仓1000。由于砧座1040所施加的压力,仓体1010可被压缩且砧座1040可接触缝钉1020。更具体地讲,在各种实施例中,仓体1010的压缩和组织接触表面1019向下的运动可使缝钉腿1021的末端1023刺穿仓体1010的第一层1011、刺穿组织T、并进入砧座1040中的成形凹坑1042中。当仓体1010被砧座1040进一步压缩时,末端1023可接触限定成形凹坑1042的壁,并且因此腿部1021可向内变形或卷曲,例如图83C所示。当缝钉腿1021被变形时,同样如图83C所示,缝钉1020的基部1022可接触钉仓支撑件1030或由钉仓支撑件1030支撑。在各种实施例中,如以下将更详细地描述,钉仓支撑件1030可包括多个支撑结构,例如缝钉支撑沟槽、狭槽、或槽1032,所述多个支撑结构能够当缝钉1020被变形时支撑缝钉1020或至少缝钉1020的基部1022。同样如图83C所示,施加至钉仓本体1010的压缩力可使第四层1014中的腔1015塌缩。除腔1015之外,钉仓本体1010还可包括一个或多个空隙(例如空隙1016),例如所述一个或多个空隙中可定位有或未定位有缝钉的一部分,所述一个或多个空隙能够允许仓体1010塌缩。在各种实施例中,腔1015和/或空隙1016能够塌缩,以使限定腔和/或空隙的壁向下挠曲并接触仓支撑表面1031和/或接触仓体1010的位于腔和/或空隙下方的层。
在比较图83B和图83C时,显然,第二层1012及第四层1014被砧座1040所施加的压缩压力基本上压缩。也可注意,第一层1011和第三层1013也被压缩。当砧座1040运动至其闭合位置时,砧座1040可通过朝钉仓支撑件1030向下推动组织接触表面1019而继续进一步压缩仓体1010。当仓体1010被进一步压缩时,砧座1040可使缝钉1020变形至其完全成形形状(如图83D所示)。参见图83D,每一缝钉1020的腿部1021可朝每一缝钉1020的基部1022向下变形,以便将组织T、第一层1011、第二层1012、第三层1013、和第四层1014的一部分捕获在可变形腿部1021与基部1022之间。在比较图83C和图83D时,更显然第二层1012和第四层1014进一步被砧座1040所施加的压缩压力显著压缩。在比较图83C和图83D时也可注意,第一层1011和第三层1013也被进一步压缩。在缝钉1020被完全或至少充分地成形之后,砧座1040可远离组织T而被抬起,并且钉仓支撑件1030可远离和/或脱离钉仓1000而运动。如图83D所示,作为上文的结果,仓体1010可植入有缝钉1020。在各种实施例中,被植入的仓体1010可沿缝钉线支撑组织。在某些情形中,被植入的仓体1010中容纳的止血剂和/或任何其它适宜的治疗药物可随着时间来处理组织。如上所述的止血剂可减少所缝合和/或所切割的组织出血,同时键合剂或组织粘合剂可随着时间的进行为组织提供强度。所植入的仓体1010可由例如ORC(氧化再生纤维素)、蛋白基质、以商品名Vicryl出售的聚乙醇酸(PGA)、聚乳酸(PLA或PLLA)、聚对二氧环己酮(PDS)、聚羟基链烷酸酯(PHA)、以商品名Monocryl出售的聚卡普隆25(PGCL)、聚己内酯(PCL)、和/或PGA、PLA、PDS、PHA、PGCL、和/或PCL的复合物等材料构成。在某些情形中,仓体1010可包括能够减小手术部位感染的可能性的抗生和/或抗菌材料,例如胶体银和/或三氯生。
在各种实施例中,仓体1010的各层可彼此连接。在至少一个实施例中,可利用至少一种粘合剂(例如纤维蛋白和/或蛋白水凝胶)将第二层1012粘附至第一层1011,将第三层1013粘附至第二层1012,并将第四层1014粘附至第三层1013。在某些实施例中,尽管未示出,然而仓体1010的各层可通过互锁机械结构连接在一起。在至少一个此类实施例中,第一层1011和第二层1012可分别包括相对应的互锁结构,例如榫槽结构和/或燕尾榫结构。相似地,第二层1012和第三层1013可分别包括相对应的互锁结构,同时第三层1013和第四层1014可分别包括相对应的互锁结构。在某些实施例中,尽管未示出,然而钉仓1000可例如包括一个或多个铆钉,所述一个或多个铆钉可延伸穿过仓体1010的一个或多个层。在至少一个此类实施例中,每一铆钉可包括邻近第一层1011定位的第一端部或头部以及邻近第四层1014而定位的第二头部,所述第四层可被组装到铆钉的第二端部或由铆钉的第二端部形成。由于仓体1010的可压缩性质,在至少一个实施例中,例如铆钉可压缩仓体1010,以使铆钉的头部可相对于仓体1010的组织接触表面1019和/或底部表面1018凹陷。在至少一个此类实施例中,各铆钉可由例如以商品名Vicryl出售的聚乙醇酸(PGA)、聚乳酸(PLA或PLLA)、聚对二氧环己酮(PDS)、聚羟基链烷酸酯(PHA)、以商品名Monocryl出售的聚卡普隆25(PGCL)、聚己内酯(PCL)、和/或PGA、PLA、PDS、PHA、PGCL、和/或PCL的复合物等可生物吸收的材料构成。在某些实施例中,除通过仓体1010中所容纳的缝钉1020之外,仓体1010的各层可不彼此连接。在至少一个此类实施例中,缝钉腿1021与仓体1010之间的摩擦接合例如可将仓体1010的各层保持在一起,并且一旦缝钉成形,则各层可被捕获在缝钉1020中。在某些实施例中,缝钉腿1021的至少一部分可包括能够增大缝钉1020与仓体1010之间的摩擦力的粗糙化表面或粗糙涂层。
如上所述,外科器械可包括第一钳口及第二钳口,第一钳口包括钉仓支撑件1030,第二钳口包括砧座1040。在各种实施例中,如以下所更详细描述,钉仓1000可包括一个或多个保留结构,所述一个或多个保留结构能够接合钉仓支撑件1030并因此将钉仓1000可释放地保持到钉仓支撑件1030。在某些实施例中,可通过至少一种粘合剂(例如,纤维蛋白和/或蛋白水凝胶)将钉仓1000粘附至钉仓支撑件1030。在使用中,在至少一种情形中,尤其是在腹腔镜式和/或内窥镜式手术中,例如第二钳口可运动至与第一钳口相对的闭合位置,使得第一钳口和第二钳口可通过套管针而被插入手术部位中。在至少一个此类实施例中,套管针可限定约5mm的孔或插管,第一钳口和第二钳口可通过所述孔或插管而被插入。在某些实施例中,第二钳口可运动至处于打开位置与闭合位置之间的部分闭合位置,所述部分闭合位置可容许第一钳口和第二钳口穿过套管针被插入,而无需使钉仓本体1010中所容纳的缝钉1020变形。在至少一个此类实施例中,当第二钳口处于其部分闭合的中间位置时,砧座1040可不对钉仓本体1010施加压缩力,而在某些其它实施例中,当第二钳口处于其部分闭合的中间位置时,砧座1040可压缩钉仓本体1010。尽管当砧座1040处于这种中间位置时可压缩钉仓本体1010,然而砧座1040可不完全地压缩钉仓本体1010,以使砧座1040接触缝钉1020和/或使得缝钉1020被砧座1040变形。一旦第一钳口和第二钳口通过套管针而被插入手术部位中,则第二钳口可被再次打开,并且砧座1040及钉仓1000可如上所述相对于靶组织进行定位。
现在参见图84A-84D,在各种实施例中,外科缝合器的端部执行器可包括位于砧座1140与钉仓支撑件1130之间的可植入钉仓1100。与上文相似,砧座1140可包括组织接触表面1141,钉仓1100可包括组织接触表面1119,并且钉仓支撑件1130可包括能够支撑钉仓1100的支撑表面1131。参见图84A,可利用砧座1140将组织T定位成使其抵靠钉仓1100的组织接触表面1119而不使钉仓1100变形,并且当砧座1140处于这种位置时,组织接触表面1141可被定位成与钉仓支撑表面1131相距距离1101a,并且组织接触表面1119可被定位成与钉仓支撑表面1131相距距离1102a。随后,现在参见图84B,当砧座1140朝钉仓支撑件1130运动时,砧座1140可向下推动钉仓1100的顶面或组织接触表面1119并压缩仓体1110的第一层1111和第二层1112。再次参见图84B,当层1111及层1112被压缩时,第二层1112可被压溃,并且缝钉1120的腿部1121可刺穿第一层1111并进入组织T。在至少一个此类实施例中,缝钉1120可至少部分地定位在第二层1112中的缝钉腔或空隙1115中,并且当第二层1112被压缩时,缝钉腔1115可塌缩并因此容许第二层1112围绕缝钉1120而塌缩。在各种实施例中,第二层1112可包括覆盖部1116,该覆盖部可延伸于缝钉腔1115之上并围绕或至少部分地围绕缝钉腔1115。图84B示出被向下压溃至缝钉腔1115中的覆盖部1116。在某些实施例中,第二层1112可包括一个或多个弱化部分,所述一个或多个弱化部分可有利于第二层1112的塌缩。在各种实施例中,这种弱化部分可包括例如能够有利于仓体1110进行可控塌缩的划痕、穿孔、和/或薄的横截面。在至少一个实施例中,第一层1111可包括能够有利于缝钉腿1121穿透第一层1111的一个或多个弱化部分。在各种实施例中,这种弱化部分可包括例如能够与缝钉腿1121对齐或至少基本上对齐的划痕、穿孔、和/或薄的横截面。
再次参见图84A,当砧座1140处于部分闭合的未击发位置时,砧座1140可被定位成与仓支撑表面1131相距距离1101a,使得其间限定有间隙。此间隙可由具有钉仓高度1102a的钉仓1100及组织T填充。当砧座1140向下运动以压缩钉仓1100时,再次参见图84B,组织接触表面1141与仓支撑表面1131之间的距离可由短于距离1101a的距离1101b限定。在各种情形中,砧座1140的组织接触表面1141与仓支撑表面1131之间的由距离1101b限定的间隙可大于原始的未变形的钉仓高度1102a。现在参见图84C,当砧座1140运动至更靠近仓支撑表面1131时,第二层1112可继续塌缩且缝钉腿1121与成形凹坑1142之间的距离可减小。相似地,组织接触表面1141与仓支撑表面1131之间的距离可减小至距离1101c,在各种实施例中,距离1101c可大于、等于、或小于原始的未变形仓高度1102a。现在参见图84D,砧座1140可运动至最终的击发位置,在最终的击发位置中,缝钉1120完全成形或至少成形至期望高度。在这种位置中,砧座1140的组织接触表面1141可与仓支撑表面1131相距距离1101d,其中距离1101d可短于原始的未变形仓高度1102a。同样如图84D所示,缝钉腔1115可完全或至少基本上塌缩,并且缝钉1120可完全或至少基本上被塌缩的第二层1112围绕。在各种情形中,砧座1140可随后远离钉仓1100运动。一旦砧座1140从钉仓1100脱离,则仓体1110可例如至少部分地再次伸展于各种位置(即,相邻的缝钉1120之间的位置)中。在至少一个实施例中,压溃的仓体1110可能不以弹性方式再次伸展。在各种实施例中,成形的缝钉1120及另外位于相邻的缝钉1120之间的仓体1110可对组织T施加压力或压缩力,这可提供各种有益的治疗效果。
如上所述,再次参见图84A所示的实施例,每一缝钉1120可包括自其延伸的缝钉腿1121。尽管缝钉1120被绘示为包括两个缝钉腿1121,然而也可利用可包括一个缝钉腿或作为另一选择包括超过两个缝钉腿(例如三个缝钉腿或四个缝钉腿)的各种缝钉。如图84A所示,每一缝钉腿1121均可嵌入仓体1110的第二层1112中,使得缝钉1120固定于第二层1112中。在各种实施例中,缝钉1120可被插入仓体1110的缝钉腔1115中,使得缝钉腿1121的末端1123在基部1122之前进入腔1115中。在各种实施例中,在末端1123被插入腔1115之后,末端1123可被按压至覆盖部1116中并切割第二层1112。在各种实施例中,缝钉1120可被密封至第二层1112中的足够深度处,使得缝钉1120相对于第二层1112不运动或至少基本上不运动。在某些实施例中,缝钉1120可被密封至第二层1112中的足够深度处,使得基部1122被定位或嵌入缝钉腔1115中。在各种其它实施例中,基部1122可不被定位或嵌入第二层1112中。再次参见图84A,在某些实施例中,基部1122可在仓体1110的底部表面1118下方延伸。在某些实施例中,基部1122可承靠于仓支撑表面1130上或直接抵靠仓支撑表面1130定位。在各种实施例中,仓支撑表面1130可包括从其延伸和/或限定在其中的支撑结构,其中在至少一个此类实施例中,缝钉1120的基部1122可定位在例如钉仓支撑件1130中的一个或多个支撑沟槽、狭槽、或槽1132中或由所述一个或多个支撑沟槽、狭槽、或槽1132支撑,以下将更详细地叙述之。
对上文进行进一步描述,现在参见图85,缝钉1120的基部1122可直接抵靠钉仓支撑件1130的支撑表面1131而定位。在各种实施例中,包括其中缝钉基部1122包括圆形或拱形底部表面1124的实施例,例如缝钉基部1122可沿钉仓支撑表面1131运动或滑动。当砧座1140在缝钉成形过程期间被压抵缝钉腿1121的末端1123时会发生这种滑动。在某些实施例中,如上所述且现在参见图86,钉仓支撑件1130中可包括一个或多个支撑狭槽1132,所述一个或多个支撑狭槽1132能够消除或至少减少缝钉基部1122与仓支撑表面1131之间的相对运动。在至少一个此类实施例中,每一支撑狭槽1132均可由表面轮廓限定,所述表面轮廓与位于支撑狭槽1132中的缝钉底部表面的轮廓相匹配或至少基本上相匹配。例如,图86所示的基部1122的底部表面1124可包括圆形或至少基本上圆形的表面,并且支撑狭槽1132也可包括圆形或至少基本上圆形的表面。在至少一个此类实施例中,用于限定狭槽1132的表面可由大于或等于限定底部表面1124的曲率半径的曲率半径限定。尽管狭槽1132可帮助防止或减少缝钉1120与钉仓支撑件1130之间的相对滑动运动,然而狭槽1132也能够防止或减少缝钉1120与钉仓支撑件1130之间的相对旋转运动。更具体地讲,在至少一个实施例中,狭槽1132能够紧密地容纳基部1122,以便防止或减少缝钉1120绕轴线1129的旋转,例如以使缝钉1120在被变形时不会旋转或扭曲。
在各种实施例中,进一步对上文进行描述,每一缝钉1120均可由圆的或至少基本上为圆的线材形成。在某些实施例中,每一缝钉的腿部及基部均可由具有非圆形横截面(例如矩形横截面)的线材形成。在至少一个此类实施例中,钉仓支撑件1130可包括对应的非圆形狭槽(例如矩形狭槽),所述非圆形狭槽能够容纳这种缝钉的基部。现在参见图87,在各种实施例中,每一缝钉1120均可包括重叠注塑至基部1122上的冠部1125(例如冠部1125),其中每一冠部1125均可定位在钉仓支撑件1130中的支撑狭槽内。在至少一个此类实施例中,每一冠部1125均可包括例如正方形和/或矩形的横截面,所述横截面能够容纳在例如钉仓支撑件1130中的正方形和/或矩形的狭槽1134内。在各种实施例中,冠部1125可由可生物吸收的塑料(例如以商品名Vicryl出售的聚乙醇酸(PGA)、聚乳酸(PLA或PLLA)、聚对二氧环己酮(PDS)、聚羟基链烷酸酯(PHA)、以商品名Monocryl出售的聚卡普隆25(PGCL)、聚己内酯(PCL)、和/或PGA、PLA、PDS、PHA、PGCL、和/或PCL的复合物)构成,并可通过例如注模方法围绕缝钉1120的基部1122而形成。各种冠部及用于形成各种冠部的方法公开于2006年9月29日提出申请的名称为“SURGICALSTAPLES HAVING COMPRESSIBLE OR CRUSHABLE MEMBERS FORSECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FORDEPLOYING THE SAME”的美国专利申请序列号11/541,123中。再次参见图87,狭槽1134还可包括导入部或斜角1135,该导入部或斜角能够有利于将冠部1125插入狭槽1134中。在各种实施例中,当钉仓1100被组装至钉仓支撑件1130时,缝钉1120的基部和/或冠部可定位在狭槽1134内。在某些实施例中,当钉仓1100被组装至钉仓支撑件1130时,缝钉1120的冠部1125可与狭槽1134对齐。在至少一个此类实施例中,冠部1125可不进入狭槽1134中,直至对缝钉腿1121施加压缩力且缝钉1120的基部和/或冠部被向下推动至狭槽1134中。
现在参见图88和图89,在各种实施例中,钉仓(例如,钉仓1200)可包括可压缩并可植入的仓体1210,仓体1210包括外层1211及内层1212。与上文相似,钉仓1200可包括位于仓体1210内的多个缝钉1220。在各种实施例中,每一缝钉1220均可包括基部1222和从基部1222延伸的一个或多个缝钉腿1221。在至少一个此类实施例中,缝钉腿1221可插入内层1212中并被密封至例如使缝钉1220的基部1222邻接和/或邻近内层1212的底部表面1218定位。在图88和图89所示的实施例中,内层1212不包括能够容纳缝钉1220的一部分的缝钉腔,而在其它实施例中,内层1212可包括这种缝钉腔。在各种实施例中,对上文进行进一步描述,内层1212可由能够容许仓体1210在对其施加压缩负载时进行塌缩的可压缩材料(例如可生物吸收的泡沫和/或氧化再生纤维素(ORC))构成。在各种实施例中,内层1212可由例如包含聚乳酸(PLA)和/或聚乙醇酸(PGA)的冻干泡沫构成。ORC可以商品名Surgicel商购获得并可包括松的织物(像外科海绵一样)、松的纤维(像棉球一样)和/或泡沫。在至少一个实施例中,内层1212可由其中包含和/或上面涂覆有药物(例如冷冻干燥的凝血酶和/或纤维蛋白)的材料构成,所述药物例如可被患者体内的流体水活化和/或活化。在至少一个此类实施例中,冷冻干燥的凝血酶和/或纤维蛋白可保持在例如Vicryl(PGA)基质上。然而,在某些情形中,例如当钉仓1200被插入患者体内的手术部位中时,可活化的药物可被无意地活化。再次参见图88和图89,在各种实施例中,外层1211可由水不可渗透的或至少水基本上不可渗透的材料构成,以使液体不接触或至少基本上不接触内层1212,直至仓体1210被压缩且缝钉腿穿透外层1211之后和/或外层1211以某种方式被切开之后。在各种实施例中,外层1211可由支撑材料和/或塑性材料(例如聚对二氧环己酮(PDS)和/或聚乙醇酸(PGA))构成。在某些实施例中,外层1211可包括环绕内层1212及缝钉1220的包裹物。更具体地讲,在至少一个实施例中,缝钉1220可被插入内层1212及外层1211中并围绕包括内层1212和缝钉1220的子组件而被包裹并随后被密封。
现在参见图90和图91,在各种实施例中,钉仓(例如,钉仓1300)可包括可压缩并可植入的仓体1310,仓体1310包括外层1311及内层1312。与上文相似,钉仓1300还可包括位于仓体1310内的缝钉1320,其中每一缝钉1320均可包括基部1322和从基部1322延伸的一个或多个腿部1321。类似于钉仓1200,缝钉1320的基部1322可在内层1312的底部表面1318下方延伸,并且外层1311可围绕基部1322。在至少一个此类实施例中,外层1311可具有足够的挠性来包围每一缝钉基部1322,使得外层1311适形于基部1322的轮廓。再次参见图89,在至少一个可供选择的实施例中,外层1211可具有足够的刚性,使得其围绕基部1222延伸而不适形于每一基部1222。在任何情形中,在各种实施例中,外层1311可定位在缝钉1320的基部1322与用于支撑钉仓1300的钉仓支撑表面(例如支撑表面1031或1131)之间。在至少一个此类实施例中,外层1311可定位在基部1322与限定在钉仓支撑表面中的支撑狭槽(例如狭槽1032或1132)之间。在至少一个此类实施例中,对上文进行进一步描述,外层1311能够限制基部1322的运动和/或增大基部1322与钉仓支撑表面和/或支撑狭槽之间的摩擦系数以便减少其间的相对运动。现在参见图92和图93,在各种可供选择的实施例中,钉仓(例如钉仓1400)的外层可不完全地围绕位于其中的缝钉。在至少一个此类实施例中,在缝钉1420的缝钉腿1421插入仓体1410中之前,可压缩并可植入的仓体1410的外层1411可被组装至内层1412。作为上文的结果,缝钉1420的基部1422可延伸于外层1411的外侧,并且在至少一个此类实施例中,例如基部1422可直接定位在钉仓支撑表面1031或1131内的支撑狭槽1032或1132中。在各种实施例中,当缝钉腿1421插穿外层1411时,缝钉腿1421可切开外层1411。在各种情形中,由缝钉腿1421形成的孔可紧密地围绕缝钉腿1421,使得缝钉腿1421与外层1411之间泄漏极少(如果存在的话)的流体,这能够减少或防止钉仓本体1410中容纳的药物被过早地活化和/或泄漏出仓体1410的可能性。
如上所述,再次参见图88和图89,缝钉1220的腿部1221可嵌入仓体1210内,并且缝钉1220的基部1222可自内层1212的底部表面1218向外延伸。在各种实施例中,对上文进行进一步描述,内层1212可不包括能够容纳缝钉1220的缝钉腔。现在参见图94和图95,在各种其它实施例中,钉仓(例如钉仓1500)可包括可压缩并可植入的仓体1510,该仓体包括能够在其中容纳缝钉1520的至少一部分的缝钉腔1515。在至少一个此类实施例中,缝钉1520的缝钉腿1521的顶部可嵌入内层1512中,而缝钉腿1521的底部及基部1522可定位在缝钉腔1515内。在某些实施例中,基部1522可完全定位在缝钉腔1515中,而在一些实施例中,基部1522可至少部分地在内层1512的底部表面1518下方延伸。与上文相似,外层1511可围绕内层1512和位于内层1512中的缝钉1520。现在参见图96,在某些其它实施例中,钉仓1600可包括位于可压缩并可植入的仓体1610中的缝钉腔1615内的缝钉1620,其中缝钉1620的至少一部分未被外层1611围绕。在至少一个此类实施例中,每一缝钉1620均可包括至少部分地嵌入内层1612中的缝钉腿1621以及围绕外层1611向外延伸的基部1622。
现在参见图97和图98,在各种实施例中,钉仓(例如,钉仓1700)可包括可压缩并可植入的仓体1710以及至少部分地位于仓体1710内的多个缝钉1720。仓体1710可包括外层1711、内层1712、和对齐矩阵1740,该对齐矩阵能够将缝钉1720对齐和/或在仓体1710内保持就位。在至少一个实施例中,内层1712可包括能够在其中容纳对齐矩阵1740的凹陷部1741。在各种实施例中,对齐矩阵1140可压配于凹陷部1741内和/或换句话讲利用至少一种粘合剂(例如,纤维蛋白和/或蛋白水凝胶)适宜地固定至内层1712。在至少一个实施例中,凹陷部1741能够使得对齐矩阵1740的底部表面1742与内层1712的底部表面1718对齐或至少基本上对齐。在某些实施例中,对齐矩阵的底部表面1742可相对于第二层1712的底部表面1718凹陷和/或从底部表面1718延伸。在各种实施例中,每一缝钉1720均可包括基部1722和从基部1722延伸的一个或多个腿部1721,其中缝钉腿1721的至少一部分可延伸穿过对齐矩阵1740。对齐矩阵1740还可包括例如延伸穿过其中的多个孔和/或狭槽,所述多个孔和/或狭槽能够在其中容纳缝钉腿1721。在至少一个此类实施例中,每一孔均能够紧密地容纳缝钉腿1721,使得缝钉腿1721与孔的侧壁之间发生很小的(如果有的话)相对运动。在某些实施例中,对齐矩阵孔可不完全延伸穿过对齐矩阵1740,并且当缝钉腿1721被推动穿过对齐矩阵1740时,缝钉腿1721可需要切开对齐矩阵1740。
在某些实施例中,对齐矩阵1740可由模制的塑性本体构成,在至少一个实施例中,所述模制的塑性本体可比内层1712和/或外层1711更硬或可压缩性更低。在至少一个此类实施例中,对齐矩阵1740可由塑性材料和/或任何其它适宜的材料(例如聚对二氧环己酮(PDS)和/或聚乙醇酸(PGA))构成。在某些实施例中,对齐矩阵1740可组装至内层1712,并且随后缝钉腿1721可插穿对齐矩阵1740并嵌入内层1712中。在各种实施例中,对齐矩阵1740的底部表面1742可包括能够至少部分地容纳缝钉1720的基部1722的一个或多个沟槽、狭槽、或槽。与上文相似,外层1711可放置于包括内层1712、对齐矩阵1740、和缝钉1720的子组件周围。作为另外一种选择,外层1711可放置于包括内层1712及对齐矩阵1740的子组件周围,其中缝钉1720可随后插穿外层1711、对齐矩阵1740、和内层1712。在任一情形中,作为上文的结果,内层1712、对齐矩阵1740、和/或外层1711能够将缝钉1720保持就位,直至和/或在缝钉1720以上述方式被砧座变形。在至少一个此类实施例中,对齐矩阵1740可用于在钉仓1700被植入患者体内之前将缝钉1720保持就位,以及在钉仓1700被植入之后沿缝钉线固定组织。在至少一个实施例中,例如缝钉1720可被固定于对齐矩阵1740内而不被嵌入内层1712和/或外层1711中。
现在参见图99-105,在各种实施例中,可通过压缩内层1812、将缝钉(例如,缝钉1820)插入内层1812中、并用外层1811包裹内层1812来组装钉仓(例如,钉仓1800)。主要参见图99,可压缩的内层1812被示为包括被限定在其中的多个缝钉腔1815,然而也可设想出如上所述其中内层1812不包括缝钉腔的其它实施例。现在参见图100,可压缩的内层1812可定位在传送板1850与支撑板1860之间并被压缩于传送板1950的压缩表面1852与支撑板1860的压缩表面1862之间。如图100所示,内层1812的顶面及底部表面可朝向彼此而被压缩,并且响应于此,内层1812可沿侧向向外膨胀。在某些实施例中,内层1812可被压缩至例如其原始高度的大约三分之一的高度处,并且在其压缩状态中可具有例如约0.06”至约0.08”之间的高度或厚度。同样如图100所示,传送板1850还可包括位于多个缝钉井1853内的多个缝钉(例如缝钉1820)。另外,传送板1850还可包括多个驱动器1851,所述多个驱动器1851能够将缝钉1820向上推出缝钉井1853外。现在参见图101,可利用驱动器1851将缝钉1820的缝钉腿1821推入压缩的内层1812中并使其穿过压缩的内层1812。在各种实施例中,驱动器1851能够使得当缝钉1820从传送板1850的缝钉井1853中被完全部署时,驱动器1851的顶面被定位成与传送板1850的压缩表面1852齐平或至少几乎齐平。在某些实施例中,同样如图101所示,支撑板1860可包括多个容纳孔1861,所述多个容纳孔1861能够在缝钉腿1821被推动穿过内层1812之后,容纳孔1861容纳缝钉腿1821或至少缝钉腿1821的末端。在其中内层1812已被压缩至短于缝钉1820高度的高度处的实施例中,容纳孔1861或类似结构可为必需的,因此当缝钉1820从缝钉井1853中被完全射出时,缝钉腿1821可从压缩的内层1812的顶面突起。在某些其它实施例中,内层1812可被压缩至高于缝钉1820高度的高度处,因此不需要支撑板1860中的容纳孔1861。
现在参见图102,在缝钉1820被插入内层1812中之后,支撑板1860可远离传送板1850而行进,以便容许内层1812减压。在这种情形中,内层1812可以弹性方式再次伸展至其原始或至少接近原始的未压缩高度。当内层1812再次伸展时,内层1812的高度可增大至超过缝钉1820的高度且缝钉1820的缝钉腿1821不再从内层1812的顶面突起。在各种情形中,容纳孔1861能够将缝钉腿1821保持就位,至少直到支撑板1860已运动至足够远而使腿部1821不再位于容纳孔1861内。在这种情形中,容纳孔1861可在内层1812再次伸展时帮助内层1812内的缝钉1820保持相对对齐。在各种情形中,内层1812及位于其中的缝钉1820可包括子组件1801,现在参见图103,子组件1801可例如被插入外层1811中。在至少一个此类实施例中,外层1811可包括被限定在其中的腔1802,腔1802能够在其中容纳子组件1801。在各种情形中,可利用工具(例如镊子1855)将外层1811牵拉至子组件1801上。现在参见图104,一旦子组件1801完全位于外层1811内,则外层1811可被密封。在各种实施例中,可利用对外层1811的一部分施加热能来密封外层1811。更具体地讲,在至少一个实施例中,外层1811可由塑性材料构成,其中外层1811的开口端可由一种或多种被加热的元素或铁1856热熔,以便将外层1811的开口端的周边结合和/或密封在一起。现在参见图105,在至少一个此类实施例中,外层1811的多余部分1857可被移除,并且随后可如本文所述来使用钉仓1800。
如上所述,钉仓可位于钉仓附接部中和/或固定到钉仓附接部。现在参见图106和图107,在各种实施例中,钉仓附接部可包括钉仓通道(例如钉仓通道1930),该钉仓通道能够在其中容纳钉仓(例如钉仓1900)的至少一部分。在至少一个实施例中,钉仓通道1930可包括底部支撑表面1931、第一侧向支撑壁1940、和第二侧向支撑壁1941。在使用中,钉仓1900可定位在钉仓通道1930内,使得钉仓1900抵靠和/或邻近底部支撑表面1931定位,并位于第一侧向支撑壁1940与第二侧向支撑壁1941之间。在某些实施例中,第一侧向支撑壁1940与第二侧向支撑壁1941之间可限定有侧向间隙。在至少一个此类实施例中,钉仓1900可包括侧向宽度1903,侧向宽度1903相同于和/或宽于支撑壁1940与1941之间所限定的侧向间隙,使得钉仓1900的可压缩并可植入的仓体1910可牢固地配合于壁1940与1941之间。在某些其它实施例中,钉仓1900的侧向宽度1903可短于第一侧壁1940与第二侧壁1941之间所限定的间隙。在各种实施例中,壁1940和1941以及底部支撑表面1931的至少一部分可由冲压的金属通道限定,而在至少一个实施例中,侧向支撑壁1940和/或侧向支撑壁1941的至少一部分可由挠性材料(例如弹性体材料)构成。主要参见图106,钉仓通道1930的第一侧壁1940和第二侧壁1941均可由从底部支撑表面1931向上延伸的刚性部分1933和从刚性部分1933向上延伸的挠性部分1934构成。
在各种实施例中,对上文进行进一步描述,钉仓1900的仓体1910可由一种或多种可压缩的层(例如,第一层1911及第二层1912)构成。当仓体1910被砧座以上述方式压缩抵靠底部支撑表面1931时,仓体1910的侧部可侧向地延伸。在其中钉仓1930由刚性侧壁构成的实施例中,刚性侧壁可防止或至少限制仓体1910的侧向伸展,因此仓体1910内可产生显著量的内部压力或应力。在钉仓1930的至少一部分由挠性侧壁构成的实施例中,挠性侧壁能够侧向地屈曲并容许仓体1910的侧部侧向地伸展,从而减小仓体1910内所产生的内部压力或应力。在仓通道不包括侧壁或所包括的侧壁相对地短于钉仓的实施例中,钉仓的侧部可不受抑制地或至少基本上不受抑制地沿侧向延伸。现在参见图107,在任何情形中,钉仓通道2030可包括侧壁2040和2041,所述侧壁2040和2041可完全由挠性材料(例如弹性体材料)构成。钉仓通道2030还可包括沿钉仓通道2030的底部支撑表面2031的边延伸的侧向狭槽2033,该侧向狭槽能够在其中容纳并固定侧壁2040和2041的至少一部分。在某些实施例中,侧壁2040和2041可经由搭扣配合和/或压配结构而固定于狭槽2033中,而在至少一些实施例中,侧壁2040和2041可通过一种或多种粘合剂固定于狭槽2033中。在至少一个实施例中,侧壁2040和2041可在使用期间从底部支撑表面2031拆卸。在任何情形中,当仓体2010中植入有缝钉2020时,可压缩并可植入的仓体2010可从侧壁2040和2041拆卸和/或脱离。
现在参见图108,在各种实施例中,外科器械可包括轴2150以及从轴2150的远端延伸的端部执行器。与上文相似,端部执行器可包括钉仓通道2130、可在打开位置与闭合位置之间运动的砧座2140、以及位于钉仓通道2130与砧座2140之间的钉仓2100。同样类似于上文,钉仓2100可包括可压缩并可植入的仓体2110以及位于仓体2110中的多个缝钉2120。在各种实施例中,钉仓通道2130可包括底部支撑表面2131、远端2135和近端2136,所述钉仓2100可抵靠底部支撑表面2130而定位。在至少一个实施例中,如图108所示,钉仓2100可包括第一端部2105和第二端部2106,所述第一端部可定位在钉仓通道2130的远端2135中,所述第二端部2106可定位在钉仓通道2130的近端2136中。在各种实施例中,钉仓通道2130的远端2135可包括至少一个远端保留结构(例如保留壁2137);相似地,近端2136可包括至少一个近端保留结构(例如保留壁2138)。在至少一个此类实施例中,远端保留壁2137与近端保留壁2138之间可限定有缝隙,所述缝隙可等于或小于钉仓2100的长度,使得当钉仓2100被插入钉仓通道2130中时,钉仓2100可牢固地配合于钉仓通道2130内。
再次参见图88和图89,在各种实施例中,钉仓(例如,钉仓1200)可包括平的或至少基本上为平的组织接触表面1219。在至少一个此类实施例中,钉仓1200的钉仓本体1210可包括第一端部1205和第二端部1206,所述第一端部可由第一高度或厚度1207限定,所述第二端部1206可由第二高度或厚度限定,其中第一高度1207可等于或至少基本上等于第二高度1208。在某些实施例中,仓体1210可在第一端部1205与第二端部1206之间包括恒定的或至少基本上恒定的高度或厚度。在至少一个此类实施例中,组织接触表面1219可平行或至少基本上平行于仓体1210的底部表面1218。再次参见图108,在各种实施例中,钉仓2100的仓体2110的第一端部2105可由第一高度2107限定,该第一高度不同于第二端部2106的第二高度2108。在所示实施例中,第一高度2107大于第二高度2108,然而在可供选择的实施例中,第二高度2108可大于第一高度2107。在各种实施例中,仓体2110的高度可在第一端部2105与第二端部2106之间线性地和/或几何地减小。在至少一个此类实施例中,在第一端部2105与第二端部2106之间延伸的组织接触表面2119可沿第一端部2105与第二端部2106之间限定的角度进行取向。在至少一个此类实施例中,组织接触表面2119可不平行于仓体2110的底部表面2118和/或不平行于钉仓通道2130的支撑表面2131。
再次参见图108和图109,在各种实施例中,砧座2140可包括组织接触表面2141,当砧座2140处于闭合位置时,组织接触表面2141可平行于或至少基本上平行于钉仓通道2130的支撑表面2131,如图109所示。当砧座2140处于闭合位置时,砧座2140能够对钉仓2100的第一端部2105的压缩程度大于第二端部2106,这是因为第一端部2105的高度较高,而第二端部2106的高度较低。在一些情形中,包括其中位于组织接触表面2119与2141之间的组织T具有恒定的或至少基本上恒定的厚度的情形,组织T及仓2100中在端部执行器的远端处所产生的压力可大于在端部执行器的近端处所产生的压力。更具体地讲,当砧座2140与钉仓2100之间的组织T具有基本上恒定的厚度时,位于砧座2140的远端2145与钉仓2100的第一端部2105之间的组织T被压缩的程度可大于位于砧座2140的近端2146与钉仓2100的第二端部2106之间的组织T。在各种实施例中,端部执行器的近端与远端之间的组织T中可产生压力梯度。更具体地讲,在至少一个实施例中,当砧座2140与钉仓2100之间的组织T具有基本上恒定的厚度且钉仓2100的高度从端部执行器的远端到近端线性地减小时,组织T中的压力可从端部执行器的远端到端部执行器的近端线性地减小。相似地,在至少一个实施例中,当砧座2140与钉仓2100之间的组织T具有基本上恒定的厚度且钉仓2100的高度从端部执行器的远端到近端几何地减小时,组织T中的压力可从端部执行器的远端到端部执行器的近端几何地减小。
再次参见图108,在各种实施例中,位于钉仓2100与砧座2140之间的组织T可不具有遍及其中的恒定的厚度。在至少一个这种情形中,位于砧座2140的近端2146与钉仓2100的第二端部2106之间的组织T可厚于位于砧座2140的远端2145与钉仓2100的第一端部2105之间的组织T。因此,在这种情形中,较厚的组织T可通常位于钉仓2100的较低的近端2106上方,并且较薄的组织T可通常位于较高的远端2105上方。在使用中,轴2150的击发衬圈2152可沿轴脊2151朝远侧推进,使得击发衬圈2152接合砧座2140的凸轮部2143,并使砧座2140朝钉仓2100旋转,如图109所示。一旦砧座2140旋转至完全闭合的位置,则组织T可被压缩于组织接触表面2119与2141之间,并且尽管钉仓2100的高度可在端部执行器的近端与远端之间不恒定,然而施加至组织T的压力或压缩力在组织T中可为恒定的或至少基本上恒定的。更具体地讲,当较薄的组织T可与钉仓2100的较高的高度相关且较厚的组织T可与钉仓2100的较低的高度相关时,组织T及钉仓2100的累加高度或高度之和可在端部执行器的近端与远端之间为恒定的或至少基本上恒定的,因此砧座2140对此累加高度的压缩在累加高度中可为恒定的或至少基本上恒定的。
再次参见图108和图109,在各种实施例中,钉仓2100可包括非对称构型。在至少一个此类实施例中,例如钉仓2100在其第一端部2105处的高度可高于钉仓2100在其第二端部2106处的高度。在某些实施例中,钉仓2100和/或钉仓通道2130可包括一个或多个对齐和/或保留结构,所述一个或多个对齐和/或保留结构能够确保钉仓2100仅沿一个方向(即,其中第一端部2105位于钉仓通道2130的远端2135中且第二端部2106位于近端2136中的方向)定位在钉仓通道2130内。在各种可供选择的实施例中,钉仓2100和/或钉仓通道2130可包括一个或多个对齐和/或保留结构,所述一个或多个对齐和/或保留结构能够容许钉仓2100沿不止一个方向定位在钉仓通道2130内。现在参见图110,例如钉仓2100可被定位在钉仓通道2130内,以使钉仓2100的第一端部2105可定位在钉仓通道2130的近端2136中且第二端部2106可定位在远端2135中。因此,在各种实施例中,较低高度的钉仓2100可邻近远侧保留壁2137定位,而较高高度的钉仓2100可邻近近侧保留壁2138定位。在至少一个此类实施例中,钉仓2100可被适宜地设置以对在端部执行器的远端内具有较厚部分而在端部执行器的近端内具有较薄部分的组织T施加恒定的或至少基本上恒定的加紧压力。在各种实施例中,钉仓2100例如可在钉仓通道2130内被选择性地取向。在至少一个此类实施例中,钉仓2100的对齐和/或保留结构可为对称的,并且外科医生可沿例如图108和图110所示的方向可在钉仓通道2130内对钉仓2100进行取向。
对上文进进一步描述,可植入的仓体2110可包括纵向轴线2109,当钉仓2100被定位在钉仓通道2130中时,纵向轴线2109可在端部执行器的近端与远端之间延伸。在各种实施例中,仓体2110的厚度可在第一端部2105与第二端部2106之间沿纵向轴线2109大致减小和/或大致增大。在至少一个此类实施例中,底部表面2118与组织接触表面2119之间的距离或高度可在第一端部2105与第二端部2106之间大致减小和/或大致增大。在某些实施例中,仓体2110的厚度沿纵向轴线2109既可增大也可减小。在至少一个此类实施例中,仓体2110的厚度可包括在厚度上增大的一个或多个部分以及在厚度上可减小的一个或多个部分。再次参见图Z,在各种实施例中,钉仓2100可包括定位在其中的多个缝钉2120。在使用中,如上所述,当砧座2140运动至闭合位置时,缝钉2120可变形。在某些实施例中,每一缝钉2120可具有相同的或至少基本上相同的高度。在至少一个此类实施例中,可例如从缝钉基部的底部到缝钉最高腿部的顶部或末端来测量缝钉的高度。
在各种实施例中,钉仓内的缝钉可具有不同的缝钉高度。在至少一个此类实施例中,钉仓可包括具有第一缝钉高度的第一组缝钉和具有第二缝钉高度的第二组缝钉,所述第一组缝钉被定位在可压缩的仓体的第一部分中,并且第二组缝钉被定位在可压缩的仓体的第二部分中。在至少一个实施例中,第一缝钉高度可高于第二缝钉高度,并且第一组缝钉可被定位在钉仓2100的第一端部2105中,而第二组缝钉可被定位在第二端部2106中。作为另外一种选择,较高的第一组缝钉可被定位在钉仓2100的第二端部2106中,而较低的第二组缝钉可被定位在第一端部2105中。在某些实施例中,可利用多个缝钉组,其中每一组各自具有不同的缝钉高度。在至少一个此类实施例中,具有中间缝钉高度的第三组可在第一组缝钉与第二组缝钉之间被定位在仓体2110中。在各种实施例中,钉仓中的缝钉排内的每一缝钉可分别包括不同的缝钉高度。在至少一个实施例中,缝钉排内的最高缝钉可被定位在缝钉排的第一端部上,并且最低的缝钉可被定位在该缝钉排的相对端上。在至少一个此类实施例中,位于最高缝钉与最低缝钉之间的缝钉可被设置成使得缝钉高度例如在最高缝钉与最低缝钉之间下降。
现在参见图111,在各种实施例中,外科缝合器的端部执行器可包括砧座2240、钉仓通道2230、以及由钉仓通道2230支撑的钉仓2200。钉仓2200可包括可压缩并可植入的仓体2210以及被定位在仓体2210中的多个缝钉(例如缝钉2220a及缝钉2220b)。在各种实施例中,钉仓通道2230可包括仓支撑表面2231以及限定在仓支撑表面2231中的多个缝钉支撑狭槽(例如支撑狭槽2232a和2232b)。在至少一个此类实施例中,钉仓2200可包括缝钉2220a的两个外侧行和缝钉2220b的两个内侧行,其中支撑狭槽2232a能够支撑缝钉2220a,并且支撑狭槽2232b能够支撑缝钉2220b。参见图111和图112,砧座2240可包括被限定在其中的多个缝钉成形凹坑2242,所述多个缝钉成形凹坑2242能够当砧座2240朝钉仓2200运动时所述多个缝钉成形凹坑2242容纳缝钉2220a和2220b并使其变形。在至少一个此类实施例中,支撑狭槽2232a的底部表面可与缝钉成形凹坑2242的顶面相距第一距离2201a,而支撑狭槽2232b的底部表面可与缝钉成形凹坑2242的顶面相距第二距离2201b。在至少一个此类实施例中,由于其中限定有支撑狭槽2232b的支撑表面2231中具有升高的台阶,因此支撑狭槽2232b更靠近砧座2240定位。由于具有不同的距离2201a和2201b,因此在各种实施例中,缝钉2220a的外侧行及缝钉2220b的内层行可变形至不同的成形高度。在各种情形中,变形至不同成形高度的缝钉可对所缝合的组织T施加不同的夹紧压力或力。除上文所述之外,缝钉可在起初具有不同的未成形缝钉高度。再次参见图111,在至少一个此类实施例中,外层缝钉2220a的初始未成形高度可大于内侧缝钉2220b的初始未成形高度。如图111和图112所示,未成形高度低于外侧缝钉2220a的内侧缝钉2220b也可具有低于外侧缝钉2220b的成形高度。在各种可供选择的实施例中,内侧缝钉2220b可具有高于外侧缝钉2220a的未成形高度而具有低于外侧缝钉2220a的变形缝钉高度。
在各种实施例中,对上文进行进一步描述,砧座2240可运动到闭合位置(如图112所示),以便压缩仓体2210并使缝钉2220a及2220b变形。在某些实施例中,包括图111和图112所示端部执行器的外科缝合器例如还可包括切割构件,所述切割构件能够横切位于砧座2240与钉仓2200之间的组织T。在至少一个此类实施例中,砧座2240、钉仓通道2230和/或钉仓2200可限定狭槽,所述狭槽能够在其中可滑动地容纳切割构件。更具体而言,砧座2240可包括狭槽部2249,钉仓通道2230可包括狭槽部2239,并且钉仓2200可包括狭槽部2203,当砧座2240处于闭合位置或至少基本上闭合的位置时,狭槽部2249、狭槽部2239、和狭槽部2203可相互对齐或至少基本上对齐。在各种实施例中,在砧座2240被闭合且缝钉2220a、2220b变形之后,切割构件可从端部执行器的近端朝端部执行器的远端运动。在至少一个实施例中,切割构件可以与缝钉变形过程不相关的方式运动。在某些实施例中,切割构件可在缝钉变形的同时推进。在任何情形中,在至少一个实施例中,切割构件能够沿位于缝钉2220b形成的内侧行之间的路径切开组织。
在各种实施例中,如图112所示,内侧缝钉2220b可被成形至低于外侧缝钉2220a的高度,其中内侧缝钉2220b可对与切割构件所形成的切割线相邻的组织施加较大的夹紧压力或力。在至少一个此类实施例中,内侧缝钉2220b所形成的较大夹紧压力或力可提供各种有益的治疗效果,例如使被切开组织T减少出血,而外侧缝钉2220a所形成的较小的夹紧压力可在缝合的组织内提供灵活性。再次参见图111和图112,在各种实施例中,砧座2240还可包括附接到砧座2240的至少一块支撑材料(例如支撑材料2260)。在至少一个此类实施例中,缝钉2220a、2220b的腿部能够当钉仓2200被砧座2240压缩并随后接触砧座2240中的缝钉成形凹坑2242时,缝钉2220a、2220b的腿部切开支撑材料2260和/或穿过支撑材料2260中的孔。当缝钉2220a、2220b的腿部变形时,所述腿部可再次接触和/或切开支撑材料2260。在各种实施例中,支撑材料2260可改善所缝合组织的止血能力和/或为所缝合组织提供强度。
再次参见图111和图112,在各种实施例中,仓体2210的底部表面可包括阶梯式轮廓,所述阶梯式轮廓与仓支撑表面2231的阶梯式轮廓匹配或至少基本上匹配。在某些实施例中,仓体2210的底部表面可变形以匹配或至少基本上匹配仓支撑表面2231的轮廓。现在参见图113,在各种实施例中,类似于图111所示端部执行器的端部执行器例如可包括定位在其中的钉仓2300。钉仓2300可包括具有内层2312和外层2311的可压缩并可植入的本体2310,其中对上文进行进一步描述,在至少一个实施例中,外层2311可由水不可渗透的材料构成。在各种实施例中,外层2311可围绕缝钉2220a、2220b延伸并可分别位于缝钉2220、2220b与支撑狭槽2232a、2232b之间。现在参见图114,在各种实施例中,类似于图111所示端部执行器的端部执行器例如可包括定位在其中的钉仓2400。类似于钉仓2300,钉仓2400的可压缩并可植入的仓体2410可包括内层2412及外层2411;然而,在至少一个实施例中,仓体2410中可不包括切割构件狭槽。在至少一个此种实施例中,切割构件可需要例如在其穿过钉仓而被推进时切开内层2412和/或外层2411。
现在参见图115,在各种实施例中,外科缝合器的端部执行器可包括砧座2540、钉仓通道2530、以及定位于钉仓通道2530中的钉仓2500。与上文相似,钉仓2500可包括可压缩并可植入的仓体2510、缝钉2220a的外侧行、以及缝钉2220b的内侧行。钉仓通道2530可包括平的或至少基本上平的仓支撑表面2531及限定在仓支撑表面2531中的缝钉支撑狭槽2532。砧座2540可包括阶梯式表面2541以及限定在阶梯式表面2541中的多个缝钉成形凹坑(例如成形凹坑2542a和2542b)。与上文相似,成形凹坑2542a与支撑狭槽2532之间可限定有距离,所述距离大于成形凹坑2452b与支撑狭槽2532之间的距离。在各种实施例中,砧座2540还可包括附接到砧座2540的阶梯式表面2541的一块支撑材料2560。在至少一个此类实施例中,支撑材料2560可适形于或至少基本上适形于阶梯式表面2541。在各种实施例中,支撑材料2560可通过至少一种粘合剂(例如,纤维蛋白和/或蛋白水凝胶)可移除地附接到表面2541。在某些实施例中,仓体2510还可包括阶梯式外形,在至少一个实施例中,所述阶梯式外形平行于或至少基本上平行于砧座2540的阶梯式表面2541。更具体地讲,在至少一个实施例中,砧座2540可包括朝钉仓2500延伸的阶梯2548,其中阶梯2548可包括阶梯高度,所述阶梯高度等于或至少基本上等于从仓体2510延伸的阶梯2508的阶梯高度。在至少一个此类实施例中,作为上文的结果,例如可压缩仓体2510可被捕获在第一缝钉2220a中的量可不同于可压缩仓体2510可被捕获在第二缝钉2220b中的量。
现在参见图116,在各种实施例中,端部执行器可包括砧座2640、钉仓通道2530、以及位于砧座2640与钉仓通道2530之间的钉仓2600。钉仓2600可包括可压缩并可植入的仓体2610,仓体2610包括内层2612、外层2611、以及定位在仓体2610中的多个缝钉(例如缝钉2220a和2200b)。在各种实施例中,砧座2640可在表面2641中包括多个缝钉成形凹坑2642,并且钉仓通道2530可包括限定在支撑表面2531中的多个缝钉成形狭槽2532。如图116所示,砧座表面2641可平行于或至少基本上平行于仓支撑表面2531,其中每一成形凹坑2642可被定位成与相对的且相对应的缝钉支撑狭槽2532相距相等或至少基本上相等的距离。在各种实施例中,钉仓2600所包括的缝钉可具有相同或至少基本上相同的初始未成形缝钉高度以及相同或至少基本上相同的成形缝钉高度。在某些其它实施例中,外侧缝钉排可包括缝钉2220a且内侧缝钉排可包括缝钉2220b,其中如上所述,缝钉2220a和2220b可具有不同的未成形缝钉高度。当砧座2640朝钉仓2600运动至闭合位置时,缝钉2220a和2220b可被成形为使缝钉2220a和2220b具有相同的或至少基本上相同的成形缝钉高度。在至少一个此种实施例中,作为上文的结果,成形的外侧缝钉2220a及内侧缝钉2220b中可容纳有相同的或至少基本上相同的量的可压缩仓体2610;然而,当外侧缝钉2220a具有高于内侧缝钉2220b的未成形缝钉高度然而可具有相同的成形缝钉高度时,例如,外侧缝钉2220a中所产生的夹紧压力可大于内侧缝钉2220b中所产生的夹紧压力。
现在参见图117,在各种实施例中,外科缝合器的端部执行器可包括砧座2740、钉仓通道2530、以及定位于钉仓通道2530中的钉仓2700。与上文相似,钉仓2700可包括可压缩并可植入的仓体2710,仓体2710包括内层2712、外层2711、以及定位在仓体2710中的多个缝钉(例如缝钉2220a和2220b)。在至少一个实施例中,仓体2710的厚度可穿过其宽度而发生变化。在至少一个此类实施例中,仓体2710可包括中心部2708和侧部2709,其中中心部2708的厚度可大于侧部2709的厚度。在各种实施例中,仓体2710的最厚的部分可位于中心部2708处,而仓体2710的最薄的部分可位于侧部2709处。在至少一个此类实施例中,仓体2710的厚度可在中心部2708与侧部2709之间逐渐减小。在某些实施例中,仓体2710的厚度可在中心部2708与侧部2709之间线性地和/或几何地减小。在至少一个此类实施例中,仓体2710的组织接触表面2719可包括从中心部2708朝侧部2709向下比降的两个倾斜的或成角度的表面。在各种实施例中,砧座2740可包括两个倾斜的或成角度的表面,所述两个倾斜的或成角度的表面平行于或至少基本上平行于倾斜的组织接触表面2719。在至少一个实施例中,砧座2740还可包括附接到砧座2740的倾斜表面的至少一块支撑材料2760。
在各种实施例中,对上文进行进一步描述,钉仓2700中的内侧缝钉排可包括较高的缝钉2220a,并且外侧缝钉排可包括较低的缝钉2220b。在至少一个实施例中,较高的缝钉2220a可被定位在较厚的中心部2708中和/或与中心部2708相邻,而缝钉2220b可被定位在侧部2709中和/或与侧部2709相邻。在至少一个此类实施例中,作为上文的结果,较高的缝钉2220a可比较低的缝钉2220b捕获更多的可植入仓体2710的材料。这种情形可使缝钉2220a比缝钉2220b对组织T施加更大的夹紧压力。在某些实施例中,尽管较高的缝钉2220a中可比较低的缝钉2220b捕获更多的仓体2710的材料,然而由于缝钉成形凹坑2742a和2742b具有倾斜的结构,因此较高的缝钉2220a可比较低的缝钉2220b具有更高的成形缝钉高度。可利用这种考虑因素在缝钉2220a和2220b所捕获的组织中达到期望的夹紧压力,其中作为结果,例如缝钉2220a中的夹紧压力可大于、小于、或等于缝钉2220b对组织施加的夹紧压力。在图117所示端部执行器的各种可供选择的实施例中,较低的缝钉2220b可定位在仓体2710的较厚的中心部2708中和/或邻近中心部2708,并且较高的缝钉2220a可定位在较薄的侧部2709中和/或邻近侧部2709。此外,尽管钉仓2700被绘示成包括内侧及外侧缝钉排,然而钉仓2700可包括额外的缝钉排,例如位于内侧缝钉排与外侧缝钉排之间的缝钉排。在至少一个此类实施例中,例如中间缝钉排的未成形缝钉高度可介于缝钉2220a的未成形缝钉高度与缝钉2220b的未成形缝钉高度之间,并且中间缝钉排的成形缝钉高度可介于缝钉2220a的成形缝钉高度与缝钉2220b的成形缝钉高度之间。
现在参见图118,在各种实施例中,外科缝合器的端部执行器可包括砧座2840、钉仓通道2530、以及定位于钉仓通道2530中的钉仓2800。与上文相似,钉仓2800可包括可压缩并可植入的仓体2810,仓体2810包括内层2812、外层2811、以及定位在仓体2810中的多个缝钉(例如缝钉2220a和2220b)。在至少一个实施例中,仓体2810的厚度可穿过其宽度而发生变化。在至少一个此类实施例中,仓体2810可包括中心部2808和侧部2809,其中中心部2808的厚度可小于侧部2809的厚度。在各种实施例中,仓体2810的最薄的部分可位于中心部2808处,而仓体2810的最厚的部分可位于侧部2809处。在至少一个此类实施例中,仓体2810的厚度可在中心部2808与侧部2809之间逐渐增大。在某些实施例中,仓体2810的厚度可在中心部2808与侧部2809之间线性地和/或几何地增大。在至少一个此类实施例中,仓体2810的组织接触表面2819可包括从中心部2808朝侧部2809向上比降的两个倾斜的或成角度的表面。在各种实施例中,砧座2840可包括两个倾斜的或成角度的表面,所述两个倾斜的或成角度的表面平行于或至少基本上平行于倾斜的组织接触表面2819。在至少一个实施例中,砧座2840还可包括附接到砧座2840的倾斜表面的至少一块支撑材料2860。在各种实施例中,对上文进行进一步描述,钉仓2800中的外侧缝钉排可包括较高的缝钉2220a,并且内侧缝钉排可包括较低的缝钉2220b。在至少一个实施例中,较高的缝钉2220a可被定位在较厚的侧部2809中和/或与侧部2809相邻,而缝钉2220b可被定位在中心部2808中和/或与中心部2808相邻。在至少一个此类实施例中,作为上文的结果,较高的缝钉2220a可比较低的缝钉2220b捕获更多的可植入仓体2810的材料。
如上文参照图111的实施例所述,例如,钉仓通道2230可包括阶梯式支撑表面2231,阶梯式支撑表面2231能够相对于砧座2240将缝钉2220a及2220b支撑在不同高度处。在各种实施例中,钉仓通道2230可由金属构成,并且支撑表面2231中的阶梯可通过例如研磨操作而形成于支撑表面2231中。现在参见图119,在各种实施例中,外科器械的端部执行器可包括钉仓通道2930,该钉仓通道包括定位在其中的支撑插入件2935。更具体地讲,在至少一个实施例中,钉仓通道2930可被形成为使其具有例如平的或至少基本上平的支撑表面2931,该支撑表面能够支撑插入件2935,该支撑插入件包括用于将钉仓2200的缝钉2220a和2220b支撑在不同高度处的阶梯式表面。在至少一个此类实施例中,插入件2935可包括平的或至少基本上平的底部表面,所述底部表面可抵靠支撑表面2931而定位。插入件2935还可包括支撑狭槽、沟槽、或槽2932a和2932b,支撑狭槽、沟槽、或槽2932a和2932b能够将缝钉2220a和2220b分别支撑在不同高度处。与上文相似,插入件2935可包括被限定在其中的刀狭槽2939,刀狭槽2939能够容许切割构件穿过其中。在各种实施例中,钉仓通道2930可由相同或不同于支撑插入件2935的材料构成。在至少一个此类实施例中,钉仓通道2930及支撑插入件2935两者均可例如由金属构成,而在其它实施例中,钉仓通道2930可例如由金属构成,并且支撑插入件2935可例如由塑料构成。在各种实施例中,支撑插入件2935可被紧固和/或焊接到钉仓通道2930中。在某些实施例中,支撑插入件2935可搭扣配合和/或压配到钉仓通道2930中。在至少一个实施例中,可使用粘合剂将支撑插入件2935固定于钉仓通道2930中。
现在参见图120,在各种实施例中,外科缝合器的端部执行器可包括砧座3040、钉仓通道3030、以及位于钉仓通道3030中的可压缩并可植入的钉仓3000。与上文相似,砧座3040可包括被限定在其中的多个缝钉成形凹坑3042以及能够将切割构件可滑动地容纳在其中的刀狭槽3049。同样类似于上文,钉仓通道3030可包括被限定在其中的多个缝钉支撑狭槽3032以及也能够将切割构件可滑动地容纳在其中的刀狭槽3039。在各种实施例中,钉仓3000可包括第一层3011、第二层3012、以及定位在钉仓3000中的多个缝钉(例如缝钉3020a及3020b)。在至少一个实施例中,缝钉3020a的未成形缝钉高度可高于缝钉3020b的未成形缝钉高度。在各种实施例中,第一层3011可由第一可压缩材料构成,并且第二层3012可由第二可压缩材料构成。在某些实施例中,第一可压缩材料的压缩率可高于第二可压缩材料,而在某些其它实施例中,第一可压缩材料的压缩率可低于第二可压缩材料。在至少一个实施例中,第一可压缩材料可由可包含第一弹性比率的弹性材料构成,并且第二可压缩材料可由可包含第二弹性比率的弹性材料构成,所述第二弹性比率不同于所述第一弹性比率。在各种实施例中,第一可压缩材料的弹性比率可大于第二可压缩材料的弹性比率。在某些其它实施例中,第一可压缩材料的弹性比率可小于第二可压缩材料的弹性比率。在各种实施例中,第一可压缩层可包含第一刚度,并且第二可压缩层可包含第二刚度,其中第一刚度不同于第二刚度。在各种实施例中,第一可压缩层的刚度可大于第二可压缩层的刚度。在某些其它实施例中,第一可压缩层的刚度可小于第二可压缩层的刚度。
再次参见图120,在各种实施例中,钉仓3000的第二层3012可穿过其宽度包括恒定的或至少基本上恒定的厚度。在至少一个实施例中,第一层3011的厚度可穿过其宽度而发生变化。在至少一个此类实施例中,第一层3011可包括一个或多个阶梯3008,阶梯3008可在仓体3010的某些部分(例如中心部)中增大仓体3010的厚度。再次参见图120,较低的缝钉3020b可定位在阶梯3008(即仓体3010的较厚部分)中或与阶梯3008对齐,并且较高的缝钉3020a可定位在仓体3010的较薄部分中或与所述较薄部分对齐。在各种实施例中,作为仓体3010的较厚部分及较薄部分的结果,仓体3010的沿缝钉3020b形成的内侧行的刚度可大于沿缝钉3020a形成的外侧行的刚度。在各种实施例中,第一层3011可连接到第二层3012。在至少一个此类实施例中,第一层3011和第二层3012可包括互锁结构,所述互锁结构可将层3011和3012保持在一起。在某些实施例中,第一层3011可包括第一层合物并且第二层3012可包括第二层合物,其中第一层合物可通过一种或多种粘合剂粘附至第二层合物。在各种实施例中,钉仓3000可包括刀狭槽3003,刀狭槽3003能够在其中可滑动地容纳切割构件。
现在参见图121,在各种实施例中,钉仓3100可包括可压缩并可植入的仓体3110,仓体3110包括单层可压缩材料以及定位于仓体3110中的多个缝钉(例如,缝钉3020b)。在至少一个实施例中,仓体3110的厚度可穿过其宽度而变化。在至少一个此类实施例中,仓体3110可包括沿仓体3110的边延伸的台阶3108。现在参见图122,在各种实施例中,钉仓3200可包括可压缩并可植入的仓体3210,该仓体3210包括单层可压缩材料以及定位在仓体3210中的多个缝钉(例如缝钉3020b)。在至少一个实施例中,仓体3210的厚度可穿过其宽度而变化。在至少一个此类实施例中,仓体3210可包括沿仓体3210的中心部延伸的台阶3208。现在参见图123,在各种实施例中,钉仓3300可包括可压缩并可植入的仓体3310,其中与上文相似,仓体3310的厚度可穿过其宽度而变化。在至少一个实施例中,仓体3310的厚度可在仓体3310的侧部与中心部之间几何地增大。在至少一个此类实施例中,仓体3310的厚度可由拱形或弯曲的外形限定并可包括拱形或弯曲的组织接触表面3319。在某些实施例中,仓体3310的厚度及组织接触表面3319的轮廓可由例如一个曲率半径或作为另一选择由多个曲率半径限定。现在参见图124,在各种实施例中,钉仓3400可包括可压缩并可植入的仓体3410,其中仓体3410的厚度可在仓体3410的侧部与中心部之间线性地或至少基本上线性地增大。
现在参见图125,在各种实施例中,钉仓3500可包括可压缩并可植入的仓体3510以及位于仓体3510中的多个缝钉3520。可植入的仓体3510可包括第一内层3512、第二内层3513、和外层3511。在至少一个实施例中,第一内层3512可包含第一厚度并且第二内层3513可包含第二厚度,其中第二内层3513可厚于第一内层3512。在至少一个可供选择的实施例中,第一内层3512可厚于第二内层3513。在另一可供选择的实施例中,第一内层3512与第二内层3513可具有相同或至少基本上相同的厚度。在某些实施例中,每一缝钉3520可包括基部3522和从基部3522延伸的一个或多个可变形腿部3521。在各种实施例中,每一腿部3521可包括嵌入第一内层3511中的末端3523,另外缝钉3520的每一基部3522可嵌入第二内层3512中。在至少一个实施例中,第一内层3512和/或第二内层3513可包括存储在其中的至少一种药物,并且在各种实施例中,外层3511可包封并密封第一内层3512和第二内层3513,使得只有外层3511被缝钉3520刺穿之后药物才会流出钉仓本体3510。更具体地讲,对上文进行进一步描述,可抵靠着抵靠钉仓3500的组织接触表面3519而定位的组织向下推动砧座,使得仓体3510被压缩且表面3519朝缝钉末端3523并至少部分地在缝钉末端3523下方向下运动,使得末端3523使外层3511破裂或刺穿外层3511。在缝钉腿3521使外层3511破裂之后,至少一种药物M可流出围绕缝钉腿3521的仓体3510。在各种情形中,仓体3510的额外压缩可将额外的药物M挤出仓体3510,如图126所示。
再次参见图125,在各种实施例中,外层3511可包括水不可渗透的或至少基本上不可渗透的包裹层,所述包裹层能够1)防止药物过早地流出钉仓3500;以及2)防止例如手术部位内的流体过早地进入钉仓3500中。在某些实施例中,第一内层3512可包括存储或吸收于其中的第一药物,并且第二内层3513可包括存储或吸收于其中的第二药物,其中第二药物可不同于第一药物。在至少一个实施例中,仓体3510的使外层3511破裂的初始压缩通常可使第一内层3512释放出第一药物,并且仓体3510的后续压缩通常可使第二内层3513释放出第二药物。然而,在此类实施例中,第一药物和第二药物的某些部分可同时被释放,但最初被释放的药物的大部分可由第一药物构成,并且随后被释放的药物的大部分可由第二药物构成。在某些实施例中,对上文进行进一步描述,第一内层3512可由比第二内层3513具有更大可压缩性的材料构成,使得可低于后续压缩力或压力的初始压缩力或压力可在第一内层3512中产生比第二内层3513中更大的初始挠曲量。第一内层3512中的这种较大的初始挠曲量可使从第一内层3512中释放出的第一药物的部分大于从第二内层3513中释放出的第二药物。在至少一个实施例中,第一内层3512可比第二内层3513更加多孔和/或更具挠性。在至少一个此类实施例中,第一内层3512可包括被限定在其中的多个孔或空隙3508,并且第二内层3513可包括被限定在其中的多个孔或空隙3509,其中在各种实施例中,孔3508能够将第一药物存储在第一内层3512中,并且孔3509能够将第二药物存储在第二内层3513中。在某些实施例中,第一内层3512中的孔3508和第二内层3513中的孔3509的尺寸及密度可被选择成提供本文所述的所需结果。
再次参见图125及图126,在各种实施例中,外层3511、第一内层3512、和/或第二内层3513可由可生物吸收的材料构成。在至少一个实施例中,第一内层3512可由第一可生物吸收的材料构成,第二内层3513可由第二可生物吸收的材料构成,并且外层3511可由第三可生物吸收的材料构成,其中第一可生物吸收的材料、第二可生物吸收的材料、和/或第三可生物吸收的材料可由不同的材料构成。在某些实施例中,第一可生物吸收的材料可以第一速率被生物吸收,第二可生物吸收的材料可以第二速率被生物吸收,并且第三可生物吸收的材料可以第三速率被生物吸收,其中第一速率、第二速率、和/或第三速率可不同。在至少一个此类实施例中,当材料以特定的速率被生物吸收时,这种速率可被定义成在单位时间内被患者身体吸收的材料质量的量。众所周知,不同患者的身体可以不同的速率吸收不同的材料,因此这种速率可被表达成平均速率以解释这种可变性。在任何情形中,与较慢的速率相比,较快的速率可为在单位时间内更多的质量被吸收的速率。再次参见图125和图126,在各种实施例中,第一内层3512和/或第二内层3513的构成材料可比外层3511的构成材料更快地被生物吸收。在至少一个此类实施例中,第一内层3512和/或第二内层3513可由可生物吸收的泡沫、组织密封剂、和/或止血材料(例如氧化再生纤维素(ORC))构成,并且外层3511可由支撑材料和/或塑性材料(例如以商品名Vicryl出售的聚乙醇酸(PGA)、聚乳酸(PLA、PLLA)、聚对二氧环己酮(PDS)、聚羟基链烷酸酯(PHA)、以商品名Monocryl出售的聚卡普隆25(PGCL)、聚己内酯(PCL)、和/或PGA、PLA、PDS、PHA、PGCL、和/或PCL的复合物)构成。在此类实施例中,第一内层3512和/或第二内层3513例如可直接处理组织并可减少组织出血,其中外层3514可提供长期的结构支撑并可以较慢的速率被生物吸收。
对上文进行进一步描述,由于外层3511的可生物吸收的速率较慢,因此外层3511可在缝钉线内的组织愈合时支撑组织或在结构上增强组织。在某些实施例中,第一内层3512和第二内层3513其中之一的构成材料可比另一者的构成材料更快地被生物吸收。在至少一个实施例中,其中的一层可提供治疗材料的初始释放,并且另一层可提供相同治疗材料和/或不同治疗材料的缓释。在至少一个此类实施例中,治疗材料可从层3512、3513被释放的速率可取决于其中吸收或分散有药物的最底层的可吸收性。例如,在至少一个实施例中,包括第一内层3512的基板可比包括第二内层3513的基板更快地被生物吸收,因此例如药物从第一内层3512释放的速度可快于从第二内层3513的释放的速度。在各种实施例中,如本文所述,仓体3510的层3511、3512、和3513中的一者或多者可通过至少一种粘合剂(例如,纤维蛋白和/或蛋白水凝胶)相互粘附。在某些实施例中,粘合剂可为可水溶的并能够当钉仓3500被植入时和/或被植入某段时间之后释放各层之间的连接。在至少一个此类实施例中,粘合剂能够比外层3511、第一内层3512、和/或第二内层3513更快地被生物吸收。
现在参见图127及图128,在各种实施例中,钉仓(例如,钉仓3600)可包括仓体3610,仓体3610包括可压缩的第一层3611、附接到第一层3611的第二层3612、以及附接到第二层3612的可移除的可压缩层3613。在至少一个此类实施例中,例如第一层3611可由可压缩的泡沫材料构成,第二层3612可包括利用一种或多种粘合剂粘附到第一层3611的层合材料,并且第三层3613可包括利用一种或多种粘合剂可移除地粘附到第二层3612的可压缩泡沫材料。在各种实施例中,钉仓3600还可包括位于仓体3610中的多个缝钉(例如缝钉3620)。在至少一个此类实施例中,例如每一缝钉3620可包括位于第三层3613中的基部3622以及从基部3622穿过第二层3612而向上延伸至第一层3611中的一个或多个可变形腿部3621。在使用中,对上文进行进一步描述,钉仓本体3610的顶面3619可被砧座向下推动,直至缝钉腿3621穿透顶面3619及靶组织并接触砧座为止。在缝钉腿3621完全变形之后,砧座可远离钉仓3600运动,使得钉仓3600的可压缩层可至少部分地再次伸展。在各种情形中,缝钉穿过组织而插入时可使组织出血。在至少一个实施例中,第三层3613可由吸收材料(例如蛋白水凝胶)构成,所述吸收材料可从被缝合的组织吸除血液。除上文之外或作为上文的替代,第三层3613可由止血材料和/或组织密封剂(例如经冷冻干燥的凝血酶和/或纤维蛋白)构成,所述止血材料和/或组织密封剂能够减少组织出血。在某些实施例中,第三层3613可对第一层3611和第二层3612提供结构支撑,其中第三层3613可由可生物吸收的材料和/或不可生物吸收的材料构成。在任何情形中,在各种实施例中,在钉仓3610被植入之后,第三层3613可从第二层3612上拆卸。在其中第三层3613包括具有可植入品质的材料的实施例中,外科医生可选择是否移除仓体3610的第三层3613。在至少一个实施例中,第三层3613能够以整体形式从第二层3612移除。
在各种实施例中,第一层3611可由第一泡沫材料构成,并且第三层3613可由第二泡沫材料构成,第二泡沫材料可不同于第一泡沫材料。在至少一个实施例中,第一泡沫材料可具有第一密度并且第二泡沫材料可具有第二密度,其中第一密度可不同于第二密度。在至少一个此类实施例中,第二密度可高于第一密度,其中作为结果,第三层3613可比第一层3611的可压缩性更小或具有更低的压缩率。在至少一个可供选择的实施例中,第一密度可高于第二密度,其中作为结果,第一层3611可比第三层3613的可压缩性更小或具有更低的压缩率。现在参见图129和图130,在各种实施例中,类似于钉仓3600,钉仓3700可包括仓体3710,该仓体3710包括第一可压缩的泡沫层3711、附接到第一层3711的第二层3712、以及可移除地附接到第二层3712的可拆卸的第三可压缩泡沫层3713。在至少一个此类实施例中,第三层3713可包括多个缝钉容纳狭槽或切口3709,所述多个缝钉容纳狭槽或图案3709可分别能够在其中容纳缝钉3620的至少一部分(例如缝钉基部3622)。在某些实施例中,缝钉3620能够在缝钉容纳狭槽3709中滑动,或换言之,第三层3713能够例如当钉仓3700抵靠靶组织而定位并被砧座压缩时,第三层3713相对于缝钉3620滑动。在至少一个实施例中,容纳狭槽3709能够使缝钉3620与容纳狭槽3709的侧壁之间存在空隙。在至少一个此类实施例中,作为上文的结果,当缝钉3620变形时,缝钉3620可不将第三层3713的一部分捕获在其中,如图129和图130所示。在某些其它实施例中,缝钉容纳狭槽3709的邻近第二层3712的末端可由第三层3713的一部分闭合,因此当缝钉3620变形时,第三层3713的至少一部分可被捕获在缝钉3620内。在任何情形中,第三层3713例如可包括一个或多个穿孔和/或划痕3708,所述一个或多个穿孔和/或划痕3708能够容许第三层3713以两部分或更多部分从第二层3712被移除,如图129所示。在图129中,第三层3713的其中一部分被示为通过工具3755移除。在各种实施例中,穿孔3708可沿位于第一缝钉排与第二缝钉排中间的线设置。
再次参见图129及图130,在各种实施例中,缝钉3620的基部3622可位于容纳狭槽3709中,其中在至少一个实施例中,容纳狭槽3709的侧壁能够接触缝钉腿3621并将缝钉腿3621可释放地保持于定位上。在某些实施例中,尽管未示出,然而第三层3713可包括围绕缝钉线内所有缝钉的细长狭槽。在至少一个此类实施例中,包括四个缝钉排的钉仓例如可包括与钉仓底层中的每一缝钉排对齐的细长狭槽。对上文进行进一步描述,钉仓3600和/或钉仓3700的至少一部分可被植入患者体内,并且钉仓的至少一部分可从患者体内移除。再次参见图129和图130,在至少一个实施例中,第一层3711和第二层3712可被捕获在缝钉3620内并可与缝钉3620一起被植入,而第三层3713可任选地从钉仓3700中被移除或拆卸。在各种情形中,移除已植入钉仓的一部分可减少患者身体必须吸收的材料的量,这可提供各种有益的治疗效果。在例如通过腹腔镜式工具3755将钉仓的一部分拆卸并移除的情形中,所拆卸的钉仓部分可通过套管针(例如具有5mm孔的套管针)从手术部位被移除。在某些实施例中,仓体可包括不止一个可被移除的层。例如,仓体3710可包括第四层,其中仓体3710的第三层3713可由止血材料构成,并且第四层可由支撑层构成。在至少一个此类实施例中,外科医生例如可移除支撑层并随后选择是否移除止血层。
现在参见图131,在各种实施例中,钉仓(例如,钉仓3800)可包括仓体3810,仓体3810包括外层3811及内层3812。内层3812可由可压缩的泡沫材料构成,并且外层3811可至少部分地围绕内层3812进行包裹。在至少一个实施例中,外层3811可包括第一部分3811a和第二部分3811b,该第一部分能够定位在内层3812的第一侧上,该第二部分能够定位在内层3812的第二侧上,其中第一部分3811a和第二部分3811b可通过挠性铰链(例如铰链3809)连接。在至少一个此类实施例中,可对内层3812的第一侧和/或第二侧涂覆至少一种粘合剂(例如,纤维蛋白和/或蛋白水凝胶)以将外层3811的某些部分固定至第一侧和/或第二侧。在各种实施例中,外层3811可包括自其延伸的一个或多个紧固构件。在至少一个此类实施例中,外层3811可包括从外层3811的一侧延伸并可被安放在可压缩内层3812中的多个可变形腿部3821。在至少一个此类实施例中,腿部3821可不从内层3812的第二侧突起,而在至少一个可供选择的实施例中,腿部3821可至少部分地从内层3812突起。当可压缩的仓体3810被压缩时,在使用中,腿部3821能够刺穿内层3812及外层3811的第二部分3811b。在某些实施例中,外层3811的第二部分3811b可包括被限定在其中的孔(例如孔3808),所述孔能够容纳缝钉腿3821。在某些实施例中,钉仓3800的至少某些部分可包括刀狭槽3803,该刀狭槽能够在其中可滑动地容纳切割构件。在至少一个此类实施例中,刀狭槽3803可不完全穿过仓体3810的厚度而延伸,因此当切割构件相对于仓体3810运动时,切割构件可切开仓体3810。
现在参见图132,在各种实施例中,与钉仓3800相似,钉仓3900可包括仓体3910,仓体3910包括内层3812及外层3811,其中外层3811可包括邻近内层3812的第一侧而定位的第一部分3811a以及邻近内层3812的第二侧而定位的第二部分3811b。在至少一个实施例中,与上文相似,外层3811可包括从其延伸的一个或多个紧固构件。在至少一个此类实施例中,外层3811可包括自外层3811的一侧延伸并可被安放于可压缩内层3812中的多个可变形腿部3921。在某些实施例中,每一可变形腿部3921可包括从其突起的至少一个吊钩或倒钩3923,所述至少一个吊钩或倒钩3923能够接合外层3811的第二部分3811b并因此将外层3811保持到内层3812。在至少一个此类实施例中,倒钩3923能够自内层3812的第二侧突起并延伸穿过外层3811的第二部分3811b中的孔3808,使得倒钩3923可接合外层3811的外表面并将外层3811锁定到内层3812。为构造钉仓3900,内层3812可被至少部分地压缩,以使倒钩自内层3812突起并进入孔3808中。在至少一个此类实施例中,例如当钉仓3900被插入钉仓中时,钉仓3900可被至少部分地预压缩。在某些实施例中,对上文进行进一步描述,腿部3921的至少一部分可嵌入外层3811的第一部分3811a中,其中在至少一个实施例中,外层3811可由塑性材料(例如聚对二氧环己酮(PDS)和/或聚乙醇酸(PGA))构成,并且所述塑性材料可围绕腿部3921的至少一部分重叠注塑。
现在参见图133-137,在各种实施例中,钉仓(例如,钉仓4000)可包括仓体4010,仓体4010包括可压缩的第一层4011、第二层4012、以及定位于仓体4010中的多个缝钉4020。参见图135,在某些实施例中,每一缝钉4020可包括基部4022和从基部4022延伸的至少一个可变形腿部4023。参见图133,在至少一个实施例中,钉仓4000可被定位在钉仓通道4030与外科缝合器的端部执行器的砧座4040之间,其中仓体4010的第二层4012和/或缝钉4020的基部4022可抵靠钉仓通道4030定位。现在参见图134,在各种实施例中,第二层4012可包括一层脱脂棉4060,所述一层脱脂棉4060通过脱脂棉支撑框架4061彼此互连。在至少一个此类实施例中,脱脂棉4060及脱脂棉支撑框架4061可由模制的塑性材料(例如聚乙醇酸(PGA))构成。每一脱脂棉4060可包括一个或多个孔或狭槽4062,所述一个或多个孔或狭槽4062能够容纳延伸穿过其中的缝钉腿4021,如图135和图136所示。每一脱脂棉4060还可包括被限定在其中的容纳狭槽4063,该容纳狭槽能够容纳缝钉4020的基部4022。再次参见图134,在各种实施例中,脱脂棉4060和/或脱脂棉支撑框架4061可包括多个划痕、穿孔或类似结构,所述多个划痕、穿孔或类似结构能够容许脱脂棉4060在所需位置处从脱脂棉支撑框架4061被拆卸。相似地,参见图136,一个或多个脱脂棉4060例如可沿包括穿孔和/或划痕4064的线彼此连接。在使用中,可压缩的泡沫层4011可抵靠靶组织T而定位,并且仓体4010可由砧座4040压缩以使砧座4040能够使缝钉4020变形。当缝钉4020变形时,每一缝钉4020的缝钉腿4021可将组织T、第一层4011的一部分、以及脱脂棉4060捕获在变形的缝钉内。当钉仓通道4030远离已植入的钉仓4060而运动时,例如脱脂棉支撑框架4061可从脱脂棉4060拆卸和/或各脱脂棉4060可自彼此拆卸。在某些情形中,当缝钉4020被砧座4040以上述方式变形时,脱脂棉4060可从框架4061和/或彼此拆卸。
在本文所述的各种实施例中,当砧座运动到闭合位置时,钉仓的缝钉可由砧座完全成形。现在参见图138-141,在各种其它实施例中,钉仓(例如钉仓4100)的缝钉可通过运动至闭合位置的砧座以及使缝钉朝闭合的砧座运动的缝钉驱动器系统而变形。钉仓4100可包括可压缩的仓体4110,可压缩的仓体4110可例如由泡沫材料以及至少部分地位于可压缩仓体4110内的多个缝钉4120构成。在各种实施例中,缝钉驱动器系统可包括驱动器夹持器4160、位于驱动器夹持器4160内的多个缝钉驱动器4162、以及钉仓盘4180,该钉仓盘能够将缝钉驱动器4162保持在驱动器夹持器4160中。在至少一个此类实施例中,缝钉驱动器4162可被定位在驱动器夹持器4160中的一个或多个狭槽4163内,其中狭槽4163的侧壁可帮助朝砧座向上引导缝钉驱动器4162。在各种实施例中,缝钉4120可由缝钉驱动器4162支撑在狭槽4163内,其中在至少一个实施例中,当缝钉4120及缝钉驱动器4162处于其未击发位置时,缝钉4120可完全位于狭槽4163中。在某些其它实施例中,当缝钉4120及缝钉驱动器4162处于其未击发位置时,缝钉4120的至少一部分可穿过狭槽4163的开口端4161向上延伸。现在主要参见图139,在至少一个此类实施例中,缝钉4120的基部可定位在驱动器夹持器4160内,并且缝钉4120的末端可嵌入可压缩的仓体4110内。在某些实施例中,缝钉4120的大约三分之一的高度可定位在驱动器夹持器4160内,并且缝钉4120的大约三分之二的高度可定位在仓体4110内。参见图138A,在至少一个实施例中,例如钉仓4100还可围绕仓体4110及驱动器夹持器4160而包括水不可渗透的包裹层或膜4111。
在使用中,例如,钉仓4100可位于钉仓通道内,并且砧座可朝钉仓4100运动到闭合位置。在各种实施例中,当砧座运动至其闭合位置时,砧座可接触并压缩可压缩的仓体4110。在某些实施例中,当砧座处于其闭合位置时,砧座可不接触缝钉4120。在某些其它实施例中,当砧座运动至其闭合位置时,砧座可接触缝钉4120的腿部并至少部分地使缝钉4120变形。在两种情形中的任一情形中,钉仓4100还可包括一个或多个橇4170,所述一个或多个橇4170可在钉仓4100内沿纵向推进,使得橇4170可随后接合缝钉驱动器4162并使缝钉驱动器4162及缝钉4120朝砧座运动。在各种实施例中,橇4170可在钉仓盘4180与缝钉驱动器4162之间滑动。在其中砧座的闭合已使缝钉4120的成形过程开始的实施例中,缝钉4120朝砧座向上运动可完成成形过程并使缝钉4120变形至其完全成形的高度或至少期望的高度。在其中砧座的闭合未使缝钉4120变形的实施例中,缝钉4120朝砧座向上运动可开始并完成成形过程并使缝钉4120变形至其完全成形的高度或至少期望的高度。在各种实施例中,橇4170可从钉仓4100的近端推进到钉仓4100的远端,使得在位于钉仓4100的远端中的缝钉4120完全成形之前,位于钉仓4100的近端中的缝钉4120完全成形。参见图140,在至少一个实施例中,橇4170可分别包括至少一个成角度的或倾斜的表面4711,所述至少一个成角度的或倾斜的表面4711能够在缝钉驱动器4162下方滑动并如图141所示提升缝钉驱动器4162。
在各种实施例中,对上文进行进一步描述,缝钉4120可被成形,以便将组织T的至少一部分及钉仓4100的可压缩仓体4110的至少一部分捕获在其中。在缝钉4120成形之后,外科缝合器的砧座及钉仓通道4130可远离已植入的钉仓4100而运动。在各种情形中,仓盘4180可以固定方式接合钉仓通道4130,其中作为结果,当钉仓通道4130被拉离已植入的仓体4110时,仓盘4180可自可压缩的仓体4110拆卸。再次参见图138,在各种实施例中,仓盘4180可包括相对的侧壁4181,该仓体4110能够可移除地定位在相对的侧壁4181之间。在至少一个此类实施例中,可压缩的仓体4110可被压缩于侧壁4181之间,使得在使用期间仓体4110能够可移除地保持在侧壁4181之间且当仓盘4180被拉离时,仓体4110从仓盘4180可释放地脱离。在至少一个此类实施例中,驱动器夹持器4160可连接到仓盘4180,使得当仓盘4180自手术部位被移除时,驱动器保持器4160、驱动器4162、和/或橇4170可保持在仓盘4180中。在某些其它实施例中,驱动器4162可从驱动器夹持器4160中被射出并留在手术部位中。在至少一个此类实施例中,各驱动器4162可由例如以商品名Vicryl出售的聚乙醇酸(PGA)、聚乳酸(PLA或PLLA)、聚对二氧环己酮(PDS)、聚羟基链烷酸酯(PHA)、以商品名Monocryl出售的聚卡普隆25(PGCL)、聚己内酯(PCL)、和/或PGA、PLA、PDS、PHA、PGCL、和/或PCL的复合物等可生物吸收的材料构成。在各种实施例中,驱动器4162可附接到缝钉4120,使得驱动器4162部署有缝钉4120。在至少一个此类实施例中,每一驱动器4162可包括例如能够容纳缝钉4120的基部的槽,其中在至少一个实施例中,所述槽能够以压配方式和/或搭扣配合方式容纳缝钉基部。
在某些实施例中,对上文进行进一步描述,驱动器夹持器4160和/或橇4170可从仓盘4180中被射出。在至少一个此类实施例中,橇4170可在仓盘4180与驱动器夹持器4160之间滑动,使得当橇4170推进以向上驱动缝钉驱动器4162及缝钉4120时,橇4170也可使驱动器夹持器4160向上运动到仓盘4180之外。在至少一个此类实施例中,驱动器夹持器4160和/或橇4170可由例如以商品名Vicryl出售的聚乙醇酸(PGA)、聚乳酸(PLA或PLLA)、聚对二氧环己酮(PDS)、聚羟基链烷酸酯(PHA)、以商品名Monocryl出售的聚卡普隆25(PGCL)、聚己内酯(PCL)、和/或PGA、PLA、PDS、PHA、PGCL、和/或PCL的复合物等可生物吸收的材料构成。在各种实施例中,橇4170可整体地形成和/或附接到驱动棒或切割构件,所述驱动棒或切割构件穿过钉仓4100而推动橇4170。在此类实施例中,橇4170可不从仓盘4180中被射出并可与外科缝合器保持在一起,而在橇4170未附接到驱动棒的其它实施例中,橇4170可留在手术部位中。在任何情形中,对上文进行进一步描述,仓体4110的可压缩性可容许在外科缝合器的端部执行器中使用较厚的钉仓,这是因为当缝合器的砧座闭合时,仓体4110可压缩或塌缩。在某些实施例中,作为在砧座闭合时缝钉被至少部分地变形的结果,可使用较高的缝钉(例如具有约0.18”缝钉高度的缝钉),例如其中约0.12”的缝钉高度可被定位在可压缩层4110中,并且其中可压缩层4110可具有约0.14”的未压缩高度。
现在参见图142-145,在各种实施例中,钉仓(例如,钉仓4200)可包括可压缩的仓体4210、位于可压缩仓体4210中的多个缝钉4220、以及多个挠性的横向支撑构件4234。现在参见图143,在各种实施例中,钉仓4200可定位在砧座4240与钉仓通道4230中间,其中在至少一个实施例中,侧向支撑构件4234可附接到钉仓通道4230。当砧座4240向下运动以压缩仓体4210并至少部分地使缝钉4220变形时,如图144所示,仓体4210的侧部可侧向地膨胀并向外推动侧向支撑构件4234。在至少一个此类实施例中,侧向支撑构件4234可附接到仓体4210,并且当仓体4210如上所述侧向地膨胀时,侧向支撑构件4234可从仓体4210拆卸,如图144所示。在至少一个实施例中,侧向支撑构件4234可利用至少一种粘合剂(例如,纤维蛋白和/或蛋白水凝胶)粘附到仓体4210。与上文相似,砧座4240闭合时可仅部分地使缝钉4220变形,其中可通过如图145所示穿过钉仓4200推进一个或多个橇4270来完成缝钉4220的成形。现在参见图147和图148,在各种实施例中,橇4270可被切割构件4280从钉仓4200的近端推进到钉仓4200的远端。在至少一个此类实施例中,切割构件4280可包括切割元件或刀4283,所述切割元件或刀4283可穿过组织T和/或可压缩的仓体4210而推进。在某些实施例中,切割构件4280可包括凸轮构件4282,凸轮构件4282可沿钳口4230及4240的外表面推进并将所述钳口运动或保持就位。在各种实施例中,作为上文的结果,缝钉4220可在组织T被切开的同时或至少基本上同时被成形至其最终形状。在至少一个此类实施例中,橇4270可相对于刀4283被定位在远侧,使得仅在组织的推进部分被完全缝合时组织T才被切开。
再次参见图147和图148,在各种实施例中,橇4270可包括单独的可滑动构件,所述可滑动构件一起由切割构件4280推进。在至少一个此类实施例中,橇4270可被容纳在钉仓4200中,并且切割构件4280可被击发棒4281推进至钉仓4200中,使得切割构件4280接合橇4270并朝远侧推进橇4270。在某些实施例中,各橇4270可彼此连接。在两种情形中的任一种情形中,每一橇4270可包括成角度的表面或凸轮4271,该成角度的表面或凸轮4271能够提升在缝钉排中对齐的缝钉4220。在某些实施例中,成角度的表面4271可与切割构件4280形成为整体。再次参见图147和图148,在至少一个实施例中,每一缝钉4200可包括基部及冠部4229,至少一个可变形构件从基部延伸,并且冠部4229重叠注塑到缝钉4200的基部和/或可变形构件的至少一部分上和/或围绕所述至少一部分而定位。在各种实施例中,例如这种冠部4229能够由橇4270直接驱动。更具体地讲,在至少一个实施例中,缝钉4220的冠部4229能够使得在橇4270的成角度的表面4271与冠部4229之间未定位有缝钉驱动器的情况下,成角度的表面4271可在冠部4229下方直接接触冠部4229而滑动。在此类实施例中,每一冠部4229均包括至少一个协作的成角度或倾斜的表面,所述至少一个协作的成角度或倾斜的表面可由橇4270的成角度的表面4271接合,使得当橇4270在缝钉4220下方滑动时,协作的成角度表面可向上驱动缝钉4220。
现在参见图146,在各种实施例中,钉仓(例如,钉仓4300)可包括可压缩的本体4310以及定位于可压缩的本体4310中的多个缝钉4320。与上文相似,钉仓4300可包括挠性的侧向支撑件4334,该挠性的侧向支撑件可附接到钉仓通道和/或粘附到可压缩的本体4310。除上文所述者之外,挠性的侧向支撑件4334可由一个或多个支杆或连接构件4335连接到一起,所述一个或多个支杆或连接构件4335能够将侧向支撑件4334保持在一起。在使用中,连接构件4335能够防止或至少抑制侧向支撑件4334过早地从仓体4310拆卸。在某些实施例中,连接构件4335能够在钉仓4300被砧座压缩之后,该连接构件将侧向支撑件4334保持在一起。在此类实施例中,侧向支撑件4334可抵抗仓体4310的侧部的侧向膨胀或位移。在某些实施例中,切割构件(例如切割构件4280)能够当切割构件4280在仓体4310中朝远侧运动时,切割构件会横切连接构件4335。在至少一个此类实施例中,切割构件4280能够朝远侧推动一个或多个橇(例如橇4270),以便使缝钉4320抵靠砧座而成形。橇4270可引导切割刀刃4283,使得切割构件4280不会横切连接构件4335,直至邻近连接构件4335的缝钉4320完全成形或至少成形至期望高度为止。在各种情形中,连接构件4335与侧向支撑件4334协作可防止或至少减少可压缩仓体4310的侧向运动并同时防止或至少减少位于仓体4310内的缝钉4320的侧向运动。在这种情形中,连接构件4335可将缝钉4320保持就位,直至缝钉4320变形,并且连接构件4335可随后切割以释放仓体4310的侧部。如上所述,侧向支撑件4334可连接到钉仓通道,因此在钉仓4300被植入之后,侧向支撑件4334可与钉仓通道一起从手术部位被移除。在某些实施例中,侧向支撑件4334可由可植入的材料构成并可被留在手术部位中。在至少一个实施例中,连接构件4335可被定位在仓体4310与组织T中间,并且在连接构件4335从侧向支撑件4334拆卸之后,连接构件4335可保持植入患者体内。在至少一个此类实施例中,连接构件4335可由可植入的材料构成,并且在某些实施例中,连接构件4335可例如由与侧向支撑构件4334相同的材料构成。在各种实施例中,连接构件4335和/或侧向支撑件4334可由例如以商品名Vicryl出售的聚乙醇酸(PGA)、聚乳酸(PLA或PLLA)、聚对二氧环己酮(PDS)、聚羟基链烷酸酯(PHA)、以商品名Monocryl出售的聚卡普隆25(PGCL)、聚己内酯(PCL)、和/或PGA、PLA、PDS、PHA、PGCL、和/或PCL的复合物等挠性的可生物吸收的材料构成。在各种实施例中,连接构件可包括用于连接各侧向支撑件4334的材料薄片。在某些实施例中,钉仓可包括延伸穿过仓体4310的顶面的连接构件以及围绕仓体4310的底部表面而延伸的连接构件。
现在参见图149,在各种实施例中,钉仓可包括缝钉(例如,缝钉4420),所述缝钉可包括被插入冠部分中的线材部。在至少一个实施例中,线材部可由金属(例如钛和/或不锈钢)和/或塑料(例如聚对二氧环己酮(PDS)和/或聚乙醇酸(PGA))构成。在至少一个实施例中,冠部分可由金属(例如钛和/或不锈钢)和/或塑料(例如聚对二氧环己酮(PDS)和/或聚乙醇酸(PGA))构成。在某些实施例中,每一缝钉4420的线材部可包括基部4422和从基部4422延伸的可变形腿部4421,其中每一缝钉4420的冠部分可包括冠部4429,冠部4429能够在其中容纳基部4422的至少一部分。现在参见图150A-150C,为组装每一缝钉4420的各部分,可将线材部的腿部4421插入冠部4429中的开口4426中,其中开口4426能够将腿部4421引导至基部腔4427中。线材部还可被插入冠部4429中,使得腿部4421离开基部腔4427且线材部的基部4422进入基部腔4427中。在至少一个此类实施例中,基部腔4427能够使得当基部4422进入基部腔4427时,线材部在冠部4429中旋转,以使缝钉腿4421指向向上的或至少基本上向上的方向。再次参见图149,在各种实施例中,冠部4429可包括离孔4425,离孔4425能够在其中容纳缝钉腿4421。
在各种实施例中,对上文进行进一步描述,外科缝合器可包括橇4470,橇4470能够横贯钉仓4400和钉仓通道4430并朝砧座行进仓体4410内所容纳的缝钉4420。在各种情形中,橇4470可从钉仓通道4430的近端运动到仓通道4430的远端,以植入仓体4410和缝钉4420。在某些情形中,橇4470可缩回或返回到仓通道4430的近端,并且另一钉仓4400可被插入仓通道4430中。一旦新的钉仓4400被定位在仓通道4430中,则橇4470可再次朝远侧推进。在各种实施例中,外科缝合器可包括一个或多个锁定结构,所述一个或多个锁定结构可在仓通道4430中未定位有新的钉仓4400的情况下防止橇4470再次朝远侧推进。再次参见图149,在至少一个此类实施例中,钉仓通道4430可包括锁定肩部4439,该锁定肩部能够防止或至少限制橇4470朝远侧运动。更具体地讲,橇4470能够除非橇4470由提升结构4428至少部分地向上提升超过肩部4439,否则橇4470邻接肩部4439,提升结构4428例如在钉仓4400内的最近侧缝钉4420之间延伸。换言之,当新的钉仓4400中不存在最近侧缝钉4420时,橇4470无法推进。因此,当仓通道4430中存在已用过的钉仓4400时或仓通道4430中不存在任何钉仓4400时,橇4470无法在仓通道4430中推进。
现在参见图151,对上文进行进一步描述,钉仓(例如,钉仓4500)可被定位在钉仓通道4530中并可包括可压缩的仓体4510、定位于仓体4510中的多个缝钉4520、以及仓盘或保持器4580。在各种实施例中,可压缩的仓体4510可包括外层4511及内层4512,其中在至少一个实施例中,外层4511可以密封方式包围内层4512。在至少一个此类实施例中,外层4511可在内层4512与仓盘4580之间延伸。在某些其它实施例中,外层4511可仅部分地围绕内层4512,并且在至少一个此类实施例中,外层4511和仓盘4580可协作地包围或至少基本上包围内层4512。在各种实施例中,对上文进行进一步描述,缝钉4520可由仓盘4580支撑,其中仓盘4580可包括能够支撑缝钉4520的一个或多个缝钉支撑通道。在某些实施例中,仓盘4580可附接到仓体4510,其中在至少一个此类实施例中,仓体4510可在仓盘4580的相对的侧壁之间被侧向地压缩。在各种实施例中,仓盘4580的侧壁可侧向地支撑仓体4510,在至少一个此类实施例中,仓盘4580可包括从底部支撑件4583向上延伸至仓体4510中的一个或多个壁或翅片4582。在至少一个此类实施例中,仓体4510中可包括一个或多个狭槽或通道,所述一个或多个狭槽或通道能够容纳壁4582和/或与壁4582互锁。在各种实施例中,壁4582可部分地或几乎全部地延伸穿过仓体4510。在至少一个此类实施例中,壁4582可在缝钉4520形成的第一行与缝钉4520形成额第二行之间沿纵向延伸穿过钉仓4500。
在各种实施例中,仓体4510和/或仓盘4580可包括协作保留结构,所述协作保留结构可在仓盘4580与仓体4510之间提供搭扣配合。在某些实施例中,钉仓4500可被定位在仓通道4530中,使得仓盘4580抵靠仓通道4530而定位和/或附接到仓通道4530。在至少一个实施例中,仓盘4580能够可拆卸地联接到仓通道4530,使得在钉仓4500被砧座4540压缩且缝钉4520变形之后,仓盘4580可从仓通道4530拆卸并可与仓体4510一起被植入。在至少一个此类实施例中,仓盘4580可由例如以商品名Vicryl出售的聚乙醇酸(PGA)、聚乳酸(PLA或PLLA)、聚对二氧环己酮(PDS)、聚羟基链烷酸酯(PHA)、以商品名Monocryl出售的聚卡普隆25(PGCL)、聚己内酯(PCL)、和/或PGA、PLA、PDS、PHA、PGCL、和/或PCL的复合物等可生物吸收的材料构成。在某些实施例中,外科缝合器还可包括击发机构和/或驱动器,所述击发机构和/或驱动器可在仓盘4580上在钉仓通道4530与底部驱动表面中间滑动,所述底部驱动表面能够从仓通道4530中提升或射出仓盘4580。在某些实施例中,仓体4510能够可拆卸地联接到仓盘4580,使得在钉仓4500被砧座4540压缩且缝钉4520变形之后,仓体4510可从仓盘4580拆卸。在至少一个此类实施例中,仓盘4580可保持以固定方式接合仓通道4530,使得仓盘4580与仓通道4530一起从手术部位被移除。在某些实施例中,外科缝合器还可包括击发机构和/或驱动器,所述击发机构和/或驱动器可在仓体4510上在钉仓盘4580与底部驱动表面中间滑动,所述底部驱动表面能够从仓盘4580中提升或射出仓体4510。在至少一个此类实施例中,钉仓4500还可包括位于仓盘4580与缝钉4520中间的缝钉驱动器,使得当击发机构朝远侧滑动时,缝钉驱动器及缝钉4520可朝砧座被向上驱动。在至少一个此类实施例中,缝钉驱动器可至少部分地嵌入可压缩的仓体4510中。
在各种实施例中,与上文相似,钉仓4500可包括锁定结构,所述锁定结构能够防止或至少限制切割构件朝远侧运动,除非钉仓通道4530中已定位有未击发的钉仓4500。在某些实施例中,钉仓盘4580可包括例如用于在钉仓通道4530内向上提升切割构件并使其超过锁定表面的表面。在其中仓通道4530中不存在包括仓盘4580的钉仓4500的情形中,切割构件无法推进。在至少一个实施例中,钉仓4500内的最近侧缝钉和/或任何其它适宜的缝钉可包括提升表面,所述提升表面可完全将切割构件提升超过锁定表面。除上文所述之外或替代上文所述,钉仓4500的各部分可由具有不同颜色的材料构成。在此类实施例中,外科医生能够在视觉上识别钉仓通道4530中何时存在未击发和/或击发的钉仓。在至少一个此类实施例中,仓体4510的外层4511可具有第一颜色,仓盘4580可具有第二颜色,并且钉仓通道4530可具有第三颜色。如果外科医生看见第一颜色,则外科医生可知道钉仓通道4530中存在未击发的仓4500;如果外科医生看见第二颜色,则外科医生可知道钉仓通道4530中存在击发的仓4500且需要将剩余的仓盘4580移除;且如果外科医生看见第三颜色,则外科医生可知道仓通道4530中未保留有钉仓4500的任何部分。
现在参见图152,在各种实施例中,钉仓(例如,钉仓4600)可包括可压缩并可植入的仓体4610以及定位于仓体4610中的多个缝钉4620。仓体4610可包括外层4611和内层4612。在某些实施例中,内层4612可包括被限定在其中的多个凹坑(例如凹坑或腔4615),所述多个凹坑可有利于仓体4610的塌缩。在至少一个此类实施例中,内层4612可包括波纹形或蜂巢构型的点阵,所述点阵能够承受压缩力或压力,只要该压缩力或压力不超过特定的阈值即可。当未超过阈值时,内层4612可关于所施加的压缩力或压力而以线性的或至少基本上线性的速率变形。在压缩力或压力超过阈值之后,内层4612可由于压缩负载而突然被压垮至大的挠曲量并塌缩或弯曲。在各种实施例中,内层4612的点阵可由能够连接到一起的多个亚层4612a构成。在至少一个实施例中,每一亚层4612a可包括多个交替的沟与脊或波,所述多个交替的沟与脊或波可与相邻亚层4612a的交替的沟与脊对齐。在至少一个此类实施例中,第一亚层4612a的沟可被定位成与第二亚层4612a的脊相邻;相似地,第一亚层4612a的脊可被定位成与第二亚层4612a的沟相邻。在各种实施例中,相邻的亚层4612a可通过至少一种粘合剂(例如,纤维蛋白和/或蛋白水凝胶)相互粘附和/或粘附到外层4611。图153示出在仓体4610已塌缩且缝钉4620已变形以抵靠仓体4610而捕获并保持组织T之后的钉仓4600。
现在参见图154-156,在各种实施例中,钉仓(例如,钉仓4700)可包括可压缩并可植入的仓体4710以及定位于仓体4710中的多个缝钉4720。与上文相似,仓体4710可包括外层4711和内层4712,其中内层4712可包括多个亚层4712a。同样与上文相似,每一亚层4712a可包括交替的沟4717和脊4718,所述交替的沟和脊可相互对齐以在其间限定凹坑或腔4715。在至少一个此类实施例中,沟4717和/或脊4718可沿相互平行的和/或平行于纵向轴线4709的轴线延伸。在各种实施例中,缝钉4720可在多个缝钉排中对齐,所述多个缝钉排可沿相互平行的和/或平行于纵向轴线4709的轴线延伸。再次参见图152和图153,在各种可供选择的实施例中,仓体4600中所容纳的缝钉4620可沿轴线延伸,所述轴线横跨或垂直于由亚层4612a的沟及脊所限定的轴线。再次参见图154-156,缝钉4720可延伸穿过沟4717和脊4718,其中缝钉4720与亚层4712a之间的摩擦力可将缝钉4720保持在仓体4710中。在某些实施例中,所述多个亚层4712a可由支撑材料和/或塑性材料(例如聚对二氧环己酮(PDS)和/或聚乙醇酸(PGA))构成,所述支撑材料和/或塑性材料可例如能够将缝钉4720保持在直立的取向、和/或将缝钉4720保持成相对于彼此如图154和图155所示对齐。图156示出在仓体4710塌缩且缝钉4720变形以抵靠仓体4710捕获并保持组织T之后的钉仓4700。
再次参见图154-156,在各种实施例中,当仓体4710被压缩时,仓体4710可弹性地或以弹性方式塌缩。在至少一个此类实施例中,当仓体4710被压缩时,沟4717及脊4718在每一亚层4712a中所形成的波可被平化或至少基本上被平化,此可使沟4717与脊4718之间所限定的腔4715塌缩或至少基本上塌缩。在各种情形中,当从仓体4710上移除压缩力或压力之后,所述仓体或仓体的至少某些部分可弹性地或以弹性方式再次伸展。在至少一个此类实施例中,当仓体4710被压缩时,相邻亚层4712a的沟4717与脊4718之间的连接可保持未受损或至少基本上未受损,使得在从仓体4710上移除压缩力之后,亚层4712a可偏置沟4717与脊4718本身使其远离彼此并因此使仓体4710至少部分地再次伸展。在某些实施例中,当仓体4710被压缩时,其可以塑性方式变形或被压溃,因此在从仓体4710上移除压缩力或压力之后,仓体4710可不再次伸展。现在参见图157,在某些实施例中,钉仓(例如钉仓4800)可包括可压溃的仓体4810,该可压溃的仓体包括外层4811和内层4812,其中内层4812可包括波纹形的、蜂巢构型的点阵,所述点阵具有在其中限定的多个凹坑或腔4815。在各种实施例中,限定内层4812的点阵的壁可包括一个或多个弱化的或薄的横截面4819,所述一个或多个弱化的或薄的横截面4819能够容许限定点阵的壁在仓体4810被压缩时破裂。在这种情形中,当钉仓4800被植入时,仓体4810可被压溃。
现在参见图158-160,在各种实施例中,钉仓(例如,钉仓4900)例如可包括仓体4910,仓体4910包括外层4911以及定位于外层4911的顶部与底部之间的多个可塌缩元件4912。主要参见图158和图159,钉仓4900还可包括多个缝钉4920,其中每一缝钉4920可被定位在可塌缩元件4912中。更具体地讲,每一可塌缩元件4912可包括第一部分4912a、第二部分4012b、和第三部分4012c,所述第一部分4912a、第二部分4012b和第三部分4012c可协作地在其中限定腔4915,所述腔能够容纳缝钉4920。在使用中,对上文进行进一步描述,钉仓4900可被定位在钉仓通道中并可对组织接触表面4919施加压缩力以压缩仓体4910。当组织接触表面4919向下运动时,可塌缩元件4912可塌缩。在这种情形中,每一可塌缩元件4912的第二部分4912b可塌缩至对应的第一部分4912a中;相似地,每一可塌缩元件4912的第三部分4912c可塌缩至对应的第二部分4912b中。当仓体4910被压缩且可塌缩元件4912塌缩时,位于可塌缩元件4912中的缝钉4920可变形,如图160所示。在各种实施例中,每一可塌缩元件4912的第二部分4912b可带有摩擦地接合对应的第一部分4912a和/或压配于对应的第一部分4912a中,使得一旦对可塌缩元件4912施加的压缩力超过用于将第一部分4912a和第二部分4912b保持在其延伸位置(图159)中的保留力,则第一部分4912a和第二部分4912b可开始相对于彼此进行滑动。相似地,每一可塌缩元件4912的第三部分4912c可带有摩擦地接合对应的第二部分4912b和/或压配于对应的第二部分4912b中,使得一旦对可塌缩元件4912施加的压缩力超过用于将第二部分4912b和第三部分4912c保持在其延伸位置(图159)中的保留力,则第二部分4912b和第三部分4912c可开始相对于彼此进行滑动。
在许多本文所述的实施例中,钉仓中可包括多个缝钉。在各种实施例中,这种缝钉可由被变形为基本上U形构型并具有两个缝钉腿的金属线材构成。可设想出其中缝钉可包括不同构型(例如被接合在一起并具有三个或更多个缝钉腿的两个或更多个线材)的其它实施例。在各种实施例中,用于形成缝钉的一个或多个线材可包括圆的或至少基本上圆的横截面。在至少一个实施例中,缝钉线材可包括任何其它适宜的横截面,例如正方形和/或矩形的横截面。在某些实施例中,缝钉可由塑料线材构成。在至少一个实施例中,缝钉可由涂覆有塑料的金属线材构成。在各种实施例中,除缝钉之外或作为缝钉的替代,仓可包括任何适宜类型的紧固件。在至少一个此类实施例中,这种紧固件可包括可枢转的臂,所述臂在被砧座接合时会被折叠。在某些实施例中,可利用分为两部分的紧固件。在至少一个此类实施例中,钉仓可包括多个第一紧固件部,并且砧座可包括多个第二紧固件部;当砧座抵靠钉仓而被压缩时,第二紧固件部连接到第一紧固件部。在某些实施例中,如上所述,可在钉仓内推进橇或驱动器以便完成缝钉的成形过程。在某些实施例中,可在砧座内推进橇或驱动器,以便使一个或多个成形构件向下运动至与相对的钉仓及缝钉或位于钉仓中的紧固件接合。
在本文所述的各种实施例中,钉仓可包括存储在其中的四个缝钉排。在至少一个实施例中,所述四个缝钉排可被设置成两个内侧缝钉排和两个外侧缝钉排。在至少一个此类实施例中,内侧缝钉排及外侧缝钉排可被定位在钉仓内的切割构件或刀狭槽的第一侧上;相似地,内侧缝钉排和外侧缝钉排可被定位在切割构件或刀狭槽的第二侧上。在某些实施例中,钉仓可不包括切割构件狭槽;然而,作为钉仓狭槽的替代,此种钉仓可包括能够由切割构件切开的指定部分。在各种实施例中,可将各内侧缝钉排设置于钉仓内,使得其与切割构件狭槽等距地或至少基本上等距地间隔开。相似地,可将各外侧缝钉排设置于钉仓内,使得其与切割构件狭槽等距地或至少基本上等距地间隔开。在各种实施例中,钉仓可包括多于或少于四个缝钉排存储在钉仓内。在至少一个实施例中,钉仓可包括六个缝钉排。在至少一个此类实施例中,钉仓可在切割构件狭槽的第一侧上包括三个缝钉排,并且在切割构件狭槽的第二侧上包括三个缝钉排。在某些实施例中,钉仓可包括奇数个缝钉排。例如,钉仓可在切割构件狭槽的第一侧上包括两个缝钉排,并且在切割构件狭槽的第二侧上包括三个缝钉排。在各种实施例中,缝钉排可包括具有相同或至少基本上相同的未成形缝钉高度的缝钉。在某些其它实施例中,一个或多个缝钉排可包括与其它缝钉具有不同的未成形缝钉高度的缝钉。在至少一个此类实施例中,例如切割构件狭槽的第一侧上的缝钉可具有第一未成形高度,并且切割构件狭槽的第二侧上的缝钉可具有第二未成形高度,所述第二未成形高度不同于所述第一高度。
现在参见图161A-161D,在各种实施例中,外科缝合器的端部执行器可包括:仓附接部(例如,钉仓通道5030);紧固件仓(例如,钉仓5000),可移除地位于钉仓通道5030中;以及钳口5040,与钉仓5000及钉仓通道5030相对地定位。钉仓5000可包括可压缩本体5010及多个缝钉5020、和/或至少部分地位于可压缩本体5010中的任何其它适宜的紧固件。在至少一个此类实施例中,每一缝钉5020可包括基部5022和从基部5022向上延伸的腿部5021,其中腿部5021的至少一部分可被嵌入仓体5010中。在各种实施例中,可压缩本体5010可包括顶面或组织接触表面5019及底部表面5018,其中底部表面5018可抵靠钉仓通道5030的支撑表面5031而定位并由支撑表面5031支撑。与上文相似,支撑表面5031例如可包括被限定在其中的多个支撑狭槽5032(图161D),所述多个支撑狭槽5032能够容纳并支撑缝钉5020的基部5022。在各种实施例中,外科缝合器的端部执行器还可包括保留矩阵(例如保留矩阵5050),所述保留矩阵能够接合缝钉5020并将组织捕获在保留矩阵与缝钉5020之间。在至少一个此类实施例中,保留矩阵5050能够可移除地安装到钳口5040。在使用中,一旦钉仓5000被定位在钉仓通道5030中,则钳口5040及附接到钳口5040的保留矩阵5050可朝钉仓5000和钉仓通道5030运动。在至少一个实施例中,钳口5040可沿轴线5099向下运动,使得当钳口5040闭合时,钳口5040及钉仓通道5030保持彼此平行或至少基本上平行。更具体地讲,在至少一个此类实施例中,钳口5040可被闭合,以使当钳口5040朝钉仓5000运动时,保留矩阵5050的组织接触表面5051平行于或至少基本上平行于钉仓5000的组织接触表面5019。
现在参见图161A,在各种实施例中,保留矩阵5050能够可拆卸地固定到钳口5040,使得当保留矩阵5050附接到钳口5040时,保留矩阵5050与钳口5040之间存在很小的(如果有的话)相对运动。在至少一个实施例中,钳口5040可包括一个或多个保留结构,所述一个或多个保留结构能够将保留矩阵5050保持就位。在至少一个此类实施例中,保留矩阵5050可搭扣配合和/或压配于钳口5040中。在某些实施例中,可利用至少一种粘合剂将保留矩阵5050粘附至钳口5040。在任何情形中,钳口5040可运动至其中保留矩阵5050接触组织T且组织T抵靠钉仓5000的组织接触表面5019而定位的位置中。当组织T被钳口5040定位成抵靠钉仓5000时,所述钉仓5000的可压缩本体5010可被钳口5040压缩或可不被其压缩。在两种情形中的任一种情形中,在各种实施例中,缝钉5200的腿部5021可不穿过钉仓5000的组织接触表面5019而突起,如图161A所示。此外,同样如图161A所示,在保留矩阵5050不接合缝钉5020的情况下,钳口5040能够抵靠可压缩本体5010来保持组织T。此类实施例可容许外科医生多次打开和闭合钳口5040,以便例如在不损坏组织T的情况下获得端部执行器在手术部位中的期望定位。然而,设想了其它实施例,其中缝钉末端5023能够在仓体5010被砧座5040压缩之前从组织接触表面5019突起。现在参见图161B,一旦端部执行器被适宜地定位,则钳口5040可朝钉仓通道5030向下运动,使得可压缩本体5010被砧座5040压缩,并使得组织接触表面5019相对于缝钉5020被向下推动。当组织接触表面5019被向下推动时,缝钉腿5021的末端5023可刺穿组织接触表面5019并刺穿组织T的至少一部分。在这种情形中,保留矩阵5050可定位在缝钉5020上方,使得保留矩阵5050的保留孔5052与缝钉腿5021的末端5023对齐或至少基本上对齐。
现在参见图161C,当沿轴线5099向下推动保留矩阵5050时,缝钉5020的缝钉腿5021可进入保留孔5052中。在各种实施例中,缝钉腿5021可接合保留孔5052的侧壁。在某些实施例中,如以下所更详细描述,保留矩阵可包括延伸至保留孔5052中和/或围绕保留孔5052的一个或多个保留构件,所述一个或多个保留构件能够接合缝钉腿5021。在两种情形中的任一种情形中,缝钉腿5021可被保持在保留孔5052中。在各种情形中,缝钉腿5021的末端5023可进入保留孔5052中并可带有摩擦地接合保留构件和/或孔5052的侧壁。当保留矩阵5050朝缝钉5020的基部5022被推动时,缝钉腿5021可相对于侧壁和/或保留构件进行滑动。作为上文的结果,缝钉腿5021与保留矩阵5050之间可产生滑动摩擦力,其中这种滑动摩擦力可抵抗保留矩阵5050插入至缝钉5020上。在各种实施例中,当保留矩阵5050沿缝钉5020的缝钉腿5021向下滑动时,保留矩阵5050与缝钉5020之间的滑动摩擦力可为恒定的或至少基本上恒定的。在某些实施例中,由于例如缝钉腿5021、保留孔5052、和/或延伸至保留孔5052中和/或围绕保留孔5052的保留构件在几何形状上的变化;当保留矩阵5050沿缝钉腿5021向下滑动时,滑动摩擦力可增大和/或减小。在各种实施例中,钉仓5000的可压缩本体5010也可抵抗保留矩阵5050插入缝钉5020中。更具体地讲,可压缩本体5010可例如由弹性材料构成,所述弹性材料可对保留矩阵5050施加抗力;当可压缩本体5010被压缩的距离增大时,所述抗力增大。在至少一个此类实施例中,由于仓体5010而使抗力产生的增大可与仓体5010被压缩的距离线性地成比例或至少基本上线性地成比例。在某些实施例中,由于仓体5010而使抗力产生的增大可与仓体5010被压缩的距离几何地成比例。
在各种实施例中,对上文进行进一步描述,可对钳口5040和保留矩阵5050施加足够的击发力,以克服上述抗力及摩擦力。在使用中,保留矩阵5050可相对于缝钉5020被安放至任何适宜的深度处。在至少一个实施例中,保留矩阵5050可相对于缝钉5020的基部5022被安放至一深度处,以便将两层或更多层组织固定到一起并在组织内产生压缩力或压力。在各种情形中,包括保留矩阵5050及缝钉5020的系统可容许外科医生通过选择保留矩阵5050被安放的深度来选择对组织施加的压缩力或压力的大小。例如,保留矩阵5050可朝缝钉5020的缝钉基部5022被向下推动,直至保留矩阵5050被安放至与支撑狭槽5032的底部相距特定深度5011为止,其中越浅的深度5011可产生施加至组织T的越高的压缩力或压力,而越深的深度5011可产生施加至组织T的越低的压缩力或压力。在各种实施例中,施加到组织T的压缩力或压力可与保留矩阵5050被安放的深度5011线性地成比例或至少基本上线性地成比例。在各种情形中,施加到组织T的压缩力或压力可取决于位于保留矩阵5050与钉仓5020之间的组织T的厚度。更具体地讲,对于给定的距离5011,较厚组织T的存在可比较薄组织T的存在产生更高的压缩力或压力。
在各种情形中,对上文进行进一步描述,外科医生可调整保留矩阵5050被安放的深度以导致位于端部执行器内的较厚和/或较薄的组织,并以与组织厚度无关的方式对组织T施加特定的或预定的压力。例如,当紧固较薄的组织T时,外科医生可将保留矩阵5050安放至较浅的深度5011,或当紧固较厚的组织T时将其安放至较深的深度5011,以便在组织内达到相同或至少基本上相同的压缩力。在某些实施例中,对上文进行进一步描述,外科医生可选择性地确定对位于保留矩阵5050与钉仓5010之间的组织T施加的压缩力的大小。在各种情形中,外科医生可将保留矩阵5050与缝钉5020接合,并将保留矩阵5050定位成与缝钉5020的基部5022相距第一距离,以便对组织施加第一压缩压力。作为另外一种选择,外科医生可将保留矩阵5050定位成与基部5022相距第二距离,所述第二距离短于所述第一距离,以便对组织施加大于第一压力的第二压缩压力。作为另外一种选择,外科医生可将保留矩阵5050定位成与基部5022相距第三距离,所述第三距离短于所述第二距离,以便对组织施加大于第二压力的第三压缩压力。在各种实施例中,包括保留矩阵5050及缝钉5020的紧固系统能够容许外科医生对靶组织施加宽范围的压缩压力。
现在参见图161D,在各种实施例中,缝钉腿5021可穿过保留矩阵5050而被插入,使得缝钉腿顶端5023延伸至保留矩阵5050的顶面上方。再次参见图161C,在至少一个实施例中,钳口5040还可包括被限定在其中的间隙孔5042,该间隙孔能够当缝钉腿末端5023穿过保留矩阵5050中的保留孔5052时容纳缝钉腿末端5023。在至少一个此类实施例中,间隙孔5042可与保留孔5052对齐,使得腿部5021不接触钳口5040。在各种实施例中,间隙孔5042可具有足够的深度,使得不论保留矩阵5050被安放的距离为何,缝钉腿5021均不接触钳口5040。现在参见图161D,在保留矩阵5050与缝钉5020接合并被安放到所需位置之后,钉仓通道5030及钳口5040可远离组织T而运动。更具体地讲,钉仓通道5030可从所植入的钉仓5000拆卸,并且砧座5040可从所植入的保留矩阵5050拆卸。当钳口5040远离保留矩阵5050而行进且缝钉支撑件5032远离缝钉基部5022而行进时,尽管钳口5040及钉仓通道5030不再对保留矩阵5050及基部5022提供支撑,然而仍可保持保留矩阵5050与基部5022的底部之间的距离5011。在各种实施例中,尽管被压缩的仓体5010和/或被压缩的组织T对保留矩阵5050施加偏置力,然而缝钉腿5021与保留矩阵5050之间的静摩擦力可足以将保留矩阵5050保持就位。在至少一个此类实施例中,仓体5010可由弹性材料构成,所述弹性材料在被压缩时可对保留矩阵5050和缝钉5020施加弹性偏置力,使得所述弹性偏置力趋于推动保留矩阵5050及缝钉5020以使其分开,然而这种运动受到缝钉腿5021与保留矩阵5050之间的摩擦接合的对抗。
在各种实施例中,如上所述,保留矩阵可包括多个保留孔,其中每一保留孔能够在其中容纳紧固件的腿部。在至少一个实施例中,现在参见图162,其中示出保留矩阵5150的一部分,该部分可包括由周边5156限定的保留孔5152。在各种实施例中,孔5152的周边5156可包括圆形或至少基本上圆形的外形和/或任何其它适宜的外形。在某些实施例中,保留矩阵5150可包括一个或多个保留构件(例如保留构件5153),所述一个或多个保留构件延伸至孔5152中并能够当紧固件支腿插入孔5152中时,所述孔5152接合该紧固件支腿。在至少一个此类实施例中,每一保留构件5153可包括朝中心轴线5159(即,朝孔5152的中心)向内延伸的悬臂。在各种实施例中,每一悬臂可包括第一端部和第二端部,所述第一端部附接到保留矩阵本体5158,所述第二端部形成保留孔5152的周边5156。在某些实施例中,保留孔5152的周边5156可由第一直径或宽度限定,并且紧固件支腿可由第二直径或宽度限定,其中所述第二直径可大于所述第一直径。在至少一个此类实施例中,紧固件支腿能够接触保留构件5153中的一者或多者并使其挠曲,以便在紧固件支腿插入保留孔5152中时使保留孔5152的直径增大。在某些实施例中,对上文进行进一步描述,紧固件支腿所限定的周边可大于保留孔5152的周边5156,使得当紧固件支腿插入周边5156中时,紧固件支腿可使周边5156扩展。
再次参见图162,在各种实施例中,孔5152可由可变形构件5153限定,其中每一可变形构件5153能够相对于或独立于其它可变形构件5153而挠曲。在至少一个此类实施例中,相邻的可变形构件5153可被狭槽5154分开,该狭槽能够容许每一可变形构件5153相对于其它可变形构件5153屈曲。在某些实施例中,每一狭槽5154可包括位于保留矩阵本体5158中的第一端部5155、开口至保留孔5152中的第二端部、以及在第一端部5155与第二端部之间延伸的恒定的或至少基本上恒定的宽度。在各种其它实施例中,每一狭槽5154的宽度可不一致,并且每一狭槽5154在其第一端部与第二端部之间的宽度可增大和/或减小。在某些实施例中,狭槽5154的第一端部5155可包括放大部(例如圆形部),所述放大部既可为附接到保留矩阵本体5158的可变形构件5153的基部提供张力释放,也可增大可变形构件5153的挠性。在各种实施例中,可变形构件5153和/或狭槽5154的几何形状可被选择成为可变形构件5153提供期望的挠性。在某些实施例中,例如狭槽5154可被加长,以形成更长的可变形构件5153,该更长的可变形构件可比具有较短长度的可变形构件5153更具挠性。在至少一个实施例中,每一可变形构件5153的宽度可被选择成为其提供期望的挠性。更具体地讲,具有较薄宽度的可变形构件可比具有较厚宽度的可变形构件更具挠性。再次参见图162,在某些实施例中,可变形构件5153的悬臂的附接到保留矩阵本体5158的第一端部可宽于悬臂的第二端部。在至少一个此类实施例中,悬臂可在其第一端部与第二端部之间以线性或至少基本上线性的方式逐渐变细。
再次参见图162,在各种实施例中,保留矩阵本体5158可包括具有组织接触表面5151及顶面5157的平的或至少基本上平的材料薄片。在至少一个此类实施例中,组织接触表面5151与顶面5157可相互平行或至少基本上相互平行。在各种实施例中,每一可变形构件5153可包括第一部分5153a和第二部分5153b,其中第一部分5153a可沿第一方向延伸,并且第二部分5153b可沿不同方向或第二方向延伸。在至少一个此类实施例中,保留矩阵本体5158可限定平面,并且可变形构件5153的第一部分5153a可位于此平面内。在各种实施例中,可变形构件5153的第二部分5153b可相对于第一部分5153a成角度地延伸。在至少一个此类实施例中,第二部分5153b可沿远离保留矩阵本体5158的顶面5157的方向延伸,并且在某些实施例中,第二部分5153b可朝保留孔5152的中心轴线5159会聚。在任何情形中,在各种实施例中,第二部分5153b能够当紧固件支腿穿过第二部分5153b而被插入时,第二部分5153b会远离中心轴线5159而挠曲。在其中缝钉5020的缝钉腿5021插入保留孔5152中的实施例中,可变形构件5153可沿大致远离缝钉5120的基部5122的方向变形。因此,在某些实施例中,可变形构件5153可沿与缝钉腿5021被插入的方向相同或至少基本上相同的大致方向挠曲。
再次参见图BD,在各种实施例中,可变形构件5153的第二部分5153b例如可分别包括锋利的顶端,所述锋利的顶端能够当缝钉腿5021插入其中时,所述顶端抵靠缝钉腿5021进行滑动。第二部分5153b的锋利末端也能够如果缝钉腿5021沿相反方向(即,将从保留孔5052移除缝钉腿5021的方向)被牵拉,则所述锋利末端咬合至缝钉腿5021中。在某些情形中,第二部分5153b可相对于缝钉腿5021的边倾斜大于90度的角度,因此当缝钉腿5021受到趋于从保留孔5052中撤出缝钉腿5021的力时,第二部分5153b可挖入或掘入缝钉腿5021的边中。在某些实施例中,缝钉腿5021可在其表面中包括压痕和/或腔(例如微压痕),所述压痕和/或腔能够例如在其中容纳可变形构件5053的末端。在至少一个此类实施例中,当对缝钉腿5021施加撤出力时,可变形构件5053的末端可被困于或掘入缝钉腿5021的压痕中。在各种实施例中,作为第二部分5153b掘入缝钉腿5021中的结果,为从保留孔5022中移除缝钉腿5021而作用的力可仅将第二部分5153b安放至缝钉腿5021中的更深处并增大移除缝钉腿5021期望的力。此外,由于第二部分5153b向上倾斜,因此在至少一个实施例中,第二部分5153b可更容许缝钉腿5021插入保留孔5152中且更抵抗缝钉腿5021的撤出。因此,在至少一个实施例中,将缝钉腿5021插入保留孔5022中期望的力可小于从保留孔5022中移除缝钉腿5021期望的力。在各种实施例中,例如从保留孔5022中移除缝钉腿5021期望的力可比将缝钉腿5021插入保留孔5022中期望的力约50%。在各种其它实施例中,例如移除缝钉腿5021期望的力可比插入缝钉腿5021期望的力约10%至约100%之间。在某些实施例中,例如移除缝钉腿5021期望的力可为插入缝钉腿5021期望的力的约100%、约150%、约200%、和/或比插入缝钉腿5021期望的力约200%。
再次参见图162,在某些实施例中,第二部分5153b可围绕孔5152沿圆周设置并可在第二部分5153b与孔5152之间限定凹坑。更具体地讲,第二部分5153b可限定凹坑5160,凹坑5160能够当紧固件支腿被插入保留孔5152中时,凹坑5160容纳紧固件支腿的末端。在各种实施例中,可变形构件5153的第二部分5153b可包括环形的或至少基本上环形的轮廓,所述轮廓例如可协作地限定凹坑1560的环形的或至少基本上环形的外形。在至少一个此类实施例中,第二部分5153b可限定锥形的或截头锥形的凹坑。在各种实施例中,凹坑可由适宜数目的可变形构件(例如四个可变形构件5153(图162)、六个可变形构件5153(图163)、或八个可变形构件5153(图164))限定。现在参见图165,在某些实施例中,保留矩阵(例如保留矩阵5250)的可变形构件例如可形成锥体形状或至少基本上为锥体的形状。在各种实施例中,保留矩阵5250例如可包括多个保留孔(例如保留孔5252),所述多个保留孔可由周边5256限定。在各种实施例中,周边5256可包括多边形的或至少基本上为多边形的外形和/或其它适宜的外形。在某些实施例中,保留矩阵5250可包括一个或多个保留构件(例如保留构件5253),所述一个或多个保留构件延伸至孔5252中并能够当紧固件支腿插入孔5252中时,所述孔5252接合该紧固件支腿。在至少一个此类实施例中,每一保留构件5253可包括朝中心轴线5259(即,朝孔5252的中心)向内延伸的悬臂。在各种实施例中,每一悬臂可包括第一端部和第二端部,所述第一端部附接到保留矩阵本体5258,所述第二端部形成保留孔5252的周边5256。在某些实施例中,保留孔5252的周边5256可由第一直径或宽度限定,并且紧固件支腿可由第二直径或宽度限定,其中所述第二直径可大于所述第一直径。在至少一个此类实施例中,紧固件支腿能够接触保留构件5253中的一者或多者并使其挠曲,以便在紧固件支腿插入保留孔5252中时使保留孔5252的直径增大。在某些实施例中,对上文进行进一步描述,紧固件支腿所限定的周边可大于保留孔5252的周边5256,使得当紧固件支腿插入周边5256中时,紧固件支腿可使周边5256扩展。
再次参见图165,在各种实施例中,孔5252可由可变形构件5253限定,其中每一可变形构件5253能够相对于或独立于其它可变形构件5253而挠曲。在至少一个此类实施例中,相邻的可变形构件5253可被狭槽5254分开,狭槽5254能够容许每一可变形构件5253相对于其它可变形构件5253屈曲。在各种实施例中,保留矩阵本体5258可包括具有组织接触表面5251及顶面5257的平的或至少基本上平的材料薄片。在至少一个此类实施例中,组织接触表面5251与顶面5257可相互平行或至少基本上相互平行。在各种实施例中,每一可变形构件5253可包括第一部分5253a和第二部分5253b,其中第一部分5253a可沿第一方向延伸,并且第二部分5253b可沿不同方向或第二方向延伸。在至少一个此类实施例中,保留矩阵本体5258可限定平面,并且可变形构件5253的第一部分5253a可位于此平面内。在各种实施例中,可变形构件5253的第二部分5253b可相对于第一部分5253a成角度地延伸。在至少一个此类实施例中,第二部分5253b可沿远离保留矩阵本体5258的顶面5257的方向延伸,并且在某些实施例中,第二部分5253b可朝保留孔5252的中心轴线5259会聚。在任何情形中,在各种实施例中,第二部分5253b能够当紧固件支腿穿过第二部分5253b而被插入时,第二部分5253b会远离中心轴线5259挠曲。再次参见图165,在某些实施例中,第二部分5253b可围绕孔5252沿圆周设置并可在第二部分5253b与孔5252之间限定凹坑。更具体地讲,第二部分5253b可限定凹坑,所述凹坑能够当紧固件支腿被插入保留孔5252中时,所述凹坑容纳紧固件支腿的末端。在各种实施例中,可变形构件5253的第二部分5253b例如可限定多边形或至少基本上为多边形的凹坑。在各种实施例中,凹坑可由适宜数目的可变形构件(例如可限定正方形的四个可变形构件5253(图165)、可限定六边形的六个可变形构件5253(图166)、或可限定八边形的八个可变形构件5253(图167))限定。
现在参见图168,在各种实施例中,保留矩阵(例如,保留矩阵5350)可由平的或至少基本上平的材料(例如,钛和/或不锈钢)薄片形成。在至少一个此类实施例中,可通过一个或多个冲压过程在保留矩阵5350的本体5358中形成多个孔5352。材料薄片可被定位在冲压模具中,所述模具在致动时可将材料的某些部分冲压出,以便形成例如狭槽5354、狭槽5354的孔5355、和/或保留孔5352的周边5356。冲压模具也能够将可变形构件5353弯曲成适宜的构型。在至少一个此类实施例中,冲压模具可使第二部分5353b沿折线5353c相对于第一部分5353a向上变形。现在参见图169,在各种实施例中,保留矩阵(例如保留矩阵5450)可包括多个保留孔5452。与上文相似,每一保留孔5452的周边5456可由被狭槽或狭缝5454间隔开的多个可变形构件5453限定。在至少一个此类实施例中,每一可变形构件5453的整体均可被向上弯曲,其中包括可变形构件5453的悬臂的自由端可限定周边5456。在各种实施例中,保留矩阵5450可包括围绕或至少基本上围绕保留孔5452的多个孔5455。在至少一个此类实施例中,孔5455可围绕或包围由可变形构件5453的悬臂的固定端限定的周边而被布置成圆形阵列。在某些实施例中,每一孔5455可包括圆形或至少基本上圆形的周边和/或任何其它适宜的周边。在使用中,孔5455既可为附接到保留矩阵本体5458的可变形构件5453的基部提供张力释放,又可增大可变形构件5453的挠性。在各种实施例中,较大的孔5455与较小的孔5455相比可使可变形构件5453更具挠性。此外,更靠近可变形构件5453的孔5455与更远的孔5455相比可提供更大的挠性。
现在参见图170,在各种实施例中,保留矩阵(例如,保留矩阵5550)可包括多个保留孔5552。每一保留孔5552均可包括细长狭槽5554,该细长狭槽具有放大的圆形或至少基本上圆形的末端5555。在至少一个此类实施例中,末端5555可由宽于狭槽5554的直径限定。在某些实施例中,细长狭槽5554和末端5555可沿纵向轴线5559定位和/或居中。在各种实施例中,狭槽5554及末端5555可限定两个相对的凸片5553,所述两个相对的凸片5553能够接合紧固件的腿部,并且在紧固件支腿穿过凸片5553而被插入时,所述两个相对的凸片5553会发生挠曲。在至少一个实施例中,具有越大周长或直径的末端5555可限定越长的凸片5553,所述凸片5553可比具有较小周长或直径的末端5555所限定的凸片5553更具挠性。在各种实施例中,末端5555可具有相同的周长及直径,并且在至少一个此类实施例中,每一凸片5553可关于与纵向轴线5559垂直或至少基本上垂直的轴线对称。作为另外一种选择,末端5555可具有不同的周长和/或直径,其中在至少一个实施例中,每一凸片5553可不关于其轴线对称。在至少一个这种可供选择的实施例中,当紧固件支腿穿过保留孔5552而被插入时,凸片5553可绕其轴线扭曲。现在参见图171,在各种实施例中,保留矩阵(例如保留矩阵5650)可包括多个保留孔5652。每一保留孔5652均可包括细长狭槽5654,该细长狭槽包括圆形或至少基本上圆形的末端5655。在至少一个此类实施例中,细长狭槽5654及末端5655可沿纵向轴线5659定位和/或居中。在各种实施例中,每一末端5655均可由与狭槽5654的宽度相同或至少基本上相同的直径限定。
现在参见图172,在各种实施例中,保留矩阵(例如,保留矩阵5750)可包括多个保留孔5752。每一保留孔5752可包括具有放大末端5755的多个狭槽(例如狭槽5754)。在至少一个此类实施例中,狭槽5754及末端5755可沿纵向轴线5759定位和/或居中。在各种实施例中,轴线5759可沿相互垂直或横跨的方向延伸。在某些实施例中,狭槽5754和末端5755可例如限定四个凸片5753,所述四个凸片5753能够接合紧固件支腿,并且当紧固件支腿穿过保留孔5752而被插入时,所述四个凸片5753发生挠曲。在至少一个实施例中,每一凸片5753可包括三角形的或至少基本上为三角形的构型(例如等边三角形)。现在参见图173,在各种其它实施例中,保留矩阵(例如保留矩阵5850)可包括多个保留孔5852。每一保留孔5852可包括具有末端5855的多个狭槽(例如狭槽5854),其中狭槽5854和末端5855可沿纵向轴线5859定位和/或居中。在各种实施例中,轴线5859可沿相互垂直或横跨的方向延伸。在某些实施例中,狭槽5854及末端5855可限定凸片5853,凸片5853能够接合紧固件支腿,并且当紧固件支腿穿过保留孔5852而被插入时,凸片5853发生挠曲。在至少一个实施例中,每一凸片5853可包括拱形的外形。更具体地讲,与图170中所示的尖的末端不同,每一凸片5853可包括弯曲的末端,所述末端能够接触紧固件支腿。
现在参见图174,在各种实施例中,保留矩阵(例如,保留矩阵5950)可包括多个保留孔5952。每一保留孔5952可包括多个狭槽(例如狭槽5954),其中每一狭槽5954可沿轴线5959延伸和/或居中。在各种实施例中,轴线5959可彼此横跨,并且在至少一个此类实施例中,轴线5959可被设置成使得所有轴线5959延伸穿过保留孔5952的中心且彼此等距地或至少基本上等距地间隔开。在至少一个实施例中,每一狭槽5954可包括面向保留孔5952的中心的开口端以及位于狭槽5954的相对末端处的第二端部或封闭端5955。与上文相似,狭槽5954及末端5955可例如限定三个凸片5953,所述三个凸片5953能够接合紧固件支腿,并且当紧固件支腿穿过保留孔5952而被插入时,所述三个凸片5953发生挠曲。在各种实施例中,每一凸片5953可包括在狭槽5954的相邻末端5955之间延伸的拱形构型。现在参见图175,在各种实施例中,保留矩阵(例如保留矩阵6050)可包括多个保留孔6052。每一保留孔6052可包括凸片6053,凸片6053能够接合紧固件支腿,并且当紧固件支腿被插入保留孔6052中时,凸片6053发生挠曲。在至少一个此类实施例中,凸片6053可包括固定到保留矩阵本体6058的基部以及包括拱形或弯曲外形6056的自由端,所述自由端能够接触紧固件支腿。在某些实施例中,紧固件支腿可为由圆形线材构成的缝钉腿,其中弯曲的外形6056能够与圆形线材的弯曲外表面匹配或至少基本上匹配。
再次参见图175,在各种实施例中,保留矩阵本体6058可包括多个狭槽6054和孔6055,所述多个狭槽6054和孔6055能够限定凸片6053和保留孔6052的各个部分。在至少一个实施例中,凸片6053可包括矩形构型,所述矩形构型包括平行的或至少基本上平行的边。现在参见图176,在某些实施例中,保留矩阵(例如保留矩阵6150)可包括多个保留孔6152。每一保留孔6152可包括凸片6153,该凸片能够接合紧固件支腿,并且当紧固件支腿被插入保留孔6152中时,该凸片发生挠曲。在至少一个此类实施例中,凸片6153可包括固定到保留矩阵本体6158的基部以及包括拱形或弯曲外形6156的自由端,所述自由端能够接触紧固件支腿。在各种实施例中,保留矩阵本体6158可包括多个狭槽6154及孔6155,所述多个狭槽6154及孔6155能够限定凸片6153及保留孔6152的各个部分。在至少一个实施例中,凸片6153可包括逐渐变细的构型,所述逐渐变细的构型包括拱形的边。在至少一个此类实施例中,凸片6153可几何地逐渐变细,例如使得基部宽于自由端。
在各种实施例中,如上所述,紧固系统可包括多个缝钉,所述多个缝钉包括穿过保留矩阵中的多个保留孔而被插入的缝钉腿。在某些实施例中,如以下所更详细地描述,缝钉可被保持在第一钳口中,并且保留矩阵可被保持在第二钳口中,其中第一钳口与第二钳口中的至少一者可朝另一者运动。在各种情形中,位于第一钳口中的缝钉可被固定于其中,使得当保留矩阵与缝钉腿接合时,缝钉腿与保留孔对齐。参见图177和图178,在某些实施例中,紧固件系统可包括例如位于外科缝合器的第一钳口中的钉仓6200以及例如位于外科缝合器的第二钳口中的保留矩阵6250。现在参见图184和图185,对上文进行进一步描述,保留矩阵6250可包括多个保留孔6252,其中每一保留孔6252可包括由一个或多个可挠曲构件6253限定的周边6256。在至少一个此类实施例中,对上文进行进一步描述,用于限定每一孔6252的可挠曲构件6253可限定凹坑6201。在各种实施例中,每一凹坑6201可包括例如弯曲和/或凹形表面,所述弯曲和/或凹形表面例如能够在缝钉腿与保留孔6252未对齐并首先接触可挠曲构件6253和/或组织接触表面6251的情形中将缝钉腿的末端引导至孔6252中。
在各种实施例中,对上文进行进一步描述,紧固系统还可包括多个缝钉6220,所述多个缝钉6220包括可穿过保留矩阵6250中的保留孔6252而被插入的缝钉腿6221。在至少一个此类实施例中,每一缝钉6220可包括例如基本上为U形的构型,所述构型包括基部6222,所述缝钉腿6221可从基部6222向上延伸。现在参见图180和图181,在各种实施例中,保留矩阵6250中的保留孔6252可被布置成例如两个平行的或至少基本上平行的纵行,所述纵行可沿保留矩阵的纵向轴线或平行于所述纵向轴线延伸。在某些实施例中,第一行中的保留孔6252可相对于第二行中的保留孔6252偏移或错列。在至少一个此类实施例中,每一缝钉6220可包括位于第一行的保留孔6252中的第一缝钉腿6221以及位于第二行的保留孔6252中的第二缝钉腿6221,其中作为结果,基部6222可沿横跨保留矩阵6250的纵向轴线的方向延伸。在至少一个此类实施例中,缝钉6220可相互平行或至少基本上相互平行。更具体地讲,例如缝钉6220a的基部6222a可平行于或至少基本上平行于缝钉6220b的基部6222b,所述缝钉6220b的基部6222b可平行于或至少基本上平行于缝钉6220c的基部6222c。在至少一个实施例中,例如缝钉6220a的缝钉腿6221a所限定的平面可平行于或至少基本上平行于缝钉6220b的缝钉腿6221b所限定的平面,并且缝钉6220b的缝钉腿6221b所限定的平面可平行于或至少基本上平行于缝钉6220c的缝钉腿6221所限定的平面。
现在参见图177和179,在各种实施例中,钉仓6200可包括多个缝钉6220以及包括多个对齐引导件(例如,狭槽、沟槽、和/或孔)的对齐矩阵6260,所述多个对齐引导件能够对齐缝钉6220。在各种情形中,对齐矩阵6260能够使得在保留矩阵6250接合缝钉腿6221之前,缝钉6220的缝钉腿6221与保留矩阵6250中的保留孔6252对齐。现在参见图182和图183,在各种实施例中,对齐矩阵6260可包括多个对齐孔6262,所述多个对齐孔6262能够紧密地容纳缝钉6220的缝钉腿6221。在至少一个此类实施例中,每一缝钉6220可包括基部6222和从基部6222延伸的两个缝钉腿6221,其中缝钉6220的基部6222可围绕保留矩阵6260的底部表面6264延伸,并且缝钉腿6221可穿过对齐孔6262而向上延伸。在某些实施例中,每一对齐孔6262可为圆形的或至少基本上圆形的,并且限定对齐孔6262的直径可等于或稍大于穿过其中而延伸的缝钉腿6221的直径。在各种实施例中,对齐矩阵6260还可包括多个凸起的构件6263,所述多个凸起的构件6263可从对齐矩阵6260的顶面6261向上延伸并围绕或至少部分地围绕对齐孔6262。在某些实施例中,凸起的构件6263可提供更长的对齐孔6262,其中在各种情形中,较长的孔6262可比较短的孔6262更好地控制缝钉腿6221的对齐。
在使用中,在各种实施例中,支撑钉仓6200的第一钳口可位于将被缝合的组织的一侧上,并且支撑保留矩阵6250的第二钳口可被定位在组织的另一侧上。在某些实施例中,一旦钳口相对于组织被适当地定位,则第二钳口及保留矩阵6250可朝钉仓6200运动。在各种实施例中,当缝钉腿6221穿过保留矩阵6250的保留孔6252而被插入时,保留矩阵6250的组织接触表面或底部表面6251可接触组织并将组织压抵于对齐矩阵6260的组织接触表面或顶面6261上。在各种其它实施例中,如以下将更详细地描述,钉仓6200还可例如包括位于对齐矩阵6260的顶面6261上方并可接触组织的可压缩仓体。再次参见图179和图183,在某些实施例中,对齐矩阵6260还可包括被限定在其中的一个或多个孔6203;当对齐矩阵6260抵靠组织而定位时,所述一个或多个孔6203能够在其中容纳组织的一部分。在其中可压缩仓体位于对齐矩阵6260上方和/或抵靠对齐矩阵6260的实施例中,当仓体被压缩时,可压缩仓体的一部分可进入孔6203中。相似地,保留矩阵6250可包括多个孔6202,所述多个孔6202能够当保留矩阵6250抵靠组织而定位时,所述多个孔6202在其中容纳组织的至少一部分。
对上文进行进一步描述,当缝钉6220的缝钉腿6221穿过保留矩阵6250的保留孔6252而被插入时,缝钉腿6221的顶端可从保留矩阵6250的顶面6257向上突起。在各种情形中,如上所述,缝钉腿6221的末端可在穿过保留孔6252而被插入之后保持未弯曲。现在参见图186-189,在某些实施例中,包括钉仓6200及保留矩阵6250的紧固系统可包括多个保护性帽或覆盖件(例如帽6270),所述多个保护性帽或覆盖件可安装至突起于保留矩阵6250上方的缝钉腿6221。在各种实施例中,每一帽6270可完全或至少部分地覆盖缝钉腿6221的锋利末端,使得所述锋利末端不会接触与其相邻的组织。现在参见图189,在至少一个实施例中,每一帽6270可包括被限定在其中的孔6271,该孔能够在其中紧密地容纳缝钉腿6221的末端。在各种实施例中,帽6270可由弹性材料(例如硅氧烷、聚异戊二烯、Sanoprene、和/或天然橡胶)构成。在至少一个实施例中,孔6271的周长或直径可小于插入其中的缝钉腿6221的周长或直径。在至少一个此类实施例中,保护性帽6270中的孔6271可扩展以在其中容纳缝钉腿6221。在各种可供选择的实施例中,帽6270可不包括孔,并且缝钉腿6221的末端能够当腿部6221插入帽6270时,所述末端切开帽6270。在任何情形中,在各种实施例中,每一帽6270均可被安放至缝钉腿6221上,直至帽6270的基部6272邻接或邻近保留矩阵6250的顶面6257而定位为止。在各种情形中,帽6270能够使得其被紧密地安放至缝钉腿6221的末端上,以使其不会轻易地从所述末端上被移除。在某些实施例中,每一帽6270可例如包括锥形的或至少基本上为锥形的外表面。在各种实施例中,帽6270可包括任何适宜的形状,例如包括抛物线形或至少基本上为抛物线形的外表面的形状。
在各种实施例中,例如可使用图190-192中所示的外科缝合器来部署例如上述紧固件系统。在各种实施例中,端部执行器可包括第一钳口或钉仓通道6230和第二钳口6240,第一钳口或钉仓通道6230能够将钉仓6200支撑在其中,并且第二钳口6240能够支撑保留矩阵6250及所述多个保护性帽6270。主要参见图190,其示出处于打开构型的第二钳口6240,钳口6230和6240可相对于组织T被定位成使得组织T位于保留矩阵6250与钉仓6200之间。在各种实施例中,如上所述,钉仓6200还可包括可压缩仓体(例如仓体6210),所述可压缩仓体中可定位有缝钉6220和对齐矩阵6260。在至少一个此类实施例中,组织T可抵靠仓体6210的顶面而定位。在某些实施例中,第二钳口6240可包括多个凹陷部或孔6245以及一个或多个保留结构或保持器,所述多个凹陷部或孔6245能够容纳多个保护性帽6270,并且所述一个或多个保留结构或保持器能够相对于帽6270将保留矩阵6250保持就位。在至少一个此类实施例中,保留矩阵6250能够将帽6270保持在孔6245中。现在参见图202,在各种实施例中,每一孔6245均能够将帽6270的一部分或全部容纳在其中。在某些实施例中,孔6245的尺寸被足够地设定成且能够例如使得可通过压配和/或搭扣配合结构中的至少一者将帽6270固定于孔6245中。在某些实施例中,可利用至少一种粘合剂来将帽6270固定于孔6245中。在至少一个此类实施例中,这种粘合剂可被选择成使得在帽6270接合缝钉腿6221且第二钳口6240远离已植入的紧固件组件运动之后,帽6270可从第二钳口6240拆卸。现在参见图203,在某些实施例中,第二钳口6240还可包括至少一个覆盖薄片6246,所述至少一个覆盖薄片6246可组装至第二钳口6240并可在帽6270上方延伸且将帽6270保持在孔6245中。在至少一个此类实施例中,例如可利用至少一种粘合剂将覆盖薄片6246的至少一部分固定到钳口6240。在使用中,在至少一个实施例中,在端部执行器被插入手术部位之前,覆盖薄片6246可至少部分地从钳口6240拆卸。在某些实施例中,覆盖薄片6246可由可植入材料(例如PDS和/或PGA)构成,当缝钉腿6221从保留矩阵6250暴露时,所述可植入材料可被缝钉腿6221切开。在至少一个此类实施例中,覆盖薄片6246可在覆盖件6270与保留矩阵6250之间被固定于紧固系统中。
现在参见图191,对上文进行进一步描述,钳口6240可从打开位置运动到闭合位置,在闭合位置中,组织T抵靠保留矩阵6250及仓体6210而定位。在这种位置中,保留矩阵6250可不接合缝钉6220。在各种实施例中,钳口6240可通过致动器6235而在其打开位置与其闭合位置之间运动。在至少一个此类实施例中,钳口6240可包括自其延伸的远侧销6243和近侧销6244,其中远侧销6243可在限定在仓通道6230中的远侧狭槽6233内垂直地或至少基本上垂直地滑动,并且其中近侧销6244可在同样限定在钉仓通道6230中的近侧狭槽6234内垂直地或至少基本上垂直地滑动。在使用中,致动器6235可朝近侧缩回,以将销6243和6244驱动至其相应的狭槽6233和6234的上端中,如图191所示。在至少一个此类实施例中,致动器6235可包括远侧驱动狭槽6236和近侧驱动狭槽6237,其中驱动狭槽6236和6237的侧壁能够分别接触远侧销6243和近侧销6244,并在致动器6235朝近侧运动时向上驱动销6243和6244。更具体地讲,当致动器6235朝近侧运动时,远侧销6243可使远侧驱动狭槽6236的倾斜的第一部分6236a向上滑动至中间部分或第二部分6236b中;相似地,近侧销6244可使远侧驱动狭槽6237的倾斜的第一部分6237a向上滑动至中间部分或第二部分6237b中。当销6243和6244两者均向上运动时,钳口6240可朝组织T向下旋转至闭合位置。
现在参见图192,对上文进行进一步描述,致动器6235可进一步朝近侧被拉动,以朝第一钳口6230向下推动第二钳口6240、压缩仓体6210、并使保留矩阵6250及多个保护性帽6270与缝钉6220的缝钉腿接合。在至少一个此类实施例中,致动器6235的额外的近侧运动可使驱动狭槽6236和6237的侧壁分别接触销6243和6244并分别朝狭槽6233和6234的底端向下驱动销6243和6244。在这种情形中,致动器6235可朝近侧被牵拉,使得远侧销6243离开驱动狭槽6236的第二部分6236b并进入倾斜的第三部分6236c,并且相似地,近侧销6244离开驱动狭槽6237的第二部分6237b并进入倾斜的第三部分6237c。当销6243和6244两者均向下运动时,第二钳口6240可朝第一钳口6230向下运动至击发位置。在至少一个此类实施例中,第二钳口6240可向下运动,使得保留矩阵6250保持平行于或至少基本上平行于仓体6210的顶面和/或平行于或至少基本上平行于对齐矩阵6260。在任何情形中,一旦保留矩阵6250及保护性帽6270接合缝钉6220的缝钉腿6221,如图194所示,则第二钳口6240可返回至打开的或至少基本上打开的位置。在至少一个此类实施例中,致动器6235可朝远侧被推动,以将销6243和6244分别驱动至狭槽6233和6234的末端,并且随后一旦销穿过相应的驱动狭槽6236和6237的中间部分6236b和6237b,则致动器6235朝狭槽6233和6234的底端被向下驱动。一旦第二钳口6240被打开,则第一钳口6230可从已植入的钉仓6200拆卸,并且第一钳口6230和第二钳口6240可远离已植入的紧固件组件而被移除,如图193所示。
再次参见图192,读者应注意,尽管保留矩阵6250和帽6270已接合缝钉腿6221,然而图中并未将销6243及6244示出为被安放于其相应狭槽6233及6234的最底部中。当厚的组织T位于保留矩阵6250与仓体6210之间时会发生这种情形。现在参见图195,在其中薄的组织T位于保留矩阵6250与仓体6210之间的情形中,销6243和6244可进一步被向下驱动至其相应的狭槽6233和6234中,如图197所示。一般来讲,在至少一个此类实施例中,致动器6235可朝近侧被牵拉,以便通过上述和图195-197所示的进程来向上及向下驱动销6243和6244,并且由于组织T较薄,保留矩阵6250及保护性帽6270可进一步被驱动至缝钉6220的缝钉腿6221上,如图198和图199所示。在各种实施例中,作为保留矩阵6250所提供的可调整性的结果,无论捕获在端部执行器内的组织是厚的还是薄的,均可在所紧固的组织中获得相同的或至少基本上相同的压缩压力。在某些实施例中,保留矩阵6250所提供的可调整性可容许外科医生通过选择保留矩阵6250被安放的深度来选择对组织施加较大的压缩压力还是较小的压缩压力。在至少一个此类实施例中,保留矩阵6250可被安放至缝钉腿6221上的范围例如可通过狭槽6233和6234的长度或范围确定。
在各种实施例中,如上所述,保护性帽6270可由例如能够抓紧缝钉腿6221的末端的柔软的或挠性的材料构成。在某些实施例中,保护性帽6270可由可生物吸收的塑料(例如以商品名Vicryl出售的聚乙醇酸(PGA)、聚乳酸(PLA或PLLA)、聚对二氧环己酮(PDS)、聚羟基链烷酸酯(PHA)、以商品名Monocryl出售的聚卡普隆25(PGCL)、聚己内酯(PCL)、和/或PGA、PLA、PDS、PHA、PGCL、和/或PCL的复合物)和/或生物相容性金属(例如钛和/或不锈钢)构成。如图189所示,在至少一个实施例中,每一帽6270可不连接至其它帽6270。在某些其它实施例中,一个或多个帽6270可被安装至保留矩阵6250。在至少一个此类实施例中,帽6270可例如通过至少一种粘合剂连接到保留矩阵6250,其中帽6270中的孔6271可与保留矩阵6270中的保留孔6252对齐或至少基本上对齐。现在参见图200,在各种实施例中,保护性帽(例如帽6370)可限定内腔或穹窿6374,内腔或穹窿6374可例如能够将缝钉腿6221的末端容纳在其中。在至少一个此类实施例中,帽6370可包括底部6372和延伸穿过底部6372的孔6371。在各种实施例中,孔6371可由一个或多个可挠曲的构件6373限定,所述一个或多个可挠曲的构件6373能够当缝钉腿6221穿过其中而被插入时,所述一个或多个可挠曲的构件6373可发生挠曲。在某些实施例中,例如两个或更多个帽6370可连接在一起以形成帽6370的阵列。现在参见图201,在至少一个此类实施例中,多个帽6370可通过材料薄片6375而连接在一起。在某些实施例中,薄片6375可具有足够的刚性以便保持帽6370的期望的排列和/或对齐方式。在至少一个实施例中,帽6370可由生物相容性金属(例如钛和/或不锈钢)构成,并且薄片6375可由可生物吸收的塑料(例如以商品名Vicryl出售的聚乙醇酸(PGA)、聚乳酸(PLA或PLLA)、聚对二氧环己酮(PDS)、聚羟基链烷酸酯(PHA)、以商品名Monocryl出售的聚卡普隆25(PGCL)、聚己内酯(PCL)、和/或PGA、PLA、PDS、PHA、PGCL、和/或PCL的复合物)构成。在各种实施例中,薄片6375可由其中存储和/或分散有抗菌剂(例如胶体银和/或三氯生)的可生物吸收的材料构成,例如在薄片6375被生物吸收时,所述抗菌剂可被释放。
在各种实施例中,对上文进行进一步描述,例如可利用注模方法将薄片6375注模于帽6370周围,使得帽6370被嵌入薄片6375中。在某些其它实施例中,例如可利用注模方法来模制薄片6375,其中例如在注模方法期间和/或注模方法之后,可利用冲压方法在薄片6375中形成孔6376。在两种情形中的任一种情形中,可将帽6370插入孔6376中并利用压配和/或搭扣配合互连方法和/或至少一种粘合剂将其固定于孔6376中。在某些实施例中,每一帽6370可包括围绕或至少部分地围绕帽6370周边的环形沟槽,所述环形沟槽能够将孔6376的周边容纳在其中。在某些实施例中,薄片6375可由能够容许帽6370之间进行相对运动的挠性和/或柔韧材料构成。在至少一个此类实施例中,挠性薄片6375可由例如橡胶、塑料、和/或硅氧烷材料构成,并且帽6370可由刚性材料(例如金属)构成。在至少一个此类实施例中,与上文相似,可将挠性材料模制于帽6370周围。在某些实施例中,例如可将帽6370按压至预先模制的薄片6375中。在各种实施例中,可将挠性材料的硬度选择成提供薄片6375期望的刚度。在某些实施例中,薄片6375能够使其包括挠性的带。在任何情形中,薄片6375可有利于将帽6370组装至端部执行器中,这是因为可同时将多个帽6370定位和/或对齐于端部执行器中。此外,用于连接帽6370的薄片6375一旦被植入,则可例如沿缝钉线来强化或支持缝钉。除用于连接帽6370的薄片之外或作为所述薄片的替代,帽6370可通过多个链节连接在一起。在至少一个此类实施例中,这种链节可为挠性的并可容许帽6370之间进行相对运动。
现在参见图204和205,在各种实施例中,保护性帽(例如,帽6470)可包括成形表面,所述成形表面能够使缝钉腿的顶端变形。在至少一个此类实施例中,帽6470可包括基部6472,该基部可包括延伸穿过其中的孔6471。在各种实施例中,孔6471能够将缝钉腿(例如缝钉腿6221)紧密地容纳在其中。在至少一个此类实施例中,限定孔6471的直径或周长可等于或大于缝钉腿6221的直径或周长。在各种实施例中,帽6470还可包括腔或穹窿6474,该腔或穹窿能够当缝钉腿6221被插入帽6470中时容纳缝钉腿6221的末端。主要参见图205,帽6470还可包括砧座或成形表面6473,该砧座或成形表面能够使缝钉腿6221挠曲并变形。在某些情形中,成形表面6473例如可为弯曲的和/或凹形的,并能够当缝钉腿6221被插入帽6470时使缝钉腿6221卷曲。在某些实施例中,缝钉腿6221可被充分地变形以使其无法穿过孔6471而被撤出,因此帽6470可被锁定至缝钉腿6221。在至少一个此类实施例中,帽6470的基部6472可限定围绕孔6471而延伸的唇缘,所述唇缘可防止已变形的缝钉腿6221从腔6474中被移除。在各种情形中,作为上文的结果,一个或多个帽6470可防止或抑制保留矩阵(例如保留矩阵6250)从缝钉6220倒退或脱离。在各种实施例中,尽管未示出,然而帽6470可对称地或至少基本上对称地形成,并且孔6471可沿穿过帽6470延伸的中心轴线6479定位。再次参见图204,在各种可供选择的实施例中,孔6471可相对于中心轴线6479偏移。在至少一个此类实施例中,偏移的孔6471可容许缝钉腿6221接触成形表面6473的一侧并卷曲到成形表面6473的另一侧,而不是接触成形表面6473的中心,如在上述包括居中设置的孔6471的实施例中可能发生的一样。
在各种实施例中,如上所述,保留矩阵(例如,保留矩阵6250)可由材料薄片及穿过所述材料薄片而延伸的多个保留孔6252构成。在至少某些实施例中,构成保留矩阵6250的材料薄片可为刚性的或基本上不可挠曲的。在某些其它实施例中,保留矩阵可由保留矩阵元件的阵列以及用于连接所述保留矩阵元件的多个挠性连接件或链节构成。现在参见图206,在各种实施例中,保留矩阵或保留矩阵6550的一部分可包括多个元件本体6505,所述多个元件本体6505可由一个或多个连接链节6507连接在一起。在至少一个实施例中,每一元件本体6505均可包括多个可变形构件6553,所述多个可变形构件6553可在其中限定保留孔6552。在某些实施例中,保留矩阵6550的元件本体6505及连接链节6507可形成为一体并可包括一体式材料块。在各种实施例中,保留矩阵6550可例如由金属材料(例如钛和/或不锈钢)冲压或浇铸而成。在至少一个实施例中,保留矩阵6550可由塑料(例如,聚醚醚铜(PEEK)、以商品名缝线(Prolene)出售的聚丙烯、以商品名Ethibond和Mersilene出售的聚对苯二甲酸乙二醇酯、聚偏二氟乙烯、聚偏二氟乙烯-共-六氟丙烯、以商品名Pronova出售的聚六氟丙烯-VDF、和/或以商品名Ethilon&Nurolon出售的长链脂肪族聚合物尼龙6及尼龙6,6)构成,并可例如通过注模方法形成。在某些实施例中,元件本体6505可不与连接链节6507形成一体。在各种实施例中,可产生多个单一的元件本体6505,所述多个单一的元件本体6505随后被连接在一起并被嵌入保留矩阵中。在至少一个此类实施例中,元件本体6505可由金属材料(例如钛和/或不锈钢)冲压而成并被放置于塑料注射模具中,其中可将塑料材料注入模具中以形成围绕或至少部分地围绕元件本体6505的边缘6506和从边缘6506延伸的连接链节6507。在某些其它实施例中,一个或多个连接件点阵可被形成为包括限定在多个边缘6506中的孔,其中每一这种孔均能够将元件本体6505容纳在其中。在至少一个实施例中,每一元件本体6505可包括圆形的或至少基本上为圆形的外周边;相似地,每一边缘6506中可限定有圆形的或至少基本上为圆形的孔,其中所述孔的直径可等于或小于元件本体6505的直径。在至少一个此类实施例中,元件本体6505可压配或嵌入边缘6505中的孔中。在某些实施例中,可利用至少一种粘合剂将元件本体6505固定于孔中。
在某些实施例中,对上文进行进一步描述,保留矩阵可包括多个元件本体6505以及多个连接链节6507,所述多个连接链节6507可以任何适宜的阵列(例如,图207-210所示者)来连接元件本体6505。不论阵列的图案为何,在各种实施例中,连接链节6507能够容许元件本体6505与保留孔6552相对于彼此进行运动。在至少一个此类实施例中,构成保留矩阵6550的元件本体6505及连接链节6507的点阵一旦与组织接合便能够拉伸、扭曲、塌缩、和/或换句话讲屈曲,以便容许组织内的至少一些运动而同时抵抗组织进行较大的运动。在各种实施例中,每一连接链节6507可包括挠性构件,所述挠性构件能够拉伸、扭曲、和/或塌缩,以便例如容许保留矩阵6550在保留矩阵元件6505之间屈曲。再次参见图206,限定自边缘6506延伸的每一链节6507的宽度可窄于元件本体6505和/或边缘6506的宽度。参见图207-210,在某些实施例中,一个或多个链节6507可包括直的部分,所述直的部分例如沿相邻的元件本体6506之间的线延伸。在至少一个此类实施例中,每一链节6507可包括附接到第一边缘6506的第一端部和附接到第二边缘6506的第二端部。再次参见图206,在某些实施例中,两个或更多个链节6507可彼此连接。在至少一个此类实施例中,例如两个或更多个链节6507可被连接于中间铰链6509处。在各种实施例中,例如铰链6509的横截面厚度与链节6507的横截面厚度相比可沿一个或多个方向减小,这可容许相连的链节6507相对于彼此运动。在某些实施例中,保留矩阵6550还可包括铰链6508,铰链6508可将链节6507连接到边缘6506并容许链节6507与边缘6506之间相对运动。与铰链6509相似,例如铰链6508的横截面厚度与链节6507的横截面厚度相比可沿一个或多个方向减小。
在各种实施例中,对上文进行进一步描述,相连的链节6507可沿不同的方向延伸。在至少一个此类实施例中,第一链节6507可沿第一方向延伸,并且第二链节6507可沿第二方向延伸,其中所述第一方向可不同于所述第二方向。在某些实施例中,第一链节6507可沿第一线延伸,并且第二链节6507可沿第二线延伸,其中所述第一线与所述第二线可成角度(例如约30度、约45度、约60度、和/或约90度)地相交。在各种实施例中,铰链6508和/或铰链6509可包括活动铰链,所述活动铰链可容许链节6507相对于彼此多次运动而不会断裂。在某些实施例中,铰链6508和/或铰链6509可包括易碎或易断裂的部分,所述易碎或易断裂的部分可在过度屈曲和/或过多次数地屈曲时断裂。在至少一个此类实施例中,这种易碎部可容许保留矩阵6550的一个或多个部分与保留矩阵6550的另一部分断开。在各种实施例中,铰链6508和/或铰链6509例如可包括保留矩阵6550的比保留矩阵6550的其它部分更容易切割的段。更具体地,已植入的保留矩阵及由已植入的保留矩阵紧固的组织可时常出于各种原因被切割构件切开,并且为了有利于进行这种横切,铰链6508和/或铰链6509例如可提供途径或薄的段,切割构件可穿过所述途径或薄的段更容易地穿过保留矩阵6550。在各种实施例中,对上文进行进一步描述,连接链节6507可包括例如限定在其中的一个或多个铸造结构或材料镦锻,所述一个或多个铸造结构或材料镦锻可有利于连接链节6507的弯曲、断裂、和/或切割。
在各种实施例中,保留矩阵可包括多个保留矩阵元件(例如,矩阵元件本体6505),所述多个保留矩阵元件可嵌入挠性材料薄片或材料带中。在至少一个实施例中,挠性材料薄片可由可生物吸收的弹性体材料(例如硅氧烷)形成,其中所述挠性薄片可产生有限定在其中的多个孔。在至少一个此类实施例中,可模制出实心的挠性薄片并在所述挠性薄片中穿孔形成多个孔。在各种可供选择的实施例中,可模制挠性薄片并在模制过程中形成限定在其中的孔。在两种情形中的任一种情形中,保留矩阵元件6505例如可被插入并保持在挠性薄片中。在某些其它实施例中,与上文相似,挠性薄片可形成于矩阵元件6505周围。在至少一个实施例中,挠性薄片可例如由机织网和/或任何其它适宜的材料构成。对上文进行进一步描述,这种机织网可易于横切。
现在参见图211和212,在各种实施例中,包括保留矩阵(例如,保留矩阵6250)的紧固件系统还可包括覆盖件(例如,覆盖件6670),当缝钉腿6221的顶端延伸至保留矩阵6250的顶面6257上方时,所述覆盖件可覆盖所述顶端。在各种实施例中,覆盖件6670可附接到保留矩阵6250。在某些实施例中,覆盖件6670和/或保留矩阵6250可包括保留结构,所述保留结构能够将覆盖件6670保持到保留矩阵6250。在至少一个实施例中,可利用至少一种粘合剂将覆盖件6670粘附到保留矩阵6250。在至少一个实施例中,覆盖件6670可由单个层构成,然而覆盖件6670被示出为包括两个层,如以下所更详细地描述。主要参见图212,在各种实施例中,缝钉腿6221的顶端可延伸穿过覆盖件6670的底部表面6673;然而,覆盖件6670可包括足够的厚度,以使缝钉顶端不会延伸穿过覆盖件6670的顶面6675。因此,在至少一个此类实施例中,缝钉腿6221的末端可不从覆盖件6670突起。在各种实施例中,覆盖件6670可包括多个层。在至少一个此类实施例中,覆盖件6670可包括第一层6671和第二层6672。在至少一个实施例中,第一层6671和第二层6672可相互附接,其中在至少一个实施例中,第二层6672可包括附接到第一层6671的底部表面6676。在各种实施例中,第一层6671和第二层6672可包括不同的厚度,而在某些实施例中,其可包括相同的厚度。在至少一个实施例中,第一层6671和第二层6672可包括基本上相同的宽度和/或长度。在可供选择的实施例中,层6671和6672可包括不同的宽度和/或长度。
在各种实施例中,对上文进行进一步描述,第一层6671可由能够被缝钉腿6211切开的可压缩泡沫、网状材料、和/或水凝胶构成。在至少一个实施例中,第二层6672可由更坚韧的材料或皮肤(例如PGA和/或PDS)和/或任何适宜的支撑材料构成。在至少一个此种实施例中,缝钉腿6221能够穿透第一层6671;然而,在各种实施例中,缝钉腿6221可无法穿透第二层6672。在某些实施例中,第二层6672可由具有足够弹性和/或韧性的材料构成,所述材料可容许第二层6672被缝钉腿6221接触并移位,但不被缝钉腿6221的缝钉末端切割或仅被少量地切割。尽管图中未示出,然而覆盖件可包括不止两个层,其中这些层中的一者或多者可为耐渗透的。在至少一个此类实施例中,在使用中,保留矩阵6250可抵靠组织而定位并被紧固且朝远侧推动,使得缝钉6220的缝钉腿6221穿过组织T及保留矩阵6250中的保留孔6252而被推动,并进入覆盖件6270的第一层6271中。在各种实施例中,缝钉腿6221的末端可不进入或至少基本上不进入覆盖件6270的第二层6272中。在保留矩阵6250被适当地定位之后,钳口6240可被打开,并且覆盖件6670及保留矩阵6250可从钳口6240拆卸,如图211所示。如图211所示,钳口6640能够保持不止一个保留矩阵6250及覆盖件6670。在至少一个此类实施例中,钳口6640可包括两个通道6679,所述两个通道6679可分别能够在其中容纳覆盖件6670以及相对于覆盖件6670而定位的保留矩阵6250,使得每一保留矩阵6250的组织接触表面6251从钳口6240的底部向下靠。在至少一个此类实施例中,保留矩阵6250及覆盖件6270可在刀狭槽6678的每一侧上容纳在钳口6640中。在使用中,保留矩阵6250及覆盖件6670两者可同时被部署和/或相对于穿过其而定位的相对的钉仓(例如仓6200)被部署于相同的深度处。随后,在各种实施例中,可由横贯刀狭槽6678的切割构件沿切割线切开被紧固的组织,其中钳口6640可随后被再次打开。在某些实施例中,覆盖件6670可不附接到保留矩阵6250。在至少一个此类实施例中,覆盖件6670可被定位在通道6679中并可通过能够被固定到钳口6640的保留矩阵6250而被保持在通道6679中。在各种实施例中,每一保留矩阵6250可宽于和/或长于其相应的覆盖件6670,使得保留矩阵6250可将其覆盖件6670的整体保持就位。在某些实施例中,每一保留矩阵6250可例如与其相应的覆盖件6670包括相同的宽度和/或长度。
在各种实施例中,如上所述,紧固件系统可包括能够附接到保留矩阵(例如,保留矩阵6250)的材料层。现在参见图215,在至少一个实施例中,材料层6870可附接到保留矩阵6250的底部表面6251。在某些实施例中,层6870和/或保留矩阵6250可包括保留结构,所述保留结构能够将层6870保持到保留矩阵6250。在至少一个实施例中,可利用至少一种粘合剂将层6870粘附到保留矩阵6250。在任何情形中,层6870可包括底部表面或组织接触表面6873,底部表面或组织接触表面6873能够当保留矩阵6250朝缝钉6220向下运动以使保留孔6252与缝钉腿6221相接合时,底部表面或组织接触表面6873接触组织T。在至少一个此类实施例中,层6870可由可压缩材料(例如可生物吸收的泡沫)构成,所述可压缩材料可被压缩于保留矩阵6250的底部表面6251与组织T之间。在各种实施例中,层6870还可包括存储和/或吸收于其中的至少一种药物,所述至少一种药物可在层6870被压缩时从层6870中释放。在至少一个实施例中,所述药物可包括至少一种组织密封剂、止血剂、和/或抗菌材料(例如电离的银和/或三氯生)。在各种实施例中,层6870的压缩可从层6870中挤出药物,使得组织T的表面的全部或至少很大一部分涂覆有药物。此外,当层6870被压缩且缝钉腿6221穿透组织T及层6870时,药物例如可沿缝钉腿6221流下并治疗已被缝钉腿6221切开的组织。在各种实施例中,保留矩阵6250的本体可包括由生物相容性材料(例如钛和/或不锈钢)构成的第一层,并且底层6870可包括由可生物吸收材料(例如氧化再生纤维素(ORC)、如(液态的或被冷冻干燥的)纤维蛋白和/或凝血酶等生物活性剂、甘油、处于蓬松或泡沫构型的可吸收猪明胶、和/或例如电离的银和/或三氯生等抗菌物)构成的第二层。另外的可生物吸收材料可包括例如Surgicel Nu-Knit、Surgicel Fibrillar、以商品名Promogran出售的胶原/ORC(其为与胶原矩阵形式构建物的混合物)、以商品名Vicryl出售的聚乙醇酸(PGA)、聚乳酸(PLA或PLLA)、聚对二氧环己酮(PDS)、聚羟基链烷酸酯(PHA)、以商品名Monocryl出售的聚卡普隆25(PGCL)、聚己内酯(PCL)、和/或PGA、PLA、PDS、PHA、PGCL、和/或PCL的复合物。尽管图215中仅示出一个层6870,然而可使用任何适宜数目的层。在至少一个实施例中,包括第一药物的第一层可附接到保留矩阵6250,并且包括第二药物或不同药物的第二层可附接到第一层。在至少一个此类实施例中,可使用多个层,其中每一层可包括容纳在其中的不同药物和/或不同的药物组合。
现在参见图213,在各种实施例中,紧固件系统可包括附接到保留矩阵6250的底部表面6251的材料层6770。在某些实施例中,层6770和/或保留矩阵6250可包括保留结构,所述保留结构能够将层6770保持到保留矩阵6250。在至少一个实施例中,可利用至少一种粘合剂将层6770粘附到保留矩阵6250。在任何情形中,层6770可包括底部表面或组织接触表面6773,底部表面或组织接触表面6773能够当保留矩阵6250朝缝钉6220向下运动以使保留孔6252与缝钉腿6221相接合时,底部表面或组织接触表面6773接触组织T。在至少一个此类实施例中,层6770可由可压缩材料(例如可生物吸收的泡沫)构成,所述可压缩材料可被压缩于保留矩阵6250的表面6251与组织T之间。在各种实施例中,层6770还可包括一个或多个囊或胞6774,所述一个或多个囊或胞6774能够在其中存储至少一种药物。参见图214,在某些实施例中,囊6774可与保留孔6252对齐或至少基本上对齐,使得当缝钉腿6221穿过组织T及层6770而被推动时,缝钉腿6221可刺穿囊6774和/或换句话讲使囊6774破裂。在囊6774破裂之后,存储在囊6774中的至少一种药物M可流出至组织T上。在至少一个此类实施例中,药物M可包括流体,所述流体可沿缝钉腿6221留下或依靠毛细作用流下并治疗被缝钉腿切开的组织T。作为上文的结果,存储在囊6774中的药物可对组织提供局部治疗。在某些实施例中,薄片6770中的囊6774中可存储有不同的药物。例如,第一组囊6774中可存储有第一药物或第一药物组合,并且第二组囊中可存储有不同的药物或不同的药物组合。在各种实施例中,层6770可由挠性的硅氧烷薄片构成,并且囊6774可代表硅氧烷薄片中的空隙。在至少一个此类实施例中,硅氧烷薄片可包括能够相互附接的两个层,其中囊6774可被限定在所述两个层之间。在各种实施例中,层6770可包括一个或多个薄的段或弱化部分(例如局部穿孔),所述一个或多个薄的段或弱化部分可有利于腿部6221切开层6770并使囊6774破裂。在某些实施例中,囊6774的至少一部分可被定位在穹窿6777中,其中穹窿6777可从薄片6770向上延伸。在至少一个此类实施例中,穹窿6777和/或囊6774的至少一部分可被定位在保留矩阵6250中所形成的凹坑6201内。在某些实施例中,囊6774可包括不彼此连接的独立的胞。在某些其它实施例中,囊6774中的一者或多者可经由延伸穿过层6770的一个或多个通路、导管、和/或通道而相互流体连通。公布于2010年8月24日且名称为“ADHESIVE AND MECHANICAL FASTENER”的美国专利No.7,780,685的公开内容据此全文以引用方式并入本文。
在各种实施例中,对上文进行进一步描述,其中包括仓体、缝钉、和/或对齐矩阵的钉仓可被加载至端部执行器的第一钳口中,并且相似地,保留矩阵和/或一个或多个覆盖件可被加载至端部执行器的第二钳口中。现在参见图216,在某些实施例中,可使用器械(例如仓加载器6990)将两个或更多个紧固件仓同时插入端部执行器中。在至少一个实施例中,例如仓加载器6990可包括柄部6991及仓载体6992,其中仓载体6992可包括第一保留部和第二保留部,所述第一保留部能够将钉仓6200的仓体6210保持到仓载体6992,并且所述第二保留部能够保持仓体6980,该仓体6980在其中支撑多个保护性帽6270并沿仓体6980的底部表面支撑保留矩阵6250。在各种实施例中,第一保留部和第二保留部可分别包括一个或多个保留构件,所述一个或多个保留构件能够可释放地接合仓体6210和6980。现在参见图217和图218,在使用中,端部执行器可包括第一钳口或底部钳口6230和第二钳口或顶部钳口6940,其中钉仓6200可被加载至第一钳口6230中,并且仓体6980可被加载至第二钳口6940中。在各种情形中,顶部钳口6940可通过致动器6235而从打开位置(图217)旋转到闭合位置(图218),其中致动器6235的操作如上所述,为简明起见此处不再赘述。现在参见图218,一旦顶部钳口6940处于其闭合位置,则仓载体6992的远端6993可被插入端部执行器中,使得钉仓6200穿过第一钳口6930的远端6938而滑动至第一钳口6230中的第一附接部或通道6939中。相似地,仓载体6992的远端6993可被插入端部执行器中,使得仓体6980穿过第二钳口6940的远端6948而滑动至第二钳口6940中的第二附接部或通道6949中。手持仓加载器6990的柄部6991的外科医生或其它临床医生可分别穿过通道6939和6949而推动钉仓6200及仓体6980,直至钉仓6200及仓体6980被完全安放于通道6939和6949中。
当钉仓6200和仓体6980被安放时,钉仓6200和仓体6980可分别接合其相应的钳口6230和6940中的一个或多个保留部,如以下所更详细地描述。现在参见图219,在任何情形中,一旦钉仓6200及仓体6980被安放,则仓加载器6990可从钉仓6200及仓体6980上拆卸并从端部执行器上移除。在至少一个此类实施例中,用于将钉仓6200保持在第一钳口6230中的保留力可大于用于将钉仓6200保持到仓载体6992的保留力,使得当仓载体6992朝远侧被推出端部执行器时,钉仓6200可保持在第一钳口6230后方。相似地,用于将仓体6980保持在第二钳口6940中的保留力可大于用于将仓体6940保持到仓载体6992的保留力,使得当仓载体6992朝远侧被推出端部执行器时,仓体6940可保持在第二钳口6940后方。一旦仓加载器6990从端部执行器被移除,则所加载的第一钳口6230及所加载的第二钳口6940可相对于将被缝合的组织T进行定位。现在参见图220,第二钳口6940可从打开位置(图219)运动到击发位置(图220),以便使仓体6980所携载的保留矩阵6250及所述多个保护性帽6270与位于钉仓6200中的缝钉6220相接合。
现在参见图221及图222,第二钳口6940可被再次打开,并且所述多个保护性帽6270及保留矩阵6250可从仓体6980上拆卸,使得帽6270及保留矩阵6250可保持与组织T及钉仓6200接合。在至少一个实施例中,仓体6980可包括多个凹坑及一个或多个保留狭槽,所述多个帽6270能够可移除地定位在所述多个凹坑中,并且所述一个或多个保留狭槽能够将保留矩阵6250可移除地保持到仓体6980。在各种实施例中,在第二钳口6940打开之后,第二钳口6940的与仓体6980相接合的保留构件可将仓体6980保持在第二钳口6940中。在某些实施例中,仓体6980能够当第二钳口6940打开时撕裂,使得仓体6980的一部分与帽6270及保留矩阵6250一起被植入,并且仓体6980的一部分保留在第二钳口6940中。相似地,再次参见图221和图222,在第二钳口6940打开之后,第一钳口6230的与仓体6210相接合的保留构件可将仓体6210保持在第一钳口6230中。在某些实施例中,仓体6210能够当第一钳口6230远离已植入的仓6200被牵拉时撕裂,使得仓体6210的一部分与缝钉6220及对齐矩阵6260一起被植入,并且仓体6210的一部分保留于第一钳口6230中。现在参见图223-225,在各种实施例中,钉仓(例如钉仓6900)可包括沿仓体6910的长度延伸的一个或多个纵向保留狭槽6913,例如当钉仓6900被插入钳口6930中时,所述一个或多个纵向保留狭槽6913能够在其中容纳从钳口6930延伸的一个或多个纵向保留导轨6916。在使用中,在至少一个实施例中,例如在钉仓6900穿过保持通道6939的远端6938而滑动之前,保留狭槽6913的末端可与保留导轨6916的远端对齐。
再次参见图225,在各种实施例中,钳口6940可包括两个保持通道6949,其中每一保持通道6949能够在其中容纳包括多个帽6270及保留矩阵6250的仓体6980。在某些实施例中,每一仓体6980可包括一个或多个纵向保持肩部6917,所述一个或多个纵向保持肩部6917能够当仓体6980被插入钳口6940中的其相应的保持通道6949中时,所述一个或多个纵向保持肩部6917沿第二钳口6940的一个或多个纵向保留导轨6918滑动。在各种实施例中,当仓体6980从存储在其中的帽6270及保留矩阵6250上拆卸时,保留导轨6918及保持肩部6917可协作地将仓体6980保持在第二钳口6940中。现在参见图224,在各种实施例中,第二钳口6940还可包括自其延伸的一个或多个远侧凸块或保留构件6915,所述一个或多个远侧凸块或保留构件6915能够将仓体6980可移除地锁定在其相应的保持通道中。在至少一个此类实施例中,第二钳口6940可包括远侧凸块6915,远侧凸块6915相对于每一保持通道6949能够及定位成使得当仓体6980被插入通道6949中时,每一仓体6980可围绕凸块6915屈曲,其中,就在仓体6915被完全安放于通道6949中时,仓体6980的远端可清洁凸块6915并按扣于凸块6915上方。为在仓体6980被用过之后将其移除,如上所述,可将仓体6980拉回到凸块6915上方并将其从保持通道6949上移除。与上文相似,第一钳口6930可包括自其延伸的一个或多个远侧保留凸块6914,所述一个或多个远侧保留凸块6914能够当钉仓6900被完全安放时,所述一个或多个远侧保留凸块6914被容纳在仓体6910中的一个或多个保留沟槽或狭槽6912(图223)中。
在各种实施例中,对上文进行进一步描述,其中定位有多个第一紧固件的第一紧固件仓可被定位在外科紧固装置的第一钳口中,并且其中定位有多个第二紧固件的第二紧固件仓可被定位在外科紧固装置的第二钳口中。在使用中,第一钳口和/或第二钳口可朝另一者运动,以便使第一紧固件与第二紧固件接合并将组织固定于其间。在某些实施例中,当第一紧固件与第二紧固件接合时,第一紧固件仓与第二紧固件仓可相互接合。在至少一个实施例中,第一紧固件仓的本体可由第一可压缩材料构成,并且第二紧固件仓的本体可由第二可压缩材料构成,其中第一本体和/或第二本体可抵靠被紧固的组织而被压缩。在组织被紧固之后,第一钳口可远离已植入的第一紧固件仓运动,并且第二钳口可远离已植入的第二紧固件仓运动。随后,第一钳口可再次加载有另一第一紧固件仓或类似元件,并且第二钳口可再次加载另一第二紧固件仓或类似元件,并可再次使用外科紧固器械。尽管可在一些实施例中使用缝钉,然而也可设想出包括其它类型的紧固件(例如当相互接合时锁定在一起的分为两部分的紧固件)的其它实施例。在至少一个此类实施例中,第一紧固件仓可包括用于存储第一紧固件部的第一存储部,并且第二紧固件仓可包括用于存储第二紧固件部的第二存储部。在各种实施例中,本文所述的紧固系统可利用包括任何适宜类型的材料和/或形式的紧固件。在某些实施例中,紧固件可包括穿透构件。这种穿透构件可例如由聚合物、复合物、和/或多层式基板构成。多层式基板的例子可为具有弹性体或聚合物涂层的线材或薄片基板。其可为薄的薄片,并且被形成为使得穿透构件被取向成垂直于或至少基本上垂直于连接构件。穿透构件可包括矩形的外形、半圆形的外形、和/或任何横梁外形。在各种实施例中,可利用任何适宜的方法(例如线材挤出方法)来制造本文所述的紧固件。另一种可能性是使用精密加工方法来形成中空的穿透构件。这些穿透构件可由不同于线材挤出方法且使用材料组合的方法加工而成。
如上所述,缝钉腿的穿过保留矩阵突起的顶端可由一个或多个帽和/或覆盖件覆盖。在某些实施例中,缝钉腿的末端在插穿保留矩阵之后可变形。在至少一个实施例中,用于保持保留矩阵的钳口还可包括位于保留孔上方和/或与保留孔对齐的砧座凹坑,所述砧座凹坑能够在缝钉腿突起于保留矩阵上方时使缝钉腿变形。在各种实施例中,每一缝钉的缝钉腿可例如朝彼此和/或朝缝钉的中心向内卷曲。在某些其它实施例中,缝钉的缝钉腿中的一者或多者可远离其它缝钉腿和/或远离缝钉的中心而向外卷曲。在各种实施例中,不论缝钉腿沿哪一方向卷曲,缝钉腿的末端均可接触保留矩阵的本体并可不再次进入已被缝钉紧固的组织中。在至少一个实施例中,缝钉腿在穿过保留矩阵之后的变形可将保留矩阵锁定在定位中。
现在参见图226及图227,在各种实施例中,外科缝合器械(例如,外科缝合器7000)可包括第一钳口7030和第二钳口7040,其中第二钳口7040可通过致动器6235的运动而朝向并远离第一钳口7030行进。致动器6235的操作如上所述,为简明起见此处不再赘述。在各种实施例中,第一钳口7030可包括远端7031及近端7032,其中第一钳口7030可限定在远端7031与近端7032之间延伸的通道,所述通道能够容纳钉仓。为便于图示,图226中未绘示出这种钉仓的仓体,然而这种钉仓可包括仓体、位于仓体内的缝钉6220、以及位于缝钉6220下方的缝钉驱动器7012。在某些实施例中,尽管为简明起见未在图226中示出,然而第二钳口7040能够将保留矩阵(例如保留矩阵6250)保持在缝钉6220之上和/或如上所述移将保留矩阵运动至与缝钉6220的腿部接合。在至少一个实施例中,外科缝合器7000还可包括例如位于第一钳口7030中的橇7010,橇7010可从第一钳口7030的远端7031朝近端7032滑动并朝第二钳口7040的保留矩阵提升缝钉驱动器7012及支撑在缝钉驱动器7012上的缝钉6220。在各种其它实施例中,例如橇7010可从近端7032朝远端7031运动,以便部署缝钉6020。在至少一个实施例中,橇7010可包括一个或多个倾斜的斜坡或凸轮7011,所述一个或多个倾斜的斜坡或凸轮7011能够在缝钉驱动器7012下方滑动并向上提升缝钉驱动器7012。在各种实施例中,外科缝合器7000还可包括例如可操作地联接到橇7010的拉杆或推杆,所述拉杆或推杆可通过位于外科缝合器7000的柄部和/或轴上的致动器而朝近侧和/或朝远侧运动。
再次参见图226,在各种实施例中,外科缝合器7000的第二钳口7040可包括框架7041、远端7048、及与远端7048相对定位的近端7049。在某些实施例中,第二钳口7040还可包括导向系统,所述导向系统包括沿框架7041的纵向轴线延伸的一个或多个导轨(例如导轨7045及7046),如以下所更详细地描述,所述一个或多个导轨能够引导能够在缝钉6220的缝钉腿6221穿过保留矩阵之后接合缝钉6220的缝钉腿并使其变形的一个或多个砧座或凸轮。在至少一个此类实施例中,导轨7045及7046可包括沿引导线材或缆线,所述引导线材或缆线例如沿框架7041的顶部或顶面、围绕远侧柱7047、并返回沿框架7041的顶部或顶面而延伸。如上所述,并且现在主要参见图228和图230,在各种实施例中,第二钳口7040还可包括一个或多个砧座或凸轮(例如第一砧座7050和第二砧座7060),所述一个或多个砧座或凸轮可沿第二钳口7040纵向地运动,以便在缝钉6220的腿部穿过保留矩阵之后使所述腿部变形。在至少一个实施例中,外科缝合器7000还可包括连接到和/或可操作地联接到第一砧座7050的第一砧座驱动器或致动器7051,该第一砧座驱动器或致动器能够朝近侧牵拉第一砧座7050和/或朝远侧推动第一砧座7050。相似地,在至少一个实施例中,外科缝合器7000还可包括连接到和/或可操作地联接到第二砧座7060的第二砧座驱动器或致动器,所述第二砧座驱动器或致动器能够朝远侧推动第二砧座7060和/或朝近侧牵拉第二砧座7060。在各种实施例中,第一砧座7050可包括导槽7052,并且第二砧座7060可包括导槽7062,该导槽7052和导槽7062可分别能够将导轨7045或导轨7046可滑动地容纳在其中。在至少一个此类实施例中,导轨7045及7046可被紧密地容纳在导槽7052及7062内,使得可防止或至少限制导轨7045及7046与导槽7052及7062之间发生相对的侧向运动或左右运动。
在某些实施例中,对上文进行进一步描述,可朝近侧拉动第一砧座7050并可朝远侧拉动第二砧座7060。参见图226,在至少一个实施例中,导轨7045及7046和远侧柱7047可包括滑轮系统,所述滑轮系统能够朝远侧牵拉第二砧座7060和/或朝近侧牵拉第二砧座7060。在至少一个此类实施例中,导轨7045及导轨7046可包括围绕远侧柱7047而延伸的连续线材或缆线,其中所述连续线材的一部分可被牵拉以使线材围绕远侧柱7047而轮转。在各种实施例中,导轨7046例如可被安装至第二砧座7060,使得当连续缆线沿第一方向轮转时,第二砧座7060可朝钳口7040的远端7048而被拉向远侧,并且当连续缆线沿第二方向或相反方向轮转时,第二砧座7060可朝近端7049而被拉向近侧。现在参见图228,在至少一个实施例中,导轨7046可被固定于导槽7062中,使得可在其间传递拉力。在至少一个此类实施例中,导轨7045能够在另一导槽7062中滑动。在各种实施例中,第一砧座7050可以与第二砧座7060无关的方式工作,并且滑轮系统及限定在第一砧座7050中的导槽7052能够可滑动地容纳导轨7045及7046,使得容许滑轮系统及导槽7052与导轨7045及7046之间进行相对运动。在各种实施例中,构成导轨7045及7046的连续缆线可具有足够的挠性,以便适应顶部钳口7040的打开及闭合。连续缆线也可具有足够的挠性以便适应第二钳口7060朝向及远离底部钳口7030的垂直运动,下文将更详细地描述。
再次参见图228及图230,在各种实施例中,第一砧座7050可包括自其延伸的凸轮从动件7055,凸轮从动件7055能够骑跨于限定在第二钳口7040的框架7041中的一个或多个凸轮狭槽或导槽(例如凸轮狭槽7070(图231))中。更具体地讲,在至少一个实施例中,框架7041可包括沿框架7041的第一侧纵向延伸的第一凸轮狭槽7070以及沿框架7041的第二侧或相对侧纵向延伸的第二凸轮7070,其中自第一砧座7050的第一侧延伸的凸轮从动件7055可骑跨于第一凸轮狭槽7070中,并且从第一砧座7050的第二侧延伸的凸轮从动件7055可骑跨于第二凸轮狭槽7070中。在至少一个此类实施例中,每一凸轮狭槽7070的轮廓可为相同的或至少基本上相同的,并可相互对齐或至少基本上对齐。相似地,在各种实施例中,第二砧座7060可包括自其延伸的凸轮从动件7065,凸轮从动件7065能够骑跨于限定在第二钳口7040的框架7041中的凸轮狭槽7070(图231)中。更具体地讲,在至少一个实施例中,从第二砧座7060的第一侧延伸的凸轮从动件7065可骑跨于第一凸轮狭槽7070中,并且从第二砧座7060的第二侧延伸的凸轮从动件7065可骑跨于第二凸轮狭槽7070中。在使用中,第一砧座7050的凸轮从动件7055和第二砧座7060的凸轮从动件7065可在凸轮狭槽7070内滑动,使得当第一砧座7050和第二砧座7060被拉向近侧和/或被推向远侧时,第一砧座7050和第二砧座7060沿凸轮狭槽7070的轮廓推进。在各种实施例中,每一凸轮狭槽7070可包括多个停歇部分或上部7071以及多个驱动器部或下部7072,所述多个停歇部或上部7071以及所述多个驱动器部分或下部7072能够在砧座7050及7060沿纵向(即,在框架7041的远端7048与近端7049之间)运动的同时垂直地(即,朝向及远离底部钳口7030)运动砧座7050及7060,如以下所更详细地描述。
当外科缝合器7000处于未击发状态时,参见图231,第一砧座7050可被定位在框架7041的远端7048处,并且第二砧座7060可被定位在框架7041的近端7049处;此外,现在参见图232,当外科缝合器7000处于未击发状态时,位于第一钳口7030中的缝钉6220可尚未被插入组织T和/或位于组织T上方的保留矩阵中。现在参见图233,在使用中,缝钉驱动器7012可在钉仓的缝钉腔7033内向上驱动缝钉6220;另外,第一砧座7050可从框架7041的远端7048朝远端7049向近侧运动,以便接合缝钉6220的缝钉腿6221。在至少一个实施例中,在第一砧座7050与缝钉6220的缝钉腿6221接合之前可向上驱动缝钉6220。在各种实施例中,在第一砧座7050推进至接触缝钉腿6221之前,橇7010可向上部署所有的缝钉6220,或作为另外一种选择,橇7010可在第一砧座7050朝近侧运动的同时朝近侧运动,然而橇7010可充分地引导第一砧座7050以将缝钉6220部署于第一砧座7050前方。在各种实施例中,如图233所示,凸轮狭槽7070能够或被设置成使得例如当第一凸轮7050穿过停歇部或上部时,第一凸轮7050的成形表面(例如成形表面或凸轮表面7053及7054)可接触缝钉腿6221中的至少一些缝钉腿6221。在各种情形中,第一砧座7050的凸轮从动件7055可分别被定位在凸轮狭槽7070的停歇部7071中,使得成形表面7053及7054处于抬高的位置,并使得当砧座7050由此穿过停歇部中时,缝钉腿6221仅部分地变形。当第一凸轮7050沿凸轮狭槽7070进一步运动时,如图234所示,第一砧座7050的凸轮从动件7055可被驱动至凸轮狭槽7070的驱动部或下部7072中,使得成形表面7053及7054朝缝钉腿6021向下垂直运动,以便将缝钉腿6021驱动至其完全成形的构型中。随后,当第一砧座7050进一步沿凸轮狭槽7070推进时,第一砧座7050可被向上垂直驱动至凸轮狭槽7070的另一组停歇部7071中。如图233和图234所示,读者应注意,第一砧座7050可仅接合某些缝钉腿而不接合其它缝钉腿。在至少一个此类实施例中,第一砧座7050能够例如仅使包括缝钉6220的远侧缝钉腿6221的一组缝钉腿变形。在至少一个此类实施例中,第一砧座7050能够使远侧缝钉腿6221朝缝钉6220的中心变形。在各种实施例中,每一近侧缝钉腿6221均可两次被第一砧座7050(即,被第一成形表面7053及与第一成形表面7053对齐的第二成形表面7054)接触。在至少一个此类实施例中,当第一砧座7050处于停歇部或上部中时,第一成形表面7053可使远侧缝钉腿6221变形至部分变形构型,并且当第一砧座7050运动至驱动部或下部中时,第二成形表面7054可使远侧缝钉腿6221变形至完全成形构型。现在参见图228和图229,在各种实施例中,第一砧座7050可包括多个第一成形表面7053及多个第二成形表面7054,以便在缝钉腿6221被布置成不止一行或一条线时使缝钉6220的远侧缝钉腿6221变形。在各种实施例中,如下文所更详细地描述,例如第二砧座7060可使缝钉6020的近侧缝钉腿6221变形。
在各种实施例中,对上文进行进一步描述,第一砧座7050可从框架7041的远端7048运动至近端7049,以便使缝钉6220的所有远侧缝钉腿6221变形。读者应注意,第一砧座7050可相对于未变形的近侧缝钉腿6221向上及向下运动,并且为适应这种相对运动,在各种实施例中,第一砧座7050可包括一个或多个间隙狭槽7057(图230),所述一个或多个间隙狭槽7057能够当第一砧座7050使远侧缝钉腿6221弯曲时容纳未弯曲的近侧缝钉腿6221。相似地,再次参见图228,第二砧座7060可包括间隙狭槽7067,该间隙狭槽能够当第一砧座7050如上所述在其停歇部与驱动部之间运动时适应上下运动的第一凸轮致动器7051的垂直运动。在所有远侧缝钉腿6221被弯曲之后,在至少一个实施例中,砧座致动器7061可使第二砧座7060从框架7041的近端7049运动至远端7048。与上文相似,现在参见图235,例如第二砧座7060的凸轮从动件7065可在凸轮狭槽7070内滑动,使得第二砧座7060在停歇部或上部与驱动部或下部之间运动,以便使近侧缝钉腿6221朝缝钉6220的中心向内变形。与上文相似,第二砧座7060可包括多个第一成形或凸轮表面7063以及多个第二成形或凸轮表面7064,所述多个第一成形或凸轮表面7063以及所述多个第二成形或凸轮表面7064可分别能够使近侧缝钉腿6021中的一者或多者至少部分地变形和/或完全变形。再次参见图229,第二砧座7060可包括多个第一成形表面7063及多个第二成形表面7064,所述多个第一成形表面7063及所述多个第二成形表面7064能够使排列成多个行或多条线的缝钉6220的近侧缝钉腿6221变形。同样如图229所示,第二砧座7060的第一成形表面7063和第二成形表面7064可不与第一砧座7050的第一成形表面7053和第二成形表面7054对齐,其中作为结果,缝钉6220的近侧腿部6221可与缝钉6220的远侧腿部6221位于不同的行或线中。读者还应注意,当第二砧座7060朝远侧运动时,第二砧座7060可推动第一砧座7050。在至少一个此类实施例中,第二砧座7060可将第一砧座7050推回至框架7041的远端7048中,使得第一砧座7050可返回至其初始位置或未击发位置。在缝钉6220的所有近侧缝钉腿6221均变形之后,第二砧座7060可朝近侧缩回并返回至其初始位置或未击发位置。如此一来,外科缝合器7000可复位成使得可在第一钳口7030中定位新的钉仓,并可在第二钳口7040中定位新的保留矩阵,以便再次使用外科缝合器7000。
在各种实施例中,如上所述,外科缝合器可包括两个或更多个砧座,所述两个或更多个砧座可沿纵向行进以便沿横切方向接合多个缝钉的腿部。在某些实施例中,外科缝合器可包括朝近侧运动的砧座,例如以使第一组缝钉腿变形并例如使第二组缝钉腿变形。在至少一个此类实施例中,这种砧座可包括例如面向近侧的成形表面及面向远侧的成形表面。
现在参见图236,在各种实施例中,砧座(例如,砧座7140)可包括底部表面或组织接触表面7141以及限定在底部表面或组织接触表面7141中的多个成形凹坑7142。在至少一个实施例中,砧座7140可包括能够焊接到框架7144中的不止一个板(例如凹坑板7143)。在至少一个此类实施例中,每一凹坑板7143均可定位在框架7144中的板通道7145中并通过延伸穿过框架7144的焊接狭槽7146而被焊接到框架7144以便形成纵向焊接件7147。在各种实施例中,纵向焊接件7147例如可包括沿焊接狭槽7146的整个长度延伸的连续焊接件或沿焊接狭槽7146的长度延伸的一系列在空间上间隔开的焊接点。在各种实施例中,每一凹坑板7143均可包括已被焊接到一起的两个或更多个板部分。在至少一个此类实施例中,每一凹坑板7143均可包括能够沿接缝7148焊接到一起的第一板部分7143a和第二板部分7143b。在各种实施例中,在板7143被焊接到框架7144中的板通道7145中之前,每一板7143的第一板部分7143a和第二板部分7143b可被焊接到一起。在至少一个此类实施例中,第一板部分7143a和第二板部分7143b可包括能够配合到一起以形成紧密接缝7148的相配合的外形(例如图236中所示的锯齿形外形)。在至少一个实施例中,每一板7143可包括例如约.02”的高度,所述高度可高于板通道7145的深度,使得板7143的组织接触表面7141从砧座7040的框架7044延伸。现在参见图237,在某些实施例中,板7143可例如通过位于板7143的远端处的至少一个焊接件7149而连接到一起。
如图236和图237所示,每一凹坑板7143均可包括被限定在其中的多个成形凹坑7142。在各种实施例中,可通过任何适宜的制造方法(例如研磨方法和/或电极燃烧方法)在板7143中形成成形凹坑7142。现在参见图238和图239,在至少一个此类实施例中,例如可通过以下方法来制造每一成形凹坑7142:首先形成深井7150,随后围绕深井7150形成拱形的或弯曲的表面7151,然后在弯曲的表面7151中形成缝钉腿引导沟槽7152。在各种其它实施例中,可以任何适宜的顺序来执行这些步骤。现在参见图240,在各种实施例中,缝钉成形凹坑7142可被形成为使成形凹坑的内缘7153被一致的或至少基本上一致的间隙7154间隔开。在至少一个此类实施例中,间隙7154可例如为大约.008”。此外,在至少一个此类实施例中,成形凹坑7142可沿两个或更多个行或线定位,成形凹坑7142的中心线可被一致的或至少基本上一致的间距7155间隔开。在至少一个此类实施例中,中心线之间的间距7155可例如为大约.035”。再次参见图240,在各种实施例中,每一成形凹坑7142可在窄的宽度7156与宽的宽度7157之间逐渐变细。在至少一个此类实施例中,例如窄的宽度7156可为大约.045”,并且宽的宽度7157可为大约.075”。在各种实施例中,板7143可由与框架7144相同的材料构成。在至少一个此类实施例中,板7143及框架7144两者均可例如由不锈钢(例如300系列或400系列的不锈钢)和/或钛构成。在各种其它实施例中,板7143及框架7144可由不同的材料构成。在至少一个此类实施例中,板7143可例如由陶瓷材料构成,并且框架7144可例如由不锈钢和/或钛构成。在各种情形中,根据所使用的材料,例如除上述焊接方法之外或作为上述焊接方法的替代,还可使用至少一种钎焊方法将板7143固定于框架7144中。
现在参见图241-243,在各种实施例中,砧座7240可包括框架7244以及可被插入框架7244中的多个凹坑板7243。与上文相似,每一凹坑板7243可包括被限定在其中的多个成形凹坑7242。在至少一个实施例中,砧座框架7244可包括被限定在其中的保留狭槽7246,该保留狭槽能够容纳从凹坑板7243延伸的保留导轨7247。为将凹坑板7243组装到砧座框架7244,该砧座框架7244的侧壁7245可向外屈曲或展开(如图242所示),以使保留狭槽7246变宽,从而使每一保留狭槽7246可在其中容纳凹坑板7243的保留导轨7247。一旦保留导轨7247被定位在保留狭槽7246中,侧壁7245即可被释放(如图243所示),从而容许框架7244以弹性方式缩回和/或返回至其未屈曲状态。在这种情形中,保留狭槽7246可缩回并因此将保留导轨7247捕获在其中。在某些实施例中,保留导轨7247和/或保留狭槽7246可包括一个或多个相配合的锥形表面;在屈曲的保留狭槽7246被释放之后,所述一个或多个相配合的锥形表面可形成能够将保留导轨7247保持在保留狭槽7246中的锥形锁接合。与上文相似,凹坑板7243可由与框架7244相同或不同的材料构成。在至少一个此类实施例中,板7243可例如由陶瓷材料构成,并且框架7244可例如由不锈钢和/或钛构成。在各种情形中,根据所使用的材料,例如可使用至少一种钎焊方法和/或至少一种焊接方法将板7243固定于框架7244中。
可将本发明所公开的装置设计为单次使用后即进行处理,或者可将它们设计为可多次使用。然而,在任一种情况下,所述装置均可进行修复,以在至少一次使用后再次使用。重新恢复可包括如下步骤的任意组合:拆卸该装置、然后清洗或置换某些部分以及随后组装。特别是,所述装置可以拆卸,而且可以任意组合选择性地置换或移除该装置任意数目的特定零件或部分。清洗和/或置换特定部分后,该装置可以在修复设施处重新组装以便随后使用,或者在即将进行外科手术前由外科手术队重新组装。本领域的技术人员将会知道,装置的修复可利用多种用于拆卸、清洗/置换和重新组装的技术。这些技术的使用以及所得的修复装置均在本发明的范围内。
优选的是,在手术前处理本文所述的装置。首先,获取新的或用过的装置,并在必要时对装置进行清洁。然后对装置进行消毒。在一种消毒技术中,将该装置置于闭合并密封的容器中,例如塑料或TYVEK袋中。然后将容器和装置置于能够穿透该容器的辐射区,例如γ辐射、x-射线或高能电子。辐射将装置上和容器中的细菌杀死。然后将灭菌后的装置保存在消毒容器中。该密封容器保持装置无菌直到在医疗设施中打开该容器。
以引用方式全文或部分地并入本文的任何专利、公布或其它公开材料均仅在所并入的材料不与本发明所述的现有定义、陈述或其它公开材料相冲突的范围内并入本文。由此,在必要的程度下,本文所明确阐述的公开内容将取代以引用方式并入本文的任何相冲突材料。如果据述以引用方式并入本文但与本文所述的现有定义、陈述或其它公开材料相冲突的任何材料或其部分,仅在所并入的材料和现有的公开材料之间不产生冲突的程度下并入本文。
尽管已经将本发明作为示例性设计进行了描述,但还可以在本公开的实质和范围内对本发明进行修改。因此本专利申请旨在涵盖采用本发明一般原理的任何变型、用途或改型。此外,本专利申请旨在涵盖本发明所属领域中属于已知或惯有实践范围内的与本公开不同的型式。

Claims (2)

1.一种钉仓,包括:
多个缝钉,其中每一所述缝钉包括基部以及从所述基部延伸的可变形构件,其中每一所述可变形构件包括末端;
可植入的钉仓本体,所述可植入的钉仓本体包括:
由第一材料构成的第一可压缩层,其中所述基部被嵌入所述第一可压缩层中;
由第二材料构成的第二可压缩层,其中所述末端被嵌入所述第二可压缩层中,其中所述第一可压缩层包含第一刚度,其中所述第二可压缩层包含第二刚度,并且其中所述第一刚度不同于所述第二刚度;以及
围绕所述第一可压缩层和所述第二可压缩层的包裹物,其中当所述可植入的钉仓本体被砧座压缩时,所述末端能够切割所述包裹物。
2.一种紧固件仓,包括:
多个紧固件,其中每一所述紧固件包括基部以及从所述基部延伸的可变形构件,其中每一所述可变形构件包括末端;以及
可植入的仓体,所述可植入的仓体包括:
由第一材料构成的第一可压缩层合物,其中所述基部被嵌入所述第一可压缩层合物中;
由第二材料构成的第二可压缩层合物,其中所述末端被嵌入所述第二可压缩层合物中,其中所述第一可压缩层合物包含第一刚度,其中所述第二可压缩层合物包含第二刚度,并且其中所述第一刚度不同于所述第二刚度;以及
围绕所述第一可压缩层合物和所述第二可压缩层合物的包裹物,其中当所述可植入的仓体被砧座压缩时,所述末端能够切割所述包裹物。
CN201180047613.5A 2010-09-30 2011-09-27 包括多个层的可植入紧固件仓 Active CN103140182B (zh)

Applications Claiming Priority (24)

Application Number Priority Date Filing Date Title
US12/894,338 US8864007B2 (en) 2010-09-30 2010-09-30 Implantable fastener cartridge having a non-uniform arrangement
US12/894,377 US8393514B2 (en) 2010-09-30 2010-09-30 Selectively orientable implantable fastener cartridge
US12/894,367 US9033203B2 (en) 2010-09-30 2010-09-30 Fastening instrument for deploying a fastener system comprising a retention matrix
US12/894,361 US8529600B2 (en) 2010-09-30 2010-09-30 Fastener system comprising a retention matrix
US12/894,318 US8814024B2 (en) 2010-09-30 2010-09-30 Fastener system comprising a plurality of connected retention matrix elements
US12/894,322 US8740034B2 (en) 2010-09-30 2010-09-30 Surgical stapling instrument with interchangeable staple cartridge arrangements
US12/894,369 US20120080344A1 (en) 2010-09-30 2010-09-30 Implantable fastener cartridge comprising a support retainer
US12/894,306 US9044227B2 (en) 2010-09-30 2010-09-30 Collapsible fastener cartridge
US12/894,345 US8783542B2 (en) 2010-09-30 2010-09-30 Fasteners supported by a fastener cartridge support
US12/894,383 US8752699B2 (en) 2010-09-30 2010-09-30 Implantable fastener cartridge comprising bioabsorbable layers
US12/894,350 US20120080478A1 (en) 2010-09-30 2010-09-30 Surgical staple cartridges with detachable support structures and surgical stapling instruments with systems for preventing actuation motions when a cartridge is not present
US12/894,340 US8899463B2 (en) 2010-09-30 2010-09-30 Surgical staple cartridges supporting non-linearly arranged staples and surgical stapling instruments with common staple-forming pockets
US12/894,330 US8757465B2 (en) 2010-09-30 2010-09-30 Fastener system comprising a retention matrix and an alignment matrix
US12/894,312 US8925782B2 (en) 2010-09-30 2010-09-30 Implantable fastener cartridge comprising multiple layers
US12/894,327 US8978956B2 (en) 2010-09-30 2010-09-30 Jaw closure arrangements for surgical instruments
US12/894,351 US9113864B2 (en) 2010-09-30 2010-09-30 Surgical cutting and fastening instruments with separate and distinct fastener deployment and tissue cutting systems
US12/894,312 2010-09-30
US12/894,388 US8474677B2 (en) 2010-09-30 2010-09-30 Fastener system comprising a retention matrix and a cover
US12/894,311 US8763877B2 (en) 2010-09-30 2010-09-30 Surgical instruments with reconfigurable shaft segments
US12/894,360 US9113862B2 (en) 2010-09-30 2010-09-30 Surgical stapling instrument with a variable staple forming system
US12/894,339 US8840003B2 (en) 2010-09-30 2010-09-30 Surgical stapling instrument with compact articulation control arrangement
US12/894,376 US9044228B2 (en) 2010-09-30 2010-09-30 Fastener system comprising a plurality of fastener cartridges
US12/894,389 US8740037B2 (en) 2010-09-30 2010-09-30 Compressible fastener cartridge
PCT/US2011/053538 WO2012044630A1 (en) 2010-09-30 2011-09-27 Implantable fastener cartridge comprising multiple layers

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Families Citing this family (1411)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5865361A (en) 1997-09-23 1999-02-02 United States Surgical Corporation Surgical stapling apparatus
US11229472B2 (en) 2001-06-12 2022-01-25 Cilag Gmbh International Modular battery powered handheld surgical instrument with multiple magnetic position sensors
ES2426719T3 (es) 2002-06-17 2013-10-24 Covidien Lp Estructuras de soporte anular
US9060770B2 (en) 2003-05-20 2015-06-23 Ethicon Endo-Surgery, Inc. Robotically-driven surgical instrument with E-beam driver
US20070084897A1 (en) 2003-05-20 2007-04-19 Shelton Frederick E Iv Articulating surgical stapling instrument incorporating a two-piece e-beam firing mechanism
US8182501B2 (en) 2004-02-27 2012-05-22 Ethicon Endo-Surgery, Inc. Ultrasonic surgical shears and method for sealing a blood vessel using same
US9072535B2 (en) 2011-05-27 2015-07-07 Ethicon Endo-Surgery, Inc. Surgical stapling instruments with rotatable staple deployment arrangements
US11998198B2 (en) 2004-07-28 2024-06-04 Cilag Gmbh International Surgical stapling instrument incorporating a two-piece E-beam firing mechanism
US11890012B2 (en) 2004-07-28 2024-02-06 Cilag Gmbh International Staple cartridge comprising cartridge body and attached support
US8215531B2 (en) 2004-07-28 2012-07-10 Ethicon Endo-Surgery, Inc. Surgical stapling instrument having a medical substance dispenser
US8905977B2 (en) 2004-07-28 2014-12-09 Ethicon Endo-Surgery, Inc. Surgical stapling instrument having an electroactive polymer actuated medical substance dispenser
CA2582520C (en) 2004-10-08 2017-09-12 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instrument
US7938307B2 (en) 2004-10-18 2011-05-10 Tyco Healthcare Group Lp Support structures and methods of using the same
US7845536B2 (en) 2004-10-18 2010-12-07 Tyco Healthcare Group Lp Annular adhesive structure
ES2530775T3 (es) 2004-10-18 2015-03-05 Covidien Lp Estructura adhesiva anular
US9364229B2 (en) 2005-03-15 2016-06-14 Covidien Lp Circular anastomosis structures
US7934630B2 (en) 2005-08-31 2011-05-03 Ethicon Endo-Surgery, Inc. Staple cartridges for forming staples having differing formed staple heights
US20070194082A1 (en) 2005-08-31 2007-08-23 Morgan Jerome R Surgical stapling device with anvil having staple forming pockets of varying depths
US11246590B2 (en) 2005-08-31 2022-02-15 Cilag Gmbh International Staple cartridge including staple drivers having different unfired heights
US11484312B2 (en) 2005-08-31 2022-11-01 Cilag Gmbh International Staple cartridge comprising a staple driver arrangement
US10159482B2 (en) 2005-08-31 2018-12-25 Ethicon Llc Fastener cartridge assembly comprising a fixed anvil and different staple heights
US9237891B2 (en) 2005-08-31 2016-01-19 Ethicon Endo-Surgery, Inc. Robotically-controlled surgical stapling devices that produce formed staples having different lengths
US7669746B2 (en) 2005-08-31 2010-03-02 Ethicon Endo-Surgery, Inc. Staple cartridges for forming staples having differing formed staple heights
US8800838B2 (en) 2005-08-31 2014-08-12 Ethicon Endo-Surgery, Inc. Robotically-controlled cable-based surgical end effectors
US20070191713A1 (en) 2005-10-14 2007-08-16 Eichmann Stephen E Ultrasonic device for cutting and coagulating
US20070106317A1 (en) 2005-11-09 2007-05-10 Shelton Frederick E Iv Hydraulically and electrically actuated articulation joints for surgical instruments
US7621930B2 (en) 2006-01-20 2009-11-24 Ethicon Endo-Surgery, Inc. Ultrasound medical instrument having a medical ultrasonic blade
US8186555B2 (en) 2006-01-31 2012-05-29 Ethicon Endo-Surgery, Inc. Motor-driven surgical cutting and fastening instrument with mechanical closure system
US11278279B2 (en) 2006-01-31 2022-03-22 Cilag Gmbh International Surgical instrument assembly
US8708213B2 (en) 2006-01-31 2014-04-29 Ethicon Endo-Surgery, Inc. Surgical instrument having a feedback system
US20110295295A1 (en) 2006-01-31 2011-12-01 Ethicon Endo-Surgery, Inc. Robotically-controlled surgical instrument having recording capabilities
US9861359B2 (en) 2006-01-31 2018-01-09 Ethicon Llc Powered surgical instruments with firing system lockout arrangements
US8820603B2 (en) 2006-01-31 2014-09-02 Ethicon Endo-Surgery, Inc. Accessing data stored in a memory of a surgical instrument
US20110024477A1 (en) 2009-02-06 2011-02-03 Hall Steven G Driven Surgical Stapler Improvements
US20120292367A1 (en) 2006-01-31 2012-11-22 Ethicon Endo-Surgery, Inc. Robotically-controlled end effector
US11224427B2 (en) 2006-01-31 2022-01-18 Cilag Gmbh International Surgical stapling system including a console and retraction assembly
US8161977B2 (en) 2006-01-31 2012-04-24 Ethicon Endo-Surgery, Inc. Accessing data stored in a memory of a surgical instrument
US7845537B2 (en) 2006-01-31 2010-12-07 Ethicon Endo-Surgery, Inc. Surgical instrument having recording capabilities
US20110006101A1 (en) 2009-02-06 2011-01-13 EthiconEndo-Surgery, Inc. Motor driven surgical fastener device with cutting member lockout arrangements
US7753904B2 (en) 2006-01-31 2010-07-13 Ethicon Endo-Surgery, Inc. Endoscopic surgical instrument with a handle that can articulate with respect to the shaft
US8763879B2 (en) 2006-01-31 2014-07-01 Ethicon Endo-Surgery, Inc. Accessing data stored in a memory of surgical instrument
US11793518B2 (en) 2006-01-31 2023-10-24 Cilag Gmbh International Powered surgical instruments with firing system lockout arrangements
US9629626B2 (en) 2006-02-02 2017-04-25 Covidien Lp Mechanically tuned buttress material to assist with proper formation of surgical element in diseased tissue
US7793813B2 (en) 2006-02-28 2010-09-14 Tyco Healthcare Group Lp Hub for positioning annular structure on a surgical device
US8236010B2 (en) 2006-03-23 2012-08-07 Ethicon Endo-Surgery, Inc. Surgical fastener and cutter with mimicking end effector
US8992422B2 (en) 2006-03-23 2015-03-31 Ethicon Endo-Surgery, Inc. Robotically-controlled endoscopic accessory channel
EP2015681B1 (en) 2006-05-03 2018-03-28 Datascope Corp. Tissue closure device
EP2018248B1 (en) 2006-05-19 2015-11-04 Applied Medical Resources Corporation Surgical stapler
US8322455B2 (en) 2006-06-27 2012-12-04 Ethicon Endo-Surgery, Inc. Manually driven surgical cutting and fastening instrument
US7740159B2 (en) 2006-08-02 2010-06-22 Ethicon Endo-Surgery, Inc. Pneumatically powered surgical cutting and fastening instrument with a variable control of the actuating rate of firing with mechanical power assist
US10130359B2 (en) 2006-09-29 2018-11-20 Ethicon Llc Method for forming a staple
US10568652B2 (en) 2006-09-29 2020-02-25 Ethicon Llc Surgical staples having attached drivers of different heights and stapling instruments for deploying the same
US8720766B2 (en) 2006-09-29 2014-05-13 Ethicon Endo-Surgery, Inc. Surgical stapling instruments and staples
US11980366B2 (en) 2006-10-03 2024-05-14 Cilag Gmbh International Surgical instrument
US7866525B2 (en) 2006-10-06 2011-01-11 Tyco Healthcare Group Lp Surgical instrument having a plastic surface
US8584921B2 (en) 2006-10-06 2013-11-19 Covidien Lp Surgical instrument with articulating tool assembly
ES2627615T3 (es) 2006-10-26 2017-07-28 Covidien Lp Dispositivo que utiliza aleaciones con memoria de forma para conexión de contrafuerte
US7845533B2 (en) 2007-06-22 2010-12-07 Tyco Healthcare Group Lp Detachable buttress material retention systems for use with a surgical stapling device
US11291441B2 (en) 2007-01-10 2022-04-05 Cilag Gmbh International Surgical instrument with wireless communication between control unit and remote sensor
US8652120B2 (en) 2007-01-10 2014-02-18 Ethicon Endo-Surgery, Inc. Surgical instrument with wireless communication between control unit and sensor transponders
US8840603B2 (en) 2007-01-10 2014-09-23 Ethicon Endo-Surgery, Inc. Surgical instrument with wireless communication between control unit and sensor transponders
US8684253B2 (en) 2007-01-10 2014-04-01 Ethicon Endo-Surgery, Inc. Surgical instrument with wireless communication between a control unit of a robotic system and remote sensor
US8459520B2 (en) 2007-01-10 2013-06-11 Ethicon Endo-Surgery, Inc. Surgical instrument with wireless communication between control unit and remote sensor
US11039836B2 (en) 2007-01-11 2021-06-22 Cilag Gmbh International Staple cartridge for use with a surgical stapling instrument
US8540128B2 (en) 2007-01-11 2013-09-24 Ethicon Endo-Surgery, Inc. Surgical stapling device with a curved end effector
EP3087929B1 (en) 2007-03-06 2020-04-29 Covidien LP Surgical stapling apparatus
US8590762B2 (en) 2007-03-15 2013-11-26 Ethicon Endo-Surgery, Inc. Staple cartridge cavity configurations
US8142461B2 (en) 2007-03-22 2012-03-27 Ethicon Endo-Surgery, Inc. Surgical instruments
US8911460B2 (en) 2007-03-22 2014-12-16 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instruments
US8226675B2 (en) 2007-03-22 2012-07-24 Ethicon Endo-Surgery, Inc. Surgical instruments
US8057498B2 (en) 2007-11-30 2011-11-15 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instrument blades
US8893946B2 (en) 2007-03-28 2014-11-25 Ethicon Endo-Surgery, Inc. Laparoscopic tissue thickness and clamp load measuring devices
US8038045B2 (en) 2007-05-25 2011-10-18 Tyco Healthcare Group Lp Staple buttress retention system
US11672531B2 (en) 2007-06-04 2023-06-13 Cilag Gmbh International Rotary drive systems for surgical instruments
US8534528B2 (en) 2007-06-04 2013-09-17 Ethicon Endo-Surgery, Inc. Surgical instrument having a multiple rate directional switching mechanism
US7832408B2 (en) 2007-06-04 2010-11-16 Ethicon Endo-Surgery, Inc. Surgical instrument having a directional switching mechanism
US8931682B2 (en) 2007-06-04 2015-01-13 Ethicon Endo-Surgery, Inc. Robotically-controlled shaft based rotary drive systems for surgical instruments
US7665646B2 (en) 2007-06-18 2010-02-23 Tyco Healthcare Group Lp Interlocking buttress material retention system
US7753245B2 (en) 2007-06-22 2010-07-13 Ethicon Endo-Surgery, Inc. Surgical stapling instruments
US8308040B2 (en) 2007-06-22 2012-11-13 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with an articulatable end effector
US8062330B2 (en) 2007-06-27 2011-11-22 Tyco Healthcare Group Lp Buttress and surgical stapling apparatus
US11849941B2 (en) 2007-06-29 2023-12-26 Cilag Gmbh International Staple cartridge having staple cavities extending at a transverse angle relative to a longitudinal cartridge axis
US8808319B2 (en) 2007-07-27 2014-08-19 Ethicon Endo-Surgery, Inc. Surgical instruments
US8882791B2 (en) 2007-07-27 2014-11-11 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instruments
US8523889B2 (en) 2007-07-27 2013-09-03 Ethicon Endo-Surgery, Inc. Ultrasonic end effectors with increased active length
US9044261B2 (en) 2007-07-31 2015-06-02 Ethicon Endo-Surgery, Inc. Temperature controlled ultrasonic surgical instruments
US8430898B2 (en) 2007-07-31 2013-04-30 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instruments
US8512365B2 (en) 2007-07-31 2013-08-20 Ethicon Endo-Surgery, Inc. Surgical instruments
US8061576B2 (en) 2007-08-31 2011-11-22 Tyco Healthcare Group Lp Surgical instrument
AU2008308606B2 (en) 2007-10-05 2014-12-18 Ethicon Endo-Surgery, Inc. Ergonomic surgical instruments
US10010339B2 (en) 2007-11-30 2018-07-03 Ethicon Llc Ultrasonic surgical blades
US8561870B2 (en) 2008-02-13 2013-10-22 Ethicon Endo-Surgery, Inc. Surgical stapling instrument
US8540133B2 (en) 2008-09-19 2013-09-24 Ethicon Endo-Surgery, Inc. Staple cartridge
US8453908B2 (en) 2008-02-13 2013-06-04 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with improved firing trigger arrangement
US7905381B2 (en) 2008-09-19 2011-03-15 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with cutting member arrangement
US7766209B2 (en) 2008-02-13 2010-08-03 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with improved firing trigger arrangement
JP5410110B2 (ja) 2008-02-14 2014-02-05 エシコン・エンド−サージェリィ・インコーポレイテッド Rf電極を有する外科用切断・固定器具
US8636736B2 (en) 2008-02-14 2014-01-28 Ethicon Endo-Surgery, Inc. Motorized surgical cutting and fastening instrument
US7819298B2 (en) 2008-02-14 2010-10-26 Ethicon Endo-Surgery, Inc. Surgical stapling apparatus with control features operable with one hand
US7866527B2 (en) 2008-02-14 2011-01-11 Ethicon Endo-Surgery, Inc. Surgical stapling apparatus with interlockable firing system
US8622274B2 (en) 2008-02-14 2014-01-07 Ethicon Endo-Surgery, Inc. Motorized cutting and fastening instrument having control circuit for optimizing battery usage
US8573465B2 (en) 2008-02-14 2013-11-05 Ethicon Endo-Surgery, Inc. Robotically-controlled surgical end effector system with rotary actuated closure systems
US8758391B2 (en) 2008-02-14 2014-06-24 Ethicon Endo-Surgery, Inc. Interchangeable tools for surgical instruments
US8752749B2 (en) 2008-02-14 2014-06-17 Ethicon Endo-Surgery, Inc. Robotically-controlled disposable motor-driven loading unit
US9179912B2 (en) 2008-02-14 2015-11-10 Ethicon Endo-Surgery, Inc. Robotically-controlled motorized surgical cutting and fastening instrument
US11986183B2 (en) 2008-02-14 2024-05-21 Cilag Gmbh International Surgical cutting and fastening instrument comprising a plurality of sensors to measure an electrical parameter
US8459525B2 (en) 2008-02-14 2013-06-11 Ethicon Endo-Sugery, Inc. Motorized surgical cutting and fastening instrument having a magnetic drive train torque limiting device
US8657174B2 (en) * 2008-02-14 2014-02-25 Ethicon Endo-Surgery, Inc. Motorized surgical cutting and fastening instrument having handle based power source
US7793812B2 (en) 2008-02-14 2010-09-14 Ethicon Endo-Surgery, Inc. Disposable motor-driven loading unit for use with a surgical cutting and stapling apparatus
US8584919B2 (en) 2008-02-14 2013-11-19 Ethicon Endo-Sugery, Inc. Surgical stapling apparatus with load-sensitive firing mechanism
US11272927B2 (en) 2008-02-15 2022-03-15 Cilag Gmbh International Layer arrangements for surgical staple cartridges
US10390823B2 (en) 2008-02-15 2019-08-27 Ethicon Llc End effector comprising an adjunct
US8608044B2 (en) 2008-02-15 2013-12-17 Ethicon Endo-Surgery, Inc. Feedback and lockout mechanism for surgical instrument
US20090206131A1 (en) 2008-02-15 2009-08-20 Ethicon Endo-Surgery, Inc. End effector coupling arrangements for a surgical cutting and stapling instrument
US20090206139A1 (en) * 2008-02-15 2009-08-20 Ethicon Endo-Surgery, Inc. Buttress material for a surgical instrument
US8733611B2 (en) * 2008-03-12 2014-05-27 Covidien Lp Ratcheting mechanism for surgical stapling device
US9089360B2 (en) 2008-08-06 2015-07-28 Ethicon Endo-Surgery, Inc. Devices and techniques for cutting and coagulating tissue
PL3476312T3 (pl) 2008-09-19 2024-03-11 Ethicon Llc Stapler chirurgiczny z urządzeniem do dopasowania wysokości zszywek
US9005230B2 (en) 2008-09-23 2015-04-14 Ethicon Endo-Surgery, Inc. Motorized surgical instrument
US11648005B2 (en) 2008-09-23 2023-05-16 Cilag Gmbh International Robotically-controlled motorized surgical instrument with an end effector
US8210411B2 (en) 2008-09-23 2012-07-03 Ethicon Endo-Surgery, Inc. Motor-driven surgical cutting instrument
US9386983B2 (en) 2008-09-23 2016-07-12 Ethicon Endo-Surgery, Llc Robotically-controlled motorized surgical instrument
US8628544B2 (en) 2008-09-23 2014-01-14 Covidien Lp Knife bar for surgical instrument
US9050083B2 (en) * 2008-09-23 2015-06-09 Ethicon Endo-Surgery, Inc. Motorized surgical instrument
US7988028B2 (en) 2008-09-23 2011-08-02 Tyco Healthcare Group Lp Surgical instrument having an asymmetric dynamic clamping member
US8608045B2 (en) 2008-10-10 2013-12-17 Ethicon Endo-Sugery, Inc. Powered surgical cutting and stapling apparatus with manually retractable firing system
US20100147921A1 (en) 2008-12-16 2010-06-17 Lee Olson Surgical Apparatus Including Surgical Buttress
US8485413B2 (en) 2009-02-05 2013-07-16 Ethicon Endo-Surgery, Inc. Surgical stapling instrument comprising an articulation joint
US8414577B2 (en) 2009-02-05 2013-04-09 Ethicon Endo-Surgery, Inc. Surgical instruments and components for use in sterile environments
US8397971B2 (en) 2009-02-05 2013-03-19 Ethicon Endo-Surgery, Inc. Sterilizable surgical instrument
US8517239B2 (en) 2009-02-05 2013-08-27 Ethicon Endo-Surgery, Inc. Surgical stapling instrument comprising a magnetic element driver
US8444036B2 (en) 2009-02-06 2013-05-21 Ethicon Endo-Surgery, Inc. Motor driven surgical fastener device with mechanisms for adjusting a tissue gap within the end effector
BRPI1008667A2 (pt) 2009-02-06 2016-03-08 Ethicom Endo Surgery Inc aperfeiçoamento do grampeador cirúrgico acionado
US7967179B2 (en) 2009-03-31 2011-06-28 Tyco Healthcare Group Lp Center cinch and release of buttress material
US8348126B2 (en) 2009-03-31 2013-01-08 Covidien Lp Crimp and release of suture holding buttress material
US8016178B2 (en) 2009-03-31 2011-09-13 Tyco Healthcare Group Lp Surgical stapling apparatus
US9486215B2 (en) 2009-03-31 2016-11-08 Covidien Lp Surgical stapling apparatus
US8365972B2 (en) 2009-03-31 2013-02-05 Covidien Lp Surgical stapling apparatus
US9700339B2 (en) 2009-05-20 2017-07-11 Ethicon Endo-Surgery, Inc. Coupling arrangements and methods for attaching tools to ultrasonic surgical instruments
US8344596B2 (en) 2009-06-24 2013-01-01 Ethicon Endo-Surgery, Inc. Transducer arrangements for ultrasonic surgical instruments
US8663220B2 (en) 2009-07-15 2014-03-04 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instruments
US8986302B2 (en) 2009-10-09 2015-03-24 Ethicon Endo-Surgery, Inc. Surgical generator for ultrasonic and electrosurgical devices
US11090104B2 (en) 2009-10-09 2021-08-17 Cilag Gmbh International Surgical generator for ultrasonic and electrosurgical devices
US10441345B2 (en) 2009-10-09 2019-10-15 Ethicon Llc Surgical generator for ultrasonic and electrosurgical devices
USRE47996E1 (en) 2009-10-09 2020-05-19 Ethicon Llc Surgical generator for ultrasonic and electrosurgical devices
US9168054B2 (en) 2009-10-09 2015-10-27 Ethicon Endo-Surgery, Inc. Surgical generator for ultrasonic and electrosurgical devices
US9610080B2 (en) 2009-10-15 2017-04-04 Covidien Lp Staple line reinforcement for anvil and cartridge
US8157151B2 (en) 2009-10-15 2012-04-17 Tyco Healthcare Group Lp Staple line reinforcement for anvil and cartridge
US9693772B2 (en) 2009-10-15 2017-07-04 Covidien Lp Staple line reinforcement for anvil and cartridge
US10842485B2 (en) 2009-10-15 2020-11-24 Covidien Lp Brachytherapy buttress
US20150231409A1 (en) 2009-10-15 2015-08-20 Covidien Lp Buttress brachytherapy and integrated staple line markers for margin identification
US10293553B2 (en) 2009-10-15 2019-05-21 Covidien Lp Buttress brachytherapy and integrated staple line markers for margin identification
US8353439B2 (en) 2009-11-19 2013-01-15 Ethicon Endo-Surgery, Inc. Circular stapler introducer with radially-openable distal end portion
US8851354B2 (en) 2009-12-24 2014-10-07 Ethicon Endo-Surgery, Inc. Surgical cutting instrument that analyzes tissue thickness
US8220688B2 (en) 2009-12-24 2012-07-17 Ethicon Endo-Surgery, Inc. Motor-driven surgical cutting instrument with electric actuator directional control assembly
US8267300B2 (en) 2009-12-30 2012-09-18 Ethicon Endo-Surgery, Inc. Dampening device for endoscopic surgical stapler
US8608046B2 (en) 2010-01-07 2013-12-17 Ethicon Endo-Surgery, Inc. Test device for a surgical tool
US8961547B2 (en) 2010-02-11 2015-02-24 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instruments with moving cutting implement
US8951272B2 (en) 2010-02-11 2015-02-10 Ethicon Endo-Surgery, Inc. Seal arrangements for ultrasonically powered surgical instruments
US8469981B2 (en) 2010-02-11 2013-06-25 Ethicon Endo-Surgery, Inc. Rotatable cutting implement arrangements for ultrasonic surgical instruments
US8486096B2 (en) 2010-02-11 2013-07-16 Ethicon Endo-Surgery, Inc. Dual purpose surgical instrument for cutting and coagulating tissue
US8579928B2 (en) 2010-02-11 2013-11-12 Ethicon Endo-Surgery, Inc. Outer sheath and blade arrangements for ultrasonic surgical instruments
US8858577B2 (en) 2010-05-19 2014-10-14 University Of Utah Research Foundation Tissue stabilization system
GB2480498A (en) 2010-05-21 2011-11-23 Ethicon Endo Surgery Inc Medical device comprising RF circuitry
US8795327B2 (en) 2010-07-22 2014-08-05 Ethicon Endo-Surgery, Inc. Electrosurgical instrument with separate closure and cutting members
US9192431B2 (en) 2010-07-23 2015-11-24 Ethicon Endo-Surgery, Inc. Electrosurgical cutting and sealing instrument
US8789740B2 (en) 2010-07-30 2014-07-29 Ethicon Endo-Surgery, Inc. Linear cutting and stapling device with selectively disengageable cutting member
US8783543B2 (en) 2010-07-30 2014-07-22 Ethicon Endo-Surgery, Inc. Tissue acquisition arrangements and methods for surgical stapling devices
US8672207B2 (en) 2010-07-30 2014-03-18 Ethicon Endo-Surgery, Inc. Transwall visualization arrangements and methods for surgical circular staplers
US8360296B2 (en) 2010-09-09 2013-01-29 Ethicon Endo-Surgery, Inc. Surgical stapling head assembly with firing lockout for a surgical stapler
US9289212B2 (en) 2010-09-17 2016-03-22 Ethicon Endo-Surgery, Inc. Surgical instruments and batteries for surgical instruments
US8632525B2 (en) 2010-09-17 2014-01-21 Ethicon Endo-Surgery, Inc. Power control arrangements for surgical instruments and batteries
US9877720B2 (en) 2010-09-24 2018-01-30 Ethicon Llc Control features for articulating surgical device
US8733613B2 (en) 2010-09-29 2014-05-27 Ethicon Endo-Surgery, Inc. Staple cartridge
US9364233B2 (en) 2010-09-30 2016-06-14 Ethicon Endo-Surgery, Llc Tissue thickness compensators for circular surgical staplers
US9386988B2 (en) 2010-09-30 2016-07-12 Ethicon End-Surgery, LLC Retainer assembly including a tissue thickness compensator
US9307989B2 (en) 2012-03-28 2016-04-12 Ethicon Endo-Surgery, Llc Tissue stapler having a thickness compensator incorportating a hydrophobic agent
US9314246B2 (en) 2010-09-30 2016-04-19 Ethicon Endo-Surgery, Llc Tissue stapler having a thickness compensator incorporating an anti-inflammatory agent
US9220500B2 (en) * 2010-09-30 2015-12-29 Ethicon Endo-Surgery, Inc. Tissue thickness compensator comprising structure to produce a resilient load
US11812965B2 (en) 2010-09-30 2023-11-14 Cilag Gmbh International Layer of material for a surgical end effector
US9220501B2 (en) 2010-09-30 2015-12-29 Ethicon Endo-Surgery, Inc. Tissue thickness compensators
US9216019B2 (en) * 2011-09-23 2015-12-22 Ethicon Endo-Surgery, Inc. Surgical stapler with stationary staple drivers
US9629814B2 (en) 2010-09-30 2017-04-25 Ethicon Endo-Surgery, Llc Tissue thickness compensator configured to redistribute compressive forces
US9788834B2 (en) 2010-09-30 2017-10-17 Ethicon Llc Layer comprising deployable attachment members
US9204880B2 (en) 2012-03-28 2015-12-08 Ethicon Endo-Surgery, Inc. Tissue thickness compensator comprising capsules defining a low pressure environment
US11849952B2 (en) 2010-09-30 2023-12-26 Cilag Gmbh International Staple cartridge comprising staples positioned within a compressible portion thereof
US9839420B2 (en) 2010-09-30 2017-12-12 Ethicon Llc Tissue thickness compensator comprising at least one medicament
US11298125B2 (en) 2010-09-30 2022-04-12 Cilag Gmbh International Tissue stapler having a thickness compensator
US8746535B2 (en) 2010-09-30 2014-06-10 Ethicon Endo-Surgery, Inc. Tissue thickness compensator comprising detachable portions
US9232941B2 (en) 2010-09-30 2016-01-12 Ethicon Endo-Surgery, Inc. Tissue thickness compensator comprising a reservoir
US8893949B2 (en) 2010-09-30 2014-11-25 Ethicon Endo-Surgery, Inc. Surgical stapler with floating anvil
RU2013119928A (ru) 2010-09-30 2014-11-10 Этикон Эндо-Серджери, Инк. Сшивающая система, содержащая удерживающую матрицу и выравнивающую матрицу
US10945731B2 (en) 2010-09-30 2021-03-16 Ethicon Llc Tissue thickness compensator comprising controlled release and expansion
US9301752B2 (en) 2010-09-30 2016-04-05 Ethicon Endo-Surgery, Llc Tissue thickness compensator comprising a plurality of capsules
US9332974B2 (en) 2010-09-30 2016-05-10 Ethicon Endo-Surgery, Llc Layered tissue thickness compensator
US8814024B2 (en) 2010-09-30 2014-08-26 Ethicon Endo-Surgery, Inc. Fastener system comprising a plurality of connected retention matrix elements
US8998061B2 (en) 2010-10-01 2015-04-07 Covidien Lp Surgical fastener applying apparatus
US8695866B2 (en) 2010-10-01 2014-04-15 Ethicon Endo-Surgery, Inc. Surgical instrument having a power control circuit
US9750502B2 (en) 2010-10-01 2017-09-05 Covidien Lp Surgical stapling device for performing circular anastomosis and surgical staples for use therewith
WO2012054829A2 (en) * 2010-10-22 2012-04-26 Medrobotics Corporation Highly articulated robotic probes and methods of production and use of such probes
US8348130B2 (en) 2010-12-10 2013-01-08 Covidien Lp Surgical apparatus including surgical buttress
US9113940B2 (en) 2011-01-14 2015-08-25 Covidien Lp Trigger lockout and kickback mechanism for surgical instruments
US9084602B2 (en) 2011-01-26 2015-07-21 Covidien Lp Buttress film with hemostatic action for surgical stapling apparatus
US8852214B2 (en) 2011-02-04 2014-10-07 University Of Utah Research Foundation System for tissue fixation to bone
US8479968B2 (en) 2011-03-10 2013-07-09 Covidien Lp Surgical instrument buttress attachment
US8632462B2 (en) 2011-03-14 2014-01-21 Ethicon Endo-Surgery, Inc. Trans-rectum universal ports
US9044229B2 (en) 2011-03-15 2015-06-02 Ethicon Endo-Surgery, Inc. Surgical fastener instruments
US8800841B2 (en) 2011-03-15 2014-08-12 Ethicon Endo-Surgery, Inc. Surgical staple cartridges
US8926598B2 (en) 2011-03-15 2015-01-06 Ethicon Endo-Surgery, Inc. Surgical instruments with articulatable and rotatable end effector
WO2012141679A1 (en) * 2011-04-11 2012-10-18 Hassan Chandra Surgical technique(s) and/or device(s)
US8789737B2 (en) 2011-04-27 2014-07-29 Covidien Lp Circular stapler and staple line reinforcement material
BR112013027757B1 (pt) * 2011-04-29 2021-06-15 Ethicon Endo-Surgery, Inc Cartucho de grampos para uso com um grampeador cirúrgico
JP6026509B2 (ja) 2011-04-29 2016-11-16 エシコン・エンド−サージェリィ・インコーポレイテッドEthicon Endo−Surgery,Inc. ステープルカートリッジ自体の圧縮可能部分内に配置されたステープルを含むステープルカートリッジ
US11207064B2 (en) 2011-05-27 2021-12-28 Cilag Gmbh International Automated end effector component reloading system for use with a robotic system
US20130012958A1 (en) * 2011-07-08 2013-01-10 Stanislaw Marczyk Surgical Device with Articulation and Wrist Rotation
US20130012983A1 (en) * 2011-07-08 2013-01-10 Tyco Healthcare Group Lp Surgical Instrument with Flexible Shaft
US9351751B2 (en) * 2011-07-08 2016-05-31 Covidien Lp Swinging bars with axial wheels to drive articulating cables
US9259265B2 (en) 2011-07-22 2016-02-16 Ethicon Endo-Surgery, Llc Surgical instruments for tensioning tissue
US9198661B2 (en) 2011-09-06 2015-12-01 Ethicon Endo-Surgery, Inc. Stapling instrument comprising a plurality of staple cartridges stored therein
US9999408B2 (en) 2011-09-14 2018-06-19 Ethicon Endo-Surgery, Inc. Surgical instrument with fluid fillable buttress
US20130075447A1 (en) * 2011-09-22 2013-03-28 II William B. Weisenburgh Adjunct therapy device for applying hemostatic agent
US8985429B2 (en) * 2011-09-23 2015-03-24 Ethicon Endo-Surgery, Inc. Surgical stapling device with adjunct material application feature
US9050084B2 (en) 2011-09-23 2015-06-09 Ethicon Endo-Surgery, Inc. Staple cartridge including collapsible deck arrangement
US8899464B2 (en) * 2011-10-03 2014-12-02 Ethicon Endo-Surgery, Inc. Attachment of surgical staple buttress to cartridge
US8864795B2 (en) * 2011-10-03 2014-10-21 Covidien Lp Surgical forceps
US9675351B2 (en) 2011-10-26 2017-06-13 Covidien Lp Buttress release from surgical stapler by knife pushing
DE102011085512A1 (de) * 2011-10-31 2013-05-02 Richard Wolf Gmbh Handhabe für ein medizinisches Instrument
US8584920B2 (en) 2011-11-04 2013-11-19 Covidien Lp Surgical stapling apparatus including releasable buttress
US8740036B2 (en) 2011-12-01 2014-06-03 Covidien Lp Surgical instrument with actuator spring arm
CA2798716A1 (en) * 2011-12-13 2013-06-13 Peermedical Ltd. Removable tip endoscope
US9351732B2 (en) 2011-12-14 2016-05-31 Covidien Lp Buttress attachment to degradable polymer zones
US9010608B2 (en) 2011-12-14 2015-04-21 Covidien Lp Releasable buttress retention on a surgical stapler
US9351731B2 (en) 2011-12-14 2016-05-31 Covidien Lp Surgical stapling apparatus including releasable surgical buttress
US9237892B2 (en) 2011-12-14 2016-01-19 Covidien Lp Buttress attachment to the cartridge surface
US9113885B2 (en) 2011-12-14 2015-08-25 Covidien Lp Buttress assembly for use with surgical stapling device
US8967448B2 (en) 2011-12-14 2015-03-03 Covidien Lp Surgical stapling apparatus including buttress attachment via tabs
US9220505B2 (en) * 2011-12-16 2015-12-29 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with locking feature to lock anvil actuator
US9186148B2 (en) 2012-01-05 2015-11-17 Ethicon Endo-Surgery, Inc. Tissue stapler anvil feature to prevent premature jaw opening
US9010609B2 (en) 2012-01-26 2015-04-21 Covidien Lp Circular stapler including buttress
US9010612B2 (en) 2012-01-26 2015-04-21 Covidien Lp Buttress support design for EEA anvil
US9326773B2 (en) 2012-01-26 2016-05-03 Covidien Lp Surgical device including buttress material
JP6165780B2 (ja) 2012-02-10 2017-07-19 エシコン・エンド−サージェリィ・インコーポレイテッドEthicon Endo−Surgery,Inc. ロボット制御式の手術器具
US9931116B2 (en) 2012-02-10 2018-04-03 Covidien Lp Buttress composition
US9044230B2 (en) 2012-02-13 2015-06-02 Ethicon Endo-Surgery, Inc. Surgical cutting and fastening instrument with apparatus for determining cartridge and firing motion status
US8820606B2 (en) 2012-02-24 2014-09-02 Covidien Lp Buttress retention system for linear endostaplers
US9078653B2 (en) 2012-03-26 2015-07-14 Ethicon Endo-Surgery, Inc. Surgical stapling device with lockout system for preventing actuation in the absence of an installed staple cartridge
RU2640005C2 (ru) * 2012-03-28 2017-12-25 Этикон Эндо-Серджери, Инк. Компенсатор толщины ткани, содержащий по меньшей мере одно лекарственное средство
CN104334098B (zh) 2012-03-28 2017-03-22 伊西康内外科公司 包括限定低压强环境的胶囊剂的组织厚度补偿件
MX353040B (es) 2012-03-28 2017-12-18 Ethicon Endo Surgery Inc Unidad retenedora que incluye un compensador de grosor de tejido.
US9198662B2 (en) 2012-03-28 2015-12-01 Ethicon Endo-Surgery, Inc. Tissue thickness compensator having improved visibility
MX358135B (es) 2012-03-28 2018-08-06 Ethicon Endo Surgery Inc Compensador de grosor de tejido que comprende una pluralidad de capas.
US9237921B2 (en) 2012-04-09 2016-01-19 Ethicon Endo-Surgery, Inc. Devices and techniques for cutting and coagulating tissue
US9226766B2 (en) 2012-04-09 2016-01-05 Ethicon Endo-Surgery, Inc. Serial communication protocol for medical device
US9439668B2 (en) 2012-04-09 2016-09-13 Ethicon Endo-Surgery, Llc Switch arrangements for ultrasonic surgical instruments
US9241731B2 (en) 2012-04-09 2016-01-26 Ethicon Endo-Surgery, Inc. Rotatable electrical connection for ultrasonic surgical instruments
US9724118B2 (en) 2012-04-09 2017-08-08 Ethicon Endo-Surgery, Llc Techniques for cutting and coagulating tissue for ultrasonic surgical instruments
DE102012007648A1 (de) * 2012-04-18 2013-10-24 Karl Storz Gmbh & Co. Kg Mikroinvasives medizinisches Instrument
JP5997365B2 (ja) * 2012-04-18 2016-09-28 カーディカ インコーポレイテッド 外科用ステープラ用の安全ロックアウト
TWI468144B (zh) * 2012-05-11 2015-01-11 Univ Nat Central 用於重建手術之量測與導引裝置
US11871901B2 (en) 2012-05-20 2024-01-16 Cilag Gmbh International Method for situational awareness for surgical network or surgical network connected device capable of adjusting function based on a sensed situation or usage
US9101358B2 (en) 2012-06-15 2015-08-11 Ethicon Endo-Surgery, Inc. Articulatable surgical instrument comprising a firing drive
US9364220B2 (en) * 2012-06-19 2016-06-14 Covidien Lp Apparatus for endoscopic procedures
US8747238B2 (en) 2012-06-28 2014-06-10 Ethicon Endo-Surgery, Inc. Rotary drive shaft assemblies for surgical instruments with articulatable end effectors
US20140001231A1 (en) 2012-06-28 2014-01-02 Ethicon Endo-Surgery, Inc. Firing system lockout arrangements for surgical instruments
US9072536B2 (en) 2012-06-28 2015-07-07 Ethicon Endo-Surgery, Inc. Differential locking arrangements for rotary powered surgical instruments
US20140005718A1 (en) 2012-06-28 2014-01-02 Ethicon Endo-Surgery, Inc. Multi-functional powered surgical device with external dissection features
US20140005678A1 (en) 2012-06-28 2014-01-02 Ethicon Endo-Surgery, Inc. Rotary drive arrangements for surgical instruments
US9282974B2 (en) 2012-06-28 2016-03-15 Ethicon Endo-Surgery, Llc Empty clip cartridge lockout
US9119657B2 (en) 2012-06-28 2015-09-01 Ethicon Endo-Surgery, Inc. Rotary actuatable closure arrangement for surgical end effector
US9101385B2 (en) 2012-06-28 2015-08-11 Ethicon Endo-Surgery, Inc. Electrode connections for rotary driven surgical tools
US11278284B2 (en) 2012-06-28 2022-03-22 Cilag Gmbh International Rotary drive arrangements for surgical instruments
US9289256B2 (en) 2012-06-28 2016-03-22 Ethicon Endo-Surgery, Llc Surgical end effectors having angled tissue-contacting surfaces
US9561038B2 (en) 2012-06-28 2017-02-07 Ethicon Endo-Surgery, Llc Interchangeable clip applier
EP2866686A1 (en) 2012-06-28 2015-05-06 Ethicon Endo-Surgery, Inc. Empty clip cartridge lockout
US9125662B2 (en) 2012-06-28 2015-09-08 Ethicon Endo-Surgery, Inc. Multi-axis articulating and rotating surgical tools
US9028494B2 (en) 2012-06-28 2015-05-12 Ethicon Endo-Surgery, Inc. Interchangeable end effector coupling arrangement
US20140005705A1 (en) * 2012-06-29 2014-01-02 Ethicon Endo-Surgery, Inc. Surgical instruments with articulating shafts
BR112014032776B1 (pt) 2012-06-28 2021-09-08 Ethicon Endo-Surgery, Inc Sistema de instrumento cirúrgico e kit cirúrgico para uso com um sistema de instrumento cirúrgico
US9226767B2 (en) 2012-06-29 2016-01-05 Ethicon Endo-Surgery, Inc. Closed feedback control for electrosurgical device
US9408622B2 (en) 2012-06-29 2016-08-09 Ethicon Endo-Surgery, Llc Surgical instruments with articulating shafts
US20140005702A1 (en) 2012-06-29 2014-01-02 Ethicon Endo-Surgery, Inc. Ultrasonic surgical instruments with distally positioned transducers
US9283045B2 (en) 2012-06-29 2016-03-15 Ethicon Endo-Surgery, Llc Surgical instruments with fluid management system
US9393037B2 (en) 2012-06-29 2016-07-19 Ethicon Endo-Surgery, Llc Surgical instruments with articulating shafts
US9820768B2 (en) 2012-06-29 2017-11-21 Ethicon Llc Ultrasonic surgical instruments with control mechanisms
US9326788B2 (en) 2012-06-29 2016-05-03 Ethicon Endo-Surgery, Llc Lockout mechanism for use with robotic electrosurgical device
US9198714B2 (en) 2012-06-29 2015-12-01 Ethicon Endo-Surgery, Inc. Haptic feedback devices for surgical robot
US9351754B2 (en) 2012-06-29 2016-05-31 Ethicon Endo-Surgery, Llc Ultrasonic surgical instruments with distally positioned jaw assemblies
US9271783B2 (en) 2012-07-17 2016-03-01 Covidien Lp End-effector assembly including a pressure-sensitive layer disposed on an electrode
US9572576B2 (en) 2012-07-18 2017-02-21 Covidien Lp Surgical apparatus including surgical buttress
US10835241B2 (en) 2012-07-30 2020-11-17 Conextions, Inc. Devices, systems, and methods for repairing soft tissue and attaching soft tissue to bone
US10219804B2 (en) * 2012-07-30 2019-03-05 Conextions, Inc. Devices, systems, and methods for repairing soft tissue and attaching soft tissue to bone
US9427309B2 (en) 2012-07-30 2016-08-30 Conextions, Inc. Soft tissue repair devices, systems, and methods
US11944531B2 (en) 2012-07-30 2024-04-02 Conextions, Inc. Devices, systems, and methods for repairing soft tissue and attaching soft tissue to bone
US10390935B2 (en) 2012-07-30 2019-08-27 Conextions, Inc. Soft tissue to bone repair devices, systems, and methods
US11957334B2 (en) 2012-07-30 2024-04-16 Conextions, Inc. Devices, systems, and methods for repairing soft tissue and attaching soft tissue to bone
US9629632B2 (en) 2012-07-30 2017-04-25 Conextions, Inc. Soft tissue repair devices, systems, and methods
US11253252B2 (en) 2012-07-30 2022-02-22 Conextions, Inc. Devices, systems, and methods for repairing soft tissue and attaching soft tissue to bone
US20140048580A1 (en) 2012-08-20 2014-02-20 Covidien Lp Buttress attachment features for surgical stapling apparatus
CN102813540A (zh) * 2012-08-28 2012-12-12 刘忠臣 三明治订书机式消化道吻合切割闭合器
US9713474B2 (en) 2012-09-17 2017-07-25 The Cleveland Clinic Foundation Endoscopic stapler
JP6275727B2 (ja) 2012-09-28 2018-02-07 エシコン・エンド−サージェリィ・インコーポレイテッドEthicon Endo−Surgery,Inc. 多機能バイポーラ鉗子
US9161753B2 (en) 2012-10-10 2015-10-20 Covidien Lp Buttress fixation for a circular stapler
US9386985B2 (en) 2012-10-15 2016-07-12 Ethicon Endo-Surgery, Llc Surgical cutting instrument
US9095367B2 (en) 2012-10-22 2015-08-04 Ethicon Endo-Surgery, Inc. Flexible harmonic waveguides/blades for surgical instruments
US10201365B2 (en) 2012-10-22 2019-02-12 Ethicon Llc Surgeon feedback sensing and display methods
US20140131418A1 (en) 2012-11-09 2014-05-15 Covidien Lp Surgical Stapling Apparatus Including Buttress Attachment
US9192384B2 (en) 2012-11-09 2015-11-24 Covidien Lp Recessed groove for better suture retention
US20140135804A1 (en) 2012-11-15 2014-05-15 Ethicon Endo-Surgery, Inc. Ultrasonic and electrosurgical devices
US9289207B2 (en) 2012-11-29 2016-03-22 Ethicon Endo-Surgery, Llc Surgical staple with integral pledget for tip deflection
US9295466B2 (en) 2012-11-30 2016-03-29 Covidien Lp Surgical apparatus including surgical buttress
US9681936B2 (en) 2012-11-30 2017-06-20 Covidien Lp Multi-layer porous film material
US9402627B2 (en) 2012-12-13 2016-08-02 Covidien Lp Folded buttress for use with a surgical apparatus
CN103156660B (zh) * 2012-12-26 2015-05-06 苏州天臣国际医疗科技有限公司 圆管型吻合器
CN103908313A (zh) * 2012-12-29 2014-07-09 苏州天臣国际医疗科技有限公司 外科手术器械
US9750497B2 (en) 2013-01-03 2017-09-05 Just Right Surgical, Llc Device for use in laparoscopic surgery and method of use
US8517240B1 (en) * 2013-01-03 2013-08-27 Just Right Surgical, Llc Medical device and method of use
US9204881B2 (en) 2013-01-11 2015-12-08 Covidien Lp Buttress retainer for EEA anvil
US9433420B2 (en) 2013-01-23 2016-09-06 Covidien Lp Surgical apparatus including surgical buttress
US9192383B2 (en) 2013-02-04 2015-11-24 Covidien Lp Circular stapling device including buttress material
US9414839B2 (en) 2013-02-04 2016-08-16 Covidien Lp Buttress attachment for circular stapling device
MX365654B (es) 2013-02-08 2019-06-10 Ethicon Endo Surgery Inc Capas implantables de múltiples grosores para dispositivos de engrapado quirúrgicos.
US9386984B2 (en) 2013-02-08 2016-07-12 Ethicon Endo-Surgery, Llc Staple cartridge comprising a releasable cover
US20140224857A1 (en) * 2013-02-08 2014-08-14 Ethicon Endo-Surgery, Inc. Staple cartridge comprising a compressible portion
US9504470B2 (en) 2013-02-25 2016-11-29 Covidien Lp Circular stapling device with buttress
US10092292B2 (en) 2013-02-28 2018-10-09 Ethicon Llc Staple forming features for surgical stapling instrument
US9795379B2 (en) * 2013-02-28 2017-10-24 Ethicon Llc Surgical instrument with multi-diameter shaft
US20140239047A1 (en) 2013-02-28 2014-08-28 Covidien Lp Adherence concepts for non-woven absorbable felt buttresses
RU2669463C2 (ru) 2013-03-01 2018-10-11 Этикон Эндо-Серджери, Инк. Хирургический инструмент с мягким упором
US9554794B2 (en) 2013-03-01 2017-01-31 Ethicon Endo-Surgery, Llc Multiple processor motor control for modular surgical instruments
RU2672520C2 (ru) 2013-03-01 2018-11-15 Этикон Эндо-Серджери, Инк. Шарнирно поворачиваемые хирургические инструменты с проводящими путями для передачи сигналов
US20140252064A1 (en) * 2013-03-05 2014-09-11 Covidien Lp Surgical stapling device including adjustable fastener crimping
US9782173B2 (en) 2013-03-07 2017-10-10 Covidien Lp Circular stapling device including buttress release mechanism
US9345481B2 (en) 2013-03-13 2016-05-24 Ethicon Endo-Surgery, Llc Staple cartridge tissue thickness sensor system
US9629628B2 (en) 2013-03-13 2017-04-25 Covidien Lp Surgical stapling apparatus
US9717498B2 (en) 2013-03-13 2017-08-01 Covidien Lp Surgical stapling apparatus
US9814463B2 (en) 2013-03-13 2017-11-14 Covidien Lp Surgical stapling apparatus
US9888921B2 (en) 2013-03-13 2018-02-13 Covidien Lp Surgical stapling apparatus
EP4144303A1 (en) 2013-03-14 2023-03-08 Applied Medical Resources Corporation Surgical stapler with partial pockets
US20140263541A1 (en) 2013-03-14 2014-09-18 Ethicon Endo-Surgery, Inc. Articulatable surgical instrument comprising an articulation lock
US9402624B1 (en) * 2013-03-14 2016-08-02 Ascension Orthopedics, Inc. Bone fixation staple
US9629629B2 (en) 2013-03-14 2017-04-25 Ethicon Endo-Surgey, LLC Control systems for surgical instruments
US10226273B2 (en) 2013-03-14 2019-03-12 Ethicon Llc Mechanical fasteners for use with surgical energy devices
US9486212B2 (en) * 2013-03-15 2016-11-08 Orthohelix Surgical Designs, Inc. Bone staple storage, inserter, and method for use therewith
ES2937067T3 (es) 2013-03-15 2023-03-23 Applied Med Resources Grapadora quirúrgica con mordaza expandible
KR102649677B1 (ko) 2013-03-15 2024-03-21 어플라이드 메디컬 리소시스 코포레이션 회전가능 샤프트를 구비한 구동 메커니즘을 갖는 수술용 스테이플러
US9241728B2 (en) 2013-03-15 2016-01-26 Ethicon Endo-Surgery, Inc. Surgical instrument with multiple clamping mechanisms
PL3498176T3 (pl) 2013-03-20 2021-09-27 Bard Peripheral Vascular, Inc. Urządzenie biopsyjne
RU2524125C1 (ru) * 2013-03-21 2014-07-27 Государственное бюджетное образовательное учреждение высшего профессионального образования "Самарский государственный медицинский университет" Министерства здравоохранения Российской Федерации Способ защиты слизисто-надкостничного лоскута при пластике ороантрального сообщения
US9510827B2 (en) 2013-03-25 2016-12-06 Covidien Lp Micro surgical instrument and loading unit for use therewith
US9572577B2 (en) 2013-03-27 2017-02-21 Ethicon Endo-Surgery, Llc Fastener cartridge comprising a tissue thickness compensator including openings therein
US9795384B2 (en) 2013-03-27 2017-10-24 Ethicon Llc Fastener cartridge comprising a tissue thickness compensator and a gap setting element
US20140291379A1 (en) 2013-03-27 2014-10-02 Ethicon Endo-Surgery, Inc. Tissue thickness compensator comprising a cutting member path
US9332984B2 (en) 2013-03-27 2016-05-10 Ethicon Endo-Surgery, Llc Fastener cartridge assemblies
BR112015026109B1 (pt) 2013-04-16 2022-02-22 Ethicon Endo-Surgery, Inc Instrumento cirúrgico
US9867612B2 (en) 2013-04-16 2018-01-16 Ethicon Llc Powered surgical stapler
JP6267784B2 (ja) * 2013-04-16 2018-01-24 テレフレックス メディカル インコーポレイテッド 再使用可能なハンドル及び取り外し可能な針組立体付きのニードルスコピック器械
US9687233B2 (en) * 2013-05-09 2017-06-27 Dextera Surgical Inc. Surgical stapling and cutting apparatus—deployment mechanisms, systems and methods
DE102013208924A1 (de) * 2013-05-14 2014-12-04 Johnson & Johnson Medical Gmbh Chirurgisches Implantat umfassend einer Lage mit Öffnungen
US9574644B2 (en) 2013-05-30 2017-02-21 Ethicon Endo-Surgery, Llc Power module for use with a surgical instrument
US10085746B2 (en) 2013-06-28 2018-10-02 Covidien Lp Surgical instrument including rotating end effector and rotation-limiting structure
US9629633B2 (en) * 2013-07-09 2017-04-25 Covidien Lp Surgical device, surgical adapters for use between surgical handle assembly and surgical loading units, and methods of use
CN105682573B (zh) * 2013-08-23 2018-09-21 伊西康内外科有限责任公司 用于可消毒外科器械的罩保持构造
CN106028966B (zh) 2013-08-23 2018-06-22 伊西康内外科有限责任公司 用于动力外科器械的击发构件回缩装置
US20150053748A1 (en) * 2013-08-23 2015-02-26 Ethicon Endo-Surgery, Inc. Secondary battery arrangements for powered surgical instruments
US9662108B2 (en) 2013-08-30 2017-05-30 Covidien Lp Surgical stapling apparatus
EP2845549B1 (de) * 2013-09-10 2016-08-31 Erbe Elektromedizin GmbH Chirurgisches Instrument mit verbessertem Betätigungsgetriebe
US9814514B2 (en) 2013-09-13 2017-11-14 Ethicon Llc Electrosurgical (RF) medical instruments for cutting and coagulating tissue
US20140171986A1 (en) 2013-09-13 2014-06-19 Ethicon Endo-Surgery, Inc. Surgical Clip Having Comliant Portion
US10856901B2 (en) 2013-09-18 2020-12-08 Teleflex Medical Incorporated Exchanger surgical access port assembly and methods of use
CN103505264B (zh) * 2013-09-18 2015-06-24 大连理工大学 经椎弓根通道治疗胸腰椎爆裂骨折的微创手术器械
US9049905B2 (en) * 2013-10-23 2015-06-09 GM Global Technology Operations LLC Clip and coupling assembly
US9655620B2 (en) 2013-10-28 2017-05-23 Covidien Lp Circular surgical stapling device including buttress material
CN105682570B (zh) 2013-11-04 2019-02-01 柯惠Lp公司 手术紧固件施加装置
CA2926782A1 (en) 2013-11-04 2015-05-07 Covidien Lp Surgical fastener applying apparatus
EP3065648A1 (en) 2013-11-04 2016-09-14 Covidien LP Surgical fastener applying apparatus
ES2847574T3 (es) 2013-11-05 2021-08-03 Bard Inc C R Dispositivo de biopsia que tiene vacío integrado
US20150134076A1 (en) * 2013-11-08 2015-05-14 Ethicon Endo-Surgery, Inc. Hybrid adjunct materials for use in surgical stapling
US9936950B2 (en) 2013-11-08 2018-04-10 Ethicon Llc Hybrid adjunct materials for use in surgical stapling
US9265926B2 (en) 2013-11-08 2016-02-23 Ethicon Endo-Surgery, Llc Electrosurgical devices
US9700311B2 (en) 2013-11-08 2017-07-11 Ethicon Llc Tissue ingrowth materials and method of using the same
US20150134077A1 (en) 2013-11-08 2015-05-14 Ethicon Endo-Surgery, Inc. Sealing materials for use in surgical stapling
US10456129B2 (en) 2013-11-08 2019-10-29 Ethicon Llc Positively charged implantable materials and method of forming the same
US10485545B2 (en) 2013-11-19 2019-11-26 Datascope Corp. Fastener applicator with interlock
WO2015088655A1 (en) 2013-12-12 2015-06-18 Covidien Lp Gear train assemblies for robotic surgical systems
GB2521229A (en) 2013-12-16 2015-06-17 Ethicon Endo Surgery Inc Medical device
GB2521228A (en) 2013-12-16 2015-06-17 Ethicon Endo Surgery Inc Medical device
EP4344684A3 (en) 2013-12-17 2024-10-09 Standard Bariatrics Inc. Resection line guide for a medical procedure
US9867613B2 (en) 2013-12-19 2018-01-16 Covidien Lp Surgical staples and end effectors for deploying the same
DE102014117393A1 (de) * 2013-12-19 2015-06-25 Karl Storz Gmbh & Co. Kg Dreh- und abwinkelbares medizinisches Instrument
US9681870B2 (en) 2013-12-23 2017-06-20 Ethicon Llc Articulatable surgical instruments with separate and distinct closing and firing systems
US9839428B2 (en) 2013-12-23 2017-12-12 Ethicon Llc Surgical cutting and stapling instruments with independent jaw control features
BR112016014748B1 (pt) * 2013-12-23 2022-07-05 Ethicon Endo-Surgery, Llc Conjunto de cartucho de prendedores
US20150173756A1 (en) 2013-12-23 2015-06-25 Ethicon Endo-Surgery, Inc. Surgical cutting and stapling methods
US10265065B2 (en) 2013-12-23 2019-04-23 Ethicon Llc Surgical staples and staple cartridges
US9724092B2 (en) * 2013-12-23 2017-08-08 Ethicon Llc Modular surgical instruments
US9642620B2 (en) 2013-12-23 2017-05-09 Ethicon Endo-Surgery, Llc Surgical cutting and stapling instruments with articulatable end effectors
JP6594881B2 (ja) * 2013-12-23 2019-10-23 エシコン エルエルシー 締結具移動面を含む発射部材を備える締結具カートリッジ
WO2015101184A1 (zh) * 2013-12-31 2015-07-09 苏州天臣国际医疗科技有限公司 直线缝合切割装置
US9795436B2 (en) 2014-01-07 2017-10-24 Ethicon Llc Harvesting energy from a surgical generator
US9655616B2 (en) * 2014-01-22 2017-05-23 Covidien Lp Apparatus for endoscopic procedures
US9700312B2 (en) 2014-01-28 2017-07-11 Covidien Lp Surgical apparatus
US9962161B2 (en) 2014-02-12 2018-05-08 Ethicon Llc Deliverable surgical instrument
US9848874B2 (en) 2014-02-14 2017-12-26 Covidien Lp Small diameter endoscopic stapler
US9974541B2 (en) * 2014-02-14 2018-05-22 Covidien Lp End stop detection
JP6462004B2 (ja) 2014-02-24 2019-01-30 エシコン エルエルシー 発射部材ロックアウトを備える締結システム
AU2015101974B4 (en) * 2014-02-24 2020-12-24 Ethicon Endo-Surgery, Llc. Staple cartridge including a barbed staple
US9884456B2 (en) 2014-02-24 2018-02-06 Ethicon Llc Implantable layers and methods for altering one or more properties of implantable layers for use with fastening instruments
US20150250474A1 (en) 2014-03-04 2015-09-10 Maquet Cardiovascular Llc Surgical implant and method and instrument for installing the same
US10499908B2 (en) 2014-03-04 2019-12-10 Maquet Cardiovascular Llc Surgical implant and method and instrument for installing the same
US11583384B2 (en) 2014-03-12 2023-02-21 Conextions, Inc. Devices, systems, and methods for repairing soft tissue and attaching soft tissue to bone
US9554854B2 (en) 2014-03-18 2017-01-31 Ethicon Endo-Surgery, Llc Detecting short circuits in electrosurgical medical devices
BR112016021815B1 (pt) * 2014-03-26 2022-07-19 Ethicon Endo-Surgery, Llc. Método para controlar um instrumento cirúrgico
US9820738B2 (en) 2014-03-26 2017-11-21 Ethicon Llc Surgical instrument comprising interactive systems
US9913642B2 (en) 2014-03-26 2018-03-13 Ethicon Llc Surgical instrument comprising a sensor system
US9690362B2 (en) 2014-03-26 2017-06-27 Ethicon Llc Surgical instrument control circuit having a safety processor
BR112016021943B1 (pt) 2014-03-26 2022-06-14 Ethicon Endo-Surgery, Llc Instrumento cirúrgico para uso por um operador em um procedimento cirúrgico
US20180132850A1 (en) 2014-03-26 2018-05-17 Ethicon Llc Surgical instrument comprising a sensor system
US20150272582A1 (en) 2014-03-26 2015-10-01 Ethicon Endo-Surgery, Inc. Power management control systems for surgical instruments
US10463421B2 (en) 2014-03-27 2019-11-05 Ethicon Llc Two stage trigger, clamp and cut bipolar vessel sealer
US10092310B2 (en) 2014-03-27 2018-10-09 Ethicon Llc Electrosurgical devices
AU2015241267A1 (en) 2014-03-29 2016-10-20 Standard Bariatrics, Inc. End effectors, surgical stapling devices, and methods of using same
US9724096B2 (en) * 2014-03-29 2017-08-08 Standard Bariatrics, Inc. End effectors, surgical stapling devices, and methods of using same
US9737355B2 (en) 2014-03-31 2017-08-22 Ethicon Llc Controlling impedance rise in electrosurgical medical devices
US9757126B2 (en) 2014-03-31 2017-09-12 Covidien Lp Surgical stapling apparatus with firing lockout mechanism
US9913680B2 (en) 2014-04-15 2018-03-13 Ethicon Llc Software algorithms for electrosurgical instruments
CN106456158B (zh) 2014-04-16 2019-02-05 伊西康内外科有限责任公司 包括非一致紧固件的紧固件仓
BR112016023876B1 (pt) * 2014-04-16 2022-07-26 Ethicon Endo-Surgery, Llc Cartucho de prendedores para uso com um instrumento prendedor para prender tecido
JP6636452B2 (ja) 2014-04-16 2020-01-29 エシコン エルエルシーEthicon LLC 異なる構成を有する延在部を含む締結具カートリッジ
JP6532889B2 (ja) 2014-04-16 2019-06-19 エシコン エルエルシーEthicon LLC 締結具カートリッジ組立体及びステープル保持具カバー配置構成
US9943310B2 (en) 2014-09-26 2018-04-17 Ethicon Llc Surgical stapling buttresses and adjunct materials
US20150297223A1 (en) 2014-04-16 2015-10-22 Ethicon Endo-Surgery, Inc. Fastener cartridges including extensions having different configurations
US10299792B2 (en) 2014-04-16 2019-05-28 Ethicon Llc Fastener cartridge comprising non-uniform fasteners
US9668733B2 (en) 2014-04-21 2017-06-06 Covidien Lp Stapling device with features to prevent inadvertent firing of staples
US9844378B2 (en) 2014-04-29 2017-12-19 Covidien Lp Surgical stapling apparatus and methods of adhering a surgical buttress thereto
US9861366B2 (en) 2014-05-06 2018-01-09 Covidien Lp Ejecting assembly for a surgical stapler
CN110680437B (zh) 2014-05-15 2023-01-31 柯惠Lp公司 手术紧固件施加装置
TWI558483B (zh) * 2014-05-20 2016-11-21 Pull nail tool
CN104042305A (zh) * 2014-05-29 2014-09-17 白少华 一种能探查胆道的精密手术钳
US9801630B2 (en) 2014-06-10 2017-10-31 Ethicon Llc Methods and devices for reinforcing a staple line
US10206686B2 (en) 2014-06-10 2019-02-19 Ethicon Llc Bronchus sealants and methods of sealing bronchial tubes
US9826965B2 (en) 2014-06-10 2017-11-28 Ethicon Llc Devices for sealing a body lumen
US10610226B2 (en) 2014-06-10 2020-04-07 Ethicon Endo-Surgery, Inc. Methods and devices for sealing stapled tissue
US10172611B2 (en) 2014-06-10 2019-01-08 Ethicon Llc Adjunct materials and methods of using same in surgical methods for tissue sealing
US9848871B2 (en) 2014-06-10 2017-12-26 Ethicon Llc Woven and fibrous materials for reinforcing a staple line
US9913646B2 (en) 2014-06-10 2018-03-13 Ethicon Llc Devices for sealing staples in tissue
EP3566662B1 (en) 2014-06-11 2021-01-20 Applied Medical Resources Corporation Surgical stapler with circumferential firing
US10045781B2 (en) 2014-06-13 2018-08-14 Ethicon Llc Closure lockout systems for surgical instruments
US9543725B2 (en) * 2014-06-18 2017-01-10 Yu-Hsin Li Pliers for crimping electrical terminals
JP5945642B2 (ja) * 2014-06-24 2016-07-05 オリンパス株式会社 内視鏡の湾曲操作機構
EP3071131B1 (en) 2014-07-15 2019-02-27 Teleflex Medical Incorporated Exchanger surgical access port assembly
US10285724B2 (en) 2014-07-31 2019-05-14 Ethicon Llc Actuation mechanisms and load adjustment assemblies for surgical instruments
CN106456174B (zh) 2014-08-04 2019-08-23 奥林巴斯株式会社 手术用器具以及组织切离单元
US9788835B2 (en) 2014-09-02 2017-10-17 Ethicon Llc Devices and methods for facilitating ejection of surgical fasteners from cartridges
US9795380B2 (en) * 2014-09-02 2017-10-24 Ethicon Llc Devices and methods for facilitating closing and clamping of an end effector of a surgical device
BR112017004361B1 (pt) 2014-09-05 2023-04-11 Ethicon Llc Sistema eletrônico para um instrumento cirúrgico
US10470911B2 (en) 2014-09-05 2019-11-12 Standard Bariatrics, Inc. Sleeve gastrectomy calibration tube and method of using same
US10111679B2 (en) 2014-09-05 2018-10-30 Ethicon Llc Circuitry and sensors for powered medical device
US11311294B2 (en) 2014-09-05 2022-04-26 Cilag Gmbh International Powered medical device including measurement of closure state of jaws
KR102649260B1 (ko) 2014-09-15 2024-03-20 어플라이드 메디컬 리소시스 코포레이션 자동-조정 스테이플 높이를 가진 수술용 스테이플러
CA2995825A1 (en) * 2014-09-15 2016-03-24 Stepwise Ltd Tissue staplers, stapler heads, and methods of surgically fastening and cutting a bodily tissue
US9629747B2 (en) 2014-09-17 2017-04-25 Iantech, Inc. Devices and methods for cutting lenticular tissue
CN107072814B (zh) 2014-09-17 2021-01-26 卡尔蔡司白内障医疗技术公司 用于取出晶状体组织的装置和方法
US10105142B2 (en) 2014-09-18 2018-10-23 Ethicon Llc Surgical stapler with plurality of cutting elements
CN106999183B (zh) * 2014-09-26 2021-08-10 伊西康有限责任公司 用于钉仓的外科钉和驱动器布置
CN108472041A (zh) * 2014-09-26 2018-08-31 伊西康有限责任公司 用于施加可径向扩张的紧固件行的圆形紧固件仓
BR112017005981B1 (pt) 2014-09-26 2022-09-06 Ethicon, Llc Material de escora para uso com um cartucho de grampos cirúrgicos e cartucho de grampos cirúrgicos para uso com um instrumento cirúrgico
US11523821B2 (en) 2014-09-26 2022-12-13 Cilag Gmbh International Method for creating a flexible staple line
US10076325B2 (en) 2014-10-13 2018-09-18 Ethicon Llc Surgical stapling apparatus comprising a tissue stop
US9924944B2 (en) 2014-10-16 2018-03-27 Ethicon Llc Staple cartridge comprising an adjunct material
US11141153B2 (en) 2014-10-29 2021-10-12 Cilag Gmbh International Staple cartridges comprising driver arrangements
US10517594B2 (en) 2014-10-29 2019-12-31 Ethicon Llc Cartridge assemblies for surgical staplers
US11504192B2 (en) 2014-10-30 2022-11-22 Cilag Gmbh International Method of hub communication with surgical instrument systems
JP6023921B2 (ja) * 2014-10-31 2016-11-09 オリンパス株式会社 手術用器具
US9844376B2 (en) 2014-11-06 2017-12-19 Ethicon Llc Staple cartridge comprising a releasable adjunct material
US10639092B2 (en) 2014-12-08 2020-05-05 Ethicon Llc Electrode configurations for surgical instruments
US10736636B2 (en) 2014-12-10 2020-08-11 Ethicon Llc Articulatable surgical instrument system
JP6480585B2 (ja) * 2014-12-11 2019-03-13 コヴィディエン リミテッド パートナーシップ 自動拘止機構を有するステープラ
US10188385B2 (en) 2014-12-18 2019-01-29 Ethicon Llc Surgical instrument system comprising lockable systems
US10085748B2 (en) 2014-12-18 2018-10-02 Ethicon Llc Locking arrangements for detachable shaft assemblies with articulatable surgical end effectors
US9987000B2 (en) 2014-12-18 2018-06-05 Ethicon Llc Surgical instrument assembly comprising a flexible articulation system
US10004501B2 (en) * 2014-12-18 2018-06-26 Ethicon Llc Surgical instruments with improved closure arrangements
US9844375B2 (en) 2014-12-18 2017-12-19 Ethicon Llc Drive arrangements for articulatable surgical instruments
BR112017012996B1 (pt) 2014-12-18 2022-11-08 Ethicon Llc Instrumento cirúrgico com uma bigorna que é seletivamente móvel sobre um eixo geométrico imóvel distinto em relação a um cartucho de grampos
MX2017008106A (es) * 2014-12-18 2018-03-06 Ethicon Llc Instrumentos quirurgicos con arreglos de cierre mejorados.
US10117649B2 (en) 2014-12-18 2018-11-06 Ethicon Llc Surgical instrument assembly comprising a lockable articulation system
US9844374B2 (en) 2014-12-18 2017-12-19 Ethicon Llc Surgical instrument systems comprising an articulatable end effector and means for adjusting the firing stroke of a firing member
US10835216B2 (en) 2014-12-24 2020-11-17 Covidien Lp Spinneret for manufacture of melt blown nonwoven fabric
US10245095B2 (en) 2015-02-06 2019-04-02 Ethicon Llc Electrosurgical instrument with rotation and articulation mechanisms
US10470767B2 (en) 2015-02-10 2019-11-12 Covidien Lp Surgical stapling instrument having ultrasonic energy delivery
US10039545B2 (en) 2015-02-23 2018-08-07 Covidien Lp Double fire stapling
US10130367B2 (en) 2015-02-26 2018-11-20 Covidien Lp Surgical apparatus
US10085749B2 (en) 2015-02-26 2018-10-02 Covidien Lp Surgical apparatus with conductor strain relief
US20160249910A1 (en) 2015-02-27 2016-09-01 Ethicon Endo-Surgery, Llc Surgical charging system that charges and/or conditions one or more batteries
US10180463B2 (en) 2015-02-27 2019-01-15 Ethicon Llc Surgical apparatus configured to assess whether a performance parameter of the surgical apparatus is within an acceptable performance band
US11154301B2 (en) 2015-02-27 2021-10-26 Cilag Gmbh International Modular stapling assembly
US9993258B2 (en) 2015-02-27 2018-06-12 Ethicon Llc Adaptable surgical instrument handle
US10064642B2 (en) * 2015-03-04 2018-09-04 Covidien Lp Surgical instrument for dissecting tissue
US9855040B2 (en) 2015-03-04 2018-01-02 Covidien Lp Surgical stapling loading unit having articulating jaws
US9895148B2 (en) 2015-03-06 2018-02-20 Ethicon Endo-Surgery, Llc Monitoring speed control and precision incrementing of motor for powered surgical instruments
US10548504B2 (en) 2015-03-06 2020-02-04 Ethicon Llc Overlaid multi sensor radio frequency (RF) electrode system to measure tissue compression
US9808246B2 (en) 2015-03-06 2017-11-07 Ethicon Endo-Surgery, Llc Method of operating a powered surgical instrument
US9924961B2 (en) 2015-03-06 2018-03-27 Ethicon Endo-Surgery, Llc Interactive feedback system for powered surgical instruments
US9993248B2 (en) 2015-03-06 2018-06-12 Ethicon Endo-Surgery, Llc Smart sensors with local signal processing
US10045776B2 (en) 2015-03-06 2018-08-14 Ethicon Llc Control techniques and sub-processor contained within modular shaft with select control processing from handle
US9901342B2 (en) 2015-03-06 2018-02-27 Ethicon Endo-Surgery, Llc Signal and power communication system positioned on a rotatable shaft
JP2020121162A (ja) 2015-03-06 2020-08-13 エシコン エルエルシーEthicon LLC 測定の安定性要素、クリープ要素、及び粘弾性要素を決定するためのセンサデータの時間依存性評価
US10617412B2 (en) 2015-03-06 2020-04-14 Ethicon Llc System for detecting the mis-insertion of a staple cartridge into a surgical stapler
US10245033B2 (en) 2015-03-06 2019-04-02 Ethicon Llc Surgical instrument comprising a lockable battery housing
US10687806B2 (en) 2015-03-06 2020-06-23 Ethicon Llc Adaptive tissue compression techniques to adjust closure rates for multiple tissue types
US10441279B2 (en) 2015-03-06 2019-10-15 Ethicon Llc Multiple level thresholds to modify operation of powered surgical instruments
US20160262738A1 (en) * 2015-03-12 2016-09-15 Nir Altman Superelastic articulating mechanism
US10342602B2 (en) 2015-03-17 2019-07-09 Ethicon Llc Managing tissue treatment
US10321950B2 (en) 2015-03-17 2019-06-18 Ethicon Llc Managing tissue treatment
US9918717B2 (en) 2015-03-18 2018-03-20 Covidien Lp Pivot mechanism for surgical device
US10595929B2 (en) 2015-03-24 2020-03-24 Ethicon Llc Surgical instruments with firing system overload protection mechanisms
US10390825B2 (en) 2015-03-31 2019-08-27 Ethicon Llc Surgical instrument with progressive rotary drive systems
US10463368B2 (en) 2015-04-10 2019-11-05 Covidien Lp Endoscopic stapler
CA2981826A1 (en) 2015-04-10 2016-10-13 Covidien Lp Surgical stapler with integrated bladder
EP3981335B1 (en) 2015-05-01 2023-11-08 C. R. Bard, Inc. Biopsy device
US10299789B2 (en) 2015-05-05 2019-05-28 Covidie LP Adapter assembly for surgical stapling devices
US10117650B2 (en) 2015-05-05 2018-11-06 Covidien Lp Adapter assembly and loading units for surgical stapling devices
US10039532B2 (en) 2015-05-06 2018-08-07 Covidien Lp Surgical instrument with articulation assembly
US10143474B2 (en) 2015-05-08 2018-12-04 Just Right Surgical, Llc Surgical stapler
JP6511608B2 (ja) * 2015-05-15 2019-05-15 株式会社神戸製鋼所 等方圧加圧装置、およびそれを用いた加圧処理方法
CA2986480A1 (en) 2015-05-25 2016-12-01 Covidien Lp Small diameter surgical stapling device
US10349941B2 (en) 2015-05-27 2019-07-16 Covidien Lp Multi-fire lead screw stapling device
US10172615B2 (en) 2015-05-27 2019-01-08 Covidien Lp Multi-fire push rod stapling device
US10034684B2 (en) 2015-06-15 2018-07-31 Ethicon Llc Apparatus and method for dissecting and coagulating tissue
US11020140B2 (en) 2015-06-17 2021-06-01 Cilag Gmbh International Ultrasonic surgical blade for use with ultrasonic surgical instruments
US10052102B2 (en) 2015-06-18 2018-08-21 Ethicon Llc Surgical end effectors with dual cam actuated jaw closing features
BR112017027281B1 (pt) * 2015-06-18 2022-12-13 Ethicon Llc Instrumento cirúrgico
US11129669B2 (en) 2015-06-30 2021-09-28 Cilag Gmbh International Surgical system with user adaptable techniques based on tissue type
US11141213B2 (en) 2015-06-30 2021-10-12 Cilag Gmbh International Surgical instrument with user adaptable techniques
US10357303B2 (en) 2015-06-30 2019-07-23 Ethicon Llc Translatable outer tube for sealing using shielded lap chole dissector
US11051873B2 (en) 2015-06-30 2021-07-06 Cilag Gmbh International Surgical system with user adaptable techniques employing multiple energy modalities based on tissue parameters
US10034704B2 (en) 2015-06-30 2018-07-31 Ethicon Llc Surgical instrument with user adaptable algorithms
US10898256B2 (en) 2015-06-30 2021-01-26 Ethicon Llc Surgical system with user adaptable techniques based on tissue impedance
US10154852B2 (en) 2015-07-01 2018-12-18 Ethicon Llc Ultrasonic surgical blade with improved cutting and coagulation features
US10548599B2 (en) 2015-07-20 2020-02-04 Covidien Lp Endoscopic stapler and staple
US9987012B2 (en) 2015-07-21 2018-06-05 Covidien Lp Small diameter cartridge design for a surgical stapling instrument
US10064622B2 (en) 2015-07-29 2018-09-04 Covidien Lp Surgical stapling loading unit with stroke counter and lockout
US10045782B2 (en) 2015-07-30 2018-08-14 Covidien Lp Surgical stapling loading unit with stroke counter and lockout
US11154300B2 (en) 2015-07-30 2021-10-26 Cilag Gmbh International Surgical instrument comprising separate tissue securing and tissue cutting systems
US10194913B2 (en) 2015-07-30 2019-02-05 Ethicon Llc Surgical instrument comprising systems for assuring the proper sequential operation of the surgical instrument
CA2994554A1 (en) 2015-08-06 2017-02-09 Applied Medical Resources Corporation Surgical stapler having locking articulation joint
US10617418B2 (en) 2015-08-17 2020-04-14 Ethicon Llc Implantable layers for a surgical instrument
MX2022009705A (es) 2015-08-26 2022-11-07 Ethicon Llc Metodo para formar una grapa contra un yunque de un instrumento de engrapado quirurgico.
US11058426B2 (en) 2015-08-26 2021-07-13 Cilag Gmbh International Staple cartridge assembly comprising various tissue compression gaps and staple forming gaps
BR112018003739B1 (pt) * 2015-08-26 2023-04-25 Ethicon Llc Conjunto de cartucho de grampos para grampear tecido
CN108348239B (zh) * 2015-08-26 2021-03-09 伊西康有限责任公司 包括各种组织压缩间隙和钉成形间隙的钉仓组件
JP6828018B2 (ja) 2015-08-26 2021-02-10 エシコン エルエルシーEthicon LLC ステープルの特性変更を可能にし、カートリッジへの充填を容易にする外科用ステープルストリップ
MX2018002389A (es) * 2015-08-26 2018-08-01 Ethicon Llc Unidad de cartucho de grapas que comprende cavidades de grapas para proporcionar mejor direccionamiento de las grapas.
US10172973B2 (en) 2015-08-31 2019-01-08 Ethicon Llc Surgical adjuncts and medicants for promoting lung function
US10279086B2 (en) 2015-08-31 2019-05-07 Ethicon Llc Composite adjunct materials for delivering medicants
US10245034B2 (en) 2015-08-31 2019-04-02 Ethicon Llc Inducing tissue adhesions using surgical adjuncts and medicants
US10188389B2 (en) 2015-08-31 2019-01-29 Ethicon Llc Adjunct material for delivery to colon tissue
US10076324B2 (en) 2015-08-31 2018-09-18 Ethicon Llc Adjunct material to provide controlled drug elution
US10194936B2 (en) 2015-08-31 2019-02-05 Ethicon Endo-Surgery, Llc Adjunct material for delivery to stomach tissue
US10349938B2 (en) 2015-08-31 2019-07-16 Ethicon Llc Surgical adjuncts with medicants affected by activator materials
US9937283B2 (en) 2015-08-31 2018-04-10 Ethicon Endo-Surgery, Llc Adjunct material to provide drug elution from vessels
US10130738B2 (en) 2015-08-31 2018-11-20 Ethicon Llc Adjunct material to promote tissue growth
US10463366B2 (en) 2015-08-31 2019-11-05 Ethicon Llc Adjunct materials for delivery to liver tissue
US10213520B2 (en) 2015-08-31 2019-02-26 Ethicon Llc Surgical adjuncts having medicants controllably releasable therefrom
US10188390B2 (en) 2015-08-31 2019-01-29 Ethicon Llc Adjunct material to provide heterogeneous drug elution
US10569071B2 (en) 2015-08-31 2020-02-25 Ethicon Llc Medicant eluting adjuncts and methods of using medicant eluting adjuncts
US10086116B2 (en) 2015-08-31 2018-10-02 Ethicon Llc Adjunct material to provide controlled drug release
US10076329B2 (en) 2015-08-31 2018-09-18 Ethicon Llc Adjunct material to promote tissue growth in a colon
US10285692B2 (en) 2015-08-31 2019-05-14 Ethicon Llc Adjuncts for surgical devices including agonists and antagonists
US11020116B2 (en) 2015-08-31 2021-06-01 Ethicon Llc Surgical adjuncts with medicants affected by activators
US10111661B2 (en) 2015-08-31 2018-10-30 Ethicon Llc Matrix metalloproteinase inhibiting adjuncts for surgical devices
US10499913B2 (en) 2015-08-31 2019-12-10 Ethicon Llc Tubular surgical constructs including adjunct material
BR112018003994B1 (pt) * 2015-09-02 2022-12-13 Ethicon Llc Acionador de grampos cirúrgicos, cartucho de grampos cirúrgicos e instrumento cirúrgico
US10357252B2 (en) * 2015-09-02 2019-07-23 Ethicon Llc Surgical staple configurations with camming surfaces located between portions supporting surgical staples
RU2720322C2 (ru) * 2015-09-02 2020-04-28 ЭТИКОН ЭлЭлСи Матрицы выталкивателей хирургических скоб
MX2022006189A (es) 2015-09-02 2022-06-16 Ethicon Llc Configuraciones de grapas quirurgicas con superficies de leva situadas entre porciones que soportan grapas quirurgicas.
ITUB20153493A1 (it) * 2015-09-09 2017-03-09 Gruppo Mecc Luciani S R L Attrezzatura per l'applicazione di borchie.
US10285837B1 (en) 2015-09-16 2019-05-14 Standard Bariatrics, Inc. Systems and methods for measuring volume of potential sleeve in a sleeve gastrectomy
US10238386B2 (en) 2015-09-23 2019-03-26 Ethicon Llc Surgical stapler having motor control based on an electrical parameter related to a motor current
US10327769B2 (en) 2015-09-23 2019-06-25 Ethicon Llc Surgical stapler having motor control based on a drive system component
US10076326B2 (en) 2015-09-23 2018-09-18 Ethicon Llc Surgical stapler having current mirror-based motor control
US10105139B2 (en) 2015-09-23 2018-10-23 Ethicon Llc Surgical stapler having downstream current-based motor control
US10363036B2 (en) 2015-09-23 2019-07-30 Ethicon Llc Surgical stapler having force-based motor control
US10085751B2 (en) 2015-09-23 2018-10-02 Ethicon Llc Surgical stapler having temperature-based motor control
US10111684B2 (en) 2015-09-25 2018-10-30 Covidien Lp Adapter assembly including a removable trocar assembly
US10299878B2 (en) 2015-09-25 2019-05-28 Ethicon Llc Implantable adjunct systems for determining adjunct skew
US20170086829A1 (en) 2015-09-30 2017-03-30 Ethicon Endo-Surgery, Llc Compressible adjunct with intermediate supporting structures
US10980539B2 (en) 2015-09-30 2021-04-20 Ethicon Llc Implantable adjunct comprising bonded layers
US11890015B2 (en) 2015-09-30 2024-02-06 Cilag Gmbh International Compressible adjunct with crossing spacer fibers
US10524788B2 (en) 2015-09-30 2020-01-07 Ethicon Llc Compressible adjunct with attachment regions
US10194973B2 (en) 2015-09-30 2019-02-05 Ethicon Llc Generator for digitally generating electrical signal waveforms for electrosurgical and ultrasonic surgical instruments
US10213204B2 (en) 2015-10-02 2019-02-26 Covidien Lp Micro surgical instrument and loading unit for use therewith
US10441371B2 (en) * 2015-10-02 2019-10-15 Vanderbilt University Concentric tube robot
ITUB20154593A1 (it) 2015-10-13 2017-04-13 Gd Spa Metodo ed unita di incarto per piegare uno sbozzato destinato a formare un contenitore in modo da realizzare una parete anteriore scatolata e due pareti laterali scatolate di un coperchio incernierato del contenitore.
US10595930B2 (en) 2015-10-16 2020-03-24 Ethicon Llc Electrode wiping surgical device
US10959771B2 (en) 2015-10-16 2021-03-30 Ethicon Llc Suction and irrigation sealing grasper
CN111803163B (zh) * 2015-10-20 2024-04-26 柯惠有限合伙公司 具有组织间隙指示器组件的圆形缝合器
US10772632B2 (en) 2015-10-28 2020-09-15 Covidien Lp Surgical stapling device with triple leg staples
US10085745B2 (en) * 2015-10-29 2018-10-02 Ethicon Llc Extensible buttress assembly for surgical stapler
US10314588B2 (en) * 2015-10-29 2019-06-11 Ethicon Llc Fluid penetrable buttress assembly for a surgical stapler
US20170119123A1 (en) * 2015-10-29 2017-05-04 Nina Butler Sanders Method and apparatus for attaching false hair
US10441286B2 (en) * 2015-10-29 2019-10-15 Ethicon Llc Multi-layer surgical stapler buttress assembly
US10595864B2 (en) 2015-11-24 2020-03-24 Covidien Lp Adapter assembly for interconnecting electromechanical surgical devices and surgical loading units, and surgical systems thereof
US10335179B2 (en) * 2015-11-24 2019-07-02 Ethicon Llc Surgical device with knife lockout
US10111660B2 (en) 2015-12-03 2018-10-30 Covidien Lp Surgical stapler flexible distal tip
US10265068B2 (en) 2015-12-30 2019-04-23 Ethicon Llc Surgical instruments with separable motors and motor control circuits
US10368865B2 (en) 2015-12-30 2019-08-06 Ethicon Llc Mechanisms for compensating for drivetrain failure in powered surgical instruments
US10179022B2 (en) 2015-12-30 2019-01-15 Ethicon Llc Jaw position impedance limiter for electrosurgical instrument
US10292704B2 (en) 2015-12-30 2019-05-21 Ethicon Llc Mechanisms for compensating for battery pack failure in powered surgical instruments
US10610219B2 (en) 2015-12-31 2020-04-07 Ethicon Llc Surgical stapler with curved outer surface on anvil
US10258334B2 (en) 2015-12-31 2019-04-16 Ethicon Llc Surgical stapler with variable height drivers for uniform staple formation
US10561474B2 (en) 2015-12-31 2020-02-18 Ethicon Llc Surgical stapler with end of stroke indicator
US10285693B2 (en) 2015-12-31 2019-05-14 Ethicon Llc Surgical stapler with locking translatable pin
US10575892B2 (en) 2015-12-31 2020-03-03 Ethicon Llc Adapter for electrical surgical instruments
US10575848B2 (en) 2015-12-31 2020-03-03 Ethicon Llc Surgical stapler with fixed jaw support pin
US10045780B2 (en) 2015-12-31 2018-08-14 Ethicon Llc Method of applying staples in lower anterior bowel resection
US10966717B2 (en) 2016-01-07 2021-04-06 Covidien Lp Surgical fastener apparatus
US11058448B2 (en) 2016-01-15 2021-07-13 Cilag Gmbh International Modular battery powered handheld surgical instrument with multistage generator circuits
US10660623B2 (en) 2016-01-15 2020-05-26 Covidien Lp Centering mechanism for articulation joint
US11229471B2 (en) 2016-01-15 2022-01-25 Cilag Gmbh International Modular battery powered handheld surgical instrument with selective application of energy based on tissue characterization
US11129670B2 (en) 2016-01-15 2021-09-28 Cilag Gmbh International Modular battery powered handheld surgical instrument with selective application of energy based on button displacement, intensity, or local tissue characterization
US10716615B2 (en) 2016-01-15 2020-07-21 Ethicon Llc Modular battery powered handheld surgical instrument with curved end effectors having asymmetric engagement between jaw and blade
US10765431B2 (en) * 2016-01-18 2020-09-08 Covidien Lp Endoscopic surgical clip applier
US10624785B2 (en) 2016-01-30 2020-04-21 Carl Zeiss Meditec Cataract Technology Inc. Devices and methods for ocular surgery
US11213293B2 (en) 2016-02-09 2022-01-04 Cilag Gmbh International Articulatable surgical instruments with single articulation link arrangements
US10588625B2 (en) 2016-02-09 2020-03-17 Ethicon Llc Articulatable surgical instruments with off-axis firing beam arrangements
JP6911054B2 (ja) 2016-02-09 2021-07-28 エシコン エルエルシーEthicon LLC 非対称の関節構成を備えた外科用器具
US10349937B2 (en) 2016-02-10 2019-07-16 Covidien Lp Surgical stapler with articulation locking mechanism
US10420559B2 (en) 2016-02-11 2019-09-24 Covidien Lp Surgical stapler with small diameter endoscopic portion
US11224426B2 (en) 2016-02-12 2022-01-18 Cilag Gmbh International Mechanisms for compensating for drivetrain failure in powered surgical instruments
US10448948B2 (en) 2016-02-12 2019-10-22 Ethicon Llc Mechanisms for compensating for drivetrain failure in powered surgical instruments
US10258331B2 (en) 2016-02-12 2019-04-16 Ethicon Llc Mechanisms for compensating for drivetrain failure in powered surgical instruments
US10555769B2 (en) 2016-02-22 2020-02-11 Ethicon Llc Flexible circuits for electrosurgical instrument
US11284890B2 (en) 2016-04-01 2022-03-29 Cilag Gmbh International Circular stapling system comprising an incisable tissue support
US10617413B2 (en) 2016-04-01 2020-04-14 Ethicon Llc Closure system arrangements for surgical cutting and stapling devices with separate and distinct firing shafts
US10709446B2 (en) 2016-04-01 2020-07-14 Ethicon Llc Staple cartridges with atraumatic features
US11064997B2 (en) 2016-04-01 2021-07-20 Cilag Gmbh International Surgical stapling instrument
US10357246B2 (en) 2016-04-01 2019-07-23 Ethicon Llc Rotary powered surgical instrument with manually actuatable bailout system
ES2938241T3 (es) 2016-04-12 2023-04-05 Applied Med Resources Grapadora quirúrgica con un mango motorizado
EP3442430B1 (en) 2016-04-12 2021-07-14 Applied Medical Resources Corporation Reload shaft assembly for surgical stapler
JP7015246B2 (ja) 2016-04-12 2022-02-02 アプライド メディカル リソーシーズ コーポレイション 関節運動機構体を備えた外科用ステープラ
US10405859B2 (en) 2016-04-15 2019-09-10 Ethicon Llc Surgical instrument with adjustable stop/start control during a firing motion
US11179150B2 (en) 2016-04-15 2021-11-23 Cilag Gmbh International Systems and methods for controlling a surgical stapling and cutting instrument
US10492783B2 (en) 2016-04-15 2019-12-03 Ethicon, Llc Surgical instrument with improved stop/start control during a firing motion
US11607239B2 (en) 2016-04-15 2023-03-21 Cilag Gmbh International Systems and methods for controlling a surgical stapling and cutting instrument
US10335145B2 (en) 2016-04-15 2019-07-02 Ethicon Llc Modular surgical instrument with configurable operating mode
US10357247B2 (en) 2016-04-15 2019-07-23 Ethicon Llc Surgical instrument with multiple program responses during a firing motion
US10426467B2 (en) 2016-04-15 2019-10-01 Ethicon Llc Surgical instrument with detection sensors
US10456137B2 (en) 2016-04-15 2019-10-29 Ethicon Llc Staple formation detection mechanisms
US10828028B2 (en) 2016-04-15 2020-11-10 Ethicon Llc Surgical instrument with multiple program responses during a firing motion
US10426469B2 (en) 2016-04-18 2019-10-01 Ethicon Llc Surgical instrument comprising a primary firing lockout and a secondary firing lockout
US20170296173A1 (en) 2016-04-18 2017-10-19 Ethicon Endo-Surgery, Llc Method for operating a surgical instrument
EP3235445B1 (en) 2016-04-18 2022-04-20 Ethicon LLC Surgical instrument comprising a lockout
US11317917B2 (en) 2016-04-18 2022-05-03 Cilag Gmbh International Surgical stapling system comprising a lockable firing assembly
US10258337B2 (en) 2016-04-20 2019-04-16 Ethicon Llc Surgical staple cartridge with severed tissue edge adjunct
US10653420B2 (en) 2016-04-20 2020-05-19 Ethicon Llc Compliant compensation features for end effector of surgical stapling instrument
US10646269B2 (en) 2016-04-29 2020-05-12 Ethicon Llc Non-linear jaw gap for electrosurgical instruments
US10485607B2 (en) 2016-04-29 2019-11-26 Ethicon Llc Jaw structure with distal closure for electrosurgical instruments
US10702329B2 (en) 2016-04-29 2020-07-07 Ethicon Llc Jaw structure with distal post for electrosurgical instruments
US10456193B2 (en) 2016-05-03 2019-10-29 Ethicon Llc Medical device with a bilateral jaw configuration for nerve stimulation
US10561419B2 (en) 2016-05-04 2020-02-18 Covidien Lp Powered end effector assembly with pivotable channel
US20170325878A1 (en) * 2016-05-11 2017-11-16 Ethicon Llc Suction and irrigation sealing grasper
US11065022B2 (en) 2016-05-17 2021-07-20 Covidien Lp Cutting member for a surgical instrument
WO2017205333A1 (en) 2016-05-26 2017-11-30 Covidien Lp Robotic surgical assemblies
US10959731B2 (en) 2016-06-14 2021-03-30 Covidien Lp Buttress attachment for surgical stapling instrument
US10893863B2 (en) 2016-06-24 2021-01-19 Ethicon Llc Staple cartridge comprising offset longitudinal staple rows
CN109310431B (zh) 2016-06-24 2022-03-04 伊西康有限责任公司 包括线材钉和冲压钉的钉仓
USD826405S1 (en) 2016-06-24 2018-08-21 Ethicon Llc Surgical fastener
BR112018076831B1 (pt) * 2016-06-24 2023-01-31 Ethicon Llc Sistema de grampeamento cirúrgico
USD822206S1 (en) 2016-06-24 2018-07-03 Ethicon Llc Surgical fastener
US10537382B2 (en) * 2016-06-24 2020-01-21 Ethicon Llc Surgical instrument with latching trigger lockout
USD850617S1 (en) 2016-06-24 2019-06-04 Ethicon Llc Surgical fastener cartridge
USD847989S1 (en) 2016-06-24 2019-05-07 Ethicon Llc Surgical fastener cartridge
US10245064B2 (en) 2016-07-12 2019-04-02 Ethicon Llc Ultrasonic surgical instrument with piezoelectric central lumen transducer
US10893883B2 (en) 2016-07-13 2021-01-19 Ethicon Llc Ultrasonic assembly for use with ultrasonic surgical instruments
US10842522B2 (en) 2016-07-15 2020-11-24 Ethicon Llc Ultrasonic surgical instruments having offset blades
CN106108965B (zh) * 2016-07-28 2019-05-10 上海逸思医疗科技有限公司 一种吻合器的缝合钉成形钉高调节机构及包括该调节机构的吻合器
US10376305B2 (en) 2016-08-05 2019-08-13 Ethicon Llc Methods and systems for advanced harmonic energy
US10285723B2 (en) 2016-08-09 2019-05-14 Ethicon Llc Ultrasonic surgical blade with improved heel portion
USD847990S1 (en) 2016-08-16 2019-05-07 Ethicon Llc Surgical instrument
US10779847B2 (en) 2016-08-25 2020-09-22 Ethicon Llc Ultrasonic transducer to waveguide joining
US10952759B2 (en) 2016-08-25 2021-03-23 Ethicon Llc Tissue loading of a surgical instrument
US10751117B2 (en) 2016-09-23 2020-08-25 Ethicon Llc Electrosurgical instrument with fluid diverter
US11696822B2 (en) 2016-09-28 2023-07-11 Conextions, Inc. Devices, systems, and methods for repairing soft tissue and attaching soft tissue to bone
US10631857B2 (en) * 2016-11-04 2020-04-28 Covidien Lp Loading unit for surgical instruments with low profile pushers
US11642126B2 (en) 2016-11-04 2023-05-09 Covidien Lp Surgical stapling apparatus with tissue pockets
US11026686B2 (en) 2016-11-08 2021-06-08 Covidien Lp Structure for attaching buttress to anvil and/or cartridge of surgical stapling instrument
US10492784B2 (en) 2016-11-08 2019-12-03 Covidien Lp Surgical tool assembly with compact firing assembly
US10603064B2 (en) 2016-11-28 2020-03-31 Ethicon Llc Ultrasonic transducer
US11266430B2 (en) 2016-11-29 2022-03-08 Cilag Gmbh International End effector control and calibration
US10463371B2 (en) 2016-11-29 2019-11-05 Covidien Lp Reload assembly with spent reload indicator
US10945727B2 (en) 2016-12-21 2021-03-16 Ethicon Llc Staple cartridge with deformable driver retention features
US10588632B2 (en) 2016-12-21 2020-03-17 Ethicon Llc Surgical end effectors and firing members thereof
US10758229B2 (en) 2016-12-21 2020-09-01 Ethicon Llc Surgical instrument comprising improved jaw control
US11419606B2 (en) 2016-12-21 2022-08-23 Cilag Gmbh International Shaft assembly comprising a clutch configured to adapt the output of a rotary firing member to two different systems
BR112019012209A2 (pt) * 2016-12-21 2019-11-12 Ethicon Llc pares de bolsos de formação de grampos bilateralmente assimétricos
US10695055B2 (en) 2016-12-21 2020-06-30 Ethicon Llc Firing assembly comprising a lockout
US20180168615A1 (en) 2016-12-21 2018-06-21 Ethicon Endo-Surgery, Llc Method of deforming staples from two different types of staple cartridges with the same surgical stapling instrument
US20180168633A1 (en) 2016-12-21 2018-06-21 Ethicon Endo-Surgery, Llc Surgical stapling instruments and staple-forming anvils
US10499914B2 (en) 2016-12-21 2019-12-10 Ethicon Llc Staple forming pocket arrangements
US20180168625A1 (en) 2016-12-21 2018-06-21 Ethicon Endo-Surgery, Llc Surgical stapling instruments with smart staple cartridges
US10537324B2 (en) 2016-12-21 2020-01-21 Ethicon Llc Stepped staple cartridge with asymmetrical staples
US11090048B2 (en) 2016-12-21 2021-08-17 Cilag Gmbh International Method for resetting a fuse of a surgical instrument shaft
US10687810B2 (en) 2016-12-21 2020-06-23 Ethicon Llc Stepped staple cartridge with tissue retention and gap setting features
CN110114014B (zh) 2016-12-21 2022-08-09 爱惜康有限责任公司 包括端部执行器闭锁件和击发组件闭锁件的外科器械系统
US10856868B2 (en) 2016-12-21 2020-12-08 Ethicon Llc Firing member pin configurations
JP7010956B2 (ja) 2016-12-21 2022-01-26 エシコン エルエルシー 組織をステープル留めする方法
US10918385B2 (en) 2016-12-21 2021-02-16 Ethicon Llc Surgical system comprising a firing member rotatable into an articulation state to articulate an end effector of the surgical system
US10617414B2 (en) 2016-12-21 2020-04-14 Ethicon Llc Closure member arrangements for surgical instruments
JP7134969B2 (ja) * 2016-12-21 2022-09-12 エシコン エルエルシー 外科用ステープル留め器具及びステープル形成アンビル
JP2020501750A (ja) 2016-12-21 2020-01-23 エシコン エルエルシーEthicon LLC 発射部材ピンの構成
US11134942B2 (en) 2016-12-21 2021-10-05 Cilag Gmbh International Surgical stapling instruments and staple-forming anvils
MX2019007436A (es) 2016-12-21 2019-10-24 Ethicon Llc Efector de extremo quirúrgico articulable con arreglo de vástago asimétrico.
JP6983893B2 (ja) 2016-12-21 2021-12-17 エシコン エルエルシーEthicon LLC 外科用エンドエフェクタ及び交換式ツールアセンブリのためのロックアウト構成
US20180168619A1 (en) 2016-12-21 2018-06-21 Ethicon Endo-Surgery, Llc Surgical stapling systems
MX2019007420A (es) 2016-12-21 2019-10-30 Ethicon Llc Unidad de disparo que comprende un fusible de estados fallidos múltiples.
US10426471B2 (en) 2016-12-21 2019-10-01 Ethicon Llc Surgical instrument with multiple failure response modes
MX2019007449A (es) * 2016-12-21 2019-11-18 Ethicon Llc Engrapadoras quirúrgicas con sistemas de cierre y disparo independientemente accionables.
JP2020501779A (ja) 2016-12-21 2020-01-23 エシコン エルエルシーEthicon LLC 外科用ステープル留めシステム
US11684367B2 (en) 2016-12-21 2023-06-27 Cilag Gmbh International Stepped assembly having and end-of-life indicator
CN110099643B (zh) * 2016-12-21 2022-10-14 爱惜康有限责任公司 钉仓以及其中的钉和钉腔的布置
US10813638B2 (en) 2016-12-21 2020-10-27 Ethicon Llc Surgical end effectors with expandable tissue stop arrangements
US10993715B2 (en) 2016-12-21 2021-05-04 Ethicon Llc Staple cartridge comprising staples with different clamping breadths
US10709901B2 (en) 2017-01-05 2020-07-14 Covidien Lp Implantable fasteners, applicators, and methods for brachytherapy
CN106725681A (zh) * 2017-01-12 2017-05-31 常州健瑞宝医疗器械有限公司 腔内直线切割吻合器
US10874768B2 (en) 2017-01-20 2020-12-29 Covidien Lp Drug eluting medical device
US10952767B2 (en) 2017-02-06 2021-03-23 Covidien Lp Connector clip for securing an introducer to a surgical fastener applying apparatus
US11033325B2 (en) 2017-02-16 2021-06-15 Cilag Gmbh International Electrosurgical instrument with telescoping suction port and debris cleaner
US10765426B2 (en) 2017-02-17 2020-09-08 Ethicon Llc Systems for coupling adjuncts to an end effector
US10806451B2 (en) * 2017-02-17 2020-10-20 Ethicon Llc Surgical stapler with cooperating distal tip features on anvil and staple cartridge
US10478183B2 (en) 2017-02-17 2019-11-19 Ethicon Llc Adjunct release for surgical staplers
US11006954B2 (en) 2017-02-17 2021-05-18 Ethicon Llc Suction attachment of an adjunct to a surgical instrument
US20180235625A1 (en) 2017-02-17 2018-08-23 Ethicon Llc End effector with adjunct materials
US10575850B2 (en) 2017-02-17 2020-03-03 Ethicon Llc Systems for release of adjunct in a surgical stapling device
US11202632B2 (en) 2017-02-17 2021-12-21 Cilag Gmbh International Adjunct material with mating features
US10881402B2 (en) 2017-02-17 2021-01-05 Ethicon Llc Surgical end effector adjunct attachment
US10729438B2 (en) 2017-02-17 2020-08-04 Ethicon Llc Hybrid mechanism for attachment of an adjunct to a surgical instrument
US11141150B2 (en) 2017-02-17 2021-10-12 Cilag Gmbh International Buttress loader for surgical staplers
US10646221B2 (en) 2017-02-17 2020-05-12 Ethicon Llc Surgical adjunct retaining mechanisms
US10555734B2 (en) 2017-02-17 2020-02-11 Ethicon Llc Methods and systems for mating constrictable adjunct materials with end effectors
US10485544B2 (en) 2017-02-17 2019-11-26 Ethicon Llc End effector having extension features for mating with adjuncts
US10925601B2 (en) 2017-02-17 2021-02-23 Ethicon Llc Surgical end effector adjunct attachment
US10869663B2 (en) 2017-02-17 2020-12-22 Ethicon Llc End effector configured to mate with adjunct materials
US10716564B2 (en) 2017-02-17 2020-07-21 Ethicon Llc Stapling adjunct attachment
US10478280B2 (en) 2017-02-17 2019-11-19 Ethicon Llc Methods and devices for delivering and securing adjunct materials to a treatment site
US20180235618A1 (en) 2017-02-22 2018-08-23 Covidien Lp Loading unit for surgical instruments with low profile pushers
US10849621B2 (en) 2017-02-23 2020-12-01 Covidien Lp Surgical stapler with small diameter endoscopic portion
US11350915B2 (en) 2017-02-23 2022-06-07 Covidien Lp Surgical stapler with small diameter endoscopic portion
US10925607B2 (en) 2017-02-28 2021-02-23 Covidien Lp Surgical stapling apparatus with staple sheath
US10299790B2 (en) 2017-03-03 2019-05-28 Covidien Lp Adapter with centering mechanism for articulation joint
US10368868B2 (en) 2017-03-09 2019-08-06 Covidien Lp Structure for attaching buttress material to anvil and cartridge of surgical stapling instrument
US10799284B2 (en) 2017-03-15 2020-10-13 Ethicon Llc Electrosurgical instrument with textured jaws
US10660641B2 (en) 2017-03-16 2020-05-26 Covidien Lp Adapter with centering mechanism for articulation joint
US11096610B2 (en) 2017-03-28 2021-08-24 Covidien Lp Surgical implants including sensing fibers
US11497546B2 (en) 2017-03-31 2022-11-15 Cilag Gmbh International Area ratios of patterned coatings on RF electrodes to reduce sticking
US10765442B2 (en) * 2017-04-14 2020-09-08 Ethicon Llc Surgical devices and methods for biasing an end effector to a closed configuration
US10603035B2 (en) 2017-05-02 2020-03-31 Covidien Lp Surgical loading unit including an articulating end effector
US11324502B2 (en) 2017-05-02 2022-05-10 Covidien Lp Surgical loading unit including an articulating end effector
US10524784B2 (en) 2017-05-05 2020-01-07 Covidien Lp Surgical staples with expandable backspan
US10390826B2 (en) 2017-05-08 2019-08-27 Covidien Lp Surgical stapling device with elongated tool assembly and methods of use
US10420551B2 (en) 2017-05-30 2019-09-24 Covidien Lp Authentication and information system for reusable surgical instruments
US10478185B2 (en) 2017-06-02 2019-11-19 Covidien Lp Tool assembly with minimal dead space
US11045199B2 (en) * 2017-06-09 2021-06-29 Covidien Lp Handheld electromechanical surgical system
US10932784B2 (en) * 2017-06-09 2021-03-02 Covidien Lp Handheld electromechanical surgical system
US10939911B2 (en) 2017-06-13 2021-03-09 Ethicon Llc Surgical stapler with end effector coating
US11058804B2 (en) 2017-06-13 2021-07-13 Ethicon Llc Surgical fastener device for the prevention of ECM degradation
US20180353174A1 (en) 2017-06-13 2018-12-13 Ethicon Llc Surgical Stapler with Controlled Healing
US10327767B2 (en) 2017-06-20 2019-06-25 Ethicon Llc Control of motor velocity of a surgical stapling and cutting instrument based on angle of articulation
USD890784S1 (en) 2017-06-20 2020-07-21 Ethicon Llc Display panel with changeable graphical user interface
US10624633B2 (en) 2017-06-20 2020-04-21 Ethicon Llc Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument
USD879808S1 (en) 2017-06-20 2020-03-31 Ethicon Llc Display panel with graphical user interface
US11071554B2 (en) 2017-06-20 2021-07-27 Cilag Gmbh International Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on magnitude of velocity error measurements
US10881399B2 (en) 2017-06-20 2021-01-05 Ethicon Llc Techniques for adaptive control of motor velocity of a surgical stapling and cutting instrument
US11517325B2 (en) 2017-06-20 2022-12-06 Cilag Gmbh International Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured displacement distance traveled over a specified time interval
US11653914B2 (en) 2017-06-20 2023-05-23 Cilag Gmbh International Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument according to articulation angle of end effector
US10888321B2 (en) 2017-06-20 2021-01-12 Ethicon Llc Systems and methods for controlling velocity of a displacement member of a surgical stapling and cutting instrument
US10390841B2 (en) 2017-06-20 2019-08-27 Ethicon Llc Control of motor velocity of a surgical stapling and cutting instrument based on angle of articulation
US10368864B2 (en) 2017-06-20 2019-08-06 Ethicon Llc Systems and methods for controlling displaying motor velocity for a surgical instrument
US10779820B2 (en) 2017-06-20 2020-09-22 Ethicon Llc Systems and methods for controlling motor speed according to user input for a surgical instrument
US10646220B2 (en) 2017-06-20 2020-05-12 Ethicon Llc Systems and methods for controlling displacement member velocity for a surgical instrument
US10307170B2 (en) 2017-06-20 2019-06-04 Ethicon Llc Method for closed loop control of motor velocity of a surgical stapling and cutting instrument
US11382638B2 (en) 2017-06-20 2022-07-12 Cilag Gmbh International Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified displacement distance
US10881396B2 (en) 2017-06-20 2021-01-05 Ethicon Llc Surgical instrument with variable duration trigger arrangement
US10813639B2 (en) 2017-06-20 2020-10-27 Ethicon Llc Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on system conditions
US10980537B2 (en) 2017-06-20 2021-04-20 Ethicon Llc Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified number of shaft rotations
USD879809S1 (en) 2017-06-20 2020-03-31 Ethicon Llc Display panel with changeable graphical user interface
US11090046B2 (en) 2017-06-20 2021-08-17 Cilag Gmbh International Systems and methods for controlling displacement member motion of a surgical stapling and cutting instrument
US11324503B2 (en) 2017-06-27 2022-05-10 Cilag Gmbh International Surgical firing member arrangements
US10993716B2 (en) 2017-06-27 2021-05-04 Ethicon Llc Surgical anvil arrangements
US10772629B2 (en) * 2017-06-27 2020-09-15 Ethicon Llc Surgical anvil arrangements
BR112019026738A2 (pt) * 2017-06-27 2020-06-30 Ethicon Llc disposições de bigorna cirúrgica
US11090049B2 (en) 2017-06-27 2021-08-17 Cilag Gmbh International Staple forming pocket arrangements
US10856869B2 (en) 2017-06-27 2020-12-08 Ethicon Llc Surgical anvil arrangements
US11266405B2 (en) 2017-06-27 2022-03-08 Cilag Gmbh International Surgical anvil manufacturing methods
US10716614B2 (en) 2017-06-28 2020-07-21 Ethicon Llc Surgical shaft assemblies with slip ring assemblies with increased contact pressure
US11246592B2 (en) 2017-06-28 2022-02-15 Cilag Gmbh International Surgical instrument comprising an articulation system lockable to a frame
US10903685B2 (en) 2017-06-28 2021-01-26 Ethicon Llc Surgical shaft assemblies with slip ring assemblies forming capacitive channels
US11564686B2 (en) 2017-06-28 2023-01-31 Cilag Gmbh International Surgical shaft assemblies with flexible interfaces
US11259805B2 (en) 2017-06-28 2022-03-01 Cilag Gmbh International Surgical instrument comprising firing member supports
USD854151S1 (en) 2017-06-28 2019-07-16 Ethicon Llc Surgical instrument shaft
USD851762S1 (en) 2017-06-28 2019-06-18 Ethicon Llc Anvil
CN110799119B (zh) * 2017-06-28 2023-04-18 爱惜康有限责任公司 具有可轴向移动的闭合构件的外科器械
US10779824B2 (en) 2017-06-28 2020-09-22 Ethicon Llc Surgical instrument comprising an articulation system lockable by a closure system
US11298128B2 (en) 2017-06-28 2022-04-12 Cilag Gmbh International Surgical system couplable with staple cartridge and radio frequency cartridge, and method of using same
USD906355S1 (en) 2017-06-28 2020-12-29 Ethicon Llc Display screen or portion thereof with a graphical user interface for a surgical instrument
USD869655S1 (en) 2017-06-28 2019-12-10 Ethicon Llc Surgical fastener cartridge
US10211586B2 (en) 2017-06-28 2019-02-19 Ethicon Llc Surgical shaft assemblies with watertight housings
EP3420947B1 (en) 2017-06-28 2022-05-25 Cilag GmbH International Surgical instrument comprising selectively actuatable rotatable couplers
US10765427B2 (en) 2017-06-28 2020-09-08 Ethicon Llc Method for articulating a surgical instrument
US10758232B2 (en) 2017-06-28 2020-09-01 Ethicon Llc Surgical instrument with positive jaw opening features
US10258418B2 (en) 2017-06-29 2019-04-16 Ethicon Llc System for controlling articulation forces
US10398434B2 (en) 2017-06-29 2019-09-03 Ethicon Llc Closed loop velocity control of closure member for robotic surgical instrument
US11007022B2 (en) 2017-06-29 2021-05-18 Ethicon Llc Closed loop velocity control techniques based on sensed tissue parameters for robotic surgical instrument
US10932772B2 (en) 2017-06-29 2021-03-02 Ethicon Llc Methods for closed loop velocity control for robotic surgical instrument
US10898183B2 (en) 2017-06-29 2021-01-26 Ethicon Llc Robotic surgical instrument with closed loop feedback techniques for advancement of closure member during firing
US10820920B2 (en) 2017-07-05 2020-11-03 Ethicon Llc Reusable ultrasonic medical devices and methods of their use
US11304695B2 (en) 2017-08-03 2022-04-19 Cilag Gmbh International Surgical system shaft interconnection
US11471155B2 (en) 2017-08-03 2022-10-18 Cilag Gmbh International Surgical system bailout
US11944300B2 (en) 2017-08-03 2024-04-02 Cilag Gmbh International Method for operating a surgical system bailout
US11974742B2 (en) 2017-08-03 2024-05-07 Cilag Gmbh International Surgical system comprising an articulation bailout
US10849625B2 (en) 2017-08-07 2020-12-01 Covidien Lp Surgical buttress retention systems for surgical stapling apparatus
KR20200040228A (ko) 2017-08-09 2020-04-17 알콘 인코포레이티드 자체 조명식 미세 수술 캐뉼라 장치
US10912562B2 (en) 2017-08-14 2021-02-09 Standard Bariatrics, Inc. End effectors, surgical stapling devices, and methods of using same
US10945733B2 (en) 2017-08-23 2021-03-16 Covidien Lp Surgical buttress reload and tip attachment assemblies for surgical stapling apparatus
US10624636B2 (en) 2017-08-23 2020-04-21 Covidien Lp Surgical stapling device with floating staple cartridge
US10806452B2 (en) 2017-08-24 2020-10-20 Covidien Lp Loading unit for a surgical stapling instrument
EP3678573A4 (en) 2017-09-06 2021-06-02 Covidien LP LIMIT SCALING OF SURGICAL ROBOTS
US11399829B2 (en) 2017-09-29 2022-08-02 Cilag Gmbh International Systems and methods of initiating a power shutdown mode for a surgical instrument
US10765429B2 (en) 2017-09-29 2020-09-08 Ethicon Llc Systems and methods for providing alerts according to the operational state of a surgical instrument
USD917500S1 (en) 2017-09-29 2021-04-27 Ethicon Llc Display screen or portion thereof with graphical user interface
USD907648S1 (en) 2017-09-29 2021-01-12 Ethicon Llc Display screen or portion thereof with animated graphical user interface
US10743872B2 (en) 2017-09-29 2020-08-18 Ethicon Llc System and methods for controlling a display of a surgical instrument
US11490951B2 (en) 2017-09-29 2022-11-08 Cilag Gmbh International Saline contact with electrodes
US11484358B2 (en) 2017-09-29 2022-11-01 Cilag Gmbh International Flexible electrosurgical instrument
US10796471B2 (en) 2017-09-29 2020-10-06 Ethicon Llc Systems and methods of displaying a knife position for a surgical instrument
US10729501B2 (en) 2017-09-29 2020-08-04 Ethicon Llc Systems and methods for language selection of a surgical instrument
US11033323B2 (en) 2017-09-29 2021-06-15 Cilag Gmbh International Systems and methods for managing fluid and suction in electrosurgical systems
USD907647S1 (en) 2017-09-29 2021-01-12 Ethicon Llc Display screen or portion thereof with animated graphical user interface
US11801098B2 (en) 2017-10-30 2023-10-31 Cilag Gmbh International Method of hub communication with surgical instrument systems
US11510741B2 (en) 2017-10-30 2022-11-29 Cilag Gmbh International Method for producing a surgical instrument comprising a smart electrical system
US11317919B2 (en) 2017-10-30 2022-05-03 Cilag Gmbh International Clip applier comprising a clip crimping system
US11291510B2 (en) 2017-10-30 2022-04-05 Cilag Gmbh International Method of hub communication with surgical instrument systems
US11229436B2 (en) 2017-10-30 2022-01-25 Cilag Gmbh International Surgical system comprising a surgical tool and a surgical hub
US11311342B2 (en) 2017-10-30 2022-04-26 Cilag Gmbh International Method for communicating with surgical instrument systems
US11564756B2 (en) 2017-10-30 2023-01-31 Cilag Gmbh International Method of hub communication with surgical instrument systems
US11141160B2 (en) 2017-10-30 2021-10-12 Cilag Gmbh International Clip applier comprising a motor controller
US11090075B2 (en) 2017-10-30 2021-08-17 Cilag Gmbh International Articulation features for surgical end effector
US10932806B2 (en) 2017-10-30 2021-03-02 Ethicon Llc Reactive algorithm for surgical system
US11134944B2 (en) 2017-10-30 2021-10-05 Cilag Gmbh International Surgical stapler knife motion controls
US11911045B2 (en) 2017-10-30 2024-02-27 Cllag GmbH International Method for operating a powered articulating multi-clip applier
CN107802303B (zh) * 2017-10-31 2020-08-11 无锡贝恩外科器械有限公司 单缝合腔镜吻合器
US10779903B2 (en) 2017-10-31 2020-09-22 Ethicon Llc Positive shaft rotation lock activated by jaw closure
US10842490B2 (en) 2017-10-31 2020-11-24 Ethicon Llc Cartridge body design with force reduction based on firing completion
US10993714B2 (en) * 2017-11-28 2021-05-04 Covidien Lp Surgical stapling instrument and associated trigger mechanisms
US10925603B2 (en) 2017-11-14 2021-02-23 Covidien Lp Reload with articulation stabilization system
US11420861B2 (en) * 2017-11-15 2022-08-23 The Coca-Cola Company Dispenser with haptic feedback touch-to-pour user interface
US10863987B2 (en) 2017-11-16 2020-12-15 Covidien Lp Surgical instrument with imaging device
CN107928732B (zh) * 2017-12-05 2019-12-13 宁波维尔凯迪医疗器械有限公司 一种保险机构及具有该结构的吻合器
US11141151B2 (en) 2017-12-08 2021-10-12 Covidien Lp Surgical buttress for circular stapling
BR112020011860A2 (pt) 2017-12-14 2020-11-24 Carl Zeiss Meditec Cataract Technology Inc. dispositivos e métodos para cirurgia ocular
US11197670B2 (en) 2017-12-15 2021-12-14 Cilag Gmbh International Surgical end effectors with pivotal jaws configured to touch at their respective distal ends when fully closed
US11033267B2 (en) 2017-12-15 2021-06-15 Ethicon Llc Systems and methods of controlling a clamping member firing rate of a surgical instrument
US10743874B2 (en) 2017-12-15 2020-08-18 Ethicon Llc Sealed adapters for use with electromechanical surgical instruments
US10779825B2 (en) 2017-12-15 2020-09-22 Ethicon Llc Adapters with end effector position sensing and control arrangements for use in connection with electromechanical surgical instruments
US10687813B2 (en) 2017-12-15 2020-06-23 Ethicon Llc Adapters with firing stroke sensing arrangements for use in connection with electromechanical surgical instruments
US10869666B2 (en) 2017-12-15 2020-12-22 Ethicon Llc Adapters with control systems for controlling multiple motors of an electromechanical surgical instrument
US10779826B2 (en) 2017-12-15 2020-09-22 Ethicon Llc Methods of operating surgical end effectors
US11071543B2 (en) 2017-12-15 2021-07-27 Cilag Gmbh International Surgical end effectors with clamping assemblies configured to increase jaw aperture ranges
US10966718B2 (en) 2017-12-15 2021-04-06 Ethicon Llc Dynamic clamping assemblies with improved wear characteristics for use in connection with electromechanical surgical instruments
US10743875B2 (en) 2017-12-15 2020-08-18 Ethicon Llc Surgical end effectors with jaw stiffener arrangements configured to permit monitoring of firing member
US10828033B2 (en) 2017-12-15 2020-11-10 Ethicon Llc Handheld electromechanical surgical instruments with improved motor control arrangements for positioning components of an adapter coupled thereto
US11006955B2 (en) 2017-12-15 2021-05-18 Ethicon Llc End effectors with positive jaw opening features for use with adapters for electromechanical surgical instruments
US10716565B2 (en) 2017-12-19 2020-07-21 Ethicon Llc Surgical instruments with dual articulation drivers
US11045270B2 (en) 2017-12-19 2021-06-29 Cilag Gmbh International Robotic attachment comprising exterior drive actuator
US10729509B2 (en) 2017-12-19 2020-08-04 Ethicon Llc Surgical instrument comprising closure and firing locking mechanism
USD910847S1 (en) 2017-12-19 2021-02-16 Ethicon Llc Surgical instrument assembly
US11020112B2 (en) 2017-12-19 2021-06-01 Ethicon Llc Surgical tools configured for interchangeable use with different controller interfaces
US10835330B2 (en) 2017-12-19 2020-11-17 Ethicon Llc Method for determining the position of a rotatable jaw of a surgical instrument attachment assembly
US12102317B2 (en) 2017-12-20 2024-10-01 Conextions, Inc. Devices, systems, and methods for repairing soft tissue and attaching soft tissue to bone
US10973509B2 (en) 2017-12-20 2021-04-13 Conextions, Inc. Devices, systems, and methods for repairing soft tissue and attaching soft tissue to bone
US11547397B2 (en) 2017-12-20 2023-01-10 Conextions, Inc. Devices, systems, and methods for repairing soft tissue and attaching soft tissue to bone
US11883019B2 (en) 2017-12-21 2024-01-30 Cilag Gmbh International Stapling instrument comprising a staple feeding system
US11129680B2 (en) 2017-12-21 2021-09-28 Cilag Gmbh International Surgical instrument comprising a projector
US11076853B2 (en) 2017-12-21 2021-08-03 Cilag Gmbh International Systems and methods of displaying a knife position during transection for a surgical instrument
US11311290B2 (en) 2017-12-21 2022-04-26 Cilag Gmbh International Surgical instrument comprising an end effector dampener
US11559308B2 (en) 2017-12-28 2023-01-24 Cilag Gmbh International Method for smart energy device infrastructure
US11969216B2 (en) 2017-12-28 2024-04-30 Cilag Gmbh International Surgical network recommendations from real time analysis of procedure variables against a baseline highlighting differences from the optimal solution
US11903601B2 (en) 2017-12-28 2024-02-20 Cilag Gmbh International Surgical instrument comprising a plurality of drive systems
US12127729B2 (en) 2017-12-28 2024-10-29 Cilag Gmbh International Method for smoke evacuation for surgical hub
US11056244B2 (en) 2017-12-28 2021-07-06 Cilag Gmbh International Automated data scaling, alignment, and organizing based on predefined parameters within surgical networks
US11324557B2 (en) 2017-12-28 2022-05-10 Cilag Gmbh International Surgical instrument with a sensing array
US11659023B2 (en) 2017-12-28 2023-05-23 Cilag Gmbh International Method of hub communication
US11266468B2 (en) 2017-12-28 2022-03-08 Cilag Gmbh International Cooperative utilization of data derived from secondary sources by intelligent surgical hubs
US10932872B2 (en) 2017-12-28 2021-03-02 Ethicon Llc Cloud-based medical analytics for linking of local usage trends with the resource acquisition behaviors of larger data set
US20190206569A1 (en) 2017-12-28 2019-07-04 Ethicon Llc Method of cloud based data analytics for use with the hub
US10595887B2 (en) 2017-12-28 2020-03-24 Ethicon Llc Systems for adjusting end effector parameters based on perioperative information
US11389164B2 (en) 2017-12-28 2022-07-19 Cilag Gmbh International Method of using reinforced flexible circuits with multiple sensors to optimize performance of radio frequency devices
US11202570B2 (en) 2017-12-28 2021-12-21 Cilag Gmbh International Communication hub and storage device for storing parameters and status of a surgical device to be shared with cloud based analytics systems
US11678881B2 (en) 2017-12-28 2023-06-20 Cilag Gmbh International Spatial awareness of surgical hubs in operating rooms
US10892899B2 (en) 2017-12-28 2021-01-12 Ethicon Llc Self describing data packets generated at an issuing instrument
US11132462B2 (en) 2017-12-28 2021-09-28 Cilag Gmbh International Data stripping method to interrogate patient records and create anonymized record
US11179208B2 (en) 2017-12-28 2021-11-23 Cilag Gmbh International Cloud-based medical analytics for security and authentication trends and reactive measures
US11311306B2 (en) 2017-12-28 2022-04-26 Cilag Gmbh International Surgical systems for detecting end effector tissue distribution irregularities
US11771487B2 (en) 2017-12-28 2023-10-03 Cilag Gmbh International Mechanisms for controlling different electromechanical systems of an electrosurgical instrument
US11376002B2 (en) 2017-12-28 2022-07-05 Cilag Gmbh International Surgical instrument cartridge sensor assemblies
US11234756B2 (en) 2017-12-28 2022-02-01 Cilag Gmbh International Powered surgical tool with predefined adjustable control algorithm for controlling end effector parameter
US10695081B2 (en) 2017-12-28 2020-06-30 Ethicon Llc Controlling a surgical instrument according to sensed closure parameters
US11529187B2 (en) 2017-12-28 2022-12-20 Cilag Gmbh International Surgical evacuation sensor arrangements
US11419667B2 (en) 2017-12-28 2022-08-23 Cilag Gmbh International Ultrasonic energy device which varies pressure applied by clamp arm to provide threshold control pressure at a cut progression location
US11464535B2 (en) 2017-12-28 2022-10-11 Cilag Gmbh International Detection of end effector emersion in liquid
US11744604B2 (en) 2017-12-28 2023-09-05 Cilag Gmbh International Surgical instrument with a hardware-only control circuit
US11998193B2 (en) 2017-12-28 2024-06-04 Cilag Gmbh International Method for usage of the shroud as an aspect of sensing or controlling a powered surgical device, and a control algorithm to adjust its default operation
US10987178B2 (en) 2017-12-28 2021-04-27 Ethicon Llc Surgical hub control arrangements
US11446052B2 (en) 2017-12-28 2022-09-20 Cilag Gmbh International Variation of radio frequency and ultrasonic power level in cooperation with varying clamp arm pressure to achieve predefined heat flux or power applied to tissue
US10944728B2 (en) 2017-12-28 2021-03-09 Ethicon Llc Interactive surgical systems with encrypted communication capabilities
US11969142B2 (en) 2017-12-28 2024-04-30 Cilag Gmbh International Method of compressing tissue within a stapling device and simultaneously displaying the location of the tissue within the jaws
US11786251B2 (en) 2017-12-28 2023-10-17 Cilag Gmbh International Method for adaptive control schemes for surgical network control and interaction
US10943454B2 (en) 2017-12-28 2021-03-09 Ethicon Llc Detection and escalation of security responses of surgical instruments to increasing severity threats
US11364075B2 (en) 2017-12-28 2022-06-21 Cilag Gmbh International Radio frequency energy device for delivering combined electrical signals
US11612444B2 (en) 2017-12-28 2023-03-28 Cilag Gmbh International Adjustment of a surgical device function based on situational awareness
US11026751B2 (en) 2017-12-28 2021-06-08 Cilag Gmbh International Display of alignment of staple cartridge to prior linear staple line
US11464559B2 (en) 2017-12-28 2022-10-11 Cilag Gmbh International Estimating state of ultrasonic end effector and control system therefor
US11896322B2 (en) 2017-12-28 2024-02-13 Cilag Gmbh International Sensing the patient position and contact utilizing the mono-polar return pad electrode to provide situational awareness to the hub
US11423007B2 (en) 2017-12-28 2022-08-23 Cilag Gmbh International Adjustment of device control programs based on stratified contextual data in addition to the data
US11633237B2 (en) 2017-12-28 2023-04-25 Cilag Gmbh International Usage and technique analysis of surgeon / staff performance against a baseline to optimize device utilization and performance for both current and future procedures
US11571234B2 (en) 2017-12-28 2023-02-07 Cilag Gmbh International Temperature control of ultrasonic end effector and control system therefor
US11096693B2 (en) 2017-12-28 2021-08-24 Cilag Gmbh International Adjustment of staple height of at least one row of staples based on the sensed tissue thickness or force in closing
US11304720B2 (en) 2017-12-28 2022-04-19 Cilag Gmbh International Activation of energy devices
US12096916B2 (en) 2017-12-28 2024-09-24 Cilag Gmbh International Method of sensing particulate from smoke evacuated from a patient, adjusting the pump speed based on the sensed information, and communicating the functional parameters of the system to the hub
US10898622B2 (en) 2017-12-28 2021-01-26 Ethicon Llc Surgical evacuation system with a communication circuit for communication between a filter and a smoke evacuation device
US11100631B2 (en) 2017-12-28 2021-08-24 Cilag Gmbh International Use of laser light and red-green-blue coloration to determine properties of back scattered light
US11308075B2 (en) 2017-12-28 2022-04-19 Cilag Gmbh International Surgical network, instrument, and cloud responses based on validation of received dataset and authentication of its source and integrity
US11278281B2 (en) 2017-12-28 2022-03-22 Cilag Gmbh International Interactive surgical system
US11896443B2 (en) 2017-12-28 2024-02-13 Cilag Gmbh International Control of a surgical system through a surgical barrier
US11291495B2 (en) 2017-12-28 2022-04-05 Cilag Gmbh International Interruption of energy due to inadvertent capacitive coupling
US10892995B2 (en) 2017-12-28 2021-01-12 Ethicon Llc Surgical network determination of prioritization of communication, interaction, or processing based on system or device needs
US11253315B2 (en) 2017-12-28 2022-02-22 Cilag Gmbh International Increasing radio frequency to create pad-less monopolar loop
US11410259B2 (en) 2017-12-28 2022-08-09 Cilag Gmbh International Adaptive control program updates for surgical devices
US11273001B2 (en) 2017-12-28 2022-03-15 Cilag Gmbh International Surgical hub and modular device response adjustment based on situational awareness
US10966791B2 (en) 2017-12-28 2021-04-06 Ethicon Llc Cloud-based medical analytics for medical facility segmented individualization of instrument function
US11304699B2 (en) 2017-12-28 2022-04-19 Cilag Gmbh International Method for adaptive control schemes for surgical network control and interaction
US11051876B2 (en) 2017-12-28 2021-07-06 Cilag Gmbh International Surgical evacuation flow paths
US11304745B2 (en) 2017-12-28 2022-04-19 Cilag Gmbh International Surgical evacuation sensing and display
US11284936B2 (en) 2017-12-28 2022-03-29 Cilag Gmbh International Surgical instrument having a flexible electrode
US11419630B2 (en) 2017-12-28 2022-08-23 Cilag Gmbh International Surgical system distributed processing
US20190201142A1 (en) 2017-12-28 2019-07-04 Ethicon Llc Automatic tool adjustments for robot-assisted surgical platforms
US11786245B2 (en) 2017-12-28 2023-10-17 Cilag Gmbh International Surgical systems with prioritized data transmission capabilities
US11166772B2 (en) 2017-12-28 2021-11-09 Cilag Gmbh International Surgical hub coordination of control and communication of operating room devices
US11864728B2 (en) 2017-12-28 2024-01-09 Cilag Gmbh International Characterization of tissue irregularities through the use of mono-chromatic light refractivity
US11832840B2 (en) 2017-12-28 2023-12-05 Cilag Gmbh International Surgical instrument having a flexible circuit
US11589888B2 (en) 2017-12-28 2023-02-28 Cilag Gmbh International Method for controlling smart energy devices
US11257589B2 (en) 2017-12-28 2022-02-22 Cilag Gmbh International Real-time analysis of comprehensive cost of all instrumentation used in surgery utilizing data fluidity to track instruments through stocking and in-house processes
US12062442B2 (en) 2017-12-28 2024-08-13 Cilag Gmbh International Method for operating surgical instrument systems
US11576677B2 (en) 2017-12-28 2023-02-14 Cilag Gmbh International Method of hub communication, processing, display, and cloud analytics
US11424027B2 (en) 2017-12-28 2022-08-23 Cilag Gmbh International Method for operating surgical instrument systems
US11602393B2 (en) 2017-12-28 2023-03-14 Cilag Gmbh International Surgical evacuation sensing and generator control
US11818052B2 (en) 2017-12-28 2023-11-14 Cilag Gmbh International Surgical network determination of prioritization of communication, interaction, or processing based on system or device needs
US11832899B2 (en) 2017-12-28 2023-12-05 Cilag Gmbh International Surgical systems with autonomously adjustable control programs
US11666331B2 (en) 2017-12-28 2023-06-06 Cilag Gmbh International Systems for detecting proximity of surgical end effector to cancerous tissue
US11069012B2 (en) 2017-12-28 2021-07-20 Cilag Gmbh International Interactive surgical systems with condition handling of devices and data capabilities
US11147607B2 (en) 2017-12-28 2021-10-19 Cilag Gmbh International Bipolar combination device that automatically adjusts pressure based on energy modality
US11109866B2 (en) 2017-12-28 2021-09-07 Cilag Gmbh International Method for circular stapler control algorithm adjustment based on situational awareness
US11857152B2 (en) 2017-12-28 2024-01-02 Cilag Gmbh International Surgical hub spatial awareness to determine devices in operating theater
US11937769B2 (en) 2017-12-28 2024-03-26 Cilag Gmbh International Method of hub communication, processing, storage and display
US11304763B2 (en) 2017-12-28 2022-04-19 Cilag Gmbh International Image capturing of the areas outside the abdomen to improve placement and control of a surgical device in use
US10849697B2 (en) 2017-12-28 2020-12-01 Ethicon Llc Cloud interface for coupled surgical devices
US11540855B2 (en) 2017-12-28 2023-01-03 Cilag Gmbh International Controlling activation of an ultrasonic surgical instrument according to the presence of tissue
US20190201042A1 (en) 2017-12-28 2019-07-04 Ethicon Llc Determining the state of an ultrasonic electromechanical system according to frequency shift
US11432885B2 (en) 2017-12-28 2022-09-06 Cilag Gmbh International Sensing arrangements for robot-assisted surgical platforms
US11076921B2 (en) 2017-12-28 2021-08-03 Cilag Gmbh International Adaptive control program updates for surgical hubs
US11160605B2 (en) 2017-12-28 2021-11-02 Cilag Gmbh International Surgical evacuation sensing and motor control
WO2019133144A1 (en) 2017-12-28 2019-07-04 Ethicon Llc Detection and escalation of security responses of surgical instruments to increasing severity threats
US10758310B2 (en) 2017-12-28 2020-09-01 Ethicon Llc Wireless pairing of a surgical device with another device within a sterile surgical field based on the usage and situational awareness of devices
US20190201139A1 (en) 2017-12-28 2019-07-04 Ethicon Llc Communication arrangements for robot-assisted surgical platforms
US10755813B2 (en) 2017-12-28 2020-08-25 Ethicon Llc Communication of smoke evacuation system parameters to hub or cloud in smoke evacuation module for interactive surgical platform
US11317937B2 (en) 2018-03-08 2022-05-03 Cilag Gmbh International Determining the state of an ultrasonic end effector
US11559307B2 (en) 2017-12-28 2023-01-24 Cilag Gmbh International Method of robotic hub communication, detection, and control
US10945732B2 (en) 2018-01-17 2021-03-16 Covidien Lp Surgical stapler with self-returning assembly
US10695140B2 (en) 2018-02-15 2020-06-30 Ethicon Llc Near field communication between a surgical instrument and a robotic surgical system
US10702349B2 (en) 2018-02-20 2020-07-07 Ethicon Llc Robotic surgical instrument communication
BR112020016895A2 (pt) 2018-02-21 2020-12-15 Ethicon Llc Arcabouços entrelaçados para tecido
JP2021514250A (ja) * 2018-02-21 2021-06-10 エシコン エルエルシーEthicon LLC 編まれた組織スキャフォールド
USD885574S1 (en) 2018-02-21 2020-05-26 Ethicon Llc Knitted tissue scaffold
US10799237B2 (en) 2018-02-21 2020-10-13 Ethicon Llc Three dimensional adjuncts
USD882782S1 (en) 2018-02-21 2020-04-28 Ethicon Llc Three dimensional adjunct
US10959721B2 (en) 2018-02-21 2021-03-30 Ethicon Llc Three dimensional adjuncts
US10695061B2 (en) 2018-02-21 2020-06-30 Ethicon Llc Knitted tissue scaffolds
US11065000B2 (en) 2018-02-22 2021-07-20 Covidien Lp Surgical buttresses for surgical stapling apparatus
KR102680497B1 (ko) 2018-02-27 2024-07-04 어플라이드 메디컬 리소시스 코포레이션 전동 핸들을 갖는 수술용 스테이플러
JP7134243B2 (ja) 2018-03-02 2022-09-09 コヴィディエン リミテッド パートナーシップ 外科用ステープル留め器具
US11534196B2 (en) 2018-03-08 2022-12-27 Cilag Gmbh International Using spectroscopy to determine device use state in combo instrument
US11337746B2 (en) 2018-03-08 2022-05-24 Cilag Gmbh International Smart blade and power pulsing
US11259830B2 (en) 2018-03-08 2022-03-01 Cilag Gmbh International Methods for controlling temperature in ultrasonic device
US11278280B2 (en) 2018-03-28 2022-03-22 Cilag Gmbh International Surgical instrument comprising a jaw closure lockout
US11471156B2 (en) 2018-03-28 2022-10-18 Cilag Gmbh International Surgical stapling devices with improved rotary driven closure systems
US11219453B2 (en) 2018-03-28 2022-01-11 Cilag Gmbh International Surgical stapling devices with cartridge compatible closure and firing lockout arrangements
US11090047B2 (en) 2018-03-28 2021-08-17 Cilag Gmbh International Surgical instrument comprising an adaptive control system
US10973520B2 (en) 2018-03-28 2021-04-13 Ethicon Llc Surgical staple cartridge with firing member driven camming assembly that has an onboard tissue cutting feature
US20190298353A1 (en) 2018-03-28 2019-10-03 Ethicon Llc Surgical stapling devices with asymmetric closure features
US11259806B2 (en) 2018-03-28 2022-03-01 Cilag Gmbh International Surgical stapling devices with features for blocking advancement of a camming assembly of an incompatible cartridge installed therein
US11096688B2 (en) 2018-03-28 2021-08-24 Cilag Gmbh International Rotary driven firing members with different anvil and channel engagement features
US11207067B2 (en) 2018-03-28 2021-12-28 Cilag Gmbh International Surgical stapling device with separate rotary driven closure and firing systems and firing member that engages both jaws while firing
CN112074240A (zh) 2018-03-28 2020-12-11 数据显示器公司 心耳排除装置
US11406382B2 (en) 2018-03-28 2022-08-09 Cilag Gmbh International Staple cartridge comprising a lockout key configured to lift a firing member
WO2019191015A1 (en) 2018-03-29 2019-10-03 Covidien Lp Robotic surgical systems and instrument drive assemblies
CN112004452B (zh) * 2018-04-26 2024-04-02 奥林巴斯株式会社 螺旋管和内窥镜
US10758237B2 (en) 2018-04-30 2020-09-01 Covidien Lp Circular stapling apparatus with pinned buttress
US11426163B2 (en) 2018-05-09 2022-08-30 Covidien Lp Universal linear surgical stapling buttress
US11432818B2 (en) 2018-05-09 2022-09-06 Covidien Lp Surgical buttress assemblies
US11284896B2 (en) 2018-05-09 2022-03-29 Covidien Lp Surgical buttress loading and attaching/detaching assemblies
US10849622B2 (en) 2018-06-21 2020-12-01 Covidien Lp Articulated stapling with fire lock
US11219460B2 (en) 2018-07-02 2022-01-11 Covidien Lp Surgical stapling apparatus with anvil buttress
CN112702972A (zh) 2018-07-26 2021-04-23 柯惠Lp公司 外科机器人系统
US10736631B2 (en) 2018-08-07 2020-08-11 Covidien Lp End effector with staple cartridge ejector
US10912559B2 (en) 2018-08-20 2021-02-09 Ethicon Llc Reinforced deformable anvil tip for surgical stapler anvil
US11207065B2 (en) 2018-08-20 2021-12-28 Cilag Gmbh International Method for fabricating surgical stapler anvils
US11039834B2 (en) 2018-08-20 2021-06-22 Cilag Gmbh International Surgical stapler anvils with staple directing protrusions and tissue stability features
US10842492B2 (en) 2018-08-20 2020-11-24 Ethicon Llc Powered articulatable surgical instruments with clutching and locking arrangements for linking an articulation drive system to a firing drive system
US11324501B2 (en) 2018-08-20 2022-05-10 Cilag Gmbh International Surgical stapling devices with improved closure members
US10856870B2 (en) 2018-08-20 2020-12-08 Ethicon Llc Switching arrangements for motor powered articulatable surgical instruments
US20200054321A1 (en) 2018-08-20 2020-02-20 Ethicon Llc Surgical instruments with progressive jaw closure arrangements
US11083458B2 (en) 2018-08-20 2021-08-10 Cilag Gmbh International Powered surgical instruments with clutching arrangements to convert linear drive motions to rotary drive motions
USD914878S1 (en) 2018-08-20 2021-03-30 Ethicon Llc Surgical instrument anvil
US11291440B2 (en) 2018-08-20 2022-04-05 Cilag Gmbh International Method for operating a powered articulatable surgical instrument
US11253256B2 (en) 2018-08-20 2022-02-22 Cilag Gmbh International Articulatable motor powered surgical instruments with dedicated articulation motor arrangements
US11045192B2 (en) 2018-08-20 2021-06-29 Cilag Gmbh International Fabricating techniques for surgical stapler anvils
US10779821B2 (en) 2018-08-20 2020-09-22 Ethicon Llc Surgical stapler anvils with tissue stop features configured to avoid tissue pinch
CN109822626B (zh) * 2018-09-13 2021-01-26 阳江市港富实业有限公司 剪刀
US10849620B2 (en) 2018-09-14 2020-12-01 Covidien Lp Connector mechanisms for surgical stapling instruments
US10806459B2 (en) 2018-09-14 2020-10-20 Covidien Lp Drug patterned reinforcement material for circular anastomosis
US11510669B2 (en) 2020-09-29 2022-11-29 Covidien Lp Hand-held surgical instruments
US10952729B2 (en) 2018-10-03 2021-03-23 Covidien Lp Universal linear buttress retention/release assemblies and methods
JP2022513373A (ja) * 2018-10-19 2022-02-07 ナイス サージカル ソリューションズ ピーティーイー. リミテッド 低侵襲手術処置のためのデバイス及び方法
US11090051B2 (en) 2018-10-23 2021-08-17 Covidien Lp Surgical stapling device with floating staple cartridge
US11197673B2 (en) 2018-10-30 2021-12-14 Covidien Lp Surgical stapling instruments and end effector assemblies thereof
EP3880279A4 (en) * 2018-11-13 2022-08-17 Pulse NeedleFree Systems, Inc. BALL LOCKING DEVICE WITH RETAINING PIN
US11051809B2 (en) 2018-12-31 2021-07-06 Cilag Gmbh International Cartridge receiving jaw for surgical stapler and associated method of manufacture with MIM
US11103245B2 (en) 2018-12-31 2021-08-31 Cilag Gmbh International Knife for surgical stapler and associated method of manufacture with MIM and hip
CN113260316B (zh) * 2018-12-31 2024-09-10 维瓦舒尔医疗设备有限公司 可调整血管封闭装置
US11141777B2 (en) 2018-12-31 2021-10-12 Cilag Gmbh International Multi-piece jaw assembly for surgical clip applier
US11291450B2 (en) 2018-12-31 2022-04-05 Cilag Gmbh International Anvil for circular surgical stapler and associated method of manufacture with MIM
US11134941B2 (en) 2018-12-31 2021-10-05 Cilag Gmbh International Cartridge receiving jaw for surgical stapler and associated method of manufacture with stamping
US11259804B2 (en) 2018-12-31 2022-03-01 Cilag Gmbh International Frame for surgical stapler and associated method of manufacture with stamping
US11607217B2 (en) 2018-12-31 2023-03-21 Cilag Gmbh International Surgical stapler shaft formed of segments of different materials
US10912563B2 (en) 2019-01-02 2021-02-09 Covidien Lp Stapling device including tool assembly stabilizing member
US11298129B2 (en) 2019-02-19 2022-04-12 Cilag Gmbh International Method for providing an authentication lockout in a surgical stapler with a replaceable cartridge
US11357503B2 (en) 2019-02-19 2022-06-14 Cilag Gmbh International Staple cartridge retainers with frangible retention features and methods of using same
US11369377B2 (en) 2019-02-19 2022-06-28 Cilag Gmbh International Surgical stapling assembly with cartridge based retainer configured to unlock a firing lockout
US11317915B2 (en) 2019-02-19 2022-05-03 Cilag Gmbh International Universal cartridge based key feature that unlocks multiple lockout arrangements in different surgical staplers
US11464511B2 (en) 2019-02-19 2022-10-11 Cilag Gmbh International Surgical staple cartridges with movable authentication key arrangements
EP3930588A1 (en) 2019-02-27 2022-01-05 Applied Medical Resources Corporation Surgical stapling instrument having a two-position lockout mechanism
US11344297B2 (en) 2019-02-28 2022-05-31 Covidien Lp Surgical stapling device with independently movable jaws
US11376000B2 (en) * 2019-03-13 2022-07-05 Covidien Lp Surgical stapler anvil with directionally biased staple pockets
US11259808B2 (en) 2019-03-13 2022-03-01 Covidien Lp Tool assemblies with a gap locking member
US11992282B2 (en) 2019-03-15 2024-05-28 Cilag Gmbh International Motion capture controls for robotic surgery
US11172929B2 (en) 2019-03-25 2021-11-16 Cilag Gmbh International Articulation drive arrangements for surgical systems
US11147551B2 (en) 2019-03-25 2021-10-19 Cilag Gmbh International Firing drive arrangements for surgical systems
US11696761B2 (en) 2019-03-25 2023-07-11 Cilag Gmbh International Firing drive arrangements for surgical systems
US11147553B2 (en) 2019-03-25 2021-10-19 Cilag Gmbh International Firing drive arrangements for surgical systems
EP3946079A1 (en) 2019-03-29 2022-02-09 Applied Medical Resources Corporation Reload cover for surgical stapling system
US11284892B2 (en) 2019-04-01 2022-03-29 Covidien Lp Loading unit and adapter with modified coupling assembly
US11284893B2 (en) 2019-04-02 2022-03-29 Covidien Lp Stapling device with articulating tool assembly
US11241228B2 (en) 2019-04-05 2022-02-08 Covidien Lp Surgical instrument including an adapter assembly and an articulating surgical loading unit
US11730472B2 (en) 2019-04-25 2023-08-22 Covidien Lp Surgical system and surgical loading units thereof
US11452528B2 (en) 2019-04-30 2022-09-27 Cilag Gmbh International Articulation actuators for a surgical instrument
US20200345356A1 (en) 2019-04-30 2020-11-05 Ethicon Llc Intelligent firing associated with a surgical instrument
US11426251B2 (en) 2019-04-30 2022-08-30 Cilag Gmbh International Articulation directional lights on a surgical instrument
US11903581B2 (en) 2019-04-30 2024-02-20 Cilag Gmbh International Methods for stapling tissue using a surgical instrument
US20200345357A1 (en) 2019-04-30 2020-11-05 Ethicon Llc Intelligent firing associated with a surgical instrument
US11253254B2 (en) 2019-04-30 2022-02-22 Cilag Gmbh International Shaft rotation actuator on a surgical instrument
US20200345359A1 (en) 2019-04-30 2020-11-05 Ethicon Llc Tissue stop for a surgical instrument
US11648009B2 (en) 2019-04-30 2023-05-16 Cilag Gmbh International Rotatable jaw tip for a surgical instrument
US11471157B2 (en) 2019-04-30 2022-10-18 Cilag Gmbh International Articulation control mapping for a surgical instrument
US11432816B2 (en) 2019-04-30 2022-09-06 Cilag Gmbh International Articulation pin for a surgical instrument
US11478245B2 (en) 2019-05-08 2022-10-25 Covidien Lp Surgical stapling device
US11596403B2 (en) 2019-05-08 2023-03-07 Covidien Lp Surgical stapling device
US11628020B2 (en) 2019-06-19 2023-04-18 Virtuoso Surgical, Inc. Insertable robot for minimally invasive surgery
USD952144S1 (en) 2019-06-25 2022-05-17 Cilag Gmbh International Surgical staple cartridge retainer with firing system authentication key
USD950728S1 (en) 2019-06-25 2022-05-03 Cilag Gmbh International Surgical staple cartridge
USD964564S1 (en) 2019-06-25 2022-09-20 Cilag Gmbh International Surgical staple cartridge retainer with a closure system authentication key
US12004740B2 (en) 2019-06-28 2024-06-11 Cilag Gmbh International Surgical stapling system having an information decryption protocol
US20200405308A1 (en) 2019-06-28 2020-12-31 Ethicon Llc Surgical instrument including a firing lockout
US11426167B2 (en) 2019-06-28 2022-08-30 Cilag Gmbh International Mechanisms for proper anvil attachment surgical stapling head assembly
US20200405292A1 (en) 2019-06-28 2020-12-31 Ethicon Llc Surgical instrument including a battery unit
US11497492B2 (en) 2019-06-28 2022-11-15 Cilag Gmbh International Surgical instrument including an articulation lock
US20200405306A1 (en) 2019-06-28 2020-12-31 Ethicon Llc Surgical instrument including a firing system bailout
US11771419B2 (en) 2019-06-28 2023-10-03 Cilag Gmbh International Packaging for a replaceable component of a surgical stapling system
US11399837B2 (en) 2019-06-28 2022-08-02 Cilag Gmbh International Mechanisms for motor control adjustments of a motorized surgical instrument
US11051807B2 (en) 2019-06-28 2021-07-06 Cilag Gmbh International Packaging assembly including a particulate trap
US20200405307A1 (en) 2019-06-28 2020-12-31 Ethicon Llc Control circuit comprising a coating
US11638587B2 (en) 2019-06-28 2023-05-02 Cilag Gmbh International RFID identification systems for surgical instruments
US11553971B2 (en) 2019-06-28 2023-01-17 Cilag Gmbh International Surgical RFID assemblies for display and communication
US11219455B2 (en) 2019-06-28 2022-01-11 Cilag Gmbh International Surgical instrument including a lockout key
US11246678B2 (en) 2019-06-28 2022-02-15 Cilag Gmbh International Surgical stapling system having a frangible RFID tag
US11298127B2 (en) 2019-06-28 2022-04-12 Cilag GmbH Interational Surgical stapling system having a lockout mechanism for an incompatible cartridge
US11376098B2 (en) 2019-06-28 2022-07-05 Cilag Gmbh International Surgical instrument system comprising an RFID system
US11627959B2 (en) 2019-06-28 2023-04-18 Cilag Gmbh International Surgical instruments including manual and powered system lockouts
US11291451B2 (en) 2019-06-28 2022-04-05 Cilag Gmbh International Surgical instrument with battery compatibility verification functionality
US11464601B2 (en) 2019-06-28 2022-10-11 Cilag Gmbh International Surgical instrument comprising an RFID system for tracking a movable component
US11241235B2 (en) 2019-06-28 2022-02-08 Cilag Gmbh International Method of using multiple RFID chips with a surgical assembly
US11660163B2 (en) 2019-06-28 2023-05-30 Cilag Gmbh International Surgical system with RFID tags for updating motor assembly parameters
US11523822B2 (en) 2019-06-28 2022-12-13 Cilag Gmbh International Battery pack including a circuit interrupter
US11478241B2 (en) 2019-06-28 2022-10-25 Cilag Gmbh International Staple cartridge including projections
US11298132B2 (en) 2019-06-28 2022-04-12 Cilag GmbH Inlernational Staple cartridge including a honeycomb extension
US11684434B2 (en) 2019-06-28 2023-06-27 Cilag Gmbh International Surgical RFID assemblies for instrument operational setting control
US11259803B2 (en) 2019-06-28 2022-03-01 Cilag Gmbh International Surgical stapling system having an information encryption protocol
US11224497B2 (en) 2019-06-28 2022-01-18 Cilag Gmbh International Surgical systems with multiple RFID tags
JP2022540111A (ja) * 2019-07-10 2022-09-14 ボストン サイエンティフィック サイムド,インコーポレイテッド 組織を締結するためのシステムおよび装置
US11224424B2 (en) 2019-08-02 2022-01-18 Covidien Lp Linear stapling device with vertically movable knife
US11969169B2 (en) 2019-09-10 2024-04-30 Covidien Lp Anvil buttress loading unit for a surgical stapling apparatus
US11638584B2 (en) 2019-09-16 2023-05-02 Cilag Gmbh International Compressible non-fibrous adjuncts
US11490890B2 (en) 2019-09-16 2022-11-08 Cilag Gmbh International Compressible non-fibrous adjuncts
US11571208B2 (en) 2019-10-11 2023-02-07 Covidien Lp Surgical buttress loading units
US11406385B2 (en) 2019-10-11 2022-08-09 Covidien Lp Stapling device with a gap locking member
BR112022008009A2 (pt) 2019-11-04 2022-07-12 Standard Bariatrics Inc Sistemas e métodos de realização de cirurgia usando a retração de tensão da lei de laplace durante a cirurgia
US11123068B2 (en) 2019-11-08 2021-09-21 Covidien Lp Surgical staple cartridge
CN110946646B (zh) * 2019-11-11 2021-04-20 浙江天松医疗器械股份有限公司 多功能切割钳及其安装方法、操作方法
US11974743B2 (en) 2019-12-02 2024-05-07 Covidien Lp Linear stapling device with a gap locking member
US11707274B2 (en) 2019-12-06 2023-07-25 Covidien Lp Articulating mechanism for surgical instrument
USD1013868S1 (en) 2019-12-09 2024-02-06 Fetal Life, Llc Medical device
US20210169399A1 (en) * 2019-12-09 2021-06-10 Himanshu Nandlal Shah Device and Method for Detecting Uterine Activity
US11523824B2 (en) 2019-12-12 2022-12-13 Covidien Lp Anvil buttress loading for a surgical stapling apparatus
US11109862B2 (en) 2019-12-12 2021-09-07 Covidien Lp Surgical stapling device with flexible shaft
US11589864B2 (en) 2019-12-13 2023-02-28 Dinesh Vyas Stapler apparatus and methods for use
US20220008068A1 (en) * 2019-12-13 2022-01-13 Dinesh Vyas Stapler apparatus and methods for use
US20230056943A1 (en) * 2019-12-13 2023-02-23 Dinesh Vyas Stapler apparatus and methods for use
US11737747B2 (en) 2019-12-17 2023-08-29 Covidien Lp Hand-held surgical instruments
US11234698B2 (en) 2019-12-19 2022-02-01 Cilag Gmbh International Stapling system comprising a clamp lockout and a firing lockout
US11504122B2 (en) 2019-12-19 2022-11-22 Cilag Gmbh International Surgical instrument comprising a nested firing member
US11559304B2 (en) 2019-12-19 2023-01-24 Cilag Gmbh International Surgical instrument comprising a rapid closure mechanism
US12035913B2 (en) 2019-12-19 2024-07-16 Cilag Gmbh International Staple cartridge comprising a deployable knife
US11291447B2 (en) 2019-12-19 2022-04-05 Cilag Gmbh International Stapling instrument comprising independent jaw closing and staple firing systems
US11446029B2 (en) 2019-12-19 2022-09-20 Cilag Gmbh International Staple cartridge comprising projections extending from a curved deck surface
US11701111B2 (en) 2019-12-19 2023-07-18 Cilag Gmbh International Method for operating a surgical stapling instrument
US11931033B2 (en) 2019-12-19 2024-03-19 Cilag Gmbh International Staple cartridge comprising a latch lockout
US11529137B2 (en) 2019-12-19 2022-12-20 Cilag Gmbh International Staple cartridge comprising driver retention members
US11607219B2 (en) 2019-12-19 2023-03-21 Cilag Gmbh International Staple cartridge comprising a detachable tissue cutting knife
US11304696B2 (en) 2019-12-19 2022-04-19 Cilag Gmbh International Surgical instrument comprising a powered articulation system
US11911032B2 (en) 2019-12-19 2024-02-27 Cilag Gmbh International Staple cartridge comprising a seating cam
US11529139B2 (en) 2019-12-19 2022-12-20 Cilag Gmbh International Motor driven surgical instrument
US11844520B2 (en) 2019-12-19 2023-12-19 Cilag Gmbh International Staple cartridge comprising driver retention members
US11576672B2 (en) 2019-12-19 2023-02-14 Cilag Gmbh International Surgical instrument comprising a closure system including a closure member and an opening member driven by a drive screw
US11464512B2 (en) 2019-12-19 2022-10-11 Cilag Gmbh International Staple cartridge comprising a curved deck surface
US11950797B2 (en) 2019-12-30 2024-04-09 Cilag Gmbh International Deflectable electrode with higher distal bias relative to proximal bias
US12114912B2 (en) 2019-12-30 2024-10-15 Cilag Gmbh International Non-biased deflectable electrode to minimize contact between ultrasonic blade and electrode
US11937863B2 (en) 2019-12-30 2024-03-26 Cilag Gmbh International Deflectable electrode with variable compression bias along the length of the deflectable electrode
US12023086B2 (en) 2019-12-30 2024-07-02 Cilag Gmbh International Electrosurgical instrument for delivering blended energy modalities to tissue
US11944366B2 (en) 2019-12-30 2024-04-02 Cilag Gmbh International Asymmetric segmented ultrasonic support pad for cooperative engagement with a movable RF electrode
US11911063B2 (en) 2019-12-30 2024-02-27 Cilag Gmbh International Techniques for detecting ultrasonic blade to electrode contact and reducing power to ultrasonic blade
US11696776B2 (en) 2019-12-30 2023-07-11 Cilag Gmbh International Articulatable surgical instrument
US11986201B2 (en) 2019-12-30 2024-05-21 Cilag Gmbh International Method for operating a surgical instrument
US11779387B2 (en) 2019-12-30 2023-10-10 Cilag Gmbh International Clamp arm jaw to minimize tissue sticking and improve tissue control
US11937866B2 (en) 2019-12-30 2024-03-26 Cilag Gmbh International Method for an electrosurgical procedure
US20210196358A1 (en) 2019-12-30 2021-07-01 Ethicon Llc Electrosurgical instrument with electrodes biasing support
US11452525B2 (en) 2019-12-30 2022-09-27 Cilag Gmbh International Surgical instrument comprising an adjustment system
US12082808B2 (en) 2019-12-30 2024-09-10 Cilag Gmbh International Surgical instrument comprising a control system responsive to software configurations
US11660089B2 (en) 2019-12-30 2023-05-30 Cilag Gmbh International Surgical instrument comprising a sensing system
US12053224B2 (en) 2019-12-30 2024-08-06 Cilag Gmbh International Variation in electrode parameters and deflectable electrode to modify energy density and tissue interaction
US11786291B2 (en) 2019-12-30 2023-10-17 Cilag Gmbh International Deflectable support of RF energy electrode with respect to opposing ultrasonic blade
US11779329B2 (en) 2019-12-30 2023-10-10 Cilag Gmbh International Surgical instrument comprising a flex circuit including a sensor system
US12064109B2 (en) 2019-12-30 2024-08-20 Cilag Gmbh International Surgical instrument comprising a feedback control circuit
US11812957B2 (en) 2019-12-30 2023-11-14 Cilag Gmbh International Surgical instrument comprising a signal interference resolution system
US11707318B2 (en) 2019-12-30 2023-07-25 Cilag Gmbh International Surgical instrument with jaw alignment features
US20210196270A1 (en) 2019-12-30 2021-07-01 Ethicon Llc Surgical instrument comprising a flex circuit
US12076006B2 (en) 2019-12-30 2024-09-03 Cilag Gmbh International Surgical instrument comprising an orientation detection system
US20210196361A1 (en) 2019-12-30 2021-07-01 Ethicon Llc Electrosurgical instrument with monopolar and bipolar energy capabilities
US11759251B2 (en) 2019-12-30 2023-09-19 Cilag Gmbh International Control program adaptation based on device status and user input
CA3163998A1 (en) 2019-12-31 2021-07-08 Applied Medical Resources Corporation Electrosurgical system with tissue and maximum current identification
US11278282B2 (en) 2020-01-31 2022-03-22 Covidien Lp Stapling device with selective cutting
US11452524B2 (en) 2020-01-31 2022-09-27 Covidien Lp Surgical stapling device with lockout
US11890014B2 (en) 2020-02-14 2024-02-06 Covidien Lp Cartridge holder for surgical staples and having ridges in peripheral walls for gripping tissue
US11344301B2 (en) 2020-03-02 2022-05-31 Covidien Lp Surgical stapling device with replaceable reload assembly
US11344302B2 (en) 2020-03-05 2022-05-31 Covidien Lp Articulation mechanism for surgical stapling device
US11707278B2 (en) 2020-03-06 2023-07-25 Covidien Lp Surgical stapler tool assembly to minimize bleeding
US11246593B2 (en) 2020-03-06 2022-02-15 Covidien Lp Staple cartridge
US11357505B2 (en) 2020-03-10 2022-06-14 Covidien Lp Surgical stapling apparatus with firing lockout mechanism
US11317911B2 (en) 2020-03-10 2022-05-03 Covidien Lp Tool assembly with replaceable cartridge assembly
US11406383B2 (en) 2020-03-17 2022-08-09 Covidien Lp Fire assisted powered EGIA handle
US11547407B2 (en) 2020-03-19 2023-01-10 Covidien Lp Staple line reinforcement for surgical stapling apparatus
JP7490802B2 (ja) 2020-03-24 2024-05-27 コヴィディエン リミテッド パートナーシップ 交換可能なステープルカートリッジを備える外科用ステープル留め装置
US11331098B2 (en) 2020-04-01 2022-05-17 Covidien Lp Sled detection device
US11426159B2 (en) 2020-04-01 2022-08-30 Covidien Lp Sled detection device
US11504117B2 (en) 2020-04-02 2022-11-22 Covidien Lp Hand-held surgical instruments
KR102126675B1 (ko) * 2020-04-08 2020-06-26 이유민 복강경용 스태플러
US11337699B2 (en) 2020-04-28 2022-05-24 Covidien Lp Magnesium infused surgical buttress for surgical stapler
US11653921B2 (en) 2020-05-04 2023-05-23 Bolder Surgical, Llc Anti-buckling actuation members for a surgical instrument
US11607216B2 (en) 2020-05-06 2023-03-21 Janssen Pharmaceuticals, Inc. Adaptive responses from smart packaging of drug delivery absorbable adjuncts
US11937794B2 (en) 2020-05-11 2024-03-26 Covidien Lp Powered handle assembly for surgical devices
US11406387B2 (en) 2020-05-12 2022-08-09 Covidien Lp Surgical stapling device with replaceable staple cartridge
US11191537B1 (en) 2020-05-12 2021-12-07 Covidien Lp Stapling device with continuously parallel jaws
US11534167B2 (en) 2020-05-28 2022-12-27 Covidien Lp Electrotaxis-conducive stapling
USD974560S1 (en) 2020-06-02 2023-01-03 Cilag Gmbh International Staple cartridge
USD975850S1 (en) 2020-06-02 2023-01-17 Cilag Gmbh International Staple cartridge
USD975851S1 (en) 2020-06-02 2023-01-17 Cilag Gmbh International Staple cartridge
USD967421S1 (en) 2020-06-02 2022-10-18 Cilag Gmbh International Staple cartridge
USD966512S1 (en) 2020-06-02 2022-10-11 Cilag Gmbh International Staple cartridge
USD976401S1 (en) 2020-06-02 2023-01-24 Cilag Gmbh International Staple cartridge
USD975278S1 (en) 2020-06-02 2023-01-10 Cilag Gmbh International Staple cartridge
US11191538B1 (en) 2020-06-08 2021-12-07 Covidien Lp Surgical stapling device with parallel jaw closure
US11844517B2 (en) 2020-06-25 2023-12-19 Covidien Lp Linear stapling device with continuously parallel jaws
US11324500B2 (en) 2020-06-30 2022-05-10 Covidien Lp Surgical stapling device
CN115955943A (zh) 2020-06-30 2023-04-11 标准肥胖病研究公司 用于防止或减少腹腔镜手术过程中的吹气损失的系统、装置和方法
US12023027B2 (en) 2020-07-02 2024-07-02 Covidien Lp Surgical stapling device with compressible staple cartridge
US11517305B2 (en) 2020-07-09 2022-12-06 Covidien Lp Contoured staple pusher
US11446028B2 (en) 2020-07-09 2022-09-20 Covidien Lp Tool assembly with pivotable clamping beam
CN116209400A (zh) 2020-07-21 2023-06-02 柯惠有限合伙公司 用于钉仓的装运盖
US11883024B2 (en) 2020-07-28 2024-01-30 Cilag Gmbh International Method of operating a surgical instrument
US11266402B2 (en) 2020-07-30 2022-03-08 Covidien Lp Sensing curved tip for surgical stapling instruments
US11439392B2 (en) 2020-08-03 2022-09-13 Covidien Lp Surgical stapling device and fastener for pathological exam
US11395654B2 (en) 2020-08-07 2022-07-26 Covidien Lp Surgical stapling device with articulation braking assembly
US11602342B2 (en) 2020-08-27 2023-03-14 Covidien Lp Surgical stapling device with laser probe
USD1029255S1 (en) 2020-09-01 2024-05-28 Cilag Gmbh International Stapling cartridge assembly with a compressible adjunct
US11707276B2 (en) 2020-09-08 2023-07-25 Covidien Lp Surgical buttress assemblies and techniques for surgical stapling
US11678878B2 (en) 2020-09-16 2023-06-20 Covidien Lp Articulation mechanism for surgical stapling device
US11660092B2 (en) 2020-09-29 2023-05-30 Covidien Lp Adapter for securing loading units to handle assemblies of surgical stapling instruments
US11406384B2 (en) 2020-10-05 2022-08-09 Covidien Lp Stapling device with drive assembly stop member
US11576674B2 (en) 2020-10-06 2023-02-14 Covidien Lp Surgical stapling device with articulation lock assembly
US11399833B2 (en) 2020-10-19 2022-08-02 Covidien Lp Anvil buttress attachment for surgical stapling apparatus
US11517390B2 (en) 2020-10-29 2022-12-06 Cilag Gmbh International Surgical instrument comprising a limited travel switch
US12053175B2 (en) 2020-10-29 2024-08-06 Cilag Gmbh International Surgical instrument comprising a stowed closure actuator stop
US11779330B2 (en) 2020-10-29 2023-10-10 Cilag Gmbh International Surgical instrument comprising a jaw alignment system
US11534259B2 (en) 2020-10-29 2022-12-27 Cilag Gmbh International Surgical instrument comprising an articulation indicator
US11717289B2 (en) 2020-10-29 2023-08-08 Cilag Gmbh International Surgical instrument comprising an indicator which indicates that an articulation drive is actuatable
USD980425S1 (en) 2020-10-29 2023-03-07 Cilag Gmbh International Surgical instrument assembly
AU2021368658A1 (en) 2020-10-29 2023-06-01 Applied Medical Resources Corporation Material combinations and processing methods for a surgical instrument
US11896217B2 (en) 2020-10-29 2024-02-13 Cilag Gmbh International Surgical instrument comprising an articulation lock
AU2021368128A1 (en) 2020-10-29 2023-06-01 Applied Medical Resources Corporation Actuation shaft retention mechanism for surgical stapler
CA3196928A1 (en) 2020-10-29 2022-05-05 Kevin Hudson Surgical stapler having a powered handle
US11844518B2 (en) 2020-10-29 2023-12-19 Cilag Gmbh International Method for operating a surgical instrument
US20220133303A1 (en) 2020-10-29 2022-05-05 Ethicon Llc Surgical instrument comprising sealable interface
US11452526B2 (en) 2020-10-29 2022-09-27 Cilag Gmbh International Surgical instrument comprising a staged voltage regulation start-up system
US11931025B2 (en) 2020-10-29 2024-03-19 Cilag Gmbh International Surgical instrument comprising a releasable closure drive lock
USD1013170S1 (en) 2020-10-29 2024-01-30 Cilag Gmbh International Surgical instrument assembly
US11617577B2 (en) 2020-10-29 2023-04-04 Cilag Gmbh International Surgical instrument comprising a sensor configured to sense whether an articulation drive of the surgical instrument is actuatable
US11890007B2 (en) 2020-11-18 2024-02-06 Covidien Lp Stapling device with flex cable and tensioning mechanism
US11690617B2 (en) 2020-11-25 2023-07-04 Cilag Gmbh International Compressible knitted adjuncts with finished edges
US11446027B2 (en) 2020-11-25 2022-09-20 Cilag Gmbh International Compressible knitted adjuncts with surface features
US11707279B2 (en) 2020-11-25 2023-07-25 Cilag Gmbh International Compressible knitted adjuncts with finished edges
US11678883B2 (en) 2020-11-25 2023-06-20 Cilag Gmbh International Compressible knitted adjuncts with varying interconnections
US11648007B2 (en) 2020-11-25 2023-05-16 Cilag Gmbh International Compressible knitted adjuncts with varying fiber features
US11737751B2 (en) 2020-12-02 2023-08-29 Cilag Gmbh International Devices and methods of managing energy dissipated within sterile barriers of surgical instrument housings
US11944296B2 (en) 2020-12-02 2024-04-02 Cilag Gmbh International Powered surgical instruments with external connectors
US11653915B2 (en) 2020-12-02 2023-05-23 Cilag Gmbh International Surgical instruments with sled location detection and adjustment features
US11849943B2 (en) 2020-12-02 2023-12-26 Cilag Gmbh International Surgical instrument with cartridge release mechanisms
US11744581B2 (en) 2020-12-02 2023-09-05 Cilag Gmbh International Powered surgical instruments with multi-phase tissue treatment
US11678882B2 (en) 2020-12-02 2023-06-20 Cilag Gmbh International Surgical instruments with interactive features to remedy incidental sled movements
US11890010B2 (en) 2020-12-02 2024-02-06 Cllag GmbH International Dual-sided reinforced reload for surgical instruments
US11653920B2 (en) 2020-12-02 2023-05-23 Cilag Gmbh International Powered surgical instruments with communication interfaces through sterile barrier
US11627960B2 (en) 2020-12-02 2023-04-18 Cilag Gmbh International Powered surgical instruments with smart reload with separately attachable exteriorly mounted wiring connections
US11737774B2 (en) 2020-12-04 2023-08-29 Covidien Lp Surgical instrument with articulation assembly
CN112741658B (zh) * 2020-12-14 2022-01-07 苏州法兰克曼医疗器械有限公司 一种切割刀一次击发驱动的切割吻合器
US11819200B2 (en) 2020-12-15 2023-11-21 Covidien Lp Surgical instrument with articulation assembly
US11553914B2 (en) 2020-12-22 2023-01-17 Covidien Lp Surgical stapling device with parallel jaw closure
US11534170B2 (en) 2021-01-04 2022-12-27 Covidien Lp Anvil buttress attachment for surgical stapling apparatus
US11744582B2 (en) 2021-01-05 2023-09-05 Covidien Lp Surgical stapling device with firing lockout mechanism
US11759206B2 (en) 2021-01-05 2023-09-19 Covidien Lp Surgical stapling device with firing lockout mechanism
US11759207B2 (en) 2021-01-27 2023-09-19 Covidien Lp Surgical stapling apparatus with adjustable height clamping member
US11517313B2 (en) 2021-01-27 2022-12-06 Covidien Lp Surgical stapling device with laminated drive member
US11812964B2 (en) 2021-02-26 2023-11-14 Cilag Gmbh International Staple cartridge comprising a power management circuit
US11950777B2 (en) 2021-02-26 2024-04-09 Cilag Gmbh International Staple cartridge comprising an information access control system
US11701113B2 (en) 2021-02-26 2023-07-18 Cilag Gmbh International Stapling instrument comprising a separate power antenna and a data transfer antenna
US11730473B2 (en) 2021-02-26 2023-08-22 Cilag Gmbh International Monitoring of manufacturing life-cycle
US11925349B2 (en) 2021-02-26 2024-03-12 Cilag Gmbh International Adjustment to transfer parameters to improve available power
US11749877B2 (en) 2021-02-26 2023-09-05 Cilag Gmbh International Stapling instrument comprising a signal antenna
US11751869B2 (en) 2021-02-26 2023-09-12 Cilag Gmbh International Monitoring of multiple sensors over time to detect moving characteristics of tissue
US12108951B2 (en) 2021-02-26 2024-10-08 Cilag Gmbh International Staple cartridge comprising a sensing array and a temperature control system
US11744583B2 (en) 2021-02-26 2023-09-05 Cilag Gmbh International Distal communication array to tune frequency of RF systems
US11980362B2 (en) 2021-02-26 2024-05-14 Cilag Gmbh International Surgical instrument system comprising a power transfer coil
US11696757B2 (en) 2021-02-26 2023-07-11 Cilag Gmbh International Monitoring of internal systems to detect and track cartridge motion status
US11723657B2 (en) 2021-02-26 2023-08-15 Cilag Gmbh International Adjustable communication based on available bandwidth and power capacity
US11793514B2 (en) 2021-02-26 2023-10-24 Cilag Gmbh International Staple cartridge comprising sensor array which may be embedded in cartridge body
US11950779B2 (en) 2021-02-26 2024-04-09 Cilag Gmbh International Method of powering and communicating with a staple cartridge
US11717300B2 (en) 2021-03-11 2023-08-08 Covidien Lp Surgical stapling apparatus with integrated visualization
US11806011B2 (en) 2021-03-22 2023-11-07 Cilag Gmbh International Stapling instrument comprising tissue compression systems
US11717291B2 (en) 2021-03-22 2023-08-08 Cilag Gmbh International Staple cartridge comprising staples configured to apply different tissue compression
US11826012B2 (en) 2021-03-22 2023-11-28 Cilag Gmbh International Stapling instrument comprising a pulsed motor-driven firing rack
US11737749B2 (en) 2021-03-22 2023-08-29 Cilag Gmbh International Surgical stapling instrument comprising a retraction system
US11759202B2 (en) 2021-03-22 2023-09-19 Cilag Gmbh International Staple cartridge comprising an implantable layer
US11826042B2 (en) 2021-03-22 2023-11-28 Cilag Gmbh International Surgical instrument comprising a firing drive including a selectable leverage mechanism
US11723658B2 (en) 2021-03-22 2023-08-15 Cilag Gmbh International Staple cartridge comprising a firing lockout
US11452574B1 (en) 2021-03-23 2022-09-27 Standard Bariatrics, Inc. Systems and methods for preventing tissue migration in surgical staplers
US11857183B2 (en) 2021-03-24 2024-01-02 Cilag Gmbh International Stapling assembly components having metal substrates and plastic bodies
US11903582B2 (en) 2021-03-24 2024-02-20 Cilag Gmbh International Leveraging surfaces for cartridge installation
US20220304682A1 (en) 2021-03-24 2022-09-29 Ethicon Llc Fastener cartridge with non-repeating fastener rows
US11849944B2 (en) 2021-03-24 2023-12-26 Cilag Gmbh International Drivers for fastener cartridge assemblies having rotary drive screws
US11896219B2 (en) 2021-03-24 2024-02-13 Cilag Gmbh International Mating features between drivers and underside of a cartridge deck
US11832816B2 (en) 2021-03-24 2023-12-05 Cilag Gmbh International Surgical stapling assembly comprising nonplanar staples and planar staples
US12102323B2 (en) 2021-03-24 2024-10-01 Cilag Gmbh International Rotary-driven surgical stapling assembly comprising a floatable component
US11944336B2 (en) 2021-03-24 2024-04-02 Cilag Gmbh International Joint arrangements for multi-planar alignment and support of operational drive shafts in articulatable surgical instruments
US11849945B2 (en) 2021-03-24 2023-12-26 Cilag Gmbh International Rotary-driven surgical stapling assembly comprising eccentrically driven firing member
US11744603B2 (en) 2021-03-24 2023-09-05 Cilag Gmbh International Multi-axis pivot joints for surgical instruments and methods for manufacturing same
US11793516B2 (en) 2021-03-24 2023-10-24 Cilag Gmbh International Surgical staple cartridge comprising longitudinal support beam
US11786243B2 (en) 2021-03-24 2023-10-17 Cilag Gmbh International Firing members having flexible portions for adapting to a load during a surgical firing stroke
US11896218B2 (en) 2021-03-24 2024-02-13 Cilag Gmbh International Method of using a powered stapling device
US11786239B2 (en) 2021-03-24 2023-10-17 Cilag Gmbh International Surgical instrument articulation joint arrangements comprising multiple moving linkage features
US11974750B2 (en) 2021-03-26 2024-05-07 Covidien Lp Surgical staple cartridge
US20220313262A1 (en) 2021-03-30 2022-10-06 Cilag Gmbh International Composite adjuncts that degrade through multiple different mechanisms
US11896226B2 (en) 2021-03-30 2024-02-13 Cilag Gmbh International Compressible adjuncts with healing-dependent degradation profile
US20220313255A1 (en) 2021-03-30 2022-10-06 Cilag Gmbh International Smart packaging for tissue adjuncts
US11504125B2 (en) 2021-03-30 2022-11-22 Cilag Gmbh International Tissue thickness compensating adjuncts having regions of differential expansion
US11839374B2 (en) 2021-03-30 2023-12-12 Cilag Gmbh International Compressible adjuncts with drug release features
US11602341B2 (en) 2021-03-30 2023-03-14 Cilag Gmbh International Compressible adjuncts with drug release features
US11849950B2 (en) * 2021-03-30 2023-12-26 Cilag Gmbh International Compressible adjuncts with drug dosage control features
US11850332B2 (en) 2021-03-30 2023-12-26 Cilag Gmbh International Method for treating tissue
US11627961B2 (en) 2021-03-30 2023-04-18 Cilag Gmbh International Compressible adjuncts with different behavioral zones
US11786240B2 (en) 2021-03-30 2023-10-17 Cilag Gmbh International Using smart packaging in adjusting use of tissue adjuncts
US20220313145A1 (en) 2021-03-30 2022-10-06 Cilag Gmbh International Monitoring healing after tissue adjunct implantation
US12059153B2 (en) 2021-03-30 2024-08-13 Cilag Gmbh International Implantable adjuncts having adjustable degradation profile
US20220313256A1 (en) 2021-03-30 2022-10-06 Cilag Gmbh International Passively powered packaging for tissue adjuncts
US11864765B2 (en) 2021-03-30 2024-01-09 Cilag Gmbh International Compressible adjuncts with fluid control features
US11497495B2 (en) 2021-03-31 2022-11-15 Covidien Lp Continuous stapler strip for use with a surgical stapling device
US11666330B2 (en) 2021-04-05 2023-06-06 Covidien Lp Surgical stapling device with lockout mechanism
US11857184B2 (en) 2021-04-30 2024-01-02 Cilag Gmbh International Surgical instrument comprising a rotation-driven and translation-driven tissue cutting knife
US20220346785A1 (en) 2021-04-30 2022-11-03 Cilag Gmbh International Surgical instrument comprising end effector with energy sensitive resistance elements
US20220346859A1 (en) 2021-04-30 2022-11-03 Cilag Gmbh International Surgical instrument comprising independently activatable segmented electrodes
US11918275B2 (en) 2021-04-30 2024-03-05 Cilag Gmbh International Electrosurgical adaptation techniques of energy modality for combination electrosurgical instruments based on shorting or tissue impedance irregularity
US20220346773A1 (en) 2021-04-30 2022-11-03 Cilag Gmbh International Surgical staple for use with combination electrosurgical instruments
US20220346853A1 (en) 2021-04-30 2022-11-03 Cilag Gmbh International Electrosurgical techniques for sealing, short circuit detection, and system determination of power level
US20220346786A1 (en) 2021-04-30 2022-11-03 Cilag Gmbh International Shaft system for surgical instrument
US20220346861A1 (en) 2021-04-30 2022-11-03 Cilag Gmbh International Surgical systems configured to cooperatively control end effector function and application of therapeutic energy
US20220346784A1 (en) 2021-04-30 2022-11-03 Cilag Gmbh International Surgical instrument comprising a closure bar and a firing bar
US20220346860A1 (en) 2021-04-30 2022-11-03 Cilag Gmbh International Surgical systems configured to control therapeutic energy application to tissue based on cartridge and tissue parameters
US20220346787A1 (en) 2021-04-30 2022-11-03 Cilag Gmbh International Interchangeable end effector reloads
US11826043B2 (en) 2021-04-30 2023-11-28 Cilag Gmbh International Staple cartridge comprising formation support features
US20220346781A1 (en) 2021-04-30 2022-11-03 Cilag Gmbh International Staple cartridge comprising staple drivers and stability supports
US11944295B2 (en) 2021-04-30 2024-04-02 Cilag Gmbh International Surgical instrument comprising end effector with longitudinal sealing step
US11931035B2 (en) 2021-04-30 2024-03-19 Cilag Gmbh International Articulation system for surgical instrument
US11576670B2 (en) 2021-05-06 2023-02-14 Covidien Lp Surgical stapling device with optimized drive assembly
WO2022238836A1 (en) 2021-05-10 2022-11-17 Cilag Gmbh International Bioabsorbable staple comprising mechanisms for slowing the absorption of the staple
WO2022238844A1 (en) 2021-05-10 2022-11-17 Cilag Gmbh International Absorbable surgical staple comprising a coating
WO2022238847A1 (en) 2021-05-10 2022-11-17 Cilag Gmbh International Adaptive control of surgical stapling instrument based on staple cartridge type
US20220370065A1 (en) 2021-05-10 2022-11-24 Cilag Gmbh International Dissimilar staple cartridges with different bioabsorbable components
US20220354490A1 (en) 2021-05-10 2022-11-10 Cilag Gmbh International Absorbable surgical staple comprising at least two coatings
EP4178458A1 (en) 2021-05-10 2023-05-17 Cilag GmbH International System of surgical staple cartridges comprising absorbable staples
US11812956B2 (en) 2021-05-18 2023-11-14 Covidien Lp Dual firing radial stapling device
US11696755B2 (en) 2021-05-19 2023-07-11 Covidien Lp Surgical stapling device with reload assembly removal lockout
US11771423B2 (en) 2021-05-25 2023-10-03 Covidien Lp Powered stapling device with manual retraction
US11510673B1 (en) 2021-05-25 2022-11-29 Covidien Lp Powered stapling device with manual retraction
US11701119B2 (en) 2021-05-26 2023-07-18 Covidien Lp Powered stapling device with rack release
EP4181797A1 (en) 2021-05-28 2023-05-24 Cilag GmbH International Stapling instrument comprising an articulation control display
EP4167872A1 (en) 2021-05-28 2023-04-26 Cilag GmbH International Stapling instrument comprising jaw mounts
WO2022249094A1 (en) 2021-05-28 2022-12-01 Cilag Gmbh International Stapling instrument comprising a control system that controls a firiing stroke length
EP4164515A1 (en) 2021-05-28 2023-04-19 Cilag GmbH International Stapling instrument comprising a firing lockout
EP4178461A1 (en) 2021-05-28 2023-05-17 Cilag GmbH International Stapling instrument comprising a mounted shaft orientation sensor
WO2022249088A1 (en) 2021-05-28 2022-12-01 Cilag Gmbh International Stapling instrument comprising a staple cartridge insertion stop
US11826047B2 (en) 2021-05-28 2023-11-28 Cilag Gmbh International Stapling instrument comprising jaw mounts
CN113288277B (zh) * 2021-05-31 2022-04-29 常州安康医疗器械有限公司 一种具有补缝功能的钉仓
US11576675B2 (en) 2021-06-07 2023-02-14 Covidien Lp Staple cartridge with knife
US11510670B1 (en) 2021-06-23 2022-11-29 Covidien Lp Buttress attachment for surgical stapling apparatus
US11596399B2 (en) 2021-06-23 2023-03-07 Covidien Lp Anvil buttress attachment for surgical stapling apparatus
US11672538B2 (en) 2021-06-24 2023-06-13 Covidien Lp Surgical stapling device including a buttress retention assembly
US11707275B2 (en) 2021-06-29 2023-07-25 Covidien Lp Asymmetrical surgical stapling device
US11617579B2 (en) 2021-06-29 2023-04-04 Covidien Lp Ultra low profile surgical stapling instrument for tissue resections
US11602344B2 (en) 2021-06-30 2023-03-14 Covidien Lp Surgical stapling apparatus with firing lockout assembly
US11678879B2 (en) 2021-07-01 2023-06-20 Covidien Lp Buttress attachment for surgical stapling apparatus
US11684368B2 (en) 2021-07-14 2023-06-27 Covidien Lp Surgical stapling device including a buttress retention assembly
US12076013B2 (en) 2021-08-03 2024-09-03 Covidien Lp Surgical buttress attachment assemblies for surgical stapling apparatus
US11540831B1 (en) 2021-08-12 2023-01-03 Covidien Lp Staple cartridge with actuation sled detection
US11779334B2 (en) 2021-08-19 2023-10-10 Covidien Lp Surgical stapling device including a manual retraction assembly
US11576671B1 (en) 2021-08-20 2023-02-14 Covidien Lp Small diameter linear surgical stapling apparatus
US12023028B2 (en) 2021-08-20 2024-07-02 Covidien Lp Articulating surgical stapling apparatus with pivotable knife bar guide assembly
US11707277B2 (en) 2021-08-20 2023-07-25 Covidien Lp Articulating surgical stapling apparatus with pivotable knife bar guide assembly
US11801052B2 (en) 2021-08-30 2023-10-31 Covidien Lp Assemblies for surgical stapling instruments
US11864761B2 (en) 2021-09-14 2024-01-09 Covidien Lp Surgical instrument with illumination mechanism
WO2023052937A1 (en) 2021-09-29 2023-04-06 Cilag Gmbh International Surgical system for altering the body's sensing of food
US20230096268A1 (en) 2021-09-29 2023-03-30 Cilag Gmbh International Methods for Controlling Cooperative Surgical Instruments
US20230094266A1 (en) 2021-09-29 2023-03-30 Cilag Gmbh International Methods and Systems for Controlling Cooperative Surgical Instruments
US11660094B2 (en) 2021-09-29 2023-05-30 Covidien Lp Surgical fastening instrument with two-part surgical fasteners
WO2023052935A1 (en) 2021-09-29 2023-04-06 Cilag Gmbh International Surgical devices, systems, and methods for control of one visualization with another
WO2023052941A1 (en) 2021-09-29 2023-04-06 Cilag Gmbh International Surgical system for delivering energy to tissue in an anatomic space and monitoring a tissue parameter in a different anatomic space
WO2023052943A1 (en) 2021-09-29 2023-04-06 Cilag Gmbh International Surgical devices, systems, and methods for control of one visualization with another
WO2023052947A1 (en) 2021-09-29 2023-04-06 Cilag Gmbh International Surgical devices, systems, and methods for control of one visualization with another
US20230100698A1 (en) 2021-09-29 2023-03-30 Cilag Gmbh International Methods for Controlling Cooperative Surgical Instruments
WO2023052936A1 (en) 2021-09-29 2023-04-06 Cilag Gmbh International Systems for controlling cooperative surgical instruments with variable surgical site access trajectories
US11653922B2 (en) 2021-09-29 2023-05-23 Covidien Lp Surgical stapling device with firing lockout mechanism
EP4271295A1 (en) 2021-09-29 2023-11-08 Cilag GmbH International Surgical devices, systems, and methods for control of one visualization with another
US11849949B2 (en) 2021-09-30 2023-12-26 Covidien Lp Surgical stapling device with firing lockout member
US12035909B2 (en) 2021-10-13 2024-07-16 Covidien Lp Surgical stapling device with firing lockout mechanism
US11751875B2 (en) 2021-10-13 2023-09-12 Coviden Lp Surgical buttress attachment assemblies for surgical stapling apparatus
US11957337B2 (en) 2021-10-18 2024-04-16 Cilag Gmbh International Surgical stapling assembly with offset ramped drive surfaces
US20230121835A1 (en) 2021-10-18 2023-04-20 Cilag Gmbh International Anvil comprising an arrangement of forming pockets proximal to tissue stop
US11877745B2 (en) 2021-10-18 2024-01-23 Cilag Gmbh International Surgical stapling assembly having longitudinally-repeating staple leg clusters
US11980363B2 (en) 2021-10-18 2024-05-14 Cilag Gmbh International Row-to-row staple array variations
US11992218B2 (en) 2021-10-18 2024-05-28 Cilag Gmbh International Metal injection molded anvil for circular surgical stapler
US20230119119A1 (en) 2021-10-18 2023-04-20 Cilag Gmbh International Cable-driven actuation system for robotic surgical tool attachment
US20230120209A1 (en) 2021-10-20 2023-04-20 Cilag Gmbh International Lockout arrangements for surgical instruments
US20230135811A1 (en) 2021-10-28 2023-05-04 Cilag Gmbh International Surgical instrument cartridge with unique resistor for surgical instrument identification
US12089841B2 (en) 2021-10-28 2024-09-17 Cilag CmbH International Staple cartridge identification systems
US11937816B2 (en) 2021-10-28 2024-03-26 Cilag Gmbh International Electrical lead arrangements for surgical instruments
US11950781B2 (en) 2021-10-29 2024-04-09 Cilag Gmbh International Discrete adjunct attachment features for surgical stapler
US11998204B2 (en) * 2021-10-29 2024-06-04 Cilag Gmbh International Compressible adjunct for surgical stapler
US11957342B2 (en) 2021-11-01 2024-04-16 Cilag Gmbh International Devices, systems, and methods for detecting tissue and foreign objects during a surgical operation
US11806017B2 (en) 2021-11-23 2023-11-07 Covidien Lp Anvil buttress loading system for surgical stapling apparatus
AU2022400783A1 (en) * 2021-12-01 2024-07-11 Banyan Licensing L.L.C. Respiratory apparatus
CN113974737B (zh) * 2021-12-14 2023-12-22 苏州法兰克曼医疗器械有限公司 一种腔镜电动切割吻合器
CN118871042A (zh) 2022-02-24 2024-10-29 柯惠有限合伙公司 外科医疗装置
US12082811B2 (en) * 2022-03-24 2024-09-10 Cilag Gmbh International Surgical stapler anvil jaw with variable firing member slot
US20230301656A1 (en) * 2022-03-25 2023-09-28 Cilag Gmbh International Tissue cushion adjuncts for surgical stapler end effector
US12082834B2 (en) 2022-03-25 2024-09-10 Cilag Gmbh International Tissue cushion adjunct with staple leg support features for surgical stapler end effector
US12114882B2 (en) 2022-03-25 2024-10-15 Cilag Gmbh International Surgical stapler features for stapling variable thickness tissue
US20240016119A1 (en) * 2022-05-19 2024-01-18 James Vernon Henrekin Horse mane banding apparatus and method
WO2023242710A1 (en) 2022-06-15 2023-12-21 Cilag Gmbh International Impact mechanism for grasp clamp fire
WO2024069559A1 (en) 2022-09-29 2024-04-04 Cilag Gmbh International Adapting tissue treatment motion parameters based on situational parameters
WO2024069571A1 (en) 2022-09-29 2024-04-04 Cilag Gmbh International Adaptive firing control algorithm based on mechanical actuation of user controls
WO2024069556A1 (en) 2022-09-29 2024-04-04 Cilag Gmbh International Motor adjustments in absence of motor drive signal
WO2024069557A1 (en) 2022-09-29 2024-04-04 Cilag Gmbh International Monitoring one drive system to adapt the motor driven aspect of a second drive system
US20240108335A1 (en) 2022-09-29 2024-04-04 Cilag Gmbh International Adaptive firing control algorithm based on mechanical actuation of user controls
WO2024069560A1 (en) 2022-09-29 2024-04-04 Cilag Gmbh International Surgical systems with dynamic force to fire adjustments
WO2024069555A1 (en) 2022-09-29 2024-04-04 Cilag Gmbh International Utilizing local firing parameters to initiate motor control adjustments in surgical systems
EP4408305A1 (en) 2022-09-29 2024-08-07 Cilag GmbH International Adaptation of independent firing and closure powered stapling systems
WO2024188131A1 (zh) * 2023-03-10 2024-09-19 天臣国际医疗科技股份有限公司 手术器械
CN117414170B (zh) * 2023-12-18 2024-02-20 深圳市健怡康医疗器械科技有限公司 一种用于器官移植手术的大血管吻合器

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN101455577A (zh) * 2007-12-12 2009-06-17 苏州天臣国际医疗科技有限公司 医用切割装订器械
CN101721236A (zh) * 2008-10-29 2010-06-09 苏州天臣国际医疗科技有限公司 外科切割装订器械

Family Cites Families (1284)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US1306107A (en) 1919-06-10 Assigotob to amebxcak
DE273689C (zh) 1913-08-07 1914-05-08
US662587A (en) 1900-05-18 1900-11-27 Charles Chandler Blake Insulated support for electric conductors.
US951393A (en) 1909-04-06 1910-03-08 John N Hahn Staple.
US1671593A (en) 1927-03-05 1928-05-29 Arthur J Kercher Temperature-control system
US2132295A (en) 1937-05-05 1938-10-04 Hawkins Earl Stapling device
US2211117A (en) 1937-09-06 1940-08-13 Rieter Joh Jacob & Cie Ag Device for drawing rovings in speeders and spinning machines
US2161632A (en) 1937-12-20 1939-06-06 Martin L Nattenheimer Fastening device
US2526902A (en) 1947-07-31 1950-10-24 Norman C Rublee Insulating staple
FR999646A (fr) 1949-11-16 1952-02-04 Dispositif serre-câble
US2674149A (en) 1952-03-01 1954-04-06 Jerry S Benson Multiple pronged fastener device with spreading means
FR1112936A (fr) 1954-10-20 1956-03-20 Moteur électrique et commande à trois vitesses enfermés dans une gaine
US2853074A (en) 1956-06-15 1958-09-23 Edward A Olson Stapling instrument for surgical purposes
DE1775926U (de) 1958-06-11 1958-10-16 Rudolf W Dipl Ing Ihmig Kugelschreibermine.
US3032769A (en) 1959-08-18 1962-05-08 John R Palmer Method of making a bracket
GB939929A (en) 1959-10-30 1963-10-16 Vasilii Fedotovich Goodov Instrument for stitching blood vessels, intestines, bronchi and other soft tissues
US3166072A (en) 1962-10-22 1965-01-19 Jr John T Sullivan Barbed clips
US3357296A (en) 1965-05-14 1967-12-12 Keuneth W Lefever Staple fastener
GB1210522A (en) 1966-10-10 1970-10-28 United States Surgical Corp Instrument for placing lateral gastro-intestinal anastomoses
US3490675A (en) 1966-10-10 1970-01-20 United States Surgical Corp Instrument for placing lateral gastrointestinal anastomoses
GB1217159A (en) 1967-12-05 1970-12-31 Coventry Gauge & Tool Co Ltd Torque limiting device
US3551987A (en) 1968-09-12 1971-01-05 Jack E Wilkinson Stapling clamp for gastrointestinal surgery
US3643851A (en) 1969-08-25 1972-02-22 United States Surgical Corp Skin stapler
US3744495A (en) 1970-01-02 1973-07-10 M Johnson Method of securing prolapsed vagina in cattle
US3662939A (en) 1970-02-26 1972-05-16 United States Surgical Corp Surgical stapler for skin and fascia
FR2084475A5 (zh) * 1970-03-16 1971-12-17 Brumlik George
US3717294A (en) 1970-12-14 1973-02-20 Surgical Corp Cartridge and powering instrument for stapling skin and fascia
US3746002A (en) 1971-04-29 1973-07-17 J Haller Atraumatic surgical clamp
CA960189A (en) 1971-07-12 1974-12-31 Hilti Aktiengesellschaft Nail holder assembly
US3751902A (en) 1972-02-22 1973-08-14 Emhart Corp Apparatus for installing insulation on a staple
US4198734A (en) 1972-04-04 1980-04-22 Brumlik George C Self-gripping devices with flexible self-gripping means and method
GB1339394A (en) 1972-04-06 1973-12-05 Vnii Khirurgicheskoi Apparatur Dies for surgical stapling instruments
US3819100A (en) 1972-09-29 1974-06-25 United States Surgical Corp Surgical stapling instrument
USRE28932E (en) 1972-09-29 1976-08-17 United States Surgical Corporation Surgical stapling instrument
US3821919A (en) 1972-11-10 1974-07-02 Illinois Tool Works Staple
JPS5033988U (zh) 1973-07-21 1975-04-11
US3885491A (en) 1973-12-21 1975-05-27 Illinois Tool Works Locking staple
US3894174A (en) 1974-07-03 1975-07-08 Emhart Corp Insulated staple and method of making the same
US4129059A (en) 1974-11-07 1978-12-12 Eck William F Van Staple-type fastener
US4060089A (en) 1975-09-03 1977-11-29 United States Surgical Corporation Surgical fastening method and device therefor
US4573468A (en) 1977-05-26 1986-03-04 United States Surgical Corporation Hollow body organ stapling instrument and disposable cartridge employing relief vents
US4207898A (en) 1978-03-27 1980-06-17 Senco Products, Inc. Intralumenal anastomosis surgical stapling instrument
US4321002A (en) 1978-03-27 1982-03-23 Minnesota Mining And Manufacturing Company Medical stapling device
US4198982A (en) 1978-03-31 1980-04-22 Memorial Hospital For Cancer And Allied Diseases Surgical stapling instrument and method
US4340331A (en) 1979-03-26 1982-07-20 Savino Dominick J Staple and anviless stapling apparatus therefor
SU886900A1 (ru) 1979-03-26 1981-12-07 Всесоюзный научно-исследовательский и испытательный институт медицинской техники Хирургический сшивающий аппарат дл наложени линейных швов
US4261244A (en) 1979-05-14 1981-04-14 Senco Products, Inc. Surgical staple
US4275813A (en) 1979-06-04 1981-06-30 United States Surgical Corporation Coherent surgical staple array
US4429695A (en) 1980-02-05 1984-02-07 United States Surgical Corporation Surgical instruments
AU534210B2 (en) 1980-02-05 1984-01-12 United States Surgical Corporation Surgical staples
US4396139A (en) 1980-02-15 1983-08-02 Technalytics, Inc. Surgical stapling system, apparatus and staple
US4317451A (en) 1980-02-19 1982-03-02 Ethicon, Inc. Plastic surgical staple
US4428376A (en) 1980-05-02 1984-01-31 Ethicon Inc. Plastic surgical staple
US4331277A (en) 1980-05-23 1982-05-25 United States Surgical Corporation Self-contained gas powered surgical stapler
DE3036217C2 (de) 1980-09-25 1986-12-18 Siemens AG, 1000 Berlin und 8000 München Fernbedienbares medizinisches Gerät
AU542936B2 (en) 1980-10-17 1985-03-28 United States Surgical Corporation Self centering staple
US4500024A (en) 1980-11-19 1985-02-19 Ethicon, Inc. Multiple clip applier
US4409057A (en) 1981-01-19 1983-10-11 Minnesota Mining & Manufacturing Company Staple supporting and removing strip
US4382326A (en) 1981-01-19 1983-05-10 Minnesota Mining & Manufacturing Company Staple supporting and staple removing strip
US4379457A (en) 1981-02-17 1983-04-12 United States Surgical Corporation Indicator for surgical stapler
SU1009439A1 (ru) 1981-03-24 1983-04-07 Предприятие П/Я Р-6094 Хирургический сшивающий аппарат дл наложени анастомозов на пищеварительном тракте
SU982676A1 (ru) 1981-04-07 1982-12-23 Всесоюзный научно-исследовательский и испытательный институт медицинской техники Хирургическа скобка
US4383634A (en) 1981-05-26 1983-05-17 United States Surgical Corporation Surgical stapler apparatus with pivotally mounted actuator assemblies
US4485816A (en) 1981-06-25 1984-12-04 Alchemia Shape-memory surgical staple apparatus and method for use in surgical suturing
FR2509490B1 (fr) 1981-07-09 1985-02-22 Tractel Sa Mecanisme de debrayage pour appareil de traction agissant sur un cable qui le traverse
US4475679A (en) 1981-08-07 1984-10-09 Fleury Jr George J Multi-staple cartridge for surgical staplers
US4632290A (en) 1981-08-17 1986-12-30 United States Surgical Corporation Surgical stapler apparatus
JPS5844033A (ja) 1981-09-11 1983-03-14 富士写真光機株式会社 内視鏡用アダプタ−型処置具導入装置
US4402445A (en) 1981-10-09 1983-09-06 United States Surgical Corporation Surgical fastener and means for applying same
US4809695A (en) 1981-10-21 1989-03-07 Owen M. Gwathmey Suturing assembly and method
US4415112A (en) 1981-10-27 1983-11-15 United States Surgical Corporation Surgical stapling assembly having resiliently mounted anvil
DE3204532C2 (de) 1982-02-10 1983-12-08 B. Braun Melsungen Ag, 3508 Melsungen Chirurgische Hautklammer
DE3210466A1 (de) 1982-03-22 1983-09-29 Peter Dipl.-Kfm. Dr. 6230 Frankfurt Gschaider Verfahren und vorrichtung zur durchfuehrung von handhabungsprozessen
US4664305A (en) 1982-05-04 1987-05-12 Blake Joseph W Iii Surgical stapler
US4467805A (en) 1982-08-25 1984-08-28 Mamoru Fukuda Skin closure stapling device for surgical procedures
US4604786A (en) 1982-11-05 1986-08-12 The Grigoleit Company Method of making a composite article including a body having a decorative metal plate attached thereto
US4676245A (en) 1983-02-09 1987-06-30 Mamoru Fukuda Interlocking surgical staple assembly
JPS59168848A (ja) 1983-03-11 1984-09-22 エチコン・インコ−ポレ−テツド 非金属製の生物に適合性の無菌の外科装置
US4506671A (en) 1983-03-30 1985-03-26 United States Surgical Corporation Apparatus for applying two-part surgical fasteners
US4522327A (en) 1983-05-18 1985-06-11 United States Surgical Corporation Surgical fastener applying apparatus
US4573469A (en) 1983-06-20 1986-03-04 Ethicon, Inc. Two-piece tissue fastener with coinable leg staple and retaining receiver and method and instrument for applying same
US4531522A (en) 1983-06-20 1985-07-30 Ethicon, Inc. Two-piece tissue fastener with locking top and method for applying same
US4693248A (en) 1983-06-20 1987-09-15 Ethicon, Inc. Two-piece tissue fastener with deformable retaining receiver
US4532927A (en) 1983-06-20 1985-08-06 Ethicon, Inc. Two-piece tissue fastener with non-reentry bent leg staple and retaining receiver
US4548202A (en) * 1983-06-20 1985-10-22 Ethicon, Inc. Mesh tissue fasteners
GR81919B (zh) 1983-06-20 1984-12-12 Ethicon Inc
SU1175891A1 (ru) 1983-08-16 1985-08-30 Предприятие П/Я А-7840 Устройство дл формовани изделий
US4944443A (en) 1988-04-22 1990-07-31 Innovative Surgical Devices, Inc. Surgical suturing instrument and method
US4530453A (en) 1983-10-04 1985-07-23 United States Surgical Corporation Surgical fastener applying apparatus
US4667674A (en) 1983-10-04 1987-05-26 United States Surgical Corporation Surgical fastener exhibiting improved hemostasis
US4589416A (en) 1983-10-04 1986-05-20 United States Surgical Corporation Surgical fastener retainer member assembly
US4505414A (en) 1983-10-12 1985-03-19 Filipi Charles J Expandable anvil surgical stapler
US4610383A (en) 1983-10-14 1986-09-09 Senmed, Inc. Disposable linear surgical stapler
JPS60137406U (ja) 1984-02-24 1985-09-11 シ−アイ化成株式会社 マグネツトシ−ト
EP0162151B1 (de) 1984-03-29 1989-05-24 Siemens Aktiengesellschaft Optisches Mehrzeilen-Lesegerät für die maschinelle Zeichenerkennung
US4612933A (en) 1984-03-30 1986-09-23 Senmed, Inc. Multiple-load cartridge assembly for a linear surgical stapling instrument
US4607638A (en) 1984-04-20 1986-08-26 Design Standards Corporation Surgical staples
US5002553A (en) 1984-05-14 1991-03-26 Surgical Systems & Instruments, Inc. Atherectomy system with a clutch
GB8417562D0 (en) 1984-07-10 1984-08-15 Surgical Design Services Fasteners
US4741336A (en) 1984-07-16 1988-05-03 Ethicon, Inc. Shaped staples and slotted receivers (case VII)
US4605004A (en) 1984-07-16 1986-08-12 Ethicon, Inc. Surgical instrument for applying fasteners said instrument including force supporting means (case IV)
IN165375B (zh) 1984-07-16 1989-10-07 Ethicon Inc
US4655222A (en) 1984-07-30 1987-04-07 Ethicon, Inc. Coated surgical staple
US4754909A (en) 1984-08-09 1988-07-05 Barker John M Flexible stapler
US4671445A (en) 1984-08-09 1987-06-09 Baxter Travenol Laboratories, Inc. Flexible surgical stapler assembly
US4608981A (en) 1984-10-19 1986-09-02 Senmed, Inc. Surgical stapling instrument with staple height adjusting mechanism
US4605001A (en) * 1984-10-19 1986-08-12 Senmed, Inc. Surgical stapling instrument with dual staple height mechanism
US4767044A (en) 1984-10-19 1988-08-30 United States Surgical Corporation Surgical fastener applying apparatus
US4566620A (en) 1984-10-19 1986-01-28 United States Surgical Corporation Articulated surgical fastener applying apparatus
US4573622A (en) 1984-10-19 1986-03-04 United States Surgical Corporation Surgical fastener applying apparatus with variable fastener arrays
US4580712A (en) 1984-10-19 1986-04-08 United States Surgical Corporation Surgical fastener applying apparatus with progressive application of fastener
US4787387A (en) 1984-11-08 1988-11-29 American Cyanamid Company Surgical closure element
JPS635697Y2 (zh) 1985-04-04 1988-02-17
US4750902A (en) 1985-08-28 1988-06-14 Sonomed Technology, Inc. Endoscopic ultrasonic aspirators
US4728020A (en) 1985-08-30 1988-03-01 United States Surgical Corporation Articulated surgical fastener applying apparatus
SU1377053A1 (ru) 1985-10-02 1988-02-28 В. Г. Сахаутдинов, Р. А. Талипов, Р. М. Халиков и 3. X. Гарифуллин Хирургический сшивающий аппарат
US4610250A (en) 1985-10-08 1986-09-09 United States Surgical Corporation Two-part surgical fastener for fascia wound approximation
US4715520A (en) 1985-10-10 1987-12-29 United States Surgical Corporation Surgical fastener applying apparatus with tissue edge control
SU1333319A2 (ru) 1985-12-10 1987-08-30 Петрозаводский государственный университет им.О.В.Куусинена Ушиватель полых органов
US4634419A (en) 1985-12-13 1987-01-06 Cooper Lasersonics, Inc. Angulated ultrasonic surgical handpieces and method for their production
US4903697A (en) 1986-03-27 1990-02-27 Semion Resnick Cartridge assembly for a surgical stapling instrument
US4827911A (en) 1986-04-02 1989-05-09 Cooper Lasersonics, Inc. Method and apparatus for ultrasonic surgical fragmentation and removal of tissue
US4747820A (en) 1986-04-09 1988-05-31 Cooper Lasersonics, Inc. Irrigation/aspiration manifold and fittings for ultrasonic surgical aspiration system
JPH01500966A (ja) 1986-04-21 1989-04-06 グローベ コントロール フイナンツ アクチエンゲゼルシヤフト 吻合部を作成する装置と方法
SU1561964A1 (ru) 1986-04-24 1990-05-07 Благовещенский государственный медицинский институт Хирургический сшивающий аппарат
GB8612267D0 (en) 1986-05-20 1986-06-25 Mixalloy Ltd Flat products
FR2598905B1 (fr) 1986-05-22 1993-08-13 Chevalier Jean Michel Dispositif d'interruption de la circulation d'un fluide dans un conduit a paroi souple, notamment un viscere creux et ensemble de pince comportant ce dispositif
GB8613852D0 (en) 1986-06-06 1986-07-09 Neptune Measurement Ltd Vortex shedding body
US4890613A (en) 1986-09-19 1990-01-02 Ethicon, Inc. Two piece internal organ fastener
US4752024A (en) * 1986-10-17 1988-06-21 Green David T Surgical fastener and surgical stapling apparatus
JPH0755222B2 (ja) 1986-12-12 1995-06-14 オリンパス光学工業株式会社 処置具
US4865030A (en) 1987-01-21 1989-09-12 American Medical Systems, Inc. Apparatus for removal of objects from body passages
JP2553390B2 (ja) 1987-02-10 1996-11-13 ヴァーソ プロダクツ オーストラリア ピーティワイ.リミテッド 静脈用カフ装着器
US4719917A (en) 1987-02-17 1988-01-19 Minnesota Mining And Manufacturing Company Surgical staple
DE3709067A1 (de) 1987-03-19 1988-09-29 Ewald Hensler Medizinisches, insbesondere chirurgisches instrument
US4777780A (en) 1987-04-21 1988-10-18 United States Surgical Corporation Method for forming a sealed sterile package
US4941623A (en) 1987-05-12 1990-07-17 United States Surgical Corporation Stapling process and device for use on the mesentery of the abdomen
US5285944A (en) 1987-05-26 1994-02-15 United States Surgical Corporation Surgical stapler apparatus
US4844068A (en) 1987-06-05 1989-07-04 Ethicon, Inc. Bariatric surgical instrument
US4848637A (en) 1987-06-11 1989-07-18 Pruitt J Crayton Staple device for use on the mesenteries of the abdomen
US4773420A (en) 1987-06-22 1988-09-27 U.S. Surgical Corporation Purse string applicator
US4821939A (en) 1987-09-02 1989-04-18 United States Surgical Corporation Staple cartridge and an anvilless surgical stapler
US5158567A (en) 1987-09-02 1992-10-27 United States Surgical Corporation One-piece surgical staple
SU1509051A1 (ru) 1987-09-14 1989-09-23 Институт прикладной физики АН СССР Ушиватель органов
US4931047A (en) 1987-09-30 1990-06-05 Cavitron, Inc. Method and apparatus for providing enhanced tissue fragmentation and/or hemostasis
US5015227A (en) 1987-09-30 1991-05-14 Valleylab Inc. Apparatus for providing enhanced tissue fragmentation and/or hemostasis
US4805617A (en) 1987-11-05 1989-02-21 Ethicon, Inc. Surgical fastening systems made from polymeric materials
US5106627A (en) 1987-11-17 1992-04-21 Brown University Research Foundation Neurological therapy devices
US4834720A (en) 1987-12-24 1989-05-30 Becton, Dickinson And Company Implantable port septum
US4819853A (en) 1987-12-31 1989-04-11 United States Surgical Corporation Surgical fastener cartridge
GB8800909D0 (en) 1988-01-15 1988-02-17 Ethicon Inc Gas powered surgical stapler
US4805823A (en) 1988-03-18 1989-02-21 Ethicon, Inc. Pocket configuration for internal organ staplers
DE8809501U1 (de) * 1988-07-26 1988-11-24 Schad, Karl, 7201 Kolbingen Chirurgisches Instrument
US4869415A (en) 1988-09-26 1989-09-26 Ethicon, Inc. Energy storage means for a surgical stapler
CA1308782C (en) 1988-10-13 1992-10-13 Gyrus Medical Limited Screening and monitoring instrument
JPH0630945Y2 (ja) 1988-10-21 1994-08-22 株式会社イナックス サイホン洗浄式便器
ATE129622T1 (de) 1988-11-11 1995-11-15 United States Surgical Corp Chirurgisches instrument.
US5197648A (en) 1988-11-29 1993-03-30 Gingold Bruce S Surgical stapling apparatus
US4978333A (en) 1988-12-20 1990-12-18 Valleylab, Inc. Resonator for surgical handpiece
US4986808A (en) 1988-12-20 1991-01-22 Valleylab, Inc. Magnetostrictive transducer
US4930674A (en) 1989-02-24 1990-06-05 Abiomed, Inc. Surgical stapler
US5186711A (en) 1989-03-07 1993-02-16 Albert Einstein College Of Medicine Of Yeshiva University Hemostasis apparatus and method
NL8900600A (nl) 1989-03-13 1990-10-01 Bso Buro Voor Systeemontwikkel Tweetalige kennisbank.
US5522817A (en) 1989-03-31 1996-06-04 United States Surgical Corporation Absorbable surgical fastener with bone penetrating elements
US5104397A (en) 1989-04-14 1992-04-14 Codman & Shurtleff, Inc. Multi-position latching mechanism for forceps
SU1708312A1 (ru) 1989-05-16 1992-01-30 Всесоюзный научно-исследовательский и испытательный институт медицинской техники Хирургический аппарат дл сшивани костной ткани
US5222976A (en) 1989-05-16 1993-06-29 Inbae Yoon Suture devices particularly useful in endoscopic surgery
US5505363A (en) 1989-05-26 1996-04-09 United States Surgical Corporation Surgical staples with plated anvils
US5040715B1 (en) 1989-05-26 1994-04-05 United States Surgical Corp Apparatus and method for placing staples in laparoscopic or endoscopic procedures
US4978049A (en) 1989-05-26 1990-12-18 United States Surgical Corporation Three staple drive member
US4932960A (en) 1989-09-01 1990-06-12 United States Surgical Corporation Absorbable surgical fastener
CH677728A5 (zh) 1989-10-17 1991-06-28 Bieffe Medital Sa
US5088997A (en) 1990-03-15 1992-02-18 Valleylab, Inc. Gas coagulation device
SU1722476A1 (ru) 1990-04-02 1992-03-30 Свердловский Филиал Научно-Производственного Объединения "Фтизиопульмонология" Устройство дл временной окклюзии трубчатых органов
US5002543A (en) 1990-04-09 1991-03-26 Bradshaw Anthony J Steerable intramedullary fracture reduction device
US5116349A (en) 1990-05-23 1992-05-26 United States Surgical Corporation Surgical fastener apparatus
US5074454A (en) 1990-06-04 1991-12-24 Peters Ronald L Surgical stapler
US5342395A (en) 1990-07-06 1994-08-30 American Cyanamid Co. Absorbable surgical repair devices
SU1752361A1 (ru) 1990-07-10 1992-08-07 Производственное Объединение "Челябинский Тракторный Завод Им.В.И.Ленина" Хирургический сшивающий аппарат
RU2008830C1 (ru) 1990-07-13 1994-03-15 Константин Алексеевич Додонов Электрохирургический аппарат
US5163598A (en) 1990-07-23 1992-11-17 Rudolph Peters Sternum stapling apparatus
US5240231A (en) 1990-07-31 1993-08-31 Industrial Maintenance And Contract Services Limited Partnership Slag control system
US5234447A (en) 1990-08-28 1993-08-10 Robert L. Kaster Side-to-end vascular anastomotic staple apparatus
US5156315A (en) 1990-09-17 1992-10-20 United States Surgical Corporation Arcuate apparatus for applying two-part surgical fasteners
US5156614A (en) 1990-09-17 1992-10-20 United States Surgical Corporation Apparatus for applying two-part surgical fasteners
US5653373A (en) 1990-09-17 1997-08-05 United States Surgical Corporation Arcuate apparatus for applying two-part surgical fasteners
DE484677T1 (de) 1990-10-05 1993-11-25 United States Surgical Corp Verfahren und Vorrichtung zum Anbringen von Klammern bei laparoskopischen oder endoskopischen Eingriffen.
US5042707A (en) 1990-10-16 1991-08-27 Taheri Syde A Intravascular stapler, and method of operating same
USD330699S (en) 1990-10-19 1992-11-03 W. W. Cross, Inc. Insulated staple
FR2668361A1 (fr) 1990-10-30 1992-04-30 Mai Christian Agrafe et plaque d'osteosynthese a compression dynamique auto-retentive.
JPH04171869A (ja) 1990-11-05 1992-06-19 Toshiba Corp 物体検出装置
US5129570A (en) 1990-11-30 1992-07-14 Ethicon, Inc. Surgical stapler
US5122156A (en) 1990-12-14 1992-06-16 United States Surgical Corporation Apparatus for securement and attachment of body organs
US5141144A (en) 1990-12-18 1992-08-25 Minnesota Mining And Manufacturing Company Stapler and firing device
CA2055985A1 (en) 1990-12-20 1992-06-21 Daniel Shichman Fascia clip
US5222963A (en) 1991-01-17 1993-06-29 Ethicon, Inc. Pull-through circular anastomosic intraluminal stapler with absorbable fastener means
US5571285A (en) 1991-02-19 1996-11-05 Ethicon, Inc. Surgical staple for insertion into tissue
US5336232A (en) 1991-03-14 1994-08-09 United States Surgical Corporation Approximating apparatus for surgical jaw structure and method of using the same
CA2061885A1 (en) 1991-03-14 1992-09-15 David T. Green Approximating apparatus for surgical jaw structure
US5171253A (en) 1991-03-22 1992-12-15 Klieman Charles H Velcro-like closure system with absorbable suture materials for absorbable hemostatic clips and surgical strips
US5065929A (en) 1991-04-01 1991-11-19 Ethicon, Inc. Surgical stapler with locking means
US5246156A (en) 1991-09-12 1993-09-21 Ethicon, Inc. Multiple fire endoscopic stapling mechanism
US5297714A (en) 1991-04-17 1994-03-29 Ethicon, Inc. Surgical staple with modified "B" shaped configuration
US5257713A (en) 1991-05-07 1993-11-02 United States Surgical Corporation Surgical fastening device
US5413267A (en) * 1991-05-14 1995-05-09 United States Surgical Corporation Surgical stapler with spent cartridge sensing and lockout means
US5137198A (en) 1991-05-16 1992-08-11 Ethicon, Inc. Fast closure device for linear surgical stapling instrument
FI93607C (fi) 1991-05-24 1995-05-10 John Koivukangas Leikkaustoimenpidelaite
US5190517A (en) 1991-06-06 1993-03-02 Valleylab Inc. Electrosurgical and ultrasonic surgical system
US5221036A (en) 1991-06-11 1993-06-22 Haruo Takase Surgical stapler
US5282829A (en) 1991-08-15 1994-02-01 United States Surgical Corporation Hollow body implants
GR920100358A (el) 1991-08-23 1993-06-07 Ethicon Inc Οργανο συρραφής χειρουργικής αναστομώσεως.
US5350104A (en) 1991-08-23 1994-09-27 Ethicon, Inc. Sealing means for endoscopic surgical anastomosis stapling instrument
US5263973A (en) 1991-08-30 1993-11-23 Cook Melvin S Surgical stapling method
SE9102812L (sv) 1991-09-27 1993-01-18 Lars Erik Gustafsson Saett att faststaella aktuell lungfunktion samt anordning foer att indikera naemnda lungfunktion
US5275608A (en) 1991-10-16 1994-01-04 Implemed, Inc. Generic endoscopic instrument
CA2075141C (en) 1991-10-17 1998-06-30 Donald A. Morin Anvil for surgical staplers
US5497933A (en) 1991-10-18 1996-03-12 United States Surgical Corporation Apparatus and method for applying surgical staples to attach an object to body tissue
US5364001A (en) 1991-10-18 1994-11-15 United States Surgical Corporation Self contained gas powered surgical apparatus
US5307976A (en) 1991-10-18 1994-05-03 Ethicon, Inc. Linear stapling mechanism with cutting means
US5326013A (en) 1991-10-18 1994-07-05 United States Surgical Corporation Self contained gas powered surgical apparatus
US5478003A (en) 1991-10-18 1995-12-26 United States Surgical Corporation Surgical apparatus
AU657364B2 (en) 1991-10-18 1995-03-09 United States Surgical Corporation Self contained gas powered surgical apparatus
US6250532B1 (en) 1991-10-18 2001-06-26 United States Surgical Corporation Surgical stapling apparatus
US5289963A (en) 1991-10-18 1994-03-01 United States Surgical Corporation Apparatus and method for applying surgical staples to attach an object to body tissue
US5312023A (en) 1991-10-18 1994-05-17 United States Surgical Corporation Self contained gas powered surgical apparatus
US5443198A (en) 1991-10-18 1995-08-22 United States Surgical Corporation Surgical fastener applying apparatus
DE537571T1 (de) 1991-10-18 1993-10-14 United States Surgical Corp Gerät zum Anbringen von chirurgischen Befestigungen.
CA2078794C (en) 1991-10-18 1998-10-06 Frank J. Viola Locking device for an apparatus for applying surgical fasteners
US5711472A (en) 1991-10-18 1998-01-27 United States Surgical Corporation Self contained gas powered surgical apparatus
DE4135502C1 (zh) 1991-10-28 1993-02-18 Bader, Paul, 7070 Schwaebisch Gmuend, De
US5197649A (en) 1991-10-29 1993-03-30 The Trustees Of Columbia University In The City Of New York Gastrointestinal endoscoptic stapler
US5350400A (en) 1991-10-30 1994-09-27 American Cyanamid Company Malleable, bioabsorbable, plastic staple; and method and apparatus for deforming such staple
US5395034A (en) 1991-11-07 1995-03-07 American Cyanamid Co. Linear surgical stapling instrument
EP0566725B1 (en) 1991-11-08 2003-06-04 Boston Scientific Limited Ablation electrode with insulated temperature sensing elements
DE4136890C2 (de) 1991-11-09 1995-08-03 Goetze Elastomere Gmbh Gehäuseverschlußdeckel
US5439467A (en) 1991-12-03 1995-08-08 Vesica Medical, Inc. Suture passer
FR2685557B1 (fr) 1991-12-23 1995-06-23 Baco Const Elect Appareil electrique avec bornes de raccordement.
ATE150953T1 (de) 1992-01-13 1997-04-15 Schneider Usa Inc Chirurgisches schneidinstrument
US5383880A (en) 1992-01-17 1995-01-24 Ethicon, Inc. Endoscopic surgical system with sensing means
US5433721A (en) 1992-01-17 1995-07-18 Ethicon, Inc. Endoscopic instrument having a torsionally stiff drive shaft for applying fasteners to tissue
EP0623008A1 (en) 1992-01-21 1994-11-09 Valleylab, Inc. Electrosurgical control for a trocar
US5284128A (en) 1992-01-24 1994-02-08 Applied Medical Resources Corporation Surgical manipulator
US5271543A (en) 1992-02-07 1993-12-21 Ethicon, Inc. Surgical anastomosis stapling instrument with flexible support shaft and anvil adjusting mechanism
WO1993015648A1 (en) 1992-02-07 1993-08-19 Wilk Peter J Endoscope with disposable insertion member
AU663543B2 (en) 1992-02-07 1995-10-12 Sherwood Services Ag Ultrasonic surgical apparatus
US5348259A (en) 1992-02-10 1994-09-20 Massachusetts Institute Of Technology Flexible, articulable column
GB2264242A (en) 1992-02-12 1993-08-25 Johnson Matthey Plc Heating catalytic converters
US5282806A (en) 1992-08-21 1994-02-01 Habley Medical Technology Corporation Endoscopic surgical instrument having a removable, rotatable, end effector assembly
US5281216A (en) 1992-03-31 1994-01-25 Valleylab, Inc. Electrosurgical bipolar treating apparatus
US5484095A (en) 1992-03-31 1996-01-16 United States Surgical Corporation Apparatus for endoscopically applying staples individually to body tissue
US5223675A (en) 1992-04-02 1993-06-29 Taft Anthony W Cable fastener
GB9207315D0 (en) 1992-04-03 1992-05-13 Donaldson William B M Method and apparatus for ocular motility testing
US5236440A (en) 1992-04-14 1993-08-17 American Cyanamid Company Surgical fastener
US5355897A (en) 1992-04-16 1994-10-18 Ethicon, Inc. Method of performing a pyloroplasty/pylorectomy using a stapler having a shield
US5242457A (en) 1992-05-08 1993-09-07 Ethicon, Inc. Surgical instrument and staples for applying purse string sutures
US5484451A (en) 1992-05-08 1996-01-16 Ethicon, Inc. Endoscopic surgical instrument and staples for applying purse string sutures
US5344059A (en) 1992-05-19 1994-09-06 United States Surgical Corporation Surgical apparatus and anvil delivery system therefor
US5389098A (en) 1992-05-19 1995-02-14 Olympus Optical Co., Ltd. Surgical device for stapling and/or fastening body tissues
JPH0630945A (ja) 1992-05-19 1994-02-08 Olympus Optical Co Ltd 縫合器
US5658300A (en) 1992-06-04 1997-08-19 Olympus Optical Co., Ltd. Tissue fixing surgical instrument, tissue-fixing device, and method of fixing tissues
JPH0647050A (ja) 1992-06-04 1994-02-22 Olympus Optical Co Ltd 組織縫合結紮器
US5263629A (en) 1992-06-29 1993-11-23 Ethicon, Inc. Method and apparatus for achieving hemostasis along a staple line
US5221281A (en) 1992-06-30 1993-06-22 Valleylab Inc. Electrosurgical tubular trocar
US5258012A (en) 1992-06-30 1993-11-02 Ethicon, Inc. Surgical fasteners
US5258009A (en) 1992-06-30 1993-11-02 American Cyanamid Company Malleable, bioabsorbable,plastic staple having a knotted configuration; and method and apparatus for deforming such staple
US5222975A (en) 1992-07-13 1993-06-29 Lawrence Crainich Surgical staples
US5762458A (en) 1996-02-20 1998-06-09 Computer Motion, Inc. Method and apparatus for performing minimally invasive cardiac procedures
US5368215A (en) 1992-09-08 1994-11-29 United States Surgical Corporation Surgical apparatus and detachable anvil rod therefor
FR2695560B1 (fr) 1992-09-17 1994-11-04 Oreal Composition cosmétique filtrante photostable contenant un filtre UV-A et un polymère filtre du type silicone benzotriazole.
JP2669277B2 (ja) 1992-09-18 1997-10-27 株式会社日立製作所 セラミックス焼結体の寿命予測法及び装置
US5485952A (en) 1992-09-23 1996-01-23 United States Surgical Corporation Apparatus for applying surgical fasteners
US5423471A (en) 1992-10-02 1995-06-13 United States Surgical Corporation Apparatus for applying two-part surgical fasteners in laparoscopic or endoscopic procedures
US5601224A (en) 1992-10-09 1997-02-11 Ethicon, Inc. Surgical instrument
US5381943A (en) 1992-10-09 1995-01-17 Ethicon, Inc. Endoscopic surgical stapling instrument with pivotable and rotatable staple cartridge
US5431323A (en) 1992-10-09 1995-07-11 Ethicon, Inc. Endoscopic surgical instrument with pivotable and rotatable staple cartridge
US5662662A (en) 1992-10-09 1997-09-02 Ethicon Endo-Surgery, Inc. Surgical instrument and method
US5718548A (en) 1992-10-20 1998-02-17 Clipmaster Corporation Pty Ltd Staple assembly
CA2108605A1 (en) 1992-10-21 1994-04-22 Nagabhushanam Totakura Bioabsorbable foam pledget
GB2272159A (en) 1992-11-10 1994-05-11 Andreas G Constantinides Surgical/diagnostic aid
IL103737A (en) 1992-11-13 1997-02-18 Technion Res & Dev Foundation Stapler device particularly useful in medical suturing
US5441483A (en) 1992-11-16 1995-08-15 Avitall; Boaz Catheter deflection control
US5389104A (en) 1992-11-18 1995-02-14 Symbiosis Corporation Arthroscopic surgical instruments
US5346504A (en) 1992-11-19 1994-09-13 Ethicon, Inc. Intraluminal manipulator with a head having articulating links
AU672227B2 (en) 1992-11-30 1996-09-26 Sherwood Services Ag An ultrasonic surgical handpiece and an energy initiator to maintain the vibration and linear dynamics
US5807393A (en) 1992-12-22 1998-09-15 Ethicon Endo-Surgery, Inc. Surgical tissue treating device with locking mechanism
FR2699806B1 (fr) 1992-12-30 1995-03-24 Duthoit Francois Instrument, destiné notamment à permettre l'extraction de tronçons veineux pathologiques tels que des varices.
DE4301272A1 (de) 1993-01-19 1994-07-21 Eltromat Ges Fuer Ind Elektron Vorrichtung zur Bestimmung des Registerfehlers zwischen den einzelnen Farben beim Mehrfarbendruck in einer Langbahn-Rollenrotationsdruckmaschine
US5468253A (en) 1993-01-21 1995-11-21 Ethicon, Inc. Elastomeric medical device
US5358510A (en) 1993-01-26 1994-10-25 Ethicon, Inc. Two part surgical fastener
US5304204A (en) 1993-02-09 1994-04-19 Ethicon, Inc. Receiverless surgical fasteners
EP0684789A1 (en) 1993-02-22 1995-12-06 Valleylab, Inc. A laparoscopic dissection tension retractor device and method
US5342396A (en) 1993-03-02 1994-08-30 Cook Melvin S Staples
US5397324A (en) 1993-03-10 1995-03-14 Carroll; Brendan J. Surgical stapler instrument and method for vascular hemostasis
US5312329A (en) 1993-04-07 1994-05-17 Valleylab Inc. Piezo ultrasonic and electrosurgical handpiece
US5370645A (en) 1993-04-19 1994-12-06 Valleylab Inc. Electrosurgical processor and method of use
US5540375A (en) 1993-04-20 1996-07-30 United States Surgical Corporation Endoscopic stapler
WO1994023954A1 (en) 1993-04-20 1994-10-27 Asahi Kasei Kogyo Kabushiki Kaisha Lithographic printing original plate and method for producing the same
EP0625335B1 (en) 1993-04-20 1997-11-19 United States Surgical Corporation Surgical stapler
US6716232B1 (en) 1993-04-30 2004-04-06 United States Surgical Corporation Surgical instrument having an articulated jaw structure and a detachable knife
GB9309142D0 (en) 1993-05-04 1993-06-16 Gyrus Medical Ltd Laparoscopic instrument
US5415334A (en) 1993-05-05 1995-05-16 Ethicon Endo-Surgery Surgical stapler and staple cartridge
US5364003A (en) 1993-05-05 1994-11-15 Ethicon Endo-Surgery Staple cartridge for a surgical stapler
US5352229A (en) 1993-05-12 1994-10-04 Marlowe Goble E Arbor press staple and washer and method for its use
US5549621A (en) 1993-05-14 1996-08-27 Byron C. Sutherland Apparatus and method for performing vertical banded gastroplasty
CA2124109A1 (en) 1993-05-24 1994-11-25 Mark T. Byrne Endoscopic surgical instrument with electromagnetic sensor
FI96303C (fi) 1993-05-28 1996-06-10 Kci Kone Cranes Int Oy Menetelmä kantopyörän suuntaamiseksi
GB9314391D0 (en) 1993-07-12 1993-08-25 Gyrus Medical Ltd A radio frequency oscillator and an electrosurgical generator incorporating such an oscillator
US5478354A (en) 1993-07-14 1995-12-26 United States Surgical Corporation Wound closing apparatus and method
US5582617A (en) 1993-07-21 1996-12-10 Charles H. Klieman Surgical instrument for endoscopic and general surgery
US5709680A (en) 1993-07-22 1998-01-20 Ethicon Endo-Surgery, Inc. Electrosurgical hemostatic device
US5372596A (en) 1993-07-27 1994-12-13 Valleylab Inc. Apparatus for leakage control and method for its use
US5503320A (en) 1993-08-19 1996-04-02 United States Surgical Corporation Surgical apparatus with indicator
US5447417A (en) 1993-08-31 1995-09-05 Valleylab Inc. Self-adjusting pump head and safety manifold cartridge for a peristaltic pump
US5441193A (en) 1993-09-23 1995-08-15 United States Surgical Corporation Surgical fastener applying apparatus with resilient film
US5405344A (en) 1993-09-30 1995-04-11 Ethicon, Inc. Articulable socket joint assembly for an endoscopic instrument for surgical fastner track therefor
CA2133159A1 (en) 1993-09-30 1995-03-31 Eric J. Butterfield Surgical instrument having improved manipulating means
US5542594A (en) 1993-10-06 1996-08-06 United States Surgical Corporation Surgical stapling apparatus with biocompatible surgical fabric
CA2132917C (en) 1993-10-07 2004-12-14 John Charles Robertson Circular anastomosis device
US5496312A (en) 1993-10-07 1996-03-05 Valleylab Inc. Impedance and temperature generator control
US6210403B1 (en) 1993-10-07 2001-04-03 Sherwood Services Ag Automatic control for energy from an electrosurgical generator
US5725554A (en) 1993-10-08 1998-03-10 Richard-Allan Medical Industries, Inc. Surgical staple and stapler
US5562682A (en) 1993-10-08 1996-10-08 Richard-Allan Medical Industries, Inc. Surgical Instrument with adjustable arms
US5560532A (en) 1993-10-08 1996-10-01 United States Surgical Corporation Apparatus and method for applying surgical staples to body tissue
US5487499A (en) 1993-10-08 1996-01-30 United States Surgical Corporation Surgical apparatus for applying surgical fasteners including a counter
GB9322464D0 (en) 1993-11-01 1993-12-22 Gyrus Medical Ltd Electrosurgical apparatus
JP3414455B2 (ja) 1993-11-02 2003-06-09 オリンパス光学工業株式会社 縫合装置
US5503635A (en) 1993-11-12 1996-04-02 United States Surgical Corporation Apparatus and method for performing compressional anastomoses
US5449355A (en) 1993-11-24 1995-09-12 Valleylab Inc. Retrograde tissue splitter and method
DE4340707C2 (de) 1993-11-30 1997-03-27 Wolf Gmbh Richard Manipulator
US5465894A (en) 1993-12-06 1995-11-14 Ethicon, Inc. Surgical stapling instrument with articulated stapling head assembly on rotatable and flexible support shaft
US5743456A (en) 1993-12-16 1998-04-28 Stryker Corporation Hand actuable surgical handpiece
US5422567A (en) 1993-12-27 1995-06-06 Valleylab Inc. High frequency power measurement
US5441191A (en) * 1993-12-30 1995-08-15 Linden; Gerald E. Indicating "staples low" in a paper stapler
CA2176754A1 (en) 1993-12-30 1995-07-06 Michael Steve Klicek Bipolar ultrasonic surgery
AU1558995A (en) 1994-01-04 1995-08-01 Alpha Surgical Technologies, Inc. Stapling device
US5382247A (en) 1994-01-21 1995-01-17 Valleylab Inc. Technique for electrosurgical tips and method of manufacture and use
US5452837A (en) 1994-01-21 1995-09-26 Ethicon Endo-Surgery, Inc. Surgical stapler with tissue gripping ridge
WO1995020360A1 (en) 1994-01-31 1995-08-03 Valleylab, Inc. Telescoping bipolar electrode for non-invasive medical procedures
US5597107A (en) 1994-02-03 1997-01-28 Ethicon Endo-Surgery, Inc. Surgical stapler instrument
US5465895A (en) 1994-02-03 1995-11-14 Ethicon Endo-Surgery, Inc. Surgical stapler instrument
US5487500A (en) 1994-02-03 1996-01-30 Ethicon Endo-Surgery, Inc. Surgical stapler instrument
US5503638A (en) 1994-02-10 1996-04-02 Bio-Vascular, Inc. Soft tissue stapling buttress
JPH0833642A (ja) 1994-02-25 1996-02-06 Ethicon Endo Surgery Inc 外科用ステープラのための改良アンビル承口
WO1995023557A1 (en) 1994-03-01 1995-09-08 United States Surgical Corporation Surgical stapler with anvil sensor and lockout
DE9404459U1 (de) 1994-03-16 1994-07-14 Chr. Renz GmbH & Co, 73540 Heubach Vorrichtung zum Verpacken von Bindeelementen
JP3421117B2 (ja) 1994-03-17 2003-06-30 テルモ株式会社 外科用器具
US5484398A (en) 1994-03-17 1996-01-16 Valleylab Inc. Methods of making and using ultrasonic handpiece
US5472442A (en) 1994-03-23 1995-12-05 Valleylab Inc. Moveable switchable electrosurgical handpiece
US5541376A (en) 1994-03-28 1996-07-30 Valleylab Inc Switch and connector
CA2145723A1 (en) 1994-03-30 1995-10-01 Steven W. Hamblin Surgical stapling instrument with remotely articulated stapling head assembly on rotatable support shaft
US5715987A (en) 1994-04-05 1998-02-10 Tracor Incorporated Constant width, adjustable grip, staple apparatus and method
US5695524A (en) 1994-04-05 1997-12-09 Tracor Aerospace, Inc. Constant width, adjustable grip, staple apparatus and method
CA2144818C (en) 1994-04-07 2006-07-11 Henry Bolanos Graduated anvil for surgical stapling instruments
US5370417A (en) 1994-04-18 1994-12-06 Davidson Textron Inc. Automotive knee bolster
US5529235A (en) 1994-04-28 1996-06-25 Ethicon Endo-Surgery, Inc. Identification device for surgical instrument
US5489058A (en) 1994-05-02 1996-02-06 Minnesota Mining And Manufacturing Company Surgical stapler with mechanisms for reducing the firing force
US5470007A (en) 1994-05-02 1995-11-28 Minnesota Mining And Manufacturing Company Laparoscopic stapler with overload sensor and interlock
US5628446A (en) 1994-05-05 1997-05-13 United States Surgical Corporation Self-contained powered surgical apparatus
US5474566A (en) 1994-05-05 1995-12-12 United States Surgical Corporation Self-contained powered surgical apparatus
CA2148667A1 (en) 1994-05-05 1995-11-06 Carlo A. Mililli Self-contained powered surgical apparatus
US5843021A (en) 1994-05-09 1998-12-01 Somnus Medical Technologies, Inc. Cell necrosis apparatus
US6704210B1 (en) 1994-05-20 2004-03-09 Medtronic, Inc. Bioprothesis film strip for surgical stapler and method of attaching the same
US5814057A (en) 1994-06-03 1998-09-29 Gunze Limited Supporting element for staple region
IT1268070B1 (it) 1994-06-06 1997-02-20 Cselt Centro Studi Lab Telecom Circuito in tecnologia cmos per il pilotaggo ad alta velocita' di sorgenti ottiche.
US5732872A (en) 1994-06-17 1998-03-31 Heartport, Inc. Surgical stapling instrument
FR2721603B1 (fr) 1994-06-22 1996-09-20 Inst Francais Du Petrole Procédé de réjuvénation d'un catalyseur solide d'alkylation.
GB9413070D0 (en) 1994-06-29 1994-08-17 Gyrus Medical Ltd Electrosurgical apparatus
EP0691154A1 (en) 1994-07-07 1996-01-10 The Boc Group, Inc. Purification of nitric oxide
US5833695A (en) 1994-07-13 1998-11-10 Yoon; Inbae Surgical stapling system and method of applying staples from multiple staple cartridges
US5551622A (en) * 1994-07-13 1996-09-03 Yoon; Inbae Surgical stapler
DE9412228U1 (de) 1994-07-28 1994-09-22 Loctite Europa E.E.I.G. (E.W.I.V.), 85748 Garching Schlauchpumpe zur genauen Dosierung kleiner Flüssigkeitsmengen
GB9415539D0 (en) 1994-08-02 1994-09-21 Deas Alexander R Bit resolution optimising mechanism
US5779130A (en) 1994-08-05 1998-07-14 United States Surgical Corporation Self-contained powered surgical apparatus
EP0699418A1 (en) 1994-08-05 1996-03-06 United States Surgical Corporation Self-contained powered surgical apparatus
US5507426A (en) 1994-08-05 1996-04-16 United States Surgical Corporation Apparatus for applying surgical fasteners
US5509916A (en) 1994-08-12 1996-04-23 Valleylab Inc. Laser-assisted electrosurgery system
US5480089A (en) 1994-08-19 1996-01-02 United States Surgical Corporation Surgical stapler apparatus with improved staple pockets
CA2146508C (en) 1994-08-25 2006-11-14 Robert H. Schnut Anvil for circular stapler
US5609601A (en) 1994-09-23 1997-03-11 United States Surgical Corporation Endoscopic surgical apparatus with rotation lock
US5571116A (en) 1994-10-02 1996-11-05 United States Surgical Corporation Non-invasive treatment of gastroesophageal reflux disease
US5685474A (en) 1994-10-04 1997-11-11 United States Surgical Corporation Tactile indicator for surgical instrument
US5797538A (en) 1994-10-05 1998-08-25 United States Surgical Corporation Articulating apparatus for applying surgical fasteners to body tissue
US5901895A (en) 1994-10-05 1999-05-11 United States Surgical Corporation Articulating apparatus for applying surgical fasteners to body tissue
EP0705571A1 (en) 1994-10-07 1996-04-10 United States Surgical Corporation Self-contained powered surgical apparatus
US5868760A (en) 1994-12-07 1999-02-09 Mcguckin, Jr.; James F. Method and apparatus for endolumenally resectioning tissue
WO1996017856A1 (en) 1994-12-09 1996-06-13 Griffith University Synthesis of bidentate phosphines
JPH08164141A (ja) 1994-12-13 1996-06-25 Olympus Optical Co Ltd 処置具
US5632432A (en) 1994-12-19 1997-05-27 Ethicon Endo-Surgery, Inc. Surgical instrument
US5713505A (en) 1996-05-13 1998-02-03 Ethicon Endo-Surgery, Inc. Articulation transmission mechanism for surgical instruments
US5704534A (en) 1994-12-19 1998-01-06 Ethicon Endo-Surgery, Inc. Articulation assembly for surgical instruments
GB9425781D0 (en) 1994-12-21 1995-02-22 Gyrus Medical Ltd Electrosurgical instrument
US5628743A (en) 1994-12-21 1997-05-13 Valleylab Inc. Dual mode ultrasonic surgical apparatus
US5613966A (en) 1994-12-21 1997-03-25 Valleylab Inc System and method for accessory rate control
US5620452A (en) 1994-12-22 1997-04-15 Yoon; Inbae Surgical clip with ductile tissue penetrating members
AU701320B2 (en) 1994-12-22 1999-01-28 Ethicon Endo-Surgery, Inc. Impedance feedback monitor with query electrode for electrosurgical instrument
US5695494A (en) 1994-12-22 1997-12-09 Valleylab Inc Rem output stage topology
US5713895A (en) 1994-12-30 1998-02-03 Valleylab Inc Partially coated electrodes
US5466020A (en) 1994-12-30 1995-11-14 Valleylab Inc. Bayonet connector for surgical handpiece
JPH10503408A (ja) 1995-02-03 1998-03-31 ヴァリーラブ・インコーポレーテッド ペンシルと組み合わせた電気外科用吸引器
US5669907A (en) 1995-02-10 1997-09-23 Valleylab Inc. Plasma enhanced bipolar electrosurgical system
CN1170999C (zh) 1995-02-15 2004-10-13 总锁公司 一种锁及其制造方法
EP1374768A3 (en) 1995-02-24 2004-02-11 Nihon Kohden Corporation Capnometer
US5695504A (en) 1995-02-24 1997-12-09 Heartport, Inc. Devices and methods for performing a vascular anastomosis
US5669904A (en) 1995-03-07 1997-09-23 Valleylab Inc. Surgical gas plasma ignition apparatus and method
US6213999B1 (en) 1995-03-07 2001-04-10 Sherwood Services Ag Surgical gas plasma ignition apparatus and method
DE19509115C2 (de) 1995-03-16 1997-11-27 Deutsche Forsch Luft Raumfahrt Chirurgisches Gerät zum Vorbereiten einer Anastomose in minimal invasiver Operationstechnik
DE19509116C2 (de) 1995-03-16 2000-01-05 Deutsch Zentr Luft & Raumfahrt Flexible Struktur
US5575799A (en) 1995-03-30 1996-11-19 United States Surgical Corporation Articulating surgical apparatus
US5619992A (en) 1995-04-06 1997-04-15 Guthrie; Robert B. Methods and apparatus for inhibiting contamination of reusable pulse oximetry sensors
US5624452A (en) 1995-04-07 1997-04-29 Ethicon Endo-Surgery, Inc. Hemostatic surgical cutting or stapling instrument
WO1996032893A1 (en) 1995-04-21 1996-10-24 W.L. Gore & Associates, Inc. A surgical pledget dispensing system
US5553765A (en) 1995-04-28 1996-09-10 Ethicon Endo-Surgery, Inc. Surgical stapler with improved operating lever mounting arrangement
DE19515625C2 (de) 1995-04-28 1998-02-19 Boehringer Ingelheim Kg Verfahren zur Herstellung von enantiomerenreinen Tropasäureestern
JP3526487B2 (ja) 1995-05-08 2004-05-17 株式会社伊垣医療設計 医療用縫合材
AU5741296A (en) 1995-05-12 1996-11-29 Rodney C. Perkins Translumenal circumferential injector
US5630540A (en) 1995-05-24 1997-05-20 United States Surgical Corporation Surgical staple and staple drive member
US5599344A (en) 1995-06-06 1997-02-04 Valleylab Inc. Control apparatus for electrosurgical generator power output
EP0836433A1 (en) 1995-06-06 1998-04-22 Valleylab, Inc. Digital waveform generation for electrosurgical generators
US5720744A (en) 1995-06-06 1998-02-24 Valleylab Inc Control system for neurosurgery
WO1996039086A1 (en) 1995-06-06 1996-12-12 Valleylab Inc. Power control for an electrosurgical generator
US5628745A (en) 1995-06-06 1997-05-13 Bek; Robin B. Exit spark control for an electrosurgical generator
US5731001A (en) 1995-06-07 1998-03-24 Magruder; Judy A. Locking couplings for osmotic delivery devices
JP3917183B2 (ja) 1995-06-07 2007-05-23 ダニスコ エー/エス 組換えヘキソースオキシダーゼ、該酵素を産生する方法、および該酵素の利用
US6293942B1 (en) 1995-06-23 2001-09-25 Gyrus Medical Limited Electrosurgical generator method
US6015406A (en) 1996-01-09 2000-01-18 Gyrus Medical Limited Electrosurgical instrument
GB9600377D0 (en) 1996-01-09 1996-03-13 Gyrus Medical Ltd Electrosurgical instrument
GB9604770D0 (en) 1995-06-23 1996-05-08 Gyrus Medical Ltd An electrosurgical generator and system
IL122713A (en) 1995-06-23 2001-04-30 Gyrus Medical Ltd Electrosurgical device
DE69611912T3 (de) 1995-06-23 2005-06-09 Gyrus Medical Ltd. Elektrochirurgisches instrument
WO1997001989A1 (en) 1995-07-03 1997-01-23 Frater Dirk A System for mounting bolster material on tissue staplers
USRE38708E1 (en) 1995-07-11 2005-03-01 United States Surgical Corporation Disposable loading unit for surgical stapler
US5752644A (en) 1995-07-11 1998-05-19 United States Surgical Corporation Disposable loading unit for surgical stapler
US6053922A (en) 1995-07-18 2000-04-25 Krause; William R. Flexible shaft
US5702409A (en) 1995-07-21 1997-12-30 W. L. Gore & Associates, Inc. Device and method for reinforcing surgical staples
US5810855A (en) 1995-07-21 1998-09-22 Gore Enterprise Holdings, Inc. Endoscopic device and method for reinforcing surgical staples
US5611709A (en) 1995-08-10 1997-03-18 Valleylab Inc Method and assembly of member and terminal
US5839639A (en) 1995-08-17 1998-11-24 Lasersurge, Inc. Collapsible anvil assembly and applicator instrument
US6032849A (en) 1995-08-28 2000-03-07 United States Surgical Surgical stapler
US5762256A (en) 1995-08-28 1998-06-09 United States Surgical Corporation Surgical stapler
US5782396A (en) 1995-08-28 1998-07-21 United States Surgical Corporation Surgical stapler
DE19534618A1 (de) * 1995-09-18 1997-03-20 Karl Schad Chirurgisches Instrument
US5814055A (en) 1995-09-19 1998-09-29 Ethicon Endo-Surgery, Inc. Surgical clamping mechanism
US5776130A (en) 1995-09-19 1998-07-07 Valleylab, Inc. Vascular tissue sealing pressure control
US5827271A (en) 1995-09-19 1998-10-27 Valleylab Energy delivery system for vessel sealing
US5772659A (en) 1995-09-26 1998-06-30 Valleylab Inc. Electrosurgical generator power control circuit and method
US5702387A (en) 1995-09-27 1997-12-30 Valleylab Inc Coated electrosurgical electrode
EP0768640A3 (en) 1995-10-13 1998-11-11 Ampex Corporation A small core magnetic head with non-magnetic side support
US5697542A (en) 1995-10-19 1997-12-16 Ethicon Endo-Surgery, Inc. Endoscopic surgical stapler with compact profile
US5653721A (en) 1995-10-19 1997-08-05 Ethicon Endo-Surgery, Inc. Override mechanism for an actuator on a surgical instrument
GB9521772D0 (en) 1995-10-24 1996-01-03 Gyrus Medical Ltd An electrosurgical instrument
US5651491A (en) 1995-10-27 1997-07-29 United States Surgical Corporation Surgical stapler having interchangeable loading units
US5941442A (en) 1995-10-27 1999-08-24 United States Surgical Surgical stapler
CA2188738A1 (en) 1995-10-27 1997-04-28 Lisa W. Heaton Surgical stapler having interchangeable loading units
ES2124154B1 (es) 1995-11-08 1999-12-01 Univ Politecnica De Valencia C Metodo de preparaciion y propiedades cataliticas de un solido microporoso con alta superficie externa.
BR9612395A (pt) 1995-12-29 1999-07-13 Gyrus Medical Ltd Instrumento eletrocirúrgico e um conjunto de eltrodo eletrocirúrgico
GB9600354D0 (en) 1996-01-09 1996-03-13 Gyrus Medical Ltd Electrosurgical instrument
US6013076A (en) 1996-01-09 2000-01-11 Gyrus Medical Limited Electrosurgical instrument
US5620289A (en) 1996-02-09 1997-04-15 Curry; Rinda M. Colored staples
JP2000507119A (ja) 1996-02-13 2000-06-13 イマジン メディカル インコーポレイティド 外科アクセス装置及び外科アクセス装置を構成する方法
US5725536A (en) 1996-02-20 1998-03-10 Richard-Allen Medical Industries, Inc. Articulated surgical instrument with improved articulation control mechanism
US5797537A (en) 1996-02-20 1998-08-25 Richard-Allan Medical Industries, Inc. Articulated surgical instrument with improved firing mechanism
US6436107B1 (en) 1996-02-20 2002-08-20 Computer Motion, Inc. Method and apparatus for performing minimally invasive surgical procedures
US6010054A (en) 1996-02-20 2000-01-04 Imagyn Medical Technologies Linear stapling instrument with improved staple cartridge
US5820009A (en) 1996-02-20 1998-10-13 Richard-Allan Medical Industries, Inc. Articulated surgical instrument with improved jaw closure mechanism
US5855583A (en) 1996-02-20 1999-01-05 Computer Motion, Inc. Method and apparatus for performing minimally invasive cardiac procedures
US5800379A (en) 1996-02-23 1998-09-01 Sommus Medical Technologies, Inc. Method for ablating interior sections of the tongue
DE19609116A1 (de) 1996-03-08 1997-09-18 Eloma Gmbh Verfahren und Vorrichtung zum Garen von Nahrungsmitteln
US5697543A (en) 1996-03-12 1997-12-16 Ethicon Endo-Surgery, Inc. Linear stapler with improved firing stroke
IL117607A0 (en) 1996-03-21 1996-07-23 Dev Of Advanced Medical Produc Surgical stapler and method of surgical fastening
WO1997035533A1 (en) 1996-03-25 1997-10-02 Enrico Nicolo Surgical mesh prosthetic material and methods of use
US5785232A (en) 1996-04-17 1998-07-28 Vir Engineering Surgical stapler
US5836503A (en) 1996-04-22 1998-11-17 United States Surgical Corporation Insertion device for surgical apparatus
US6149660A (en) 1996-04-22 2000-11-21 Vnus Medical Technologies, Inc. Method and apparatus for delivery of an appliance in a vessel
US6050472A (en) 1996-04-26 2000-04-18 Olympus Optical Co., Ltd. Surgical anastomosis stapler
US5772379A (en) 1996-05-24 1998-06-30 Evensen; Kenneth Self-filling staple fastener
US6119913A (en) 1996-06-14 2000-09-19 Boston Scientific Corporation Endoscopic stapler
GB2314274A (en) 1996-06-20 1997-12-24 Gyrus Medical Ltd Electrode construction for an electrosurgical instrument
US5735874A (en) 1996-06-21 1998-04-07 Ethicon Endo-Surgery, Inc. Variable position handle locking mechanism
US5702408A (en) 1996-07-17 1997-12-30 Ethicon Endo-Surgery, Inc. Articulating surgical instrument
US6440146B2 (en) 1996-07-23 2002-08-27 United States Surgical Corporation Anastomosis instrument and method
US6024748A (en) 1996-07-23 2000-02-15 United States Surgical Corporation Singleshot anastomosis instrument with detachable loading unit and method
US6083234A (en) 1996-07-23 2000-07-04 Surgical Dynamics, Inc. Anastomosis instrument and method
US5730758A (en) 1996-09-12 1998-03-24 Allgeyer; Dean O. Staple and staple applicator for use in skin fixation of catheters
US5752965A (en) 1996-10-21 1998-05-19 Bio-Vascular, Inc. Apparatus and method for producing a reinforced surgical fastener suture line
US5769892A (en) 1996-10-22 1998-06-23 Mitroflow International Inc. Surgical stapler sleeve for reinforcing staple lines
GB9626512D0 (en) 1996-12-20 1997-02-05 Gyrus Medical Ltd An improved electrosurgical generator and system
US6074401A (en) 1997-01-09 2000-06-13 Coalescent Surgical, Inc. Pinned retainer surgical fasteners, instruments and methods for minimally invasive vascular and endoscopic surgery
US5908402A (en) 1997-02-03 1999-06-01 Valleylab Method and apparatus for detecting tube occlusion in argon electrosurgery system
BR9808202A (pt) 1997-03-05 2005-02-09 Univ Columbia Dispositivo eletrotérmico para a vedação e união ou corte de tecido
US6033399A (en) 1997-04-09 2000-03-07 Valleylab, Inc. Electrosurgical generator with adaptive power control
US5919198A (en) 1997-04-17 1999-07-06 Ethicon Endo-Surgery, Inc. Disposable cartridge with drivers
GB9708268D0 (en) 1997-04-24 1997-06-18 Gyrus Medical Ltd An electrosurgical instrument
USH2037H1 (en) 1997-05-14 2002-07-02 David C. Yates Electrosurgical hemostatic device including an anvil
DE19721076A1 (de) 1997-05-20 1998-11-26 Trw Repa Gmbh Verfahren zum Herstellen eines Seilabschnittes mit einem Befestigungselement für ein Fahrzeuginsassen-Rückhaltesystem sowie mit diesem Verfahren hergestellter Seilabschnitt
US5951552A (en) 1997-06-30 1999-09-14 Ethicon Endo-Surgery, Inc. Capacitively coupled cordless electrosurgical instrument
US7021878B1 (en) 1997-07-03 2006-04-04 Trackers Company Categorizing fasteners and construction connectors using visual identifiers
FR2765794B1 (fr) 1997-07-11 1999-09-03 Joel Bardeau Dispositif d'eveinage notamment pour endoeveinage
US6338737B1 (en) 1997-07-17 2002-01-15 Haviv Toledano Flexible annular stapler for closed surgery of hollow organs
US5937951A (en) 1997-07-18 1999-08-17 Ethicon Endo-Surgery, Inc. Skin stapler with rack and pinion staple feed mechanism
EP0996376A1 (en) 1997-07-18 2000-05-03 Gyrus Medical Limited An electrosurgical instrument
JP2001510067A (ja) 1997-07-18 2001-07-31 ガイラス・メディカル・リミテッド 電気外科用器具
GB9900964D0 (en) 1999-01-15 1999-03-10 Gyrus Medical Ltd An electrosurgical system
DE69824851T2 (de) 1997-07-18 2005-07-21 Gyrus Medical Ltd., St. Mellons Ein elektrochirurgisches instrument
JP3811291B2 (ja) 1998-07-02 2006-08-16 オリンパス株式会社 内視鏡システム
US6267761B1 (en) 1997-09-09 2001-07-31 Sherwood Services Ag Apparatus and method for sealing and cutting tissue
ES2238768T3 (es) 1997-09-10 2005-09-01 Sherwood Services Ag Instrumento bipolar para la fusion de vasos.
AU9478498A (en) 1997-09-11 1999-03-29 Genzyme Corporation Articulating endoscopic implant rotator surgical apparatus and method for using same
US5865361A (en) 1997-09-23 1999-02-02 United States Surgical Corporation Surgical stapling apparatus
GB2329840C (en) 1997-10-03 2007-10-05 Johnson & Johnson Medical Biopolymer sponge tubes
US5984949A (en) 1997-10-06 1999-11-16 Levin; John M. Tissue hooks and tools for applying same
US5947984A (en) 1997-10-10 1999-09-07 Ethicon Endo-Surger, Inc. Ultrasonic clamp coagulator apparatus having force limiting clamping mechanism
US6117148A (en) 1997-10-17 2000-09-12 Ravo; Biagio Intraluminal anastomotic device
US6086600A (en) 1997-11-03 2000-07-11 Symbiosis Corporation Flexible endoscopic surgical instrument for invagination and fundoplication
DE19749597C2 (de) 1997-11-10 2003-04-10 Brasseler Gmbh & Co Kg Geb Dentalinstrument
US6050996A (en) 1997-11-12 2000-04-18 Sherwood Services Ag Bipolar electrosurgical instrument with replaceable electrodes
US6187003B1 (en) 1997-11-12 2001-02-13 Sherwood Services Ag Bipolar electrosurgical instrument for sealing vessels
US6228083B1 (en) 1997-11-14 2001-05-08 Sherwood Services Ag Laparoscopic bipolar electrosurgical instrument
US6068627A (en) 1997-12-10 2000-05-30 Valleylab, Inc. Smart recognition apparatus and method
US6171330B1 (en) 1997-12-15 2001-01-09 Sofradim Production Pneumatic surgical instrument for the distribution and placement of connecting or fastening means
EP0923907A1 (en) 1997-12-19 1999-06-23 Gyrus Medical Limited An electrosurgical instrument
US6033427A (en) 1998-01-07 2000-03-07 Lee; Benjamin I. Method and device for percutaneous sealing of internal puncture sites
US6156056A (en) 1998-01-09 2000-12-05 Ethicon, Inc. Suture buttress
GB2336214A (en) 1998-01-16 1999-10-13 David William Taylor Preventionof multiple use of limited use devices
US6096074A (en) 1998-01-27 2000-08-01 United States Surgical Stapling apparatus and method for heart valve replacement
KR19980033430A (ko) 1998-02-02 1998-07-25 이상욱 엔진 흡기 시스템
RU2141279C1 (ru) 1998-03-11 1999-11-20 Кондратюк Георгий Константинович Универсальная насадка
US6099551A (en) 1998-03-12 2000-08-08 Shelhigh, Inc. Pericardial strip and stapler assembly for dividing and sealing visceral tissues and method of use thereof
US6042601A (en) 1998-03-18 2000-03-28 United States Surgical Corporation Apparatus for vascular hole closure
GB9807303D0 (en) 1998-04-03 1998-06-03 Gyrus Medical Ltd An electrode assembly for an electrosurgical instrument
WO1999048430A1 (en) 1998-03-26 1999-09-30 Gyrus Medical Limited An electrosurgical instrument
GB2335858A (en) 1998-04-03 1999-10-06 Gyrus Medical Ltd Resectoscope having pivoting electrode assembly
NL1008846C2 (nl) 1998-04-08 1999-03-16 Cooeperatief Advies En Onderzo Inrichting voor het ondersteunen van een zonnepaneel op een schuin dak.
US6517566B1 (en) 1998-05-11 2003-02-11 Surgical Connections, Inc. Devices and methods for treating e.g. urinary stress incontinence
US6601749B2 (en) 1998-06-19 2003-08-05 Scimed Life Systems, Inc. Multi fire full thickness resectioning device
US6478210B2 (en) 2000-10-25 2002-11-12 Scimed Life Systems, Inc. Method and device for full thickness resectioning of an organ
US6629630B2 (en) 1998-06-19 2003-10-07 Scimed Life Systems, Inc. Non-circular resection device and endoscope
US6585144B2 (en) 1998-06-19 2003-07-01 Acimed Life Systems, Inc. Integrated surgical staple retainer for a full thickness resectioning device
US6126058A (en) 1998-06-19 2000-10-03 Scimed Life Systems, Inc. Method and device for full thickness resectioning of an organ
US6228098B1 (en) 1998-07-10 2001-05-08 General Surgical Innovations, Inc. Apparatus and method for surgical fastening
JP3806518B2 (ja) 1998-07-17 2006-08-09 オリンパス株式会社 内視鏡治療装置
DE19836950B4 (de) 1998-08-17 2004-09-02 Deutsches Zentrum für Luft- und Raumfahrt e.V. Chirurgisches Instrument in Form eines Nahtklammergerätes
WO2000024330A1 (en) 1998-10-23 2000-05-04 Sherwood Services Ag Open vessel sealing forceps with disposable electrodes
WO2000024322A1 (en) 1998-10-23 2000-05-04 Applied Medical Resources Corporation Surgical grasper with inserts and method of using same
DE19851291A1 (de) 1998-11-06 2000-01-05 Siemens Ag Operationsarbeitsplatztaugliches Dateneingabegerät
US6102271A (en) 1998-11-23 2000-08-15 Ethicon Endo-Surgery, Inc. Circular stapler for hemorrhoidal surgery
US6200330B1 (en) * 1998-11-23 2001-03-13 Theodore V. Benderev Systems for securing sutures, grafts and soft tissue to bone and periosteum
JP2000171730A (ja) 1998-12-08 2000-06-23 Olympus Optical Co Ltd バッテリ式携帯内視鏡装置
MC200005A1 (fr) 1999-02-02 2000-04-12 Bizzio Nickolas Pompe à injection pour machine distributrice de colorants
US6387113B1 (en) 1999-02-02 2002-05-14 Biomet, Inc. Method and apparatus for repairing a torn meniscus
DE19906191A1 (de) 1999-02-15 2000-08-17 Ingo F Herrmann Endoskop
US6083242A (en) 1999-02-17 2000-07-04 Holobeam, Inc. Surgical staples with deformation zones of non-uniform cross section
GB9905209D0 (en) 1999-03-05 1999-04-28 Gyrus Medical Ltd Electrosurgery system
GB9905211D0 (en) 1999-03-05 1999-04-28 Gyrus Medical Ltd Electrosurgery system and instrument
GB9905210D0 (en) 1999-03-05 1999-04-28 Gyrus Medical Ltd Electrosurgical system
US6179776B1 (en) 1999-03-12 2001-01-30 Scimed Life Systems, Inc. Controllable endoscopic sheath apparatus and related method of use
WO2000057796A1 (en) 1999-03-31 2000-10-05 Rosenblatt Peter L Systems and methods for soft tissue reconstruction
JP2000287987A (ja) 1999-04-01 2000-10-17 Olympus Optical Co Ltd 充電式医療装置
US6248117B1 (en) 1999-04-16 2001-06-19 Vital Access Corp Anastomosis apparatus for use in intraluminally directed vascular anastomosis
US6325805B1 (en) 1999-04-23 2001-12-04 Sdgi Holdings, Inc. Shape memory alloy staple
US6383201B1 (en) * 1999-05-14 2002-05-07 Tennison S. Dong Surgical prosthesis for repairing a hernia
JP4503725B2 (ja) 1999-05-17 2010-07-14 オリンパス株式会社 内視鏡治療装置
US6921412B1 (en) 1999-05-18 2005-07-26 Cryolife, Inc. Self-supporting, shaped, three-dimensional biopolymeric materials and methods
GB9911956D0 (en) 1999-05-21 1999-07-21 Gyrus Medical Ltd Electrosurgery system and method
GB9911954D0 (en) 1999-05-21 1999-07-21 Gyrus Medical Ltd Electrosurgery system and instrument
DE19924311A1 (de) 1999-05-27 2000-11-30 Walter A Rau Klammerschneidegerät und Zusatzvorrichtung für ein solches
GB9912625D0 (en) 1999-05-28 1999-07-28 Gyrus Medical Ltd An electrosurgical generator and system
GB9912627D0 (en) 1999-05-28 1999-07-28 Gyrus Medical Ltd An electrosurgical instrument
US8025199B2 (en) 2004-02-23 2011-09-27 Tyco Healthcare Group Lp Surgical cutting and stapling device
US6716233B1 (en) 1999-06-02 2004-04-06 Power Medical Interventions, Inc. Electromechanical driver and remote surgical instrument attachment having computer assisted control capabilities
US6793652B1 (en) 1999-06-02 2004-09-21 Power Medical Interventions, Inc. Electro-mechanical surgical device
US6517565B1 (en) 1999-06-02 2003-02-11 Power Medical Interventions, Inc. Carriage assembly for controlling a steering wire steering mechanism within a flexible shaft
US8241322B2 (en) 2005-07-27 2012-08-14 Tyco Healthcare Group Lp Surgical device
US6491201B1 (en) 2000-02-22 2002-12-10 Power Medical Interventions, Inc. Fluid delivery mechanism for use with anastomosing, stapling, and resecting instruments
US6443973B1 (en) 1999-06-02 2002-09-03 Power Medical Interventions, Inc. Electromechanical driver device for use with anastomosing, stapling, and resecting instruments
US6264087B1 (en) 1999-07-12 2001-07-24 Powermed, Inc. Expanding parallel jaw device for use with an electromechanical driver device
US7032798B2 (en) 1999-06-02 2006-04-25 Power Medical Interventions, Inc. Electro-mechanical surgical device
US7695485B2 (en) 2001-11-30 2010-04-13 Power Medical Interventions, Llc Surgical device
US6315184B1 (en) 1999-06-02 2001-11-13 Powermed, Inc. Stapling device for use with an electromechanical driver device for use with anastomosing, stapling, and resecting instruments
US7951071B2 (en) 1999-06-02 2011-05-31 Tyco Healthcare Group Lp Moisture-detecting shaft for use with an electro-mechanical surgical device
GB9913652D0 (en) 1999-06-11 1999-08-11 Gyrus Medical Ltd An electrosurgical generator
FR2795301B1 (fr) 1999-06-25 2001-08-31 Prec Instrument de chirurgie endoscopique
US6488196B1 (en) 1999-06-30 2002-12-03 Axya Medical, Inc. Surgical stapler and method of applying plastic staples to body tissue
US6325810B1 (en) 1999-06-30 2001-12-04 Ethicon, Inc. Foam buttress for stapling apparatus
US6333029B1 (en) 1999-06-30 2001-12-25 Ethicon, Inc. Porous tissue scaffoldings for the repair of regeneration of tissue
JP2001035827A (ja) 1999-07-16 2001-02-09 Memc Kk 高濃度オゾン水、同オゾン水の調製方法、および同オゾン水を使用した洗浄方法
US6402766B2 (en) 1999-07-23 2002-06-11 Ethicon, Inc. Graft fixation device combination
US6436110B2 (en) 1999-07-23 2002-08-20 Ethicon, Inc. Method of securing a graft using a graft fixation device
US7063712B2 (en) 2001-04-27 2006-06-20 Cardica, Inc. Anastomosis method
US7766924B1 (en) * 1999-07-28 2010-08-03 Cardica, Inc. System for performing anastomosis
US6391038B2 (en) 1999-07-28 2002-05-21 Cardica, Inc. Anastomosis system and method for controlling a tissue site
US7303570B2 (en) * 1999-07-28 2007-12-04 Cardica, Inc. Anastomosis tool having a connector holder
WO2001008717A1 (en) 1999-08-03 2001-02-08 Smith & Nephew, Inc. Controlled release implantable devices
US6488659B1 (en) 1999-08-05 2002-12-03 Biocardia, Inc. System and method for delivering thermally sensitive and reverse-thermal gelation materials
US7662161B2 (en) 1999-09-13 2010-02-16 Rex Medical, L.P Vascular hole closure device
US7267679B2 (en) 1999-09-13 2007-09-11 Rex Medical, L.P Vascular hole closure device
US6358224B1 (en) 1999-09-24 2002-03-19 Tyco Healthcare Group Lp Irrigation system for endoscopic surgery
CA2322061A1 (en) 1999-10-05 2001-04-05 Anil K. Nalagatla Stapling instrument having two staple forming surfaces
US6749560B1 (en) 1999-10-26 2004-06-15 Circon Corporation Endoscope shaft with slotted tube
EP1095627A1 (en) 1999-10-27 2001-05-02 Everest Medical Corporation Electrosurgical probe for surface treatment
CA2324532A1 (en) 1999-10-28 2001-04-28 Elio C. Burguera Coupling system
DE19951940C2 (de) 1999-10-28 2001-11-29 Karlsruhe Forschzent Endoskopisch einsetzbares Klammernahtgerät
US6558379B1 (en) 1999-11-18 2003-05-06 Gyrus Medical Limited Electrosurgical system
US6494896B1 (en) 1999-11-30 2002-12-17 Closure Medical Corporation Applicator for laparoscopic or endoscopic surgery
US6736825B2 (en) 1999-12-14 2004-05-18 Integrated Vascular Interventional Technologies, L C (Ivit Lc) Paired expandable anastomosis devices and related methods
US6197042B1 (en) 2000-01-05 2001-03-06 Medical Technology Group, Inc. Vascular sheath with puncture site closure apparatus and methods of use
HU225908B1 (en) 2000-01-24 2007-12-28 Ethicon Endo Surgery Europe Surgical circular stapling head
US6193129B1 (en) 2000-01-24 2001-02-27 Ethicon Endo-Surgery, Inc. Cutting blade for a surgical anastomosis stapling instrument
KR20000018255A (ko) 2000-01-26 2000-04-06 임인권 금속 또는 세라믹 구슬을 적용한 매연 포집 방법 및 그방법을 이용한 매연저감 장치
GB0223348D0 (en) 2002-10-08 2002-11-13 Gyrus Medical Ltd A surgical instrument
GB0002849D0 (en) 2000-02-08 2000-03-29 Gyrus Medical Ltd An electrosurgical instrument and an electosurgery system including such an instrument
WO2001062164A2 (en) 2000-02-22 2001-08-30 Power Medical Interventions, Inc. An electromechanical driver and remote surgical instrument attachment having computer assisted control capabilities
US7770773B2 (en) 2005-07-27 2010-08-10 Power Medical Interventions, Llc Surgical device
US8016855B2 (en) 2002-01-08 2011-09-13 Tyco Healthcare Group Lp Surgical device
GB0004179D0 (en) 2000-02-22 2000-04-12 Gyrus Medical Ltd Tissue resurfacing
US6488197B1 (en) 2000-02-22 2002-12-03 Power Medical Interventions, Inc. Fluid delivery device for use with anastomosing resecting and stapling instruments
US6533157B1 (en) 2000-02-22 2003-03-18 Power Medical Interventions, Inc. Tissue stapling attachment for use with an electromechanical driver device
US6273897B1 (en) 2000-02-29 2001-08-14 Ethicon, Inc. Surgical bettress and surgical stapling apparatus
AU2001247292B2 (en) 2000-03-06 2006-04-06 Covidien Lp Apparatus and method for performing a bypass procedure in a digestive system
IL139788A (en) 2000-11-20 2006-10-05 Minelu Zonnenschein Stapler for endoscopes
WO2001067964A2 (en) 2000-03-16 2001-09-20 Medigus Ltd. Fundoplication apparatus and method
JP4194209B2 (ja) 2000-03-30 2008-12-10 キヤノン株式会社 移動通信用準公衆システム
US6858005B2 (en) 2000-04-03 2005-02-22 Neo Guide Systems, Inc. Tendon-driven endoscope and methods of insertion
US6837846B2 (en) 2000-04-03 2005-01-04 Neo Guide Systems, Inc. Endoscope having a guide tube
US6517528B1 (en) 2000-04-13 2003-02-11 Scimed Life Systems, Inc. Magnetic catheter drive shaft clutch
RU2187249C2 (ru) 2000-04-27 2002-08-20 Общество с ограниченной ответственностью "ЭНДОМЕДИУМ+" Хирургический инструмент
US6387114B2 (en) 2000-04-28 2002-05-14 Scimed Life Systems, Inc. Gastrointestinal compression clips
US7510566B2 (en) * 2000-05-19 2009-03-31 Coapt Systems, Inc. Multi-point tissue tension distribution device and method, a chin lift variation
US6485503B2 (en) 2000-05-19 2002-11-26 Coapt Systems, Inc. Multi-point tissue tension distribution device, a brow and face lift variation, and a method of tissue approximation using the device
US6419695B1 (en) 2000-05-22 2002-07-16 Shlomo Gabbay Cardiac prosthesis for helping improve operation of a heart valve
US6805273B2 (en) 2002-11-04 2004-10-19 Federico Bilotti Surgical stapling instrument
DE10026683C2 (de) 2000-05-30 2003-07-10 Ethicon Endo Surgery Europe Chirurgisches Klammersetzgerät
DE10031436A1 (de) 2000-06-28 2002-01-10 Alexander Von Fuchs Gleitschutz für einen Gehäusekopf medizinischer Instrumente
US6863694B1 (en) 2000-07-03 2005-03-08 Osteotech, Inc. Osteogenic implants derived from bone
WO2002007608A2 (en) 2000-07-20 2002-01-31 Tiva Medical, Inc. Hand-actuated articulating surgical tool
AU2002224520A1 (en) 2000-07-21 2002-02-05 Atropos Limited A cannula
US8366787B2 (en) 2000-08-04 2013-02-05 Depuy Products, Inc. Hybrid biologic-synthetic bioabsorbable scaffolds
WO2002017799A1 (en) 2000-08-30 2002-03-07 Cerebral Vascular Applications Inc. Medical instrument
US6767356B2 (en) 2000-09-01 2004-07-27 Angiolink Corporation Advanced wound site management systems and methods
US7144729B2 (en) 2000-09-01 2006-12-05 Dfb Pharmaceuticals, Inc. Methods and compositions for tissue regeneration
US20040093024A1 (en) 2000-09-01 2004-05-13 James Lousararian Advanced wound site management systems and methods
GB0021799D0 (en) 2000-09-05 2000-10-18 Gyrus Medical Ltd Electrosurgery system
ATE485006T1 (de) 2000-09-08 2010-11-15 Abbott Vascular Inc Vorrichtung zum orten eines punktierten blutgefässes
US6817508B1 (en) 2000-10-13 2004-11-16 Tyco Healthcare Group, Lp Surgical stapling device
EP1977701B1 (en) 2000-10-13 2011-12-07 Tyco Healthcare Group LP Surgical fastener applying apparatus
WO2003079909A2 (en) 2002-03-19 2003-10-02 Tyco Healthcare Group, Lp Surgical fastener applying apparatus
US7334717B2 (en) 2001-10-05 2008-02-26 Tyco Healthcare Group Lp Surgical fastener applying apparatus
US7407076B2 (en) 2000-10-13 2008-08-05 Tyco Healthcare Group Lp Surgical stapling device
US6551333B2 (en) 2000-10-19 2003-04-22 Ethicon Endo-Surgery, Inc. Method for attaching hernia mesh
US6773438B1 (en) 2000-10-19 2004-08-10 Ethicon Endo-Surgery Surgical instrument having a rotary lockout mechanism
US20040267310A1 (en) 2000-10-20 2004-12-30 Racenet David C Directionally biased staple and anvil assembly for forming the staple
US6626906B1 (en) 2000-10-23 2003-09-30 Sdgi Holdings, Inc. Multi-planar adjustable connector
US6913608B2 (en) 2000-10-23 2005-07-05 Viacor, Inc. Automated annular plication for mitral valve repair
US6793661B2 (en) 2000-10-30 2004-09-21 Vision Sciences, Inc. Endoscopic sheath assemblies having longitudinal expansion inhibiting mechanisms
GB0026586D0 (en) 2000-10-31 2000-12-13 Gyrus Medical Ltd An electrosurgical system
JP2002143078A (ja) 2000-11-08 2002-05-21 Olympus Optical Co Ltd 内視鏡用外付チューブ
US8286845B2 (en) 2000-11-27 2012-10-16 Boston Scientific Scimed, Inc. Full thickness resection device control handle
JP2002159500A (ja) * 2000-11-28 2002-06-04 Koseki Ika Kk 靭帯固定システム
US6398795B1 (en) 2000-11-30 2002-06-04 Scimed Life Systems, Inc. Stapling and cutting in resectioning for full thickness resection devices
US6569085B2 (en) 2001-08-16 2003-05-27 Syntheon, Llc Methods and apparatus for delivering a medical instrument over an endoscope while the endoscope is in a body lumen
US6503259B2 (en) 2000-12-27 2003-01-07 Ethicon, Inc. Expandable anastomotic device
US7041868B2 (en) 2000-12-29 2006-05-09 Kimberly-Clark Worldwide, Inc. Bioabsorbable wound dressing
DE60227235D1 (de) 2001-01-24 2008-08-07 Tyco Healthcare Instrument und verfahren zur durchführung einer anastomose
JP4202138B2 (ja) 2001-01-31 2008-12-24 レックス メディカル インコーポレイテッド 胃食道組織をステープルおよび切除するための装置および方法
US20020103494A1 (en) 2001-01-31 2002-08-01 Pacey John Allen Percutaneous cannula delvery system for hernia patch
US8313496B2 (en) 2001-02-02 2012-11-20 Lsi Solutions, Inc. System for endoscopic suturing
US6997931B2 (en) 2001-02-02 2006-02-14 Lsi Solutions, Inc. System for endoscopic suturing
ES2296895T3 (es) 2001-02-27 2008-05-01 Tyco Healthcare Group Lp Montaje mezclador extremo.
US20030181900A1 (en) 2002-03-25 2003-09-25 Long Gary L. Endoscopic ablation system with a plurality of electrodes
US7097644B2 (en) 2001-03-30 2006-08-29 Ethicon Endo-Surgery, Inc. Medical device with improved wall construction
US6769590B2 (en) 2001-04-02 2004-08-03 Susan E. Vresh Luminal anastomotic device and method
WO2002080781A2 (en) 2001-04-03 2002-10-17 Tyco Healthcare Group Lp Surgical stapling device for performing circular anastomoses
US6638285B2 (en) 2001-04-16 2003-10-28 Shlomo Gabbay Biological tissue strip and system and method to seal tissue
WO2002085254A1 (en) 2001-04-20 2002-10-31 The Research Foundation Of State University Of Newyork Apparatus and method for fixation of vascular grafts
FR2823704B1 (fr) 2001-04-20 2003-07-04 Renault Dispositif de gestion thermique d'un vehicule automobile
DE10119867B4 (de) 2001-04-24 2005-10-13 Atlas Elektronik Gmbh Unterwasserantenne
DE10121305A1 (de) 2001-05-02 2002-12-12 Ethicon Endo Surgery Europe Chirurgisches Instrument
US6592597B2 (en) 2001-05-07 2003-07-15 Ethicon Endo-Surgery, Inc. Adhesive for attaching buttress material to a surgical fastening device
US6503257B2 (en) 2001-05-07 2003-01-07 Ethicon Endo-Surgery, Inc. Method for releasing buttress material attached to a surgical fastening device
US6630047B2 (en) 2001-05-21 2003-10-07 3M Innovative Properties Company Fluoropolymer bonding composition and method
IES20010547A2 (en) 2001-06-07 2002-12-11 Christy Cummins Surgical Staple
DE20121753U1 (de) 2001-06-15 2003-04-17 BEMA GmbH + Co. KG Endochirurgische Instrumente, 78576 Emmingen-Liptingen Griff für ein chirurgisches Instrument
US20030009154A1 (en) 2001-06-20 2003-01-09 Whitman Michael P. Method and system for integrated medical tracking
CN2488482Y (zh) 2001-07-05 2002-05-01 天津市华志计算机应用有限公司 机械臂的关节锁紧机构
DE20112837U1 (de) 2001-08-02 2001-10-04 Aesculap AG & Co. KG, 78532 Tuttlingen Zangen- oder pinzettenförmiges chirurgisches Instrument
ATE347862T1 (de) 2001-08-07 2007-01-15 Univ Medisch Centrum Utrecht Gerät zur verbindung eines chirurgischen geräts mit einer stabilen basis
US6592608B2 (en) 2001-12-07 2003-07-15 Biopsy Sciences, Llc Bioabsorbable sealant
DE10139153A1 (de) 2001-08-09 2003-02-27 Ingo F Herrmann Einweg-Endoskopmantel
IES20010748A2 (en) 2001-08-09 2003-02-19 Christy Cummins Surgical Stapling Device and Method
US6692507B2 (en) 2001-08-23 2004-02-17 Scimed Life Systems, Inc. Impermanent biocompatible fastener
EP1287788B1 (en) 2001-08-27 2011-04-20 Gyrus Medical Limited Electrosurgical system
US7282048B2 (en) 2001-08-27 2007-10-16 Gyrus Medical Limited Electrosurgical generator and system
WO2004078051A2 (en) 2001-08-27 2004-09-16 Gyrus Medial Limited Electrosurgical system
GB0425051D0 (en) 2004-11-12 2004-12-15 Gyrus Medical Ltd Electrosurgical generator and system
US6629988B2 (en) 2001-08-28 2003-10-07 Ethicon, Inc. Composite staple for completing an anastomosis
US6755338B2 (en) 2001-08-29 2004-06-29 Cerebral Vascular Applications, Inc. Medical instrument
NL1018874C2 (nl) 2001-09-03 2003-03-05 Michel Petronella Hub Vleugels Chirurgisch instrument.
US6747121B2 (en) 2001-09-05 2004-06-08 Synthes (Usa) Poly(L-lactide-co-glycolide) copolymers, methods for making and using same, and devices containing same
US7447967B2 (en) 2001-09-13 2008-11-04 Texas Instruments Incorporated MIMO hybrid-ARQ using basis hopping
GB2379878B (en) 2001-09-21 2004-11-10 Gyrus Medical Ltd Electrosurgical system and method
US6578751B2 (en) 2001-09-26 2003-06-17 Scimed Life Systems, Inc. Method of sequentially firing staples using springs and a rotary or linear shutter
US7108701B2 (en) 2001-09-28 2006-09-19 Ethicon, Inc. Drug releasing anastomosis devices and methods for treating anastomotic sites
ES2571339T3 (es) 2001-10-05 2016-05-24 Covidien Lp Dispositivo de grapado quirúrgico
EP2865342B1 (en) 2001-10-05 2018-04-04 Covidien LP Method of adjusting a staple gap in a surgical apparatus
US7464847B2 (en) 2005-06-03 2008-12-16 Tyco Healthcare Group Lp Surgical stapler with timer and feedback display
US20060020336A1 (en) 2001-10-23 2006-01-26 Liddicoat John R Automated annular plication for mitral valve repair
FR2831417B1 (fr) 2001-10-30 2004-08-06 Eurosurgical Instrument chirurgical
DE10158246C1 (de) 2001-11-28 2003-08-21 Ethicon Endo Surgery Europe Chirurgisches Klammersetzinstrument
US6671185B2 (en) 2001-11-28 2003-12-30 Landon Duval Intelligent fasteners
US8211119B2 (en) 2004-06-14 2012-07-03 Ethicon Endo-Surgery, Inc. Endoscopic surgical instrument having a rotational actuator
US6839612B2 (en) 2001-12-07 2005-01-04 Institute Surgical, Inc. Microwrist system for surgical procedures
US6974462B2 (en) 2001-12-19 2005-12-13 Boston Scientific Scimed, Inc. Surgical anchor implantation device
US6939358B2 (en) 2001-12-20 2005-09-06 Gore Enterprise Holdings, Inc. Apparatus and method for applying reinforcement material to a surgical stapler
JP4230915B2 (ja) * 2001-12-21 2009-02-25 シムチャ ミロ 輪状形成リング用移植システム
RU2225170C2 (ru) 2001-12-25 2004-03-10 Дубровский Аркадий Вениаминович Инструмент с поворотным устройством
CN100362969C (zh) 2001-12-27 2008-01-23 盖勒斯集团股份有限公司 电外科器械
US6729119B2 (en) 2001-12-28 2004-05-04 The Schnipke Family Limited Liability Company Robotic loader for surgical stapling cartridge
US6602252B2 (en) 2002-01-03 2003-08-05 Starion Instruments Corporation Combined dissecting, cauterizing, and stapling device
CN100409552C (zh) 2002-01-16 2008-08-06 丰田自动车株式会社 电压转换装置及方法,驱动系统和装有该驱动系统的车辆
WO2003062126A1 (en) 2002-01-17 2003-07-31 Hummer Robert J Tricycle forklift
CN1886423A (zh) 2002-01-18 2006-12-27 普罗特米克斯公司 脂联素的糖基同工型及其用途
DE10203282A1 (de) 2002-01-29 2003-08-21 Behrens Ag Friedrich Joh Befestigungsmittel und Verfahren zu seiner Herstellung
WO2003063694A1 (en) 2002-01-30 2003-08-07 Power Medical Interventions, Inc. Surgical imaging device
US7427607B2 (en) 2002-02-20 2008-09-23 Next21 K.K. Drug administration method
US7247161B2 (en) 2002-03-22 2007-07-24 Gyrus Ent L.L.C. Powered surgical apparatus, method of manufacturing powered surgical apparatus, and method of using powered surgical apparatus
JP4071642B2 (ja) 2002-03-25 2008-04-02 株式会社リコー 用紙処理装置及び画像形成システム
US7137981B2 (en) 2002-03-25 2006-11-21 Ethicon Endo-Surgery, Inc. Endoscopic ablation system with a distally mounted image sensor
US7128748B2 (en) 2002-03-26 2006-10-31 Synovis Life Technologies, Inc. Circular stapler buttress combination
US7695488B2 (en) 2002-03-27 2010-04-13 Boston Scientific Scimed, Inc. Expandable body cavity liner device
US7070083B2 (en) 2002-04-11 2006-07-04 Tyco Healthcare Group Lp Surgical stapling apparatus including an anvil and cartridge each having cooperating mating surfaces
EP1494594B1 (en) 2002-04-15 2011-07-06 Cook Biotech Incorporated Apparatus and method for producing a reinforced surgical staple line
CA2703164C (en) 2002-04-16 2013-10-08 Tyco Healthcare Group Lp Surgical stapler and method
US8241308B2 (en) 2002-04-24 2012-08-14 Boston Scientific Scimed, Inc. Tissue fastening devices and processes that promote tissue adhesion
ES2377483T3 (es) 2002-04-25 2012-03-28 Tyco Healthcare Group Lp Instrumentos quirúrgicos que incluyen sistemas microelectromecánicos (MEMS)
US8802124B2 (en) 2002-05-08 2014-08-12 Radi Medical Systems Ab Erodible vessel sealing device without chemical or biological degradation
US7238195B2 (en) 2002-05-10 2007-07-03 Tyco Healthcare Group Lp Wound closure material applicator and stapler
ES2540098T3 (es) 2002-05-10 2015-07-08 Covidien Lp Aparato grapador quirúrgico que tiene un conjunto aplicador de material para cierre de heridas
US7485141B2 (en) 2002-05-10 2009-02-03 Cordis Corporation Method of placing a tubular membrane on a structural frame
US6736854B2 (en) 2002-05-10 2004-05-18 C. R. Bard, Inc. Prosthetic repair fabric with erosion resistant edge
EP1503674B1 (en) 2002-05-10 2006-08-23 Tyco Healthcare Group Lp Electrosurgical stapling apparatus
AU2003234551A1 (en) 2002-05-13 2003-11-11 Tyco Healthcare Group, Lp Surgical stapler and disposable loading unit having different size staples
US7967839B2 (en) 2002-05-20 2011-06-28 Rocky Mountain Biosystems, Inc. Electromagnetic treatment of tissues and cells
US6638297B1 (en) 2002-05-30 2003-10-28 Ethicon Endo-Surgery, Inc. Surgical staple
US6769594B2 (en) 2002-05-31 2004-08-03 Tyco Healthcare Group, Lp End-to-end anastomosis instrument and method for performing same
US7056330B2 (en) 2002-05-31 2006-06-06 Ethicon Endo-Surgery, Inc. Method for applying tissue fastener
US6543456B1 (en) 2002-05-31 2003-04-08 Ethicon Endo-Surgery, Inc. Method for minimally invasive surgery in the digestive system
EP1515651B1 (en) 2002-06-14 2006-12-06 Power Medical Interventions, Inc. Device for clamping, cutting, and stapling tissue
ES2426719T3 (es) 2002-06-17 2013-10-24 Covidien Lp Estructuras de soporte anular
US7112214B2 (en) 2002-06-25 2006-09-26 Incisive Surgical, Inc. Dynamic bioabsorbable fastener for use in wound closure
US7699856B2 (en) 2002-06-27 2010-04-20 Van Wyk Robert A Method, apparatus, and kit for thermal suture cutting
GB2390024B (en) 2002-06-27 2005-09-21 Gyrus Medical Ltd Electrosurgical system
WO2004006980A2 (en) 2002-07-11 2004-01-22 Sightline Technologies Ltd. Piston-actuated endoscopic steering system
IL150853A0 (en) 2002-07-22 2003-02-12 Niti Medical Technologies Ltd Imppoved intussusception and anastomosis apparatus
US8579937B2 (en) 2002-07-31 2013-11-12 Covidien Lp Tool member cover and cover deployment device
US9271753B2 (en) 2002-08-08 2016-03-01 Atropos Limited Surgical device
US20040044364A1 (en) 2002-08-29 2004-03-04 Devries Robert Tissue fasteners and related deployment systems and methods
US6981978B2 (en) 2002-08-30 2006-01-03 Satiety, Inc. Methods and devices for maintaining a space occupying device in a relatively fixed location within a stomach
WO2004021868A2 (en) 2002-09-06 2004-03-18 C.R. Bard, Inc. External endoscopic accessory control system
US20040138703A1 (en) 2002-09-06 2004-07-15 Neville Alleyne Seal for posterior lateral vertebral disk cavity
US20040059362A1 (en) 2002-09-20 2004-03-25 Knodel Bryan D. Method of performing surgery using surgical device with expandable member
US7326203B2 (en) 2002-09-30 2008-02-05 Depuy Acromed, Inc. Device for advancing a functional element through tissue
EP1549200A4 (en) 2002-09-30 2008-05-07 Sightline Techn Ltd PISTONED ENDOSCOPIC INSTRUMENT
JP4049217B2 (ja) 2002-10-02 2008-02-20 イーメックス株式会社 導電性高分子成形品及び積層体を用いた装置
EP1545333B1 (en) 2002-10-04 2009-12-09 Tyco Healthcare Group Lp Tool assembly for a surgical stapling device
CA2754689C (en) 2002-10-04 2014-12-16 Tyco Healthcare Group Lp Surgical stapling device
EP2245996B1 (en) 2002-10-04 2016-12-21 Covidien LP Surgical stapler with universal articulation and tissue pre-clamp
WO2004032760A2 (en) 2002-10-04 2004-04-22 Tyco Healthcare Group, Lp Pneumatic powered surgical stapling device
JP4448449B2 (ja) 2002-10-04 2010-04-07 タイコ ヘルスケア グループ エルピー 外科用ステープリングデバイスのためのツールアセンブリ
US6958035B2 (en) 2002-10-15 2005-10-25 Dusa Pharmaceuticals, Inc Medical device sheath apparatus and method of making and using same
US7037344B2 (en) 2002-11-01 2006-05-02 Valentx, Inc. Apparatus and methods for treatment of morbid obesity
US20090149871A9 (en) 2002-11-01 2009-06-11 Jonathan Kagan Devices and methods for treating morbid obesity
NL1021935C2 (nl) 2002-11-15 2004-05-18 Tno Werkwijze voor het classificeren van een bodemsoort, meetinrichting en computer programma product voor het uitvoeren van een dergelijke werkwijze.
CN1486667A (zh) 2002-11-22 2004-04-07 带有一次性鞘套的内窥镜系统
DE10257760A1 (de) 2002-11-26 2004-06-17 Stefan Koscher Chirurgisches Instrument
US20040102783A1 (en) 2002-11-27 2004-05-27 Sutterlin Chester E. Powered Kerrison-like Rongeur system
JP2004182840A (ja) 2002-12-03 2004-07-02 Idemitsu Petrochem Co Ltd ポリアリーレンスルフィド樹脂及びその組成物、並びにこれらの製造方法
CN100369637C (zh) * 2002-12-16 2008-02-20 郡是株式会社 医疗用薄膜
US20040147909A1 (en) 2002-12-20 2004-07-29 Gyrus Ent L.L.C. Surgical instrument
US20040121982A1 (en) 2002-12-20 2004-06-24 Leo Martis Biocompatible dialysis fluids containing icodextrins
GB0230055D0 (en) 2002-12-23 2003-01-29 Gyrus Medical Ltd Electrosurgical method and apparatus
US6931830B2 (en) 2002-12-23 2005-08-23 Chase Liao Method of forming a wire package
GB0426648D0 (en) 2004-12-03 2005-01-05 Gyrus Medical Ltd An electrosurgical generator
WO2004062516A1 (en) 2003-01-09 2004-07-29 Gyrus Medical Limited An electrosurgical generator
US6821284B2 (en) 2003-01-22 2004-11-23 Novare Surgical Systems, Inc. Surgical clamp inserts with micro-tractive surfaces
US6960220B2 (en) 2003-01-22 2005-11-01 Cardia, Inc. Hoop design for occlusion device
US20040225186A1 (en) 2003-01-29 2004-11-11 Horne Guy E. Composite flexible endoscope insertion shaft with tubular substructure
US7341591B2 (en) 2003-01-30 2008-03-11 Depuy Spine, Inc. Anterior buttress staple
KR101011312B1 (ko) 2003-02-07 2011-02-07 막스 가부시키가이샤 스테이플용 리필
JP4481247B2 (ja) 2003-02-11 2010-06-16 オリンパス株式会社 オーバーチューブおよびオーバーチューブの製造方法
US20040167572A1 (en) 2003-02-20 2004-08-26 Roth Noah M. Coated medical devices
WO2004076051A2 (en) 2003-02-21 2004-09-10 Argonaut Technologies, Inc. Reactor clamp
ATE374580T1 (de) 2003-03-05 2007-10-15 Gyrus Medical Ltd Elektrochirurgischer generator und system
IL154814A0 (en) 2003-03-09 2003-10-31 Edward G Shifrin Sternal closure system, method and apparatus therefor
US20040193189A1 (en) 2003-03-25 2004-09-30 Kortenbach Juergen A. Passive surgical clip
CA2519461C (en) 2003-03-26 2012-05-29 Tyco Healthcare Group Lp Energy stored in spring with controlled release
US7933644B2 (en) 2003-03-26 2011-04-26 Cytoptics Corporation Instantaneous autonomic nervous function and cardiac predictability based on heart and pulse rate variability analysis
DE10314072B4 (de) 2003-03-28 2009-01-15 Aesculap Ag Chirurgisches Instrument
DE10324844A1 (de) 2003-04-01 2004-12-23 Tuebingen Scientific Surgical Products Gmbh Chirurgisches Instrument mit Instrumentengriff und Nullpunkteinstellung
AU2004233987A1 (en) 2003-04-25 2004-11-11 Applied Medical Resources Corporation Steerable kink-resistant sheath
US8714429B2 (en) 2003-04-29 2014-05-06 Covidien Lp Dissecting tip for surgical stapler
US20040243151A1 (en) 2003-04-29 2004-12-02 Demmy Todd L. Surgical stapling device with dissecting tip
JP4391762B2 (ja) 2003-05-08 2009-12-24 オリンパス株式会社 外科用処置具
US8636191B2 (en) 2003-05-09 2014-01-28 Covidien Lp Anastomotic staple with capillary which expels a bonding agent upon deformation
US7380696B2 (en) 2003-05-20 2008-06-03 Ethicon Endo-Surgery, Inc. Articulating surgical stapling instrument incorporating a two-piece E-beam firing mechanism
US9060770B2 (en) 2003-05-20 2015-06-23 Ethicon Endo-Surgery, Inc. Robotically-driven surgical instrument with E-beam driver
US6988649B2 (en) 2003-05-20 2006-01-24 Ethicon Endo-Surgery, Inc. Surgical stapling instrument having a spent cartridge lockout
US7143923B2 (en) 2003-05-20 2006-12-05 Ethicon Endo-Surgery, Inc. Surgical stapling instrument having a firing lockout for an unclosed anvil
US20070084897A1 (en) 2003-05-20 2007-04-19 Shelton Frederick E Iv Articulating surgical stapling instrument incorporating a two-piece e-beam firing mechanism
US7380695B2 (en) 2003-05-20 2008-06-03 Ethicon Endo-Surgery, Inc. Surgical stapling instrument having a single lockout mechanism for prevention of firing
US6978921B2 (en) 2003-05-20 2005-12-27 Ethicon Endo-Surgery, Inc. Surgical stapling instrument incorporating an E-beam firing mechanism
US7044352B2 (en) 2003-05-20 2006-05-16 Ethicon Endo-Surgery, Inc. Surgical stapling instrument having a single lockout mechanism for prevention of firing
US7090637B2 (en) 2003-05-23 2006-08-15 Novare Surgical Systems, Inc. Articulating mechanism for remote manipulation of a surgical or diagnostic tool
JP3521910B1 (ja) 2003-05-29 2004-04-26 清輝 司馬 内視鏡の外部鉗子チャンネル装置
US20060052825A1 (en) 2003-06-16 2006-03-09 Ransick Mark H Surgical implant alloy
US7905902B2 (en) 2003-06-16 2011-03-15 Ethicon Endo-Surgery, Inc. Surgical implant with preferential corrosion zone
US20040260315A1 (en) 2003-06-17 2004-12-23 Dell Jeffrey R. Expandable tissue support member and method of forming the support member
US7494039B2 (en) 2003-06-17 2009-02-24 Tyco Healthcare Group Lp Surgical stapling device
ES2516091T3 (es) 2003-06-17 2014-10-30 Covidien Lp Dispositivo de grapado quirúrgico
EP3000405A1 (en) 2003-06-20 2016-03-30 Covidien LP Surgical stapling device
US20070093869A1 (en) 2003-06-20 2007-04-26 Medtronic Vascular, Inc. Device, system, and method for contracting tissue in a mammalian body
US6964363B2 (en) 2003-07-09 2005-11-15 Ethicon Endo-Surgery, Inc. Surgical stapling instrument having articulation joint support plates for supporting a firing bar
US6786382B1 (en) 2003-07-09 2004-09-07 Ethicon Endo-Surgery, Inc. Surgical stapling instrument incorporating an articulation joint for a firing bar track
US7111769B2 (en) * 2003-07-09 2006-09-26 Ethicon Endo-Surgery, Inc. Surgical instrument incorporating an articulation mechanism having rotation about the longitudinal axis
US7055731B2 (en) 2003-07-09 2006-06-06 Ethicon Endo-Surgery Inc. Surgical stapling instrument incorporating a tapered firing bar for increased flexibility around the articulation joint
US7213736B2 (en) 2003-07-09 2007-05-08 Ethicon Endo-Surgery, Inc. Surgical stapling instrument incorporating an electroactive polymer actuated firing bar track through an articulation joint
US6981628B2 (en) 2003-07-09 2006-01-03 Ethicon Endo-Surgery, Inc. Surgical instrument with a lateral-moving articulation control
US7931695B2 (en) 2003-07-15 2011-04-26 Kensey Nash Corporation Compliant osteosynthesis fixation plate
EP1643914B1 (en) 2003-07-16 2015-09-23 Covidien LP Surgical stapling device with tissue tensioner
JP4304697B2 (ja) * 2003-07-30 2009-07-29 インターナショナル・ビジネス・マシーンズ・コーポレーション ダイナミック半導体記憶装置及びその動作方法
US20050059997A1 (en) 2003-09-17 2005-03-17 Bauman Ann M. Circular stapler buttress
US7547312B2 (en) 2003-09-17 2009-06-16 Gore Enterprise Holdings, Inc. Circular stapler buttress
US7364061B2 (en) 2003-09-29 2008-04-29 Ethicon Endo-Surgery, Inc. Surgical stapling instrument incorporating a multistroke firing position indicator and retraction mechanism
US7303108B2 (en) 2003-09-29 2007-12-04 Ethicon Endo-Surgery, Inc. Surgical stapling instrument incorporating a multi-stroke firing mechanism with a flexible rack
US6959852B2 (en) 2003-09-29 2005-11-01 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with multistroke firing incorporating an anti-backup mechanism
US7000819B2 (en) 2003-09-29 2006-02-21 Ethicon Endo-Surgery, Inc. Surgical stapling instrument having multistroke firing incorporating a traction-biased ratcheting mechanism
US7083075B2 (en) 2003-09-29 2006-08-01 Ethicon Endo-Surgery, Inc. Multi-stroke mechanism with automatic end of stroke retraction
US6905057B2 (en) 2003-09-29 2005-06-14 Ethicon Endo-Surgery, Inc. Surgical stapling instrument incorporating a firing mechanism having a linked rack transmission
US20050070929A1 (en) 2003-09-30 2005-03-31 Dalessandro David A. Apparatus and method for attaching a surgical buttress to a stapling apparatus
US7556647B2 (en) 2003-10-08 2009-07-07 Arbor Surgical Technologies, Inc. Attachment device and methods of using the same
JP4170950B2 (ja) 2003-10-10 2008-10-22 松下電器産業株式会社 光学デバイスおよびその製造方法
US7914543B2 (en) 2003-10-14 2011-03-29 Satiety, Inc. Single fold device for tissue fixation
US7296722B2 (en) 2003-10-17 2007-11-20 Tyco Healthcare Group Lp Surgical fastener applying apparatus with controlled beam deflection
US9113880B2 (en) 2007-10-05 2015-08-25 Covidien Lp Internal backbone structural chassis for a surgical device
US20090090763A1 (en) 2007-10-05 2009-04-09 Tyco Healthcare Group Lp Powered surgical stapling device
AU2004281832B2 (en) 2003-10-17 2010-11-18 Covidien Lp Surgical stapling device with independent tip rotation
US7364060B2 (en) 2003-10-17 2008-04-29 Tyco Healthcare Group Lp Surgical stapling device with tiltable anvil head
US8806973B2 (en) 2009-12-02 2014-08-19 Covidien Lp Adapters for use between surgical handle assembly and surgical end effector
US20050090817A1 (en) 2003-10-22 2005-04-28 Scimed Life Systems, Inc. Bendable endoscopic bipolar device
US20050112139A1 (en) 2003-10-23 2005-05-26 Nmk Research, Llc Immunogenic composition and method of developing a vaccine based on factor H binding sites
US7147650B2 (en) 2003-10-30 2006-12-12 Woojin Lee Surgical instrument
US7842028B2 (en) 2005-04-14 2010-11-30 Cambridge Endoscopic Devices, Inc. Surgical instrument guide device
JP2005131211A (ja) 2003-10-31 2005-05-26 Olympus Corp 内視鏡用の外付けチャンネル
JP2005131163A (ja) 2003-10-31 2005-05-26 Olympus Corp 内視鏡用の外付けチャンネル
JP2005131173A (ja) 2003-10-31 2005-05-26 Olympus Corp 内視鏡用外付けチャンネル
JP2005131164A (ja) 2003-10-31 2005-05-26 Olympus Corp 内視鏡用の外付けチャンネル
JP2005131212A (ja) 2003-10-31 2005-05-26 Olympus Corp 内視鏡用の外付けチャンネル及び内視鏡装置
JP2005137423A (ja) 2003-11-04 2005-06-02 Olympus Corp 内視鏡用の外付けチャンネルおよび外付けチャンネル用分岐部材
JP4594612B2 (ja) 2003-11-27 2010-12-08 オリンパス株式会社 挿入補助具
GB2408936B (en) 2003-12-09 2007-07-18 Gyrus Group Plc A surgical instrument
US8590764B2 (en) 2003-12-24 2013-11-26 Boston Scientific Scimed, Inc. Circumferential full thickness resectioning device
CN1634601A (zh) 2003-12-26 2005-07-06 吉林省中立实业有限公司 一种用于医疗器械灭菌的方法
US7207472B2 (en) 2003-12-30 2007-04-24 Ethicon Endo-Surgery, Inc. Cartridge with locking knife for a curved cutter stapler
US6988650B2 (en) 2003-12-30 2006-01-24 Ethicon Endo-Surgery, Inc. Retaining pin lever advancement mechanism for a curved cutter stapler
US7134587B2 (en) 2003-12-30 2006-11-14 Ethicon Endo-Surgery, Inc. Knife retraction arm for a curved cutter stapler
US7147140B2 (en) 2003-12-30 2006-12-12 Ethicon Endo - Surgery, Inc. Cartridge retainer for a curved cutter stapler
US7549563B2 (en) 2003-12-30 2009-06-23 Ethicon Endo-Surgery, Inc. Rotating curved cutter stapler
US20050139636A1 (en) 2003-12-30 2005-06-30 Schwemberger Richard F. Replaceable cartridge module for a surgical stapling and cutting instrument
US7147139B2 (en) 2003-12-30 2006-12-12 Ethicon Endo-Surgery, Inc Closure plate lockout for a curved cutter stapler
US20050143759A1 (en) 2003-12-30 2005-06-30 Kelly William D. Curved cutter stapler shaped for male pelvis
US7204835B2 (en) 2004-02-02 2007-04-17 Gyrus Medical, Inc. Surgical instrument
WO2005076892A2 (en) 2004-02-06 2005-08-25 Virologic, Inc. Method for determining reduced susceptibility of hiv to protease inhibitor treatment
GB0403020D0 (en) 2004-02-11 2004-03-17 Pa Consulting Services Portable charging device
TW200539103A (en) 2004-02-11 2005-12-01 Koninkl Philips Electronics Nv Electrophoretic display with reduced image retention using rail-stabilized driving
US8920443B2 (en) 2004-02-17 2014-12-30 Cook Biotech Incorporated Medical devices and methods useful for applying bolster material
EP2253277B1 (en) 2004-02-17 2012-09-19 Tyco Healthcare Group LP Surgical Stapling Apparatus With Locking Mechanism
US6953138B1 (en) 2004-02-18 2005-10-11 Frank W. Dworak Surgical stapler anvil with nested staple forming pockets
US8046049B2 (en) 2004-02-23 2011-10-25 Biosense Webster, Inc. Robotically guided catheter
JP2005279253A (ja) 2004-03-02 2005-10-13 Olympus Corp 内視鏡
US20050203550A1 (en) 2004-03-11 2005-09-15 Laufer Michael D. Surgical fastener
AU2005226643B2 (en) 2004-03-19 2010-07-22 Covidien Lp Anvil assembly with improved cut ring
US8181840B2 (en) * 2004-03-19 2012-05-22 Tyco Healthcare Group Lp Tissue tensioner assembly and approximation mechanism for surgical stapling device
JP2005285038A (ja) 2004-03-31 2005-10-13 Nec Corp 携帯電話機、そのメッセージ作成方法及びプログラム
US7993381B2 (en) 2004-04-01 2011-08-09 Mac Beam, Inc. Method and apparatus for treating the body
US7758612B2 (en) 2004-04-27 2010-07-20 Tyco Healthcare Group Lp Surgery delivery device and mesh anchor
WO2005110243A2 (en) * 2004-05-03 2005-11-24 Ams Research Corporation Surgical implants and related methods
US8333764B2 (en) 2004-05-12 2012-12-18 Medtronic, Inc. Device and method for determining tissue thickness and creating cardiac ablation lesions
GB2414185A (en) 2004-05-20 2005-11-23 Gyrus Medical Ltd Morcellating device using cutting electrodes on end-face of tube
IES20040368A2 (en) 2004-05-25 2005-11-30 James E Coleman Surgical stapler
WO2005122428A2 (en) 2004-06-03 2005-12-22 Widefi, Inc. Frequency translating repeater with low cost high performance local oscillator architecture
DE102004027850A1 (de) 2004-06-08 2006-01-05 Henke-Sass Wolf Gmbh Biegbarer Abschnitt eines Einführtubus eines Endoskopes und Verfahren zu dessen Herstellung
GB2415140A (en) 2004-06-18 2005-12-21 Gyrus Medical Ltd A surgical instrument
US7059508B2 (en) 2004-06-30 2006-06-13 Ethicon Endo-Surgery, Inc. Surgical stapling instrument incorporating an uneven multistroke firing mechanism having a rotary transmission
US7485133B2 (en) 2004-07-14 2009-02-03 Warsaw Orthopedic, Inc. Force diffusion spinal hook
US20090078736A1 (en) 2004-07-26 2009-03-26 Van Lue Stephen J Surgical stapler with magnetically secured components
US7857183B2 (en) 2004-07-28 2010-12-28 Ethicon Endo-Surgery, Inc. Surgical instrument incorporating an electrically actuated articulation mechanism
US8215531B2 (en) 2004-07-28 2012-07-10 Ethicon Endo-Surgery, Inc. Surgical stapling instrument having a medical substance dispenser
US7147138B2 (en) 2004-07-28 2006-12-12 Ethicon Endo-Surgery, Inc. Surgical stapling instrument having an electroactive polymer actuated buttress deployment mechanism
US7404509B2 (en) 2004-07-28 2008-07-29 Ethicon Endo-Surgery, Inc. Electroactive polymer-based articulation mechanism for linear stapler
US8905977B2 (en) 2004-07-28 2014-12-09 Ethicon Endo-Surgery, Inc. Surgical stapling instrument having an electroactive polymer actuated medical substance dispenser
US7506790B2 (en) 2004-07-28 2009-03-24 Ethicon Endo-Surgery, Inc. Surgical instrument incorporating an electrically actuated articulation mechanism
US7143925B2 (en) 2004-07-28 2006-12-05 Ethicon Endo-Surgery, Inc. Surgical instrument incorporating EAP blocking lockout mechanism
US9072535B2 (en) 2011-05-27 2015-07-07 Ethicon Endo-Surgery, Inc. Surgical stapling instruments with rotatable staple deployment arrangements
US8317074B2 (en) 2004-07-28 2012-11-27 Ethicon Endo-Surgery, Inc. Electroactive polymer-based articulation mechanism for circular stapler
AU2005203213C1 (en) 2004-07-28 2012-07-05 Ethicon Endo-Surgery, Inc. Surgical stapling instrument having an electroactive polymer actuated medical substance dispenser
US7354447B2 (en) 2005-11-10 2008-04-08 Ethicon Endo-Surgery, Inc. Disposable loading unit and surgical instruments including same
US7143926B2 (en) 2005-02-07 2006-12-05 Ethicon Endo-Surgery, Inc. Surgical stapling instrument incorporating a multi-stroke firing mechanism with return spring rotary manual retraction system
US7210609B2 (en) 2004-07-30 2007-05-01 Tools For Surgery, Llc Stapling apparatus having a curved anvil and driver
WO2006023578A2 (en) * 2004-08-17 2006-03-02 Tyco Healthcare Group, Lp Stapling support structures
WO2006023486A1 (en) 2004-08-19 2006-03-02 Tyco Healthcare Group, Lp Water-swellable copolymers and articles and coating made therefrom
US7182239B1 (en) 2004-08-27 2007-02-27 Myers Stephan R Segmented introducer device for a circular surgical stapler
US7128254B2 (en) 2004-09-07 2006-10-31 Ethicon Endo-Surgery, Inc. Surgical stapling instrument incorporating a multistroke firing mechanism having a rotary slip-clutch transmission
KR100646762B1 (ko) 2004-09-10 2006-11-23 인하대학교 산학협력단 수술용 스테이플 및 이를 구비한 수술용 자동 문합기
CA2579606C (en) 2004-09-10 2012-04-17 Ethicon Endo-Surgery, Inc. Surgical stapling instrument
JP2006081687A (ja) * 2004-09-15 2006-03-30 Max Co Ltd 医療用ステープラ
WO2006044581A2 (en) 2004-10-13 2006-04-27 Medtronic, Inc. Single-use transurethral needle ablation device
US7857813B2 (en) 2006-08-29 2010-12-28 Baxano, Inc. Tissue access guidewire system and method
US8257356B2 (en) 2004-10-15 2012-09-04 Baxano, Inc. Guidewire exchange systems to treat spinal stenosis
US8372094B2 (en) 2004-10-15 2013-02-12 Covidien Lp Seal element for anastomosis
US7455682B2 (en) 2004-10-18 2008-11-25 Tyco Healthcare Group Lp Structure containing wound treatment material
ES2530775T3 (es) * 2004-10-18 2015-03-05 Covidien Lp Estructura adhesiva anular
CA2584022C (en) 2004-10-18 2013-12-10 Tyco Healthcare Group Lp Surgical fasteners coated with wound treatment materials
US7922743B2 (en) 2004-10-18 2011-04-12 Tyco Healthcare Group Lp Structure for applying sprayable wound treatment material
AU2005295476B2 (en) 2004-10-18 2011-03-24 Covidien Lp Extraluminal sealant applicator and method
US7717313B2 (en) 2004-10-18 2010-05-18 Tyco Healthcare Group Lp Surgical apparatus and structure for applying sprayable wound treatment material
US7938307B2 (en) 2004-10-18 2011-05-10 Tyco Healthcare Group Lp Support structures and methods of using the same
US7328829B2 (en) 2004-12-13 2008-02-12 Niti Medical Technologies Ltd. Palm size surgical stapler for single hand operation
US7121446B2 (en) 2004-12-13 2006-10-17 Niti Medical Technologies Ltd. Palm-size surgical stapler for single hand operation
JP2005131423A (ja) 2005-01-06 2005-05-26 Sansei R & D:Kk パチンコ遊技機における遊技機枠の取付構造
DE102005001502A1 (de) 2005-01-10 2006-07-20 Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V. Strahlungsschutzschirm
US20060161185A1 (en) 2005-01-14 2006-07-20 Usgi Medical Inc. Methods and apparatus for transmitting force to an end effector over an elongate member
US20060173470A1 (en) 2005-01-31 2006-08-03 Oray B N Surgical fastener buttress material
US7780054B2 (en) 2005-02-18 2010-08-24 Ethicon Endo-Surgery, Inc. Surgical instrument with laterally moved shaft actuator coupled to pivoting articulation joint
US7654431B2 (en) 2005-02-18 2010-02-02 Ethicon Endo-Surgery, Inc. Surgical instrument with guided laterally moving articulation member
US7559450B2 (en) 2005-02-18 2009-07-14 Ethicon Endo-Surgery, Inc. Surgical instrument incorporating a fluid transfer controlled articulation mechanism
US7784662B2 (en) 2005-02-18 2010-08-31 Ethicon Endo-Surgery, Inc. Surgical instrument with articulating shaft with single pivot closure and double pivot frame ground
US7559452B2 (en) 2005-02-18 2009-07-14 Ethicon Endo-Surgery, Inc. Surgical instrument having fluid actuated opposing jaws
US20060289602A1 (en) 2005-06-23 2006-12-28 Ethicon Endo-Surgery, Inc. Surgical instrument with articulating shaft with double pivot closure and single pivot frame ground
US7699846B2 (en) 2005-03-04 2010-04-20 Gyrus Ent L.L.C. Surgical instrument and method
US7674263B2 (en) 2005-03-04 2010-03-09 Gyrus Ent, L.L.C. Surgical instrument and method
US20060201989A1 (en) 2005-03-11 2006-09-14 Ojeda Herminio F Surgical anvil and system for deploying the same
US7942890B2 (en) 2005-03-15 2011-05-17 Tyco Healthcare Group Lp Anastomosis composite gasket
US20070203510A1 (en) 2006-02-28 2007-08-30 Bettuchi Michael J Annular disk for reduction of anastomotic tension and methods of using the same
US7784663B2 (en) 2005-03-17 2010-08-31 Ethicon Endo-Surgery, Inc. Surgical stapling instrument having load sensing control circuitry
JP4857585B2 (ja) 2005-04-04 2012-01-18 日立工機株式会社 コードレス電動工具
US7837694B2 (en) 2005-04-28 2010-11-23 Warsaw Orthopedic, Inc. Method and apparatus for surgical instrument identification
DE102005020377B4 (de) 2005-05-02 2021-08-12 Robert Bosch Gmbh Verfahren zum Betreiben einer Elektrowerkzeugmaschine
US7806871B2 (en) 2005-05-09 2010-10-05 Boston Scientific Scimed, Inc. Method and device for tissue removal and for delivery of a therapeutic agent or bulking agent
DE102005023693A1 (de) 2005-05-23 2006-12-07 Robert Bosch Gmbh Vorrichtung zur Ansteuerung von wenigstens einer Fahrzeugkomponente zum Schutz von wenigstens einem Fahrzeuginsassen
CN101184445B (zh) 2005-05-25 2010-05-19 佳乐医疗公司 手术器械
CA2838528C (en) 2005-06-02 2016-01-05 Tyco Healthcare Group Lp Multiple coil staple and staple applier
CA2549224A1 (en) 2005-06-02 2006-12-02 Tyco Healthcare Group Lp Expandable backspan staple
US7717312B2 (en) 2005-06-03 2010-05-18 Tyco Healthcare Group Lp Surgical instruments employing sensors
AU2006344427B2 (en) 2005-06-03 2012-03-01 Covidien Lp Surgical stapler with timer and feedback display
EP1893101A4 (en) 2005-06-03 2017-01-04 Covidien LP Battery powered surgical instrument
CA2613277C (en) 2005-06-28 2016-05-10 Stryker Corporation Powered surgical tool with control module that contains a sensor for remotely monitoring the tool power generating unit
US8679154B2 (en) 2007-01-12 2014-03-25 Ethicon Endo-Surgery, Inc. Adjustable compression staple and method for stapling with adjustable compression
US8579176B2 (en) 2005-07-26 2013-11-12 Ethicon Endo-Surgery, Inc. Surgical stapling and cutting device and method for using the device
US7959050B2 (en) 2005-07-26 2011-06-14 Ethicon Endo-Surgery, Inc Electrically self-powered surgical instrument with manual release
US8627995B2 (en) 2006-05-19 2014-01-14 Ethicon Endo-Sugery, Inc. Electrically self-powered surgical instrument with cryptographic identification of interchangeable part
US8573462B2 (en) 2006-05-19 2013-11-05 Ethicon Endo-Surgery, Inc. Electrical surgical instrument with optimized power supply and drive
EP1917125B1 (en) 2005-07-27 2011-09-07 Tyco Healthcare Group LP Staple pocket arrangement for surgical stapler
US7758512B2 (en) 2005-07-28 2010-07-20 Ethicon Endo-Surgery, Inc. Electroactive polymer-based lumen traversing device
US20070027551A1 (en) 2005-07-29 2007-02-01 Farnsworth Ted R Composite self-cohered web materials
DE102005036927A1 (de) 2005-08-05 2007-02-08 Technische Universität Darmstadt Vorrichtung zur Messung der geometrischen Veränderung eines Objektes, Zugprüfmaschine und Verwendung der Vorrichtung
US7641092B2 (en) 2005-08-05 2010-01-05 Ethicon Endo - Surgery, Inc. Swing gate for device lockout in a curved cutter stapler
JP2007048132A (ja) 2005-08-11 2007-02-22 Tamura Gakuen 空港等の大規模施設の客誘導システム
US7407075B2 (en) 2005-08-15 2008-08-05 Tyco Healthcare Group Lp Staple cartridge having multiple staple sizes for a surgical stapling instrument
US7398908B2 (en) 2005-08-15 2008-07-15 Tyco Healthcare Group Lp Surgical stapling instruments including a cartridge having multiple staple sizes
US7401721B2 (en) 2005-08-15 2008-07-22 Tyco Healthcare Group Lp Surgical stapling instruments including a cartridge having multiple staple sizes
US7669746B2 (en) 2005-08-31 2010-03-02 Ethicon Endo-Surgery, Inc. Staple cartridges for forming staples having differing formed staple heights
US20070194082A1 (en) 2005-08-31 2007-08-23 Morgan Jerome R Surgical stapling device with anvil having staple forming pockets of varying depths
US7934630B2 (en) 2005-08-31 2011-05-03 Ethicon Endo-Surgery, Inc. Staple cartridges for forming staples having differing formed staple heights
US9237891B2 (en) 2005-08-31 2016-01-19 Ethicon Endo-Surgery, Inc. Robotically-controlled surgical stapling devices that produce formed staples having different lengths
US7500979B2 (en) 2005-08-31 2009-03-10 Ethicon Endo-Surgery, Inc. Surgical stapling device with multiple stacked actuator wedge cams for driving staple drivers
US8800838B2 (en) 2005-08-31 2014-08-12 Ethicon Endo-Surgery, Inc. Robotically-controlled cable-based surgical end effectors
JP4348440B2 (ja) 2005-09-01 2009-10-21 有洙 安 透過性補強材と発泡体を利用したベッド用マットレス及びその製造方法
US20070051375A1 (en) 2005-09-06 2007-03-08 Milliman Keith L Instrument introducer
US7407078B2 (en) 2005-09-21 2008-08-05 Ehthicon Endo-Surgery, Inc. Surgical stapling instrument having force controlled spacing end effector
US7467740B2 (en) 2005-09-21 2008-12-23 Ethicon Endo-Surgery, Inc. Surgical stapling instruments having flexible channel and anvil features for adjustable staple heights
EP1767163A1 (en) 2005-09-22 2007-03-28 Sherwood Services AG Bipolar forceps with multiple electrode array end effector assembly
EP1769768A1 (en) 2005-09-28 2007-04-04 DePuy Orthopädie GmbH Surgical instrument calibration
US7357287B2 (en) 2005-09-29 2008-04-15 Ethicon Endo-Surgery, Inc. Surgical stapling instrument having preloaded firing assistance mechanism
CA2561653C (en) 2005-09-30 2014-07-08 Ethicon Endo-Surgery, Inc. Electroactive polymer-based articulation mechanism for linear surgical stapler
US7635074B2 (en) 2005-10-04 2009-12-22 Tyco Healthcare Group Lp Staple drive assembly
EP2919295B1 (en) 2005-10-31 2018-08-29 Black & Decker, Inc. Method of arranging the components of a battery pack
US20070102472A1 (en) 2005-11-04 2007-05-10 Ethicon Endo-Surgery, Inc. Electrosurgical stapling instrument with disposable severing / stapling unit
US7607557B2 (en) 2005-11-04 2009-10-27 Ethicon Endo-Surgery, Inc. Surgical stapling instruments structured for pump-assisted delivery of medical agents
US7328828B2 (en) 2005-11-04 2008-02-12 Ethicon Endo-Surgery, Inc, Lockout mechanisms and surgical instruments including same
US7673783B2 (en) 2005-11-04 2010-03-09 Ethicon Endo-Surgery, Inc. Surgical stapling instruments structured for delivery of medical agents
US20070106317A1 (en) 2005-11-09 2007-05-10 Shelton Frederick E Iv Hydraulically and electrically actuated articulation joints for surgical instruments
US7799039B2 (en) 2005-11-09 2010-09-21 Ethicon Endo-Surgery, Inc. Surgical instrument having a hydraulically actuated end effector
US7673780B2 (en) 2005-11-09 2010-03-09 Ethicon Endo-Surgery, Inc. Articulation joint with improved moment arm extension for articulating an end effector of a surgical instrument
US7651017B2 (en) 2005-11-23 2010-01-26 Ethicon Endo-Surgery, Inc. Surgical stapler with a bendable end effector
US7246734B2 (en) 2005-12-05 2007-07-24 Ethicon Endo-Surgery, Inc. Rotary hydraulic pump actuated multi-stroke surgical instrument
US7670334B2 (en) 2006-01-10 2010-03-02 Ethicon Endo-Surgery, Inc. Surgical instrument having an articulating end effector
US7891531B1 (en) 2006-01-31 2011-02-22 Ward Gary L Sub-miniature surgical staple cartridge
US20110295295A1 (en) 2006-01-31 2011-12-01 Ethicon Endo-Surgery, Inc. Robotically-controlled surgical instrument having recording capabilities
US8708213B2 (en) 2006-01-31 2014-04-29 Ethicon Endo-Surgery, Inc. Surgical instrument having a feedback system
US20120292367A1 (en) 2006-01-31 2012-11-22 Ethicon Endo-Surgery, Inc. Robotically-controlled end effector
US7575144B2 (en) 2006-01-31 2009-08-18 Ethicon Endo-Surgery, Inc. Surgical fastener and cutter with single cable actuator
US7845537B2 (en) 2006-01-31 2010-12-07 Ethicon Endo-Surgery, Inc. Surgical instrument having recording capabilities
US7422139B2 (en) 2006-01-31 2008-09-09 Ethicon Endo-Surgery, Inc. Motor-driven surgical cutting fastening instrument with tactile position feedback
US7464849B2 (en) 2006-01-31 2008-12-16 Ethicon Endo-Surgery, Inc. Electro-mechanical surgical instrument with closure system and anvil alignment components
US7568603B2 (en) 2006-01-31 2009-08-04 Ethicon Endo-Surgery, Inc. Motor-driven surgical cutting and fastening instrument with articulatable end effector
US7766210B2 (en) 2006-01-31 2010-08-03 Ethicon Endo-Surgery, Inc. Motor-driven surgical cutting and fastening instrument with user feedback system
US7770775B2 (en) 2006-01-31 2010-08-10 Ethicon Endo-Surgery, Inc. Motor-driven surgical cutting and fastening instrument with adaptive user feedback
US7644848B2 (en) 2006-01-31 2010-01-12 Ethicon Endo-Surgery, Inc. Electronic lockouts and surgical instrument including same
US20070175951A1 (en) 2006-01-31 2007-08-02 Shelton Frederick E Iv Gearing selector for a powered surgical cutting and fastening instrument
US20070175950A1 (en) 2006-01-31 2007-08-02 Shelton Frederick E Iv Disposable staple cartridge having an anvil with tissue locator for use with a surgical cutting and fastening instrument and modular end effector system therefor
US7464846B2 (en) 2006-01-31 2008-12-16 Ethicon Endo-Surgery, Inc. Surgical instrument having a removable battery
US8186555B2 (en) 2006-01-31 2012-05-29 Ethicon Endo-Surgery, Inc. Motor-driven surgical cutting and fastening instrument with mechanical closure system
US7416101B2 (en) 2006-01-31 2008-08-26 Ethicon Endo-Surgery, Inc. Motor-driven surgical cutting and fastening instrument with loading force feedback
US20110024477A1 (en) 2009-02-06 2011-02-03 Hall Steven G Driven Surgical Stapler Improvements
US20070175955A1 (en) 2006-01-31 2007-08-02 Shelton Frederick E Iv Surgical cutting and fastening instrument with closure trigger locking mechanism
US8161977B2 (en) 2006-01-31 2012-04-24 Ethicon Endo-Surgery, Inc. Accessing data stored in a memory of a surgical instrument
US7753904B2 (en) 2006-01-31 2010-07-13 Ethicon Endo-Surgery, Inc. Endoscopic surgical instrument with a handle that can articulate with respect to the shaft
US20110006101A1 (en) 2009-02-06 2011-01-13 EthiconEndo-Surgery, Inc. Motor driven surgical fastener device with cutting member lockout arrangements
US9629626B2 (en) 2006-02-02 2017-04-25 Covidien Lp Mechanically tuned buttress material to assist with proper formation of surgical element in diseased tissue
CN201263101Y (zh) 2006-02-20 2009-06-24 布莱克和戴克公司 具有双换向器条组及可选串联并联连接线圈的直流电动机
CN100520351C (zh) 2006-03-03 2009-07-29 北京工业大学 单根纳米线原位力学性能测试和结构分析的方法及其装置
US8721630B2 (en) 2006-03-23 2014-05-13 Ethicon Endo-Surgery, Inc. Methods and devices for controlling articulation
US8236010B2 (en) 2006-03-23 2012-08-07 Ethicon Endo-Surgery, Inc. Surgical fastener and cutter with mimicking end effector
US8992422B2 (en) 2006-03-23 2015-03-31 Ethicon Endo-Surgery, Inc. Robotically-controlled endoscopic accessory channel
US9675375B2 (en) 2006-03-29 2017-06-13 Ethicon Llc Ultrasonic surgical system and method
US20070243227A1 (en) 2006-04-14 2007-10-18 Michael Gertner Coatings for surgical staplers
US20070246505A1 (en) * 2006-04-24 2007-10-25 Medical Ventures Inc. Surgical buttress assemblies and methods of uses thereof
US7278563B1 (en) 2006-04-25 2007-10-09 Green David T Surgical instrument for progressively stapling and incising tissue
EP2015681B1 (en) 2006-05-03 2018-03-28 Datascope Corp. Tissue closure device
EP2475063B1 (en) 2006-05-19 2014-03-05 Ethicon Endo-Surgery, Inc. Electrical surgical instrument
US8105350B2 (en) 2006-05-23 2012-01-31 Cambridge Endoscopic Devices, Inc. Surgical instrument
EP2029054A2 (en) * 2006-06-01 2009-03-04 Mor Research Applications Ltd. Membrane augmentation, such as of for treatment of cardiac valves, and fastening devices for membrane augmentation
US7615067B2 (en) 2006-06-05 2009-11-10 Cambridge Endoscopic Devices, Inc. Surgical instrument
US20070286892A1 (en) 2006-06-13 2007-12-13 Uri Herzberg Compositions and methods for preventing or reducing postoperative ileus and gastric stasis in mammals
DE202007003114U1 (de) 2006-06-13 2007-06-21 Olympus Winter & Ibe Gmbh Medizinische Zange mit Bajonettverbindung
CA2655770C (en) 2006-06-21 2013-07-30 Rudolf Steffen Device for insertion and positioning of surgical instruments and corresponding method
US8322455B2 (en) 2006-06-27 2012-12-04 Ethicon Endo-Surgery, Inc. Manually driven surgical cutting and fastening instrument
EP1875870B1 (en) 2006-07-07 2009-12-02 Ethicon Endo-Surgery, Inc. A surgical stapling instrument.
CA2592221C (en) 2006-07-11 2014-10-07 Tyco Healthcare Group Lp Skin staples with thermal properties
RU61122U1 (ru) * 2006-07-14 2007-02-27 Нина Васильевна Гайгерова Хирургический сшиватель
US7448525B2 (en) 2006-08-02 2008-11-11 Ethicon Endo-Surgery, Inc. Pneumatically powered surgical cutting and fastening instrument with manually operated retraction apparatus
US7740159B2 (en) 2006-08-02 2010-06-22 Ethicon Endo-Surgery, Inc. Pneumatically powered surgical cutting and fastening instrument with a variable control of the actuating rate of firing with mechanical power assist
US20080029574A1 (en) 2006-08-02 2008-02-07 Shelton Frederick E Pneumatically powered surgical cutting and fastening instrument with actuator at distal end
EP2068759A4 (en) 2006-08-09 2013-04-10 Coherex Medical Inc METHODS, SYSTEMS AND DEVICES FOR REDUCING THE SIZE OF AN INTERNAL TISSUE OPENING
US7708758B2 (en) 2006-08-16 2010-05-04 Cambridge Endoscopic Devices, Inc. Surgical instrument
US8794496B2 (en) 2006-09-11 2014-08-05 Covidien Lp Rotating knob locking mechanism for surgical stapling device
US7780663B2 (en) 2006-09-22 2010-08-24 Ethicon Endo-Surgery, Inc. End effector coatings for electrosurgical instruments
US20100133317A1 (en) 2006-09-29 2010-06-03 Shelton Iv Frederick E Motor-Driven Surgical Cutting And Fastening Instrument with Tactile Position Feedback
US10130359B2 (en) 2006-09-29 2018-11-20 Ethicon Llc Method for forming a staple
US8720766B2 (en) * 2006-09-29 2014-05-13 Ethicon Endo-Surgery, Inc. Surgical stapling instruments and staples
US20080082114A1 (en) 2006-09-29 2008-04-03 Mckenna Robert H Adhesive Mechanical Fastener for Lumen Creation Utilizing Tissue Necrosing Means
US8708210B2 (en) 2006-10-05 2014-04-29 Covidien Lp Method and force-limiting handle mechanism for a surgical instrument
US8584921B2 (en) 2006-10-06 2013-11-19 Covidien Lp Surgical instrument with articulating tool assembly
ATE435613T1 (de) 2006-10-06 2009-07-15 Ethicon Endo Surgery Inc Verbesserungen betreffend einen applikator zum anbringen von anastomosenringen
US20080086078A1 (en) 2006-10-06 2008-04-10 Powell Darrel M Devices for reduction of post operative ileus
US7845533B2 (en) 2007-06-22 2010-12-07 Tyco Healthcare Group Lp Detachable buttress material retention systems for use with a surgical stapling device
ES2627615T3 (es) 2006-10-26 2017-07-28 Covidien Lp Dispositivo que utiliza aleaciones con memoria de forma para conexión de contrafuerte
JP5033988B2 (ja) 2006-10-30 2012-09-26 株式会社大一商会 遊技機
US7708180B2 (en) 2006-11-09 2010-05-04 Ethicon Endo-Surgery, Inc. Surgical fastening device with initiator impregnation of a matrix or buttress to improve adhesive application
US7780685B2 (en) 2006-11-09 2010-08-24 Ethicon Endo-Surgery, Inc. Adhesive and mechanical fastener
US7721930B2 (en) 2006-11-10 2010-05-25 Thicon Endo-Surgery, Inc. Disposable cartridge with adhesive for use with a stapling device
US8114100B2 (en) 2006-12-06 2012-02-14 Ethicon Endo-Surgery, Inc. Safety fastener for tissue apposition
US7434716B2 (en) 2006-12-21 2008-10-14 Tyco Healthcare Group Lp Staple driver for articulating surgical stapler
US8459520B2 (en) 2007-01-10 2013-06-11 Ethicon Endo-Surgery, Inc. Surgical instrument with wireless communication between control unit and remote sensor
US8652120B2 (en) 2007-01-10 2014-02-18 Ethicon Endo-Surgery, Inc. Surgical instrument with wireless communication between control unit and sensor transponders
US7900805B2 (en) 2007-01-10 2011-03-08 Ethicon Endo-Surgery, Inc. Surgical instrument with enhanced battery performance
US7721936B2 (en) 2007-01-10 2010-05-25 Ethicon Endo-Surgery, Inc. Interlock and surgical instrument including same
US8840603B2 (en) 2007-01-10 2014-09-23 Ethicon Endo-Surgery, Inc. Surgical instrument with wireless communication between control unit and sensor transponders
US20110174861A1 (en) 2007-01-10 2011-07-21 Shelton Iv Frederick E Surgical Instrument With Wireless Communication Between Control Unit and Remote Sensor
US8684253B2 (en) 2007-01-10 2014-04-01 Ethicon Endo-Surgery, Inc. Surgical instrument with wireless communication between a control unit of a robotic system and remote sensor
US7738971B2 (en) 2007-01-10 2010-06-15 Ethicon Endo-Surgery, Inc. Post-sterilization programming of surgical instruments
US7954682B2 (en) 2007-01-10 2011-06-07 Ethicon Endo-Surgery, Inc. Surgical instrument with elements to communicate between control unit and end effector
US7721931B2 (en) 2007-01-10 2010-05-25 Ethicon Endo-Surgery, Inc. Prevention of cartridge reuse in a surgical instrument
US20080169328A1 (en) 2007-01-11 2008-07-17 Shelton Frederick E Buttress material for use with a surgical stapler
US8540128B2 (en) 2007-01-11 2013-09-24 Ethicon Endo-Surgery, Inc. Surgical stapling device with a curved end effector
WO2008089404A2 (en) 2007-01-19 2008-07-24 Synovis Life Technologies, Inc. Circular stapler anvil introducer
US20080200762A1 (en) 2007-02-16 2008-08-21 Stokes Michael J Flexible endoscope shapelock
WO2008100125A1 (es) 2007-02-16 2008-08-21 Marco Antonio Lopez Zepeda Manipulador uterino para realizar extirpación completa de úteros en humanos.
US8011550B2 (en) 2009-03-31 2011-09-06 Tyco Healthcare Group Lp Surgical stapling apparatus
US8011555B2 (en) 2007-03-06 2011-09-06 Tyco Healthcare Group Lp Surgical stapling apparatus
US9888924B2 (en) 2007-03-06 2018-02-13 Covidien Lp Wound closure material
EP3087929B1 (en) 2007-03-06 2020-04-29 Covidien LP Surgical stapling apparatus
US7422136B1 (en) 2007-03-15 2008-09-09 Tyco Healthcare Group Lp Powered surgical stapling device
US8590762B2 (en) 2007-03-15 2013-11-26 Ethicon Endo-Surgery, Inc. Staple cartridge cavity configurations
US7431188B1 (en) 2007-03-15 2008-10-07 Tyco Healthcare Group Lp Surgical stapling apparatus with powered articulation
EP3195814A1 (en) 2007-03-22 2017-07-26 Covidien LP Apparatus for forming variable height surgical fasteners
US8056787B2 (en) * 2007-03-28 2011-11-15 Ethicon Endo-Surgery, Inc. Surgical stapling and cutting instrument with travel-indicating retraction member
US8893946B2 (en) 2007-03-28 2014-11-25 Ethicon Endo-Surgery, Inc. Laparoscopic tissue thickness and clamp load measuring devices
US7490749B2 (en) 2007-03-28 2009-02-17 Ethicon Endo-Surgery, Inc. Surgical stapling and cutting instrument with manually retractable firing member
US9427223B2 (en) 2007-04-09 2016-08-30 Creative Surgical, Llc Frame device
US8006885B2 (en) 2007-04-09 2011-08-30 Tyco Healthcare Group Lp Surgical stapling apparatus with powered retraction
US7950560B2 (en) 2007-04-13 2011-05-31 Tyco Healthcare Group Lp Powered surgical instrument
JP4348714B2 (ja) 2007-05-10 2009-10-21 シャープ株式会社 データ送信システム及びデータ送信方法
US7931660B2 (en) 2007-05-10 2011-04-26 Tyco Healthcare Group Lp Powered tacker instrument
US7823761B2 (en) 2007-05-16 2010-11-02 The Invention Science Fund I, Llc Maneuverable surgical stapler
US7810691B2 (en) 2007-05-16 2010-10-12 The Invention Science Fund I, Llc Gentle touch surgical stapler
US7832611B2 (en) 2007-05-16 2010-11-16 The Invention Science Fund I, Llc Steerable surgical stapler
US8038045B2 (en) 2007-05-25 2011-10-18 Tyco Healthcare Group Lp Staple buttress retention system
US7810693B2 (en) 2007-05-30 2010-10-12 Ethicon Endo-Surgery, Inc. Surgical stapling and cutting instrument with articulatable end effector
US7549564B2 (en) 2007-06-22 2009-06-23 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with an articulating end effector
US7798386B2 (en) 2007-05-30 2010-09-21 Ethicon Endo-Surgery, Inc. Surgical instrument articulation joint cover
US20080300624A1 (en) * 2007-05-30 2008-12-04 Ethicon Endo-Surgery, Inc. Tissue Stabilizer and Fastener
US8157145B2 (en) 2007-05-31 2012-04-17 Ethicon Endo-Surgery, Inc. Pneumatically powered surgical cutting and fastening instrument with electrical feedback
US20080296346A1 (en) 2007-05-31 2008-12-04 Shelton Iv Frederick E Pneumatically powered surgical cutting and fastening instrument with electrical control and recording mechanisms
US7832408B2 (en) 2007-06-04 2010-11-16 Ethicon Endo-Surgery, Inc. Surgical instrument having a directional switching mechanism
US7819299B2 (en) 2007-06-04 2010-10-26 Ethicon Endo-Surgery, Inc. Surgical instrument having a common trigger for actuating an end effector closing system and a staple firing system
US8931682B2 (en) 2007-06-04 2015-01-13 Ethicon Endo-Surgery, Inc. Robotically-controlled shaft based rotary drive systems for surgical instruments
US7905380B2 (en) 2007-06-04 2011-03-15 Ethicon Endo-Surgery, Inc. Surgical instrument having a multiple rate directional switching mechanism
US7731072B2 (en) 2007-06-18 2010-06-08 Ethicon Endo-Surgery, Inc. Surgical stapling and cutting instrument with improved anvil opening features
US7950561B2 (en) 2007-06-18 2011-05-31 Tyco Healthcare Group Lp Structure for attachment of buttress material to anvils and cartridges of surgical staplers
US7665646B2 (en) 2007-06-18 2010-02-23 Tyco Healthcare Group Lp Interlocking buttress material retention system
US7753245B2 (en) 2007-06-22 2010-07-13 Ethicon Endo-Surgery, Inc. Surgical stapling instruments
US7604150B2 (en) 2007-06-22 2009-10-20 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with an anti-back up mechanism
US7441685B1 (en) 2007-06-22 2008-10-28 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with a return mechanism
US7658311B2 (en) 2007-06-22 2010-02-09 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with a geared return mechanism
US7597229B2 (en) 2007-06-22 2009-10-06 Ethicon Endo-Surgery, Inc. End effector closure system for a surgical stapling instrument
US8308040B2 (en) 2007-06-22 2012-11-13 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with an articulatable end effector
US8062330B2 (en) * 2007-06-27 2011-11-22 Tyco Healthcare Group Lp Buttress and surgical stapling apparatus
US8348972B2 (en) 2007-07-11 2013-01-08 Covidien Lp Surgical staple with augmented compression area
US7556185B2 (en) 2007-08-15 2009-07-07 Tyco Healthcare Group Lp Surgical instrument with flexible drive mechanism
US9005238B2 (en) 2007-08-23 2015-04-14 Covidien Lp Endoscopic surgical devices
US7967181B2 (en) 2007-08-29 2011-06-28 Tyco Healthcare Group Lp Rotary knife cutting systems
US7624902B2 (en) 2007-08-31 2009-12-01 Tyco Healthcare Group Lp Surgical stapling apparatus
US9597080B2 (en) 2007-09-24 2017-03-21 Covidien Lp Insertion shroud for surgical instrument
US8517241B2 (en) 2010-04-16 2013-08-27 Covidien Lp Hand-held surgical devices
US7909220B2 (en) 2007-10-05 2011-03-22 Tyco Healthcare Group Lp Surgical stapler having an articulation mechanism
US20120289979A1 (en) 2007-10-08 2012-11-15 Sherif Eskaros Apparatus for Supplying Surgical Staple Line Reinforcement
WO2009048589A1 (en) 2007-10-08 2009-04-16 Gore Enterprise Holdings, Inc. Apparatus for supplying surgical staple line reinforcement
EP2752169B1 (en) 2007-10-17 2015-10-14 Davol, Inc. Fixating means between a mesh and mesh deployment means especially useful for hernia repair surgeries
US7922063B2 (en) 2007-10-31 2011-04-12 Tyco Healthcare Group, Lp Powered surgical instrument
US7954687B2 (en) 2007-11-06 2011-06-07 Tyco Healthcare Group Lp Coated surgical staples and an illuminated staple cartridge for a surgical stapling instrument
EP2060492B1 (de) 2007-11-16 2011-11-30 Msk-Verpackungs-Systeme Gesellschaft Mit Beschränkter Haftung Vorrichtung zum Uberziehen einer Schlauchfolie bzw. einer Folienhaube über einen Gutstapel
JP5377944B2 (ja) 2007-11-30 2013-12-25 住友ベークライト株式会社 胃瘻用シース、シース付きダイレータ、挿入補助具付き胃瘻用シース、胃瘻カテーテルキット
US8727199B2 (en) 2008-01-03 2014-05-20 Covidien Lp Surgical stapler
US20090198272A1 (en) 2008-02-06 2009-08-06 Lawrence Kerver Method and apparatus for articulating the wrist of a laparoscopic grasping instrument
US8348129B2 (en) 2009-10-09 2013-01-08 Ethicon Endo-Surgery, Inc. Surgical stapler having a closure mechanism
US7766209B2 (en) 2008-02-13 2010-08-03 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with improved firing trigger arrangement
US8453908B2 (en) 2008-02-13 2013-06-04 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with improved firing trigger arrangement
US8561870B2 (en) 2008-02-13 2013-10-22 Ethicon Endo-Surgery, Inc. Surgical stapling instrument
US7905381B2 (en) 2008-09-19 2011-03-15 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with cutting member arrangement
US8540133B2 (en) 2008-09-19 2013-09-24 Ethicon Endo-Surgery, Inc. Staple cartridge
US8636736B2 (en) 2008-02-14 2014-01-28 Ethicon Endo-Surgery, Inc. Motorized surgical cutting and fastening instrument
US7819296B2 (en) 2008-02-14 2010-10-26 Ethicon Endo-Surgery, Inc. Surgical stapling apparatus with retractable firing systems
US8584919B2 (en) 2008-02-14 2013-11-19 Ethicon Endo-Sugery, Inc. Surgical stapling apparatus with load-sensitive firing mechanism
US7819297B2 (en) 2008-02-14 2010-10-26 Ethicon Endo-Surgery, Inc. Surgical stapling apparatus with reprocessible handle assembly
US8657174B2 (en) 2008-02-14 2014-02-25 Ethicon Endo-Surgery, Inc. Motorized surgical cutting and fastening instrument having handle based power source
US7819298B2 (en) 2008-02-14 2010-10-26 Ethicon Endo-Surgery, Inc. Surgical stapling apparatus with control features operable with one hand
US7861906B2 (en) 2008-02-14 2011-01-04 Ethicon Endo-Surgery, Inc. Surgical stapling apparatus with articulatable components
US9179912B2 (en) 2008-02-14 2015-11-10 Ethicon Endo-Surgery, Inc. Robotically-controlled motorized surgical cutting and fastening instrument
US7866527B2 (en) 2008-02-14 2011-01-11 Ethicon Endo-Surgery, Inc. Surgical stapling apparatus with interlockable firing system
US8459525B2 (en) 2008-02-14 2013-06-11 Ethicon Endo-Sugery, Inc. Motorized surgical cutting and fastening instrument having a magnetic drive train torque limiting device
US7913891B2 (en) 2008-02-14 2011-03-29 Ethicon Endo-Surgery, Inc. Disposable loading unit with user feedback features and surgical instrument for use therewith
US8752749B2 (en) 2008-02-14 2014-06-17 Ethicon Endo-Surgery, Inc. Robotically-controlled disposable motor-driven loading unit
US7810692B2 (en) 2008-02-14 2010-10-12 Ethicon Endo-Surgery, Inc. Disposable loading unit with firing indicator
US8758391B2 (en) 2008-02-14 2014-06-24 Ethicon Endo-Surgery, Inc. Interchangeable tools for surgical instruments
US7857185B2 (en) 2008-02-14 2010-12-28 Ethicon Endo-Surgery, Inc. Disposable loading unit for surgical stapling apparatus
US20090206133A1 (en) 2008-02-14 2009-08-20 Ethicon Endo-Surgery, Inc. Articulatable loading units for surgical stapling and cutting instruments
US7793812B2 (en) 2008-02-14 2010-09-14 Ethicon Endo-Surgery, Inc. Disposable motor-driven loading unit for use with a surgical cutting and stapling apparatus
US8573465B2 (en) 2008-02-14 2013-11-05 Ethicon Endo-Surgery, Inc. Robotically-controlled surgical end effector system with rotary actuated closure systems
US20090206137A1 (en) * 2008-02-15 2009-08-20 Ethicon Endo-Surgery, Inc. Disposable loading units for a surgical cutting and stapling instrument
US20090206139A1 (en) 2008-02-15 2009-08-20 Ethicon Endo-Surgery, Inc. Buttress material for a surgical instrument
US7980443B2 (en) 2008-02-15 2011-07-19 Ethicon Endo-Surgery, Inc. End effectors for a surgical cutting and stapling instrument
US10390823B2 (en) 2008-02-15 2019-08-27 Ethicon Llc End effector comprising an adjunct
US20090206131A1 (en) 2008-02-15 2009-08-20 Ethicon Endo-Surgery, Inc. End effector coupling arrangements for a surgical cutting and stapling instrument
US7959051B2 (en) 2008-02-15 2011-06-14 Ethicon Endo-Surgery, Inc. Closure systems for a surgical cutting and stapling instrument
US8608044B2 (en) 2008-02-15 2013-12-17 Ethicon Endo-Surgery, Inc. Feedback and lockout mechanism for surgical instrument
US20090242610A1 (en) 2008-03-26 2009-10-01 Shelton Iv Frederick E Disposable loading unit and surgical instruments including same
US7926691B2 (en) * 2008-04-14 2011-04-19 Tyco Healthcare Group, L.P. Variable compression surgical fastener cartridge
US8231040B2 (en) 2008-04-14 2012-07-31 Tyco Healthcare Group Lp Variable compression surgical fastener cartridge
US8100310B2 (en) 2008-04-14 2012-01-24 Tyco Healthcare Group Lp Variable compression surgical fastener apparatus
US20090255974A1 (en) 2008-04-14 2009-10-15 Tyco Healthcare Group Lp Single loop surgical fastener apparatus for applying variable compression
US8231041B2 (en) 2008-04-14 2012-07-31 Tyco Healthcare Group Lp Variable compression surgical fastener cartridge
US8028884B2 (en) 2008-04-22 2011-10-04 Tyco Healthcare Group Lp Cartridge for applying varying amounts of tissue compression
US8186556B2 (en) * 2008-05-09 2012-05-29 Tyco Healthcare Group Lp Variable compression surgical fastener apparatus
WO2009137761A2 (en) 2008-05-09 2009-11-12 Elmer Valin Laparoscopic gastric and intestinal trocar
US8091756B2 (en) 2008-05-09 2012-01-10 Tyco Healthcare Group Lp Varying tissue compression using take-up component
US7922061B2 (en) 2008-05-21 2011-04-12 Ethicon Endo-Surgery, Inc. Surgical instrument with automatically reconfigurable articulating end effector
WO2009143331A1 (en) 2008-05-21 2009-11-26 Cook Biotech Incorporated Devices and methods for applying bolster materials to surgical fastening apparatuses
US8016176B2 (en) 2008-06-04 2011-09-13 Tyco Healthcare Group, Lp Surgical stapling instrument with independent sequential firing
US8011551B2 (en) 2008-07-01 2011-09-06 Tyco Healthcare Group Lp Retraction mechanism with clutch-less drive for use with a surgical apparatus
US8211125B2 (en) 2008-08-15 2012-07-03 Ethicon Endo-Surgery, Inc. Sterile appliance delivery device for endoscopic procedures
US8047236B2 (en) 2008-09-12 2011-11-01 Boston Scientific Scimed, Inc. Flexible conduit with locking element
US8083120B2 (en) 2008-09-18 2011-12-27 Ethicon Endo-Surgery, Inc. End effector for use with a surgical cutting and stapling instrument
US20100069942A1 (en) 2008-09-18 2010-03-18 Ethicon Endo-Surgery, Inc. Surgical instrument with apparatus for measuring elapsed time between actions
US7837080B2 (en) 2008-09-18 2010-11-23 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with device for indicating when the instrument has cut through tissue
US9386983B2 (en) 2008-09-23 2016-07-12 Ethicon Endo-Surgery, Llc Robotically-controlled motorized surgical instrument
US9050083B2 (en) 2008-09-23 2015-06-09 Ethicon Endo-Surgery, Inc. Motorized surgical instrument
US8210411B2 (en) 2008-09-23 2012-07-03 Ethicon Endo-Surgery, Inc. Motor-driven surgical cutting instrument
US9005230B2 (en) 2008-09-23 2015-04-14 Ethicon Endo-Surgery, Inc. Motorized surgical instrument
US8608045B2 (en) 2008-10-10 2013-12-17 Ethicon Endo-Sugery, Inc. Powered surgical cutting and stapling apparatus with manually retractable firing system
US8020743B2 (en) 2008-10-15 2011-09-20 Ethicon Endo-Surgery, Inc. Powered articulatable surgical cutting and fastening instrument with flexible drive member
US7918377B2 (en) 2008-10-16 2011-04-05 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with apparatus for providing anvil position feedback
US8231042B2 (en) 2008-11-06 2012-07-31 Tyco Healthcare Group Lp Surgical stapler
GB0822110D0 (en) 2008-12-03 2009-01-07 Angiomed Ag Catheter sheath for implant delivery
US20100147921A1 (en) 2008-12-16 2010-06-17 Lee Olson Surgical Apparatus Including Surgical Buttress
US8770460B2 (en) 2008-12-23 2014-07-08 George E. Belzer Shield for surgical stapler and method of use
US20110278343A1 (en) * 2009-01-29 2011-11-17 Cardica, Inc. Clamping of Hybrid Surgical Instrument
US8414577B2 (en) 2009-02-05 2013-04-09 Ethicon Endo-Surgery, Inc. Surgical instruments and components for use in sterile environments
US8485413B2 (en) 2009-02-05 2013-07-16 Ethicon Endo-Surgery, Inc. Surgical stapling instrument comprising an articulation joint
US8517239B2 (en) 2009-02-05 2013-08-27 Ethicon Endo-Surgery, Inc. Surgical stapling instrument comprising a magnetic element driver
US8397971B2 (en) 2009-02-05 2013-03-19 Ethicon Endo-Surgery, Inc. Sterilizable surgical instrument
US20100193566A1 (en) 2009-02-05 2010-08-05 Ethicon Endo-Surgery, Inc. Surgical stapling instrument
US8444036B2 (en) 2009-02-06 2013-05-21 Ethicon Endo-Surgery, Inc. Motor driven surgical fastener device with mechanisms for adjusting a tissue gap within the end effector
US8245899B2 (en) 2009-02-06 2012-08-21 Ethicon Endo-Surgery, Inc. Driven surgical stapler improvements
US20110024478A1 (en) 2009-02-06 2011-02-03 Shelton Iv Frederick E Driven Surgical Stapler Improvements
US20130066304A1 (en) 2009-02-27 2013-03-14 Modular Surgical, Inc. Apparatus and methods for hybrid endoscopic and laparoscopic surgery
US8317071B1 (en) 2009-03-09 2012-11-27 Cardica, Inc. Endocutter with auto-feed buttress
US7918376B1 (en) 2009-03-09 2011-04-05 Cardica, Inc. Articulated surgical instrument
US8066167B2 (en) 2009-03-23 2011-11-29 Ethicon Endo-Surgery, Inc. Circular surgical stapling instrument with anvil locking system
US8016178B2 (en) 2009-03-31 2011-09-13 Tyco Healthcare Group Lp Surgical stapling apparatus
US7988027B2 (en) 2009-03-31 2011-08-02 Tyco Healthcare Group Lp Crimp and release of suture holding buttress material
US8328064B2 (en) 2009-05-06 2012-12-11 Covidien Lp Pin locking mechanism for a surgical instrument
US8056789B1 (en) 2009-06-03 2011-11-15 Cardica, Inc. Staple and feeder belt configurations for surgical stapler
US9463260B2 (en) 2009-06-29 2016-10-11 Covidien Lp Self-sealing compositions
US8276802B2 (en) 2009-07-11 2012-10-02 Tyco Healthcare Group Lp Surgical instrument with double cartridge and anvil assemblies
US20110011916A1 (en) 2009-07-16 2011-01-20 New York University Anastomosis device
US8328062B2 (en) * 2009-07-21 2012-12-11 Covidien Lp Surgical instrument with curvilinear tissue-contacting surfaces
US8276801B2 (en) 2011-02-01 2012-10-02 Tyco Healthcare Group Lp Surgical stapling apparatus
US8360299B2 (en) 2009-08-11 2013-01-29 Covidien Lp Surgical stapling apparatus
US8733612B2 (en) 2009-08-17 2014-05-27 Covidien Lp Safety method for powered surgical instruments
US8152041B2 (en) 2009-10-14 2012-04-10 Tyco Healthcare Group Lp Varying tissue compression aided by elastic members
US8413872B2 (en) * 2009-10-28 2013-04-09 Covidien Lp Surgical fastening apparatus
US8162138B2 (en) 2009-11-09 2012-04-24 Containmed, Inc. Universal surgical fastener sterilization caddy
US8353439B2 (en) 2009-11-19 2013-01-15 Ethicon Endo-Surgery, Inc. Circular stapler introducer with radially-openable distal end portion
US8136712B2 (en) 2009-12-10 2012-03-20 Ethicon Endo-Surgery, Inc. Surgical stapler with discrete staple height adjustment and tactile feedback
US8851354B2 (en) 2009-12-24 2014-10-07 Ethicon Endo-Surgery, Inc. Surgical cutting instrument that analyzes tissue thickness
US8220688B2 (en) 2009-12-24 2012-07-17 Ethicon Endo-Surgery, Inc. Motor-driven surgical cutting instrument with electric actuator directional control assembly
US8267300B2 (en) 2009-12-30 2012-09-18 Ethicon Endo-Surgery, Inc. Dampening device for endoscopic surgical stapler
US8608046B2 (en) 2010-01-07 2013-12-17 Ethicon Endo-Surgery, Inc. Test device for a surgical tool
US8313509B2 (en) 2010-01-19 2012-11-20 Covidien Lp Suture and retainer assembly and SULU
US8348127B2 (en) 2010-04-07 2013-01-08 Covidien Lp Surgical fastener applying apparatus
US20110275901A1 (en) 2010-05-07 2011-11-10 Ethicon Endo-Surgery, Inc. Laparoscopic devices with articulating end effectors
US20110276083A1 (en) 2010-05-07 2011-11-10 Ethicon Endo-Surgery, Inc. Bendable shaft for handle positioning
US8464925B2 (en) 2010-05-11 2013-06-18 Ethicon Endo-Surgery, Inc. Methods and apparatus for delivering tissue treatment compositions to stapled tissue
US8646674B2 (en) 2010-05-11 2014-02-11 Ethicon Endo-Surgery, Inc. Methods and apparatus for delivering tissue treatment compositions to stapled tissue
US8783543B2 (en) 2010-07-30 2014-07-22 Ethicon Endo-Surgery, Inc. Tissue acquisition arrangements and methods for surgical stapling devices
US8672207B2 (en) 2010-07-30 2014-03-18 Ethicon Endo-Surgery, Inc. Transwall visualization arrangements and methods for surgical circular staplers
US8789740B2 (en) 2010-07-30 2014-07-29 Ethicon Endo-Surgery, Inc. Linear cutting and stapling device with selectively disengageable cutting member
WO2012016967A1 (en) * 2010-08-01 2012-02-09 Seckin Tamer A Surgical method and apparatus
US8360296B2 (en) 2010-09-09 2013-01-29 Ethicon Endo-Surgery, Inc. Surgical stapling head assembly with firing lockout for a surgical stapler
US9289212B2 (en) 2010-09-17 2016-03-22 Ethicon Endo-Surgery, Inc. Surgical instruments and batteries for surgical instruments
US8632525B2 (en) 2010-09-17 2014-01-21 Ethicon Endo-Surgery, Inc. Power control arrangements for surgical instruments and batteries
US9877720B2 (en) 2010-09-24 2018-01-30 Ethicon Llc Control features for articulating surgical device
US8733613B2 (en) 2010-09-29 2014-05-27 Ethicon Endo-Surgery, Inc. Staple cartridge
US9332974B2 (en) 2010-09-30 2016-05-10 Ethicon Endo-Surgery, Llc Layered tissue thickness compensator
US9307989B2 (en) 2012-03-28 2016-04-12 Ethicon Endo-Surgery, Llc Tissue stapler having a thickness compensator incorportating a hydrophobic agent
US9220500B2 (en) 2010-09-30 2015-12-29 Ethicon Endo-Surgery, Inc. Tissue thickness compensator comprising structure to produce a resilient load
US9232941B2 (en) 2010-09-30 2016-01-12 Ethicon Endo-Surgery, Inc. Tissue thickness compensator comprising a reservoir
US9839420B2 (en) 2010-09-30 2017-12-12 Ethicon Llc Tissue thickness compensator comprising at least one medicament
US9364233B2 (en) 2010-09-30 2016-06-14 Ethicon Endo-Surgery, Llc Tissue thickness compensators for circular surgical staplers
US9220501B2 (en) 2010-09-30 2015-12-29 Ethicon Endo-Surgery, Inc. Tissue thickness compensators
US9204880B2 (en) 2012-03-28 2015-12-08 Ethicon Endo-Surgery, Inc. Tissue thickness compensator comprising capsules defining a low pressure environment
US20120248169A1 (en) 2010-09-30 2012-10-04 Ethicon Endo-Surgery, Inc. Methods for forming tissue thickness compensator arrangements for surgical staplers
US9216019B2 (en) 2011-09-23 2015-12-22 Ethicon Endo-Surgery, Inc. Surgical stapler with stationary staple drivers
US9386988B2 (en) 2010-09-30 2016-07-12 Ethicon End-Surgery, LLC Retainer assembly including a tissue thickness compensator
US9301752B2 (en) 2010-09-30 2016-04-05 Ethicon Endo-Surgery, Llc Tissue thickness compensator comprising a plurality of capsules
US9788834B2 (en) 2010-09-30 2017-10-17 Ethicon Llc Layer comprising deployable attachment members
US9314246B2 (en) 2010-09-30 2016-04-19 Ethicon Endo-Surgery, Llc Tissue stapler having a thickness compensator incorporating an anti-inflammatory agent
US8814024B2 (en) 2010-09-30 2014-08-26 Ethicon Endo-Surgery, Inc. Fastener system comprising a plurality of connected retention matrix elements
US8893949B2 (en) 2010-09-30 2014-11-25 Ethicon Endo-Surgery, Inc. Surgical stapler with floating anvil
US8746535B2 (en) 2010-09-30 2014-06-10 Ethicon Endo-Surgery, Inc. Tissue thickness compensator comprising detachable portions
US8695866B2 (en) 2010-10-01 2014-04-15 Ethicon Endo-Surgery, Inc. Surgical instrument having a power control circuit
USD650074S1 (en) 2010-10-01 2011-12-06 Ethicon Endo-Surgery, Inc. Surgical instrument
US8523043B2 (en) 2010-12-07 2013-09-03 Immersion Corporation Surgical stapler having haptic feedback
US8348130B2 (en) 2010-12-10 2013-01-08 Covidien Lp Surgical apparatus including surgical buttress
US9084602B2 (en) 2011-01-26 2015-07-21 Covidien Lp Buttress film with hemostatic action for surgical stapling apparatus
US8632462B2 (en) 2011-03-14 2014-01-21 Ethicon Endo-Surgery, Inc. Trans-rectum universal ports
US8857693B2 (en) 2011-03-15 2014-10-14 Ethicon Endo-Surgery, Inc. Surgical instruments with lockable articulating end effector
US8540131B2 (en) 2011-03-15 2013-09-24 Ethicon Endo-Surgery, Inc. Surgical staple cartridges with tissue tethers for manipulating divided tissue and methods of using same
US9044229B2 (en) 2011-03-15 2015-06-02 Ethicon Endo-Surgery, Inc. Surgical fastener instruments
US8926598B2 (en) 2011-03-15 2015-01-06 Ethicon Endo-Surgery, Inc. Surgical instruments with articulatable and rotatable end effector
US8800841B2 (en) 2011-03-15 2014-08-12 Ethicon Endo-Surgery, Inc. Surgical staple cartridges
US20120234895A1 (en) 2011-03-15 2012-09-20 Ethicon Endo-Surgery, Inc. Surgical staple cartridges and end effectors with vessel measurement arrangements
AU2012201645B2 (en) 2011-04-29 2015-04-16 Covidien Lp Surgical stapling apparatus
US9492170B2 (en) * 2011-08-10 2016-11-15 Ethicon Endo-Surgery, Inc. Device for applying adjunct in endoscopic procedure
US9198661B2 (en) 2011-09-06 2015-12-01 Ethicon Endo-Surgery, Inc. Stapling instrument comprising a plurality of staple cartridges stored therein
US9050084B2 (en) 2011-09-23 2015-06-09 Ethicon Endo-Surgery, Inc. Staple cartridge including collapsible deck arrangement
US8585721B2 (en) 2011-10-12 2013-11-19 Covidien Lp Mesh fixation system
US8967448B2 (en) * 2011-12-14 2015-03-03 Covidien Lp Surgical stapling apparatus including buttress attachment via tabs
US20130256373A1 (en) 2012-03-28 2013-10-03 Ethicon Endo-Surgery, Inc. Devices and methods for attaching tissue thickness compensating materials to surgical stapling instruments
US9198662B2 (en) 2012-03-28 2015-12-01 Ethicon Endo-Surgery, Inc. Tissue thickness compensator having improved visibility
AU2013203675B2 (en) * 2012-05-31 2014-11-27 Covidien Lp Hand held surgical handle assembly, surgical adapters for use between surgical handle assembly and surgical end effectors, and methods of use
US20140048580A1 (en) 2012-08-20 2014-02-20 Covidien Lp Buttress attachment features for surgical stapling apparatus
US9386984B2 (en) 2013-02-08 2016-07-12 Ethicon Endo-Surgery, Llc Staple cartridge comprising a releasable cover
US20140224857A1 (en) 2013-02-08 2014-08-14 Ethicon Endo-Surgery, Inc. Staple cartridge comprising a compressible portion
US10561417B2 (en) * 2013-12-09 2020-02-18 Covidien Lp Adapter assembly for interconnecting electromechanical surgical devices and surgical loading units, and surgical systems thereof

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN101455577A (zh) * 2007-12-12 2009-06-17 苏州天臣国际医疗科技有限公司 医用切割装订器械
CN101721236A (zh) * 2008-10-29 2010-06-09 苏州天臣国际医疗科技有限公司 外科切割装订器械

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