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.

<CIT> describes a surgical stapler end effector assembly which comprises a staple cartridge, an anvil, and a buttress assembly. The staple cartridge comprises a plurality of staples and a deck. The staple cartridge is operable to drive the staples through the deck. The anvil is movable from an open position toward the staple cartridge to reach a closed position. The anvil includes an underside having staple forming surface configured to receive staples driven through the deck. The buttress assembly comprises a buttress body and an adhesive material. The adhesive material comprises a polymer. The polymer is bioabsorbable. The polymer is in a flowable state on the buttress body.

<CIT> describes a piece of buttress material and an end-effector of a surgical instrument including features which can aid a surgeon in properly and quickly attaching the piece of buttress material to the end-effector. In various embodiments, a piece of buttress material can include retention features which can be engaged with portions of an end-effector to releasably retain the piece of buttress material to at least a portion of the end-effector. Similarly, an end-effector can include features configured to engage portions of a piece of buttress material to releasably retain the piece of buttress material to the end-effector. In at least one embodiment, more than one piece of buttress material can be releasably retained to an end-effector.

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.

The present invention provides an adjunct loading system according to the appended claims.

Embodiments of the claimed invention are illustrated by <FIG>. Other figures and the corresponding parts of the description are useful for understanding the invention. The present 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. The invention is defined by the appended independent claim <NUM>, with additional embodiments defined by the dependent claims.

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," 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.). 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) 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). 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> entitled "Method for Creating a Flexible Staple Line," filed on September <NUM>, <NUM>.

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> entitled "Surgical Stapling Devices That Produce Formed Staples Having Different Lengths" and filed February <NUM>, <NUM>, 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> entitled "Systems And Methods For Controlling A Segmented Circuit" and filed March <NUM>, <NUM>, <CIT> entitled "Layer Comprising Deployable Attachment Members" and filed February <NUM>, <NUM>, <CIT> entitled "Selectively Orientable Implantable Fastener Cartridge" and filed September <NUM>, <NUM>, <CIT> entitled "Surgical Stapling Devices That Produce Formed Staples Having Different Lengths" and filed February <NUM>, <NUM>, <CIT> entitled "Surgical Instrument Incorporating EAP Blocking Lockout Mechanism" and filed June <NUM>, <NUM>, <CIT> entitled "Sealing Materials For Use In Surgical Stapling" and filed November <NUM>, <NUM>, entitled "Sealing Materials for Use in Surgical Procedures, and filed on November <NUM>, <NUM>, <CIT>, entitled "Hybrid Adjunct Materials for Use in Surgical Stapling," and filed on November <NUM>, <NUM>, <CIT>, entitled "Positively Charged Implantable Materials and Method of Forming the Same," and filed on November <NUM>, <NUM>, <CIT>, entitled "Tissue Ingrowth Materials and Method of Using the Same," and filed on November <NUM>, <NUM>, <CIT>, entitled "Hybrid Adjunct Materials for Use in Surgical Stapling," and filed on November <NUM>, <NUM>, <CIT>, entitled "Surgical Instrument Comprising a Sensor System," and filed on March <NUM>, <NUM>, and <CIT>, entitled "Adjunct Materials and Methods of Using Same in Surgical Methods for Tissue Sealing," and filed on June <NUM>, <NUM>.

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> entitled "Selectively Orientable Implantable Fastener Cartridge" and filed September <NUM>, <NUM>.

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> entitled "Fastener Cartridge Comprising A Releasably Attached Tissue Thickness Compensator" and filed February <NUM>, <NUM>. 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> entitled "Method for Creating a Flexible Staple Line," filed on September <NUM>, <NUM>.

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> entitled "Adhesive Film Laminate" and filed February <NUM>, <NUM>, and in <CIT> entitled "Minimally Invasive Medical Implant And Insertion Device And Method For Using The Same" and filed September <NUM>, <NUM>.

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 adjuncts that have 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> entitled "Medicant Eluting Adjuncts and Methods of Using Medicant Eluting Adjuncts" and filed August <NUM>, <NUM>.

Adjunct materials can be applied to one or both jaws of an end effector of a surgical instrument in various ways. For example, an adjunct material can be manually positioned on a jaw. It is desired to releasably couple an adjunct to a jaw such that the adjunct does not slip off the jaw prior to application of the adjunct to tissue when staples are fired. However, some approaches may not result in a secure enough attachment of the adjunct to a jaw. This compromises the ability of a surgeon to manipulate the surgical instrument with the adjunct as desired during the surgical procedure.

Accordingly, in some embodiments, systems and methods are provided for applying an adjunct material to a jaw of an end effector to be releasably retained thereon. The adjunct material can be coupled to the jaw using an adhesive that can be applied to the adjunct and/or the jaw in a controlled manner. In some implementations, the adjunct material can be coupled to the jaw via an intermediate polymer layer.

In some embodiments, an adjunct loading member of a loading system can be used that is configured to releasably hold at least one adjunct material. The adjunct material is configured to be transferred from the adjunct loading member to a jaw of first and second jaws of an end effector. A supporting member of a suitable configuration is configured to releasably retain the adjunct material that can be associated with the supporting member in various ways. For example, the adjunct material can be disposed on the supporting member. Additionally or alternatively, the supporting member can be in the form of retaining feature(s) releasably holding the adjunct material in the adjunct loading member. The adjunct loading member also includes an adhesive depot having an adhesive configured, in embodiments not in accordance with the claimed invention, to transition from a non-flowable state to a flowable state upon the application of heat when the adjunct material is released from the adjunct loading member and transferred to the jaw. Once the adhesive in the flowable state is cooled, it adheres to the jaw and is thus used to retain the adjunct material on the jaw.

The adjunct material is configured to be released from the adjunct loading member under application of a load. The adjunct is transferred to the jaw and is caused to adhere to the jaw using the adhesive disposed in the adhesive depot when the adhesive is in the flowable state. Heat can be applied to the adhesive prior to or at least partially at the time when the adjunct is being released from the adjunct loading member to the jaw. The load can be applied by the jaws of the end effector when the adjunct loading member is clamped therebetween. Alternatively, the load can be applied to the adjunct loading member manually or in other ways. The application of at least one of load and heat causes the adhesive from the adhesive depot to be used to retain the adjunct material on the jaw of the end effector.

<FIG> illustrates an example of a portion an end effector <NUM> configured to releasably retain an adjunct material on one or both of its first and second opposed jaws configured to clamp tissue therebetween, in accordance with the described techniques. The end effector <NUM>, partially illustrated in <FIG>, has a first jaw having a cartridge body or cartridge <NUM> and a second jaw having an anvil (not shown), with the first and second jaws being configured to clamp tissue therebetween. The cartridge body <NUM> is configured to releasably retain thereon an implantable adjunct material <NUM>. The end effector <NUM> can be coupled to a distal end of a shaft of the surgical instrument (not shown). The end effector <NUM> can be used in any suitable surgical instrument, for example, a linear surgical stapler (e.g., stapler <NUM> in <FIG>, stapler <NUM> in <FIG>, or any other surgical stapler, including a circular stapler, such as stapler <NUM> in <FIG>) which can be suitable for use with at least one adjunct.

As shown in <FIG>, the cartridge body <NUM> has a plurality of staple or staple-holding cavities <NUM> configured to seat staples therein, the staple-holding cavities <NUM> opening on a tissue-facing surface <NUM> of the cartridge <NUM>. The staple cavities <NUM> form a certain pattern on the surface of the cartridge <NUM> which corresponds to a pattern of staple-forming cavities formed in the anvil (not shown). The cartridge <NUM> includes a cutting element or knife channel <NUM> extending between distal and proximal ends 102d, 102p of the cartridge <NUM>. The knife channel <NUM> is configured to receive a cutting element (e.g., a knife) as it moves distally therethrough. As shown in <FIG>, the staple cavities <NUM> can form three rows on both sides of the cutting element channel <NUM>, though it should be appreciated that the staple cavities <NUM> can form any other patterns on the tissue-facing surface <NUM>.

The cartridge body <NUM> can be in the form of a staple channel configured to support a staple cartridge, which can be removably and replaceably seated within the staple channel. Furthermore, in some embodiments, the cartridge <NUM> can be part of a disposable loading unit coupled distally to a shaft of a surgical instrument.

In this example, the end effector <NUM> is configured to releasably retain thereon the implantable adjunct material (or "adjunct") <NUM>. In the illustrated implementation, the adjunct material <NUM> releasably retained on the cartridge <NUM> is discussed, though it should be appreciated that the anvil can also have an adjunct material releasably retained thereon. The adjunct material <NUM> can be applied to the cartridge <NUM> using a loading member of a loading system, such as an adjunct loading member <NUM> shown in <FIG> and discussed in detail below.

Regardless of the configuration of the loading member, the adjunct material <NUM> is configured to be transferred from the loading member to the cartridge <NUM> using an adhesive depot having an adhesive configured to transition from a non-flowable state to a flowable state upon the application of heat when the adjunct material is released from the adjunct loading member and transferred to the jaw to retain the adjunct material on the jaw. The adhesive depot can have a variety of configurations and it can be configured to allow the adhesive to be released therefrom in a variety of ways. In this example, as shown in <FIG>, the adhesive depot is in the form of protrusions formed on a polymer attachment layer or polymer layer <NUM> disposed on a jaw-facing surface of the adjunct material <NUM>, as also shown schematically in <FIG>. In particular, the polymer layer <NUM>, shown in <FIG> with its jaw-facing surface <NUM> facing up for the illustration purposes only, has a plurality of protrusions <NUM> including or formed from an adhesive. In <FIG>, the polymer layer <NUM> has two shorter protrusions (collectively referred to as 114a, 114b) at each of distal and proximal ends 112d, 112p thereof, respectively, and two longer protrusions 114c disposed between the protrusions 114a, 114b. The pairs of protrusions 114a, 114b, 114c are formed along a longitudinal axis A2 of the polymer layer <NUM>, and symmetrically with respect to a centerline of the polymer layer <NUM>.

As shown in <FIG>, the tissue-facing surface <NUM> of the cartridge <NUM> can include attachment features <NUM> configured to engage the protrusions <NUM>. In particular, the adhesive included in the protrusions <NUM> or from which the protrusions <NUM> are formed can be disposed on the attachment features <NUM>. The attachment features <NUM> can have various configurations. For example, they can be formed as recesses in the cartridge <NUM>. Additionally or alternatively, the attachment features <NUM> can include a roughness pattern, which can be formed in any suitable manner. The roughness pattern can have any suitable texture. For example, in one embodiment, the attachment features <NUM> can be formed by making grooves having a pattern of multiple "Xs" (or other shapes or features) on the surface of the jaw. In this example, the cartridge <NUM> is shown to have six attachment features formed at the distal and proximal ends 102d, 102p thereof, symmetrically with respect to the channel <NUM>. It should be appreciated however that a cartridge of an end effector can include any other number of the attachment features (e.g., less then eight or greater than eight).

The protrusions <NUM> formed on the polymer layer <NUM> and the attachment features <NUM> formed on (or in) the cartridge <NUM> can have various shapes, including different shapes. For example, they can be generally elongate and rectangular, as shown in <FIG>. Additionally or alternatively, they can be square, semi-circular (e.g., having a semi-circular or oval shape as viewed from the top), and/or they can have any other suitable regular or irregular shapes.

In some embodiments, at least one protrusion can be formed at a location on the polymer layer corresponding to a location of an attachment feature formed on the jaw. Thus, as shown in <FIG>, the six protrusions <NUM> are formed on the polymer layer <NUM> at locations that correspond to the locations of the six attachment features <NUM>. The length and width of the protrusions <NUM> can be different from those of the attachment features <NUM>. In addition, in some cases, one protrusion can be disposed over more than one attachment feature, and vise versa. Thus, the protrusions formed on the polymer layer and the attachment features formed on the jaw can form various patterns and can correspond to one another in various manners.

Regardless of the specific number, size, and locations of adhesive protrusions formed on the polymer layer <NUM>, the polymer layer <NUM> is used to attach the adjunct material <NUM> to the cartridge <NUM>. The surface of the polymer layer <NUM> that is opposed to the surface <NUM> on which the protrusions <NUM> are formed can be coupled to the adjunct material <NUM> in various ways. For example, at least a portion of the polymer layer <NUM> can be formed from a pressure-sensitive adhesive such that the adjunct material <NUM> can be coupled with the polymer layer <NUM> that is, in turn, coupled with the jaw.

In some embodiments, as shown in <FIG>, the end effector <NUM> can include an additional polymer layer <NUM> shown in the form of two portions. The additional polymer layer <NUM> can be disposed between the adjunct material <NUM> and the polymer layer <NUM> or between the polymer layer <NUM> and the cartridge <NUM>. The additional polymer layer <NUM> can be formed from an adhesive configured to transition from a non-flowable state to a flowable state upon the application of heat. Thus, when the additional polymer layer <NUM> is configured to be disposed between the polymer layer <NUM> and the cartridge <NUM>, it is effectively additionally used to couple the adjunct material <NUM> to the jaw <NUM>. It should be appreciated however that the additional polymer layer <NUM> is optional and may not be present.

The adjunct material <NUM> can be formed from any suitable material or a combination of materials, which are discussed above. The unit "inch" used in the following parts of the description is defined as: <NUM> inch = <NUM>. In some embodiments, the adjunct material <NUM> can have a thickness of from about <NUM> (<NUM> inches) to about <NUM> (<NUM> inches). In some embodiments, the adjunct material <NUM> can have a thickness of from about <NUM> (<NUM> inches) to about <NUM> (<NUM> inches). The polymer layer can have a thickness of from about <NUM> (<NUM> inches) to about <NUM> (<NUM> inches), and projections 116d, 116p can have a height or thickness of from about <NUM> (<NUM> inches) to about <NUM> (<NUM> inches).

As mentioned above, in the described embodiments, the adjunct material is configured to be transferred from an adjunct loading member to a jaw of an end effector. <FIG> show an example of an adjunct loading member <NUM> of a loading system that is configured to release the adjunct material to retain the adjunct material in the jaw, using at least one of heat and load (force). <FIG> shows a top view of the adjunct loading member <NUM>, whereas <FIG> shows a cross-sectional view of the adjunct loading member <NUM> when it is disposed on a jaw <NUM> of an end effector.

As in the illustrated example, the adjunct loading member <NUM> can be the form of a generally rectangular frame-like holder configured to releasably couple one or more adjuncts to one or both jaws of the end effector (not shown in <FIG>). In the illustrated example, the adjunct loading member <NUM> is in the form of a first (e.g., top) and second (e.g., bottom) generally rectangular housings <NUM>, <NUM> coupled to one another e.g., via a coupling member. In this example, the adjunct loading member <NUM> can be used to apply a single adjunct to a jaw. It should be appreciated however, that, in some embodiments, a loader like the adjunct loading member <NUM> or a similar loader, can be used to apply a respective adjunct to each jaw of an end effector.

As shown in <FIG>, the adjunct loading member <NUM> includes at least one heating component <NUM> configured to be activated to apply heat to an adhesive depot having an adhesive configured to transition from a non-flowable state to adhering flowable state upon the application of heat. In this example, as shown in <FIG>, the adjunct loading member <NUM> can retain thereon an adjunct material <NUM> and a polymer layer <NUM> having protrusions <NUM>. The adjunct material <NUM> and the polymer layer <NUM> can be similar, for example, to the adjunct material <NUM> and the polymer layer <NUM>, though any suitable number of the protrusions <NUM> can be formed on the polymer layer <NUM>.

As shown in <FIG>, the adjunct material <NUM> can be releasably retained on a supporting member <NUM> that can be configured in any suitable manner so as to retain the adjunct material <NUM>. The supporting member <NUM> that can have or can be in the form of, for example, retaining features (not shown) configured to releasably hold the adjunct material <NUM>. The adjunct material <NUM> can be disposed in any suitable way with respect to the supporting member. For example, in some embodiments, the supporting member <NUM> can be in the form of features formed on one or more sides of the adjunct material <NUM>. In this way, when load is applied to the adjunct loading member <NUM>, the supporting member <NUM> is caused to release the adjunct material <NUM> therefrom, thus causing the adjunct material to be transferred to a jaw of an end effector. <FIG> illustrates by way of example a jaw of an end effector in the form of a cartridge <NUM> that has the adjunct loading member <NUM> associated wherewith. The cartridge <NUM> is shown in <FIG> to have the adjunct material <NUM> transferred thereto and coupled thereto using the polymer layer <NUM>. It should be appreciated that, although not shown in <FIG>, in use, the load is applied to the adjunct loading member <NUM> by a first jaw having an anvil and the second jaw having cartridge <NUM> that are clamped together with the adjunct loading member <NUM> disposed therebetween.

In the described embodiments, the adjunct material <NUM> is transferred from the adjunct loading member <NUM> to the cartridge <NUM> under application of load and the adjunct material <NUM> is caused to be retained on the cartridge <NUM> using an adhesive that is caused to transition to a flowable state under application of heat. Thus, in use, the adjunct loading member <NUM> releasably holding the adjunct material <NUM> is positioned between the jaws of the end effector (only the cartridge <NUM> of the end effector is shown in <FIG>). To transfer the adjunct material <NUM> from the adjunct loading member <NUM> to the jaw <NUM>, the first and second jaws are approximated to thereby apply load to the adjunct loading member <NUM>, which causes the adjunct material <NUM> to be released from the adjunct loading member <NUM>. The adjunct loading member <NUM> can be configured such that it exposes the side of the polymer layer <NUM> (having the adjunct <NUM> coupled thereto) having the protrusions <NUM>. The application of load can cause the supporting member <NUM> and, in some implementations, other portions or features of the adjunct loading member <NUM> to crack, break, deform (e.g., bend, flex, etc.) or otherwise change their configuration to thereby release the adjunct <NUM> from the adjunct loading member <NUM>. In some embodiments, the housings <NUM>, <NUM> of the adjunct loading member <NUM> can be configured to deform or break to release the adjunct <NUM> from the adjunct loading member <NUM> when the adjunct loading member 200is clamped between the jaws <NUM> (and not shown) of the end effector such that the load is applied thereto. As such, the adjunct <NUM> can be "squeezed out" of the adjunct loading member <NUM>. The adjunct loading member <NUM> can be disposable such that it can be discarded after the adjunct <NUM> (and the polymer layer <NUM> coupled thereto) is transferred to the jaw.

Heat is applied to at least a portion of an adhesive depot such as the protrusions <NUM> of the polymer layer <NUM> having an adhesive and disposed in the adjunct loading member <NUM> in association with the adjunct material <NUM>, which causes the adhesive to transition from a non-flowable state to adhering flowable state when the adjunct material <NUM> is released from the adjunct loading member <NUM> and transferred to the jaw <NUM>. For example, under the application of heat, the adhesive from which the protrusions <NUM> are formed can transition from a substantially non-liquid state (in which it is in the non-flowable state) to at least partially liquid state (in which the adhesive is in the flowable state). In the at least partially liquid state, the protrusions <NUM> can become less viscous such that their material can flow and interconnect or adhere with the surface of the cartridge <NUM>. The cartridge <NUM> can have attachment features (e.g., similar to the attachment features <NUM> in <FIG>) that can have the protrusions <NUM> in the flowable state disposed thereon such that the protrusions <NUM> on the polymer layer <NUM> adhere to the surface of the cartridge <NUM>. Because the polymer layer <NUM> is coupled to the adjunct material <NUM>, adhering the polymer layer's protrusions <NUM> to the cartridge <NUM> causes the adjunct material <NUM> to be releasably retained on the jaw <NUM>. When the material from which the protrusions <NUM> are formed is cooled and thus transitions to the flowable state, the protrusions <NUM> remain attached to the cartridge <NUM>.

In some embodiments, the adjunct loading member <NUM> can be activated (e.g., using a button, switch, or other suitable trigger on the member <NUM> or a remote trigger), to apply heat to the polymer layer <NUM> before (or as) the load is applied to the adjunct loading member <NUM>. For example, the heating component <NUM> can be activated before the adjunct loading member <NUM> is positioned between the jaws of the end effector. The adjunct loading member <NUM> can be configured to deliver to the polymer layer <NUM> heat of a desired temperature (e.g., in a range of from about <NUM> to about <NUM>) for an appropriate duration of time (e.g., from about <NUM> seconds to about <NUM> seconds) such that the application of heat causes the protrusions <NUM> of the polymer layer <NUM> to transition from the non-flowable state to the flowable, deformable state. In some embodiments, an indicator configured to indicate that the adhesive has been sufficiently heated to the deformable state can be activated. This can be, for example, a light indicator, an audio indicator, etc..

Once the protrusions <NUM> are in the flowable state, the adjunct loading member <NUM> can be disposed between the approximated jaws that cause the protrusions <NUM>, and thus the adjunct <NUM> coupled thereto, to attach to the jaw <NUM>. Furthermore, in some embodiments, heat can be applied once the adjunct loading member <NUM> is disposed between the jaws but prior to the jaws applying the load to the adjunct loading member <NUM>. As another variation, the adjunct loading member <NUM> can be activated to apply heat to at least a portion of the polymer layer <NUM> and adjunct <NUM> at least partially simultaneously with the load being applied to the adjunct loading member <NUM>.

Regardless of the specific timing of the application of load and heat to the adjunct <NUM> and polymer layer <NUM>, the adhesive of the protrusions <NUM> is caused to transition to the flowable state in which the protrusions <NUM> attach to the jaw <NUM> thus causing, after the heat is no longer applied, the polymer layer <NUM> to be attached to the jaw. The application of at least one of the load and heat can also cause the adjunct <NUM> to couple to the polymer layer <NUM>.

The heating component <NUM> can have various configurations. For example, as shown in <FIG>, the heating component <NUM> includes a resistive heating element <NUM> in the form of a wire, which is connected to a power source <NUM>. In the illustrated example, as shown, the heating element <NUM> includes higher resistance portions <NUM> along its length. The locations of the higher resistance portions <NUM> can correspond to regions on the polymer layer to which heat is desired to be applied, e.g. regions having the protrusions <NUM> (<FIG>). Thus, power can be applied to the heating element <NUM> to cause localized heating near the higher resistance portions <NUM>. In this way, the heat is applied selectively to the polymer layer and to the adjunct material coupled thereto.

In some embodiments the heating element <NUM> can include a switch <NUM> configured to close the circuit and to allow current to flow through the heating element. The switch <NUM> can be operated using a suitable trigger associated with the adjunct loading member <NUM> (e.g., a button or other switch on the loader 200activated by closure of the end effector or by the person loading the device or a remote control), though the heating element <NUM> can be activated in other suitable ways. The heat generated by the higher resistance portions <NUM> causes the adhesive portions of the polymer layer, such as the protrusions, to transition to the flowable state and thus couple the polymer layer and the adjunct coupled thereto to the jaw when the polymer layer and adjunct are transferred to the jaw.

The heating component <NUM> can be of any suitable type. For example, the heating component <NUM> can be made of a rigid material, e.g., ceramic, that is coated with an elastic or compliant material. In some embodiments, the heating component <NUM> can be in the form of a resistive wire embedded into silicone, e.g., such that the silicone is cured around the resistive wire. The resistive wire is configured to effect the heating, whereas the silicone allows for some degree of compliance when clamping a stapler onto the loader. The heating component <NUM> can be coupled to the housings <NUM>, <NUM> in any suitable manner, e.g., via brackets.

As mentioned above, the adjunct loading member <NUM> is generally be configured such that the adjunct <NUM> is releasably retained in association therewith adjunct loading member <NUM> using a supporting member <NUM>. The supporting member <NUM> can be in the form of a surface and/or it can include retaining features that can releasably couple the adjunct <NUM> and the polymer layer <NUM> to the adjunct loading member <NUM>. The adjunct <NUM> can be disposed on the heating component <NUM>, as shown schematically by way of example only in <FIG>. In this way, once the heating component <NUM> is activated, heat is applied to the adjunct <NUM> and the polymer layer <NUM> that faces the jaw <NUM>.

In some embodiments, an adjunct loading member, which can be similar to the adjunct loading member <NUM> can be configured to releasably retain first and second adjuncts, each configured to be transferred to a respective one of first and second jaws of an end effector. The adjuncts can be secured to both jaws of the end effector simultaneously. A heating component can be configured to apply heat to polymer layer's protrusions or other adhesive depots associated with the adjuncts to retain the adjuncts on the respective jaws. Furthermore, in some embodiments, the heating component can be in the form of two heating components disposed in the removable loader such that each of the heating components is configured to apply heat to a different adjunct that can be associated therewith (e.g., via the loader or manually).

After the adjunct <NUM> is coupled to the jaw <NUM> and the heat is no longer applied thereto, the adhesive from which the protrusions <NUM> are formed can at least partially return to the original state, although not to the original shape. This can occur because the heat source is removed (i.e. the adjunct loading member <NUM> is removed, or the power to the heaters is switched off after a set time) and the adhesive is exposed to a room temperature. This can be done while the polymer layer <NUM> remains at least partially associated with the adjunct loading member <NUM>. Also, the adjunct loading member <NUM> can be part of a loading system including other components, and such loading system can be configured to cool the adhesive coupling the polymer layer <NUM> to the jaw. For example, a cool air can be applied to the polymer layer <NUM> coupled to the adjunct <NUM>. In some embodiments, the cooling can be done using a separate component.

In some embodiments, a trigger associated with the loader (e.g., a switch) is configured to be activated to turn on the heating components once the end effector is clamped onto the loader. This causes the resistors to be heated which thus cause the polymer layer to be heated. The compression or load from the end effector causes the adhesive to flow and conform to the features on the jaw. The power to the resistors can automatically cease after a preset time (either a timer in the circuit, or the circuit can self-destruct with time/heat, or the battery can expire, etc.). After the heat is no longer applied, the polymer adhesive will cool, e.g., due to the thermal mass of the jaws. The loader, or other suitable component, can be configured to, after a time sufficient for the adhesive to cool and thus transition to an adhered state has passed, provide an indication indicating that the process of adhering the adhesive (and thus coupling the adjunct to the jaw) has been completed. The indication can be provided in any suitable way - for example, it can be a visual (e.g., light) indicator, audio indicator, any combination of a visual/audio indicator, etc..

Regardless of the manner in which the adhesive coupling the polymer layer <NUM> to the jaw <NUM> is cooled, the adhesive at least partially hardens or solidifies. The adjunct <NUM> is coupled to the jaw <NUM> via the polymer layer <NUM> with the protrusions <NUM> in a releasable manner and can thus be separated from the jaw <NUM>. For example, when staples are fired from the jaw <NUM>, the bond between the adhesive and the jaw <NUM> can break or crack.

The polymer layer <NUM> and the protrusions <NUM> formed thereon can be made from any suitable material or a combination of materials. Also, they can be bioabsorbable and/or biodegradable. The protrusions <NUM> can be formed from a material having a lower melting point than a melting point of a material from which the polymer layer <NUM> is made. For example, if the material from which the protrusions <NUM> are made is PDO, its melting point can be less than about <NUM>. However, materials with a melting point that is less than about <NUM> can be used additionally or alternatively. When heat is applied to the polymer layer <NUM> (e.g., selectively, such that portion(s) of the protrusions are exposed to heat), the adhesive of the protrusions <NUM> can be transitioned to a flowable state, whereas the state of an adhesive from which the polymer layer <NUM> is made does not change.

In some embodiments not defined by the appended claims, an adhesive depot having an adhesive configured to transition from a non-flowable state to a flowable state upon the application of heat is in the form of a plurality of reservoirs. The plurality of reservoirs can be formed in a supporting layer of an adjunct loading member and each can releasably hold the adhesive.

<FIG> illustrate an embodiment of an adjunct loading member <NUM> releasably holding first and second adjunct materials <NUM>, <NUM> on first and second supporting members <NUM>, <NUM>, respectively. The adjunct loading member <NUM> is used to transfer the first and second adjunct materials <NUM>, <NUM> to first and second jaws <NUM>, <NUM> of an end effector <NUM>, as discussed below. In this example, the first jaw <NUM> has a cartridge (which can be removably and replaceably seated in the jaw or which can be part of a reloadable unit including the first jaw <NUM> or both the first and second jaws <NUM>, <NUM>), and the second jaw <NUM> has an anvil.

In the illustrated embodiment, the adjunct loading member <NUM> is in the form of a generally rectangular member having first and second generally rectangular housings <NUM>, <NUM> coupled to one another. As shown, the adjunct loading member <NUM> includes an adjunct holding member <NUM> extending between the housings <NUM>, <NUM> and including various components. In particular, the adjunct holding member <NUM> includes body members 416a, 416b shown in the left and right sides of the adjunct loading member <NUM>, respectively, brackets 410a, 412a at one side of the adjunct loading member <NUM> (left in <FIG>), brackets 410b, 412b at another side of the adjunct loading member <NUM> (right in <FIG>), and the first and second supporting members <NUM>, <NUM> extending between the body members 416a, 416b.

The supporting members <NUM>, <NUM> are disposed in the adjunct loading member <NUM> such that their mid-portions having the first and second adjunct materials <NUM>, <NUM> releasably retained thereon are not encompassed by the housings <NUM>, <NUM>. The brackets 410a, 410b extend over the body members 416a, 416b at one side thereof (bottom in <FIG>) and retain the first adjunct <NUM> over the supporting member <NUM>. In a similar manner, the brackets 412a, 412b extend over the body members 416a, 416b at another, opposed side thereof (top in <FIG>) and retain the second adjunct <NUM> over the supporting member <NUM>.

As shown, each of the brackets has a straight portion (e.g., a portion <NUM> of the bracket 410a) extending along and over one of the body members 416a, 416b, and a trapezoid-shaped deformable portion (e.g., a portion <NUM> of the bracket 410a) extending from the straight portion towards a center of the adjunct loading member <NUM>. One end of each of the trapezoid-shaped deformable portion of the brackets 410a, 410b, and 412a, 412a is disposed over the first and second adjunct materials <NUM>, <NUM>, respectively. It should be appreciated that the brackets are shown to have the trapezoid-shaped deformable portion by way of example only, as the brackets can have any other configuration.

In the illustrated embodiments, the adhesive depots are in the form of reservoirs formed in the supporting members. Thus, as shown in <FIG>, the supporting member <NUM> has reservoirs 424a, 424b, and the supporting member <NUM> has reservoirs 426a, 426b. Each of the reservoirs 424a, 424b, 426a, 426b releasably holds an adhesive and includes an opening through which the adhesive can be released from that reservoir. For example, in <FIG>, the reservoir 426a is shown to have an opening 430a, and other reservoirs have similar openings. As also shown, each of the adjunct materials <NUM>, <NUM> includes a plurality of openings each having a reservoir with adhesive associated therewith. In particular, the adjunct material <NUM> has openings 310a, 310b disposed adjacent to the openings in the reservoirs 424a, 424b. Similarly, the adjunct material <NUM> has openings 312a, 312b disposed adjacent to the openings in the reservoirs 426a, 426b. It should be appreciated, however, that in some embodiments, the reservoirs can be configured differently - e.g., they may not have openings, but can have a breakable, meltable, or otherwise removable enclosure that allows to retain the adhesive in the reservoirs and that can be removed when it is desired to release the adhesive. Additionally or alternatively, openings configured to allow an adhesive to flow from the reservoir can be formed in the supporting member.

The openings, such as the openings 310a, 310b in the adjunct material <NUM> and the openings 312a, 312b in the adjunct material <NUM>, are formed at locations in the adjuncts at which it is desired to form attachment portions or points (made of an adhesive) that couple the adjuncts to the jaw. The opening locations in each of the adjuncts can be selected so as to facilitate attachment of the adjunct to the jaw and to also facilitate release of the adjunct from the jaw. It should be appreciated that the adjuncts <NUM>, <NUM>, which are shown in <FIG> in cross-section, can include more than two openings. Multiple openings can be formed so as to attach the adjunct to the jaw using an adhesive at more than two locations. For example, four, six, eight, or more openings can be formed in each of the adjuncts. Also, although, as in the example in <FIG>, the openings can be formed in pairs (e.g., they can be disposed symmetrically along a centerline of the adjunct), an odd number (e.g., three, five, etc.) of openings can be formed, which corresponds to an odd number of attachment points to be formed when the adjunct is coupled to the jaw.

The adjunct loading member <NUM> has first and second heating components <NUM>, <NUM> extending through the supporting members <NUM>, <NUM> that are configured to apply heat to the adhesive held in the reservoirs 424a, 424b and 426a, 426b, respectively, to cause the adhesive to transition from a non- flowable state to a flowable state. In some implementations, a single heating component can be used. Also, the first and second heating components <NUM>, <NUM> can be parts of the same heating component. The openings 310a, 310b, 312a, 312b are configured to receive the adhesive transitioning to the flowable state when the adhesive material is released from a respective one of the reservoirs and through the opening to a jaw-facing surface of the respective adjunct material to thereby retain that adjunct material on the jaw.

In use, the adjunct loading member <NUM> having the adjunct materials <NUM>, <NUM> releasably retained thereon is disposed between the first and second jaws <NUM>, <NUM> of the end effector <NUM>, as shown in <FIG> that illustrates the adjunct loading member <NUM> before a load is applied thereto. The load is then applied to the adjunct loading member <NUM> by the first and second jaws <NUM>, <NUM> that clamp the adjunct loading member <NUM> therebetween, as shown in <FIG>. Under the application of load exerted by the jaws, the adjunct loading member <NUM> is at least partially deformed, which causes the adjunct materials <NUM>, <NUM> to be transferred to the jaws <NUM>, <NUM>, respectively. For example, the brackets 410a, 410b, and the brackets 412a, 412a can be at least partially deformed. Also, the supporting members <NUM>, <NUM>, which can be formed from a silicone or other deformable and resilient material(s), are deformed under the load, as shown in <FIG>. When load is applied to the adjunct loading member <NUM>, the supporting members <NUM>, <NUM> apply pressure to the adjunct materials <NUM>, <NUM>, which can be done in the manner that facilitates uniform application of the load to the adjunct materials. This helps apply the adjunct to the jaws in a uniform manner.

In the illustrated example, the adjunct loading member <NUM> is configured so that the adjunct materials <NUM>, <NUM> are transferred substantially simultaneously to the jaws <NUM>, <NUM>. It should be appreciated, however, that in some embodiments the adjunct loading member can be configured to transfer one adjunct to an end effector's jaw.

Before or at the time when the load is applied to the adjunct loading member <NUM>, the heating components <NUM>, <NUM> are activated to cause heat to be applied to the reservoirs 424a, 424b and 426a, 426b, respectively, to cause the adhesive in the reservoirs to transition from the non-flowable state to the flowable state. The adhesive can be stored in the reservoirs 424a, 424b, 426a, 426b in a substantially non-liquid state, and, under the application of heat, the adhesive can become at least partially liquid such that it can be used to couple the adjunct materials to the jaws. As shown in <FIG>, when the load is applied, the adhesive is released from the reservoirs, through the openings in the adjuncts <NUM>, <NUM>, and onto the surface of the jaws <NUM>, <NUM>. In this way, the portions of adhesive427a, 427b and 429a, 429b released from the reservoirs 424a, 424b and 426a, 426b, respectively, are used to retain the adjunct materials on the opposed jaws of the end effector <NUM>.

The reservoirs 424a, 424b, 426a, 426b can have any suitable configurations and they can be configured to release the adhesive stored therein in various ways. In the illustrated example, they are at least partially enclosed structures that store the adhesive. For example, they can be formed from a rigid plastic having a liquid adhesive (e.g., a pressure-sensitive adhesive) stored therein. As mentioned above, the reservoirs can have openings formed on the side thereof adjacent to the adjunct.

Furthermore, in some embodiments, the adjunct loading member <NUM> can include a closure component that can be disposed so as to temporarily enclose one side of the reservoirs and thereby retain the adhesive therein. With reference to <FIG>, such a closure component can be disposed between each of the supporting layers and a respective adjunct material. The closure (or a cap) can be a removable component that is removed to allow the adhesive to flow from the reservoirs. As another variation, the closure component can be in a form of component that can be disposed in at least two different ways with respect to the reservoirs. In particular, the closure component can have openings that can align with the openings in the reservoirs. However, before the adhesive is released from the reservoirs, the closure component can be disposed such that the openings therein are not aligned with the openings in the reservoirs and the closure is thus blocking the openings in the reservoirs and prevents release of the adhesive therefrom. The closure component can be, for example, slidable such that it can be moved to configuration in which its openings are aligned with the openings in the reservoirs. In some embodiments, the closure component can be in the form of a membrane or other thin member configured to rupture when pressure applied thereto exceeds a threshold.

The adjunct loading member <NUM> is configured such that it can be separated from the end effector <NUM> after the adjuncts <NUM>, <NUM> are transferred to the jaws <NUM>, <NUM> and are retained on the jaws using the adhesive. The adhesive can solidify and thus securely retain each adjunct on the jaw. In some embodiments, as discussed above, the adhesive can be allowed to solidify at a room temperature. Additionally or alternatively, it can be actively cooled using, e.g., a forced cool air.

The adhesive releasably retained in the reservoirs can be any suitable material. For example, it can be a flowable material such as polydioxanone (PDO), a high molecular weight poly(ethylene glycol) (PEG), or any other material. As mentioned above, the adhesive can be a pressure-sensitive adhesive.

Although in the illustrated embodiments heat is applied to an adhesive using an adjunct loading member, it should be appreciated that the heat can be applied in other manners. For example, in some implementations, an end effector can be configured to apply heat to the adhesive which can be releasably held in any type of an adhesive depot (e.g., a polymer layer having adhesive features, reservoirs in an adjunct loading member, etc.). The end effector can include a wire or other component that can be heated and can thus apply heat to the adhesive which thereby softens and can retain an adjunct on a jaw. In some embodiments, a separate heating component can be applied, which is not part of an end effector.

At least one adjunct can be applied to one or both jaws of the end effector during assembly of the end effector. For example, a jaw having a cartridge or both of the end effector's jaws can be pre-loaded with an adjunct during the assembly. In some cases, the jaw with the cartridge can be pre-loaded with an adjunct during the assembly, whereas an adjunct can be applied to the jaw having an anvil (e.g., using any of the adjunct loading members described herein) by a surgeon before or during a surgical procedure. Alternatively, as in the embodiments illustrated in <FIG>, adjuncts can be applied to both jaws of the end effector by a surgeon (this however can be done during assembly as well).

A configuration of an adjunct loading member can vary in different ways. <FIG> illustrates an example of an adjunct loading member <NUM> which can be similar to adjunct loading member <NUM> in <FIG>. Thus, as shown in <FIG>, the adjunct loading member <NUM> includes housings <NUM>, <NUM> coupled to one another. The adjunct loading member <NUM> also includes supporting members <NUM>, <NUM> disposed in the loading member <NUM> such that the housing <NUM>, <NUM> enclose the supporting members <NUM>, <NUM> along their perimeters. One side of the supporting members <NUM>, <NUM> is not enclosed, as shown.

The supporting members <NUM>, <NUM> have reservoirs releasably holding an adhesive, with one of the reservoirs, a reservoir 524a, shown formed in the supporting layer <NUM>. A top of another reservoir 524b is also shown formed in the supporting member <NUM>. One or both of the reservoirs and supporting members in which the reservoirs are formed can have openings that allow the adhesive stored in the reservoirs to be released therefrom. Thus, the reservoir 524b is shown to have an opening <NUM> above it, which can be formed in either the reservoir 524b itself or in the supporting member <NUM>. Also, as discussed above, a closure component can be used (not shown), and an opening can be formed in this component as well.

<FIG> shows that the adjunct loading member <NUM> releasably retains therein an adjunct material <NUM>, which is shown partially for illustration purposes. The adjunct material <NUM> includes openings <NUM> that are configured to receive the adhesive transitioning to the flowable state when the adhesive is released from a respective one of the reservoirs and through the opening to a jaw-facing surface of the respective adjunct material to thereby retain that adjunct material on the jaw. The adjunct material <NUM> is releasably retained on the supporting member <NUM>. It should be appreciated that, although it is obscured in <FIG>, the loading member <NUM> can include a second adjunct material releasably retained on the supporting member <NUM>.

The adjunct material <NUM> is releasably retained in the adjunct loading member <NUM> using retainer elements <NUM>, which can have any suitable configurations. Although the retainer elements <NUM> on one side of the adjunct material <NUM> are shown, it should be appreciated that they can also be formed on the opposed side of the adjunct material <NUM>, in which case they are obscured in <FIG>. Also, the retainer elements <NUM> can be configured such that they can be movable - e.g., when load is applied to the adjunct loading member <NUM>, the retainer elements can be caused to move towards the edges of the housings <NUM>, <NUM>, such that the retainer elements release the adjunct material <NUM>.

As shown in <FIG>, a heating component <NUM> coupled to a power source 516is disposed between the supporting members <NUM>, <NUM>. The heating component <NUM>, e.g., its higher resistance portions <NUM> are used to apply heat to respective reservoirs to cause the adhesive stored in the reservoirs to transition from a non-flowable state to a flowable state.

Similar to the adjunct loading member <NUM> in <FIG>, the adjunct loading member <NUM> is configured to have load applied thereto to cause it to release one or more adjunct materials therefrom which are transferred to jaw(s) of an end effector and are coupled to the jaw(s) using the adhesive.

In accordance with the claimed invention, an adhesive depot includes an adhesive that is substantially liquid in a non-cured state and that is configured to be transitioned to an adhering, cured state in which it is at least partially non-liquid. This involves curing the adhesive, which can be done using application of ultra violet (UV) light or infrared radiation. Additionally, load (or pressure) applied to the adhesive can facilitate curing the adhesive in some instances. In the cured, at least partially non-liquid state, the adhesive is used to couple an adjunct to a jaw of an end effector.

<FIG> illustrate an example of a portion of an adjunct loading member <NUM> including a supporting member <NUM> releasably retaining an adjunct material <NUM>. The supporting member <NUM>, which can be at least partially made from a silicone or other compressible material, includes one or more reservoirs holding an adhesive, one of which is shown as a reservoir <NUM> storing an adhesive <NUM>. As shown in <FIG>, the reservoir <NUM> is disposed adjacent to an opening <NUM> in the adjunct material <NUM>. The reservoir <NUM> can be an enclosed structure (e.g., formed from a suitable plastic) releasably holding the liquid adhesive <NUM>. The adhesive <NUM> can be any suitable UV-curable adhesive, such as, for example, polyurethane, cyanoacrylate, or any other adhesive(s).

The adjunct material <NUM> is configured to be transferred to a jaw <NUM> of an end effector which is, in this example, a jaw having an anvil. The anvil <NUM> can have a tissue-facing surface <NUM> having staple-forming cavities or pockets <NUM>. Also, as shown in <FIG>, the tissue-facing surface <NUM> has attachment portions, one of which is shown as an attachment portion <NUM> that is configured to receive the adhesive released from the reservoir <NUM>. The attachment portions can be formed between the staple-forming pockets <NUM>, though they can be formed in other areas of the tissue-facing surface <NUM>. In some embodiments, as shown in this example, the attachment portion <NUM> can include an attachment feature <NUM> made from an elastomeric material (e.g., a pad) that is coupled to the tissue-facing surface <NUM>. This feature can be patterned (e.g., knurled or otherwise roughened), which facilitates adherence of the adhesive to this portion. Also, the elastomeric material allows the attachment feature <NUM> to be deformed when the bond between the attachment portion <NUM> on the surface <NUM> and the adhesive coupled thereto (which retains an adjunct over the surface <NUM>) is broken, as discussed in more detail in the example shown in <FIG> below.

As shown, the adjunct loading member <NUM> also includes UV light applicators <NUM> configured to apply UV light to the adhesive as it is released from the adhesive reservoirs. The UV light applicators <NUM> are coupled to a cable <NUM> (e.g., a fiber optic cable) that couples the applicators to a UV light source. Also, in some embodiments, the UV light applicators <NUM> can be associated with UV-emitting light emitting diodes (LEDs).

<FIG> illustrates the adjunct loading member <NUM> before load is applied thereto. When the load so applied to the adjunct loading member <NUM> (e.g., using the jaws of the end effector, manually, etc.), the reservoir <NUM> is deformed, broken, or its configuration is otherwise changed such that the adhesive <NUM> is transferred from the reservoir <NUM>, through the opening <NUM> in the adjunct <NUM>, and onto the surface of the jaw <NUM>, as shown in <FIG>. The adhesive <NUM> is transferred to the tissue-facing surface <NUM> of the jaw <NUM> so as to be disposed on the surface of the attachment portion <NUM>. As the adhesive <NUM> is being released, the UV light applicators <NUM> are activated to apply UV light to the adhesive <NUM> to cause it to cure, as illustrated in <FIG>. In this way, the adhesive <NUM> is deposited on the surface of the jaw in the adhering, non-cured state (or only partially cured) in which it is then cured and thus attaches the adjunct <NUM> to the jaw <NUM>. The adjunct loading member <NUM> can then be separated from the end effector.

It should be appreciated that the portion of the adjunct loading member <NUM> is shown in <FIG> by way of example only. Also, the adjunct loading member <NUM> can include multiple reservoirs with the adhesive, more than one openings can be formed in the adjunct, as well as other variations are possible.

<FIG> illustrate another example of an adjunct loading member <NUM> configured to releasably hold first and second adjunct materials <NUM>, <NUM> and to apply these adjunct materials to first and second jaws <NUM>, <NUM> of an end effector <NUM>. Similar to adjunct loading member <NUM> in <FIG>, a substantially liquid adhesive released from the adjunct loading member <NUM> is configured to be cured using UV light, heat, or in other manner. As shown in <FIG>, the adjunct loading member <NUM> is similar to adjunct loading member <NUM> shown in <FIG>, and therefore a detailed description is not repeated. However, as mentioned above, the adjunct loading member <NUM>, releasably stores in reservoirs formed in first and second supporting members <NUM>, <NUM> an adhesive that is cured upon it is release from the reservoirs such that it is used to retain the adjuncts on the jaw in its cured state.

Describing by way of example one of the reservoirs included in the adjunct loading member <NUM>, a reservoir <NUM> in the supporting member <NUM> is configured to provide an adhesive <NUM> stored therein when load is applied to the adjunct loading member <NUM> as shown in <FIG>. A UV light applicator <NUM> or other (e.g., infrared radiation) applicator is configured to apply UV or other radiation to the adhesive <NUM> as it is released from the reservoir <NUM>. In this way, the adhesive is used to retain the adjunct on the jaw as the adjunct is transferred to the jaw.

Any suitable component can be used to apply radiation to an adhesive to cause it to transition from a state in which it is not cured to an adhering state in which it is cured. <FIG> illustrates one embodiment of an adjunct loading member <NUM> that can be used to apply radiation to an adjunct material <NUM>. The adjunct loading member <NUM> can be generally similar to adjunct loading member <NUM> in <FIG> and is therefore not described in detail. In this example, an adhesive stored in a reservoir, such as a reservoir <NUM> formed in a supporting member <NUM> is configured to be cured when it is released from the reservoir <NUM> when load is applied to the adjunct loading member <NUM> and the adhesive is cured using radiation emitted from a UV applicator <NUM>. Other types of radiation, however, can be used additionally or alternatively. Similar to the manner described above in connection with the adjunct loading member <NUM> (<FIG>), the adhesive can be released from the reservoir and caused to flow through an adjacent opening <NUM> formed in the adjunct <NUM>. Although not shown in <FIG>, the adjunct loading member <NUM> can also have a second adjunct material releasably retained therein and configured to be transferred therefrom and attached to a second jaw of an end effector similar to the adjunct <NUM>.

Regardless of the specific way in which an adjunct material is coupled to a jaw of an end effector, it is required to properly separate the adjunct material from the jaw when the adjunct is applied to tissue. It is desired to release the adjunct from the jaw in an efficient manner. This can be achieved, for example, by fracturing the adhesive that attaches the adjunct to the end effector. <FIG> illustrates an example of a portion of an adjunct material <NUM> attached to the jaw <NUM> of an end effector <NUM> by an adhesive <NUM>, which can be cured in a desirable manner (e.g., using a UV light applied via a loader, or in other manners). The adhesive <NUM> releasably attaches the adjunct material <NUM> to the jaw <NUM> by being at least partially disposed in an opening <NUM> formed in the adjunct material <NUM>.

Similar to adhesive <NUM> in <FIG>, the adhesive <NUM> in <FIG> is coupled to the jaw <NUM> at an attachment region or portion <NUM> on the surface of the jaw <NUM>. Similar to attachment portion <NUM> in <FIG>, the attachment portion <NUM> can have a deformable attachment feature <NUM> that is patterned to facilitate coupling the adhesive thereto. The attachment feature <NUM> can be formed from an elastomeric material such that it can deform when a force is applied thereto.

The end effector <NUM> can be configured to cause the adjunct material <NUM> to separate from the jaw <NUM> when staples are fired from a jaw <NUM> having a cartridge that is shown schematically in <FIG>. For example, as shown, the jaws <NUM>, <NUM> are approximated to clamp tissue <NUM> therebetween and a stapler driver <NUM> movably seated in the jaw <NUM> causes staples <NUM> to fire from staple holding cavities in the jaw <NUM> so as to penetrate the tissue <NUM> and the adjunct <NUM>. The staples <NUM> are urged into corresponding staple-forming cavities or pockets <NUM> formed on the surface of the jaw <NUM> such that the staples <NUM> are closed and attach the adjunct <NUM> to the tissue <NUM>.

In the example illustrated, the stapler driver <NUM> includes protruding members <NUM> configured to push the cured adhesive <NUM> towards the attachment portion <NUM> and into the attachment feature <NUM> (which can deform to some degree) when the staples <NUM> are fired. This can cause the adhesive <NUM> to break, fracture, deform, or otherwise change its configuration. In some instances the cured adhesive <NUM> can be brittle and applying load thereto causes it to fracture, crack, or break.

It should be appreciated that only portions of the adjunct <NUM> and the end effector <NUM> are shown in <FIG> and that multiple attachment portions similar to the attachment portion <NUM> (or having other configurations) can be formed on the jaw <NUM> and are used to couple the adjunct <NUM> to the jaw <NUM> using the adhesive <NUM>. Accordingly, multiple corresponding protruding members on the stapler driver <NUM> can cause the adhesive at the corresponding attachment portions to break. In this way, the adjunct <NUM> can be decoupled from the attachment region <NUM> and thereby be released from the jaw <NUM>. Thus, <FIG> illustrates the tissue <NUM> and the adjunct <NUM> stapled together by the staples <NUM> and decoupled from the jaw <NUM> and thus from the end effector <NUM>. A portion of the adhesive <NUM>, which can be a biodegradable and/or bioabsorbable material, can remain with the adjunct <NUM>, as shown.

It should be appreciated that the described adjunct materials and systems and methods used to apply the adjunct materials to at least one jaw of an end effector can have various configurations. For example, although, as discussed above, the adjunct materials can have openings formed therein that allow an adhesive from an adhesive despot to be applied to the surface of the adjunct, in some embodiments, the openings may not be formed. In such embodiments, the adhesive can be flowed from an adhesive depot (e.g., one or more reservoirs) through pores, spaces between fabric strands, or other structures in the adjunct material. For example, the adjunct material can be porous and the adhesive are flow therethrough to a surface of the jaw. The pores can be formed at any suitable ways, and, in some instances, they can be larger at predetermined locations through which the adhesive can flow easier.

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:
A loading system comprising:
an adjunct loading member;
at least one adjunct material (<NUM>, <NUM>, <NUM>, <NUM>) configured to be transferred from the adjunct loading member (<NUM>, <NUM>, <NUM>) to a tissue-facing surface of a jaw of first and second jaws (<NUM>, <NUM>, <NUM>) of an end effector (<NUM>), the first and second jaws being configured to clamp tissue therebetween, the adjunct material comprising an opening (<NUM>),
the adjunct loading member comprising a supporting member (<NUM>, <NUM>) configured to releasably retain the adjunct material, the supporting member comprising a reservoir (<NUM>, <NUM>, <NUM>) releasably holding an adhesive (<NUM>, <NUM>, <NUM>), the reservoir disposed adjacent the opening, the reservoir configured to release the adhesive when a load is applied to the adjunct loading member;
the opening being configured to receive the adhesive when the adhesive is released from the reservoir and to allow the adhesive to transfer through the opening and onto the tissue-facing surface of the jaw,
the adhesive configured to transition from a non-cured state, in which the adhesive is substantially liquid, to a cured state, in which the adhesive is at least partially non-liquid, upon the application of at least one of ultra violet light and infrared radiation, when the adjunct material is released from the adjunct loading member and transferred to the jaw, to retain the adjunct material on the jaw,
the loading system further comprising a radiation applicator (<NUM>, <NUM>, <NUM>) configured to apply the at least one of ultra violet light and infrared radiation to the adhesive.