Abstract:
An exemplary surgical method of treating tissue may include possessing a surgical tool that has at least one movable feeder belt that includes staples frangibly connected thereto, where at least one staple is oriented relative to the feeder belt in a direction angled relative to the transverse direction; placing the surgical tool adjacent to tissue; deforming at least one staple into tissue; frangibly separating at least one deformed staple from the feeder belt; advancing the feeder belt; and repeating the placing, deploying and separating. Another exemplary surgical method of treating tissue of a patient may include holding a cartridgeless surgical tool that includes staples; stapling tissue with staples in response to a single actuation of the surgical tool; and repeating the stapling at least once.

Description:
[0001]    This application is a divisional of U.S. patent application Ser. No. 11/956,988, filed Dec. 13, 2007, which in turn is a continuation-in-part of U.S. patent application Ser. No. 11/851,379, filed Sep. 6, 2007, which are herein incorporated by reference in their entirety. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The invention generally relates to surgical staples and stapling. 
       BACKGROUND 
       [0003]    An endocutter is a surgical tool that staples and cuts tissue to transect that tissue while leaving the cut ends hemostatic. An endocutter is small enough in diameter for use in minimally invasive surgery, where access to a surgical site is obtained through a trocar, port, or small incision in the body. A linear cutter is a larger version of an endocutter, and is used to transect portions of the gastrointestinal tract. A typical endocutter receives at its distal end a disposable single-use cartridge with several rows of staples, and includes an anvil opposed to the cartridge. The surgeon inserts the endocutter through a trocar or other port or incision in the body, orients the end of the endocutter around the tissue to be transected, and compresses the anvil and cartridge together to clamp the tissue. Then, a row or rows of staples are deployed on either side of the transection line, and a blade is advanced along the transection line to divide the tissue. 
         [0004]    During actuation of an endocutter, the cartridge fires all of the staples that it holds. In order to deploy more staples, the endocutter must be moved away from the surgical site and removed from the patient, after which the old cartridge is exchanged for a new cartridge. The endocutter is then reinserted into the patient. However, it can be difficult and/or time-consuming to located the surgical site after reinsertion. Further, the process of removing the endocutter from the patient after each use, replacing the cartridge, and then finding the surgical site again is tedious, inconvenient and time-consuming, particularly where a surgical procedure requires multiple uses of the endocutter. That inconvenience may discourage surgeons from using the endocutter for procedures in which use of an endocutter may benefit the patient. Similar inconveniences may accompany the use of surgical staplers other than endocutters. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0005]      FIG. 1  is a schematic view of an endocutter. 
           [0006]      FIG. 2  is a cross-section view of a trocar port positioned in a patient. 
           [0007]      FIG. 3  is a cross-section view of trocar ports positioned in a patient. 
           [0008]      FIG. 4  is a perspective view of an exemplary feeder belt with three rows of staples frangibly connected thereto. 
           [0009]      FIG. 5  is a side view of the feeder belt of  FIG. 4 . 
           [0010]      FIG. 6  is a top view of the feeder belt of  FIG. 4 . 
           [0011]      FIG. 7  is a side view of an exemplary end effector of an endocutter that utilizes the feeder belt of  FIGS. 4-6 . 
           [0012]      FIG. 8  is a perspective view of an exemplary feeder belt guide. 
           [0013]      FIG. 9  is a side cross-section view of the feeder belt guide of  FIG. 8 , not including a feeder belt. 
           [0014]      FIG. 10  is a side cross-section view of the feeder belt guide of  FIG. 8 , including a feeder belt. 
           [0015]      FIG. 11  is a perspective view of an exemplary housing of a staple holder of the exemplary end effector of  FIG. 7 . 
           [0016]      FIG. 12  is a perspective cutaway view of the exemplary end effector of  FIG. 7 . 
           [0017]      FIG. 13  is a perspective view of an exemplary wedge assembly. 
           [0018]      FIG. 14  is a perspective view of an exemplary block of the exemplary end effector of  FIG. 7 . 
           [0019]      FIG. 15  is a perspective view of an exemplary cutter. 
           [0020]      FIG. 16  is a side cutaway view of the exemplary end effector of  FIG. 7 . 
           [0021]      FIG. 17  is a perspective view of a retainer of the exemplary end effector of  FIG. 7 . 
           [0022]      FIG. 17A  is a perspective view of the underside of the retainer of  FIG. 17 . 
           [0023]      FIG. 18  is a perspective view of an exemplary feeder belt with two rows of staples frangibly connected thereto. 
           [0024]      FIG. 19  is a side view of the feeder belt of  FIG. 18 . 
           [0025]      FIG. 20  is a top view of the feeder belt of  FIG. 18 . 
           [0026]      FIG. 21  is a side cross-section view of an exemplary end effector of an endocutter that utilizes the feeder belt of  FIGS. 18-20 . 
           [0027]      FIG. 22  is a perspective view of an exemplary housing of a staple holder of the exemplary end effector of  FIG. 21 . 
           [0028]      FIG. 23  is a perspective view of a block of the exemplary end effector of  FIG. 21 . 
           [0029]      FIG. 23A  is a perspective view of a wedge assembly. 
           [0030]      FIG. 24  is a detail cross-section view of the exemplary end effector of  FIG. 21  in the vicinity of the block. 
           [0031]      FIG. 25  is a perspective view of another exemplary feeder belt with two rows of staples frangibly connected thereto. 
           [0032]      FIG. 26  is a side view of the feeder belt of  FIG. 25 . 
           [0033]      FIG. 27  is a top view of the feeder belt of  FIG. 25 . 
           [0034]      FIG. 28  is a perspective view of the distal end of another exemplary wedge assembly. 
           [0035]      FIG. 29  is a perspective view of a blood vessel after transection by an endocutter. 
           [0036]      FIG. 30  is a perspective view of sliding clamps, each in a first position relative to a corresponding feeder belt. 
           [0037]      FIG. 31  is a side view of the sliding clamps of  FIG. 30 , each in a first position relative to a corresponding feeder belt. 
           [0038]      FIG. 32  is a perspective view of the sliding clamps of  FIG. 30 , each in a second, clamping position relative to a corresponding feeder belt. 
           [0039]      FIG. 33  is a side view of the sliding clamps of  FIG. 30 , each in a second, clamping position relative to a corresponding feeder belt. 
       
    
    
       [0040]    The use of the same reference symbols in different figures indicates similar or identical items. 
       DETAILED DESCRIPTION 
       [0041]    Endocutter—Three Staple Rows 
         [0042]    Referring to  FIG. 1 , an endocutter  2  includes an end effector  4  attached to a shaft  6 , which in turn is attached to a handle  8 . The end effector  4  may be one or more separate components that are connected to the shaft  6 , or may be fabricated integrally with the distal end of the shaft  6 . Referring also to  FIGS. 2-3 , the end effector  4  and the shaft  6  may be sized to pass through a standard trocar port  10  that may be placed through tissue  12  of a patient  14 . Advantageously, the end effector  4  may be sized to pass through a trocar port  10  having an opening between 5-10 millimeters in diameter. Alternately, the endocutter  2  may be used in the course of conventional open surgery, where a trocar port is not used. Alternately, the endocutter  2  may be used in the course of minimally-invasive surgery, where access to the surgical site in the patient is gained through a mechanism or structure other than a trocar port, such as the LAP DISC® hand access device of Ethicon Endo-Surgery, Inc., or where access to the surgical site in the patient is gained through an incision or opening in which no port or other mechanism or structure is placed. 
         [0043]    The trocar port  10  is a hollow generally-tubular structure inserted into an incision in tissue  12  of a patient to hold that incision open and to prevent damage to the tissue  12  defining the incision opening that may result from the motion of tools and other objects through the incision. The trocar port  10  may be made from plastic or any other suitable biocompatible material. The trocar port  10  may have a substantially circular cross section, a substantially oval cross section, or any other suitable cross section. The particular dimensions of a trocar port  10  depend on the particular procedure to be performed on the patient  14 , and may be any suitable dimensions. The trocar port  10  may be coupled to a cutting tool (not shown) through its center that makes an opening in tissue  12 , after which the trocar port  10  is placed into tissue  12 . The cutting tool may be a spike or other cutting or puncturing device, which is removed from the trocar port  10  when the trocar port  10  is in position in the chest wall. The combination of a trocar port  10  and a cutting tool is standard in the art. 
         [0044]    Referring to  FIG. 1 , the shaft  6  of the endocutter  2  extends proximally from the end effector  4 . The shaft  6  may be flexible or rigid. The shaft  6  may be articulated in at least one location, if desired. Optionally, the shaft  6  may include a cutaway, trough or other feature (not shown) to allow a guidewire (if any) or other positioning aid that may be used in the surgical procedure to remain in place during actuation of the endocutter  2 . 
         [0045]    The handle  8  may be attached to the proximal end of the shaft  6 , or any other suitable portion of the shaft  6 . The shaft  6  may be fabricated integrally with the handle  8 . Alternately, the shaft  6  and the handle  8  may be two separate items that are connected together in any suitable manner. The handle  8  may include any mechanism, mechanisms, structure or structures that are suitably configured to actuate the end effector  4 . The handle  8  may also include a source of stored energy for actuating the end effector  4 . The source of stored energy may be mechanical (such as a spring), electrical (such as a battery), pneumatic (such as a cylinder of pressurized gas) or any other suitable source of stored energy. The source of stored energy, its regulation, and its use in actuating the end effector  4  may be as described in the U.S. patent application Ser. No. 11/054,265, filed on Feb. 9, 2005, which is herein incorporated by reference in its entirety. The handle  8  may instead, or also, include a connector or connectors suitable for receiving stored energy from an external source, such as a hose connected to a hospital utility source of pressurized gas or of vacuum, or an electrical cord connectable to a power source. 
         [0046]    Referring to  FIGS. 4-6 , a portion of a feeder belt  16  is positioned within the end effector  4 . The feeder belt  16  may be a long, narrow, thin strip of material from which one or more staples  18  extend. The feeder belt  16  may be fabricated from stainless steel, nickel-titanium alloy, or any other suitable metallic or non-metallic material. The feeder belt  16  is flexible enough, and strong enough, to be advanced linearly and then redirected around a nose or other structure in substantially the opposite direction, as described in greater detail below. Alternately, at least part of the feeder belt  16  may be rigid or at least partially rigid, such that the feeder belt  16  may be advanced or retracted substantially linearly without redirection about a structure, or may be otherwise manipulated. Each staple  18  may be shaped in any suitable manner; the staples  18  may be shaped substantially the same as one another, or may be shaped differently. As one example, each staple  18  is generally V-shaped, and has two legs  20  extending from the base of the V-shape. Referring particularly to  FIG. 5 , one leg  20  of the staple  18  may be generally straight, and the other leg  20  of the staple  18  may be gently curved. However, the legs  20  may be shaped in a different manner. Further, each leg  20  may be shaped in the same manner. The staple  18  need not be symmetrical, but can be fabricated symmetrically if desired. The base of the V-shape of the staple  18  may be curved, pointed or otherwise configured. One leg  20  of the staple  18  has a free end  22  that may be characterized as a tissue penetrating tip  22 . The tissue penetrating tip  22  may be sharpened, if desired, to facilitate penetration of tissue. However, the legs  20  of the staple  18  may have a cross-section that is small enough that the tissue penetrating tip  22  need not be sharpened in order to easily penetrate tissue. The other leg  20  is attached at one end to the feeder belt  16 . Advantageously, that leg  20  is frangibly connected to the feeder belt  16 . Thus, one end of the staple  18  may be attached to the feeder belt  16  and the other end of the staple  18  may be free. Alternately, the staple  18  may have three or more legs  20 , or may be shaped in any other suitable manner. The staples  18  may be connected to the feeder belt  16  in any suitable orientation. As one example, one or more of the staples  18  are oriented generally parallel to the longitudinal centerline of the feeder belt  16 . That is, one or more of the staples  18  each may lie in a plane that is generally parallel to the longitudinal centerline of the feeder belt  16 , as shown in  FIG. 6 . As another example, one or more of the staples  18  each may be oriented in a direction angled relative to the longitudinal centerline of the feeder belt  16 . As another example, the staples  18  each may be oriented in a direction angled relative to the transverse direction, which is the direction perpendicular to the longitudinal centerline of the feeder belt  16 . 
         [0047]    The feeder belt  16  and staples  18  may be fabricated in any suitable manner. As one example, a flat, thin sheet of material is laser cut into long strips, after which each strip is laser cut to form fingers therein that are then bent into the shape of the staples  18 . In this way, the staples  18  and the feeder belt  16  form an integral structure. However, the feeder belt  16  and staples  18  may be fabricated in any other suitable manner. As one example, the staples  18  and feeder belt are fabricated separately, and the staples  18  are then connected to the feeder belt  16  by welding, adhesive, or any other method that provides a frangible, breakable or otherwise separable connection between the staples  18  and the feeder belt  16 . 
         [0048]    A frangible connection between the feeder belt  16  and each corresponding staple  18  may be made in any suitable manner. As one example, referring particularly to  FIG. 6 , each feeder belt  16  may include at least one tab  28  protruding laterally therefrom, or defined laterally in the center thereof. Alternately, at least one tab  28  may be oriented differently. Advantageously, the tabs  28  result from laser cutting and subsequent mechanical deformation of the staples  18  during manufacturing, such that the tabs  28  and staples  18  are integral with the corresponding feeder belt  16 . However, the tabs  28  and/or staples  18  may be fabricated and connected to the feeder belt  16  in any other suitable manner. At least one staple  18  may be attached to a corresponding tab  28  in any suitable manner. The attachment between a staple  18  and the corresponding tab  28  may be made in any suitable manner, and the connection between a staple  18  and the corresponding tab  28  may have any suitable orientation. As one example, at least one tab  28  is generally rectangular, and the corresponding staple  18  extends from the proximal edge of that rectangular tab  28 . The staple  18  may be separable from the tab  28 , at a location generally at the intersection between the staple  18  and the tab  28 . The connection between a staple  18  and the corresponding tab  28  is strong enough to hold the staple  18  securely in place relative to the feeder belt  16  prior to deployment, and weak enough to be broken or otherwise separated from the tab  28  during or after deployment. Optionally, a staple  18  and/or tab  28  may include a weakened area at or near their intersection, in order to facilitate separation between the staple  18  and the feeder belt  16  during or after deployment. The weakened area may have a reduced cross-sectional area, may be notched, or otherwise structurally weakened. Alternately, the weakened area may also, or instead, be physically treated or otherwise configured to be weaker than the surrounding material, while having substantially the same physical dimensions as that surrounding material. 
         [0049]    As shown in  FIGS. 4-6 , the staples  18  are in an initial configuration prior to being deployed. In the initial configuration, the staples  18  do not substantially contact one another. Alternately, at least two of the staples  18  may contact one another in the initial configuration. The staples  18  each may lie substantially in a single plane. That is, the staple  18  may be shaped such that a single plane extends through and substantially bisects the staple  18 . Alternately, at least one staple  18  does not lie substantially in a single plane. At least one staple  18  may be positioned in a plane that is generally perpendicular to the feeder belt  16 . Alternately, at least one staple  18  may be positioned in a plane that is angled differently relative to the feeder belt  16 . One or more rows  26  of staples  18  are connected to the feeder belt  16 . Each row  26  of staples  18  is the group of staples  18  positioned at substantially the same lateral location relative to the longitudinal centerline of the feeder belt  16 , and each row  26  of staples  18  is oriented generally longitudinally. As best seen in  FIG. 6 , three rows  26  of staples  18  may be attached to the feeder belt  16 —one row  26  along each side of the feeder belt  16 , and one row  26  along the center of the feeder belt  16 . The feeder belt  16  may form a continuous loop, or may have a discrete beginning and end that are not attached to one another. Alternately, more or fewer rows  26  of staples  18  may be attached to the feeder belt  16 . Each row  26  may extend along part, or all, or the length of the feeder belt  16 . Different rows  26  may extend different lengths along the feeder belt  16 . 
         [0050]    Staples  18  in two or more different rows  26  along a single feeder belt  16  may be arranged in any suitable manner relative to one another. As one example, staples  18  in two or more different rows  26  along a single feeder belt  16  may be staggered relative to one another. That is, at a given longitudinal position along a single feeder belt  16  at which a staple  18  in one row  26  is attached to the feeder belt  16 , at least one other row  26  does not have a staple  18  attached to that feeder belt  16 . This staggering of the staples  18  promotes hemostasis in tissue treated with the end effector  4 . As may be best seen in  FIG. 6 , the center row  26  of staples  18  may be staggered relative to the rows  26  of staples  18  along the lateral edges of the feeder belt  16 . Alternately, two or more rows  26  of staples  18  may be staggered in a different manner. Alternately, staples  18  in two or more of the rows  26  along a single feeder belt  16  may be aligned with one another, along at least part of the length of the rows  26 , such that at a given longitudinal position along the feeder belt  16  at which a staple  18  in one row  26  is attached to the feeder belt  16 , each other row  26  has a staple  18  attached to the feeder belt  16  as well. Alternately, staples  18  in two or more rows  26  along a single feeder belt  16  may be arranged differently along different longitudinal portions of that feeder belt  16 . Staples  18  may be arranged relative to one another in the same manner, or differently, on different feeder belts  16  of the endocutter  2 . 
         [0051]    The staples  18  in each row  26  may be substantially evenly spaced apart from one another. That is, the distance between any two longitudinally-adjacent staples  18  in a row may be substantially the same. Alternately, at least two longitudinally-adjacent staples  18  in each row  26  may be spaced apart a distance different from the distance between two other longitudinally-adjacent staples  18 . Such a configuration may be useful where the length of the staple line is not adjustable. The staple line to be created with the end effector  4  may be fixed at a particular number of staples  18 , and consequently the staples  18  in each row may be grouped together in groups each having a length substantially the same as that fixed staple line. If so, each group of staples  18  in a row  26  may be separated from a adjacent group of staples  18  by a blank space on the feeder belt  16 , where that blank space may have any suitable length. Advantageously, no staples  18  extend from, or into an area bounded by, the blank space of the feeder belt  16 . 
         [0052]    Referring also to  FIG. 7 , the end effector  4  may include a staple holder  30  and an anvil  32 . The anvil  32  may be movable relative to the staple holder  30  to compress tissue therebetween. The anvil  32  may include standard staple bending features defined therein to facilitate closure of the staples  18 . Alternately, staple bending features may be omitted from the anvil  32 . The anvil  32  may be pivotable relative to the staple holder  30 . As one example, at least one pin  34  may extend generally laterally from the anvil  32  at a location at or near the proximal end of the anvil  32 . Each pin  34  may be received by a trough  36 , aperture, or other feature of the staple holder  30  that allows that pin  34  to rotate therein and thereby allows the anvil  32  to pivot. Referring also to  FIG. 16 , in this way, the distal end of the anvil  32  may be spaced apart from and positioned above the staple holder  30  in a first, initial position prior to clamping tissue, while the proximal end of the anvil  32  may be connected to the staple holder  30 . Alternately, the trough  36  may be located in the shaft  6  of the endocutter, such that the anvil  32  is pivotally attached to the shaft  6  and movable relative to the staple holder  30 . Alternately, the anvil  32  may be connected to and/or movable relative to the staple holder in a different manner. Alternately, the staple holder  30  may be movable relative to the anvil  32 . Alternately, the staple holder  30  and the anvil  32  may be movable relative to one another. The distal end of the staple holder  30  and the distal end of the anvil  32  may be blunt, in order to prevent inadvertent engagement of tissue with the end effector  4  during insertion of the end effector  4  into the patient and motion of the end effector  4  to a treatment site. Advantageously, the staple holder  30  is fixed to a remainder of the end effector  4  and/or the shaft  6 , and is not detachable therefrom. As set forth in greater detail below, the staple holder  30  may be fired multiple times without being withdrawn from the patient, such that there is no need to withdraw the end effector  4  from the patient after each firing of staples  18  in order to replace a staple cartridge or other component. Nevertheless, if desired the staple holder  30  may be detachable from a remainder of the end effector  4  and/or the shaft  6 ; the end effector  4  may be detachable from the shaft  6 ; and/or the shaft  6  may be detachable from the handle  8 . 
         [0053]    The staple holder  30  may include any suitable components. Referring also to  FIGS. 8-10 , the staple holder  30  may include a feeder belt guide  40 . The feeder belt guide  40  may be shaped in any suitable manner. The staple holder  30  may be configured such that the distal end of the feeder belt guide  40  is the distal end of the end effector  4 . If so, the distal end  42  of the feeder belt guide  40  may be generally blunt. The upper surface  44  of the distal end  42  of the feeder belt guide  40  may be angled generally upward, moving proximally along the feeder belt guide  40 . Alternately, the upper surface  44  of the distal end  42  of the feeder belt guide  40  may be shaped in any other suitable manner. One or more apertures  46  may be defined in the upper surface  44  of the distal end  42  of the feeder belt guide  40 . Alternately, one or more of the apertures  46  may be omitted, such that the upper surface  44  of the distal end  42  of the feeder belt guide  40  is instead continuous. The distal end  42  of the feeder belt guide  40  may include a space  48  defined therein. At least one nose  50  may protrude distally into that space  48 . Each nose  50  may be curved, and may have a convex shape. As one example, each nose  50  may have an arcuate shape, where that arc is a section of a circle. Alternately, at least one nose  50  may be shaped differently. As one example, at least one nose  50  may be shaped as two or more straight lines that collectively approximate a curve, roughly or smoothly. 
         [0054]    Referring also to  FIG. 12 , the end effector  4  may include two feeder belts  16 . In this way, staples  18  can be deployed on either side of an incision or transection to be made in tissue. Alternately, the end effector  4  may include only one feeder belt  16 , or three or more feeder belts  16 . The feeder belts  16  may be independent of one another, or connected to one another in any suitable manner. A feeder belt  16  may be routed around each nose  50 , where the noses  50  are laterally spaced from one another and positioned on opposite sides of a knife, which is described below. Each feeder belt  16  may be routed along a path that starts generally straight and in the distal direction, then is curved along the surface of the corresponding nose  50 , and then is generally straight and in the proximal direction. That is, the nose  50  changes the direction of motion of the corresponding feeder belt  16  from generally distal to generally proximal. Each nose  50  may be substantially as wide as the corresponding feeder belt  16  that moves along its surface. Alternately, at least one nose  50  may be narrower than, or wider than, the corresponding feeder belt  16 . Alternately, the nose  50  may be omitted, where the feeder belt  16  is movable generally linearly. 
         [0055]    At least one nose  50  may be bifurcated by a slot  52  defined therein. The slot  52  may be oriented generally longitudinally. However, the slot  52  may be defined in any other suitable orientation. Each feeder belt  16  is positioned in contact with at least part of a corresponding nose  50 , with staples  18  in each lateralmost row  26  of the feeder belt  16  positioned laterally on either side of the nose  50 . Where the feeder belt  16  includes a row  26  of staples  18  in the middle of that feeder belt, such as shown in  FIG. 6 , the slot  52  in the nose  50  may be laterally oriented in substantially the same position as the middle row  26  of staples  18 . In this way, the slot  52  provides space for that middle row  26  of staples  18  to slide along. Alternately, at least one nose  50  may be divided into segments by two or more slots  52 , depending on the number of rows  26  of staples  18  attached to the corresponding feeder belt  16 . Alternately, the slot or slots  52  need not extend to the distal end of the nose  50 , because the staples  18  have been deployed from the corresponding segment of the feeder belt  16  by the time that segment of the feeder belt  16  reaches the nose  50 , as described in greater detail below. Alternately, at least one slot  52  may be omitted. At least one nose  50  may extend in the proximal direction any suitable length. Similarly, the remainder of the feeder belt guide  40  may extend in the proximal direction any suitable length. The portion of the feeder belt guide  40  proximal to the distal end  42  may be referred to as the insert  43 . A knife slot  54  may extend along the length of the feeder belt guide  40 , and may extend through the upper surface  44  of the distal end  42  of the feeder belt guide  40 . 
         [0056]    Referring to  FIG. 11 , a housing  60  is shown. The housing  60  may be fabricated from a single piece of sheet metal. Alternately, the housing  60  may be fabricated in any other suitable manner and/or from any other material. The housing  60  may include a generally flat base  62 , with two outer walls  64  extending upward generally perpendicularly from the base  62 . The base  62  and outer walls  64  may be generally rectangular. The outer walls  64  may be generally parallel to one another. Alternately, the base  62  and outer walls  64  may be shaped differently, and/or oriented differently relative to one another. A top plate  66  may extend generally laterally from the upper edge of each outer wall  64 , such that the two top plates  66  generally lie in the same plane. Each top plate  66  may be generally rectangular. A number of apertures  67  may be defined in each top plate  66 , where the apertures  67  allow for deployment of staples  18  therethrough. The two top plates  66  may be spaced apart from one another along their length. An inner wall  68  extends generally downward from the inner edge of each top plate  66 , and may be generally perpendicular to the corresponding top plate  66 . Each inner wall  68  may be generally rectangular, and the inner walls  68  may be spaced apart from and generally parallel to one another. However, at least one inner wall  68  may be shaped and/or oriented differently. The inner walls  68  may be spaced apart far enough to allow a knife to pass between them, as described in greater detail below. The lower edge of at least one inner wall  68  may contact the base  62 , or may be spaced apart from the base  62 . A receiving space  70  is a volume in the housing created by the base  62 , outer wall  64 , top plate  66  and inner wall  68 . Two receiving spaces  70  may be defined in the housing  60 . 
         [0057]    At least part of the housing  60  may omit the top plates  66  and/or inner walls  68 , such that at least part of the housing  60  is generally U-shaped. The feeder belt guide  40  may be attached to the housing  60 . This attachment may be accomplished in any suitable manner. As one example, the insert  43  portion of the feeder belt guide  40  may be inserted into one or more receiving spaces  70 , then fixed thereto in any suitable manner. As another example, the feeder belt guide  40  may not include an insert  43 , and the feeder belt guide is attached to the distal end of the housing  60  in any suitable manner. As another example, the feeder belt guide  40  may be fabricated integrally with the housing  60 . Alternately, the feeder belt guide  40  is not attached to or fixed to the housing  60 . 
         [0058]    Referring also to  FIG. 13 , one or more wedge assemblies  72  extend into the staple holder  30  of the end effector  4 . Each wedge assembly  72  may include a wedge  74  at the distal end of a arm  76 . Alternately, the wedge  74  may be positioned at a different location on the arm  76 . The wedge  74  may be shaped in any suitable manner. As one example, the upper surface of the wedge  74  may include a first surface  79  that may be angled or curved upward, moving in the distal direction. The wedge  74  may also include a second surface  80  distal to the first surface  79 , where the second surface may be angled or curved downward, moving in the distal direction. The intersection between the first surface  79  and the second surface  80  may be a curved or smooth peak  82 . Alternately, the peak  82  may form an unsmoothed angle between the first surface  79  and the second surface  80 . The lower surface of the wedge  74  may be substantially linear. Alternately, the lower surface of the wedge  74  may be curved, angled or otherwise shaped in any suitable manner. A tab  78  may be connected to the proximal end of the arm  76 . Alternately, the tab  78  may be positioned at a different location on the arm  76 . The tab  78  may be substantially rectangular, or may be shaped in a different manner. The tab  78  may extend in a downward direction from the arm  76 , and the wedge  74  may extend in an upward direction from the arm  76 . Alternately, the wedge  74  and/or tab  78  are oriented differently relative to the arm  76 . Advantageously, the wedge assembly  72  is fabricated as a single, integral structure. However, the wedge assembly  72  may be assembled from separate components, in any suitable manner. Referring to  FIG. 12 , each wedge  74  may be initially positioned distal to a row  26  of staples  18 , and may be generally longitudinally aligned with, and longitudinally movable relative to, that corresponding row  26  of staples  18 . The length of each wedge  74  may be equal to or less than the longitudinal spacing between staples  18  in a row  26 , such that the wedge  74  deploys each staple  18  before moving into contact with the subsequent staple  18  in the row  26 . This configuration of wedge  74  is particularly useful where the length of the staple line is adjustable, because the deployment of one staple  18  is independent of the deployment of any other staple  18 . Alternately, the wedge  74  may be longer than the longitudinal spacing between staples  18  in a row  26 , such that deployment of one staple  18  concludes while the longitudinally-adjacent staple  18  is in the middle of deployment. Such a configuration of wedge  74  may be useful where the length of the staple line is fixed, and a blank space is provided on the feeder belt  16  between groups of staples  18  along a row  26 . 
         [0059]    Referring also to  FIG. 14 , the tab  78  of each wedge assembly  72  may be inserted into a receiving slot  86  in a block  84 . Each receiving slot  86  may be defined partially into, or completely through, the block  84 . The receiving slot or slots  86  may be defined in the upper surface  88  of the block  84 , or in a different surface of the block  84 . The receiving slot or slots  86  may be positioned at or near the distal end of the block  84 , or at a different location on the block  84 . Referring also to  FIG. 15 , a knife  90  may include a hook  92  at its proximal end. A pin  94  may extend laterally across a knife receiving slot  96  defined in the distal end of the block  84 , and the hook  92  may engage that pin  94 . The pin  94  may be generally cylindrical, or may have any other suitable shape for engaging the hook. Alternately, the knife receiving slot  96  is defined in a different part of the block  84 . Alternately, the hook  92  of the knife  90  may be a tab similar to the tab  78  of the wedge assembly  72 , and the knife receiving slot  96  may thus be configured in the same way as the receiving slots  86  for the tabs  78  of the wedge assemblies  72 . Alternately, the hook  92  may be shaped in any other suitable manner, such as a shape that is not a hook, and the knife receiving slot  96  may be configured accordingly. Alternately, the receiving slots  86 , knife receiving slot  96  and/or tabs  78  may be omitted, and the wedge assemblies  72  and/or knife  90  are connected to the block  84  in a different way, such as by molding. Alternately, the wedge assemblies  72 , knife  90  and block  84  may be fabricated as an integral unit. The block  84  may be generally shaped as a rectangular solid. Alternately, the block  84  may be shaped in any other suitable manner. A protrusion  98  may extend generally upward from the upper surface  88  of the block  84 , at a location at or near the proximal end of the block  84 . Alternately, the protrusion  98  may extend in a different direction and/or may extend from a different location on the block  84 . The protrusion  98  may be generally shaped as a rectangular solid, but may be shaped in any other suitable manner. Alternately, the block  84  may be omitted, and the wedge assembly  72  and knife  90  may be controlled and/or manipulated in any other suitable manner. 
         [0060]    At least part of the block  84  may be positioned in a space such as the recess  120  ( FIG. 17A ) defined within the end effector  4  and/or the shaft  6 , and the block  84  may be longitudinally slidable along that space in order to control the motion of the wedge assemblies  72  and the knife  90 . Alternately, the block  84  may be positioned differently relative to the end effector  4  and/or the shaft  6 . Optionally, one or more sliders  100  may extend downward from the lower surface  102  of the block  84  to engage a corresponding feature or features in the end effector  4  and/or shaft  6  in order to facilitate sliding of the block  84 . Alternately, the sliders  100  may be omitted. Referring also to  FIG. 16 , a rod  104  may be connected to the protrusion  98  in any suitable manner. As one example, the rod  104  may be molded into the protrusion  98 . The distal end of the rod  104  may be connected to the protrusion  98 , and the rod  104  may extend through the shaft  6  such that the proximal end of the rod  104  extends into the handle  8 . The rod  104  may be generally rigid, and may extend generally longitudinally into the shaft  6  and/or through the shaft  6  to the handle  8 . Alternately, the rod  104  may be flexible and/or threaded, and the rod  104  may engage corresponding threads provided in the protrusion  98  or other part of the block  84 . In this way, rotation of the rod  104  causes the block  84  to advance or retract longitudinally. 
         [0061]    Referring also to  FIG. 15 , the knife  90  may include a body  106  extending in the distal direction from the hook  92 . Like the arm  76  of a wedge assembly  72 , the body  106  of the knife  90  may be laterally thin, and longer than it is wide or high. Alternately, the body  106 , and/or at least one arm  76 , may be shaped differently. A blade  108  may be located at the distal end of the body  106 . Advantageously, the knife  90  may be fabricated as a single, integral structure. However, the knife  90  may be assembled from a separate hook  92 , body  106  and/or blade  108 . The blade  108  may be configured in any suitable manner for cutting tissue. As one example, the blade  108  includes a cutting edge  110  along its upper edge, where that cutting edge  110  may be angled upward. moving proximally along the blade  108 . Alternately, the cutting edge  110  may be oriented differently, or positioned differently on the blade  108 . Referring also to  FIG. 11 , the knife  90  is movable along at least part of the space between the inner walls  68  of the housing  60 . Part of each feeder belt  16  is positioned in each receiving space  70 , laterally outward from the inner walls  68  of the housing  60 . Thus, the knife  90  is movable longitudinally between two feeder belts  16 . 
         [0062]    Optionally, the blade  108  and/or cutting edge  110  of the knife  90  may be heated in order to cauterize tissue. Optionally, an electric current may be passed through the blade  108  of the knife  90  such that the blade  108  electrically cauterizes tissue. The blade  108  may be unipolar, or may be one pole of a bipolar system. Optionally, the knife  90  may be omitted, and in its place a wire may be used. The wire may be threaded distally into the staple holder  30 , upward from the staple holder  30  into the anvil  32 , then proximally out of the anvil  32 . Proximal motion of the wire causes the wire to move through tissue, cutting it. The wire may be an electrode, such that electricity may be applied to it to facilitate both cutting and electrocauterization of tissue. The wire may be removed after each use and a new wire advanced, in order for the end effector  4  to be able to clamp another tissue structure, and to allow the wire to be replaced each time to maximize its cutting and/or cauterizing ability. 
         [0063]    Referring also to  FIG. 16 , a cross-sectional view of the end effector  4  in an initial configuration is shown. The blade  108  of the knife  90  may be positioned entirely within the staple holder  30  in the initial configuration, to ensure that the cutting edge  110  does not incise tissue as the end effector  4  is moved to the surgical site. Further, the blade  108  may be positioned within the distal end  42  of the feeder belt guide  40  in the initial configuration. Alternately, the blade  108  may be positioned differently. In the initial configuration, the staples  18  may be positioned within the staple holder  30  in position for deployment, each located under a corresponding aperture  67  in the top plate  66 . The block  84  is located in an initial position corresponding to the initial position of the blade  108  and the wedge assemblies  72 . Advantageously, in the initial configuration, the wedge assemblies  72  and the knife  90  are each in their most-distal position. However, at least one wedge assembly  72  and/or the knife  90  may be positioned differently in the initial position. 
         [0064]    Referring also to  FIG. 17 , a retainer  112  may be positioned between the end effector  4  to the shaft  6 . Optionally, the retainer  112  may provide a connection between the end effector  4  and the shaft  6 , such as by friction or interference fitting with both the end effector  4  and the shaft  6 , or by otherwise connecting both the end effector  4  and the shaft  6  to the retainer  112 . Alternately, the retainer  112  may be positioned entirely within the end effector  4 . The retainer  112  may be shaped in any suitable manner. The retainer  112  may include an extension  114  protruding distally from a first body segment  118 , where the extension  114  includes a ramp  116  at the distal end thereof. The ramp  116  may be angled upward in the proximal direction. The ramp  116  may be generally linear. Alternately, the ramp  116  may be oriented differently, and may be curved or otherwise shaped. The first body segment  118  may be shaped and sized to be received in the proximal end of the housing  60 , and at least part of the first body segment  118  may extend into the proximal end of at least one receiving space  70  of the housing  60 . The first body segment  118  may be fixed to the housing  60 , such as by pressure or interference fitting, by adhesive, by welding, or by any other suitable mechanism or method. Alternately, the first body segment  118  is not fixed to the housing  60 . Alternately, the retainer  112  is not fixed or connected to the housing  60 . Alternately, the retainer  112  may be omitted. Optionally, at least part of the feeder belt guide  40  may be connected to the retainer  112  as well. As one example, the insert  43  of the feeder belt guide  40  may extend completely through a receiving space  70  in the housing  60  and into contact with the retainer  112 . If so, the feeder belt guide  40  may be connected to the retainer  112  in any suitable manner. 
         [0065]    Referring also to  FIG. 17A , the underside of the retainer  112  may include a recess  120  defined therein. The recess  120  may be shaped and sized to allow the block  84  to slide therein. The recess  120  may include a slot  122  defined therethrough, where the slot  122  may receive the protrusion  98  and allow the protrusion  98  to slide therein. The recess  120  and/or slot  122  may guide the motion of the block  84  longitudinally and restrict motion of the block  84  proximal or distal to certain locations, and may also or instead restrict lateral motion of the block  84 . For example, the recess  120  may include a distal wall  124  that contacts the distal end of the block  84  when the block  84  has advanced distally as far as desired, and a proximal wall  126  that contacts the proximal end of the block  84  when the block  84  has retracted proximally as far as desired. Alternately, the recess  120  may be defined in a different part of the retainer  112 , or may be omitted. 
         [0066]    Referring to  FIG. 30 , optionally sliding clamps  160  may be provided, where each set of sliding clamps  160  may be associated with a corresponding feeder belt  16 . Each set of sliding clamps  160  may include an upper clamp  162  and a lower clamp  164 , where at least one of the clamps  162 ,  164  is slidable relative to the other. The lower clamp  164  may have a slot  166  defined generally longitudinally therein and oriented generally upward. The upper clamp  162  may have a tongue  168  oriented generally downward, where the tongue  168  is sized and configured to be received in the slot  166  in the lower clamp  164 . The tongue  168  may be narrower than the remainder of the upper clamp  162 , or may be sized in any other suitable manner. The wider area of the upper clamp  162  from which the tongue  168  extends forms a ledge  169  at its lower surface. The upper surface of the upper clamp  162  may be substantially as wide as the feeder belt  16 . 
         [0067]    Referring also to  FIG. 31 , initially the distal end of the upper clamp  162  may extend further in the distal direction than the distal end of the lower clamp  164 . Alternately, the distal end of the lower clamp  164  initially may extend further in the distal direction than the distal end of the upper clamp  162 . Alternately, initially the distal ends of each clamp  162 ,  164  may extend substantially the same distance in the distal direction. The upper surface of the lower clamp  164  may have a cam surface  170  defined thereon. Similarly, the ledge  169  of the upper clamp  162  may be shaped to define a cam surface  172  thereon. The two cam surfaces  170 ,  172  engage one another such that, in the initial position of the two clamps  162 ,  164 , the height of the upper clamp  162  is lower than the height of the upper portion of the corresponding feeder belt  16 ; as a result, the feeder belt  16  can be advanced without being restrained by the upper clamp  162 . Referring also to  FIGS. 32-33 , the cam surfaces  170 ,  172  are shaped such that, as the upper clamp  162  is retracted proximally and/or the lower clamp  164  is advanced distally, the upper clamp  162  is pushed upward into contact with the feeder belt  16 . Such contact provides additional support for the feeder belt  16  during deployment of the staples  18 . 
         [0068]    Endocutter—Two Staple Rows 
         [0069]    Referring also to  FIG. 6 , the endocutter  2  described above includes an end effector  4  configured to place two or more sets of three rows  26  of staples  18 . However, the end effector  4  may be configured to place two or more sets of different numbers of rows  26  of staples  18 , such as by changing the number of rows  26  of staples  18  on the one or more feeder belts  16 . Such an end effector  4  may be configured generally as described above. As one example, referring to  FIGS. 18-20 , a feeder belt  16  may include two rows  26  of staples  18 . With such a feeder belt  16 , one row  26  of staples  18  may be located along each side of the feeder belt  16 . As a result, the feeder belt  16  may be narrower than a feeder belt  16  in which a third row  26  of staples  18  extends along the center portion of the feeder belt  16 . Thus, by reducing the number of rows  26  of staples  18 , the end effector  4  may be reduced in size. For example, the end effector  4  described above as having three rows  26  of staples  18  may be sized to fit through a trocar port  10  having a 10 mm diameter passage therethrough, and an end effector  4  having two rows  26  of staples  18  may be sized to fit through a trocar port  10  having a 5 mm diameter passage therethrough. Referring to  FIGS. 18-20 , the staples  18  may be shaped, and positioned relative to the feeder belt  16 , substantially as described above with regard to the feeder belt  16  having three rows  26  of staples  18 . Alternately, the staples  18  may be shaped differently and/or positioned in any other suitable manner relative to the feeder belt  16 . The staples  18  may be frangibly connected to the feeder belt  16  substantially as described above. Alternately, the staples  18  may be connected to the feeder belt  16  in any other suitable manner. 
         [0070]    At least two staples  18  in different rows  26  may be staggered relative to one another. That is, at a given longitudinal position along the feeder belt  16  at which a staple  18  in one row  26  is attached to the feeder belt  16 , the other row  26  does not have a staple  18  attached to the feeder belt  16 . This staggering of the staples  18  promotes hemostasis in tissue treated with the end effector  4 . Alternately, staples  18  in each row  26  may be aligned with one another, such that at a given longitudinal position along the feeder belt  16  at which a staple  18  in one row  26  is connected to the feeder belt  16 , each other row  26  has a staple  18  connected to the feeder belt  16  as well. 
         [0071]    The staples  18  in each row  26  may be substantially evenly spaced apart from one another. That is, the distance between any two longitudinally-adjacent staples  18  in a row is substantially the same. Alternately, at least two longitudinally-adjacent staples  18  in each row  26  may be spaced apart a distance different from the distance between two other longitudinally-adjacent staples  18 . Such a configuration may be useful where the length of the staple line is not adjustable. The staple line to be created with the end effector  4  may be fixed at a particular number of staples  18 , and the staples  18  in each row may be grouped together in groups each having a length substantially the same as that fixed staple line. Each group of staples  18  in a row  26  may thus be separated from the adjacent group of staples  18  by a blank space on the feeder belt  16 , where that blank space may have any suitable length. 
         [0072]    Referring to  FIG. 21 , the configuration of the end effector  4  utilizing feeder belts  16  each having two rows  26  of staples  18  is similar to the configuration of the end effector  4  utilizing feeder belts  16  each having three rows  26  of staples  18 , as shown in  FIG. 16 . Referring to  FIG. 22 , the housing  60  may be configured similarly to the housing of  FIG. 11 . The housing  60  includes two rows of apertures  67  in each top plate  66 , corresponding to the two rows  26  of staples  18  of each feeder belt  16 . Due to the presence of two, rather than three, rows of apertures  67  in each top plate  66 , the top plates  66  and thus the housing  60  overall may be narrower than the housing of  FIG. 16 . Optionally, at least part of the housing  60  may omit the top plates  66  and/or inner walls  68 . Referring to  FIGS. 23 and 24 , the block  84  optionally may be configured differently than the block  84  of  FIG. 14 , in order to fit within a narrower end effector  4 . The projection  98  may be longer in the longitudinal direction than the projection  98  of the block  84  of  FIG. 14 . The distal end or other portion of the rod  104  may be attached to the protrusion  98  in any suitable manner. As one example, the rod  104  may be molded into the protrusion  98 . A riser  130  may extend upward from the upper surface  88  of the block  84 , where a knife receiving slot  96  may be defined generally longitudinally in the riser  130 . The riser  130  may be generally triangular, or may be any other suitable shape. Optionally, the riser  130  may be connected to or part of the protrusion  98  that engages the rod  104 . A pin  94  may extend laterally across the knife receiving slot  96  of the riser  130 , and engages the hook  92  at the proximal end of the knife  90 . Alternately, the block  84  may be omitted. 
         [0073]    Two receiving slots  86  may be defined partially into, or completely through, the block  84 , generally as described with regard to  FIG. 14  above. Referring also to  FIG. 23A , another example of a wedge assembly  72  is shown. The wedge assembly  72  includes a tab  78  and an arm  76 , as with the wedge assembly  72  of  FIG. 14 . However, the wedge assembly  72  of  FIG. 23A  includes two or more wedges  74  at its distal end, where the wedges  74  may be spaced apart laterally from one another and may be generally parallel to one another. In this way, multiple wedges  74  can be controller by a single arm  76 , reducing the number of parts needed in the end effector  4  and allowing the end effector  4  to be made narrower. The wedges  74  may be shaped as set forth with regard to  FIG. 14 , or may be shaped in any other suitable manner. The tab  78  of each wedge assembly  72  of  FIG. 23A  may be inserted into a corresponding receiving slot  86  in the block  84  of  FIG. 23 . Alternately, four receiving slots  86  may be provided in the block  84  of  FIG. 23 , and the wedge assemblies  72  of  FIG. 14  may be used. Alternately, the block  84  may be configured generally as described above and shown in  FIG. 14 . 
         [0074]    Two exemplary embodiments of the end effector  4  have been described above, and in each one the end effector  4  places two sets of rows  26  of staples  18 . However, the end effector  4  may be configured to place one set, or three or more sets, of rows  26  of staples  18 . Further, the feeder belt  16  may be configured to place any desired number of rows  26  of staples  18  within a given set of rows  26 . Further, any number of feeder belts  16  may be placed on either side of the knife  90 . The number of feeder belts  16  on one side of the knife  90  may be the same as, or different from, the number of feeder belts  16  on the other side of the knife  90 . The number of feeder belts  16  utilized may be related to the type of tissue that is treated by the end effector  4 . The number of rows  26  of staples  18  may be different on each feeder belt  16 , or may be the same on each feeder belt  16 . The number of rows  26  of staples  18  on an individual feeder belt  16  may vary along the length of that feeder belt  16 , or may be constant. As another example of an end effector  4 , the knife  90  may be omitted, such that the end effector  4  is simply a stapler that does not cut tissue. If so, any suitable number of feeder belts  16  may be utilized. 
         [0075]    Referring to  FIGS. 25-27 , another exemplary feeder belt  16  having two rows  26  of staples  18  is shown. This feeder belt  16  may include a plurality of openings  132  defined therein or therethrough. The openings  132  may be round, or any other suitable shape. The openings may all be of substantially the same size and/or shape, and/or may be of different sizes and/or shapes. The openings  132  may be useful in reducing the moment of inertia of the feeder belt  16  such that the feeder belt  16  is more flexible and more easily slides along the nose  50  of the staple holder  30 . Instead, or in addition, one or more of the openings  132  may be engaged by pins or gears (not shown) in the handle  8  of the endocutter  2  in order to cause the feeder belt  16  to move. In addition to, or instead of, the openings  132 , the feeder belt  16  may have one or more notches  134  defined in one or more lateral edges thereof. Each notch  134  may be located adjacent to a tab  28 , or one or more notches  134  may be located differently. The notches  134  also may act to increase the flexibility of the feeder belt  16 , and/or to promote engagement between a mechanism in the handle  8  and the feeder belt  16 . 
         [0076]    At least one staple  18  may be shaped as a continuous curve, as may be most clearly seen in  FIG. 26 . A distal end of the staple  18  may be connected to the feeder belt  16 , such as via a tab  28  protruding laterally from the feeder belt  16 , such as described above. The staple  18  may extend proximally and downward from the tab  28 . Then, the staple  18  may continue to curve downward, but also curve distally to form a bump  136 . This bump  136  may extend to the longitudinal position of the tab  28 , further distally than the longitudinal position of the tab  28 , or not as far longitudinally as the tab  28 . Then, the staple  18  may continue to curve downward, but also curve proximally. The staple  18  continues to curve proximally, then begins to curve upward at an inflection point  138 . The staple  18  then continues to curve upward and proximally until terminating at a free end  22  at its proximal end. 
         [0077]    Referring also to  FIG. 28 , the wedge  74  of a wedge assembly  72  may have a shape that facilitates deployment of the staples of  FIGS. 25-27 . The wedge  74  may have a first segment  140  shaped to facilitate deployment of the staple  18 , and a second segment  142  shaped to facilitate shearing or otherwise separating the staple  18  from the feeder belt  16 . The first segment  140  is curved upward and distally; the curve may have any shape that facilitates formation of a staple  18 . By providing two distinct segments  140 ,  142  on the wedge  74 , formation and separation of the staple  18  can be separately controlled. 
         [0078]    Operation 
         [0079]    Referring to  FIGS. 2-3 , at least one trocar port  10  is inserted into an opening in tissue  12  of a patient  14 . Where a trocar port  10  includes a cutting tool (not shown) such as a spike, that cutting tool makes an opening in tissue  12 , after which the trocar port  12  is placed in tissue. The cutting tool may be removed from the trocar port  10  after the trocar port  10  is in position in tissue  12 . Alternately, an opening in tissue  12  may be made first with a separate tool, and the trocar port  10  is then placed in that opening. Multiple trocar ports  10 , having the same or different cross-sectional shapes and/or areas, may be placed in the patient  14 . The tissue  12  may be the chest wall of the patient  14 , thereby providing access to the thoracic cavity. However, the tissue  12  may be the abdominal wall or any other suitable tissue in the patient  14 . Alternately, the trocar port or ports  10  are not used, and access to the surgical site is gained in another manner, such as described above. 
         [0080]    Referring also to  FIGS. 1 ,  16  and  21 , the end effector  4  of the endocutter  2  is introduced into the patient  14  through one of the trocar ports  10 . At least part of the shaft  6  of the endocutter  2  may follow the end effector  4  into the patient  14 . Alternately, the trocar port or ports  10  are not used, and the endocutter  2  is used during a conventional open surgical procedure or is introduced into the patient  14  directly through an incision in tissue  12 . The end effector  4  is positioned by the user at a surgical site. As one example, referring also to  FIG. 29 , a surgical site is located on a blood vessel  148  which is to be transected. For clarity, this document describes the operation of the endocutter  2  for transection of a blood vessel  148 . However, the use of the endocutter  2  is not limited to blood vessel transection; the endocutter  2  may be used to perform any other suitable procedure at any other surgical site in the body. For example, the endocutter  2  may be used to transect a bile duct, to remove a diseased appendix, to transect gastrointestinal tissue, and/or to transect soft tissue or organs. 
         [0081]    Referring to  FIGS. 16 and 21 , at least the distal end of the anvil  32  is initially spaced apart from the staple holder  30 , such that the end effector  4  is open. The end effector  4  is advanced over the blood vessel  148  to be transected, until the entire diameter of the blood vessel  148  is located between the anvil  32  and the staple holder  30 . Advantageously, the blood vessel  148  is substantially at a right angle to the anvil  32  and the staple holder  30 . However, the blood vessel  148  may be oriented at any other suitable angle relative to the anvil  32  and the staple holder  30 . The end effector  4  is then closed, by moving the anvil  32  closer to the staple holder  30 , such that the blood vessel  148  is compressed between the anvil  32  and the staple holder  30 . Such closure of the end effector  4  may be accomplished in any standard manner or any other suitable manner. As one example, a tube may be advanced distally over the outer surface of both the anvil  32  and the staple holder  30 , compressing the anvil  32  and the staple holder  30  together. Alternately, the anvil  32  may be substantially fixed relative to a remainder of the end effector  4  and/or the shaft  6 , and the staple holder  30  may be moved closer to the anvil  32  in order to close the end effector  4 . Alternately, both the anvil  32  and the staple holder  30  are movable toward one another in order to close the end effector  4 . Closure of the end effector  4  may be performed by actuating one or more controls on the handle  8  of the endocutter  2 , and/or by releasing energy stored in the handle  8 . After the end effector  4  has been closed, the tissue to be treated is held securely by, and affirmatively controlled by, the end effector  4 . 
         [0082]    Referring also to  FIGS. 6 and 12 , the wedges  74  are in an initial position, in which each wedge  74  may be distal to the staples  18  in the corresponding row  26 . Further, referring also to  FIG. 11 , at least one staple  18  in each row  26  initially is positioned under a corresponding aperture  67  in the top plate  66  of the housing  60 . Advantageously, a staple  18  initially is positioned under each aperture  67  in the top plate  66  of the housing  60 . Referring to  FIGS. 14 and 17A , the block  84  is located at or in proximity to the distal wall  124  of the recess  120 , which is the initial position of the block  84 . Alternately, in its initial position the block  84  may be located at or in proximity to a proximal end of the recess  120 , or may be located differently relative to the recess  120 . In a staple holder  30  utilizing the block  84  of  FIG. 23 , the block  84  may be in an initial position in the staple holder  30  and/or shaft  6  of the endocutter  2 , where the block  84  is at or in proximity to a distal end of a recess or space in the staple holder  30  and/or shaft  6 . Alternately, the block  84  may be positioned at or in proximity to a proximal end of a recess or space in the staple holder  30  and/or shaft  6 , or may be positioned differently relative to the staple holder  30  and/or shaft  6 . Referring to  FIGS. 15 ,  16  and  21 , the knife  90  is in an initial position relative to the staple holder  30 , where the cutting edge  110  of the knife  90  may be held completely within the staple holder  30 . At least part of the blade  108  may be held within the staple holder  30  as well. Referring also to  FIG. 8 , the blade  108  and cutting edge  110  of the knife  90  may be located within the distal end  42  of the feeder belt guide  40 . 
         [0083]    The user then actuates one or more controls on the handle  8  to actuate the end effector  4 . As a result, the rod  104  is moved proximally by any suitable mechanism or method. As one example, the proximal end of the rod  104  extends into the handle  8 , and a mechanism within the handle  8  moves the rod  104  proximally. The mechanism may be actuated by a release of energy stored within the handle  8 . A mechanism for moving a rod  104  linearly is standard; any suitable mechanism or mechanisms may be utilized. Proximal motion of the rod  104  causes the block  84  to move proximally, as a result of the attachment between the rod  104  and the protrusion  98  from the block  84 . The proximal motion of the block  84  in turn causes the wedge assemblies  72  and knife  90 , which are attached to the block  84 , to move proximally. Alternately, the rod  104  may be rotated instead of, or in addition to, being retracted proximally, where such rotation causes proximal motion of the block  84 . 
         [0084]    If the sliding clamps  160  are used, and they have not been moved to the second position, in which the upper claim  162  contacts the feeder belt  16 , the sliding clamps  160  are moved to the second position. Such motion may include sliding the upper clamp  162  proximally and/or sliding the lower clamp  164  distally. During the sliding motion, the tongue  168  of the upper clamp  162  slides along the slot  166  of the lower clamp  164 . As the upper clamp  162  and/or lower clamp  164  slide, the cam surfaces  170 ,  172  engage one another to cause the upper surface of the upper clamp  162  to move upward into contact with the feeder belt  16 . Such contact further stabilizes the feeder belt  16  during contact between the wedges  74  and the staples  18 . 
         [0085]    Proximal motion of the wedge assemblies  72  in turn causes proximal motion of each wedge  74 , which in turn causes deployment of the staples  18 . For clarity, motion of a single wedge  74  to deploy one or more staples  18  in a corresponding row  26  is described. The wedge  74  may be initially distal to the staples  18  in the corresponding generally-linear row  26 , and the path of motion of the wedge  74  may be generally parallel to or collinear with the corresponding row  26 . As the wedge  74  moves proximally, the first surface  79  of the wedge  74  contacts the distalmost staple  18  in the corresponding row. Referring also to  FIG. 5 , contact between the first surface  79  and the staple  18  results in the application of force to the staple  18 . Because the first surface  79  is angled upward in the distal direction, that force applied to the staple  18  is exerted both proximally and upward. Further, the force applied to the staple  18  results in a moment about the tab  28  that connects the staple  18  to the feeder belt  16 . The moment acts on the staple  18  to rotate the staple  18  about the tab  28 , such that the free end  22  of the staple  18  moves upward, out of the corresponding aperture  67  in the top plate  66  of the housing  60  and into the blood vessel  148 . Alternately, where the tab  28  is not used, the force applied to the staple  18  results in a moment about the location of the connection of the staple  18  to the feeder belt  16 . During motion of the wedge  74 , the feeder belt  16  may be held substantially in place, either passively such as by friction with the corresponding nose  50 , or actively such as by a brake or clutch (not shown) in the handle  8 , shaft  6  and/or end effector  4 . 
         [0086]    The wedge  74  continues to move proximally, continuing to exert a force on the staple  18  that causes a moment about the tab  28 . As the free end  22  of the staple  18  rotates upward, it penetrates completely through the blood vessel  148  and then contacts the lower surface of the anvil  32 . Optionally, a standard staple bending feature (not shown) may be defined in the anvil  32  at the location where the free end  22  of the staple  18  contacts the anvil  32 . As the free end  22  of the staple  18  contacts the anvil  32 , the rotation of the staple  18  about the tab  28  results in motion of the free end  2  both upward and distally. However, contact between the free end  22  of the staple  18  and the anvil  32  prevents further upward motion of the free end  22  of the staple  18 . As a result, the free end  22  of the staple  18  moves distally along the lower surface of the anvil  32  and/or staple bending feature defined thereon. This motion may bend or deform the leg  20  of the staple  18  associated with the free end  22 , closing the staple  18 . The staple  18  may be fabricated from a plastically-deformable material such as stainless steel, such that deformation of the staple  18  may be plastic deformation. Alternately, at least part of at least one staple  18  may be elastically deformable or superelastically deformable. 
         [0087]    As the wedge  74  continues to move proximally, the peak  82  of the wedge  74  approaches close to the staple  18 , which may be already completely or substantially completely deformed against the anvil  32 . Alternately, deformation of the staple  18  may continue to the point where the peak  82  of the wedge  74  contacts the staple  18 . When the peak  82  reaches or comes close to the staple  18 , the force exerted on the staple  18  is primarily in the upward direction. Further, this force is exerted on the staple  18  at a location at or in proximity to the tab  28  that connects the staple  18  to the feeder belt  16 . That force shears, breaks or otherwise separates the staple  18  from the feeder belt  16 . The tab  28  is configured such that the force exerted by the peak  82  of the wedge  74 , or by a portion of the wedge  74  in proximity to the peak  82 , is sufficient to frangibly separate the staple  18  from the feeder belt  16  by shearing, breaking it off or otherwise separating it. Where the staple  18  and/or tab  28  include a weakened area at or near their intersection, the staple  18  may shear, break or otherwise separate from the feeder belt  16  at that weakened area. The peak  82  may also actively push, urge or otherwise eject the staple  18  completely out of the housing  60 . Alternately, the staple  18  is passively ejected from the housing  60 , meaning that the staple  18  is not affirmatively urged out of the housing  60 ; rather, it is simply released from the housing  60  and allowed to exit therefrom. At this point, the deformed and ejected staple  18  is in position in the blood vessel  148 . The frangibility of the staples  18  allows the staples  18  to be held securely and reliably by the feeder belt  16 , and thus by the staple holder  30 , while providing for reliable separation and deployment. The second surface  80  does not substantially contact the staple  18  or tab  28 . Alternately, the second surface  80  may be shaped or otherwise configured to assist in deformation and/or ejection of the staple  18 . 
         [0088]    As another example, the wedge  74  may be configured as shown in  FIG. 28 . As stated above, the first segment  140  of that wedge  74  may be shaped to facilitate deployment of the staple  18 , and the second segment  142  of that wedge  74  may be shaped to facilitate shearing or otherwise separating the staple  18  from the feeder belt  16 . As the wedge  74  is moved relative to a staple  18  and contacts that staple  18 , the first segment  140  of the wedge  74  encounters the staple  18  and applies a force to that staple  18  proximally and upward to form that staple  18 , substantially as described above. The first segment  140  may be shaped such that formation of the staple  18  is substantially complete by the time the first segment  140  of the wedge  74  has moved out of contact with the staple  18 . The second segment  142  may have a shape that facilitates separation of the formed staple  18  from the feeder belt  16 . As the wedge  74  continues to move proximally, the first surface  140  moves out of contact with the staple  18 , which is substantially formed, and the second surface  142  moves into contact with that substantially-formed staple  18 . Where the staple  18  is shaped such as shown in  FIGS. 25-27 , after that staple  18  has been substantially formed, the bump  136  in that staple  18  may be oriented generally downward and in the path of travel of the second surface  142 . Thus, as the second surface  142  slides proximally, it applies a force upward against the bump  136 , where that force shears, breaks or otherwise separates the formed staple  18  from the feeder belt  16 . 
         [0089]    After the staple  18  has been separated from the feeder belt  16 , the wedge  74  may continue its motion in the proximal direction. As it does so, it encounters another staple  18 , and deforms that staple  18  and separates that staple  18  from the feeder belt  16  in substantially the same manner as described above. The wedge  74  may be long enough that, as the wedge  74  has deformed one staple  18  a substantial amount but that staple  18  has not yet separated from the feeder belt  16 , the wedge  74  engages and begins to deform the next most distal staple  18 . Alternately, the wedge  74  is short enough that it completely deforms one staple  18 , which is then ejected, before the wedge  74  engages and begins to deform the next most distal staple  18 . 
         [0090]    The block  84  may be controlled to move each wedge assembly  72  and corresponding wedge  74  longitudinally along a fixed distance, such that a fixed number of staples  18  is deployed by each wedge  74  during each actuation. As a result, referring also to  FIG. 29 , the length of each staple line  146  in a blood vessel  148  or other tissue is fixed. The term “staple line” refers to the grouping of staples  18  in a row  26  after their ejection into tissue. The block  84  may be controlled to move along a fixed distance in any suitable manner. As one example, the rod  104  is movable proximally along that fixed distance during each actuation of the endocutter  2 . Each fixed number of staples  18  in a row  26  may be grouped together and separated from an adjacent group of staples  18  by a blank space on the feeder belt  16 , where that blank space may have any suitable length. The blank space allows the wedge  74  to be long enough in the longitudinal direction to engage and begin to deform a second staple  18  while that wedge  74  is still completing the deformation and/or ejection of the previous staple  18 . Thus, when the wedge  74  moves proximally far enough to encounter the blank space, no staple  18  is present for that wedge  74  to deform, such that the wedge  74  can complete deformation of each staple  18  in the group without leaving a subsequent staple  18  partially deformed. However, the wedge may be short enough that it completely deforms one staple  18 , which is then ejected, before the wedge  74  engages and begins to deform the next most distal staple  18 . 
         [0091]    Alternately, the block  84  may be selectively controlled to move each wedge assembly  72  and corresponding wedge longitudinally along a selectable distance, such that a selected number of staples  18  may be deployed by each wedge  74  during actuation. In this way, the length of the staple line  146  in a blood vessel  148  or other tissue is variable, and selectable by the user. The block  84  may be selectively controlled in any suitable manner. As one example, the rod  104  is movable proximally along a distance selectable by the user during each actuation of the endocutter  2 . The rod  104  may be actuated to move along that selected distance by the handle  8 , which also may be configured to receive user input related to the selected distance. The handle  8  may be configured in any suitable manner to control the longitudinal distance of travel of the rod  104 . As one example, the handle  8  may include a stepper motor attached to the rod  104  that translates the rod  104  a selected one of a discrete number of lengths. As another example, the handle  8  may include a mechanical stop that is movable by the user, where the rod  104  stops its proximal motion when it encounters the mechanical stop. That is, the rod  104  may be spring-loaded or biased across a distance at least as long as the longest selectable staple line  146 , and the mechanical stop is used to stop travel of the rod  104  at a distance less than the longest selectable staple line  146 . Because the distance across which the wedge  74  travels may vary during each actuation and is user selectable, advantageously no blank spaces are present in each feeder belt  16 . In addition, the wedge advantageously may be short enough that it completely deforms one staple  18 , which is then ejected, before the wedge  74  engages and begins to deform the next most distal staple  18 . 
         [0092]    Referring to  FIGS. 11-12  and  14 - 17 , as the block  84  moves proximally, it also moves the knife  90 , which is connected to the block  84  via the hook  92  or other structure at the proximal end of the knife  90 . As the knife  90  moves proximally, it cuts the tissue held between the anvil  32  and the staple holder  30 . The knife  90  may cut that tissue while the staples  18  are being deformed and ejected. As the knife  90  moves proximally from its initial position, the bottom of the blade  108  of the knife  90  may engage and ride up the ramp  116  at the distal end of the retainer  112 . As the blade  108  rides up the ramp  116 , at least part of the cutting edge  110  of the blade  108  moves above the top plates  66  of the housing and begins to cut tissue held between the anvil  32  and the staple holder  30 . After the blade  108  reaches the top of the ramp  116 , it continues to move proximally along the upper surface of the extension  114  as the block  84  continues to pull the knife  90  proximally. At least part of the blade  108  may slide between the inner walls  68  of the housing as the knife  90  is pulled proximally. Alternately, the blade  108  may be completely above the inner walls  68  of the housing, or may move in a different manner. Alternately, the ramp  116  and the extension  114  may be omitted, and the cutting edge  110  of the blade  108  may be controlled to rise above the top plates  66  of the housing  60  in another manner. Alternately, the blade  108  may be controlled to move substantially only in the longitudinal direction, such that the blade  108  does not substantially move in the vertical direction. 
         [0093]    After the fixed or selected number of staples  18  have been deformed and ejected, motion of the block  84  stops. When motion of the block  84  stops, the block  84 , wedges  74  and blade  108  are each in a final position. The blade  108  is sized and shaped such that the blade  108  has completely cut through the tissue held between the anvil  32  and the staple holder  30  when the blade  108  is in the final position. In the final position, at least one wedge  74  and/or the blade  108  may be proximal to the corresponding receiving space  70  in the housing  60 . Alternately, the wedges  74  and/or blade  108  may remain within the corresponding receiving space  70  in the housing  60  in their final position. After the fixed or selected number of staples  18  have been deformed and ejected, and the cutting edge  110  of the blade  108  has transected the tissue held between the anvil  32  and the staple holder  30 , the end effector  4  is returned to its open position, releasing the tissue. Referring also to  FIG. 29 , where that tissue is a blood vessel  148 , the blood vessel  148  has been transected into two segments, each of which has staggered rows of staples  18  forming a staple line  146  near an end thereof. Each wedge  74  actuated staples  18  in the corresponding row  26 , and as set forth about the staples  18  and the apertures  67  in the top plate  66  of the housing  60  are staggered. By staggering the rows  26  of staples  18  in a staple line  146 , hemostasis at the end of the blood vessel  148  is facilitated, because the leak path is longer in length and more convoluted than if the rows  26  of staples  18  were not staggered. 
         [0094]    As another example of actuation of the endocutter  2 , the wedge  74  may be initially proximal to the staples  18  in the corresponding row  26 , and the wedge  74  is moved distally rather than proximally to deploy one or more staples  18  in that row  26 . Such distal motion of the wedge  74  may be caused by, for example, moving the rod  104  in the distal direction. Where the wedge  74  is moved distally to deploy staples  18 , the first surface  79  and the second surface  80  of the wedge  74  may be shaped differently in order to deploy the staples  18  properly. Further, the staples  18  may be oriented backward relative to the feeder belt  16 , such that the free end  22  of each staple  18  is located distal to the point of attachment between the staple  18  and the feeder belt  16 . The other aspects of operation of the staple holder  30  also are performed substantially in reverse order from the order described above, in order to deform the staples  18  and separate them from the feeder belt  16 . 
         [0095]    Next, the endocutter  2  may be fired again, without removing the end effector  4  from the patient, changing a cartridge or other disposable staple holder, or reloading the end effector  4  from outside the endocutter  2 . To do so, the handle  8  may be actuated to return the block  84  to its initial position after the end effector  4  has been returned to its open position. Alternately, the block  84  is returned to its initial position when the end effector  4  returns to its open position, or at a different time. The rod  104  may be moved in the proximal direction to return the block  84  to its initial position. Alternately, the block  84  may be returned to its initial position in any other suitable manner. As one example, the block  84  may be biased distally, such that the rod  104  may be released and the block  84  automatically returns to the initial position. As another example, the block  84  may be biased proximally, such that the rod  104  is not affirmatively moved proximally to deploy and eject the staples  18 . If so, the rod  104  then may be used to push the block  84  distally to its initial position and hold the block  84  in that initial position. Alternately, the block  84  may be returned to its initial position in any other suitable manner. As the block  84  moves back to its initial position, it moves the wedges  74  and the blade  108  back to their initial positions, reversing the paths traveled by the wedges  74  and blade  108  during actuation of the end effector  4 . Alternately, the wedges  74  and/or blade  108  may move in a different manner and/or along a different path to return to their initial positions. Because the staples  18  that would otherwise be in the path of the wedges  74  have been deployed out of the housing  60 , the wedges  74  may return to their initial position substantially without interference. Further, because the tissue has been released from the end effector  4 , the blade  108  returns to its initial position substantially without contacting tissue. 
         [0096]    At this point, the wedges  74  and blade  108  are in their initial positions. Next, if the feeder belt  16  was restrained against motion during the previous actuation of the end effector  4  by the sliding clamps  160 , those sliding clamps are returned to the first position, in which the upper claim  162  does not restrain the feeder belt  16 . Such motion may include sliding the upper clamp  162  distally and/or sliding the lower clamp  164  proximally. During the sliding motion, the tongue  168  of the upper clamp  162  slides along the slot  166  of the lower clamp  164 . As the upper clamp  162  and/or lower clamp  164  slide, the cam surfaces  170 ,  172  engage one another to cause the upper surface of the upper clamp  162  to move downward out of contact with the feeder belt  16 , to allow the feeder belt  16  to advance. If a different or additional restraint such as a brake or clutch in the handle  8 , shaft  6  or end effector  4  was used, that restraint is released. The feeder belt  16  is then moved in order to advance fresh staples  18  into the housing  60 . This motion of the feeder belt  16  may be referred to as “advancing” the feeder belt  16 , regardless of the fact that some or all of the feeder belt  16  may be moved in a direction other than distally during that advancing. Advancing the feeder belt  16  may be accomplished in any manner. As one example, as set forth above, a feeder belt  16  is routed around each nose  50 , along a path that starts generally straight and in the distal direction, then is curved along the surface of the corresponding nose  50 , and then is generally straight and in the proximal direction, such that the nose  50  changes the direction of motion of the corresponding feeder belt  16  from generally distal to generally proximal. The portion of the feeder belt  16  located under and proximal to the nose  50  may be refracted proximally, thereby pulling the portion of the feeder belt  16  located above and proximal to the nose  50  in the distal direction and advancing fresh staples  18  into the housing  60 . The portion of the feeder belt  16  located under and proximal to the nose  50  may be retracted proximally in any suitable manner. As one example, that portion of the feeder belt  16  may extend into the handle  8 , where a gear, roller or other mechanism exerts a force directly on the feeder belt  16 . As another example, the feeder belt  16  may be connected to an intermediate structure or mechanism that extends into the handle  8  and upon which a force is exerted. As another example, referring also to  FIG. 25 , one or more openings  132  in the feeder belt  16  are engaged by one or more gears, pins or other mechanisms, such that engagement with the openings  132  is used to advance the feeder belt  16 . As another example, any other suitable mechanism, structure or method may be used to move the feeder belt  16  in order to advance fresh, undeployed staples  18  into the housing  60 . Where the feeder belt  16  is movable generally linearly, and the nose  50  is not utilized, the housing  60  may be longer, and the feeder belt  16  is simply advanced or retracted generally linearly in order to advance fresh staples  18  into the housing  60 . 
         [0097]    The feeder belt  16  may be advanced with or without feedback. As an example of advancing the feeder belt  16  without feedback, a stepper motor or other mechanism may be used to advance the feeder belt  16  a fixed distance each time. Where feedback is provided, the feeder belt  16  is advanced a distance that is related to the feedback; that distance may not be fixed every time. As one example, a pinwheel (not shown) may be configured to engage the openings  132  in the feeder belt  16  with pins, such that motion of the feeder belt  16  causes the pinwheel to rotate. Such rotation of the pinwheel may produce mechanical or electrical feedback that is transmitted mechanically or electrically to the handle  8 , such that advancement of the feeder belt  16  continues until the pinwheel has rotated a particular amount. In this way, the pinwheel provides confirmation that the feeder belt  16  has in fact advance to a position in which unfired staples  18  are in position in the housing  60  at locations corresponding to the apertures  67  in the top plates  66  of the housing  60 . As another example of feedback, an optical sensor or sensors (not shown) may be positioned in the end effector  4  to sense the openings  132 , such that the optical sensor or sensors can determine the degree of advancement of the feeder belt  16 . As another example, any other suitable mechanism may be used to generate feedback and to transmit that feedback in mechanically, electrically and/or as data to a suitable controller, which may be located in the handle  8  or in any other portion of the endocutter. The controller may be a cam, an integrated circuit, a microprocessor, an analog circuit or circuits, a digital circuit or circuits, a mechanical computer, or any other suitable controller 
         [0098]    The wedges  74  and blade  108  are in the initial position, and unfired staples  18  are in position in the housing  60  at locations corresponding to the apertures  67  in the top plates  66  of the housing  60 . The feeder belt  16  may be held substantially in place, either passively such as by friction with the corresponding nose  50 , or actively such as by a brake or clutch (not shown) in the handle  8 , shaft  6  and/or end effector  4 . At this time, the end effector  4  is configured for actuation again, and is in an initial configuration substantially as described above. The end effector  4  may then be actuated again, substantially as described above. In this way, the end effector  4  may be actuated multiple times without removing the end effector  4  through the trocar port  10  or other incision, structure or mechanism that allows access to the interior of the body of the patient. Keeping the end effector  4  within the body of the patient without withdrawing that end effector  4  through the trocar port  10  or other incision, structure or mechanism that allows access to the interior of the body of the patient may be referred to as maintaining the end effector within the body of the patient. The endocutter  2  may be actuated multiple times within the patient, without being removed from the patient, until the staples  18  in the endocutter  2  are exhausted. An indicator may be provided in the handle  8  or at another location in the endocutter  2  that shows how many unfired staples  18  remain in the endocutter  2 . 
         [0099]    Actuation of the endocutter  2  above has been generally described in terms of deployment and ejection of a single row  26  of staples  18  for clarity, where that deployment and ejection may be performed in substantially the same manner along each row  26  of staples  18 . Operation of the endocutter  2  may be substantially as described above with regard to any number of rows  26  of staples  18  on a feeder belt  16 . That is, an endocutter  2  having two rows  26  of staples  18  on a feeder belt  16 , or more than three rows of staples  18  on a feeder belt  16 , may be actuated substantially as described above. 
         [0100]    Driverless Endocutter and Operation 
         [0101]    Optionally, referring to  FIGS. 12 ,  13  and  28 , the wedges  74  may be fixed in place relative to the staple holder  30 . For example, the wedges  74  may simply be molded, cut, formed or otherwise fabricated as part of the feeder belt guide  40  or other component of the end effector  4 . As each feeder belt  16  is advanced, the most distal unformed staple  18  in each row  26  contacts the stationary wedge  74 . The feeder belt  16  then does not stop, but continues to move. As the feeder belt  16  continues to advance, the relative motion between the feeder belt  16  and the stationary wedge  74  causes the staple  18  to deform and then separate from the feeder belt  16 , in substantially the same manner as described above with regard to motion of the wedge  74  relative to the substantially stationary feeder belt  16 . Where the wedges  74  are stationary, the end effector  4  does not apply a row of staples  18  longitudinally along a staple line. Instead, the end effector  4  sequentially deploys the distalmost staple  18  in each row  26  as the feeder belt  16  pulls that staple  18  onto the corresponding wedge  74 . 
         [0102]    Alternately, for a single-use device, a number of wedges  74  equal to the number of staples  18  to be deployed are fabricated as part of the end effector  4 , and are each located immediately proximal or distal to the corresponding staple  18 . As the feeder belt  16  is moved longitudinally, each staple  18  contacts the corresponding fixed wedge  74 , deforms to a closed configuration, and then separates from the feeder belt  16 . In this way, two or more staples  18  can be deployed along a staple line at the same time, without the use of wedge assemblies  72 . Optionally, the wedges  74  may be movable downward or in another direction from a first position after deploying the staples  18 , such that a feeder belt  16  can be advanced to place new, undeployed staples  18  in position for firing, after which the wedges  74  may be moved back to their first position. 
         [0103]    Other Surgical Tools Utilizing Feeder Belt 
         [0104]    As described above, the feeder belt  16  and attached staples  18  of  FIGS. 4-6 ,  18 - 20 ,  25 - 27 , and  30 - 33  may be used in the end effector  4  of an endocutter  2 . However, the feeder belt  16  and attached staples  18  may be used in any suitable surgical tool, for human or veterinary use. As one example, the feeder belt  16  and attached staples  18  may be used in an anastomosis tool, such as described in U.S. patent application Ser. No. 11/054,265, filed on Feb. 9, 2005 (the “&#39;265 application”), which is hereby incorporated by reference in its entirety. For example, the feeder belt  16 , attached staples  18 , and any other suitable part of the mechanism described above may be placed in each arm  402  of the staple holder  38  of the &#39;265 application in lieu of the sled  482 , staples  464 , connector bays  448 , connector deployers  452 , and/or other structures and/or mechanisms described in the &#39;265 application as being present in the arm  402 . As a result, the anastomosis tool of the &#39;265 application may be actuated multiple times. Further, the arms  402  of the staple holder  38  of the &#39;265 application may be made smaller due to the smaller size of the staples  18  and the reduced amount of space required to hold the feeder belt  16 , allowing for the anastomosis of smaller vessels to one another, and allowing the staple holder  38  to access areas of the body that a larger staple holder could not. As another example, the feeder belt  16  and attached staples  18  may be used in an end-to-end anastomosis stapler, such as described in U.S. Pat. No. 6,942,675 (the “&#39;675 patent”), which is hereby incorporated by reference in its entirety. For example, the feeder belt  16  and attached staples  18  may be placed in each arm  22 ,  24  of the anastomosis tool  30 , in lieu of any or all of the mechanisms and/or structures described in the &#39;675 patent as being present in the arms  22 ,  24 . As a result, the anastomosis tool  30  may be made smaller, facilitating the end-to-end connection of a greater range of vessels, thereby further facilitating the performance of microsurgery. The anastomosis tool  30  may be placed adjacent to the vessels to be connected, such as blood vessels, and actuated as described in the &#39;675 patent, where the deployment of staples  18  may be performed substantially as described above. 
         [0105]    As another example, the feeder belt  16  and attached staples  18  may be used in an intravascular stapler, such as described in U.S. patent application Ser. No. 11/158,413 (the “&#39;413 application”), which is hereby incorporated by reference in its entirety. For example, the feeder belt  16 , attached staples  18 , and any other suitable part of the mechanism described above may be placed in the housing  14  of the stapler head  8  in lieu of any or all of the mechanisms and/or structures described in the &#39;413 application as being present in the housing  14  of the stapler head  8 . As a result, the stapler head  8  of the &#39;413 application may be made smaller, facilitating intravascular access to a greater range of blood vessels. The stapler head  8  may be placed adjacent to vascular tissue, and actuated as described in the &#39;413 application, where the deployment of staples  18  may be performed substantially as described above. 
         [0106]    As another example, the feeder belt  16  and attached staples  18  may be used in a bariatric or gastrointestinal stapler, such as used in a gastric bypass procedure or other procedures performed on the digestive system. The stapler may be placed adjacent to gastrointestinal tissue, such as the stomach, the small intestine or the large intestine, and the deployment of staples  18  may be performed substantially as described above. 
         [0107]    The feeder belt  16  and attached staples  18  may be used in any suitable surgical tool, regardless of whether that tool includes a knife  90  or other structure, mechanism or method for incising or cutting tissue. As one example, the feeder belt  16  and attached staples  18  may be used in a skin stapler for closing a pre-existing wound or incision. The skin stapler may be placed adjacent to the skin, and the deployment of staples  18  may be performed substantially as described above. 
         [0108]    While the invention has been described in detail, it will be apparent to one skilled in the art that various changes and modifications can be made and equivalents employed, without departing from the present invention. It is to be understood that the invention is not limited to the details of construction, the arrangements of components, and/or the method set forth in the above description or illustrated in the drawings. Statements in the abstract of this document, and any summary statements in this document, are merely exemplary; they are not, and cannot be interpreted as, limiting the scope of the claims. Further, the figures are merely exemplary and not limiting. Topical headings and subheadings are for the convenience of the reader only. They should not and cannot be construed to have any substantive significance, meaning or interpretation, and should not and cannot be deemed to indicate that all of the information relating to any particular topic is to be found under or limited to any particular heading or subheading. Therefore, the invention is not to be restricted or limited except in accordance with the following claims and their legal equivalents.