# Patent

## Title
Folded buttress for use with a surgical apparatus

## Abstract

An end effector for use with a surgical apparatus. The end effector comprising a staple cartridge having a tissue contacting surface defining a central longitudinal slot and an anvil plate having a tissue contacting surface defining a central longitudinal slot. A folded surgical buttress configured to overlie each of the tissue contacting surfaces of the staple cartridge and anvil plate and configured to retain the surgical buttress to the tissue contacting surfaces of each of the staple cartridge and anvil plate. The surgical buttress having a first longitudinal portion, a second longitudinal portion, and middle longitudinal portion between the first and second longitudinal portions, wherein the middle longitudinal portion is folded and configured to fit within the central longitudinal slot of each of the staple cartridge and anvil plate.

## Background
BACKGROUND
1. Technical Field
The present disclosure relates to surgical stapling apparatus including surgical buttresses which can be releasably attached to the surgical stapling apparatus, and in particular, surgical buttresses folded and contoured so as to remain securely attached.
2. Background of Related Art
Surgical stapling apparatus are employed by surgeons to sequentially or simultaneously apply one or more rows of fasteners, e.g., staples or two-part fasteners, to body tissue for the purpose of joining segments of body tissue together. Such apparatus generally include a pair of jaws or finger-like structures between which the body tissue to be joined is placed. When the stapling apparatus is actuated, or “fired”, longitudinally moving firing bars contact staple drive members in one of the jaws. The staple drive members push the surgical staples through the body tissue and into an anvil in the opposite jaw which forms the staples. If tissue is to be removed or separated, a knife blade can be provided in the jaws of the apparatus to cut the tissue between the lines of staples.
It is known to rely on a knife blade for cutting off some portion of the surgical buttress to affect release. A secondary material or mounting structure may be employed in addition to the surgical buttress (e.g., sutures) to provide attachment of the surgical buttress to the surgical stapling apparatus. Typically, firing forces are increased with each material that must be transected by the knife blade in order to release the surgical buttress.
It would be desirable to provide a surgical buttress that may be releasably secured to a surgical stapling apparatus without the need for a secondary material or mounting structure, and without the need for a knife blade to cut the secondary material or mounting structure to release the surgical buttress from the surgical stapling apparatus, thereby resulting in the use of fewer materials and lower firing forces. It would also be desirable to provide a surgical buttress having greater structural integrity and rigidity without adversely effecting a firing sequence of the surgical stapling apparatus.
SUMMARY
According to one aspect of the present disclosure, an end effector for use with a surgical apparatus wherein the end effector comprises a staple cartridge having a tissue contacting surface defining a central longitudinal slot and an anvil plate having a tissue contacting surface defining a central longitudinal slot. A folded surgical buttress configured to overlie each of the tissue contacting surfaces of the staple cartridge and anvil plate and configured to retain the surgical buttress to the tissue contacting surfaces of each of the staple cartridge and anvil plate. The surgical buttress having a first longitudinal portion, a second longitudinal portion, and middle longitudinal portion between the first and second longitudinal portions, wherein the middle longitudinal portion is folded and configured to fit within the central longitudinal slot of each of the staple cartridge and anvil plate. Preferably, the middle longitudinal portion is substantially V-shaped.
In an alternate embodiment, the surgical buttress of the staple cartridge and anvil plate each define a bottom surface, and a proximal portion with a proximal edge, wherein the proximal portion is folded in the direction of the bottom surface such that the proximal edge is adjacent the bottom surface of surgical buttress. The surgical buttress of the staple cartridge and anvil plate each have a distal portion with a distal edge, wherein the distal portion is folded in the direction of the bottom surface such that the distal edge is adjacent the bottom surface of surgical buttress.
In another aspect of the present disclosure, a staple cartridge for use with a surgical stapling apparatus, the staple cartridge comprising a cartridge body including a tissue contacting surface defining a plurality of staple retaining slots and having a central longitudinal slot and a staple disposed within each staple retaining slot of the cartridge body. A folded surgical buttress is configured to overlie each of the tissue contacting surfaces of the staple cartridge and anvil plate and configured to retain the surgical buttress to the tissue contacting surfaces of each of the staple cartridge and anvil plate. The surgical buttress has a first longitudinal portion, a second longitudinal portion and middle longitudinal portion between the first and second longitudinal portions, wherein the middle longitudinal portion is folded and configured to fit within the central longitudinal slot of each of the staple cartridge and anvil plate. Preferably, the middle longitudinal portion is substantially V-shaped.
In an alternate embodiment, the surgical buttress of the staple cartridge defines a bottom surface, and includes a proximal portion with a proximal edge, wherein the proximal portion is folded in the direction of the bottom surface such that the proximal edge is adjacent the bottom surface of surgical buttress. The surgical buttress of the staple cartridge further includes a distal portion with a distal edge, wherein the distal portion is folded in the direction of the bottom surface such that the distal edge is adjacent the bottom surface of surgical buttress.
In another aspect of the present disclosure, a surgical stapling apparatus, comprising a housing and an end effector being secured to the housing having a staple cartridge assembly having a tissue contacting surface and an anvil assembly having a tissue contacting surface, each of the staple cartridge assembly and anvil assembly having a central longitudinal slot. A folded surgical buttress is configured to overlie each of the tissue contacting surfaces of the staple cartridge and anvil plate and configured to retain the surgical buttress to the tissue contacting surfaces of each of the staple cartridge and anvil plate. The surgical buttress has a first longitudinal portion, a second longitudinal portion and middle longitudinal portion between the first and second longitudinal portions, wherein the middle longitudinal portion is folded and configured to fit within the central longitudinal slot of each of the staple cartridge and anvil plate. Preferably, the middle longitudinal portion is substantially V-shaped.



BRIEF DESCRIPTION OF THE DRAWINGS
Various embodiments of the presently disclosed interlocking buttress retention systems are disclosed herein with reference to the drawings, wherein:
FIG. 1 is a perspective view of a surgical stapling apparatus according to an embodiment of the present disclosure;
FIG. 2 is a perspective view, with parts separated, of a staple cartridge assembly of the surgical stapling apparatus of FIG. 1, illustrating an embodiment according to the present disclosure;
FIG. 3 is a perspective view, with parts separated, of an anvil assembly of the surgical stapling apparatus of FIG. 1, illustrating an embodiment of the present disclosure;
FIG. 4A is a perspective view of an alternate embodiment of a surgical buttress according to the present disclosure;
FIG. 4B is a perspective view of another alternate embodiment of a surgical buttress according to the present disclosure;
FIG. 4C is a perspective view of yet another alternate embodiment of the surgical buttress according to the present disclosure;
FIG. 4D is an enlarged area of detail depicted in FIG. 4B;
FIG. 4E is an enlarged area of detail depicted in FIG. 4C;
FIG. 5 is a perspective view of a distal end of the surgical stapling apparatus of FIG. 1, shown in use positioned about a tissue section;
FIG. 6 is a cross-sectional view taken along line 6-6 of FIG. 5; and
FIG. 7 is a perspective view of the stapled and divided tissue section of FIG. 5.



DETAILED DESCRIPTION OF THE EMBODIMENTS
Various exemplary embodiments of the present disclosure are discussed herein below in terms of surgical buttresses for use with surgical stapling apparatus. The surgical buttresses described herein may be used in sealing a wound by approximating the edges of wound tissue between a staple cartridge and an anvil plate of a surgical stapling apparatus which contains at least one surgical buttress. The at least one surgical buttress is releasably disposed onto a tissue contacting surface of surgical stapling apparatus by being configured to contour to the shape of surgical stapling apparatus. This allows the surgical buttress to remain securely atop the tissue contacting surface without the need for additional fasteners, sutures or similar structures. Firing of the surgical stapling apparatus forces legs of at least one staple to pass through an opening on the staple cartridge, the tissue, and the openings on the anvil plate to secure the surgical buttress to the tissue, to secure the adjoining tissue to one another, and to seal the tissue. The firing force of the staple releases the surgical buttress from the tissue contacting surface. Thus, the present disclosure describes surgical buttresses, surgical stapling apparatus supporting said surgical buttresses, and methods and mechanisms for using the same.
It should be understood that a variety of surgical stapling apparatus may be utilized with a surgical buttress of the present disclosure. For example, linear stapler configurations may be utilized, such as, for example staplers with Tri-Staple TechnologyTM, available through Covidien, which maintain a principal place of business at 555 Long Wharf Drive, North Haven, Conn. 06511, and transverse anastomosis staplers, such as, for example, EEATM, CEEATM, GIATM, EndoGIATM, and TATM staplers, also available through Covidien. It should also be appreciated that the principles of the present disclosure are equally applicable to surgical staplers having alternate configurations, such as, for example, end-to-end anastomosis staplers having a circular cartridge and anvil (see, e.g., commonly owned U.S. Pat. No. 5,915,616, entitled “Surgical Fastener Applying Apparatus,” the entire content of which is incorporated herein by this reference); laparoscopic staplers (see, e.g., commonly owned U.S. Pat. Nos. 6,330,965 and 6,241,139, each entitled “Surgical Stapling Apparatus,” the entire contents of each of which being incorporated herein by this reference); and transverse anastomosis staplers (see, e.g., commonly owned U.S. Pat. Nos. 5,964,394 and 7,334,717, each entitled “Surgical Fastener Applying Apparatus”, the entire contents of each of which being incorporated herein by this reference).
Embodiments of the presently disclosed surgical buttress and surgical stapling apparatus will now be described in detail with reference to the drawing figures wherein like reference numerals identify similar or identical elements. In the following discussion, the terms “proximal” and “trailing” may be employed interchangeably, and should be understood as referring to the portion of a structure that is closer to a clinician during proper use. The terms “distal” and “leading” may also be employed interchangeably, and should be understood as referring to the portion of a structure that is further from the clinician during proper use. As used herein, the term “patient” should be understood as referring to a human subject or other animal, and the term “clinician” should be understood as referring to a doctor, nurse, or other care provider and may include support personnel.
Referring now to FIG. 1, there is disclosed an exemplary surgical stapling apparatus or surgical stapler 10 for use in stapling tissue and applying a buttress material or surgical buttress to the tissue. An example of this type of surgical stapling instrument is disclosed in U.S. Pat. No. 7,128,253, the entire disclosure of which is incorporated by reference herein.
Surgical stapling apparatus 10 generally includes a handle 12 having an elongate tubular member 14 extending distally from handle 12. An end effector assembly 16 is mounted on a distal end 18 of elongate tubular member 14. End effector assembly 16 includes a first jaw or staple cartridge assembly 200 configured to receive a staple cartridge 32 therein and a second jaw or anvil assembly 300. End effector assembly 16 may be permanently affixed to elongate tubular member 14 or may be detachable and thus replaceable with a new end effector assembly 16. In addition to a replaceable end effector assembly or as an alternative thereto, the cartridge assembly 200 can be removable and replaceable. One of staple cartridge assembly 200 and anvil assembly 300 is movably mounted at distal end 18 of end effector assembly 16, and is movable between an open position spaced apart from one another to a closed position substantially adjacent to one another. Anvil assembly 300 supports an anvil plate 302 and may be fabricated from a metal material, including and not limited to stainless steel, titanium, titanium alloy, and the like. The tissue contacting surface of staple cartridge 32 may be fabricated from a material other than metal, including and not limited to plastic, thermoplastic, resin, polycarbonate, and the like.
Surgical stapling apparatus 10 further includes a trigger 33, as seen in FIG. 1, movably mounted on handle 12. Actuation of trigger 33 initially operates to move first jaw and second jaw between the open and the closed positions and simultaneously actuates surgical stapling apparatus 10 to apply lines of staples to tissue. In order to properly orient end effector assembly 16 relative to the tissue to be stapled, surgical stapling apparatus 10 is additionally provided with a rotation knob 34 mounted on handle 12. Rotation of rotation knob 34 relative to handle 12 rotates elongate tubular member 14 and end effector assembly 16 relative to handle 12 so as to properly orient end effector assembly 16 relative to the tissue to be stapled.
A driver 36, as seen in FIGS. 5 and 6, is provided to move approximate first jaw or staple cartridge assembly 200 and second jaw or anvil assembly 300 from the open position to the closed position. Driver 36 moves through a central longitudinal slot 338 (FIG. 3) formed in the anvil plate 302 of anvil assembly 300. A knife 30 with knife blade 31 is associated with driver 36 to cut tissue captured between staple cartridge assembly 200 and anvil assembly 300 as driver 36 passes through slot 338.
Reference may be made to commonly owned U.S. Pat. Nos. 5,915,616, 6,330,965, and 6,241,139, the disclosures of each of which are hereby incorporated by reference in their entirety, for a detailed discussion of the construction and operation of an exemplary surgical stapling apparatus 10.
Staple cartridge assembly 200 and/or anvil assembly 300 may be provided with a surgical buttress 500. Surgical buttress 500 is provided to reinforce and seal the lines of staples applied to tissue by surgical stapling apparatus 10. Surgical buttress 500 may be configured into any shape, size, or dimension suitable to fit any surgical stapling, fastening, or firing apparatus.
Staple cartridge assembly 200 is provided with a cartridge buttress 500a and anvil assembly 300 is provided with an anvil buttress 500b in the manners described in more detail hereinbelow. The buttresses 500a, 500b may be made from any biocompatible natural or synthetic material. The material from which the buttresses 500a, 500b are formed may be bioabsorbable or non-bioabsorbable. It should be understood that any combination of natural (including animal derived materials), synthetic, bioabsorbable and non-bioabsorbable materials may be used to form the buttress material. The buttresses 500a, 500b may be porous or non-porous, combination of porous and non-porous layers. The non-porous buttresses 500a, 500b 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. The buttress material can be a film, foam, mesh, woven, non-woven, or other material, and can be formed by molding, blown film processes, melt blown and/or spun bonding processes.
Additional exemplary materials for surgical buttresses 500a, 500b 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 incorporated herein by reference. The buttress material may be formed as described in U.S. application Ser. No. 13/293,215, the entire disclosure of which is hereby incorporated by reference herein.
As illustrated in FIGS. 2 and 3, surgical buttress 500 is releasably attached to the inwardly facing or tissue contacting surfaces 220, 320 of the staple cartridge 32 and/or the anvil plate 302. The surgical buttress 500 is folded and configured to contour to the shape of the respective staple cartridge 32 and anvil plate 302. Configuring the surgical buttress 500 to take the shape of the staple cartridge 32 or anvil plate 302 allows the surgical buttress 500 to secure to the respective tissue contacting surfaces prior to firing of the stapling apparatus 10. The folded sections also provide stability for the buttress while the instrument is used, and as tissue is grasped, the instrument is manipulated, etc.
With reference to FIG. 2, cartridge buttress 500a of staple cartridge assembly 200 is operatively secured to a tissue contacting surface 220 of staple cartridge 32. Cartridge buttress 500a has a first longitudinal portion 510, a second longitudinal portion 512, and a middle longitudinal portion 514 between the first and second longitudinal portions 510, 512. The middle longitudinal portion 514 is folded and contoured to fit firmly within a central longitudinal slot 238 of staple cartridge. In this embodiment, the first and second longitudinal portions 510, 512 remain atop the tissue contacting surface 220 of staple cartridge. The middle longitudinal portion 514 is substantially V-shaped or U-shaped such that a longitudinal gap exists along the plane defined by the first and second longitudinal portions 510, 512. Stated differently, cartridge buttress 500a includes a first condition wherein cartridge buttress 500a is substantially planar, and a second condition wherein the planar cartridge buttress 500a is folded along its longitudinal axis to define a middle longitudinal portion 514 that is substantially V-shaped, so as to define a central longitudinally extending tab or fin. The buttress could be molded in, or pressed into, this shape using heat and/or pressure.
Contouring the cartridge buttress 500a to fit within the central longitudinal slot 238 prevents the cartridge buttress 500a from lateral movement during use of the stapling apparatus 10. Further, the exact fit of the middle portion 514 within the central longitudinal slot 238 of the staple cartridge 32 provides friction that firmly secures the cartridge buttress 500a in position. The shape of the fold or folds in the buttress provides stability, and can be provided in the central portion, distal portion, proximal portion, or lateral sides of the buttress. As the knife blade 31 translates distally through central longitudinal slot 238, knife blade cuts the middle portion 514 of the cartridge buttress 500a, along the folded portion, further releasing the first and second longitudinal portions 510, 512 from the tissue contacting surface 220 of staple cartridge 32.
FIGS. 2 and 3 illustrate additional features of the buttresses 500a, 500b for securing the buttresses 500a, 500b to the respective tissue contacting surfaces 220, 320. As shown in FIG. 2, staple cartridge 32 has a first outer side surface 248a and a second outer side surface 248b. A first extension 526 of the cartridge buttress 500a extends downwardly from the first longitudinal portion 510. The first extension 526 can be formed by a folded portion that extends towards the first outer side surface 248a of staple cartridge 32 and is positioned adjacent thereto. Similarly, a second extension 528 of the cartridge buttress 500a, which can also be a folded portion of the buttress, extends downwardly from the second longitudinal portion 512 and is folded towards the second outer side surface 248b of staple cartridge 32 and positioned adjacent thereto. The first and second extensions 526, 528 allow for increased strength to maintain the positioning of the cartridge buttress 500a atop the tissue contacting surface 220 of staple cartridge 32. While the first and second extensions 526 and 528 are shown in relation to the cartridge buttress 500a, it is understood that the anvil buttress 500b may include similar features.
With reference to FIG. 3, and similar to cartridge buttress 500a, anvil buttress 500b is operatively secured to a tissue contacting surface 320 of anvil plate 302 of anvil assembly 300. Anvil buttress 500b is folded and contoured such that the middle portion 514 is positioned firmly within the central longitudinal slot 338 of anvil plate 302. First and second longitudinal portions 510, 512 of anvil plate 302 remain atop the tissue contacting surface 320 of anvil plate 302. Stated differently, anvil buttress 500b includes a first condition wherein anvil buttress 500b is substantially planar, and a second condition wherein the planar anvil buttress 500b is folded along its longitudinal axis to define a middle longitudinal portion 514 that is substantially V-shaped, so as to define a central longitudinally extending tab or fin.
As shown in FIG. 3, first extension 526 extends from first longitudinal portion 510 and is folded towards a bottom surface 536 of the anvil buttress 500b. The first extension 526 is folded towards the bottom surface 536 so as to lay adjacent the bottom surface 536 of first longitudinal portion 510 of anvil buttress 500b. The second extension 528 extending from second longitudinal portion 512 is folded towards the bottom surface 536 of second longitudinal portion 512 so as to lay adjacent the bottom surface 536 of anvil buttress 500b. This additional feature reinforces the anvil buttress 500b and prevents the anvil buttress 500b from tearing during tensioning. Folded portions can be provided at the lateral sides of the buttress to improve stability of the buttress on the cartridge and/or anvil members. While the first and second extensions 526 and 528 are shown in relation to the anvil buttresses 500b, in this embodiment, it is understood that the cartridge buttress 500a may include similar features.
FIGS. 4A-4C illustrate alternate embodiments. Surgical buttress 500 includes contouring corresponding to the shape of the staple cartridge 32 and/or anvil plate 302. For description purposes only reference is made to cartridge buttress 500a and staple cartridge 32, however, it is understood that similar construction is utilized for anvil buttress 500b and anvil plate 302. In the alternative, the anvil buttress 500b can be configured differently, for providing stability and tear resistance experienced at the anvil plate 302.
In FIG. 4A, the middle longitudinal portion 514 of the surgical buttress 500a in this example is substantially planar and configured to lie atop the tissue contacting surfaces 220 of the staple cartridge 32. In this embodiment, first longitudinal portion 510 of the cartridge buttress 500a is folded towards the first outer side surface 248a and is adjacent thereto. Similarly, second longitudinal portion 512 of the cartridge buttress 500a is folded towards the second outer side surface 248b and is adjacent thereto. The coupling between the first longitudinal portion 510 and the first outer side surface 280a, and between the second longitudinal surface 512 and the second outer side surface 248b prevents lateral movement of the cartridge buttress 500a and anchors the cartridge buttress 500a in position. Accordingly, the buttress 500a can have one or more longitudinal folded portions.
FIG. 4B illustrates another alternate embodiment, wherein cartridge buttress 500a defines a bottom surface 536, and cartridge buttress 500a includes a proximal portion 520 and a distal portion 522 that are folded towards the bottom surface 536. Proximal portion 520 of cartridge buttress 500a has a proximal edge 530 that is folded towards the bottom surface 536 so as to lay adjacent the bottom surface 536 of the cartridge buttress 500a. Similarly, distal portion 522 of cartridge buttress 500a has a distal edge 532 that is folded towards the bottom surface 536 so as to lay adjacent the bottom surface of the cartridge buttress 500a. The buttress has one or more folded ends. In this embodiment, the proximal and distal portions 520, 522 are adjacent the tissue contacting surface 220 of staple cartridge 32. It is contemplated that the embodiments discussed herein for both the staple cartridge 32 and anvil plate 302 can be used with well-known suture retention methods known in the art. For example, as shown in FIGS. 4B and 4D, a pair of notches 538 may be disposed within each of the folded regions of the proximal and distal portions 520, 522. The suture portion or portions, or some other kind of anchor, can be positioned in the notches. Alternatively or additionally, the buttress can be secured using adhesives or welding.
FIG. 4C illustrates yet another alternate embodiment, wherein the first and second longitudinal portions 510, 512 of cartridge buttress 500a are folded towards the bottom surface 536 of the cartridge buttress 500a. In a similar manner as described above, a first longitudinal edge 540 of first longitudinal portion 510 is folded towards the bottom surface 536 so as to lay adjacent the bottom surface of cartridge buttress 500a. A second longitudinal edge 542 of second longitudinal portion 512 is folded towards the bottom surface 536 so as to lay adjacent the bottom surface 536 of cartridge buttress 500a. In this embodiment, first and second longitudinal portions 510, 512 are adjacent the tissue contacting surface 220 of staple cartridge 32. Notches 538, shown in FIG. 4E, are disposed along the folded region. It is contemplated that the notches 538 may be positioned in varying configurations to correlate with the use of sutures well known in the art. The embodiments depicted in FIGS. 4B and 4C reinforce the cartridge buttress 500a and prevent the cartridge buttress 500a from tearing during tensioning.
The notches 538 used for retaining sutures disclosed herein are set forth in commonly assigned U.S. Provisional Patent No. 61/696,906, filed on Sep. 5, 2012, the entire contents of each of which is incorporated herein by reference.
Prior to assembly, the surgical buttresses 500a, 500b may be heat formed or cold folded into the contoured shape for receipt in the respective central longitudinal slots 238, 338 of staple cartridge 32 and anvil plate 302. During assembly the surgical buttresses 500a, 500b are placed onto each of the tissue contacting surfaces 220, 320 of staple cartridge assembly 200 and anvil assembly 300, respectively. Additional sutures or fasteners well known in the art may be used to further adhere the surgical buttresses 500a, 500b to each of the tissue contacting surfaces 220, 320. Additionally, other bonding methods such as adhesives, ultrasonic welding, laser welding, solvent bonding or heat pressing may be utilized in any of the embodiments disclosed herein.
As illustrated in FIG. 5, during use of surgical stapling apparatus 10, the first jaw or staple cartridge assembly 200 and the second jaw or anvil assembly 300, having surgical buttresses 500a, 500b loaded thereon (as described above) are positioned on either side of the surgical site. Tissue contacting surfaces 220, 320 of staple cartridge assembly 200 and anvil assembly 300 are positioned adjacent layers of tissue “T” to be fastened to one another.
As shown in FIG. 6, staple cartridge assembly 200 includes surgical staples 50 positioned within individual staple retaining slots 52 of staple cartridge 32. Staples 50 are of a conventional type and include a backspan 54 having a pair of legs 56 and 58 extending from backspan 54. Legs 56 and 58 terminate in tissue penetrating tips 60 and 62, respectively. Pushers 64 are located within staple retaining slots 52 and are positioned between staples 50 and the path of a drive bar 66.
In the illustrated embodiment, surgical stapling apparatus 10 is initially actuated by movement of trigger 33 relative to handle 12 (FIG. 1) causing driver 36 to move in the direction of arrow “A” (FIG. 5), and against sloped edge 21 of anvil plate 302 thereby causing anvil assembly 300 to be moved to the closed position relative to staple cartridge assembly 200. As drive bar 66 advances distally within staple cartridge 32, drive bar 66 urges pushers 64 upwardly against backspan 54 of staples 50 driving legs 56 and 58 of staples 50 through the cartridge buttresses 500a, tissue “T”, and anvil buttress 500b, towards staple forming pockets 68 in anvil plate 302 of anvil assembly 300. Tissue penetrating tips 60 and 62 of staple legs 56 and 58 are formed within staple forming pockets 68 in anvil plate 302 with backspan 54 securing surgical buttress 500 against tissue “T”.
Upon full actuation of surgical stapling apparatus 10, a knife 30 (FIG. 6) associated with surgical stapling apparatus 10 and carried by driver 36 may be utilized to cut tissue “T”, as well as surgical buttresses 500a, 500b between the rows of now formed staples 50. Upon movement of anvil assembly 300 to the open position, spaced apart from staple cartridge assembly 200, buttresses 500a, 500b are pulled away and released from respective tissue contacting surfaces 220, 320 of respective staple cartridge assembly 200 and anvil assembly 300.
The resulting tissue “T”, divided and stapled closed with staples 50, is illustrated in FIG. 7. Specifically, surgical buttresses 500a, 500b are secured against tissue “T” by legs 56, 58 and backspan 54 of staples 50. Thus, surgical buttresses 500a, 500b are stapled to tissue “T” thereby sealing and reinforcing the staple lines created by staples 50.
Persons skilled in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying figures are non-limiting exemplary embodiments, and that the description, disclosure, and figures should be construed merely exemplary of particular embodiments. It is to be understood, therefore, that the present disclosure is not limited to the precise embodiments described, and that various other changes and modifications may be effected by one skilled in the art without departing from the scope or spirit of the disclosure. Additionally, it is envisioned that the elements and features illustrated or described in connection with one exemplary embodiment may be combined with the elements and features of another exemplary embodiment without departing from the scope of the present disclosure, and that such modifications and variations are also intended to be included within the scope of the present disclosure. Accordingly, the subject matter of the present disclosure is not to be limited by what has been particularly shown and described, except as indicated by the appended claims.

## Claims

1. An end effector for use with a surgical apparatus, the end effector comprising:
a staple cartridge having a tissue contacting surface defining a central longitudinal slot;
an anvil plate having a tissue contacting surface defining a central longitudinal slot; and
a surgical buttress overlying and releasably retained on the tissue contacting surface of the staple cartridge or the anvil plate, the surgical buttress having a first longitudinal portion, a second longitudinal portion and middle longitudinal portion between the first and second longitudinal portions, the surgical buttress and including a proximal portion with a proximal edge and a distal portion with a distal edge,
wherein the middle longitudinal portion is folded and configured to fit within the central longitudinal slot of the staple cartridge or the anvil plate, and wherein at least one of the proximal portion or the distal portion of the surgical buttress is folded against the bottom surface of the surgical buttress, and positioned immediately adjacent the bottom surface of the surgical buttress and the tissue contacting surface of the staple cartridge or the anvil plate on which the surgical buttress is releasably retained.

2. The end effector of claim 1, wherein the middle longitudinal portion of the surgical buttress is substantially V-shaped or U-shaped.

3. A surgical stapling apparatus, comprising:
a handle;
an elongate tubular member extending distally from the handle; and
a staple cartridge operably coupled to a distal end of the elongated tubular member, the staple cartridge comprising: a cartridge body including a tissue contacting surface defining a plurality of staple retaining slots and having a central longitudinal slot; a staple disposed within each staple retaining slot of the cartridge body; and a surgical buttress overlying and releasably retained on the tissue contacting surface of the staple cartridge, the surgical buttress defining a bottom surface, and including a proximal portion with a proximal edge and a distal portion with a distal edge, wherein the proximal portion of the surgical buttress is folded against the bottom surface such that the proximal edge is immediately adjacent the bottom surface of the surgical buttress, and wherein the distal portion of the surgical buttress is folded against the bottom surface such that the distal edge is immediately adjacent the bottom surface of the surgical buttress and the tissue contacting surface of the staple cartridge.

4. A surgical stapling apparatus, comprising:
a handle;
an elongate tubular member extending distally from the handle;
an end effector secured to a distal end of the elongate tubular member, the end effector including a staple cartridge assembly having a tissue contacting surface and an anvil assembly having a tissue contacting surface, each of the staple cartridge assembly and anvil assembly having a central longitudinal slot; and
a surgical buttress overlying and releasably retained on the tissue contacting surface of the staple cartridge or the anvil plate, the surgical buttress having a first longitudinal portion, a second longitudinal portion and middle longitudinal portion between the first and second longitudinal portions, the surgical buttress defining a bottom surface, and including a proximal portion with a proximal edge and a distal portion with a distal edge,
wherein the proximal portion of the surgical buttress is folded against the bottom surface such that the proximal edge is immediately adjacent the bottom surface of the surgical buttress, and
wherein the distal portion of the surgical buttress is folded against the bottom surface such that the distal edge is immediately adjacent the bottom surface of the surgical buttress and the tissue contacting surface of the staple cartridge or the anvil plate on which the surgical buttress is releasably retained.