Abstract:
Disclosed is a surgical stapling apparatus and method of use that includes a cartridge assembly which is capable of being reloaded during a surgical procedure without being removed from the surgical site. This allows a surgeon to continue a surgical operation without withdrawing or removing the surgical stapler for reloading and thus reduces the length of the surgery while allowing the physician to concentrate solely on the surgical procedure rather than dividing attention between the surgical procedure and reloading of the surgical stapler. The surgical stapling apparatus includes an elongate member having a plurality of fasteners arranged in a plurality of longitudinally extending rows which is longitudinally translatable through the cartridge to position the plurality of fasteners relative to a plurality of retention slots extending through an upper surface of the cartridge.

Description:
BACKGROUND 
       [0001]    1. Technical Field 
         [0002]    The present disclosure relates to surgical staplers. More particularly, the present disclosure relates to a surgical stapling apparatus capable of being reloaded during a surgical procedure without being removed from the surgical site. 
         [0003]    2. Background of the Related Art 
         [0004]    Surgical devices for first grasping or clamping tissue between opposing jaw structure and then stapling the tissue with surgical fasteners are well known in the art. In some instruments a knife is provided to cut the tissue which has been stapled by the fasteners. Instruments for this purpose typically include two elongated members, one of which carries a staple cartridge and the other of which includes an anvil. The staple cartridge houses a plurality of staples arranged in at least two lateral rows. The anvil defines a surface for forming the staple legs as the staples are driven from the staple cartridge. In certain devices, the stapling operation is effected by cam bars that travel longitudinally through the staple cartridge. A knife may travel between the staple rows to longitudinally cut and/or open the stapled tissue between the rows of staples. 
         [0005]    Often all or part of the stapling assembly of the surgical device is located on a loading unit that is operably connected to a handle assembly. While the handle assembly is configured for multiple uses, the loading unit can be configured for a single use. After the single use is exhausted, the loading unit is removed from the handle assembly and properly disposed. 
       SUMMARY 
       [0006]    Disclosed is a surgical stapling apparatus that includes a loading unit which is capable of being reloaded during a surgical procedure without being removed from the surgical site. This allows a surgeon to continue a surgical operation without withdrawing or removing the surgical stapler for reloading and thus reduces the length of the surgery while allowing the surgeon to concentrate solely on the surgical procedure rather than dividing attention between the surgical procedure and either reloading or replacing the surgical stapler. 
         [0007]    An end effector for a surgical stapling apparatus is disclosed including a housing defining a plurality of passageways and a lumen extending longitudinally therethrough. The end effector includes a cartridge which extends from the housing having a channel extending longitudinally therethrough. An upper surface of the channel includes a plurality of retention slots extending therethrough for the reception of surgical fasteners. The end effector also includes an elongate member having a plurality of fasteners arranged in a plurality of longitudinally extending rows where the elongate member is longitudinally translatable through the housing and the cartridge. The elongate member may be made from a flexible material. A plurality of pushers is disposed within the cartridge and are operatively associated with the plurality of retention slots and adapted to support the plurality of fasteners. The end effector also includes a drive member which is movable through the cartridge and adapted to engage the plurality of pushers to urge the plurality of fasteners through the plurality of retention slots. The drive member may include an actuating member extending proximally therefrom which is adapted to move the drive member through the cartridge. 
         [0008]    Each of the plurality of pushers may include a post and the drive member may include a slot where the post of each of the plurality of pushers is adapted to engage the slot of the drive member upon actuation of the drive member. Each of the plurality of pushers may include a guide groove and each of the plurality of fasteners may include a corresponding guide portion where the guide portion is adapted to engage the guide groove to guide the fastener when the pusher urges the fastener through one of the plurality of retention slots. 
         [0009]    The housing includes an upper housing and a lower housing with the lumen being defined between the upper and lower housings. The passageways of the housing extend from the lumen and are adapted to guide the fasteners through the housing. 
         [0010]    The cartridge includes a plurality of grooved channels formed on an underside of the upper surface and aligned with the passageways of the housing. The plurality of grooved channels is laterally aligned with the plurality of retention slots of the upper surface. The plurality of retention slots may include guide surfaces which are adapted for guiding the plurality of surgical fasteners into the plurality of retention slots. 
         [0011]    The elongate member defines a plurality of openings arranged in a plurality of longitudinally extending rows where each opening is adapted to receive a fastener and each opening may include perforations where the openings are adapted to tear along the perforations. Each opening may include a pair of holes and a slit and each fastener may include a backspan and a pair of legs extending from the backspan. The backspan of each fastener may be disposed on a first side of the elongate member and the pair of legs of each fastener may extend through the elongate member to a second side of the elongate member. 
         [0012]    A surgical stapling apparatus is disclosed including an actuator assembly,a handle supported by the actuator assembly and including an actuation mechanism, an elongated body extending from the actuator assembly and an end effector at the distal end of the elongated body. The end effector includes a housing defining a plurality of passageways and a lumen extending longitudinally therethrough. A cartridge extends from the housing and includes a channel extending longitudinally therethrough. The cartridge includes an upper surface with a plurality of retention slots extending therethrough for the reception of surgical fasteners. An elongate member including a plurality of fasteners arranged in a plurality of longitudinally extending rows is longitudinally translatable through the housing and the cartridge. A plurality of pushers is disposed within the cartridge and is operatively associated with the plurality of retention slots where the plurality of pushers is adapted to support the plurality of fasteners. A drive member is movable through the cartridge and is adapted to engage the plurality of pushers to urge the plurality of fasteners through the plurality of retention slots. The elongate member may be made from a flexible material. 
         [0013]    Each fastener may include a backspan and a pair of legs extending from the backspan. The backspan of each fastener may be disposed on a first side of the elongate member and the pair of legs of each fastener may extend through the elongate member to a second side of the elongate member. 
         [0014]    The surgical stapling apparatus may further include an anvil assembly including an anvil plate for receiving and forming a fastener. The anvil assembly is in juxtaposed relation to the cartridge and at least one of the anvil assembly and the cartridge is movable in relation to the other of the anvil assembly and the cartridge. 
         [0015]    The drive member includes an actuating member extending proximally therefrom which is adapted to move the drive member through the plurality of openings of the cartridge upon actuation of the actuation mechanism. 
         [0016]    The elongate member may be adapted to translate through at least a portion of the elongated body. 
         [0017]    A method of using a reloadable surgical stapling apparatus during a surgical procedure is disclosed including inserting the surgical stapling apparatus into a surgical site, grasping a first portion of tissue between an anvil assembly and a cartridge assembly of the surgical stapling apparatus, actuating an actuator assembly of the surgical stapling apparatus to drive a first group of fasteners through retention slots of the cartridge assembly and into the first portion of tissue to secure the first group of fasteners to the first portion of tissue, actuating the actuator assembly to release the first portion of tissue and to position a second group of fasteners within the cartridge assembly in substantial alignment with the retention slots, grasping a second portion of tissue between the anvil assembly and cartridge assembly, and actuating the actuator assembly to drive the second group of fasteners through the retention slots and into the second portion of tissue to secure the second group of fasteners to the second portion of tissue. 
         [0018]    The method may further include releasing the second portion of tissue and removing the surgical stapling apparatus from the surgical site where the surgical stapling apparatus is removed from the surgical site after at least the first and second groups of fasteners have been secured to the first and second portions of tissue respectively. 
         [0019]    Driving one of the first and second groups of fasteners through the retention slots may include translating a drive member at least partially through the cartridge assembly to engage a plurality of pushers disposed in the cartridge assembly and substantially aligned with the retention slots to drive the plurality of pushers towards the retention slots. Driving the plurality of pushers towards the retention slots may include engaging guide surfaces of the plurality of pushers with one of the first and second groups of fasteners to urge the fasteners through the retention slots. 
         [0020]    The cartridge assembly may include an elongate member extending therethrough and having the first and second groups of fasteners extending therethrough and arranged in a plurality of longitudinally extending rows. Actuating the actuator assembly to position the second group of fasteners within the cartridge may include translating the elongate member through the cartridge assembly. Urging one of the first and second groups of fasteners through the retention slots may include urging backspans of the fasteners through the elongate member. Translating the elongate member through the cartridge assembly may include translating an empty portion of the elongate member out of the cartridge assembly. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0021]    Various embodiments of the present disclosure are described hereinbelow with references to the drawings, wherein: 
           [0022]      FIG. 1A  is a perspective view of a surgical stapling apparatus, with portion in phantom, in accordance with the principles of the present disclosure; 
           [0023]      FIG. 1B  is a perspective view of the distal portion of the surgical stapling apparatus of  FIG. 1A ; 
           [0024]      FIG. 2A  is a perspective view of the housing of the surgical stapling apparatus of  FIG. 1  showing the elongate member and fasteners extending out of the housing; 
           [0025]      FIG. 2B  is a front perspective view of the housing of  FIG. 2A ; 
           [0026]      FIG. 2C  is a side perspective view of the housing of  FIG. 2A ; 
           [0027]      FIG. 2D  is a side perspective of  FIG. 2C  with the lower housing removed; 
           [0028]      FIG. 2E  is a front perspective view of  FIG. 2B . with the elongate member and fasteners removed; 
           [0029]      FIG. 3A  is a perspective view of the distal portion of the surgical stapling apparatus of  FIG. 1A ; 
           [0030]      FIG. 3B  is a perspective view of the juncture between the housing and the cartridge assembly of  FIG. 3A ; 
           [0031]      FIG. 3C  is a perspective view of  FIG. 3B  with the upper housing removed; 
           [0032]      FIG. 3D  is a perspective view of the cartridge of  FIG. 3A ; 
           [0033]      FIG. 4A  is top plan view of the cartridge of  FIG. 1A ; 
           [0034]      FIG. 4B  is an end view of  FIG. 4A  showing the fasteners disposed in the grooved channels; 
           [0035]      FIG. 4C  is a bottom plan view of  FIG. 4B ; 
           [0036]      FIG. 4D  is a side cross-sectional view of  FIG. 4A ; 
           [0037]      FIG. 4E  is a perspective cross-sectional view of  FIG. 4D ; 
           [0038]      FIG. 5A  is a front perspective view of the cartridge assembly of  FIG. 1A  showing the drive member translating through the cartridge to drive the fasteners through the retention slots; 
           [0039]      FIG. 5B  is an end view of  FIG. 5A ; 
           [0040]      FIG. 5C  is a perspective view of the drive member, pushers and fasteners of  FIG. 5A ; 
           [0041]      FIG. 5D  is a perspective view of the drive member and elongate member of  FIG. 5A ; 
           [0042]      FIG. 5E  is a top plan view of the elongate member of  FIG. 5A ; 
           [0043]      FIG. 5F  is a side perspective view, partially in section, of the drive member and pushers of  FIG. 5A ; 
           [0044]      FIG. 5G  is a front perspective view of the pushers of  FIG. 5A  with fasteners resting in the guide grooves; 
           [0045]      FIG. 6A  is a perspective view of the pushers and fasteners of  FIG. 1A  showing guide grooves and guide portions on the pushers and fasteners respectively; 
           [0046]      FIG. 6B  is an alternate embodiment of the fastener of  FIG. 6A ; 
           [0047]      FIG. 6C  is an alternate embodiment of the fastener of  FIG. 6A ; 
           [0048]      FIG. 7A  is a front perspective view of the drive member and pusher of  FIG. 1A  showing the pusher seated on the peak portion; 
           [0049]      FIG. 7B  is a front perspective view of  FIG. 7A  showing the pushers with the posts engaging the channel of the drive member as the pushers translate up the ramp; 
           [0050]      FIG. 7C  is a rear perspective view of  FIG. 7A  showing only the drive member; 
           [0051]      FIG. 8  is a top view of the drive member and pusher of  FIG. 1A ; 
           [0052]      FIG. 9  is a side cross-sectional view of the sled and pusher of  FIG. 8 , taken along section line  9 - 9 , prior to the drive member engaging the pusher; 
           [0053]      FIG. 10  is a view of  FIG. 9  showing the post of the pusher engaging the channel of the drive member at the inlet opening; 
           [0054]      FIG. 11  is a view of  FIG. 10  showing the pusher translating up the ramp of the drive member; 
           [0055]      FIG. 12  is a view of  FIG. 11  showing the pusher at the peak portion of the drive member with the fastener having been formed; 
           [0056]      FIG. 13  is a view of  FIG. 12  showing the pusher after the drive member has continued proximally; 
           [0057]      FIG. 14  is a view of  FIG. 13  showing the drive member returning distally; 
           [0058]      FIG. 15  is a view of  FIG. 14  showing the outlet of the channel engaging the post of the pusher; 
           [0059]      FIG. 16  is a view of  FIG. 15  showing the post of the pusher engaging the channel to draw the pusher down the ramp of the drive member; 
           [0060]      FIG. 17  is a view of  FIG. 16  showing the pusher at the bottom of the ramp; 
           [0061]      FIG. 18  is a view of  FIG. 17  showing the pusher in pre-firing position with the drive member continuing to return distally; and 
           [0062]      FIG. 19  is a side cross-sectional view of the end effector of the surgical stapling apparatus of  FIG. 1A  after the drive member has been translated to the fully fired position. 
       
    
    
     DETAILED DESCRIPTION OF THE EMBODIMENTS 
       [0063]    In the drawings and in the description which follows, in which like references numerals identify similar or identical elements, the term “proximal” will refer to the end of the apparatus which is closest to the clinician during use, while the term “distal” will refer to the end which is furthest from the clinician, as is traditional and known in the art. 
         [0064]      FIG. 1A  illustrates a surgical stapling apparatus  10  including an embodiment of an end effector according to the present disclosure shown generally as end effector  100 . As shown in  FIG. 1A , and as will be discussed hereinbelow, end effector  100  is configured for attachment to an actuator assembly  12  to form surgical stapler  10 . Actuator assembly  12  includes a handle assembly  20  and an elongated body  30  extending from handle assembly  20 . Elongated body  30  is configured for use in closed procedures, i.e., laparoscopic, endoscopic, arthroscopic, however, elongated body  30  may be shortened or eliminated for use in open procedures. In the present disclosure, actuator assembly  12  will only be described to the extent necessary to fully disclose end effector  100 . For a more detailed description of the structure and function of a surgical stapler similar to actuator assembly  12 , please refer to commonly owned U.S. Pat. No. 5,865,361 to Milliman et al. (“Milliman &#39;361 patent”), the contents of which is incorporated herein in by reference in its entirety. 
         [0065]    Referring to  FIGS. 1A and 1B , end effector  100  includes an anvil assembly  110 , a housing  200 , a cartridge assembly  300 , an elongate member  400 , and a drive member  500 . Anvil assembly  110  includes fastener deforming depressions  112  ( FIG. 19 ) for deforming fasteners to secure tissue “T”. 
         [0066]    As seen in  FIGS. 2A-2E , housing  200  defines an elongate shape and includes an upper housing  202  and a lower housing  204  which define a gap or lumen  206  therebetween extending longitudinally through housing  200 . Housing  200  also includes a plurality of passageways  208  extending from lumen  206  into upper housing  202  and extending longitudinally through upper housing  202 . Lower housing  204  defines longitudinally extending grooves  210  extending from lumen  206  into lower housing  204  and laterally aligned with passageways  208 . Housing  200  may also include an actuation channel  212  for receiving an actuation mechanism  502  ( FIG. 5A ) therethrough. Actuation mechanism  502  may be used for actuating drive member  500 . Actuation channel  212  may, for example, be disposed in the lower housing  204 . 
         [0067]    Referring now to  FIGS. 3A-3D , cartridge assembly  300  extends from housing  200  and includes a casing  302  dimensioned and configured to receive a cartridge  304 . Cartridge  304  includes a plurality of spaced apart channels  306  extending longitudinally therethrough. Cartridge  304  also includes a plurality of retention slots  308  extending through an upper surface  310  of cartridge  304  and aligned with the plurality of fastener deforming depressions  112  of the anvil assembly  110  ( FIG. 19 ). Plurality of retention slots  308  may define a plurality of rows and each row may be associated with one of the plurality of spaced apart channels  306 . For example, each channel  306  may include an outer row of retention slots  308 A and an inner row of retention slots  308 B. A knife slot  318  may be disposed between adjacent channels  306  for receiving a knife blade (not shown) therethrough. Each channel  306  may also include additional rows of retention slots  308  as desired, where, for example, each channel  306  may include three or more rows of retention slots  308  or each channel  306  may include only a single row of retention slots  308 . 
         [0068]    Cartridge  304  also includes a plurality of grooved channels  312  extending longitudinally along an underside  314  of the upper surface  310  of cartridge  304 . Plurality of grooved channels  312  are each laterally aligned with one of the rows of retention slots  308 . As seen in  FIGS. 4A-4E , retention slots  308  may also include guide surfaces  316  on underside  314  of upper surface  310 . Guide surfaces  316  may, for example, be chamfered, angled, radial, or other types of contoured surfaces suitable to guiding fasteners through retention slots  308 . Cartridge  304  also includes a plurality of pushers  350  operatively associated with retention slots  308 , as will be described in more detail below. 
         [0069]    Referring now to  FIGS. 2A-2D ,  3 B- 3 C,  5 A,  5 D, and  5 E, elongate member  400  includes a plurality of fasteners  600  extending therethrough and arranged in a plurality of longitudinally extending rows  402 . Each of rows  402  may correspond to and align with one of the rows of retention slots  308  and additional elongate members  400  may be included where, for example, each channel  306  of cartridge  304  receives an elongate member  400 . Each fastener  600  includes a pair of legs  602  and a backspan  604  ( FIGS. 4D-4E ) where each backspan  604  is disposed on a first side of elongate member  400  and each pair of legs  602  extend through elongate member  400  to a second side. Elongate member  400  and fasteners  600  are longitudinally translatable through housing  200  where lumen  206  of housing  200  is adapted to receive elongate member  400  and passageways  208  and grooves  212  are adapted to receive legs  602  and backspan  604  of fasteners  600  respectively ( FIGS. 2B and 2C ). Passageways  208  and grooves  212  are adapted to guide fasteners  600  through housing  200  as elongate member  400  translates longitudinally through housing  200 . Elongate member  400  and fasteners  600  are also longitudinally translatable through the housing and cartridge assembly  300  to move the fasteners from a position proximal of the retention slots to a position in line with the slots. Channels  306  are adapted to receive elongate member  400  and fasteners  600 , while grooved channels  312  engage at least a portion of legs  602  of fasteners  600  to maintain the lateral position of fasteners  600  relative to retention slots  308  ( FIGS. 3B ,  3 C, and  4 B). Elongate member  400  may be made of a flexible or deformable material such as, for example, a rubber, a cotton or other cloth, fabric, or textile, a plastic web or mesh, a plastic compound, silicone, gum rubber, or any other material suitably flexible and adaptable for translation through housing  200  and cartridge assembly  300  to allow fasteners  600  to be fired by pushers  350 . Elongate member  400  includes openings  404  therethrough for the reception of fasteners  600 . Each opening  404  may include, for example, a pair of holes  406  and  408  and a slit  410  extending at least partially therebetween, as seen in  FIG. 5E . Each pair of legs  602  of fasteners  600  extends through pair of holes  406  and  408  respectively and each backspan  604  is substantially aligned with one of slits  410 . 
         [0070]    Referring now to  FIGS. 5F-5G ,  6 A- 6 C, and  7 A- 7 C, pushers  350  include a plurality of pushing surfaces  352  for engaging fasteners  600  and pushing surfaces  352  may define guide grooves  354  for engaging backspans  604  and guide portions  606  of fasteners  600 . Guide portions  606  may be defined by backspans  604  or may be in addition to backspans  604  ( FIGS. 6A-6C ). Guide grooves  354  are configured to maintain the alignment of fasteners  600  relative to retention slots  308  and to assist in guiding and stabilizing fasteners  600  as they move through retention slots  308 . Guide grooves  354  may, for example, include sloped surfaces  356  and  358  ( FIG. 6A ) for centering backspans  604  of fasteners  600  within guide grooves  354  and may define a shape corresponding to guide portions  606  for receiving and engaging guide portions  606  and backspans  604 . Sloped surfaces  356  and  358  may, for example, be any angled, radial, or contoured surface suitable to provide lateral support to fasteners  600  and assist in positioning or centering fasteners  600  during firing. Pushers  350  also include flanged portions  360  for engaging alignment slots  320  of cartridge assembly  300  and guiding pushers  350  toward retention slots  308 . Pushers  350  may also include posts or protrusions  362  ( FIG. 5G ) for engaging drive member  500 . 
         [0071]    Referring now to  FIGS. 1B ,  5 A,  5 C,  5 D,  5 F,  7 A- 7 C, and  8 - 19 , drive member  500  is longitudinally translatable through cartridge assembly  300  ( FIG. 5A ) between an initial position at a distal portion of cartridge assembly  300  ( FIG. 1B ) and a fully fired position at a proximal portion of the cartridge assembly  300  ( FIG. 19 ). It is also contemplated that the initial position may be at a proximal portion of cartridge assembly  300  and the fully fired position may be at a distal portion of cartridge assembly  300  where drive member  500  translates distally from the initial position to the fully fired position. Drive member  500  may optionally be only partially translated through cartridge assembly  300  such that only a portion of fasteners  600  is fired. 
         [0072]    Drive member  500  is operatively associated with plurality of pushers  350  such that as drive member  500  translates through cartridge assembly  300 , drive member  500  engages each of pushers  350  with ramps  504  ( FIGS. 9-12 ). Pushers  350  translate along ramps  504  to urge fasteners  600  through retention slots  308 . Pushers  350  may also include distal sloped surfaces  364  for engaging ramps  504  during translation of drive member  500  from the initial position toward the fully fired position ( FIGS. 10-12 ). 
         [0073]    Drive member  500  may include slots  506  for receiving posts  362  of pushers  350  and posts  362  may be substantially cylindrical or curved to facilitate entry into slots  506 . Alternatively posts  362  maybe any shape suitable for entry into slots  506  to provide a camming action with slots  506  including, for example, linear shapes, squares, triangles, oblong shapes, or other polygonal or curved shapes. Slots  506  each define an inlet opening  508  at a leading or proximal portion  510  of drive member  500 , a channel  512  extending substantially parallel to ramp  504  for translation of posts  362  therethrough, and an outlet opening  514  at a trailing or distal portion  516  of drive member  500 , as seen in  FIGS. 9-18 . Trailing potion  516  may also include ramps  518  and outlet openings  514  may be defined at a peak portion  522  of drive member  500  or may be defined at the trailing edge  520  of ramps  518 . Pushers  350  may include proximal sloped surfaces (not shown) for engaging ramp  518  during translation of drive member  500  from the fully fired position ( FIG. 19 ) toward the initial position ( FIG. 1B ). Channel  512  may further include a distal portion  526  ( FIG. 5F ) extending through drive member  500  parallel to ramp  518  for receiving posts  362 . In alternative embodiments, no posts  362  or slots  506  are included for use with pushers  350  where, for example, pushers  350  engage ramps  504  without the support of posts  362  and slots  506 . 
         [0074]    Referring now to  FIG. 2D ,  5 A,  5 F, and  7 A- 7 C, drive member  500  translates through cartridge assembly  300  by actuation of actuation mechanism  502  ( FIG. 5A ). Actuation mechanism  502  is operatively associated with actuator assembly  12  and is coupled to drive member  500 . Actuation mechanism  502  extends from actuator assembly  12  through actuation channel  212  of housing  200 , cartridge assembly  300 , and a lumen  524  of drive member  500 . Lumen  524  extends through drive member  500  and is adapted for the reception of actuation mechanism  502 . Lumen  524  may, for example, include an internal thread for engaging actuation mechanism  502 . Actuation mechanism  502  may be in the form of a screw, a rod or other mechanism suitable to translate drive member  500  through cartridge assembly  300 . 
         [0075]    Actuator assembly  12  may be adapted to independently translate elongate member  400  through housing  200  and cartridge assembly  300  through the use of an actuator (not shown) such as, for example, a spool, a gear system or another suitable mechanism for advancing elongate member  400  through housing  200  and cartridge assembly  300 . The actuator may directly contact elongate member  400  or may instead drive a pulley system to translate elongate member  400  through housing  200  and cartridge assembly  300 . Elongate member  400  may be wound around a pulley or other suitable mechanism at the distal end of end effector  100  and may return to housing  200  via cartridge  300 . For example, elongate member  400  may return through channels  306  of cartridge  300  to lumen  206  of housing  200 . Alternatively a separate pathway  322  ( FIG. 19 ) may be defined by both cartridge  300  and housing  200  for receiving the used portion of elongate member  400 . 
         [0076]    Elongate member  400  may, for example, include a feed mechanism  412  ( FIG. 5E ) such as a slot or cut-out which is engagable by a gear or spool mechanism to advance elongate member  400  through housing  200  and cartridge assembly  300 . The actuator may also be configured to cooperate with drive member  500  after firing to return drive member  500  to the initial position at the distal end of end effector  100  while re-loading cartridge  300  with a new set of fasteners  600 . Alternatively, drive member  500  may include hooked portions (not shown) for engaging feed mechanism  412  as drive member  500  returns to the initial position after firing where, for example, the hooked portions are angled at least partially in the distal direction such that as drive member  500  translates proximally feed mechanism  412  is not engaged with the hooked portions but when drive member  500  translates distally the hooked portions engage feed mechanism  412  and translate elongate member  400  distally by the same amount as drive member  500 . This allows cartridge assembly  300  to be reloaded through the single action of resetting or translating drive member  500  to the initial position and in addition allows a surgeon to at least partially reload cartridge assembly  300  during use. For example, if only a portion of the fasteners within cartridge assembly  300  were fired the surgeon may reset drive member  500  to the initial position to fully reload the cartridge assembly  300  by the number of fasteners which were already fired without disposing of the remaining fasteners. In addition the surgeon may, for example, perform a partial reloading of the cartridge assembly  300  by translating drive member  500  only a part of the way to the initial position after firing. This allows the surgeon to utilize variable reloading as needed during a surgical procedure without having to dispose of or replace the cartridge assembly 
         [0077]    Housing  200  may include a pre-determined number of fasteners  600  for feeding into cartridge assembly  300  where, for example, a number of reloads or groups of fasteners  600  may be provided to allow a surgeon to reload and fire surgical stapling apparatus  10  multiple times without removing cartridge assembly  300  from the operating site. Each group of fasteners  600  may correspond to the number of retention slots  308  or may correspond to only a part or portion of the number of retention slots  308  where for example multiple groups of fasteners  600  may be required to fully reload cartridge assembly  300 . 
         [0078]    Housing  200  may optionally receive elongate member  400  and fasteners  600  from an exterior source where, for example, multiple elongate members  400  may be attached or secured together during a procedure to provide additional fasteners  600  to cartridge assembly  300 . For example, elongate body  30  may be adapted to provide elongate member  400  and fasteners  600  to housing  200  and may be adapted to allow a surgeon to feed additional elongate members  400  and fasteners into housing  200 . In this way the number of fasteners  600  to be used may be tailored to a specific procedure or need of the surgeon. 
         [0079]    During use, surgical stapling apparatus  10  is inserted into the surgical site and maneuvered such that tissue “T” is positioned between anvil assembly  110  and cartridge assembly  300 . Handle assembly  20  is then actuated to close or approximate anvil assembly  110  and cartridge assembly  300  to grasp tissue “T” therebetween. After tissue “T” is grasped between anvil assembly  110  and cartridge assembly  300  actuator assembly  12  is actuated to translate drive member  500  proximally through cartridge assembly  300  from the initial position ( FIG. 1A ) to the fully fired position ( FIG. 19 ) to fire a first group of fasteners  600 . The surgical stapling apparatus  10  may come with the first group of fasteners  600  initially disposed within cartridge  300  and ready for firing or the first group of fasteners  600  may be translated into cartridge assembly  300  prior to firing. As discussed above, drive member  500  may optionally be translated only partially through cartridge assembly  300  to fire only a portion of the first group of fasteners  600  disposed within cartridge assembly  300 . As drive member  500  translates through cartridge assembly  300 , posts  362  of pushers  350  are engaged with inlet opening  508  and enter channel  512  ( FIGS. 9 and 10 ). At the same time distal sloped surfaces  364  of pushers  350  engage ramps  504  of drive member  500  and translate or slide along ramps  504  to urge elongate member  400  and fasteners  600  toward retention slots  308  ( FIGS. 11 and 12 ). As discussed above, fasteners  600  may engage guide surfaces  316  of retention slots  308  ( FIGS. 4C-4E ) to assist in guiding fasteners  600  through retention slots  308 . Guide grooves  354  of pushers  350  engage backspans  604  and guide portions  606  of fasteners  600  to urge fasteners  600  through retention slots  308  ( FIGS. 5G ,  6 A- 6 C,  12  and  19 ). As pushers  350  urge fasteners  600  through retention slots  308  fasteners  600  break through openings  404  of elongate member  400  where, for example, backspans  604  pass through slits  410  of openings  404 . The elongate member may be adapted to allow the fasteners to break through the elongate member. Openings  404  may be torn or sheared to permit passage of fasteners  600  therethrough. A portion of each of pushers  350  may also pass through respective openings  404  of elongate member  400  during firing. Once fasteners  600  are urged through retention slots  308 , legs  602  are deformed by the fastener deforming depressions  112  of anvil assembly  110  to thereby staple or fasten the tissue “T” clamped between anvil assembly  110  and cartridge assembly  300  ( FIGS. 12 ,  13 , and  19 ). 
         [0080]    As drive member  500  translates proximally toward the fully fired position each fastener  600  is urged through a respective retention slot  308 . After drive member  500  moves proximally past each of pushers  350  the fired pushers  350  remain in the fired position ( FIGS. 13 and 19 ). Alternatively the fired pushers  350  may return at least partially toward the initial unfired position by sliding along ramps  518  on trailing portion  516  of drive member  500  after exiting distal portion  526  of channel  512 . 
         [0081]    Once firing is complete, actuator assembly  12  is actuated to translate drive member  500  back to its initial position. During translation of drive member  500  back to its initial position drive member  500  engages pushers  350  to return pushers  350  to the unfired position. For example, as seen in  FIGS. 14-18 , during distal movement of drive member  500 , posts  362  of pushers  350  enter outlet opening  514  of channel  512  and engage channel  512  to draw pushers  350  down ramps  504 . Posts  362  exit inlet opening  508  at the bottom of ramps  504  to return pushers  350  to the initial position. Pushers  350  are now ready to receive a new set of fasteners  600  from elongate member  400 . Alternatively, pushers  350  may engage ramp  518  to slide towards peak portion  522  prior to posts  362  engaging channel  512  if pushers  350  did not remain in the fired position. 
         [0082]    Elongate member  400  is then translated through housing  200  and cartridge assembly  300  by actuator assembly  12  to provide a second group of fasteners  600  to pushers  350  and retention slots  308 . During this process, the empty openings  404  of elongate member  400  are translated distally past drive member  500  before returning to housing  200  via channels  306  or passageway  322  of cartridge assembly  300 . For example, some or all of a second group of fasteners  600  may be translated into cartridge assembly  300  to partially or fully reload cartridge assembly  300 . When elongate member  400  is positioned within cartridge assembly  300  such that a new set of fasteners  600  are aligned with retention slots  308  and the new set of fasteners  600  are supported on pushers  314 , surgical stapling apparatus  10  is ready to be fired. It is contemplated that elongate member  400  may be translated through housing  200  and cartridge  300  to reload cartridge  300  before, during or after the translation of drive member  500  distally to the initial position. 
         [0083]    The surgeon may then open or un-approximate anvil assembly  110  and cartridge assembly  300  to release the fastened tissue “T”. Alternatively, the surgeon may reload cartridge assembly  300  during the release of tissue “T” or after releasing tissue “T”. The surgeon may now maneuver surgical stapling apparatus  10  within the surgical site to position another portion of tissue “T” or another body tissue between anvil assembly  110  and cartridge assembly  300  as desired for further use of surgical stapling apparatus  10  without withdrawing surgical stapling apparatus  10  from the surgical site. For example, the surgeon may grasp a new portion of tissue between anvil assembly  110  and cartridge assembly  300 , fire surgical stapling apparatus  10 , and reload cartridge assembly  300  as describe above as many times as desired or necessary for the surgical procedure without removing surgical stapling apparatus  10  from the surgical site. This reduces the length of the surgical procedure, reducing the risk involved, and allows the surgeon to concentrate on the surgical procedure without dividing his attention between performing the procedure and reloading or replacing the surgical stapling apparatus  10  for further fastening of tissue. 
         [0084]    Although the illustrative embodiments of the present disclosure have been described herein with reference to the accompanying drawings, the above description, disclosure, and figures should not be construed as limiting, but merely as exemplifications of particular embodiments. It is to be understood, therefore, that the disclosure is not limited to those precise embodiments, and that various other changes and modifications may be effected therein by one skilled in the art without departing from the scope or spirit of the disclosure.