Appliance for storing, distributing and placing surgical fasteners

An appliance for storing, distributing and placing surgical fasteners comprises a handgrip body and an elongate element attached to the handgrip. The elongate element includes a magazine slide adapted to be displaced in the elongate element by a control rod. The control rod can be, in turn, actuated by the handgrip. The magazine slide also has surgical fasteners. Each surgical fastener has an anchoring bar, a catching bar and a connecting strip. A distal part of the anchoring bar has a conical shape. A distal end of the distal part of the anchoring bar has a hemispherical shape.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is related and claims priority to French Patent Application No. 04.10585, filed on Oct. 6, 2004, which is hereby incorporated by reference.

BACKGROUND

1. Technical Field

The present invention relates to an appliance for distributing and placing a couched I-shaped surgical fastener, for example for fixing parietal and visceral reinforcements, said appliance and said fastener permitting a placement that does not cause trauma to the tissues.

2. Background of Related Art

An appliance for distributing and placing I-shaped surgical fasteners is already known from WO03/075773. The fasteners described in said document comprise an anchoring bar, a catching bar and a connecting strip. They are introduced into the tissues to be fixed by means of a slotted hollow needle with a sharp bevelled end which passes through said tissues in order to deliver the fastener to the site where it is to assume its function. Thus, in this document, the needle passes through the flesh and, because of its hollow shape, may cause bleeding, and also a phenomenon known as “coring”. “Coring” is understood as the removal of a quantity of flesh corresponding to the internal volume of that part of the hollow needle having penetrated the flesh. Thus, the appliance described in said document poses risks of haemorrhage.

Moreover, in WO03/075773, when the needle with its bevelled point pricks the fabric of the prosthesis at a thread crossover or in the area of a thread, it passes through said thread or threads, possibly separating the filaments composing these threads, and this may produce resistance and packing. This damages the threads and, consequently, the prosthesis. The resistance produced may also block the mechanism of the appliance and render it unusable.

Another problem encountered with the appliance described in WO03/075773 is that, because of the necessary penetration of the bevelled needle into the flesh, the appliance does not allow a prosthesis to be stapled in the area of an anatomical structure of small thickness, that is to say in particular a thickness less than the length of the needle part passing through the flesh.

The present invention aims to remedy these problems by proposing an appliance for distributing a particular couched I-shaped fastener and able to deliver said fastener in a manner that does not cause trauma to the flesh and without causing any coring phenomenon, thereby limiting the risks of bleeding.

SUMMARY

The present invention relates to an appliance for storing, distributing and placing couched I-shaped surgical fasteners (A), comprising a handgrip body (B) equipped with at least one control means, and an elongate element (C) attached and fixed to the handgrip, in which appliance the elongate element (C) is made up of a body of tubular overall shape containing:near its distal end, a magazine slide itself containing couched I-shaped fasteners having an anchoring bar, a catching bar and a connecting strip, said magazine slide being displaceable in the elongate element by a control rod which can be actuated by the control means of the handgrip and, on the other hand, secured to a slotted and longitudinal hollow ejection barrel projecting from the distal end of said magazine slide and able to project from the elongate element (C),and, in its tubular body, on the one hand, means for distributing the stored fasteners (A) one by one, this distribution involving the transfer of the anchoring bar of the first fastener into a receiving seat arranged in the continuation of the ejection barrel and, on the other hand, an ejection plunger which can be displaced by the control means of the handgrip and which is arranged in alignment with the ejection barrel so as to push the anchoring bar of the first fastener into the latter,
characterized in that:the distal part of the anchoring bar of the fasteners (A) is of conical shape, and the distal end of this distal part is of hemispherical shape,the surface of the distal end of the ejection barrel is arranged in a plane substantially perpendicular to the longitudinal axis of the tubular body.

The present invention also relates to a couched I-shaped surgical fastener comprising an anchoring bar, a catching bar and a connecting strip, characterized in that the distal part of the anchoring bar of the fastener is of conical shape, and the distal end of this distal part is of hemispherical shape.

The present application also relates to an assembly comprising at least one couched I-shaped surgical fastener (A) and an appliance for storing, distributing and placing such fasteners (A), comprising a handgrip body (B) equipped with at least one control means, and an elongate element (C) attached and fixed to the handgrip, in which appliance the elongate element (C) is made up of a body of tubular overall shape containing:near its distal end, a magazine slide itself containing couched I-shaped fasteners (A) having an anchoring bar, a catching bar and a connecting strip, said magazine slide being displaceable in the elongate element by a control rod which can be actuated by the control means of the handgrip and, on the other hand, secured to a slotted and longitudinal hollow ejection barrel projecting from the distal end of said magazine slide and able to project from the elongate element (C),and, in its tubular body, on the one hand, means for distributing the stored fasteners (A) one by one, this distribution involving the transfer of the anchoring bar of the first fastener into a receiving seat arranged in the continuation of the ejection barrel and, on the other hand, an ejection plunger which can be displaced by the control means of the handgrip and which is arranged in alignment with the ejection barrel so as to push the anchoring bar of the first fastener into the latter,
characterized in that:the distal part of the anchoring bar of the fasteners (A) is of conical shape, and the distal end of this distal part is of hemispherical shape,the surface of the distal end of the ejection barrel is arranged in a plane substantially perpendicular to the longitudinal axis of the tubular body.

In the present application, distal end of a component is understood as the end farthest from the person using the appliance, and proximal end is understood as the end nearest to the person using the appliance.

Placement of a fastener using the appliance according to the invention does not cause trauma to the flesh. This is because the ejection barrel of the appliance according to the invention has a flat distal end which does not incise the flesh or the prosthesis, nor does it penetrate them.

Thus, in one embodiment of the invention, the ejection barrel can be made of metal and fixed on the magazine slide.

In a preferred embodiment of the invention, the ejection barrel is made of plastic and is moulded in one piece with the magazine slide. The surface of the distal end of the ejection barrel is preferably blunt. Such a configuration is preferred because such an ejection barrel is especially non-traumatizing in respect of the flesh. Such an ejection barrel does not therefore cause the phenomenon of coring. It therefore does not cause removal of a quantity of flesh capable of causing haemorrhage.

Moreover, the specific shape of the fastener according to the invention, as a conical portion ending in a hemisphere, and the specific nature of said fastener allow the latter to first force a passage through the meshes of the prosthesis without damaging the threads thereof, and therefore without destroying this prosthesis, thereafter through the human tissues without causing bleeding. The risks of packing and of haemorrhage are also avoided.

In a preferred embodiment of the invention, the fastener A is made of biocompatible plastic. It is preferably made of bioabsorbable plastic. Even more preferably, the bioabsorbable plastic is a lactic acid polymer.

By virtue of its plastic nature, the fastener slides and spreads apart the threads of the prosthesis without damaging them, so as to establish a passage at the centre of the mesh of the prosthesis.

Finally, it is possible, by virtue of the assembly according to the invention, to staple a prosthesis in the area of an anatomical structure of small thickness, for example in the area of Cooper's ligament, the thickness of which may be less than 3 mm, and to do so without the proximity of a solid structure, such as the os pubis, creating an obstacle. This is because, in the case where the fastener according to the invention comes into contact with the os pubis, its hemispherical end allows it to slide gently on this bone and to pivot easily in the tissues so as to take up position and perform its role of effective fixation.

Indeed, with the appliance according to the invention, the fact that the ejection barrel does not penetrate the prosthesis or the human tissues means that the fastener has more room in the human tissue to effect the rotation of the anchoring bar during positioning of the fastener at the moment of its ejection, compared to the case of an appliance of the prior art in which a bevelled needle also penetrates into the tissues. In particular, according to the present invention, since the ejection barrel does not have a bevelled end, the fastener can escape more quickly from the ejection barrel.

In a preferred embodiment of the invention, the length of the projecting part of the ejection barrel at the moment of ejection is less than or equal to 3 mm.

In a preferred embodiment of the invention, the total length L′ of the fastener (A) in its operating position is less than or equal to 10.5 mm.

In a preferred embodiment of the invention, the total height H of the fastener (A) in its operating position is less than or equal to 6.1 mm.

In particular, according to the invention, the overall size of the fastener is minimal. It is thus possible to store, for example, up to twenty fasteners within the magazine slide.

In a preferred embodiment of the invention, the handgrip is provided with a double non-return system ensuring appropriate use of the appliance and avoiding its becoming jammed.

In a preferred embodiment of the invention, the elongate element C comprises a step-by-step system able to move the stored fasteners A by a step P having a value equal to the length L of the catching bar of a fastener A, this step-by-step system comprising a rack effecting a drawer movement upon each ejection and being equipped with a shuttle which is mounted so as to slide on this rack, this shuttle cooperating with fixed notches of the magazine slide in order to advance by a step P on the rack upon each ejection.

Other characteristics and advantages will become evident from the description which follows with reference to the appended schematic drawing which depicts one embodiment of the assembly according to the invention.

DETAILED DESCRIPTION OF THE EMBODIMENTS

The appliance1shown inFIG. 1is intended to distribute staples A which, as shown inFIG. 2, have the overall shape of a couched I made up of two parallel bars, namely an anchoring bar2and a catching bar3, which are connected by an inclined connecting strip4. The distal part2aof the anchoring bar2has a conical shape. This distal part2acan comprise a projecting notch2bfor protecting the anchoring bar/connecting strip junction which is stressed at the moment of ejection and placement of the staple. The distal end2cof the anchoring bar2is of hemispherical shape. The distal part of the anchoring bar2is engaged first in the prosthesis and in the human body. Its particular shape described above permits easy engagement of the fastener through the prosthesis and the human tissues. The hemispherical part, combined with the conical part, allows the fastener to establish a passage through the meshes of the prosthesis by sliding along the threads and spreading them apart without damaging them. Thus, the distal part of the anchoring bar2passes through a mesh of the prosthesis without producing resistance or packing, and it then penetrates easily into the human tissues by virtue of its conical and tapered shape, but without causing trauma of said tissues, on account of the hemispherical and thus gentle and blunted shape of its distal end.

The fastener A is made of plastic, especially of biocompatible plastic, and preferably bioabsorbable plastic.

The connecting strip4is connected approximately to the centre of the anchoring bar2. The catching bar3comprises a distal part3aand a proximal part3b. The connecting strip4is connected to the catching bar3at a point close to the centre of this catching bar3, slightly offset towards its proximal part3b. The connecting strip is inclined by approximately 45° relative to the anchoring bar and catching bar. This particular embodiment of the fastener makes it possible to reduce the overall size of the fastener while giving it sufficient strength to ensure effective fixation of the prosthesis in the tissues; it is thus also possible to use this fastener to staple anatomical structures of small thickness and to store a large number of fasteners inside the appliance1, as will be seen below. The total length L′ of the fastener (A), in its operating position as shown inFIG. 2, namely from the distal end2cof its anchoring bar2to the proximal end3bof its catching bar3, is preferably less than or equal to 10.5 mm. The height H of the fastener (A), in its operating position as shown inFIG. 2, is preferably less than or equal to 6.1 mm.

As is shown inFIG. 1, the appliance1is made up of two elements, namely a grip assembly B and an elongate element C which are connected to one another with the aid of a bushing D. As the ejection barrel50(seeFIG. 18) is eccentric, the bushing D makes it possible to pivot the elongate element C and to keep it fixed in rotation in the position preferred by the surgeon for projection of the ejection barrel50.

As is shown inFIG. 8, the grip element B comprises a handgrip body4formed in two symmetrical parts which are joined by ultrasonic welding or by rivets or screws5, a handgrip6articulated on a transverse axle7of the body, a first control lever8articulated on a transverse axle9of the body and having a cam profile8a, and a second control lever10articulated on a transverse axle11of the body and having a cam profile10a.

The lower part of the first control lever8forms an arc of a circle12provided with teeth which are intended to cooperate with the branch13of a knurled wheel14articulated on a transverse axle15of the body throughout the surgical procedure, namely a phase of positioning of the appliance during which the surgeon is able to cause the ejection barrel50(seeFIG. 18) to emerge without proceeding with the ejection itself, then an ejection phase, and finally a phase in which the appliance is returned to its rest state, as will be explained hereinbelow. The knurled wheel14comprises a second, retaining branch17connected to a spring18whose fixed end is attached to the handgrip body4. The arc of a circle12comprises a first series of teeth19aof slight inclination and a second series of teeth19bof strong inclination, the two series of teeth being separated by a tooth19cof larger size.

As is shown inFIG. 3, the elongate element C comprises a tubular body20in which a magazine slide22is slidably mounted. The body20also comprises a step-by-step system23whose operation will be explained in more detail with reference toFIGS. 4 to 7.

As is shown inFIG. 4, the magazine slide22is connected to a control rod24with the aid of an axial rod21of smaller diameter which is bent at right angles. As is shown inFIG. 8, the control rod24bears on the cam profile10aof the second control lever10. The tubular body20is itself made up of two semicylindrical plastic shells assembled along their diametral plane by welding, interlocking or bonding, each of the shells itself being monolithic. The body20is preferably arranged in a tubular metal band (not shown) serving to strengthen the elongate element C.

As is shown inFIG. 8, the tubular body20also comprises a piston25penetrating into the handgrip body4and held on the cam profile8aof the first control lever8by means of a spring27which bears on a flange26of the tubular body20. The piston25is integral with a tube38which extends through it and which also extends through the spring27. The distal end of this tube38is equipped with a flange39on which is fixed a push rod42extending in the magazine slide.

The step-by-step system23is described inFIG. 3and inFIG. 4which is a sectional view through a plane offset by 90° with respect to the sectional plane ofFIG. 3. It comprises a rack28, for example of metal, equipped with notches29spaced apart regularly with a step P having a value equal to the length L (FIG. 2) of the catching bar3of a fastener A. The rack28is equipped, at its ends, with a distal block30and a proximal block31, preferably made of plastic. A shuttle32, preferably made of plastic, is mounted so as to slide on the rack28. This shuttle32comprises a distal tab33with an inclined face34permitting relative displacement, in the proximal direction, of the rack28with respect to the shuttle32. This same tab33snaps into the notches29of the rack28to prevent relative displacement, in the distal direction, of the rack28with respect to the shuttle32, as is shown inFIG. 4.

The step-by-step system23also comprises a series of notches35which are formed on the inner face of one shell20aof the tubular body20opposite the rack28and are spaced apart regularly by a step P having a value equal to the length L (FIG. 2) of the catching bar3of a fastener A. The shuttle32comprises a proximal tab36with a projection37permitting relative displacement, in the distal direction, of the shuttle and rack with respect to the shell20a. This projection37snaps into the notches35of the shell20ain order to prevent return of the shuttle32in the proximal direction.

Mounted on the shuttle32there is an abutment rod41which extends longitudinally and which penetrates into the magazine slide22in the groove53(seeFIG. 18) serving as seats for the catching bars3of the fasteners A.

As is shown inFIG. 18, the magazine slide is formed by two plastic shells22aand22bwhich are assembled, by bonding or welding, along their longitudinal and vertical mid-plane, enclosing an insert plate22c.

At its distal end, the shell22ais fixed to an ejection barrel50. This ejection barrel50is hollow and slotted, and the surface of its distal end is arranged in a plane substantially perpendicular to the longitudinal axis of the tubular body20. As used herein, the term “substantially perpendicular . . . ” means that the distal end of the ejection barrel is substantially flat such that the barrel is shaped and configured not to incise, penetrate, core or effect removal of tissue. This ejection barrel50is intended to receive the anchoring bar2of a fastener A. This ejection barrel50is made of plastic and is moulded in one piece with the magazine slide22.

Near its edges, the shell22acomprises two longitudinal grooves, namely a groove52serving as seats for the anchoring bars2of the fasteners A, and a groove53serving as seats for the catching bars3of the same fasteners. These two grooves are in one and the same vertical plane, distinct from the one passing through the ejection barrel50. The groove53serving as seats for the catching bars3opens freely from the front end of the shell22a, while the groove52serving as seats for the anchoring bars2dies out against an inclined plane visible inFIG. 19. The latter encourages the anchoring bar2of the first fastener to move transversely until this bar comes behind and into the longitudinal axis of the ejection barrel, in a receiving seat55as shown inFIG. 18.

The shell22afurther comprises, beside the ejection barrel50, a rib51which projects downwards and which, above the path of a catching bar leaving the groove53serving as seats for the catching bars3, has a sloping face51a.

FIG. 19, which depicts the appliance in the rest position, shows that, in this position, the push rod42is set back from the rear end of the ejection barrel50to uncover the receiving seat55formed in the other shell22b.

FIG. 18shows that the receiving seat55for the anchoring bar2of the first fastener is extended downwards by an inclined face56that supports the connecting strip4of the fastener. This shell22balso has a semicylindrical groove57which, together with a complementary groove58formed in the plate22c, forms a channel for guiding the push rod42. This channel is coaxial with the ejection barrel50. The proximal end of the shell22bis connected to the axial rod21, itself connected to the control rod24. In its part lying below the ejection barrel50, the distal end of the shell22bis equipped with a transverse finger59projecting towards the other shell, having a sloping face59aand the benefit of which will be specified later on.

The insert plate22chas a width allowing it to be inserted between the grooves52and53of the shell22aand a thickness allowing it to form, with this shell22a, a corridor leaving a passage for the connecting strips4of the fasteners A.

The magazine slide22thus formed has a length which allows it, for example, to store twenty fasteners A.

When the appliance is at rest, the handgrip6is in the position depicted inFIG. 8, with the control rod24bearing on the cam profile10aof the second control lever10, and the piston25bearing on the cam profile8aof the first control lever. The magazine slide22is in a retracted position inside the tubular body20. The ejection barrel50is retracted inside the body, and the push rod42which uncovers the receiving seat55exerts no force on the anchoring bar2arranged in this seat. Likewise, the catching bars3of the fasteners A on standby in the magazine are in contact with one another, while the catching bar of the last fastener is near, with or without contact, the end of the abutment rod41.

In use, for example by a laparoscopic approach, the elongate element C of the appliance is introduced, with the ejection barrel50retracted, into a trocar. Engagement is performed until there is proximity to or contact with the prosthesis61that is to be stapled to the human tissues62, as is shown inFIG. 12. The surgeon then has the possibility of deploying the ejection barrel50without in so doing triggering the ejection of the fastener A, as shown inFIG. 13. To do this, the surgeon presses the handgrip6. In a first part of the travel, the second control lever10pivots about its axis11. The cam profile10abears on the rod24which is displaced in the distal direction and pushes the magazine slide22also in the distal direction, causing the ejection barrel50to project out of the tubular body20.

Also during this first part of its travel, the branch13of the knurled wheel14cooperates with the series of teeth19aof the arc of a circle12of the first control lever8. Provided the branch13has not passed the tooth of larger size19c, the surgeon can relax his force on the handgrip and return to the rest position. The reason is that, because the end of the branch13is rounded, it does not definitively mesh in the slight inclines of the teeth19a, and these therefore allow the branch13to return to its initial position. Thus, as long as he is not exerting a force sufficient to pass the tooth19a, the surgeon can cause the ejection barrel50to project and can then return it again into the tubular body20without triggering ejection of the fastener A. This allows him to test various positions of the appliance before finally placing it in an ideal position with respect to the tissues61,62to be stapled.

Once the surgeon has pressed sufficiently on the handgrip6for the branch13of the knurled wheel14to pass the tooth19c, return is no longer possible, as shown inFIG. 9. In this figure, the branch13of the knurled wheel14is blocked against the tooth of larger size19c. During the second part of the travel, the surgeon must proceed with the ejection of the fastener. To avoid incorrect use of the appliance, which could lead to its becoming jammed, the surgeon's manoeuvre is guided until its completion. Thus, during this second part of its travel, the branch13of the knurled wheel14cooperates with the series of more strongly inclined teeth19bto permit continuation of the manoeuvre, tooth by tooth, while preventing release of the handgrip and, consequently, a reverse movement. Thus, the surgeon is obliged to press on the handgrip until the end of its travel, as is shown inFIG. 10, in order to free the branch13from the teeth19band thus trigger the ejection of the fastener A.

During this second part of the travel, the second control lever10has caused displacement of the piston25and, consequently, of the tube38and the push rod42, the displacement of the push rod42taking place relative to the magazine slide22, which remains temporarily fixed.

The push rod42is thus displaced longitudinally so that its end comes into contact with the proximal end of the anchoring bar2of the fastener A arranged in the receiving seat55and it pushes this anchoring bar into the ejection barrel50, as is shown inFIG. 14.

The movement of the anchoring bar2pulls the connecting strip4and the catching bar3of the fastener that is in the process of being distributed. The distal end3aof the catching bar3comes into abutment against the finger59, causing this bar to pivot upwards until it is standing up parallel to the reinforcement61. During this movement, its proximal end3bmeets the sloping face51aof the rib51which drives this end transversely so that, once the bar3has righted itself, this end does not abut against the ejection barrel50, but on the contrary moves away from the latter.

During this movement, the anchoring bar2advances along the ejection barrel50. When the connecting strip4escapes from the latter, the bar2can begin to tilt with the aid of the catching bar3. What happens is that, via the connecting strip4, the organized movement of the catching bar3has the effect of retaining the anchoring bar2which is thus forced to right itself and to anchor in the biological tissues62as shown inFIG. 15. Because of the unbevelled shape of the ejection barrel50and the small overall size of the anchoring bar2, the latter escapes rapidly from the ejection barrel50and then only needs a little space to right itself and rotate, as shown inFIGS. 15 and 16. The appliance1according to the invention and its fastener thus make it possible to staple prostheses in the area of anatomical structures of small thickness.

Finally, during or at the end of the righting of the anchoring bar2, the catching bar3, which is more or less parallel to the textile reinforcement61, slides, via its distal end3a, over the sloping face59aof the finger59which drives it transversely and releases it.

The length of the projecting part of the ejection barrel50at the moment of ejection may be 3 mm for example.

At the end of this movement, and as shown inFIG. 16, the release of the action on the handgrip6allows the spring27to return the magazine slide22and the push rod42. During the release of the handgrip6, the branch13of the knurled wheel14cooperates with the series of teeth19a,19b,19cin order to prevent the user from again pressing on the handgrip before the latter has returned to its rest position, as shown inFIG. 11. This second non-return system once again prevents inappropriate use of the appliance and ensures that it does not become jammed. The arc of a circle12of the first control lever8and the series of teeth19a,19band19cform, with the branch13of the knurled wheel14, a double non-return system ensuring that the appliance is used correctly and does not become jammed.

Once the handgrip6has returned to the rest position, the appliance1can be used for the subsequent fixations or can be withdrawn from the human body, as shown inFIG. 17.

While the fastener A is being distributed, the distribution means employed allow the anchoring bar2and the catching bar3to right themselves in order to ensure perfect retention of these tissues.

During the phase of distribution of the first fastener A, as shown inFIGS. 14 to 16, the receiving seat55is closed off by the push rod42and the awaiting fasteners maintain their position by virtue of a brake block (not shown) which is integral with the magazine slide22. The movement of the magazine slide22towards the front of the appliance carries with it the stock of fasteners and therefore moves them away from the free end of the abutment rod41, which is not set in motion until the end of the movement of the push rod42.

As shown inFIGS. 5 to 7, the movement of the abutment rod41is brought about by the advance of the shuttle32on the rack28.

Before use of the appliance1, as shown inFIGS. 4 and 5, the shuttle32is locked at one and the same time in a recess35of the tubular body20via the projection37of its proximal tab36and also in a notch29of the rack28via its distal tab33. At the moment when the fastener is ejected, the piston25, pushed by the first control lever8, advances in the distal direction, carrying with it the tube38and the flange39of this tube. As is shown inFIG. 6, the flange39comes into contact with the proximal block31of the rack28and moves this rack28in the distal direction. During this movement, the shuttle32is held integral with the rack via its distal tab33locked in the notch29of the rack, while its proximal tab36deflects so as to allow the projection37to pass the recess35of the tubular body20, in which it was locked, and to lock in the following recess35. Thus, the shuttle32and the abutment rod41integral with the latter advance in the distal direction by the length of a step P.

After the fastener has been ejected, the magazine slide22is returned by the spring27and its proximal end comes into contact with the distal block30of the rack28. As is shown inFIG. 7, the magazine slide22thus drives the rack28along with it in the proximal direction. On account of the sloping face34of the distal tab33of the shuttle32, the rack28moves in the proximal direction relative to the shuttle32, which for its part remains stationary in relation to the tubular body20because of its projection37locked in the second recess35of this tubular body20.

Thus, inFIG. 7, the shuttle32has advanced on the rack28by a step P in the distal direction compared toFIG. 5. This has the effect that the abutment rod41, which is integral with the shuttle32, has also advanced by a step P compared to the initial position that it occupied. In this way, upon the return of the magazine slide22, the catching bar3of the last fastener comes into contact with the distal end of the abutment rod41and retains the row of fasteners, while the magazine slide completes its return in the tubular body20.

At the end of the return of the magazine slide, the anchoring bar2of the first fastener comes into contact with the ramp54, shown inFIG. 19, which ramp ensures its transfer into the receiving seat55.

The appliance which has been described, and its fastener, are especially suitable for stapling prostheses such as parietal reinforcements without causing trauma to the flesh and without risks of haemorrhage. They are also especially useful for stapling prostheses in the area of anatomical structures of small thickness, for example Cooper's ligament, while ensuring very effective fixation, preferably only for the period of time required for fixation, on account of the preferably bioabsorbable nature of the fasteners. Moreover, the appliance and the fastener according to the invention can be used with the same effectiveness in surgical interventions performed by laparoscopy or, by contrast, open surgery.