Patent Description:
Surgical staplers are used in surgical procedures to close openings in tissue, blood vessels, ducts, shunts, or other objects or body parts involved in the particular procedure. The openings can be naturally occurring, such as passageways in blood vessels or an internal organ like the stomach, or they can be formed by the surgeon during a surgical procedure, such as by puncturing tissue or blood vessels to form a bypass or an anastomosis, or by cutting tissue during a stapling procedure.

Most staplers have a handle with an elongate shaft having a pair of movable opposed jaws formed on an end thereof for holding and forming staples therebetween. The staples are typically contained in a staple cartridge, which can house multiple rows of staples and is often disposed in one of the two jaws for ejection of the staples to the surgical site. In use, the jaws are positioned so that the object to be stapled is disposed between the jaws, and staples are ejected and formed when the jaws are closed and the device is actuated. Some staplers include a knife configured to travel between rows of staples in the staple cartridge to longitudinally cut and/or open the stapled tissue between the stapled rows.

While surgical staplers have improved over the years, a number of problems still present themselves. One common problem is that leaks can occur due to the staple forming holes when penetrating the tissue or other object in which it is disposed. Blood, air, gastrointestinal fluids, and other fluids can seep through the openings formed by the staples, even after the staple is fully formed. The tissue being treated can also become inflamed due to the trauma that results from stapling. Still further, staples, as well as other objects and materials that can be implanted in conjunction with procedures like stapling, generally lack some characteristics of the tissue in which they are implanted. For example, staples and other objects and materials can lack the natural flexibility of the tissue in which they are implanted. A person skilled in the art will recognize that it is often desirable for tissue to maintain as much of its natural characteristics as possible after staples are disposed therein.

Accordingly, there remains a need for improved devices and methods for stapling tissue, blood vessels, ducts, shunts, or other objects or body parts such that leaking and inflammation is minimized while substantially maintaining the natural characteristics of the treatment region. <CIT> relates to a bolster assembly for mounting upon a surgical stapler instrument to prevent displacement of activated staples from the stapled tissue, includes a tissue reinforcing or bolster material secured to a carriage and support structure which facilitates the mounting of the bolster material on the stapler, in which the bolster material is removably fastened to the support structure by a single length of continuous filament, in order to facilitate removal of the filament and unfastening of the bolster material from the support structure.

<CIT> relates to a staple cartridge comprising a tissue thickness compensator which is releasably retained to a support portion. In at least one embodiment, the support portion can comprise a plurality of retention members extending therefrom which are configured to releasably compress and hold the longitudinal sides of the tissue thickness compensator to the support portion. In at least one such embodiment, each retention member can comprise an inwardly-facing channel or slot which can be configured to receive the longitudinal sides of the tissue thickness compensator therein. In various circumstances, a plurality of retention members can extend along a first longitudinal side of the support portion and a plurality of retention members can extend along a second longitudinal side of the support portion wherein, in certain circumstances, the retention members can be configured to prevent, or at least limit, relative lateral movement between the tissue thickness compensator and the support portion and, in addition, prevent, or at least limit, the premature release of the tissue thickness compensator from the support portion. In various embodiments, the retention members can be integrally formed with the support portion.

The end effector can vary in many different ways. For example, the cartridge body can be a removable and replaceable cartridge body. As another example, in some implementations, the extension elements are formed along at least one of the long sides of the at least one jaw. The adjunct material has at least one mating feature that is complementary to the at least one attachment feature and is configured to releasably mate with the at least one attachment feature.

The extension elements extending beyond the nominal perimeter of the at least one jaw can extend in a plane of the at least one jaw that is parallel to a tissue contacting surface of the at least one jaw. The extension elements are formed integrally with the at least one jaw.

The extension elements extending beyond the nominal perimeter of the at least one jaw include first extension elements formed on the first jaw and second extension elements formed on the second jaw. The first and second extension elements can be formed such that, when the end effector is in the closed position, the first extension elements extend beyond the nominal perimeter of the second jaw and the second extension elements extend beyond the nominal perimeter of the first jaw. The first extension elements are staggered with respect to the second extension elements.

In some implementations, the other one of the first and second jaws has at least one second attachment feature formed thereon that is different from each of the attachment features formed on the extension elements extending beyond the nominal perimeter of the at least one jaw. The at least one second attachment feature is configured to mate with a second adjunct material to releasably retain the second adjunct material on the other jaw.

In some implementations, the at least one attachment feature can be a recess formed in the corresponding extension element formed on the at least one jaw. In other implementations, the at least one attachment feature can be a through opening formed in the corresponding extension element formed on the at least one jaw.

In another aspect, an adjunct configured to be releasably retained on a jaw of an end effector for a surgical instrument is provided that in some implementations has a generally rectangular nominal perimeter with discrete extension elements that extend beyond the nominal perimeter in a plane parallel to a surface of the adjunct configured to contact tissue, at least two of the extension elements being formed along each of long sides of the nominal perimeter and cause a shape of the adjunct to deviate from a shape of the generally rectangular nominal perimeter. The adjunct can also have a plurality of mating features for releasably retaining the adjunct on the jaw, each of the mating features being disposed on a corresponding extension element.

The adjunct can vary in many different ways. For example, the mating features can be in the form of openings. As another example, the extension elements can be formed integrally with the adjunct.

This disclosure will be more fully understood from the following detailed description taken in conjunction with the accompanying drawings, in which:.

Certain exemplary embodiments will now be described to provide an overall understanding of the principles of the structure, function, manufacture, and use of the devices and methods disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. Those skilled in the art will understand that the devices, systems, and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments and that the scope of the present invention is defined solely by the claims. The features illustrated or described in connection with one exemplary embodiment may be combined with the features of other embodiments.

It will be appreciated that the terms "proximal" and "distal" are used herein with reference to a user, such as a clinician, gripping a handle of an instrument. Other spatial terms such as "front" and "back" similarly correspond respectively to distal and proximal. It will be further appreciated that for convenience and clarity, spatial terms such as "vertical" and "horizontal" are used herein with respect to the drawings. However, surgical instruments are used in many orientations and positions, and these spatial terms are not intended to be limiting and absolute.

In some embodiments, the devices and methods described herein are provided for open surgical procedures, and in other embodiments, the devices and methods are provided for laparoscopic, endoscopic, and other minimally invasive surgical procedures. The devices may be fired directly by a human user or remotely under the direct control of a robot or similar manipulation tool. However, a person skilled in the art will appreciate that the various methods and devices disclosed herein can be used in numerous surgical procedures and applications. Those skilled in the art will further appreciate that the various instruments disclosed herein can be inserted into a body in any way, such as through a natural orifice, through an incision or puncture hole formed in tissue, or through an access device, such as a trocar cannula. For example, the working portions or end effector portions of the instruments can be inserted directly into a patient's body or can be inserted through an access device that has a working channel through which the end effector and elongated shaft of a surgical instrument can be advanced.

It can be desirable to use one or more biologic materials and/or synthetic materials, collectively referred to herein as "adjuncts" or "buttresses," in conjunction with surgical instruments to help improve surgical procedures. While a variety of different surgical end effectors can benefit from the use of adjuncts, in some exemplary embodiments the end effector can be a surgical stapler. When used in conjunction with a surgical stapler, the adjunct(s) can be disposed between and/or on jaws of the stapler, incorporated into a staple cartridge disposed in the jaws, or otherwise placed in proximity to the staples. When staples are deployed, the adjunct(s) can remain at the treatment site with the staples, in turn providing a number of benefits. For example, the adjunct(s) may reinforce tissue at the treatment site, preventing tearing or ripping by the staples at the treatment site. Tissue reinforcement may be needed to keep the staples from tearing through the tissue if the tissue is diseased, is healing from another treatment such as irradiation, medications such as chemotherapy, or other tissue property altering situation. In some instances, the adjunct(s) may minimize tissue movement in and around the staple puncture sites that can occur from tissue deformation that occurs after stapling (e.g., lung inflation, gastrointestinal tract distension, etc.). Furthermore, in some circumstances, an adjunct can be useful in distributing pressure applied by the staple thereby reducing the possibility of a staple pulling through a tissue (which can be friable) and failing to fasten the tissue as intended (so-called "cheese wiring"). Additionally, the adjunct can be at least partially stretchable and can thus allow at least partial natural motion of the tissue (e.g., expansion and contraction of lung tissue during breathing). In some embodiments, a staple line can be flexible as described, for example, in <CIT>.

It will be recognized by one skilled in the art that a staple puncture site may serve as a stress concentration and that the size of the hole created by the staple will grow when the tissue around it is placed under tension. Restricting the tissues movement around these puncture sites can minimize the size the holes may grow to under tension. In some instances, the adjunct(s) or buttress(es) can be configured to wick or absorb beneficial fluids, e.g., sealants, blood, glues, that further promote healing, and in some instances, the adjunct(s) can be configured to degrade to form a gel, e.g., a sealant, that further promotes healing. In some instances, the adjunct(s) can be used to help seal holes formed by staples as they are implanted into tissue, blood vessels, and various other objects or body parts. The adjunct(s) may also affect tissue growth through the spacing, positioning and/or orientation of any fibers or strands associated with the adjunct(s).

A variety of surgical instruments can be used in conjunction with the adjunct(s) and/or medicant(s) disclosed herein. "Adjuncts" are also referred to herein as "adjunct materials. " The surgical instruments can include surgical staplers. A variety of surgical staplers can be used, for example linear surgical staplers and circular staplers. In general, a linear stapler can be configured to create longitudinal staple lines and can include elongate jaws with a cartridge coupled thereto containing longitudinal staple rows. The elongate jaws can include a knife or other cutting element capable of creating a cut between the staple rows along tissue held within the jaws. In general, a circular stapler can be configured to create annular staple lines and can include circular jaws with a cartridge containing annular staple rows. The circular jaws can include a knife or other cutting element capable of creating a cut inside of the rows of staples to define an opening through tissue held within the jaws. The staplers can be used on a variety of tissues in a variety of different surgical procedures, for example in thoracic surgery or in gastric surgery.

<FIG> illustrates one example of a linear surgical stapler <NUM> suitable for use with one or more adjunct(s) and/or medicant(s). The stapler <NUM> generally includes a handle assembly <NUM>, a shaft <NUM> extending distally from a distal end 12d of the handle assembly <NUM>, and an end effector <NUM> at a distal end 14d of the shaft <NUM>. The end effector <NUM> has opposed lower and upper jaws <NUM>, <NUM>, although other types of end effectors can be used with the shaft <NUM>, handle assembly <NUM>, and components associated with the same. As shown in <FIG>, the lower jaw <NUM> has a staple channel <NUM> (see <FIG>) configured to support a staple cartridge <NUM>, and the upper jaw <NUM> has an anvil surface <NUM> that faces the lower jaw <NUM> and that is configured to operate as an anvil to help deploy staples of the staple cartridge <NUM> (the staples are obscured in <FIG> and <FIG>). At least one of the opposed lower and upper jaws <NUM>, <NUM> is moveable relative to the other lower and upper jaws <NUM>, <NUM> to clamp tissue and/or other objects disposed therebetween. In some implementations, one of the opposed lower and upper jaws <NUM>, <NUM> may be fixed or otherwise immovable. In some implementations, both of the opposed lower and upper jaws <NUM>, <NUM> may be movable. Components of a firing system can be configured to pass through at least a portion of the end effector <NUM> to eject the staples into the clamped tissue. In various implementations a knife blade <NUM> (see <FIG>) or other cutting element can be associated with the firing system to cut tissue during the stapling procedure. The cutting element can be configured to cut tissue at least partially simultaneously with the staples being ejected. In some circumstances, it may be advantageous if the tissue is cut after the staples have been ejected and the tissue is secured. Thus, if a surgical procedure requires that a tissue captured between the jaws be severed, the knife blade <NUM> is advanced to sever the tissue grasped between the jaws after the staples have been ejected from the staple cartridge <NUM>.

Operation of the end effector <NUM> can begin with input from a user, e.g., a clinician, a surgeon, etc., at the handle assembly <NUM>. The handle assembly <NUM> can have many different configurations designed to manipulate and operate the end effector <NUM> associated therewith. In the illustrated example, the handle assembly <NUM> has a pistol-grip type housing <NUM> with a variety of mechanical and/or electrical components disposed therein to operate various features of the instrument <NUM>. For example, the handle assembly <NUM> can include a rotation knob <NUM> mounted adjacent the distal end 12d thereof which can facilitate rotation of the shaft <NUM> and/or the end effector <NUM> with respect to the handle assembly <NUM> about a longitudinal axis L of the shaft <NUM>. The handle assembly <NUM> can further include clamping components as part of a clamping system actuated by a clamping trigger <NUM> and firing components as part of the firing system that are actuated by a firing trigger <NUM>. The clamping and firing triggers <NUM>, <NUM> can be biased to an open position with respect to a stationary handle <NUM>, for instance by a torsion spring. Movement of the clamping trigger <NUM> toward the stationary handle <NUM> can actuate the clamping system, described below, which can cause the jaws <NUM>, <NUM> to collapse towards each other and to thereby clamp tissue therebetween. Movement of the firing trigger <NUM> can actuate the firing system, described below, which can cause the ejection of staples from the staple cartridge <NUM> disposed therein and/or the advancement the knife blade <NUM> to sever tissue captured between the jaws <NUM>, <NUM>. A person skilled in the art will recognize that various configurations of components for a firing system, mechanical, hydraulic, pneumatic, electromechanical, robotic, or otherwise, can be used to eject staples and/or cut tissue.

As shown in <FIG>, the end effector <NUM> of the illustrated implementation has the lower jaw <NUM> that serves as a cartridge assembly or carrier and the opposed upper jaw <NUM> that serves as an anvil. The staple cartridge <NUM>, having a plurality of staples therein, is supported in a staple tray <NUM>, which in turn is supported within a cartridge channel of the lower jaw <NUM>. The upper jaw <NUM> has a plurality of staple forming pockets (not shown), each of which is positioned above a corresponding staple from the plurality of staples contained within the staple cartridge <NUM>. The upper jaw <NUM> can be connected to the lower jaw <NUM> in a variety of ways, although in the illustrated implementation the upper jaw <NUM> has a proximal pivoting end 34p that is pivotally received within a proximal end 56p of the staple channel <NUM>, just distal to its engagement to the shaft <NUM>. When the upper jaw <NUM> is pivoted downwardly, the upper jaw <NUM> moves the anvil surface <NUM> and the staple forming pockets formed thereon move toward the opposing staple cartridge <NUM>.

Various clamping components can be used to effect opening and closing of the jaws <NUM>, <NUM> to selectively clamp tissue therebetween. As illustrated, the pivoting end 34p of the upper jaw <NUM> includes a closure feature 34c distal to its pivotal attachment with the staple channel <NUM>. Thus, a closure tube <NUM>, whose distal end includes a horseshoe aperture 46a that engages the closure feature 34c, selectively imparts an opening motion to the upper jaw <NUM> during proximal longitudinal motion and a closing motion to the upper jaw <NUM> during distal longitudinal motion of the closure tube <NUM> in response to the clamping trigger <NUM>. As mentioned above, in various implementations, the opening and closure of the end effector <NUM> may be effected by relative motion of the lower jaw <NUM> with respect to the upper jaw <NUM>, relative motion of the upper jaw <NUM> with respect to the lower jaw <NUM>, or by motion of both jaws <NUM>, <NUM> with respect to one another.

The firing components of the illustrated implementation includes a firing bar <NUM>, as shown in <FIG>, having an E-beam <NUM> on a distal end thereof. The firing bar <NUM> is encompassed within the shaft <NUM>, for example in a longitudinal firing bar slot <NUM> of the shaft <NUM>, and guided by a firing motion from the handle <NUM>. Actuation of the firing trigger <NUM> can affect distal motion of the E-beam <NUM> through at least a portion of the end effector <NUM> to thereby cause the firing of staples contained within the staple cartridge <NUM>. As illustrated, guides <NUM> projecting from a distal end of the E-Beam <NUM> can engage a wedge sled <NUM>, shown in <FIG>, which in turn can push staple drivers <NUM> upwardly through staple cavities <NUM> formed in the staple cartridge <NUM>. Upward movement of the staple drivers <NUM> applies an upward force on each of the plurality of staples within the cartridge <NUM> to thereby push the staples upwardly against the anvil surface <NUM> of the upper jaw <NUM> and create formed staples.

In addition to causing the firing of staples, the E-beam <NUM> can be configured to facilitate closure of the jaws <NUM>, <NUM>, spacing of the upper jaw <NUM> from the staple cartridge <NUM>, and/or severing of tissue captured between the jaws <NUM>, <NUM>. In particular, a pair of top pins and a pair of bottom pins can engage one or both of the upper and lower jaws <NUM>, <NUM> to compress the jaws <NUM>, <NUM> toward one another as the firing bar <NUM> advances through the end effector <NUM>. Simultaneously, the knife <NUM> extending between the top and bottom pins can be configured to sever tissue captured between the jaws <NUM>, <NUM>.

In use, the surgical stapler <NUM> can be disposed in a cannula or port and disposed at a surgical site. A tissue to be cut and stapled can be placed between the jaws <NUM>, <NUM> of the surgical stapler <NUM>. Features of the stapler <NUM> can be maneuvered as desired by the user to achieve a desired location of the jaws <NUM>,<NUM> at the surgical site and the tissue with respect to the jaws <NUM>, <NUM>. After appropriate positioning has been achieved, the clamping trigger <NUM> can be pulled toward the stationary handle <NUM> to actuate the clamping system. The clamping trigger <NUM> can cause components of the clamping system to operate such that the closure tube <NUM> advances distally through at least a portion of the shaft <NUM> to cause at least one of the jaws <NUM>, <NUM> to collapse towards the other to clamp the tissue disposed therebetween. Thereafter, the firing trigger <NUM> can be pulled toward the stationary handle <NUM> to cause components of the firing system to operate such that the firing bar <NUM> and/or the E-beam <NUM> are advanced distally through at least a portion of the end effector <NUM> to effect the firing of staples and optionally to sever the tissue captured between the jaws <NUM>, <NUM>.

Another example of a surgical instrument in the form of a linear surgical stapler <NUM> is illustrated in <FIG>. The stapler <NUM> can generally be configured and used similar to the stapler <NUM> of <FIG>. Similar to the surgical instrument <NUM> of <FIG>, the surgical instrument <NUM> includes a handle assembly <NUM> with a shaft <NUM> extending distally therefrom and having an end effector <NUM> on a distal end thereof for treating tissue. Upper and lower jaws <NUM>, <NUM> of the end effector <NUM> can be configured to capture tissue therebetween, staple the tissue by firing of staples from a cartridge <NUM> disposed in the lower jaw <NUM>, and/or to create an incision in the tissue. In this implementation, an attachment portion <NUM> on a proximal end of the shaft <NUM> can be configured to allow for removable attachment of the shaft <NUM> and the end effector <NUM> to the handle assembly <NUM>. In particular, mating features <NUM> of the attachment portion <NUM> can mate to complementary mating features <NUM> of the handle assembly <NUM>. The mating features <NUM>, <NUM> can be configured to couple together via, e.g., a snap fit coupling, a bayonet type coupling, etc., although any number of complementary mating features and any type of coupling can be used to removably couple the shaft <NUM> to the handle assembly <NUM>. Although the entire shaft <NUM> of the illustrated implementation is configured to be detachable from the handle assembly <NUM>, in some implementations, the attachment portion <NUM> can be configured to allow for detachment of only a distal portion of the shaft <NUM>. Detachable coupling of the shaft <NUM> and/or the end effector <NUM> can allow for selective attachment of a desired end effector <NUM> for a particular procedure, and/or for reuse of the handle assembly <NUM> for multiple different procedures.

The handle assembly <NUM> can have one or more features thereon to manipulate and operate the end effector <NUM>. By way of non-limiting example, a rotation knob <NUM> mounted on a distal end of the handle assembly <NUM> can facilitate rotation of the shaft <NUM> and/or the end effector <NUM> with respect to the handle assembly <NUM>. The handle assembly <NUM> can include clamping components as part of a clamping system actuated by a movable trigger <NUM> and firing components as part of a firing system that can also be actuated by the trigger <NUM>. Thus, in some implementations, movement of the trigger <NUM> toward a stationary handle <NUM> through a first range of motion can actuate clamping components to cause the opposed jaws <NUM>, <NUM> to approximate toward one another to a closed position. In some implementations, only one of the opposed jaws <NUM>, <NUM> can move to move the jaws <NUM>, <NUM> to the closed position. Further movement of the trigger <NUM> toward the stationary handle <NUM> through a second range of motion can actuate firing components to cause the ejection of the staples from the staple cartridge <NUM> and/or the advancement of a knife or other cutting element (not shown) to sever tissue captured between the jaws <NUM>, <NUM>.

One example of a surgical instrument in the form of a circular surgical stapler <NUM> is illustrated in <FIG>. The stapler <NUM> can generally be configured and used similar to the linear staplers <NUM>, <NUM> of <FIG> and <FIG>, but with some features accommodating its functionality as a circular stapler. Similar to the surgical instruments <NUM>, <NUM>, the surgical instrument <NUM> includes a handle assembly <NUM> with a shaft <NUM> extending distally therefrom and having an end effector <NUM> on a distal end thereof for treating tissue. The end effector <NUM> can include a cartridge assembly <NUM> and an anvil <NUM>, each having a tissue-contacting surface that is substantially circular in shape. The cartridge assembly <NUM> and the anvil <NUM> can be coupled together via a shaft <NUM> extending from the anvil <NUM> to the handle assembly <NUM> of the stapler <NUM>, and manipulating an actuator <NUM> on the handle assembly <NUM> can retract and advance the shaft <NUM> to move the anvil <NUM> relative to the cartridge assembly <NUM>. The anvil <NUM> and cartridge assembly <NUM> can perform various functions and can be configured to capture tissue therebetween, staple the tissue by firing of staples from a cartridge <NUM> of the cartridge assembly <NUM> and/or can create an incision in the tissue. In general, the cartridge assembly <NUM> can house a cartridge containing the staples and can deploy staples against the anvil <NUM> to form a circular pattern of staples, e.g., staple around a circumference of a tubular body organ.

In one implementation, the shaft <NUM> can be formed of first and second portions (not shown) configured to releasably couple together to allow the anvil <NUM> to be detached from the cartridge assembly <NUM>, which may allow greater flexibility in positioning the anvil <NUM> and the cartridge assembly <NUM> in a body of a patient. For example, the first portion of the shaft <NUM> can be disposed within the cartridge assembly <NUM> and extend distally outside of the cartridge assembly <NUM>, terminating in a distal mating feature. The second portion of the shaft <NUM> can be disposed within the anvil <NUM> and extend proximally outside of the cartridge assembly <NUM>, terminating in a proximal mating feature. In use, the proximal and distal mating features can be coupled together to allow the anvil <NUM> and cartridge assembly <NUM> to move relative to one another.

The handle assembly <NUM> of the stapler <NUM> can have various actuators disposed thereon that can control movement of the stapler. For example, the handle assembly <NUM> can have a rotation knob <NUM> disposed thereon to facilitate positioning of the end effector <NUM> via rotation, and/or the trigger <NUM> for actuation of the end effector <NUM>. Movement of the trigger <NUM> toward a stationary handle <NUM> through a first range of motion can actuate components of a clamping system to approximate the jaws, i.e. move the anvil <NUM> toward the cartridge assembly <NUM>. Movement of the trigger <NUM> toward the stationary handle <NUM> through a second range of motion can actuate components of a firing system to cause the staples to deploy from the staple cartridge assembly <NUM> and/or cause advancement of a knife to sever tissue captured between the cartridge assembly <NUM> and the anvil <NUM>.

The illustrated examples of surgical stapling instruments <NUM>, <NUM>, <NUM> provide only a few examples of many different configurations, and associated methods of use, that can be used in conjunction with the disclosures provided herein. Although the illustrated examples are all configured for use in minimally invasive procedures, it will be appreciated that instruments configured for use in open surgical procedures, e.g., open linear staplers as described in <CIT>, can be used in conjunction with the disclosures provided herein. Greater detail on the illustrated examples, as well as additional examples of surgical staplers, components thereof, and their related methods of use, are provided in <CIT>, <CIT>, <CIT>, <CIT>, <CIT>, <CIT>, entitled "Sealing Materials for Use in Surgical Procedures, and filed on November <NUM>, <NUM>, <CIT>, <CIT>, <CIT>, <CIT>, <CIT>, and <CIT>.

As indicated above, various implantable adjuncts are provided for use in conjunction with surgical stapling instruments. The adjuncts can have a variety of configurations, and can be formed from various materials. In general, an adjunct can be formed from one or more of a film, a foam, an injection molded thermoplastic, a vacuum thermoformed material, a fibrous structure, and hybrids thereof. The adjunct can also include one or more biologically-derived materials and one or more drugs. Each of these materials is discussed in more detail below.

An adjunct can be formed from a foam, such as a closed-cell foam, an open-cell foam, or a sponge. An example of how such an adjunct can be fabricated is from animal derived collagen, such as porcine tendon, that can then be processed and lyophilized into a foam structure. Gelatin can also be used and processed into a foam. Examples of various foam adjuncts are further described in previously mentioned <CIT>.

An adjunct can also be made from a film formed from any suitable material or a combination of materials discussed below. The film can include one or more layers, each of which can have different degradation rates. Furthermore, the film can have various regions formed therein, for example, reservoirs that can releasably retain therein one or more medicants in a number of different forms. The reservoirs having at least one medicant disposed therein can be sealed using one or more different coating layers which can include absorbable or non-absorbable polymers. The film can be formed in various ways. For example, it can be an extruded or a compression molded film. The medicants can also be adsorbed onto the film or bound to the film via non-covalent interactions such as hydrogen bonding.

An adjunct can also be formed from injection molded thermoplastic or a vacuum thermoformed material. Examples of various molded adjuncts are further described in <CIT>. The adjunct can also be a fiber-based lattice which can be a woven fabric, knitted fabric or non-woven fabric such as a melt-blown, needle-punched or thermal-constructed loose woven fabric. An adjunct can have multiple regions that can be formed from the same type of lattice or from different types of lattices that can together form the adjunct in a number of different ways. For example, the fibers can be woven, braided, knitted, or otherwise interconnected so as to form a regular or irregular structure. The fibers can be interconnected such that the resulting adjunct is relatively loose. Alternatively, the adjunct can include tightly interconnected fibers. The adjunct can be in a form of a sheet, tube, spiral, or any other structure that can include compliant portions and/or more rigid, reinforcement portions. The adjunct can be configured such that certain regions thereof can have more dense fibers while others have less dense fibers. The fiber density can vary in different directions along one or more dimensions of the adjunct, based on an intended application of the adjunct.

The adjunct can be formed from woven, knitted, or otherwise interconnected fibers, which allows the adjunct to be stretched. For example, the adjunct can be configured to stretch in a direction along its longitudinal axis and/or in a lateral direction that is perpendicular to the longitudinal axis. While being stretchable in at least two dimensions (e.g., X and Y directions), the adjunct can provide reinforcement along its thickness (e.g., a Z direction) such that it stretches but resists tearing and pull-through by the staples. Non-limiting examples of adjuncts that are configured to be implanted such that they can stretch with the tissue are described in the above-mentioned <CIT>.

The adjunct can also be a hybrid construct, such as a laminate composite or melt-locked interconnected fiber. Examples of various hybrid construct adjuncts are further described in <CIT>, and in <CIT>.

The adjuncts in accordance with the described techniques can be formed from various materials. The materials can be used in various embodiments for different purposes. The materials can be selected in accordance with a desired therapy to be delivered to tissue so as to facilitate tissue in-growth. The materials can include bioabsorbable and biocompatible polymers, including homopolymers and copolymers. Bioabsorbable polymers can be absorbable, resorbable, bioresorbable, or biodegradable polymers.

An adjunct can also include active agents, such as active cell culture (e.g., diced autologous tissue, agents used for stem cell therapy (e.g., Biosutures and Cellerix S. ), hemostatic agents, and tissue healing agents.

The adjuncts can releasably retain therein at least one medicant that can be selected from a large number of different medicants. Medicants include, but are not limited to, drugs or other agents included within, or associated with, the adjunct that has a desired functionality. The medicants include, but are not limited to, for example, antimicrobial agents such as antibacterial and antibiotic agents, antifungal agents, antiviral agents, anti-inflammatory agents, growth factors, analgesics, anesthetics, tissue matrix degeneration inhibitors, anti-cancer agents, hemostatic agents, and other agents that elicit a biological response. The adjuncts can also be made from or include agents that enhance visibility during imaging, such as, for example, echogenic materials or radio-opaque materials.

Examples of various adjuncts and various techniques for releasing medicants from adjuncts are further described in <CIT>.

Various exemplary techniques for releasably retaining an adjunct material on one or both jaws of an end effector of a surgical instrument are described herein. Both of the opposed jaws have extension elements formed thereon that extend beyond a nominal perimeter of that jaw. The extension elements are formed outside an area of the jaw's tissue-contacting and treating surface having staple-holding cavities (if the jaw is a cartridge body) or a tissue-contacting surface having staple-forming cavities (if the jaw is an anvil). An adjunct material configured to be releasably retained on the jaw has a shape complementary to that of the jaw.

An end effector for a surgical instrument has first and second jaws, at least one of which is movable relative to the other one between open and closed positions. The first jaw has a cartridge body having on a tissue-contacting surface thereof a plurality of staple cavities configured to seat staples therein. The first jaw has a generally rectangular nominal perimeter defining a regular perimeter around outer rows of the plurality of staple cavities. The second jaw has an anvil with a plurality of staple forming cavities formed on a tissue-contacting surface thereof. The second jaw also has a generally rectangular nominal perimeter opposed to the nominal perimeter of the first jaw.

Both of the first and second jaws have a plurality of attachment features formed thereon on extension elements extending beyond the nominal perimeter of the at least one jaw. Each of the extension elements has at least one attachment feature formed thereon. For example, the attachment feature can be a projection extending from the corresponding extension element. The attachment feature is configured to mate with a corresponding mating feature formed on an adjunct material that has a shape complementary to a shape of the jaw.

<FIG>, <FIG> illustrate an example of an end effector <NUM> of a surgical instrument configured to be coupled to a distal end of an elongate shaft of the surgical instrument (not shown). The end effector <NUM> has a first jaw in the form a cartridge body <NUM> and a second opposed jaw in the form of an anvil <NUM> that are configured to clamp tissue therebetween. At least one of the cartridge body <NUM> and the anvil <NUM> is movable relative to the other between open and closed positions. In some embodiments, the cartridge body <NUM> can seat therein a removable and replaceable cartridge. Furthermore, in some embodiments, the cartridge body <NUM> can be part of a disposable loading unit coupled distally to an elongate shaft of a surgical instrument. One or both of the jaws of the end effector can have an implantable adjunct material releasably retained thereon. For example, the cartridge body <NUM> can have an adjunct material <NUM> shown in <FIG> releasably retained thereon as discussed in more detail below.

The cartridge body <NUM> has a tissue-contacting surface <NUM> having a plurality of staple cavities <NUM> (shown partially in <FIG>) configured to seat staples therein. The tissue-contacting surface <NUM> can have an adjunct material disposed thereon and may therefore not directly contact tissue. Moreover, the tissue-contacting surface <NUM> is also a tissue-treating surface. The anvil <NUM> has a plurality of staple forming cavities formed on a tissue-contacting (and treating) surface thereof, which are obscured in <FIG>. Both the cartridge body <NUM> and the anvil <NUM> are generally rectangular. As schematically shown in <FIG>, the cartridge body <NUM> has a longitudinal axis A1 and a generally rectangular nominal perimeter <NUM> defining a regular perimeter around outer rows of the plurality of staple cavities <NUM>. The nominal perimeter <NUM> has long sides 112a, 112b extending along the longitudinal axis A and short sides 114a, 114b. The anvil <NUM> also has a generally rectangular nominal perimeter opposed to the nominal perimeter <NUM> of the cartridge body <NUM>.

The cartridge body <NUM> has multiple extension elements <NUM> extending beyond the nominal perimeter <NUM>. In particular, as shown in <FIG>, the extension elements <NUM> protrude from the cartridge body <NUM> such that they extend beyond the side walls of the cartridge body <NUM>, such as a sidewall <NUM> in <FIG>. As shown, the extension elements <NUM> are formed outside the area of the cartridge body <NUM> having the staple holding cavities <NUM>. In this example, six extension elements 118a, 118b, 118c, 118d, 118e, 118f are shown formed on the cartridge body <NUM>. As shown in <FIG>, the extension elements <NUM> are formed along at least one of the long sides 112a, 112b of the nominal perimeter <NUM>, in the plane of the tissue-contacting surface <NUM> of the cartridge body <NUM>. In embodiments in which the cartridge body <NUM> is in the form of a channel configured to removably and replaceably sit therein a cartridge with staples, the extension elements are formed on a body of the channel. In embodiments in which the entire cartridge body <NUM> is removable and replaceable (e.g., as part of a disposable loading unit), the extension elements are formed on the cartridge body <NUM>.

As shown, the distal-most extension elements 118a, 118d are formed on opposite sides from a knife channel <NUM> (<FIG>) at a distal end 102d of the cartridge body <NUM>, adjacent to a distal tip <NUM>. The extension elements 118b, 118e are formed more proximally on both sides of the knife channel <NUM>, and the extension elements 118d, 118f are the closest to the proximal end 102p of the cartridge body <NUM>. In this example, the pairs of extension elements formed at opposed sides from the knife channel <NUM> (e.g., the extension elements 118a, 118d) can be disposed along the same axis, which can be perpendicular to the longitudinal axis A1 of the jaw <NUM>. The extension elements formed along the same side of the jaw can be spaced equidistantly from one another along the side of the jaw, or one or more of the extension elements can be spaced differently from other extension elements.

The extension elements <NUM> can have a number of different configurations. In the example illustrated, the extension elements <NUM> have a trapezoidal shape (e.g., of an isosceles trapezoid) with its longer base being the closest to the nominal perimeter of the cartridge body <NUM>. However, it should be appreciated that the extension elements formed on the cartridge body can be rectangular, square, semi-circular, or they can have any other suitable shape(s), including regular and irregular shapes. Also, the cartridge body can have extension elements of two or more different configurations and/or sizes.

Furthermore, six extension elements 118a, 118b, 118c, 118d, 118e, 118f are shown by way of example only, as any suitable number of extension elements can extend beyond the nominal perimeter of the cartridge body. For example, one, two, three, four, five, or greater than six extension elements can be formed. Also, a different number of extension elements can be formed on one long side 112a of the cartridge body <NUM> as compared to the cartridge body's another long side 112b.

As in the implementation shown in <FIG>, the extension elements can be formed in the plane that is parallel to the tissue-contacting surface <NUM> of the cartridge body <NUM>. However, in other implementations, one or more of the extension elements can have at least a portion thereof formed at an angle to the tissue-contacting surface <NUM> of the cartridge body <NUM>, in a manner that does not interfere with proper operation of the end effector. The extension elements 118a, 118b, 118c, 118d, 118e, 118f are formed integrally with the cartridge body <NUM>. Furthermore, in some embodiments not falling under the wording of the independent claim, the extension elements can be separate features coupled to the cartridge body <NUM> in a suitable way.

The cartridge body <NUM> and the extension elements <NUM> have a size such that the cartridge body <NUM> with the cartridge body <NUM> with the extension elements <NUM> extending therefrom fit within a trocar providing access to a surgical site. For example, in the illustrated embodiments, the cartridge body <NUM> with the extension elements <NUM> is sized such that the end effector <NUM> has an overall diameter smaller than <NUM>. As a person skilled in the art will appreciate, regardless of the specific configuration of the cartridge body or anvil, the extension elements are formed thereon such that the end effector can fit within a suitable surgical site access instrument.

As shown in <FIG>, the extension elements 118a, 118b, 118c, 118d, 118e, 118f have respective attachment features <NUM> formed thereon. In this example, each of the extension elements 118a, 118b, 118c, 118d, 118e, 118f has a respective one of the attachment features 120a, 120b, 120c, 120d, 120e, 120f formed thereon. Each of the attachment features can be in the form of a post or a projection extending from a respective extension element perpendicular to the longitudinal axis A1 of the cartridge body <NUM>, which embodiment does not form part of the claimed invention. The projection can have a rounded tip or a tip having other suitable configuration. However, it should be appreciated that the attachment features formed on the extension elements <NUM> can have any other various configurations. Also, in some implementations, the jaw (e.g., the cartridge body <NUM>) can have attachment features of more than one type formed thereon.

One or both of the cartridge body <NUM> and anvil <NUM> can have an adjunct material (or "adjunct") releasably retained thereon. In the illustrated implementation, the adjunct material has a shape complementary to a shape of the jaw on which it is mounted and the adjunct material is configured to releasably mate with the attachment features formed on the extension elements of the jaw. Thus, the adjunct has a generally rectangular nominal perimeter with discrete extension elements that extend beyond the nominal perimeter in a plane parallel to a surface of the adjunct configured to contact tissue. The extension elements can be formed on the adjunct such that at least two extension elements are formed along each of long sides of the adjunct's nominal perimeter. Each of the extension elements can have at least one mating feature configured to mate with a respective attachment features formed on the jaw.

<FIG> shows the adjunct material <NUM> that can be releasably retained on the tissue-contacting surface <NUM> of the cartridge body <NUM>. As shown in <FIG>, the adjunct material <NUM> has a shape that corresponds to the shape of the cartridge body <NUM> - extension elements <NUM>, such as elements 128a, 128b, 128c, 128d, 128e, 128f are formed that extend beyond a nominal perimeter <NUM> in a plane parallel to a surface of the adjunct <NUM> configured to contact tissue. The extension elements <NUM> can be formed integrally with the adjunct material <NUM> or they can be separate elements coupled to the adjunct <NUM> along the nominal perimeter <NUM> thereof in a suitable manner.

The extension elements 128a, 128b, 128c, 128d, 128e, 128f are configured to be disposed over the respective extension elements 118a, 118b, 118c, 118d, 118e, 118f extending beyond the nominal perimeter <NUM> of the cartridge body <NUM>. Thus, the shape of the adjunct <NUM> is such that it "traces" the shape of the cartridge body <NUM>. The size of the adjunct material <NUM> also corresponds to the size of the cartridge body <NUM>. In this way, the adjunct material <NUM> is aligned with the cartridge body <NUM> when the adjunct <NUM> is disposed thereon.

The adjunct material <NUM> can be configured to mate with the cartridge body <NUM> in a variety of different ways. In the example illustrated, as shown in <FIG>, the adjunct material <NUM> has a plurality of mating features <NUM>, such as mating features 130a, 130b, 130c, 130d, 130e, 130f that are complementary to the attachment features 120a, 120b, 120c, 120d, 120e, 120f formed on the cartridge body <NUM> and are configured to releasably mate with the attachment features 120a, 120b, 120c, 120d, 120e, 120f. In the illustrated implementation, the mating features are in the form of through openings formed in the adjunct material <NUM>. The openings are configured so as to receive the projections therein, such that the adjunct material can be released from the engagement with the jaw when staples are ejected from staple cavities.

The mating features 130a, 130b, 130c, 130d, 130e, 130f are formed on the adjunct's extension elements 128a, 128b, 128c, 128d, 128e, 128f as shown in <FIG>, at locations on these extension elements corresponding to the locations of the cartridge's attachment features 120a, 120b, 120c, 120d, 120e, 120f. In this way, when the adjunct material <NUM> is superimposed over the cartridge body <NUM>, the mating features 130a, 130b, 130c, 130d, 130e, 130f align with the cartridge's attachment features 120a, 120b, 120c, 120d, 120e such that each opening receives therein a corresponding projection. The cartridge's attachment features and adjunct's mating features can releasably mate via a friction fit or in other ways.

As shown in <FIG> illustrating a partially transparent view of the anvil <NUM>, the anvil <NUM> can also have extension elements <NUM>, such as elements 122a, 122b, 122c, 122d, 122e, 122f, formed thereon that beyond the nominal perimeter <NUM> thereof. Each of the extension elements <NUM> can have a shape and size similar to that of the extension elements <NUM> formed on the cartridge body <NUM>. For example, as illustrated, the extension elements <NUM> can be generally trapezoidal, though they can have other shapes, as the described techniques are not limited in this respect. Similar to the cartridge body <NUM>, each of the extension elements <NUM> can have a respective attachment feature <NUM> thereon for mating with an adjunct to be releasably retained on the anvil <NUM>. <FIG> illustrates that each of the extension elements 122a, 122b, 122c, 122d, 122e, 122f can have a respective one of the attachment features 126a, 126b, 126c, 126d, 126e, 126f formed thereon.

The extension elements <NUM> are formed on the anvil <NUM> in a manner such that they do not overlap with the extension elements <NUM> formed on the cartridge body <NUM>. Thus, as shown in <FIG> and additionally in <FIG> (where a shadow or footprint <NUM> of the anvil <NUM> is schematically shown superimposed over the cartridge body <NUM>), the extension elements <NUM> are staggered with respect to the extension elements <NUM>.

In the described embodiments, the respective extension elements are formed on the cartridge body <NUM> and the anvil <NUM> such that, when the end effector <NUM> is in the closed position, the cartridge body's extension elements <NUM> extend beyond the nominal perimeter of the anvil <NUM> and the anvil's extension elements <NUM> extend beyond the nominal perimeter of the cartridge body <NUM>. For example, <FIG>, showing the end effector <NUM> in a closed configuration, illustrates that the footprint of the cartridge body <NUM> is outside the footprint of the anvil <NUM> and that the extension elements 122a, 122b, 122c, 122d, 122e, 122f are staggered with respect to the extension elements 118a, 118b, 118c, 118d, 118e, 118f. However, it should be appreciated that in some implementations not forming part of the present invention, all or some of the cartridge's and anvil's extension elements are not staggered with respect to one another. For example, the cartridge's and anvil's extension elements can be formed symmetrical, such that at least one of the anvil's extension elements overlaps with at least one of the cartridge's extension elements.

<FIG> additionally illustrates an end effector <NUM> having a longitudinal axis A2, which can have a configuration similar to that of the end effector <NUM> (<FIG> and <FIG>). Thus, similar to the end effector <NUM>, the end effector <NUM> has extension elements formed, in the example of <FIG>, on both of the jaws <NUM> (cartridge body) and <NUM> (anvil). The extension elements formed on the cartridge body <NUM> and anvil <NUM> are collectively identified as extension elements <NUM>, <NUM>, respectively. In this example, each of the cartridge body <NUM> and anvil <NUM> releasably retain thereon respective adjunct materials <NUM>, <NUM> that are separately shown in <FIG>. The cartridge's extension elements <NUM> and anvil's extension elements <NUM> have attachment features, such as projections, configured to mate with corresponding mating features (e.g., openings) formed on adjunct materials <NUM>, <NUM>, respectively.

As shown in <FIG>, the adjunct materials <NUM>, <NUM> have shapes complementary to shapes of the cartridge body <NUM> and anvil <NUM>, respectively. In this example, the extension elements <NUM> formed on the cartridge body <NUM> are staggered with respect to the extension elements <NUM> formed on the anvil <NUM>. In a similar manner, the extension elements of the adjunct material <NUM> are staggered with respect to the extension elements the adjunct material <NUM>. Thus, <FIG> illustrate that, while the anvil's adjunct material <NUM> has extension features 224a, 224b along an axis B1 (also shown in <FIG>), the cartridge body's adjunct material <NUM> does not have any extension elements formed along the axis B1. However, the cartridge body's adjunct material <NUM> has extension elements 222a, 222b formed along an axis B2 (also shown in <FIG>), whereas the anvil's adjunct material <NUM> does not have extension elements formed along the axis B2.

An implantable adjunct configured to be releasably retained over a jaw of an end effector can be made from a variety of different materials described herein. For example, as discussed above, the adjunct can be formed from one or more of a film, foam, an injection molded thermoplastic, a vacuum thermoformed material, a fibrous structure, and hybrids thereof. The adjunct can also include one or more biologically-derived materials and one or more drugs. Furthermore, in the described implementations, one or more portions of the adjunct can have different properties. For example, the areas configured to be superimposed over the extensions features formed on a jaw can be configured differently from other areas of the adjunct.

A jaw (such as a cartridge body or an anvil) having extension elements and an adjunct material having a shape complementary to that jaw can have other features formed thereon for mating between these components. According to the claimed invention, the jaw has attachment features in the form of recesses or through openings formed in the corresponding extension elements of the jaw and configured to mate with respective features formed on the adjunct material.

In some implementations, the opposed jaws of the end effector can have different types of adjunct materials releasably retained thereon. Furthermore, the same or different types of adjunct materials can be coupled to the opposed jaws using the same or different techniques. For example, one adjunct material can be attached to one of the jaws via mechanical features (e.g., projections on the jaw and openings on the adjunct, as discussed above), whereas another adjunct material can be attached to the opposed jaw using a suitable adhesive material.

In some embodiments, a cartridge body (e.g., part of a reloadable unit) can have an adjunct material attached thereon via an adhesive material, while another adjunct material can be attached to the anvil using mechanical feature, such as the projections on the jaw and openings on the adjunct. The cartridge body can be manufactured with a suitable adjunct material already retained thereon. At the same time, an adjunct material can be attached to the anvil of an end effector during surgery.

In some implementations, the anvil of an end effector can have mating features in the form of female features formed on the extensions of the anvil extending beyond the anvil's nominal perimeter. The female features, configured to mate with complementary features formed in an adjunct material configured to be releasably retained on the anvil, can be shaped as openings, pockets, cleats, etc. The adjunct material's mating features can be, for example, hooks, snaps, barbs, features having expandable elements (e.g., tree- or umbrella-like features) that can releasably mate with the pocket-type openings in the anvil. Furthermore, in some implementations, the anvil can have one or more three-dimensional pockets that allow an overmold feature of the adjunct to be releasably retained thereon. The overmold feature can be, for example, a projection molded into the three-dimensional pocket. It should be appreciated that at least on of the jaws of the end effector and an adjunct configured to releasably mate with that jaw can also have these features additionally or alternatively to the features described in connection with <FIG>.

Furthermore, in some embodiments not forming part of the present invention, one or both of the jaws of the end effector may not have extension features formed thereon. In such embodiments, attachment features can be formed on an end effector's jaw within a nominal perimeter of the jaw. <FIG> illustrate an example of such an embodiment providing an anvil <NUM> of an end effector having female features formed thereon for mating with an adjunct material <NUM> that has corresponding mating features. The anvil <NUM> has a tissue-contacting surface <NUM> having a plurality of staple-forming pockets or cavities <NUM>. The staple-forming cavities <NUM> can form various patterns on the tissue-contacting surface <NUM>. In this example, the staple-forming cavities <NUM> are arranged in six rows extending along a longitudinal axis A3 of the anvil <NUM>. As shown in <FIG>, the tissue-contacting surface <NUM> has attachment features 316a, 316b, 316c, 316d formed at a distal end 300d of the anvil <NUM> between adjacent staple-forming cavities. As shown, in this example, the attachment features 316a, 316b, 316c, 316d are formed in a row that is generally perpendicular to a longitudinal axis A3 of the anvil <NUM>.

<FIG> illustrates by way of example two adjacent staple-forming cavities 312a, 314a having the attachment feature 316a therebetween, which is in the form of an overmold cleat or pocket. Thus, the attachment feature 316a and other similar attachment features are formed on the anvil's tissue-contacting surface <NUM> by overmolding a suitable polymeric material (or a polymer blend or a copolymer) between adjacent staple-forming cavities at selected locations on the tissue-contacting surface <NUM>. The attachment features 316b, 316c, 316d, as well as other attachment features formed on the tissue-contacting surface <NUM>, can be formed in a similar manner and are not shown in detail.

<FIG> also illustrates that the adjunct material <NUM> (which is shown partially in <FIG>) has a mating feature 318a configured to be received within the pocket 316a. The mating feature 318a can be in the form of an expandable (e.g., umbrella-like) mating feature extending through a thickness of the adjunct <NUM> and a portion of which expands upon being inserted into the pocket 316a. The pocket 316a and the mating feature 318a are configured to mate such that, when staples are ejected from a cartridge and formed against the staple-forming cavities, the mating features 318a are caused to be disengaged from the pocket 316a.

As shown in <FIG>, the mating feature 318a can be associated with the adjunct such that its top portion <NUM> seats on one side above the surface of the adjunct <NUM>, its mid-portion <NUM> penetrates through the adjunct's surface and extends toward the opposite side of the adjunct that comes in contact with the anvil's tissue-contacting surface <NUM>, and its expandable bottom portion <NUM> is disposed on the opposite side of the adjunct, within the pocket 316a. The expandable portion <NUM> of the mating feature 318a can have one or more portions (e.g., arms, wings, prongs, snaps, etc.) that are configured to expand when load is applied to the top portion <NUM>.

In use, the adjunct material <NUM> is brought in proximity to the tissue-contacting surface <NUM> and force can be applied to the adjunct material <NUM> to cause the mating feature 318a to be received within the pocket 316a such that the expandable portion <NUM> is received within the pocket 316a and expands to thereby releasably retain the adjunct <NUM> over the tissue-contacting surface <NUM>. It should be appreciated that the mating feature 318a can have other configurations that allow this feature to be used to releasably retain the adjunct on the jaw. The adjunct's mating features can have a changeable configuration, e.g., such that at least a portion of the feature expands, as the exemplary mating feature 318a in <FIG>. As another variation, the mating feature can be in the form of a hook or other non-expandable feature configured to be received within a recess in a jaw. The load can be applied to the adjunct <NUM> manually, or using a loader or applicator member which can be removably coupled to the end effector or removably coupled to the adjunct <NUM>. In some embodiments, the adjunct <NUM> can have an applicator (e.g., in the form of a frame of a suitable configuration disposed over the adjunct) for applying load thereto to be coupled to the adjunct <NUM>. During a surgical procedure, such applicator can be utilized to cause the adjunct <NUM> to be releasably retained over the jaw.

<FIG> shows that, besides the attachment features 316a, 316b, 316c, 316d, the tissue-contacting surface <NUM> also attachment features 320a, 320b, 320c, 320d formed at a mid-portion <NUM> of the anvil <NUM>. The tissue-contacting surface <NUM> also has attachment features 322a, 322b, 322c, 322d formed at a proximal portion 300p of the anvil <NUM>, the locations of which are shown schematically in <FIG> as these features are obscured by the adjunct <NUM>. Additionally, the tissue-contacting surface <NUM> has proximal-most attachment features 324a, 324b (obscured by the adjunct <NUM>), which locations are shown in <FIG>. The attachment features 324a, 324b are disposed at opposite sides of an anvil knife channel <NUM> extending between distal and proximal ends 300d, 300p of the anvil <NUM>.

The mid-portion attachment features 320a, 320b, 320c, 320d and the proximal attachment features 322a, 322b, 322c, 322d are arranged in two respective rows generally perpendicular to the longitudinal axis A3 of the anvil <NUM>. As in this example, the attachment features can be located symmetrically with respect to the anvil knife channel <NUM>. Regardless of its specific location, each of the attachment features is configured to releasably mate with at least one mating feature formed on the adjunct material. Thus, <FIG> schematically shows that the proximal attachment features 322a, 322b, 322c, 322d (obscured in <FIG>) are configured to mate with respective adjunct's mating feature collectively indicated as features <NUM>. These mating features can be configured similar to the feature 318a shown in <FIG>, or in another way.

It should be appreciated that the attachment features in <FIG> are shown to form three rows by way of example only, as attachment features can be formed on a tissue-contacting surface of a jaw at any desired locations, so as to form various patterns. Also, eight attachment features are shown by way of example, as any number of the attachment features can be formed on the jaw's tissue-contacting surface. Furthermore, although the anvil <NUM> is shown in <FIG>, in some implementations, features similar to those shown in <FIG> can be formed on a cartridge body of an end effector. Also, the cartridge body and the anvil of an end effector can have respective adjuncts releasably coupled thereto via different techniques. For example, the cartridge body can have extension elements with attachment features as shown in <FIG> (and in <FIG>), whereas the anvil can have openings or pockets as shown in <FIG>, or vice versa.

The devices disclosed herein can be designed to be disposed of after a single use, or they can be designed to be used multiple times. In either case, however, the device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of the steps of disassembly of the device, followed by cleaning or replacement of particular pieces and subsequent reassembly. In particular, the device can be disassembled, and any number of the particular pieces or parts of the device can be selectively replaced or removed in any combination. Upon cleaning and/or replacement of particular parts, the device can be reassembled for subsequent use either at a reconditioning facility, or by a surgical team immediately prior to a surgical procedure. Those skilled in the art will appreciate that reconditioning of a device can utilize a variety of techniques for disassembly, cleaning/replacement, and reassembly.

Claim 1:
An end effector (<NUM>) for a surgical instrument, comprising:
a first jaw having a cartridge body (<NUM>), the cartridge body having on a tissue-contacting surface (<NUM>) thereof a plurality of staple cavities (<NUM>) configured to seat staples therein, the first jaw having a generally rectangular nominal perimeter (<NUM>) defining a regular perimeter around outer rows of the plurality of staple cavities;
a second jaw having an anvil (<NUM>) with a plurality of staple forming cavities formed on a tissue-contacting surface thereof, wherein at least one of the first and second jaws is movable relative to the other between open and closed positions, the second jaw having a generally rectangular nominal perimeter (<NUM>) opposed to the nominal perimeter of the first jaw:
a plurality of attachment features (120a-f) formed on at least one jaw of the first and second jaws on extension elements (118a-f, 122a-f) extending beyond the nominal perimeter of the at least one jaw such that each of the extension elements has at least one attachment feature formed thereon, wherein the extension elements are formed integrally with the at least one jaw;
an adjunct material (<NUM>) having a shape complementary to at least one of the first and second jaws and being configured to releasably mate with the attachment features; and
wherein the extension elements comprise first extension elements (118a-f) formed on the first jaw and second extension elements (122a-f) formed on the second jaw, wherein the first extension elements are staggered with respect to the second extension elements; and
wherein the at least one attachment feature comprises a recess formed in the corresponding extension element formed on the at least one jaw, and/or
wherein the at least one attachment feature comprises a through opening formed in the corresponding extension element formed on the at least one jaw.