U.S. patent application number 14/699179 was filed with the patent office on 2015-08-20 for buttress brachytherapy and integrated staple line markers for margin identification.
The applicant listed for this patent is Covidien LP. Invention is credited to Seth Gleiman, Gerald Hodgkinson, David Racenet.
Application Number | 20150231409 14/699179 |
Document ID | / |
Family ID | 53797170 |
Filed Date | 2015-08-20 |
United States Patent
Application |
20150231409 |
Kind Code |
A1 |
Racenet; David ; et
al. |
August 20, 2015 |
BUTTRESS BRACHYTHERAPY AND INTEGRATED STAPLE LINE MARKERS FOR
MARGIN IDENTIFICATION
Abstract
A surgical buttress for use in a surgical stapling apparatus is
provided. The surgical buttress includes an elongate rectangular
body portion defining a width; a nose portion integrally formed
with and extending from a distal end of the body portion, the nose
portion defining a width that is less than the width of the body
portion; a neck portion integrally formed with and extending from a
distal end of the body portion, the neck portion defining a width;
a head portion integrally formed with and connected to a distal end
of the neck portion, the head portion defining a width; and a tail
portion integrally formed with and extending from a proximal end of
the body portion, the tail portion defining a width that is less
than the width of the body portion. The surgical buttress is formed
from a material having filaments. The surgical buttress include
radioactive material.
Inventors: |
Racenet; David;
(Killingworth, CT) ; Hodgkinson; Gerald;
(Guilford, CT) ; Gleiman; Seth; (Guilford,
CT) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Covidien LP |
Mansfield |
MA |
US |
|
|
Family ID: |
53797170 |
Appl. No.: |
14/699179 |
Filed: |
April 29, 2015 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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14163386 |
Jan 24, 2014 |
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14699179 |
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13955341 |
Jul 31, 2013 |
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14163386 |
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13419565 |
Mar 14, 2012 |
8561873 |
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13955341 |
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12579605 |
Oct 15, 2009 |
8157151 |
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13419565 |
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61992530 |
May 13, 2014 |
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61696906 |
Sep 5, 2012 |
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Current U.S.
Class: |
227/175.1 ;
600/8 |
Current CPC
Class: |
A61B 17/07292 20130101;
A61N 2005/101 20130101; A61B 2017/00893 20130101; A61B 17/068
20130101; A61N 5/1007 20130101 |
International
Class: |
A61N 5/10 20060101
A61N005/10; A61B 17/068 20060101 A61B017/068 |
Claims
1-23. (canceled)
24. A surgical buttress for use in a surgical stapling apparatus,
the surgical buttress, comprising: an elongate rectangular body
portion defining a width and being fabricated from at least one of
a biocompatible or bio absorbable material; wherein the surgical
buttress is formed with at least one marking provided at least one
of in or on the body portion, the at least one marking having a
pattern distributed along a length of the body portion.
25. The surgical buttress according to claim 24, wherein the at
least one marking is formed as a notch.
26. The surgical buttress according to claim 24, wherein the at
least one marking includes biocompatible and bioabsorbable
materials.
27. The surgical buttress according to claim 24, wherein the at
least one marking includes a biocompatible ink.
28. The surgical buttress according to claim 24, wherein the at
least one marking is sewn into the surgical buttress.
29. The surgical buttress according to claim 24, wherein the body
portion defines at least one pair of notch markings on opposing
lateral sides of the surgical buttress.
30. The surgical buttress according to claim 24, wherein the body
portion includes a plurality of markings.
31. The surgical buttress according to claim 30, wherein the
plurality of markings are formed by physical notches and ink.
32. The surgical buttress according to claim 30, wherein the
plurality of markings vary in length.
33. The surgical buttress according to claim 30, wherein the
plurality of markings are evenly spaced along a length of the
surgical buttress.
34. The surgical buttress according to claim 24, further comprising
a radioactive material embedded within the body portion.
35. The surgical buttress according to claim 34, wherein the
radioactive material is at least one brachytherapy seed.
36. The surgical buttress according to claim 24, wherein the body
portion comprises a plurality of pores.
37. The surgical buttress according to claim 36, wherein at least
one pore contains a brachytherapy seed.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application claims the benefit of and priority to U.S.
Provisional Patent Application No. 61/992,530, filed May 13, 2014,
the entire disclosure of which is incorporated by reference
herein.
[0002] The present application is a Continuation-in-Part
Application claiming the benefit of and priority to U.S. patent
application Ser. No. 14/163,386, filed on Jan. 24, 2014, which is a
Continuation-in-Part Application claiming the benefit of and
priority to U.S. patent application Ser. No. 13/955,341, filed on
Jul. 31, 2013, which is a Continuation-in-Part Application claiming
the benefit of and priority to U.S. patent application Ser. No.
13/419,565, filed on Mar. 14, 2012 (U.S. Pat. No. 8,561,873), which
is a Continuation Application claiming the benefit of and priority
to U.S. patent application Ser. No. 12/579,605, filed on Oct. 15,
2009 (U.S. Pat. No. 8,157,151), the entire content of each of which
is incorporated herein by reference.
[0003] U.S. patent application Ser. No. 13/955,341 also claims the
benefit of and priority to U.S. Provisional Patent Application No.
61/696,906, filed Sep. 5, 2012, the entire disclosure of which is
incorporated by reference herein.
BACKGROUND
[0004] 1. Technical Field
[0005] The present disclosure relates to a surgical stapling
apparatus and, more particularly, to a surgical stapling apparatus
including a detachable surgical buttress for an anvil and a staple
cartridge.
[0006] 2. Background of Related Art
[0007] Surgical stapling instruments that are used to sequentially
or simultaneously apply one or more rows of fasteners to join
segments of body tissues are well known in the art. The fasteners
are typically in the form of surgical staples but two part
polymeric fasteners can also be utilized. Such devices generally
include a pair of jaws to clamp therebetween the body tissues to be
joined. Typically, one of the jaw members includes a staple
cartridge which accommodates a plurality of staples arranged in at
least two lateral rows while the other jaw member has an anvil that
defines a surface for forming the staple legs as the staples are
driven from the staple cartridge.
[0008] When the stapling instrument is actuated, longitudinally
translating cams contact staple drive members in one of the jaws
which in turn acts upon staple pushers to sequentially or
simultaneously eject the staples from the staple cartridge. A blade
can travel between the staple rows to longitudinally cut and/or
open the stapled tissue between the rows of staples. Such
instruments are disclosed, for example, in U.S. Pat. No. 3,079,606
and U.S. Pat. No. 3,490,675.
[0009] When stapling relatively thin or fragile tissues, it is
important to effectively seal the staple line against air or fluid
leakage. Additionally, it is often necessary to reinforce the
staple line against the tissue to prevent tears in the tissue or
pulling of the staples through the tissue. One method of preventing
tears or pull through involves the placement of a biocompatible
fabric reinforcing material, or a "buttress," between the staple
and the underlying tissue. In this method, a layer of buttress
material is placed against the tissue and the tissue is stapled in
conventional manner. In more recent methods, the layer of buttress
is positioned on the stapling instrument itself prior to stapling
the tissue. Some surgical staplers utilize fasteners or clips to
temporarily connect buttress material to each of the jaws of the
staplers, i.e., one disposed on the staple cartridge assembly and
the other on the anvil assembly.
[0010] WO 2008/109125 discloses a surgical stapling apparatus that
includes a cartridge assembly, an anvil assembly, and a surgical
buttress releasebly secured by an anchor. The anchor releases the
surgical buttress during firing of the stapling apparatus.
[0011] It is a desire of the present application to provide
surgical stapling apparatus with a surgical buttress secured
thereto in a manner that minimizes shifting of the surgical
buttress, and tearing or other damage to the surgical buttress
during assembly. It would also be desirable to provide a single
profile buttress that can be used on a surgical staple cartridge
assembly and/or a surgical anvil cartridge assembly, as well as
cartridge and anvil assemblies of different sizes. Accordingly, it
is an object of this disclosure to meet the aforementioned
desires.
SUMMARY
[0012] The present disclosure relates to a surgical stapling
apparatus including a surgical buttress.
[0013] According to an aspect of the present disclosure, a surgical
stapling apparatus is provided and includes a cartridge assembly
defining a first tissue contacting surface, the cartridge assembly
housing a plurality of surgical fasteners therein, the cartridge
assembly defining at least one distal attachment point and at least
one proximal attachment point; an anvil assembly defining a second
tissue contacting surface, the anvil assembly movably secured in
relation to cartridge assembly, the anvil assembly defining at
least one distal attachment point and at least one proximal
attachment point, wherein the at least one proximal attachment
point of the anvil assembly is offset an axial distance from the at
least one proximal attachment point of the cartridge assembly; and
a surgical buttress releasably secured to each of the first tissue
contacting surface and the second tissue contacting surface, the
surgical buttress including a body portion configured to
substantially overlie at least one of the first and second tissue
contacting surfaces of either the first length and second length
cartridge assembly and anvil assembly.
[0014] Each surgical buttress defines a distal attachment feature
for registration with the distal attachment point of the cartridge
assembly and the anvil assembly; and a first proximal attachment
feature and a second proximal attachment feature offset an axial
distance from the first proximal attachment feature. The first
proximal attachment feature registers with the proximal attachment
point of the cartridge assembly; and the second proximal attachment
feature registers with the proximal attachment point of the anvil
assembly.
[0015] The surgical buttress may be disposed against the tissue
contact surface of the cartridge assembly and the surgical buttress
may be disposed against the tissue contact surface of the anvil
assembly have substantially the same length.
[0016] Each surgical buttress may have the same configuration. Each
surgical buttress may be fabricated from a biocompatible and
bioabsorbable material.
[0017] The surgical stapling apparatus may further include sutures
retaining surgical buttresses against the tissue contacting surface
of the cartridge assembly and the anvil assembly.
[0018] The surgical stapling apparatus may further include a suture
retaining a distal end portion of the surgical buttress against a
respective one of the cartridge assembly and the anvil assembly,
wherein the suture maintains the distal attachment feature of the
surgical buttress in registration with the distal attachment point
of the respective one of the cartridge assembly and the anvil
assembly.
[0019] The surgical stapling apparatus may further include a suture
retaining a proximal end portion of the surgical buttress against a
respective one of the cartridge assembly and the anvil assembly,
wherein a suture maintains the first proximal attachment feature of
the surgical buttress in registration with the proximal attachment
point of the cartridge assembly and the anvil assembly, and wherein
a suture maintains the second proximal attachment feature of the
surgical buttress in registration with the proximal attachment
point of the anvil assembly.
[0020] According to another aspect of the present disclosure, a
surgical stapling apparatus is provided and includes a cartridge
assembly defining a first tissue contacting surface, the cartridge
assembly housing a plurality of surgical fasteners therein, the
cartridge assembly being either a first length or a second length
longer than the first length; an anvil assembly defining a second
tissue contacting surface, the anvil assembly movably secured in
relation to cartridge assembly, the anvil assembly being either the
first length or the second length each corresponding to the length
of the cartridge assembly; and a surgical buttress releasably
secured to at least one of the first tissue contacting surface and
the second tissue contacting surface, the surgical buttress
including a head portion, a neck portion, and a body portion. The
head portion is connected to a distal end of the body portion by
the neck portion. The surgical buttress is configured to
substantially overlie at least one of the first and second tissue
contacting surfaces of either the first length and second length
cartridge assembly and anvil assembly.
[0021] The body portion of the surgical buttress may define a
recess formed in a proximal edge thereof, the recess longitudinally
bisecting the proximal edge. The recess may be a notch having a
v-shape profile.
[0022] The body portion of the surgical buttress may define at
least one pair of opposing proximal recesses, and each of the at
least one pair of opposing proximal recesses may be formed on an
opposing lateral side of the body portion near a proximal edge of
the surgical buttress. The at least one pair of opposing proximal
recesses may be a notch having a v-shape profile.
[0023] The body portion of the surgical buttress may further define
a pair of opposing distal recesses, and each of the pair of
opposing distal recesses may be formed on an opposing lateral side
of the body portion near a distal edge of the body portion.
[0024] The pair of opposing distal recesses may be longitudinally
tapered. A distal edge of the body portion of the surgical buttress
may be arcuate. A distal edge of the body portion of the surgical
buttress may have a transverse width dimension that is less than
that of the rest of the body portion. The head portion may have a
substantially rectangular shape.
[0025] Each surgical buttress may be fabricated from a
biocompatible and bioabsorbable material.
[0026] According to a further aspect of the present disclosure, a
surgical buttress for use in a surgical stapling apparatus is
provided. The surgical buttress includes a body portion; a neck
portion; and a head portion connected to a distal end of the body
portion by the neck portion, wherein the body portion defines at
least one pair of opposing proximal recesses, each of the at least
one pair of opposing proximal recesses is formed on an opposing
lateral side of the body portion near a proximal edge of the body
portion.
[0027] Each of the at least one pair of opposing proximal recesses
may be a notch having a v-shape profile. The body portion may
further define a pair of opposing distal recesses, each of the pair
of opposing distal recesses may be formed on an opposing lateral
side of the body portion near a distal edge of the body
portion.
[0028] The body portion of the surgical buttress may further define
a proximal edge recess formed in a proximal edge thereof, the
proximal edge recess longitudinally bisecting the proximal edge. A
distal edge of the body portion of the surgical buttress may be
arcuate. A distal edge of the body portion of the surgical buttress
may have a transverse width dimension less than that of the rest of
the body portion. The head portion may have a substantially
rectangular shape.
[0029] The surgical buttress may be fabricated from a biocompatible
and bioabsorbable material.
[0030] According to still another aspect of the present disclosure,
a surgical buttress is provided for use with a surgical stapling
apparatus having a cartridge assembly of any number of lengths and
an anvil assembly of any number of lengths corresponding to the
lengths of the cartridge assembly, wherein each of the cartridge
assembly and anvil assembly defines respective juxtaposed tissue
contacting surfaces, and wherein the cartridge assembly includes a
plurality of staples stored in staple slots thereof for formation
against staple formation pockets of the anvil assembly. The
surgical buttress includes a body portion configured and
dimensioned to overlie all of the staple slots of the cartridge
assembly for any length cartridge assembly, and/or overlie all of
the staple formation pockets of the anvil assembly for any length
anvil assembly. The surgical buttress further includes a neck
portion extending from the body portion; and a head portion
connected to the neck portion and opposite a distal end of the body
portion, wherein the body portion defines at least one pair of
opposing proximal recesses, each of the at least one pair of
opposing proximal recesses is formed on an opposing lateral side of
the body portion near a proximal edge of the body portion.
[0031] According to yet another aspect of the present disclosure a
surgical buttress for use in a surgical stapling apparatus is
provided and includes an elongate rectangular body portion defining
a width; a neck portion integrally formed with and extending from a
distal end of the body portion, the neck portion defining a width;
a head portion integrally formed with and connected to a distal end
of the neck portion, the head portion defining a width; and a tail
portion integrally formed with and extending from a proximal end of
the body portion, the tail portion defining a width. The width of
the tail portion is less than the width of the body portion, and
the surgical buttress is formed from a material having
filaments.
[0032] In certain embodiments, the width of the neck portion is
less than the width of the body portion, or the width of the neck
portion is less than the width of the tail portion, or the width of
the neck portion is more than one-half the width of the body
portion.
[0033] A length of the head portion may be greater than a length of
the tail portion. A length of the head portion may be greater than
a length of the neck portion.
[0034] The tail portion can define at least one pair of opposing
proximal recesses, each of the at least one pair of opposing
proximal recesses is formed on an opposing lateral side of the tail
portion.
[0035] The body portion can further define a pair of opposing
distal recesses, each of the pair of opposing distal recesses is
formed on an opposing lateral side of the body portion near a
distal edge of the body portion.
[0036] The tail portion of the surgical buttress can define a
proximal edge recess formed in a proximal edge thereof, wherein the
proximal edge recess longitudinally bisects the proximal edge.
[0037] The surgical buttress is desirably fabricated from a
biocompatible and bioabsorbable material.
[0038] The surgical buttress can be fabricated from a material
selected from the group consisting of polyglycolic acid, glycolide
trimethylene carbonate, polyglycolic acid trimethylene carbonate,
and blends thereof. The surgical buttress can be formed as a
non-woven material.
[0039] According to a further aspect of the present disclosure, a
surgical buttress is provided for use with a surgical stapling
apparatus having a cartridge assembly of any number of lengths and
an anvil assembly of any number of lengths corresponding to the
lengths of the cartridge assembly, wherein each of the cartridge
assembly and anvil assembly defines respective juxtaposed tissue
contacting surfaces, and wherein the cartridge assembly includes a
plurality of staples stored in staple slots thereof for formation
against staple formation pockets of the anvil assembly. The
surgical buttress includes an elongate rectangular body portion
defining a length and a width; a neck portion integrally formed
with and extending from a distal end of the body portion, the neck
portion defining a length and a width; a head portion integrally
formed with and connected to a distal end of the neck portion, the
head portion defining a length and a width; and a tail portion
integrally formed with and extending from a proximal end of the
body portion, the tail portion defining a length and a width. The
width of the tail portion is less than the width of the body
portion. The body portion and the tail portion are configured and
dimensioned to overlie all of the staple slots of the cartridge
assembly for any length cartridge assembly, and/or overlie all of
the staple formation pockets of the anvil assembly for any length
anvil assembly.
[0040] The width of the neck portion may be less than the width of
the body portion. The width of the neck portion may be less than
the width of the tail portion. The width of the neck portion may be
more than one-half the width of the body portion.
[0041] The length of the head portion may be greater than the
length of the tail portion. The length of the head portion may be
greater than the length of the neck portion.
[0042] The tail portion may define at least one pair of opposing
proximal recesses. Each of the at least one pair of opposing
proximal recesses may be formed on an opposing lateral side of the
tail portion.
[0043] The body portion may further define a pair of opposing
distal recesses. Each of the pair of opposing distal recesses may
be formed on an opposing lateral side of the body portion near a
distal edge of the body portion.
[0044] The tail portion of the surgical buttress may define a
proximal edge recess formed in a proximal edge thereof. The
proximal edge recess may longitudinally bisect the proximal
edge.
[0045] The surgical buttress may be fabricated from a biocompatible
and bioabsorbable material. The surgical buttress may be fabricated
from a material selected from the group consisting of polyglycolic
acid, glycolide trimethylene carbonate, polyglycolic acid
trimethylene carbonate, and blends thereof. The surgical buttress
can be made as a non-woven material.
[0046] According to another aspect of the present disclosure, a
surgical buttress for use in a surgical stapling apparatus is
provided. The surgical buttress includes an elongate rectangular
body portion defining a width; a nose portion integrally formed
with and extending from a distal end of the body portion, the nose
portion defining a width that is less than the width of the body
portion; a neck portion integrally formed with and extending from a
distal end of the body portion, the neck portion defining a width;
a head portion integrally formed with and connected to a distal end
of the neck portion, the head portion defining a width; and a tail
portion integrally formed with and extending from a proximal end of
the body portion, the tail portion defining a width that is less
than the width of the body portion. The surgical buttress is formed
from a material having filaments.
[0047] The width of the neck portion may be less than the width of
the nose portion. The width of the neck portion may be less than
the width of the tail portion. The width of the neck portion may be
more than one-half the width of the body portion.
[0048] The tail portion may define at least one pair of opposing
proximal recesses, each of the at least one pair of opposing
proximal recesses is formed in an opposing lateral side of the tail
portion.
[0049] The at least one pair of opposing proximal recesses may
include a first pair of opposing proximal recesses; and a second
pair of opposing proximal recesses, wherein the first pair of
opposing proximal recesses is disposed proximal of the second pair
of opposing proximal recesses.
[0050] Each of the second pair of opposing proximal recesses may
extend towards a longitudinal axis of the buttress a greater amount
than each of the first pair of opposing proximal recesses.
[0051] A side edge of the tail portion, disposed between the first
pair of opposing proximal recesses and the pair of opposing
proximal recesses, may taper towards a longitudinal axis of the
buttress from a proximal end to a distal end.
[0052] Each of the first pair of opposing proximal recesses and
each of the second pair of opposing proximal recesses may have a
v-shaped profile. A distal edge of each of the first pair of
opposing proximal recesses and each of the second pair of opposing
proximal recesses may be oriented orthogonal to a longitudinal axis
of the buttress.
[0053] The body portion may further define a pair of opposing
distal recesses. Each of the pair of opposing distal recesses may
be formed in opposing lateral sides of the nose portion.
[0054] The tail portion of the surgical buttress may define a
proximal edge recess formed in a proximal edge thereof, wherein the
proximal edge recess may longitudinally bisect the proximal
edge.
[0055] The surgical buttress may be fabricated from a biocompatible
and bioabsorbable material. The surgical buttress may be fabricated
from a material selected from the group consisting of polyglycolic
acid, glycolide trimethylene carbonate, polyglycolic acid
trimethylene carbonate, and blends thereof. The surgical buttress
may be formed as a non-woven material.
[0056] According to still another aspect of the present disclosure,
a surgical buttress for use with a surgical stapling apparatus is
provided. The surgical stapling apparatus includes a cartridge
assembly of any number of lengths and an anvil assembly of any
number of lengths corresponding to the lengths of the cartridge
assembly, wherein each of the cartridge assembly and anvil assembly
defines respective juxtaposed tissue contacting surfaces, and
wherein the cartridge assembly includes a plurality of staples
stored in staple slots thereof for formation against staple
formation pockets of the anvil assembly.
[0057] The surgical buttress includes an elongate rectangular body
portion defining a width; a nose portion integrally formed with and
extending from a distal end of the body portion, the nose portion
defining a width that is less than the width of the body portion; a
neck portion integrally formed with and extending from a distal end
of the body portion, the neck portion defining a width; a head
portion integrally formed with and connected to a distal end of the
neck portion, the head portion defining a width; and a tail portion
integrally formed with and extending from a proximal end of the
body portion, the tail portion defining a width that is less than
the width of the body portion.
[0058] The body portion and the tail portion are configured and
dimensioned to at least one of overlie all of the staple slots of
the cartridge assembly for any length cartridge assembly, and
overlie all of the staple formation pockets of the anvil assembly
for any length anvil assembly.
[0059] The width of the neck portion may be less than the width of
the nose portion.
[0060] The tail portion may define at least one pair of opposing
proximal recesses. Each of the at least one pair of opposing
proximal recesses may be formed in an opposing lateral side of the
tail portion.
[0061] The at least one pair of opposing proximal recesses may
include a first pair of opposing proximal recesses; and a second
pair of opposing proximal recesses, wherein the first pair of
opposing proximal recesses is disposed proximal of the second pair
of opposing proximal recesses.
[0062] Each of the second pair of opposing proximal recesses may
extend towards a longitudinal axis of the buttress a greater amount
than each of the first pair of opposing proximal recesses.
[0063] A side edge of the tail portion, disposed between the first
pair of opposing proximal recesses and the pair of opposing
proximal recesses, may taper towards a longitudinal axis of the
buttress from a proximal end to a distal end.
[0064] Each of the first pair of opposing proximal recesses and
each of the second pair of opposing proximal recesses may have a
v-shaped profile. A distal edge of each of the first pair of
opposing proximal recesses and each of the second pair of opposing
proximal recesses may be oriented orthogonal to a longitudinal axis
of the buttress.
[0065] The body portion may further define a pair of opposing
distal recesses. Each of the pair of opposing distal recesses may
be formed in opposing lateral sides of the nose portion.
[0066] The tail portion of the surgical buttress may define a
proximal edge recess formed in a proximal edge thereof, wherein the
proximal edge recess longitudinally bisects the proximal edge.
[0067] The surgical buttress may be formed from a non-woven
material.
[0068] According to another aspect of the present disclosure, a
surgical buttress for use in a surgical stapling apparatus is
provided. The surgical buttress includes an elongate rectangular
body portion defining a width and being fabricated from at least
one of a biocompatible or bioabsorbable material. The surgical
buttress is formed with at least one marking provided at least one
of in or on the body portion.
[0069] The at least one marking may be formed as a notch.
[0070] The at least one marking may include biocompatible and
bioabsorbable materials.
[0071] The at least one marking may include a biocompatible
ink.
[0072] The at least one marking may be sewn into the surgical
buttress.
[0073] The body portion may define at least one pair of notch
markings on opposing lateral sides of the surgical buttress.
[0074] The body portion may include a plurality of markings. The
plurality of markings may be formed by physical notches and ink.
The plurality of markings may vary in length. The plurality of
markings may be evenly spaced along a length of the surgical
buttress.
[0075] The surgical buttress may further include a radioactive
material embedded within the body portion. The radioactive material
may be at least one brachytherapy seed.
[0076] The body portion may include a plurality of pores or
pockets. The at least one pore may contain a brachytherapy
seed.
[0077] According to still another aspect of the present disclosure,
a surgical buttress for use in a surgical stapling apparatus is
provided. The surgical buttress includes a body portion; and
radioactive material provided at least one of in or on the body
portion.
[0078] The body portion may include biocompatible and bioabsorbable
materials.
[0079] The radioactive material may be at least one brachytherapy
seed.
[0080] The body portion may include a plurality of pores. At least
one pore may contain a brachytherapy seed.
[0081] The surgical buttress may be formed with at least one
marking provided at least one of in or on the body portion.
[0082] According to still another aspect of the present disclosure,
a method of embedding radioactive material into a surgical buttress
is provided. The method includes providing a surgical buttress;
providing a template capable of holding the radioactive material;
inserting the radioactive material into the template; mating the
template to the surgical buttress; and embedding the radioactive
material into the surgical buttress.
[0083] The method may further include providing a surgical buttress
comprising a plurality of pores or pockets.
[0084] The method may further include providing a template that is
capable of receiving at least one brachytherapy seed.
[0085] The method may further include inserting brachytherapy
seeds.
[0086] The method may further include embedding the radioactive
material into at least 10% of a surface area of the buttress.
[0087] The method may further include embedding the radioactive
material into a distal end of the surgical buttress.
[0088] The method may further include embedding the radioactive
material into a proximal end of the surgical buttress.
[0089] The method may further include embedding the radioactive
material uniformly across a surface area of the surgical
buttress.
BRIEF DESCRIPTION OF THE DRAWINGS
[0090] The present disclosure will be further described with
reference to the accompanying drawings, wherein like reference
numerals refer to like parts in the several views, and wherein:
[0091] FIG. 1 is a perspective view of a surgical stapling
apparatus according to an embodiment of the present disclosure;
[0092] FIG. 2 is a top, exploded, perspective view of a distal end
of a DLU of the surgical stapling apparatus of FIG. 1;
[0093] FIG. 3 is a top plan view of a buttress according to an
embodiment of the present disclosure;
[0094] FIG. 4 is a top, perspective view of a cartridge
half-section of the DLU of FIG. 2;
[0095] FIG. 5 is a perspective view of a cartridge assembly of the
DLU of FIG. 2;
[0096] FIG. 6 is an enlarged perspective view of a distal end of
the cartridge assembly of FIG. 5;
[0097] FIG. 7 is an enlarged view of the indicated area of detail
of FIG. 5;
[0098] FIG. 8 is an enlarged view of the indicated area of detail
of FIG. 7;
[0099] FIG. 9 is a perspective view of an anvil assembly of the DLU
of FIG. 2, illustrating the buttress of FIG. 3 secured thereto;
[0100] FIG. 10 is a plan view of the cartridge assembly of the DLU
of FIGS. 4-8 and the anvil assembly of the DLU of FIG. 9,
illustrating the attachment of the buttress of FIG. 3 at different
attachment points of a respective cartridge assembly and anvil
assembly;
[0101] FIG. 11 is a top plan view of a buttress according to
another embodiment of the present disclosure;
[0102] FIG. 12 is a top plan view of a buttress according to yet
another embodiment of the present disclosure;
[0103] FIG. 13 is an enlarged view of the indicated area of detail
of FIG. 12;
[0104] FIG. 14 is an enlarged view of the indicated area of detail
of FIG. 12;
[0105] FIG. 15 is a top plan view of a buttress according to
another embodiment of the present disclosure;
[0106] FIG. 16 is a top plan view of a buttress according to
another embodiment of the present disclosure;
[0107] FIG. 17 is a top plan view of a buttress according to
another embodiment of the present disclosure;
[0108] FIG. 18 is a top plan view of a buttress according to
another embodiment of the present disclosure;
[0109] FIG. 19 is a top plan view of a buttress according to
another embodiment of the present disclosure;
[0110] FIG. 20 is a cross-sectional view, as taken through 20-20 of
FIG. 19;
[0111] FIG. 21 is an enlarged view of the indicated area of detail
of FIG. 19;
[0112] FIG. 22 is a top plan view of a buttress according to
another embodiment of the present disclosure;
[0113] FIG. 23 is a top plan view of a surgical buttress according
to certain embodiments of the present disclosure;
[0114] FIG. 24 is a perspective view of a staple cartridge assembly
having a surgical buttress attached thereto in accordance with
embodiments of the present disclosure; and
[0115] FIG. 25 is a perspective detail view of one of the pockets
of a surgical buttress according to certain embodiments of the
present disclosure.
DETAILED DESCRIPTION OF EMBODIMENTS
[0116] Embodiments of the presently disclosed staple line
reinforcement for anvil and cartridge of a loading unit of a
surgical stapling apparatus will now be described in detail with
reference to the drawings, in which like reference numerals
designate identical or corresponding elements in each of the
several views. In the drawings and in the description that follows,
the term "proximal," as is traditional, will refer to the end of
the stapling apparatus which is closest to the operator, while the
term "distal" will refer to the end of the apparatus which is
farthest from the operator.
[0117] Referring now to FIG. 1, there is disclosed a linear
surgical stapling apparatus, generally referred to as 10. In the
interest of brevity, this disclosure will focus primarily on a
buttress utilized in a loading unit 100, e.g., a single use loading
unit ("SULU") or a disposable loading unit ("DLU"). For simplicity,
hereinafter, SULU or DLU will be referred to as "DLU," but it
should be understood to include either or both a DLU or SULU. An
exemplary example of this type of surgical stapling instrument is
disclosed in U.S. Pat. No. 7,128,253, the entire disclosure of
which is hereby incorporated by reference herein.
[0118] Surgical stapling apparatus 10 generally includes a handle
assembly 12 and an elongate body 14 extending distally from handle
assembly 12. A DLU 100 is releasably secured to the distal end of
elongate body 14. DLU 100 includes a cartridge assembly 200 housing
a plurality of surgical fasteners or staples 223 (see FIG. 2) and
an anvil assembly 300 movably secured in relation to cartridge
assembly 200. Handle assembly 12 includes a stationary handle
member 22, a movable handle member 24, and a barrel portion 26. An
articulation lever 30 is mounted on the forward end of barrel
portion 26 adjacent rotatable member 28 to facilitate articulation
of DLU 100. A pair of knobs 32 is movably positioned along barrel
portion 26. Knobs 32 are advanced distally to approximate or close
cartridge and/or anvil assembly 200, 300, and retracted proximally
to unapproximate or open cartridge and/or anvil assembly 200, 300.
Actuation of movable handle member 24 applies lines of staples 223
to tissue. In order to properly orient cartridge and anvil assembly
200, 300 relative to the tissue to be stapled, surgical stapling
apparatus 10 is additionally provided with a rotatable member 28 on
the forward end of barrel portion 26. Rotation of rotatable member
28 relative to handle assembly 12 rotates elongate body 14 and
loading unit 100 relative to handle assembly 12 so as to properly
orient cartridge assembly 200 and anvil assembly 300 relative to
the tissue to be stapled.
[0119] As seen in FIG. 2, cartridge assembly 200 includes a carrier
210 defining an elongated support channel 212. Elongated support
channel 212 of carrier 210 is dimensioned and configured to
selectively receive a staple cartridge 220 therein. Staple
cartridge 220 includes retention slots 222 formed therein for
receiving a plurality of fasteners 223 and pushers 226. A plurality
of spaced apart longitudinal slots extend through staple cartridge
220 to accommodate upstanding cam wedges of actuation sled 228. A
central longitudinal slot 234 is formed in and extends along the
length of staple cartridge 220 to facilitate passage of knife blade
156 of drive bar 150 therethrough. During operation of surgical
stapler 10, actuation sled 228 translates through staple cartridge
220 to advance the cam wedges into sequential contact with pushers
226, to cause pushers 226 to translate vertically within retention
slots 222 and urge staples 223 from slots 222 into staple forming
cavities of anvil plate 310 of anvil assembly 300.
[0120] As seen in FIG. 2, cartridge assembly 200 includes a
surgical cartridge buttress 500 operatively secured to an upper
surface of staple cartridge 220, by sutures "S1, S2," to overlie at
least some of retention slots 222 and/or at least a portion of a
length of longitudinal slot 234. A first suture "S1" is threaded
through each of a distal pair of recesses or attachment points 238
and around/over distal portion of cartridge buttress 500 and, and a
second suture "S2" is threaded through each of a proximal pair of
recesses or attachment points 236 and around/over proximal portion
of cartridge buttress 500. A first end of each suture "S1, S2" may
be anchored or fixed in a respective one recesses of the proximal
and distal pair of recesses or attachment points 236, 238 while a
second end of each suture "Sl, S2" passes transversely across
respective distal and proximal portions of cartridge buttress 500
and is anchored or fixed in a respective other recess of the
proximal and distal pair of recesses or attachment points 236, 238.
As seen in FIG. 10, cartridge assembly 200 defines an axial
distance "D1" between the distal pair of recesses or attachment
points 238 and the proximal pair of recesses or attachment points
236.
[0121] With reference still to FIG. 2, anvil assembly 300 includes
an anvil plate 310 having a plurality of staple deforming
pockets/cavities 310a (see FIG. 9) and a cover plate 320 secured to
a top surface of anvil plate 310. Anvil assembly 300 further
includes a knife blade 330 operatively interposed within the cavity
defined between anvil plate 310 and cover plate 320.
[0122] Anvil plate 310 defines a proximal pair of recesses or
attachment points 316 formed near a proximal end of anvil plate 310
and disposed, one each, on opposed sides of longitudinal slot 314.
Anvil plate 310 defines a distal pair of recesses or attachment
points 318 formed near a distal end of anvil plate 310 and
disposed, one each, on opposed sides of longitudinal slot 314. At
least one recess of each of the proximal pair of recesses or
attachment points 316 and the distal pair of recesses or attachment
points 318 is in the form of a slot or notch having a constricting
profile so as to frictionally engage and/or pinch a suture "S".
Anvil assembly 300 further includes a surgical anvil buttress 500
operatively secured to a lower surface of anvil plate 310, by
sutures "S3, S4," to overlie at least some of anvil pockets 310a
and/or at least a portion of a length of longitudinal slot 314.
[0123] With reference still to FIG. 2, anvil buttress 500 is
secured to a lower surface of anvil plate 310, by anchors "S3, S4",
to overlie at least some of the anvil pockets and/or at least a
portion of a length of longitudinal slot 314. In particular, an
anchor "S3" is threaded across a distal portion of the anvil
buttress 500 and each of the corresponding distal pair of recesses
or attachment points 318, and an anchor "S4" is threaded across a
proximal portion of anvil buttress 500 and each of the
corresponding proximal pair of recesses or attachment points 316.
As seen in FIG. 10, anvil assembly 300 defines an axial distance
"D2" between the distal pair of recesses or attachment points 318
and the proximal pair of recesses or attachment points 316.
[0124] Reference may be made to U.S. patent application Ser. No.
12/342,400, filed on Dec. 23, 2008 (U.S. Pat. No. 8,011,555), the
entire content of which is hereby incorporated herein by reference,
for a detailed discussion of the construction and operation of
surgical stapling apparatus 10, cartridge assembly 200 and/or anvil
assembly 300.
[0125] It is contemplated that the cartridge buttress and/or anvil
buttress can be attached by other means. For example, in any of the
embodiments disclosed herein, the buttresses can be attached using
adhesives, welding, and/or attachment features incorporated in the
buttress material.
[0126] Buttress 500 for each of cartridge assembly 200 and anvil
assembly 300 is provided to reinforce and seal staple lines applied
to tissue by surgical stapling apparatus 10. Cartridge assembly 200
and anvil assembly 300 are particularly configured to allow
surgical buttresses 500 to be localized on inwardly facing surfaces
of cartridge assembly 200 and anvil assembly 300 in order to
facilitate passage of surgical stapling apparatus 10 into the body
of a patient without risk of tearing or wrinkling of the respective
buttresses as surgical stapling apparatus 10 is inserted into and
manipulated within the body of a patient. The material from which
the buttress 500 is formed may be bioabsorbable or
non-bioabsorbable. It should be understood that any combination of
natural, synthetic, bioabsorbable and non-bioabsorbable materials
may be used to form the buttress material. The buttress material
may be porous or non-porous, or a combination of porous and
non-porous layers. The non-porous buttress material may be utilized
to retard or prevent tissue ingrowth from surrounding tissues
thereby acting as an adhesion barrier and preventing the formation
of unwanted scar tissue.
[0127] Additional exemplary materials for surgical buttresses 500
for use with the surgical stapling devices disclosed herein are set
forth in commonly assigned U.S. Pat. Nos. 5,542,594; 5,908,427;
5,964,774; and 6,045,560, and commonly assigned U.S. Application
Publication Nos. 2006/0085034, filed on Apr. 20, 2006; and
2006/0135992, filed on Jun. 22, 2006, the entire contents of each
of which is hereby incorporated herein by reference.
[0128] In an embodiment, surgical buttresses 500 may be fabricated
from a suitable biocompatible and bioabsorbable material. Surgical
buttresses 500 may also be fabricated from a non-absorbent material
which does not retain fluid, for example, surgical buttresses 500
may be fabricated from "BIOSYN.TM." (a synthetic polyester,
commercially available from Tyco Healthcare Group, LP d/b/a
COVIDIEN, North Haven, Conn.), which is made from "GLYCOMER 631" (a
block copolymer) which is a synthetic polyester composed of
glycolide, dioxanone and trimethylene carbonate.
[0129] One block of the resulting copolymer contains randomly
combined units derived from p-dioxanone (1,4-dioxan-2-one) and
trimethylene carbonate (1,3-dioxan-2-one). A second block of the
copolymer contains randomly combined units derived from glycolide
and p-dioxanone. The resulting polyester is an ABA triblock
terpolymer possessing about 60% glycolide, about 14% dioxanone, and
about 26% trimethylene carbonate.
[0130] Anvil buttress and/or cartridge buttress 500 may be
pre-loaded (i.e., from the manufacturer) onto anvil assembly 300 or
cartridge assembly 200. Additional or replacement buttresses 500
for anvil assembly 300 and/or cartridge assembly 200 may be secured
to either anvil assembly 300 or cartridge assembly 200 as needed or
desired.
[0131] In operation, with DLU 100 coupled to a distal end of
elongated body 14 of surgical stapling apparatus 10, and with anvil
and cartridge buttresses 500 pre-loaded onto anvil assembly 300 and
cartridge assembly 200, respectively, surgical stapling apparatus
10 is used in accordance with methods known by those skilled in the
art. Once anvil assembly 300 and cartridge assembly 200 are clamped
onto tissue, surgical stapling apparatus 10 is fired. In firing
surgical stapling apparatus 10, drive bar 150 is advanced from a
proximal-most position to a distal-most position of DLU 100. In so
doing, knife blade 156 of drive bar 150 enters notch 528 of
buttress 500 thereby facilitating the dividing of buttress 500 and
reducing any incidents of pushing or bunching-up of buttress 500 by
blade 156. As drive bar 150 begins to travel distally, knife blade
156 substantially simultaneously cuts through a central section of
the proximal anchors "S2, S4" of anvil assembly 300 and cartridge
assembly 200, thereby respectively freeing the proximal ends of
anvil and cartridge buttresses 500 therefrom. As knife blade 156 is
moved distally, knife blade 156 slices or cuts longitudinally
through both anvil buttress 500 and cartridge buttress 500, thereby
dividing the buttresses 500 substantially in half.
[0132] Additionally, as drive bar 150 approaches the distal-most
position, drive bar 150 and/or knife blade 156 engage a suture
cutting assembly or suture release assembly, as described in U.S.
patent application Ser. No. 12/342,400, filed on Dec. 23, 2008, the
entire content of which is hereby incorporated herein by reference,
to thereby sever or release distal sutures "S1 or S3" and thus
release a distal end of buttress 500.
[0133] With reference to FIG. 3, an embodiment of a surgical
buttress 500 having a uniform profile in accordance with the
present disclosure is illustrated. Buttress 500 includes a head
portion 510, a body portion 520, a neck portion 530 interconnecting
head portion 510 and body portion 520, and a tail portion 532
extending proximally from body portion 520.
[0134] Buttress 500 is configured to be detachably secured to any
sized anvil assembly 300 and/or cartridge assembly 200, as
described above. Body portion 520 of buttress 500 defines a pair of
opposing distal recesses 524 on transverse edges near a distal
location 522 thereof. The pair of opposing distal recesses 524 may
be utilized to secure body portion 520 to a distal end of anvil
assembly 300 and/or cartridge assembly 200, either through a use of
suture "S1 or S3" or any other type of fastener, e.g., staple.
Distal portion 522 of body portion 520 has a reduced transverse
cross-sectional dimension, e.g., angled, arcuate, so as to be
suitable for various types of anvil and cartridge assemblies having
different shapes.
[0135] Tail portion 532 of buttress 500 defines two pairs of
opposing proximal recesses 526a, 526b formed therein. Each of the
pair of proximal recesses 526a, 526b is disposed on a transverse
side of tail portion 532 near the proximal edge thereof. Such
proximal pair of recesses 526a, 526b serve to detachably secure
tail portion 532 of buttress 500 to a proximal end of anvil
assembly 300 and/or cartridge assembly 200. In order to accommodate
various types of profiles, tail portion 532 of buttress 500
preferably has been provided with two pairs of opposing recesses, a
first proximal pair of recesses 526a, and a second proximal pair of
recesses 526b (located distal of the first proximal pair of
recesses 526a). Each of the proximal pair of recesses 526a, 526b
has a substantially v-shape profile.
[0136] In particular, when buttress 500 is to be used with a
relatively longer anvil assembly 300 and/or cartridge assembly 200,
then a suture "S2 or S4" is extended across tail portion 532 of
buttress 500, passed through the proximal-most pair of recesses
526a of buttress 500, and secured to respective recesses 316 of
anvil assembly 300 and/or recesses 236 of cartridge assembly 200.
Moreover, when buttress 500 is to be used with a relatively shorter
anvil assembly 300 and/or cartridge assembly 200, then a suture "S2
or S4" is extended across tail portion 532 of buttress 500, passed
through the distal pair 526b of the proximal pair of recesses of
buttress 500, and secured to respective recess 316 of anvil
assembly 300 and/or recesses 236 of cartridge assembly 200.
[0137] According to another aspect of the present disclosure, a
single profile or configuration buttress 500 may be used in
connection with cartridge assembly 200 and/or anvil assembly 300.
For example, the buttresses 500 that are used in connection with
cartridge assembly 200 and anvil assembly 300 each may have the
same overall length, width, thickness, perimetrical profile and
material of construction.
[0138] In particular, as seen in FIG. 10, when buttress 500 is used
in connection with cartridge assembly 200, a suture "S1" may extend
transversely across a distal end portion of cartridge assembly 200
and captures or is otherwise secured to distal pair of recesses or
attachment points 238 of cartridge assembly 200, wherein suture
"S1" is in registration with distal recesses 524 of secure a distal
end of body portion 520 of buttress 500. Additionally, when
buttress 500 is used in connection with cartridge assembly 200, a
suture "S2" may extend transversely across a proximal end portion
of cartridge assembly 200 and captures or is otherwise secured to
each of a proximal pair of recesses or attachment points 236 of
cartridge assembly 200, wherein suture "S2" is in registration with
the proximal-most pair 526a of the proximal pair of recesses of
tail portion 532 of buttress 500.
[0139] With continued reference to FIG. 10, when buttress 500 is
used in connection with anvil assembly 300, a suture "S3" may
extend transversely across a distal end portion of anvil assembly
300 and captures or is otherwise secured to distal pair of recesses
or attachment points 318 of anvil assembly 300, wherein suture "S3"
is in registration with distal recesses 524 of secure a distal end
of body portion 520 of buttress 500. Additionally, when buttress
500 is used in connection with anvil assembly 300, a suture "S4"
may extend transversely across a proximal end portion of anvil
assembly 300 and captures or is otherwise secured to each of a
proximal pair of recesses or attachment points 316 of anvil
assembly 300, wherein suture "S4" is in registration with the
distal pair 526b of the proximal pair of recesses of tail portion
532 of buttress 500.
[0140] Neck portion 530 connects head portion 510 to a distal end
of body portion 520. Generally, head portion 510 is in a
substantially rectangular shape which is used as a tab to
facilitate placement of buttress 500 in position on anvil assembly
300 and/or cartridge assembly 200. Following placement of buttress
500 on anvil assembly 300 and/or cartridge assembly 200, head
portion 510 and neck portion 530 may be torn or otherwise cut away
from body portion 520.
[0141] Tail portion 532 of buttress 500 includes a notch 528 at a
proximal edge thereof. Notch 528 is substantially centered with
respect to the longitudinal axis. Notch 528 which has a triangular
or V-shape configuration may be utilized to provide a lead-in for
the knife during a cutting of buttress 500. Notch 528 has a length
"L3a", as seen in FIG. 3.
[0142] As seen in FIG. 3, buttress 500 has an overall length "La".
Body portion 520 of buttress 500 has a length "L1a", and tail
portion 532 has a length "L2a". Body portion 520 has a width "W1a"
and tail portion 532 has a width "W2a" which is less that width
"W1a" of body portion 520, wherein a shoulder 534 is defined
between a side edge of body portion 520 and a side edge of tail
portion 532. It is contemplated that a shoulder 534 is provided or
defined along each opposed side edge of buttress 500.
[0143] With continued reference to FIG. 3, neck portion 530 of
buttress 500 has a length "L4a", and head portion 510 has a length
"L5a". Neck portion 530 of buttress 500 has a width "W3a" which is
less that width "W1a" of body portion 520 and less than width "W2a"
of tail portion 532. Also, head portion 510 has a width "W4a" which
is substantially equal to width "W1a" of body portion 520.
[0144] The uniform profile of buttress 500 which simultaneously
satisfies the requirements of one or more different assemblies
offers advantages of simplifying the assembly process, minimizing
the total number of unique components, and reducing assembly costs
associated therewith.
[0145] Moreover, buttress 500 may be used on or in connection with
cartridge assembly 200 and/or anvil assembly 300. In this manner, a
single profile buttress 500 is produced and used for cartridge
assembly 200 and/or anvil assembly 300. As such, the manufacturing
and storage costs for buttresses 500 may be reduced.
[0146] As mentioned above, DLU 100 includes an anvil surgical
buttress 500 and a cartridge surgical buttress 500 pre-loaded onto
anvil assembly 300 and cartridge assembly 200. An exemplary method
of loading anvil assembly 300 and/or cartridge assembly 200 with a
buttress 500 will now be described.
[0147] During the manufacturing and/or assembly process of DLU 100,
loading of anvil assembly 300 and/or cartridge assembly 200 with
buttress 500 includes the step of placing a buttress 500 atop a
tissue contacting surface of anvil assembly 300 and/or cartridge
assembly 200 such that notch 528 of buttress is disposed near a
proximal end of anvil assembly 300 and/or cartridge assembly 200
and head portion 510 of buttress 500 extends from a distal end of
anvil assembly 300 and/or cartridge assembly 200. With buttress 500
so positioned against anvil assembly 300 and/or cartridge assembly
200, proximal sutures "S2" and/or "S4" are pulled down. Tension is
then applied to buttress 500, in a distal direction, by pulling on
head portion 510. Distal sutures "Sl" and/or "S3" are then pulled
down. At this time, all the sutures "S1-S4" are cinched in the
respective attachment points 316, 318, 236, 238 of anvil assembly
300 and/or cartridge assembly 200. Following cinching of sutures
"S1-S4," head portion 510 of buttress 500 may be released. Next,
DLU 100 may be removed from a nesting and head portion 510 and neck
portion 530 of buttress 500 may be removed or severed from body
portion 520.
[0148] While the above-described embodiments surgical staplers
incorporating the use of movable knife blades to sever and release
surgical buttresses from the tissue contacting surfaces of the
anvil assembly and the cartridge assembly have been shown and
described in relation to endoscopic surgical staplers, it is
envisioned and within the scope of the present disclosure that any
of the embodiments disclosed herein may be incorporated into any
type of surgical stapler, including and not limited to open
surgical staplers, such as, for example, linear surgical staplers,
circular staplers, and transverse surgical staplers.
[0149] Moreover, while only distal and proximal sutures have been
shown and described as securing buttress 500 to anvil assembly 300
and/or cartridge assembly 300, it is contemplated that, in any of
the embodiments disclosed herein, any number of transverse sutures
may be provided along a length of the anvil assembly and/or
cartridge assembly to aid with the securement of buttress 500 along
a length thereof.
[0150] Any of the surgical buttresses disclosed herein may be
comprised of the GLYCOMER 631 a block copolymer, or other polymers
discussed above, as a film, non-woven, mesh or other type of
material, and may also be made as a film, non-woven, mesh or other
type of material, from poly-L-lactide (PLL), or Polycaprolactam
(Nylon-6), or polyglycolic acid (PGA) each of which are
homopolymers, or from glycolide trimethylene carbonate (Gly-TMC),
which is a copolymer, PLL and Gly-TMC both being bio-degradable
polyesters polymerized through a ring opening reaction. The
non-woven material can be made utilizing a melt blown or spun bond
process, or other known process. Non-woven materials and polymers
are disclosed in U.S. patent application Ser. No. 13/293,215,
entitled Hydrophilic Medical Devices, filed Nov. 10, 2011 (U.S.
Patent Publication No. 2013-0123816), the disclosure of which is
hereby incorporated by reference in its entirety. In certain
embodiments, non-woven, felted, or other relatively supple
materials having filaments are preferred.
[0151] Turning now to FIG. 11, a surgical buttress having a uniform
profile, in accordance with another embodiment of the present
disclosure, is generally illustrated as 600. Buttress 600 includes
a head portion 610, a body portion 620, a neck portion 630
interconnecting head portion 610 and body portion 620, and a tail
portion 632 extending proximally from body portion 620.
[0152] Buttress 600, similar to buttress 500, is configured to be
detachably secured to any sized anvil assembly 300 and/or cartridge
assembly 200, as described above. Body portion 620 of buttress 600
defines a pair of opposing distal recesses 624 formed in opposed
transverse side edges near a distal location 622 thereof.
[0153] In order to accommodate various types of profiles, tail
portion 632 of buttress 600 includes two pairs of opposing
recesses, a first proximal pair of recesses 626a, and a second
proximal pair of recesses 626b (located distal of the first
proximal pair of recesses 626a). Each of the proximal pair of
recesses 626a, 626b has a substantially v-shape profile. Each of
the proximal pair of recesses 626a, 626b is shallower as compared
to the proximal pair of recesses 526a, 526b of tail portion 532 of
buttress 500.
[0154] Neck portion 630 connects head portion 610 to a distal end
of body portion 620. Generally, head portion 610 is in a
substantially rectangular shape which is used as a tab to
facilitate placement of buttress 600 in position on anvil assembly
300 and/or cartridge assembly 200. Following placement of buttress
600 on anvil assembly 300 and/or cartridge assembly 200, under at
least certain circumstances, head portion 610 and neck portion 630
may be torn, damaged, or otherwise cut away from body portion
620.
[0155] Tail portion 632 of buttress 600 includes a notch 628 at a
proximal edge thereof. Notch 628 is substantially centered with
respect to the longitudinal axis. Notch 628 which has a U shaped
configuration, a triangular, or V-shape configuration, and may be
utilized to provide a lead-in for the knife during a cutting of
buttress 600. Notch 628 has a length "L3b", as seen in FIG. 11.
Length "L3b" of notch 628 of buttress 600 is greater than length
"L3a" of notch 528 of buttress 500, and the notch 628 ends just
before the first recesses 626a.
[0156] As seen in FIG. 11, buttress 600 has an overall length "Lb",
which is greater than the overall length "La" of buttress 500. Body
portion 620 of buttress 600 has a length "L1b", and tail portion
632 has a length "L2b". Body portion 620 has a width "W1b" and tail
portion 632 has a width "W2b" which is less that width "W1b" of
body portion 620, wherein a shoulder 634 is defined between a side
edge of body portion 620 and a side edge of tail portion 632. It is
contemplated that a shoulder 634 is provided or defined along each
opposed side edge of buttress 600.
[0157] With reference to FIGS. 3 and 11, it is contemplated that
body portion 620 of buttress 600 has a length "L1b" which is
greater than length "L1a" of body portion 520 of buttress 500.
Additionally, it is contemplated that tail portion 632 of buttress
600 has a length "L2b" which is greater than length "L2a" of tail
portion 532 of buttress 500.
[0158] With reference back to FIG. 11, neck portion 630 of buttress
600 has a length "L4b", and head portion 610 has a length "L5b".
Neck portion 630 of buttress 600 has a width "W3b" which is less
that width "W1b" of body portion 620, and which is substantially
equal to width "W2b" of tail portion 632. Also, head portion 610
has a width "W4b" which is substantially equal to width "W1b" of
body portion 620.
[0159] With reference to FIGS. 3 and 11, it is contemplated that
neck portion 630 of buttress 600 has a width "W3b" which is greater
than width "W3a" of neck portion 530 of buttress 500. Additionally,
it is contemplated that head portion 610 of buttress 600 has a
length "L5b" which is greater than length "L5a" of head portion 510
of buttress 500.
[0160] Turning now to FIGS. 12-14, a surgical buttress having a
uniform profile, in accordance with yet another embodiment of the
present disclosure, is generally illustrated as 700. Buttress 700
includes a head portion 710, a body portion 720, a nose portion 736
extending distally from body portion 720, a neck portion 730
interconnecting nose portion 736 and body portion 720, and a tail
portion 732 extending proximally from body portion 720.
[0161] As illustrated in FIGS. 12-14, buttress 700 has an overall
length "Lc", which is greater than the overall length "La" of
buttress 500. Body portion 720 of buttress 700 has a length "L1c",
tail portion 732 has a length "L2c", and nose portion 734 has a
length "L6c". Body portion 720 has a width "W1c", tail portion 732
has a width "W2c" which is less that width "W1c" of body portion
720, wherein a shoulder is defined between a side edge of body
portion 720 and a side edge of tail portion 732, and nose portion
734 has a width "W5c" which is less that width "W1c" of body
portion 720, wherein a shoulder is defined between a side edge of
body portion 720 and a side edge of nose portion 734. It is
contemplated that shoulders are provided or defined along each
opposed side edge of buttress 700.
[0162] With reference to FIGS. 3, 12 and 13, it is contemplated
that body portion 720 of buttress 700 has a length "L1c" which is
greater than length "L1a" of body portion 520 of buttress 500.
Additionally, it is contemplated that tail portion 732 of buttress
700 has a length "L2c" which is greater than length "L2a" of tail
portion 532 of buttress 500.
[0163] With reference back to FIGS. 12 and 14, nose portion 736 of
buttress 700 has a length "L6c."
[0164] Neck portion 730 of buttress 700 has a length "L4c", and
head portion 710 of buttress 700 has a length "L5c". Neck portion
730 of buttress 700 has a width "W3c" which is less that width
"W5c" of nose portion 736. Head portion 710 of buttress 700 has a
width "W4c" which is substantially equal to width "W5c" of nose
portion 736.
[0165] With reference to FIGS. 12 and 13, it is contemplated that
neck portion 730 of buttress 700 has a width "W3c" which is greater
than width "W3a" of neck portion 530 of buttress 500. Additionally,
it is contemplated that head portion 710 of buttress 700 has a
length "L5c" which is substantially equal to length "L5a" of head
portion 510 of buttress 500.
[0166] Buttress 700, similar to buttress 600, is configured to be
detachably secured to any sized anvil assembly 300 and/or cartridge
assembly 200, as described above. Buttress 700 defines a pair of
opposing distal recesses 724 formed in opposed transverse side
edges of nose portion 736. Each distal recess 724 has a
substantially v-shaped profile. Specifically, each distal recess
724 includes a distal portion that is oriented orthogonal to a
longitudinal axis of buttress 700, and a proximal portion that is
oriented transverse to the longitudinal axis of buttress 700. In an
embodiment, the proximal portion of each distal recess 724 may be
oriented at about a 63.degree. angle relative to the longitudinal
axis of buttress 700.
[0167] In order to accommodate various types of profiles, tail
portion 732 of buttress 700 includes two pairs of opposing
recesses, a first proximal pair of recesses 726a, and a second
proximal pair of recesses 726b (located distal of the first
proximal pair of recesses 726a). Each of the proximal pair of
recesses 726a, 726b has a substantially v-shaped profile.
[0168] Specifically, each recess of the first proximal pair of
recesses 726a and each recess of the second proximal pair of
recesses 726b includes a distal portion that is oriented orthogonal
to a longitudinal axis of buttress 700, and a proximal portion that
is oriented transverse to the longitudinal axis of buttress 700. In
an embodiment, the proximal portion of each of the first and second
proximal pair of recesses 726a, 726b may be oriented at about a
60.degree. angle relative to the longitudinal axis of buttress
700.
[0169] As best illustrated in FIG. 13, the segment or portion of
side edges of tail portion 732, located between the first proximal
pair of recesses 726a and the second proximal pair of recesses
726b, is angled or tapers towards the longitudinal axis of buttress
700, from a proximal end to a distal end thereof.
[0170] With reference to FIGS. 12 and 13, neck portion 730 connects
head portion 710 to a distal end of nose portion 734. Generally,
head portion 710 is in a substantially rectangular shape which is
used as a tab to facilitate placement of buttress 700 in position
on anvil assembly 300 and/or cartridge assembly 200. Following
placement of buttress 700 on anvil assembly 700 and/or cartridge
assembly 200, under at least certain circumstances, head portion
710 and neck portion 730 may be torn, damaged, or otherwise cut
away from nose portion 734.
[0171] Tail portion 732 of buttress 700 includes a notch 728 at a
proximal edge thereof. Notch 728 is substantially centered with
respect to the longitudinal axis of buttress 700. Notch 728 my have
a U shaped configuration, a triangular, or V-shape configuration,
and may be utilized to provide a lead-in for the knife during a
cutting of buttress 700. Notch 728 has a length "L3c", as seen in
FIGS. 12 and 13. Length "L3c" of notch 728 of buttress 700 is
greater than length "L3a" of notch 528 of buttress 500, and the
notch 728 ends just before the first recesses 726a.
[0172] With reference to FIG. 15, a surgical buttress 800a having a
uniform profile in accordance with another embodiment of the
present disclosure is illustrated. Buttress 800a, similar to
buttress 600, is configured to be detachably secured to any sized
anvil assembly 300 and/or cartridge assembly 200, as described
above.
[0173] Surgical buttress 800a includes a body portion 820a having
at least one marking 824 disposed therein and/or thereon.
Marking(s) 824 include indicia, e.g. patterns, shapes, alphanumeric
labeling, etc., to indicate a length of the staple line. As
illustrated in FIG. 15, marking(s) 824 may be formed of
biocompatible or bioabsorable ink, and/or radiopaque ink or
material, that is imprinted longitudinally along the body portion
820a as lines 824a and/or numerals 828a. Line marking(s) 824a may
be oriented orthogonal to the longitudinal axis of the buttress
800a and may extend across an entire width of the body portion
820a. Additionally, it is contemplated that a plurality of line
markings 824a may be equidistant to one another defining a distance
"M2a" between adjacent line markings 824a. It is contemplated that
the markings can be formed using radiopaque inks and/or
materials.
[0174] Referring now to FIG. 16, a surgical buttress 800b having a
uniform profile in accordance with another embodiment of the
present disclosure is illustrated. Buttress 800b, similar to
buttress 800a, is configured to be detachably secured to any sized
anvil assembly 300 and/or cartridge assembly 200, as described
above.
[0175] Surgical buttress 800b includes a body portion 820b having
at least one marking 824' disposed therein. Marking(s) 824' include
indicia and/or recesses, score lines, embossing, etc., to indicate
a length of the staple line. As illustrated in FIG. 16, marking(s)
824' may be formed of biocompatible or bioabsorable ink, and/or
radiopaque ink, as numerals 828b and as a series of recesses or
notches 824b extending longitudinally along the body portion 820b.
Recesses 824b may be V-shaped and disposed, one each, on opposing
sides of the body portion 820b. Additionally, it is contemplated
that a plurality of recesses 824b may be equidistant to one another
defining a distance "M3a" between adjacent recesses 824b.
[0176] It is contemplated that, in any of the embodiments disclosed
herein, markings such as those disclosed herein can be
pre-incorporated in a surgical buttress to identify tissue or
specimen structures after surgical resection with a surgical
instrument or surgical stapler. The markings can be applied during
the manufacturing process by methods including thermal or laser
processes, printing, sewing, stamping, cutting, dyeing, etc.
Alternatively, the markings can be placed by forming notches or
holes. Any inks or sewn structures must be biocompatible materials
and would desirably be bioabsorbable. It is contemplated that the
markings can be used to identify the margins of diseased tissue.
For example, the buttress material will be present on the tissue
remnant and the specimen removed. A pathologist can communicate to
a surgeon the location of any tissue having anomalies with
reference to the markings
[0177] With reference to FIG. 17, a surgical buttress 800c having a
uniform profile in accordance with another embodiment of the
present disclosure is illustrated. Buttress 800c, similar to
buttress 800a, is configured to be detachably secured to any sized
anvil assembly 300 and/or cartridge assembly 200, as described
above. The buttress 800c can be provided separately and attached to
a surgical instrument by the user, or it can be pre-loaded on an
instrument, as discussed above.
[0178] Surgical buttress 800c includes a body portion 820c having
at least one marking 824'' disposed therein and/or thereon.
Marking(s) 824'' include indicia, e.g. patterns, shapes,
alphanumeric labeling, etc., to indicate a length of the staple
line. As illustrated in FIG. 17, marking(s) 824'' may be formed of
biocompatible or bioabsorable ink that is imprinted longitudinally
along the body portion 820c as lines 824c and/or numerals 828c.
Line marking(s) 824c may be oriented orthogonal to the longitudinal
axis of buttress 800c and may extend across an entire width of the
body portion 820c. Additionally, it is contemplated that a
plurality of line markings 824c may not be equidistant to one
another defining, for example, a distance "M4a" between a first
line marking 824c.sub.1 and a second line marking 824c.sub.2 and a
distance "M4b" between a second line marking 824c.sub.2 and an
adjacent line marking or third line marking 824c.sub.3.
[0179] Referring now to FIG. 18, a surgical buttress 800e having a
uniform profile in accordance with another embodiment of the
present disclosure is illustrated. Buttress 800d, similar to
buttress 800a, is configured to be detachably secured to any sized
anvil assembly 300 and/or cartridge assembly 200, as described
above.
[0180] Surgical buttress 800e includes a body portion 820e having
at least one marking 824' disposed therein. Marking(s) 824' include
indicia and/or recesses, score lines, embossing, etc., to indicate
a length of the staple line. As illustrated in FIG. 18, marking(s)
824' may be formed of biocompatible or bioabsorable ink that is
imprinted longitudinally along the body portion 820d as lines 824d
and/or numerals 828d. The markings(s) 824'' may further include a
series of recesses 826e extending longitudinally along the body
portion 820d. Recesses 826d may be V-shaped and disposed, one each,
on opposing sides of the body portion 820d. Additionally, it is
contemplated that a plurality of recesses 826d and line markings
824d are positioned in an alternating pattern and may be
equidistant to one another defining a distance "M5a" between the
line marking 824d and adjacent recess 826d.
[0181] Now turning to FIG. 19, a surgical buttress 900 having a
uniform profile in accordance with another embodiment of the
present disclosure is illustrated. Buttress 900, similar to
buttress 800a, is configured to be detachably secured to any sized
anvil assembly 300 and/or cartridge assembly 200, as described
above.
[0182] Surgical buttress 900 includes a body portion 920 having at
least one marking 924 disposed therein and/or thereon. Marking(s)
924 include indicia, e.g. patterns, shapes, alphanumeric labeling,
etc., to indicate a length of the staple line. As illustrated in
FIG. 20, marking(s) 924 may be formed of biocompatible or
bioabsorable ink that is imprinted longitudinally along the body
portion 920 as lines 924 and/or numerals 928. Line marking(s) 928
may be oriented orthogonal to the longitudinal axis of buttress 900
and may vary in length thereby extending across a percentage or an
entire width of the body portion 920. Additionally, it is
contemplated that a plurality of line markings 924 may be
equidistant to one another defining a distance "M6a" between
adjacent line markings 924. It is contemplated that any of the
embodiments disclosed herein can include the markings
disclosed.
[0183] In any of the embodiments disclosed herein, the surgical
buttress can further include at least one source of radioactive
material disposed in or on the body portion of the buttress.
[0184] The radioactive material 940 is disposed in and/or on the
body portion 920 and includes encapsulated radioactive isotopes. It
is envisioned that the radioactive material 940 is formed as
brachytherapy seeds and the seeds may be embedded into the body
portion 920 of the surgical buttress 900 prior to loading the
surgical buttress 900 into the anvil assembly 300 and/or cartridge
assembly 200. Radioactive material 940 may take the form of
individual radioactive seeds/capsules or radioactive seeds/capsules
incorporated into a biocompatible or bioabsorbable thread or the
like.
[0185] As illustrated in FIG. 20, the radioactive material 940 may
be scattered throughout the body portion 920 at varying depths.
Alternatively, the radioactive material 940 may be disposed evenly
throughout the body portion 920. Additionally, the radioactive
material 940 may be deposited on or into a section of the body
portion 920. Further, radioactive material 940 may be disposed
solely along each lateral side edge of body portion 920 of surgical
buttress 900. In this manner, radioactive material 940 is not
affected, impacted or disturbed by any staples being fired by the
stapling apparatus or by the knife blade that is advanced during a
firing of the stapling apparatus. It is contemplated that any of
the embodiments disclosed herein can include the radioactive
material.
[0186] It is contemplated that the process of embedding the
radioactive material 940 into the surgical buttress 900 includes
inserting the radioactive material 940 into a template (not shown)
capable of holding the radioactive material 940, then mating or
abutting the template with the surgical buttress 900 and embedding
the radioactive material 940 into the body portion 920 of the
surgical buttress 900.
[0187] As illustrated in FIG. 21, the radioactive material 940 may
be in the form of a seed embedded into a pore 950 or pocket
disposed in the surgical buttress 900. For example, the pore 950
may be formed while mating the template with the surgical buttress
900 prior to embedding the radioactive material 940 therein.
[0188] Now turning to FIG. 22, a surgical buttress 1000 having a
uniform profile in accordance with another embodiment of the
present disclosure is illustrated. Surgical buttress 1000 includes
a body portion 1020 that is annular in shape having at least one
marking 1024 disposed therein and/or thereon. Marking(s) 1024
include indicia, e.g. patterns, shapes, alphanumeric labeling,
etc., to indicate an arc length of the staple line. As illustrated
in FIG. 23, marking(s) 1024 may be formed of biocompatible or
bioabsorable ink, and/or radiopaque material, that is imprinted
radially about the body portion 1020 as lines 1024 and/or numerals
1028. Line marking(s) 1028 may be oriented radial to a central axis
of body portion 1020 and may extend across an entire radius of the
body portion 1020. Additionally, it is contemplated that a
plurality of line markings 1024 may be radially disposed,
equidistant to one another, defining an arc length "M7a" between
adjacent line markings 1024.
[0189] With reference still to FIG. 22, surgical buttress 1000
further includes at least one radioactive material 1040 disposed in
and/or on the body portion 1020. It is envisioned that the
radioactive material 1040 is formed as brachytherapy seed(s) and
the seed(s) may be embedded into the body portion 1020 of the
surgical buttress 1000 prior to loading the surgical buttress 1000
into a surgical stapling device.
[0190] Additionally, the radioactive material 1040 may be deposited
on or into a section of the body portion 1020. It is contemplated
that the process of embedding the radioactive material 1040 into
the surgical buttress 1000 includes inserting the radioactive
material 1040 into a template (not shown) capable of holding the
radioactive material 1040, then mating the template with the
surgical buttress 1000 and embedding the radioactive material 1040
into the body portion 1020 of the surgical buttress 1000. The
radioactive material 1040 may be embedded into a pore or pocket
(not shown) disposed in the surgical buttress 1000. For example,
the pore or pocket (not shown) may be created while mating the
template with the surgical buttress 1000 prior to embedding the
radioactive material 1040.
[0191] In any of the embodiments disclosed herein, the buttresses
may be incorporated into, or configured for use with, devices that
are part of a powered surgical system or robotic surgical
system.
[0192] It is also contemplated that, for any of the buttresses
disclosed herein, the buttress can have pre-formed (e.g., by the
manufacturer) pockets or pores configured and arranged for the
receipt of the radioactive material discussed above. It is
contemplated that brachytherapy seeds can be separately packaged
and provided, with or without a template, and that the user can
apply the seeds to the buttress or buttresses. For example, the
user (such as a surgeon or operating room nurse) can place a seed
into one or more of the pockets or pores discussed above. It is
contemplated that the pockets or pores are pre-formed in the
buttress, whether pre-loaded on a surgical instrument or not. In
certain embodiments, the pockets or pores are disposed on the
lateral edges of the surgical buttress as shown in FIGS. 23-25. The
buttress may be configured with lateral wings that extend beyond
the sides of the surgical stapler jaws. In any of the embodiments
disclosed herein, the buttress material may be porous and
configured to encourage tissue ingrowth.
[0193] FIG. 23 shows a surgical buttress 1010 having a series of
markings, which may be formed as discussed above. The markings
1020a can have a pattern 1020 that would aid a surgeon, operating
room nurse, and/or pathologist in identifying the location of
certain tissue that was excised from the body. For example, the
pattern shown has alternating shorter and longer lines, however,
other patterns may be used. The buttress 101 has a central,
proximally located notch 1022 at the location where a knife of a
surgical stapler will cut through tissue, to aid the advancement of
the knife. Such notch 1022 may be triangular or oblong in
shape.
[0194] The surgical buttress 101 can have wings or lateral edges
1024, along the long sides of the buttress, which extend beyond the
sides of the staple cartridge 1030. Such wings 1024 can include or
incorporate pockets or pores for the receipt of radioactive
material. For example, brachytherapy seeds, which may be configured
as discussed herein, can be inserted in the pockets or pores 1025.
This can be done by the manufacturer, or by the surgeon or
operating room nurse whether or not the staple cartridge assembly
has a pre-loaded buttress. A tool 1040, which can be a tweezer or a
specially designed device, can be used to safely insert the seed or
seeds 1026 into the pockets or pores 1025. One advantage of having
a plurality of pockets or pores along the length of the side edges
of the buttress 1010 is that the surgeon or operating room nurse
can insert seeds 1026 in some or all of the pockets, on one or more
sides of the buttress, or may do so in some advantageous
pattern.
[0195] Although a linear surgical stapling cartridge and buttress
is shown, other types are contemplated. For example, a buttress for
a circular stapler could have an outer circular edge with a wing or
flange that incorporates or includes pockets or pores.
[0196] It is contemplated that the radioactive material can come in
other forms. For example, the wings, or flanges, can be provided,
and a suture or strand having radioactive material inside or on it,
can be threaded through the wing or flange. It is contemplated that
the radioactive material can be provided as brachytherapy seeds
that are installed in pockets that are adhesively attached to the
wing or flange of the surgical buttress. It is contemplated that
the radioactive material is attached to a surgical buttress at
locations other than the lateral sides or outer circular edge.
[0197] It is contemplated that a surgical buttress having markings
as discussed herein may or may not include the radioactive material
or means for attaching radioactive material. It is contemplated
that a surgical buttress having the radioactive material or means
for attaching radioactive material as discussed herein may or may
not include markings.
[0198] The present disclosure also includes a surgical kit having a
surgical stapling instrument, at least one surgical buttress, and a
separate package of encapsulated radioactive material. The surgical
stapling instrument can be a circular stapler. The surgical
stapling instrument can be a surgical stapling loading unit. The
loading unit can be a staple cartridge assembly. The at least one
surgical buttress may be pre-loaded onto the surgical stapling
instrument. The at least one surgical buttress can include pockets.
The at least one surgical buttress can be formed with lateral sides
or edges and can include pockets on the lateral sides or edges of
the at least one buttress. The lateral sides or edges can include
wings that are configured to extend beyond the edges of the
cartridge and/or surgical stapling instrument jaws. The
encapsulated radioactive material may include radioactive isotopes,
such as iodine or cesium isotopes, and may be brachytherapy seeds.
The package can include shielding (e.g., for the isotopes). The
package can include a template and the isotopes can be attached to
the template.
[0199] It will be understood that various modifications may be made
to the embodiments disclosed herein. For example, the stapling
apparatus need not apply staples but rather may apply two part
fasteners as is known in the art. Further, the length of the linear
row of staples or fasteners may be modified to meet the
requirements of a particular surgical procedure. Thus, the length
of a single stroke of the actuation shaft and/or the length of the
linear row of staples and/or fasteners within a disposable loading
unit may be varied accordingly. Therefore, the above description
should not be construed as limiting, but merely as exemplifications
of preferred embodiments. Those skilled in the art will envision
other modifications within the scope and spirit of the claims
appended thereto.
* * * * *