Patent Description:
Surgical stapling apparatus are employed by surgeons to sequentially or simultaneously apply one or more rows of fasteners, e.g., staples or two-part fasteners, to body tissue for the purpose of joining segments of body tissue together. Such apparatus generally include a pair of jaws or finger-like structures between which the body tissue to be joined is placed. When the surgical stapling apparatus is actuated, or "fired," staple drive members in one of the jaws push the surgical staples through the body tissue and into an anvil in the opposite jaw which forms the staples. If body tissue is to be removed or separated, a knife blade can be provided in one of the jaws of the apparatus to cut the body tissue between the lines of staples.

Surgical supports, e.g., meshes or buttress materials, may be used in combination with surgical stapling apparatus to bridge, repair, and/or reinforce tissue defects within a patient such as those occurring, for example, in the abdominal wall, chest wall, diaphragm, or musculo-aponeurotic areas of the body. The buttress material reinforces the staple line as well as covers the juncture of the tissues to reduce leakage prior to healing. The buttress material can help promote proper staple formation while reducing twisting/malformation caused by any misalignment of tissue and/or unusual or non-uniform tissue. The buttress material can also provide support to weakened tissue, or help address differences in the thickness of tissues.

Accordingly, buttress materials provide clinical benefits. Nonetheless, improvements are desired, for example, to reduce the complexity of manufacture and/or application of the buttress materials onto surgical stapling apparatus or into tissue, or to expand the range of application for use of the buttress materials.

<CIT> discloses a loading unit for use with a surgical stapling apparatus including a tool assembly and a surgical buttress. The tool assembly includes: a cartridge assembly including a staple cartridge having a tissue facing surface, staple retaining pockets having a plurality of surgical fasteners therein, and a knife slot; and an anvil assembly including an anvil plate having a tissue facing surface defining staple forming pockets and a knife slot. The surgical buttress is attached to the tissue facing surface of at least one of the cartridge assembly or the anvil assembly, and conforms to the tissue facing surface such that the surgical buttress is deformed locally into the staple retaining pockets and the knife slot of the cartridge assembly or the staple forming pockets and the knife slot of the anvil assembly to which the surgical buttress is attached.

<CIT> discloses an assembly for releasably attaching a buttress material onto a tissue clamping member of a surgical stapling device. The assembly has a substantially rigid frame for connecting to a top surface of a tissue clamping member of the surgical stapling device when the assembly is disposed thereon. A buttress material is attached to first and second sides of the frame for abutting against a bottom surface of a tissue clamping member of a surgical stapling device when the assembly is disposed thereon.

In an aspect of this disclosure, an end effector of a surgical stapling apparatus includes an anvil buttress and an anvil assembly. The anvil buttress has a proximal end portion including a strap. The anvil assembly includes an anvil body having a proximal end portion and a distal end portion. The proximal end portion has a tissue stop configured to prevent proximal tissue migration. The tissue stop includes a strap lock. The strap lock is configured to secure the strap of the anvil buttress to the anvil assembly to secure the anvil buttress to the anvil assembly.

The tissue stop may define a buttress slot positioned to receive the proximal end portion of the anvil buttress therein. The buttress slot may include a receiving channel and a retention cavity that are separated by the strap lock. The receiving channel may extend through a distal end face of the tissue stop. The receiving channel and the retention cavity may be disposed in registration with one another to facilitate receipt of the strap therein.

In aspects, the strap lock may include a proximally-extending retention tooth to retain the strap within the tissue stop.

In various aspects, the strap lock may include a leaf spring that is movably mounted in the tissue stop to lock the strap within the tissue stop.

In still further aspects, the anvil assembly may include a distal finger configured to retain a distal end portion of the anvil buttress. The anvil buttress may define a finger aperture therethrough that is configured to receive the distal finger of the anvil assembly to secure the distal end portion of the anvil buttress to the anvil assembly.

In various aspects, the anvil buttress may include a pair of wings. The strap may extend between the pair of wings.

According to another aspect, this disclosure is directed to an end effector of a surgical stapling apparatus. The end effector includes a first jaw member, a second jaw member, and a buttress. The first jaw member includes a body having a proximal end portion, a distal end portion, and an outer side surface. The proximal end portion has a tissue stop and a strap lock. The tissue stop extends laterally outward from the outer side surface of the body. The second jaw member is coupled to the first jaw member to fasten tissue supported between the first and second jaw members. The buttress has a proximal end portion including a strap configured to engage the strap lock to secure the buttress to the tissue stop.

In aspects, the tissue stop may define a buttress slot positioned to receive the strap therein. The buttress slot may include a receiving channel and a retention cavity that are separated by the strap lock to prevent the strap from moving from the retention cavity to the receiving channel.

In various aspects, the strap lock may include a proximally-extending retention tooth to prevent distal movement of the strap relative to the tissue stop.

In some aspects, the strap lock may include a leaf spring that is movably mounted to the first jaw member to lock the strap within the tissue stop.

In aspects, the first jaw member may include a distal finger configured to retain a distal end portion of the buttress. The buttress may define a finger aperture therethrough that is configured to receive the distal finger of the first jaw member to secure the distal end portion of the buttress to the first jaw member.

According to yet another aspect, this disclosure is directed to a surgical stapling system. The surgical stapling system includes a buttress having a proximal end portion including a strap, a buttress loader supporting the buttress thereon, and an end effector. The end effector incudes a first jaw member and a second jaw member coupled to the first jaw member. The first jaw member includes a body having a proximal end portion and a distal end portion. The proximal end portion has a tissue stop including a strap lock. The first jaw member is configured to engage the buttress loader to enable the buttress loader to mount the buttress on the first jaw member. The first and second jaw members are positioned to fasten tissue supported between the first and second jaw members when the buttress is mounted on the first jaw member.

The above and other aspects, features, and advantages of this disclosure will be apparent in light of the following detailed description when taken in conjunction with the accompanying drawings, which are incorporated in and constitute a part of this specification, wherein:.

Aspects of this disclosure will now be described in detail with reference to the drawing figures wherein like reference numerals identify similar or identical elements. Throughout this description, the term "proximal" refers to a portion of a structure, or component thereof, that is closer to a user, and the term "distal" refers to a portion of the structure, or component thereof, that is farther from the user. Directional reference terms, such as "top," "bottom," "side," and the like, are used to ease description of the aspects and are not intended to have any limiting effect on the ultimate orientation of a structure or any part thereof. In the following description, well-known functions or constructions are not described in detail to avoid obscuring this disclosure in unnecessary detail.

Referring now to <FIG>, a surgical stapling system, in accordance with this disclosure, includes a surgical stapling apparatus or surgical stapler <NUM> and an anvil buttress attachment assembly <NUM> for use in stapling tissue and applying one or more anvil and/or cartridge buttress materials or surgical buttresses <NUM>, <NUM> to the tissue. The surgical stapling apparatus <NUM> generally includes a handle assembly <NUM> and an elongated tubular body portion <NUM> that extends distally from the handle assembly <NUM>, which may be in the form of an adapter assembly that is selectively removable from handle assembly <NUM>. The elongated tubular body portion <NUM> may include a surgical loading unit <NUM> that is selectively attachable to the elongated tubular body portion <NUM>. An end effector or jaw assembly <NUM> extends distally from the elongated tubular body portion <NUM> (e.g., a distal end portion of the surgical loading unit <NUM>). The jaw assembly <NUM> includes an anvil assembly <NUM> and a staple cartridge assembly <NUM>. The jaw assembly <NUM> may be permanently affixed to the elongated tubular body portion <NUM> or may be detachable with respect to the elongated tubular body portion <NUM> and thus, replaceable with a new jaw assembly <NUM>. The anvil assembly <NUM> and/or the staple cartridge assembly <NUM> is pivotable with respect to the elongated tubular body portion <NUM> such that the anvil and/or staple cartridge assemblies <NUM>, <NUM> is/are movable between an open position in which the anvil and staple cartridge assemblies <NUM>, <NUM> are spaced apart with respect to each other (<FIG>) and a closed position (not shown) in which the anvil and staple cartridge assemblies <NUM>, <NUM> are substantially adjacent each other.

The handle assembly <NUM> of the surgical stapling apparatus <NUM> includes any number of actuators 12a, 12b, 12c to facilitate a firing of jaw assembly <NUM>, an articulation and/or rotation of the jaw assembly <NUM> relative to handle assembly <NUM>, and/or an opening and/or closing of anvil and/or cartridge assemblies <NUM>, <NUM> to clamp tissue therebetween. Jaw assembly <NUM> is configured to apply lines of staples (not shown) to tissue captured between the anvil and staple cartridge assemblies <NUM>, <NUM> when fired.

For a detailed description of the structure and function of exemplary surgical stapling apparatus, one or more components of which may be included, or modified for use with the disclosed aspects, reference may be made to <CIT>, <CIT>, and <CIT> as well as <CIT>. It should be appreciated that principles of this disclosure are equally applicable to surgical stapling apparatus having other configurations such as, for example, the types described in <CIT>, <CIT>, and<CIT>. Accordingly, it should be understood that a variety of surgical stapling apparatus may be utilized with the surgical buttresses and/or surgical buttress applicators or loaders of this disclosure such as, for example, laparoscopic staplers, open staplers, transverse anastomosis staplers, and end-to-end anastomosis staplers having a circular staple cartridge and anvil, as well as staple cartridge assemblies housing surgical fasteners other than staples.

As seen in <FIG>, <FIG>, <FIG> and <FIG>, anvil assembly <NUM> of jaw assembly <NUM> of surgical stapling apparatus <NUM> includes an anvil body 20a having a proximal end portion including a tissue stop 20x configured to prevent proximal tissue migration. The tissue stop 20x having a pair of tissue stop wings 20b, 20c that extends outwardly and downwardly from opposite side surfaces of anvil body 20a. The pair of tissue stop wings 20b is positioned to extend over and cover a proximal end portion of staple cartridge assembly <NUM>. Each wing of the pair of tissue stop wings 20b, 20c defines a buttress slot 20d that extends partially therethrough such that buttress slots 20d of the pair of tissue stop wings 20b, 20c may be disposed in mirrored relation with one another. For example, as seen in <FIG>, buttress slot 20d of wing 20b extends proximally from a distal end face 20e of tissue stop wing 20b. Buttress slot 20d includes a receiving channel 20f for receiving a proximal portion of anvil buttress <NUM> and a retention cavity <NUM> that is disposed proximal to, and in registration with, receiving channel 20f for retaining a proximal portion of anvil buttress <NUM> within retention cavity <NUM>. A strap lock <NUM>, in the form of a proximally-extending retention tooth, is disposed between receiving channel 20f and retention cavity <NUM> to capture anvil buttress <NUM> within retention cavity <NUM>.

Anvil assembly <NUM> of jaw assembly <NUM> further includes a distal end portion having a distal finger 20i supported between a pair of buttress stops 20j, <NUM>. The buttress stops 20j, <NUM> are disposed proximal to distal finger 20i.

With reference to <FIG>, anvil buttress attachment assembly <NUM> of surgical stapling system includes an anvil buttress <NUM> and an anvil buttress loader <NUM> for loading anvil buttress <NUM> onto surgical stapling apparatus <NUM>. Anvil buttress <NUM> includes a buttress body <NUM> having a proximal end portion including a pair of buttress wings <NUM>, <NUM> disposed on opposite sides of buttress body <NUM>. Wings <NUM>, <NUM> are coupled to buttress body <NUM> by wing folding segments 204a, 206a that enable wings <NUM>, <NUM> to fold toward/away from one another and relative to buttress body <NUM>. Wings <NUM>, <NUM> define an upper tab opening <NUM> through a proximal end portion thereof. Wings <NUM>, <NUM> further include a transverse strap <NUM> that extends between inner side surfaces of wings <NUM>, <NUM> to connect wings <NUM>, <NUM> together. Strap <NUM> is separated from a proximal end of buttress body <NUM> and includes strap folding segments <NUM> on opposite ends thereof that enable wings <NUM>, <NUM> to fold relative to strap <NUM> as wings <NUM>, <NUM> fold relative to buttress body <NUM>. The proximal end portion of buttress body <NUM> also defines lower tab openings <NUM> that extend between outer side surfaces of buttress body <NUM> and the inner side surfaces of wings <NUM>, <NUM>.

Anvil buttress <NUM> has a distal end portion defining a finger aperture <NUM> configured to receive distal finger 20i of anvil assembly <NUM> therethrough for supporting anvil buttress <NUM> on anvil assembly <NUM> of jaw assembly <NUM>. Distal end portion of anvil buttress <NUM> further includes a distal flap <NUM> secured to a distal end of anvil buttress <NUM> by a transverse fold segment <NUM> extending along opposite sides of finger aperture <NUM> to enable distal flap <NUM> to fold relative to buttress body <NUM>. Distal flap <NUM> defines distal tab apertures 216a, 216b therethrough.

Referring now to <FIG>, anvil buttress loader <NUM> of anvil buttress attachment assembly <NUM> includes a loader body <NUM> with a tubular configuration. Loader body <NUM> defines a receiving pocket <NUM> therein for supporting anvil buttress <NUM> and receiving anvil assembly <NUM> therein. Loader body <NUM> has a proximal end portion having upper proximal tabs <NUM> and lower proximal tabs <NUM> that extend proximally from lower body <NUM>. Loader body <NUM> includes a distal end portion defining a distal buttress opening <NUM> through an upper surface of loader body <NUM>. Loader body <NUM> further includes distal tabs <NUM> that extend proximally from loader body <NUM> into distal buttress opening <NUM>.

With reference to <FIG>, with anvil buttress <NUM> mounted to anvil buttress loader <NUM> (e.g., slip-fit via tabs <NUM>, <NUM>, and <NUM>), anvil buttress loader <NUM> is advanced over anvil assembly <NUM> so that strap <NUM> cams through receiving channel 20f of buttress slot 20d along strap lock <NUM> until strap <NUM> of anvil buttress <NUM> is disposed proximal of strap lock <NUM> and captured within retention cavity <NUM> of buttress slot 20d by strap lock <NUM> so that the proximal end portion of anvil buttress <NUM> is secured to anvil assembly <NUM>. As strap <NUM> of anvil buttress <NUM> cams through buttress slot 20d, distal finger 20i of anvil assembly <NUM> extends through finger aperture <NUM> of anvil assembly <NUM> so that distal flap <NUM> of anvil buttress <NUM> abuts against stops 20j, <NUM> of anvil assembly <NUM> to secure the distal end portion of anvil buttress <NUM> to the distal end portion of anvil assembly <NUM>. When anvil buttress <NUM> is secured to anvil assembly <NUM>, wings <NUM>, <NUM> and distal flap <NUM> of anvil buttress <NUM> remain folded upwardly so that wings <NUM>, <NUM> and distal flap <NUM> extend transverse (e.g., perpendicular) to buttress body <NUM> to facilitate retention of anvil buttress <NUM> on anvil assembly <NUM>. Once the proximal and distal end portions of anvil buttress <NUM> are secured to anvil assembly <NUM>, anvil buttress loader <NUM> can be drawn distally away from anvil assembly <NUM> so that anvil buttress <NUM> slides off anvil buttress loader <NUM> and remains attached to anvil assembly <NUM>. Surgical stapling apparatus <NUM> can then be used to secure buttress to tissue upon a firing of surgical stapling apparatus <NUM>. As can be appreciated by persons of ordinary skill in the art, a knife assembly (not shown) cuts through strap <NUM> (and buttress body <NUM>) upon firing of surgical stapling apparatus so that anvil buttress <NUM> can slide off anvil assembly <NUM> as surgical stapling apparatus <NUM> is drawn proximally away from anvil buttress <NUM>.

Turning now to <FIG> and <FIG>, one aspect of an anvil assembly, generally referred to as anvil assembly <NUM> includes a strap lock in the form of a leaf spring <NUM> that is configured to flex, from an initial, unflexed position, to a flexed position as strap <NUM> cams therealong, as indicated by arrow "A. " Leaf spring <NUM> is also configured to snap back to the unflexed position, from the flexed position, as indicated by arrows "B" when the strap <NUM> passes proximally past leaf spring <NUM> and into retention cavity <NUM>. Leaf spring <NUM> can be angled to reduce an amount of bending or flexing thereof for enabling strap <NUM> to be received within retention cavity <NUM>.

As seen in <FIG>, the leaf spring can be provided in any suitable configuration such as leaf spring <NUM>, leaf spring <NUM>, and leaf spring <NUM>. In aspects, any of these leaf springs can be configured to act like a pawl and can be provided in any suitable arrangement, for example, to enable inward and/or outward flexing of such leaf springs.

With reference to <FIG> and <FIG>, in some aspects of anvil assembly <NUM>, anvil assembly <NUM> can include any suitable arrangement of buttress slots such a single buttress slot <NUM>. Buttress slot <NUM> extends from a bottom surface of one of tissue stop wings 20b through a curvilinear receiving channel <NUM> that guides strap <NUM> of anvil buttress <NUM> upwardly and proximally into retention cavity <NUM>. Buttress slot <NUM> can be positioned to cause strap <NUM> to cam and stretch along contours of tissue stop wings 20b, 20c of anvil assembly <NUM> for guiding strap <NUM> into buttress slot <NUM>.

The surgical buttresses of this disclosure may be fabricated from biocompatible materials which are bioabsorbable or non-absorbable, natural or synthetic materials. It should be understood that any combination of natural, synthetic, bioabsorbable, and/or non-bioabsorbable materials may be used to form the surgical buttresses. The surgical buttresses may be biodegradable (e.g., formed from bioabsorbable and bioresorable materials) such that the surgical buttresses decompose or are broken down (physically or chemically) under physiological conditions in the body, and the degradation products are excretable or absorbable by the body. Components or portions of the surgical buttresses may be formed from the same material or different materials.

In aspects, at least a portion of the surgical buttresses are made from biodegradable materials selected from the following group: natural collagenous materials, cat gut, and synthetic resins including those derived from alkylene carbonates, trimethylene carbonate, tetramethylene carbonate, caprolactone, valerolactone, dioxanone, polyanhydrides, polyesters, polyacrylates, polymethylmethacrylates, polyurethanes, glycolic acid, lactic acid, glycolide, lactide, polyhydroxy butyrates, polyorthoester, polyhydroxy alkanoates, homopolymers thereof, and copolymers thereof. In aspects, at least a portion of the surgical buttresses may be made from non-biodegradable materials selected from the following group: polyolefins, polyethylene, polydimethylsiloxane, polypropylene, copolymers of polyethylene and polypropylene, blends of polyethylene and polypropylene, ultra high molecular weight polyethylene, polyamides, polyesters, polyethylene terephthalate, polytetrafluoroethylene, polyether-esters, polybutester, polytetramethylene ether glycol, <NUM>,<NUM>-butanediol, and polyurethanes.

The surgical buttresses may be porous, non-porous, or combinations thereof. Suitable porous structures include, for example, fibrous structures (e.g., knitted structures, woven structures, and non-woven structures) and/or foams (e.g., open or closed cell foams). Suitable non-porous structures include, for example, films. The surgical buttresses, or portions thereof, may be a non-woven structure formed by melt-blown or melt-spun methods, a mesh material, a braid material, and/or a molded or extruded sheet. The surgical buttresses, or portions thereof, may be a single porous or non-porous layer, or include a plurality of layers including any combination of porous and/or non-porous layers.

The surgical buttresses may be provided and/or sold as part of the buttress loader and/or loading unit. Alternatively, the surgical buttress(es), the buttress loader, and/or the loading units may be provided and/or sold separately and assembled by the user. In aspects, one or more surgical buttresses, one or more buttress loaders, and/or loading units are provided in a kit. In some aspects, the kit further includes one or more end effectors (and/or surgical loading units) and, in certain aspects, the kit further includes a surgical stapler.

In any of the aspects disclosed herein, the surgical buttresses can include, or be used with, brachytherapy, chemotherapy, other medical materials or pharmaceuticals. The buttress portion of the surgical buttress can have pockets, apertures, or other features for retaining brachytherapy seeds with the buttress portion, or brachytherapy seeds or materials can be incorporated into a suture or sutures that are threaded into or through the buttress portion or otherwise attached thereto. A coating having brachytherapy materials can be applied to a buttress portion of a surgical buttress by spraying or dipping. Chemotherapy pharmaceuticals or agents can be incorporated into the buttress portion of the surgical buttress, coated thereon, or otherwise applied as part of a suture or other feature secured to the buttress portion.

As can be appreciated, securement of any of the components of the presently disclosed apparatus can be effectuated using known securement techniques such welding, crimping, gluing, fastening, etc..

The various aspects disclosed herein may also be configured to work with robotic surgical systems and what is commonly referred to as "Telesurgery. " Such systems employ various robotic elements to assist the clinician and allow remote operation (or partial remote operation) of surgical instrumentation. Various robotic arms, gears, cams, pulleys, electric and mechanical motors, etc. may be employed for this purpose and may be designed with a robotic surgical system to assist the clinician during the course of an operation or treatment. Such robotic systems may include remotely steerable systems, automatically flexible surgical systems, remotely flexible surgical systems, remotely articulating surgical systems, wireless surgical systems, modular or selectively configurable remotely operated surgical systems, etc..

Claim 1:
An end effector of a surgical stapling apparatus (<NUM>), the end effector comprising:
an anvil buttress (<NUM>) having a proximal end portion including a strap (<NUM>) ; and
an anvil assembly (<NUM>) , the anvil assembly including an anvil body (20a) having a proximal end portion and a distal end portion, the proximal end portion having a tissue stop (20x) configured to prevent proximal tissue migration, the tissue stop including a strap lock (<NUM>), the strap lock configured to secure the strap of the anvil buttress to the anvil assembly to secure the anvil buttress to the anvil assembly, wherein the tissue stop defines a buttress slot (20j, <NUM>) positioned to receive the proximal end portion of the anvil buttress therein and wherein the buttress slot includes a receiving channel (20f) and a retention cavity (<NUM>) that are separated by the strap lock.