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CN106028967A - 外科钉、钉仓和外科端部执行器 - Google Patents

外科钉、钉仓和外科端部执行器 Download PDF

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CN106028967A
CN106028967A CN201480076093.4A CN201480076093A CN106028967A CN 106028967 A CN106028967 A CN 106028967A CN 201480076093 A CN201480076093 A CN 201480076093A CN 106028967 A CN106028967 A CN 106028967A
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staple
staples
leg
base portion
cartridge
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CN106028967B (zh
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F·E·谢尔顿四世
C·O·巴克斯特三世
J·R·摩根
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Ethicon Endo Surgery Inc
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    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A61B17/0644—Surgical staples, i.e. penetrating the tissue penetrating the tissue, deformable to closed position
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
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    • A—HUMAN NECESSITIES
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    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/0682—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A—HUMAN NECESSITIES
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    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/10—Surgical instruments, devices or methods for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
    • A61B17/105—Wound clamp magazines
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
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    • A—HUMAN NECESSITIES
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    • A61B17/0686—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil having a forming anvil staying below the tissue during stapling
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    • A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
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    • A61B2017/00681—Aspects not otherwise provided for
    • A61B2017/00734—Aspects not otherwise provided for battery operated
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    • A61B2017/07214—Stapler heads
    • A61B2017/07228—Arrangement of the staples
    • A—HUMAN NECESSITIES
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    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
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    • A61B2017/07214—Stapler heads
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    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07278—Stapler heads characterised by its sled or its staple holder
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B2017/07214—Stapler heads
    • A61B2017/07285—Stapler heads characterised by its cutter
    • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10—TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10T—TECHNICAL SUBJECTS COVERED BY FORMER US CLASSIFICATION
    • Y10T29/00—Metal working
    • Y10T29/49—Method of mechanical manufacture
    • Y10T29/49995—Shaping one-piece blank by removing material

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  • Surgical Instruments (AREA)
  • Packaging Of Annular Or Rod-Shaped Articles, Wearing Apparel, Cassettes, Or The Like (AREA)
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Abstract

本发明公开了一种外科钉。该钉可限定无缝一体件。在各种实例中，钉可由材料片形成和/或模压而成。钉可包括基部和钉腿。钉驱动表面可在基部中一体形成，并且滑动件可直接接触钉驱动表面以直接驱动该钉。

Description

外科钉、钉仓和外科端部执行器
技术领域
本发明涉及外科器械，并且在各种布置方式中，涉及被设计用来切割和紧固组织的外科切割和紧固器械、用于其的紧固件仓、和被设计用于与其一起使用的外科紧固件。
背景技术
外科缝合器常常用于将钉部署到软组织中，以减少或消除软组织出血，例如尤其在组织被横切时。外科缝合器(例如诸如直线切割器)可包括端部执行器，该端部执行器可相对于细长轴组件运动或关节运动。端部执行器常常被构造成能够将软组织固定在第一钳口构件和第二钳口构件之间，其中第一钳口构件常常包括被构造成能够在其中可移除地储存钉的钉仓，并且第二钳口构件常常包括砧座。此类外科缝合器可包括用于使砧座相对于钉仓枢转的闭合系统。
如上所述，外科缝合器可被构造成能够使端部执行器的砧座相对于钉仓枢转，以便将软组织捕获在它们之间。在各种情况下，砧座可被构造成能够向软组件施加夹持力，以便将软组件紧紧地保持在砧座和钉仓之间。然而，如果外科医生不满意端部执行器的位置，则外科医生通常必须启用外科缝合器上的释放机构来将砧座枢转成打开位置，然后重新定位端部执行器。然后，钉通常通过滑动件从钉仓部署，该滑动件横贯钉仓中的通道，并致使钉抵靠砧座而变形，并且将软组织层固定在一起。滑动件可接合定位在钉和滑动件之间的驱动器，以从钉仓部署钉。常常，如本领域已知的，钉以若干钉线或钉排进行部署，以便将组织层更可靠地固定在一起。钉通常通过端部执行器的砧座而变形成“B-形式”。端部执行器还可包括切割构件，例如诸如刀，该切割构件在钉排之间推进，以在软组织层已被缝合在一起之后切除软组织。
此类外科缝合器和端部执行器的尺寸可被设计成并且被构造成能够通过套管针或其他进入开口而插入体腔中。端部执行器通常联接到尺寸被设计成穿过套管针或开口的细长轴。细长轴组件常常可操作地联接到柄部，该柄部支撑用于控制端部执行器的操作的控制系统和/或触发器。为了有利于端部执行器在体内的适当位置和取向，许多外科器械被构造成能够有利于端部执行器相对于细长轴的一部分进行关节运动。
上述讨论仅是为了举例说明本发明技术领域中相关技术目前的各个方面，而不应当视为对权利要求范围的否定。
附图说明
通过结合附图来参考本发明实施方案的以下说明，本发明的特征结构和优点以及其获取方法将会变得更加显而易见，并将更好地理解发明本身，其中：
图1为根据本公开的各种实施方案的外科器械的透视图；
图2为根据本公开的各种实施方案的图1的外科器械的柄部组件的分解透视图；
图3为根据本公开的各种实施方案的图1的外科器械的端部执行器的分解透视图；
图4为根据本公开的各种实施方案的图3的端部执行器的钉仓的透视图；
图5为根据本公开的各种实施方案的沿着图4所示平面截取的图4的钉仓的剖面透视图；
图6为根据本公开的各种实施方案的示于图4的钉仓中的钉的透视图；
图7为图6的钉的前正视图；
图8为图6的钉的后正视图；
图9为图6的钉的顶部平面图；
图10为图6的钉的底部平面图；
图11为图6的钉的右正视图；
图12为图6的钉的左正视图；
图13为图6的钉的透视图；
图14为根据本公开的各种实施方案的图6的钉和图3的端部执行器的滑动件的正视图，示出了接触钉的初始驱动表面的滑动件的前表面；
图15为图14的钉和滑动件的透视图，示出了滑动件的前表面接触钉的初始驱动表面；
图16为根据本公开的各种实施方案的图14的钉和滑动件的正视图，示出了滑动件的后表面接触钉的辅助驱动表面；
图17为图14的钉和滑动件的透视图，示出了滑动件的后表面接触钉的辅助驱动表面；
图18到图21为根据本公开的各种实施方案的图3的端部执行器的剖面正视图，示出了钉从钉仓的击发前进；
图22为根据本公开的各种实施方案的图3的钉仓和滑动件的剖面正视图，示出了处于未击发位置的钉；
图23为图22的仓和滑动件的剖面透视图，示出了处于图22所示的未击发位置的钉；
图24为根据本公开的各种实施方案的图22的仓和滑动件的剖面正视图，示出了处于部分击发位置的近侧钉对和处于未击发位置的剩余的钉；
图25为图22的仓和滑动件的剖面透视图，示出了处于图24所示的部分击发位置的近侧钉对和处于图24所示的未击发位置的剩余钉；
图26为根据本公开的各种实施方案的图22的仓和滑动件的剖面正视图，示出了处于部分击发位置的多个钉对和处于部分变形构型的近侧钉对；
图27为图22的仓和滑动件的剖面透视图，示出了处于图26的部分击发位置的多个钉对和处于图26所示的部分变形构型的近侧钉对；
图28为根据本公开的各种实施方案的图22的仓和滑动件的剖面正视图，示出了处于另外的击发位置的多个钉对和处于另外的变形构型的近侧钉对；
图29为图22的仓和滑动件的剖面透视图，示出了处于图28所示的部分击发位置的多个钉对和处于图28所示的部分变形构型的近侧钉对；
图30为根据本公开的各种实施方案的图22的仓和滑动件的剖面正视图，示出了处于部分击发位置且处于部分变形构型的多个钉对和处于射出位置且处于完全变形构型的近侧钉对；
图31为图22的仓和滑动件的剖面透视图，示出了图30所示的处于部分击发位置且处于部分变形构型的多个钉对和图30所示的处于射出位置且处于完全变形构型的近侧钉对；
图32A到图32C示出根据本公开的各种实施方案的用于由材料片形成钉的方法；
图33为根据本公开的各种实施方案的由图32A到图32C所示的方法形成的钉的透视图；
图34为图33的钉的平面图；
图35为图33的钉的前正视图；
图36为图33的钉的侧正视图；
图37为根据本公开的各种实施方案的钉的透视图；
图38为图37的钉的平面图；
图39为图37的钉的前正视图；
图40为图37的钉的侧正视图；
图41为根据本公开的各种实施方案的钉的透视图；
图42为图41的钉的平面图；
图43为图41的钉的前正视图；
图44为图41的钉的侧正视图；
图45为根据本公开的各种实施方案的钉仓的透视图；
图46为沿着图45所示平面截取的图45的钉仓的剖面透视图；
图47为图45的钉仓的平面图；
图48为根据本公开的各种实施方案的钉的透视图；
图49为图48的钉的平面图；
图50为图48的钉的前正视图；
图51为图48的钉的侧正视图；
图52为根据本公开的各种实施方案的钉的透视图；
图53为图52的钉的平面图；
图54为图52的钉的前正视图；
图55为图52的钉的侧正视图；
图56为根据本公开的各种实施方案的图4的钉仓的局部剖面正视图，示出了在钉腔中处于部分击发位置的钉；
图57为图56的钉仓的局部平面图，示出了处于图56所示的部分击发位置的钉；
图58为图56的钉仓的局部剖面正视图，示出了处于图56所示的部分击发位置的钉；
图59为根据本公开的各种实施方案的图56的钉仓的局部剖面正视图，示出了处于另一部分击发位置的钉；
图60为图56的钉仓的局部平面图，示出了处于图59所示的部分击发位置的钉；
图61为图56的钉仓的局部剖面正视图，示出了处于图59所示的部分击发位置的钉；
图62为根据本公开的各种实施方案的图56的钉仓的局部剖面正视图，示出了处于射出位置且处于变形构型的钉；
图63为图56的钉仓的局部平面图，示出了图62所示的处于射出位置且处于变形构型的钉；
图64为图56的钉仓的局部剖面正视图，示出了处于图62所示的射出位置和变形构型的钉；
图65为根据本公开的各种实施方案的端部执行器的分解透视图，该端部执行器包括多个紧固件和被构造成能够将紧固件从端部执行器射出的击发致动器；
图66为图65的紧固件击发致动器的第一部分的平面图；
图67为图66的第一部分的正视图；
图68为图65的紧固件击发致动器的第二部分的平面图；
图69为图68的第二部分的正视图；
图70为图65的端部执行器的剖面图，示出了击发致动器处于未击发、未伸出状态；
图71为图65的端部执行器的剖面图，示出了击发致动器处于伸出状态；
图72为图65的端部执行器的剖面图，示出了击发致动器处于伸出、推进状态；
图73为图65的端部执行器的剖面图，示出了端部执行器的砧座处于打开位置且击发致动器处于未击发、未伸出状态；
图74为图65的端部执行器的剖面图，示出了砧座处于闭合位置且击发致动器处于未击发、未伸出状态；
图75为被示出为处于图73所示的构型的图65的端部执行器的剖面透视图；
图76为被示出为处于图74所示的构型的图65的端部执行器的剖面图；
图77为图65的端部执行器的剖面图，示出了处于伸出状态的击发致动器以及另外处于未推进位置的刀构件；
图78为图65的端部执行器的剖面图，示出了处于推进、伸出状态的击发致动器和处于推进位置的刀构件；
图79为被示出为处于图78所示的构型的图65的端部执行器的剖面透视图；
图80为示为处于完全击发状态的图65的端部执行器的局部剖面平面图；
图81为被示出为处于图80所示的构型的图65的端部执行器的剖面正视图；
图82为被示出为处于图80所示的构型的图65的端部执行器的剖面透视图；
图83为图65的端部执行器的剖面正视图，示出了处于回缩位置的刀构件；
图84为被示出为处于图83所示的构型的图65的端部执行器的剖面透视图；
图85为被示出为处于图74所示的未伸出构型的图65的端部执行器的击发构件的透视图；
图86为被示出为处于图77所示的伸出构型的图65的端部执行器的击发构件的透视图；
图87为示为处于就在图80所示的完全击发构型之前的构型的图65的端部执行器的击发构件的透视图；
图88为被示出为处于图80所示的完全击发构型的图65的端部执行器的击发构件的透视图；
图89为包括被构造成能够将紧固件从紧固件仓射出的击发致动器的端部执行器的剖面图，示出了处于未击发位置的击发致动器；
图90为图89的端部执行器的剖面图，示出了处于部分击发位置的击发致动器；
图91为图89的端部执行器的钉仓体的平面图；
图92为与图91的仓体一起使用的击发致动器的透视图，
图93为图91的仓体的透视图；以及
图94为沿着图93中的线94-94截取的图91的仓体的剖面图。
具体实施方式
本申请的申请人还拥有以下专利申请，所述专利申请与本申请同一天提交并且全文各自以引用方式并入本文：
名称为“SURGICAL INSTRUMENTS WITH ARTICULATABLE SHAFT ARRANGEMENTS”的美国专利申请，代理案卷号END7343USNP/130300；
名称为“SURGICAL STAPLES AND STAPLE CARTRIDGES”的美国专利申请，代理案卷号END7341USNP/130301；
名称为“ARTICULATABLE SURGICAL INSTRUMENTS WITH SEPARATE AND DISTINCTCLOSING AND FIRING SYSTEMS”的美国专利申请，代理案卷号END7333USNP/130322；
名称为“SURGICAL CUTTING AND STAPLING INSTRUMENTS WITH INDEPENDENT JAWCONTROL FEATURES”的美国专利申请，代理案卷号END7336USNP/130303；
名称为“SURGICAL STAPLES AND STAPLE CARTRIDGES”的美国专利申请，代理案卷号END7331USNP/130304；
名称为“SURGICAL STAPLES AND METHODS FOR MAKING THE SAME”的美国专利申请，代理案卷号END7335USNP/130305；
名称为“SURGICAL FASTENER”的美国设计专利申请，代理案卷号END7338USDP/130307；
名称为“FASTENER CARTRIDGE COMPRISING AN EXTENDABLE FIRING MEMBER”的美国专利申请，代理案卷号END7344USNP/130308；
名称为“FASTENER CARTRIDGE COMPRISING A FIRING MEMBER CONFIGURED TODIRECTLY ENGAGE AND EJECT FASTENERS FROM THE FASTENER CARTRIDGE”的美国专利申请，代理案卷号END7339USNP/130309；
名称为“FASTENER CARTRIDGE COMPRISING A FIRING MEMBER INCLUDINGFASTENER TRANSFER SURFACES”的美国专利申请，代理案卷号END7340USNP/130310；
名称为“MODULAR SURGICAL INSTRUMENTS”的美国专利申请，代理案卷号END7342USNP/130311；
名称为“SURGICAL CUTTING AND STAPLING INSTRUMENTS WITH ARTICULATABLEEND EFFECTORS”的美国专利申请，代理案卷号END7334USNP/130312；和
名称为“SURGICAL CUTTING AND STAPLING METHODS”的美国专利申请，代理案卷号END7330USNP/130313。
现在将描述某些示例性实施方案，以从整体上理解本文所公开的装置和方法的结构、功能、制造和使用的原理。这些实施方案的一个或多个示例在附图中示出。本领域的普通技术人员将理解，本文具体描述和附图示出的装置和方法为非限制性示例性实施方案并且本发明的各种实施方案的范围仅由权利要求书限定。结合一个示例性实施方案所示或所述的特征结构可与其他实施方案的特征结构进行组合。此类修改和变型旨在包括在本发明的范围内。
本说明书通篇提及的“各种实施方案”、“一些实施方案”、“一个实施方案”或“实施方案”等，意味着结合所述实施方案描述的具体特征结构、结构或特性包括在至少一个实施方案中。因此，本说明书通篇出现的短语“在各种实施方案中”、“在一些实施方案中”、“在一个实施方案中”或“在实施方案中”等并不一定都指相同的实施方案。此外，在一个或多个实施方案中，具体特征结构、结构或特性可以任何合适的方式组合。因此，在无限制的情形下，结合一个实施方案示出或描述的具体特征结构、结构或特性可全部或部分地与一个或多个其他实施方案的特征结构、结构或特性组合。此类修改和变型旨在包括在本发明的范围内。
本文所用术语“近侧”和“远侧”是相对于操纵外科器械的柄部部分的临床医生来讲的。术语“近侧”是指最靠近临床医生的部分，并且术语“远侧”是指远离临床医生定位的部分。还应当理解，为简洁和清楚起见，本文可以结合附图使用空间术语诸如“竖直”、“水平”、“上”和“下”。然而，外科器械在许多取向和位置中使用，并且这些术语并非旨在为限制性和/或绝对的。
提供各种示例性装置和方法以执行腹腔镜式和微创外科手术操作。然而，本领域的普通技术人员将容易理解，本文所公开的各种方法和装置可用于许多外科手术和应用中，包括例如与开放式外科手术相结合。继续参阅本具体实施方式，本领域中的普通技术人员将进一步理解，本文所公开的各种器械可以任何方式插入体内，诸如通过自然腔道、通过形成于组织中的切口或穿刺孔等。器械的工作部分或端部执行器部分可被直接插入患者体内或可通过具有工作通道的进入装置插入，外科器械的端部执行器和细长轴可通过该工作通道推进。
参照图1到图3所示的示例性实施方案，外科器械100可包括柄部组件104、从柄部组件104延伸的轴114、以及从轴114延伸的端部执行器120。主要参照图3，钉仓140可加载到端部执行器120的第一钳口123的细长通道122中。在某些实施方案中，钉仓140可为例如一次性的和/或可替换的。除此之外或另选地，钉仓140可例如整合到端部执行器120中，和/或端部执行器120可为例如一次性的和/或可替换的。在各种实施方案中，外科器械100可为马达驱动的。例如，主要参照图2，马达106可定位在柄部组件104中。外科器械100的柄部组件104还可包括触发器108。例如，触发器108的致动可影响端部执行器120的钳口123,124的闭合、钉160从钉仓140的击发、和/或击发杆156和切割构件158穿过端部执行器120的平移。
主要参照图3，钉160可以能够射出的方式定位在钉仓140中。例如，至少一个滑动件190可平移穿过钉仓140以将钉160从钉仓140射出。例如，具有切割元件或刀158的击发杆156还可平移穿过钉仓140，以切割捕获在端部执行器钳口123,124之间的组织。如图3所示，击发杆156和切割元件158可从第一钳口123中的近侧位置运动到第一钳口123中的远侧位置。在各种实施方案中，例如，定位在钉仓140和砧座124中间的组织可由钉160缝合，然后由切割元件158切割。主要参照图4和图5，钉仓140可包括仓体142和限定在仓体142中的钉腔144。钉(例如诸如钉160)能够可移除地定位在钉腔144中。在某些实施方案中，每个钉腔144能够可移除地储存单个钉160。例如，每个钉腔144可具有近侧端部146和远侧端部148，并且纵向侧壁150可在每个钉腔144的近侧端部146和远侧端部148之间延伸。如本文更详细地描述的，钉腔144的近侧端部146、远侧端部148、和/或纵向侧壁150可在从钉腔144部署期间引导和/或支撑钉160。
现在参照图6到图13，钉160可包括基部162、从基部162延伸的第一钉腿164、和从基部162延伸的第二钉腿166。例如，基部162可具有近侧部分168和远侧部件170，并且基部162的中间部分172可例如定位在近侧部分168和远侧部分170之间。如图6到图13所示，第一钉腿164可从基部162的近侧部分168延伸，并且第二钉腿166可从基部162的远侧部分170延伸。例如，钉腿164,166可包括末端174，该末端可具有尖的或基本上尖的端部。在各种实施方案中，例如，末端174可有利于刺入和/或穿刺组织。在某些实施方案中，钉腿164,166可例如包括拐角边缘176，该拐角边缘可为锋利的或基本上锋利的，并且还可例如有利于刺入和/或穿刺组织。在其他实施方案中，钉腿164,166可包括圆形拐角边缘。
仍参照图6到图13，斜面184,186可定位在钉腿164,166和基部162之间。例如，上部斜面184可在钉腿164，166和基部162之间延伸，并且/或者下部斜面186可在钉腿164,166和基部162之间延伸。当组织由钉160捕获时，组织可被压缩在基部162和变形钉腿164,166之间，并且斜面184,186可接触压缩组织。在各种实施方案中，斜面184,186可例如压缩捕获的组织，并且可例如防止基部162无意地刺入和/或切割捕获组织。
在各种实施方案中，钉160的基部162可相对于钉腿174,176不对称。例如，主要参照图10，第一轴线A可限定在第一钉腿174和第二钉腿176之间，并且基部162可相对于第一轴线A不对称。基部162例如可为非线性的，并且可包括远离轴线A折曲或弯曲的至少一个侧向成型部分178。基部162或基部162的至少一部分可由第二轴线B限定。成型部分178可包括直的和/或弯的区，并且例如可大体上不平行于第一轴线A和第二轴线B。例如，成型部分178可远离第一轴线A折曲或弯曲，包括直的或基本上直的部分，并且朝向第二轴线B(图10)折曲或弯曲。
仍参照图10，钉160的质心(COM)可从第一轴线A偏移。在各种实施方案中，例如，基部162的一部分可沿第二轴线B延伸，该第二轴线B可平行于或基本上平行于第一轴线A。例如，基部162的中间部分172可平行于或基本上平行于第一轴线A。成型部分178可例如定位在近侧部分168和中间部分172之间，并且另一成型部分178可例如定位在远侧部分170和中间部分172之间。例如，成型部分178可使基部162的中间部分172从钉腿164,166侧向偏移并且从第一轴线A侧向偏移。在某些实施方案中，钉腿164,166可例如定位在由第一轴线A限定的第一平面中，并且基部162的中间部分172可定位在由第二轴线B限定的第二平面中。第二平面可例如平行于或基本上平行于第一平面，并且钉160的质心(COM)可定位在第一平面和第二平面之间。在此类实施方案中，钉160可包括可从钉160的COM偏移的腿成形平面，例如由第一轴线A限定的平面。例如，钉160的变形可例如形成修改的“B-形式”，并且钉腿164,166可为非共面的和/或从钉基部162的中间部分172侧向偏移。在各种实例中，例如，修改的“B-形式”钉成形可接合、捕获、压缩、和/或影响更大体积的组织。另外，在某些实例中，例如，修改的“B-形式”钉成形可沿不同方向和/或相异的方向对接合的组织施加力。修改的“B-形式”可限定沿三个不同方向延伸的组织截留区域。例如，组织截留区域的一部分可沿两个方向由腿部164和166限定，并且组织截留区域的另一部分可沿第三方向限定在基部162和腿部164,166之间。
在各种实施方案中，钉基部162的中间部分172可包括纵向引导表面173。例如，如本文更详细地描述，纵向引导表面173可在钉160例如从仓体142(图4和图5)击发和/或射出时抵靠钉腔144(图4和图5)中的引导表面150滑动和/或运动。在此类实施方案中，纵向引导表面173可在部署期间平衡和/或稳定钉160。此外，钉基部162的中间部分172可包括组织接触表面175(图9)，该组织接触表面可例如为平坦的或基本上平坦的。在各种实例中，基部162的组织接触表面175可形成平坦表面以接触捕获的组织，该平坦表面可提供用于对所捕获和/或所压缩组织施加和/或分布压力的宽阔和/或平滑表面。在此类实施方案中，例如，钉160内的组织撕裂和/或创伤可被减少和/或降到最低。
在各种实施方案中，钉160的基部162可包括更多驱动表面中的一个驱动表面。例如，基部162可包括初始驱动表面180和辅助驱动表面182。仍参照图6到图13，例如，基部162的近侧部分168可包括初始驱动表面180，并且/或者基部172的中间部分172可包括辅助驱动表面182。例如，近侧部分168可包括具有第一驱动表面180的凸块。例如，第一驱动表面180的凸块可包括圆形和/或斜坡表面。辅助驱动表面182可包括位于基部162的中间部分172上的斜坡。例如，辅助驱动表面182可定位在初始驱动表面180远侧和/或例如定位在基部162的近侧部分168和远侧部分170之间。例如，辅助驱动表面182可包括倾斜表面或平面，并且可沿远侧部分170的方向向下倾斜(参见图7和图8)。
主要参照图7和图8，钉中线M可被限定在第一钉腿164和第二钉腿166中间。例如，钉中线M可平分钉160，并且可穿过钉160的质心(COM)。在各种实施方案中，辅助驱动表面182可跨中线M延伸。例如，辅助驱动表面182可沿基部162的中间部分172延伸，并且可从中线M的近侧跨越至中线M的远侧。在此类实施方案中，在钉160通过滑动件190的部署期间，如本文更详细地描述，滑动件190的斜坡192可在钉的部署的一部分期间在钉160的中线M处和/或附近驱动钉160。在各种实施方案中，辅助驱动表面182的远侧端部还可包括本文更详细地描述的钉过驱动器188。主要参照图7，钉过驱动器188可包括基部162的中间部分172的最低点，并且在一些实施方案中，例如可与基部162的近侧部分168和/或远侧部分170的最低点竖直地对齐。在其他实施方案中，钉过驱动器188可竖直地定位在基部162的近侧部分168和/或远侧部分170的最低部分下方或上方。
在种实施方案中，钉160的驱动表面180,182可为分开的和相异的。例如，驱动表面180,182可侧向地和/或纵向地偏移，使得驱动表面180,182不连接和/或不相邻。例如，每个驱动表面可为独立的。例如，初始驱动表面180可与第一平面(参见图10中的轴线A)重叠，并且例如，辅助驱动表面182可与第二平面(参见图10中的轴线B)重叠。在某些实施方案中，驱动表面180,182可为平行的。例如，初始驱动表面180可沿第一轴线A(图10)延伸，并且辅助驱动表面180可沿第二轴线B(图10)延伸。在各种实施方案中，例如，具有宽度x的侧向间隙(图10和图11)可被限定在初始驱动表面180和辅助驱动表面182之间。在一些实施方案中，例如，具有宽度y的纵向间隙(图10)可被限定在初始驱动表面180和辅助驱动表面182之间。例如，初始驱动表面180可在辅助驱动表面182的近侧。此外，基部的非驱动部分(例如诸如近侧部分168和中间部分172之间的成型部分178的下部斜面186)可例如将初始驱动表面180和辅助驱动表面182分开。在各种实施方案中，例如，成型部分178可在由轴线A限定的第一平面和由轴线B限定的第二平面之间横贯。
仍参照图6到图13，钉160的驱动表面180,182中的至少一者可与钉160一体形成。例如，驱动表面180,182可被限定在钉160的基部162中。钉160可例如包括单个一体件，该单个一体件可整体地包括驱动表面180,182。例如，驱动表面180,182可包括该单个一体件的边界或周边表面。在各种情况下，钉160可例如为无缝的，并且许多不包括例如任何粘附和/或包覆模制的特征结构。此外，基部162和钉腿164,166可为邻接部分，并且基部162可例如整体地限定驱动表面180,182。在某些实例中，如本文更详细地描述，钉160可例如由单个材料件模压而成或以其他方式形成，并且可例如保持单个材料件。在各种实例中，驱动表面180,182可包括成形件的表面或平面。
现在参照图14到图17，滑动件190可从仓体142(图3)中的腔144驱动钉160。在各种实例中，滑动件190可直接接触钉160和/或可直接驱动钉160。例如，滑动件190可包括可接触钉160的至少一个驱动表面180,182的斜坡或倾斜表面192。当滑动件190相对于钉160平移时，斜坡192可推动驱动表面180,182以提升钉160。在各种实施方案中，斜坡192的倾斜度可沿其长度变化。例如，斜坡192可被设计用来在钉的部署的至少一部分期间更快地和/或更慢地提升钉160。此外，斜坡192的倾斜度可基于钉驱动表面180,182的倾斜度而设计和/或选择。例如，斜坡192可限定大于、小于、和/或等于初始驱动表面180和/或辅助驱动表面182的倾斜的倾斜。例如，斜坡192的倾斜和驱动表面180,182的倾斜之间的关系可影响钉部署的速度。
仍参照图14到图17，滑动件190可包括至少一个侧向部分191a,191b。例如，滑动件190可包括单个侧向部分、一对侧向部分、和/或多于两个侧向部分。在各种实例中，每个侧向部分191a,191b可对应于可移除地定位在仓体142中的钉排160。如图14到图17进一步所示，侧向部分191a,191b可纵向交错。例如，在某些实施方案中，第一侧向部分191a可落后或跟随第二侧向部分191b距离L的长度(图14和图16)。在其他实施方案中，例如，侧向部分191a,191b可纵向对齐和/或第二侧向部分191b可落后或跟随第一侧向部分191a,191b。在其中滑动件190包括多个侧向部分191a,191b的实施方案中，中间部分193可例如连接和/或跨接侧向部分191a,191b。
主要参照图14到图17，滑动件190可在钉160的驱动表面180,182之间传递。换句话说，滑动件190可例如对钉160的初始驱动表面180施加驱动力，并且随后可过渡以对钉160的第二或辅助驱动表面182施加驱动力。在某些实施方案中，滑动件斜坡192可包括前表面194和后表面196。例如，前表面194可与后表面196相邻和/或连接至后表面196，并且钉160可在前表面194和后表面196之间平滑过渡。例如，前表面194可接触钉160并且开始提升钉160，并且后表面196可运动成与钉160接触并且继续提升钉160。在某些实例中，例如，后表面196可将钉160平滑地提升成与前表面194脱离接合和/或不与前表面194接合。
仍参照图14到图17，例如，前表面194可与初始驱动表面180对齐，并且后表面196可与辅助驱动表面182对齐。在操作中，斜坡192的前表面194可初始接触钉160。例如，参照图14和图15，当滑动件190平移时，前表面194可接触钉160的初始驱动表面180。倾斜前表面194可对初始驱动表面180施加驱动力，初始驱动表面180可开始提升钉160的基部162。例如，钉160可由前表面194提升第一距离或高度。当滑动件190继续平移时，现在参照图16和图17，后表面196可例如运动成与钉160的辅助驱动表面182接触接合。例如，倾斜后表面196可对辅助驱动表面182施加驱动力，辅助驱动表面182可继续提升钉160的基部162。例如，钉160可由后表面194提升第二距离或高度。
在各种实例中，后表面196可例如将初始驱动表面180提升成不与斜坡192的前表面194接触和/或与斜坡192的前表面194脱离接触。例如，后表面196可接触辅助驱动表面182并且立即提升钉160，使得初级驱动表面180运动成与前表面194脱离驱动接触。在其他实施方案中，前表面194可驱动初始驱动表面180，并且后表面196可针对钉的部署的至少一部分同时驱动辅助驱动表面。当滑动件190继续平移时，后表面196可将基部162提升出钉腔144(图4和图5)和/或可将钉160从仓140(图4和图5)射出。例如，后表面196的近侧部分可包括滑动件过驱动器198。在各种实施方案中，滑动件过驱动器198可从钉仓144伸出并且可将钉过驱动器188，即，基部162的中间部分172的最低部分(参见图7)提升出钉腔144。
根据本发明的示例性应用的多个钉160的部署示于图18到图21中。在某些实施方案中，多个钉腔排144可限定在仓体142中。例如，多个钉腔排144可限定在仓狭槽143(图3)的第一侧上，并且多个钉腔排144可限定在仓狭槽143的第二侧上。图18到图21示出定位在仓体142中的两个钉腔排144中的两个钉排160。仍参照图18到图21，钉160a,160c和160e可例如定位在更内侧钉腔排144中，并且钉160b,160d和160f可例如定位在更外侧钉腔排144中。在各种实施方案中，第一内侧钉160a可比第一外侧钉160b更靠近仓狭槽143定位。例如，第一内侧钉160a可与仓狭槽143相邻，并且第一外侧钉160b可例如位于第一内侧钉160a和仓体142的侧面中间。在各种实施方案中，另外的钉排160可限定在仓体142中。例如，至少一个钉排可定位在第一钉160a和仓狭槽143中间，并且/或者至少一个钉排160可例如定位在第一外侧钉160b和仓体142的侧面中间。
主要参照图18，当滑动件190朝远侧运动时，第二侧向部分191b可接触第一内侧钉160a。例如，第二侧向部分191b的前表面194(图14到图17)可开始提升第一内侧钉160a。现在参照图19，当滑动件190继续朝远侧运动时，第二侧向部分191b的后表面196(图14到图17)可继续提升第一内侧钉160a，并且可例如使第一内侧钉160a运动成与端部执行器120的砧座152成形接触。另外，第二侧向部分191b的前表面194可例如运动成与第二内侧钉160c接触。在各种实例中，例如，第一侧向部分191a可在第二侧向部分191b运动成与第二内侧钉160c接触的同时运动成与第一外侧钉160a接触。在某些实施方案中，第一侧向部分191a和第二侧向部分191b之间的纵向落后或偏移可对应第一外侧钉160b和第二内侧钉160c之间的纵向距离。例如，第一侧向部分191a可落后第二侧向部分191b长度L(图14和图16)，并且第一外侧钉160b可从第二内侧钉160c纵向偏移长度L。在此类实施方案中，例如，第一外侧钉160a和第二内侧钉160c的部署可为同时的和/或同步的。
现在参照图20，当滑动件190继续前进时，第二侧向部分191b的后表面196可继续朝向砧座152提升第一内侧钉160a。限定在砧座152中的钉成形凹坑154可捕捉钉腿164,166，并且可使第一内侧钉160a变形。此外，例如，第二侧向部分191b可继续提升第二内侧钉160c，并且第一侧向部分191a可继续提升第一外侧钉160b。现在参照图21，当滑动件190继续朝远侧运动时，第二侧向部分191b可将第一内侧钉160a从钉腔144射出。在各种实例中，例如，滑动件过驱动器198(图14到图17)可提升钉过驱动器188以使钉基部162越过仓体142。例如，当砧座124的钉成形凹坑154继续形成第一内侧钉160a时，第二侧向部分191b可继续提升第二内侧钉160c，并且第一侧向部分191a可继续提升第一外侧钉160b。另外，第二侧向部分191b可例如运动成与第三内侧钉160e接触，并且第一侧向部分191a可例如运动成与第二外侧钉160d接触。在各种实例中，类似于上述，第二外侧钉160d可从第三内侧钉160e纵向偏移长度L(图14和图16)。
如本文所述，钉160可从仓140顺序地击发。例如，当滑动件190朝远侧运动时，滑动件190可从仓体142的近侧部分朝向仓体142的远侧部分顺序地击发钉160。如本文所述，滑动件190可在击发第二、更远侧、内侧钉160c之前击发第一、更近侧、内侧钉160a。在其他实施方案中，滑动件190可朝近侧平移，以从钉仓击发钉160。在此类实施方案中，滑动件190可从钉仓140的远侧部分朝向钉仓140的近侧部分顺序地击发钉160。此外，钉160从钉仓140的击发可为定步的或同步的。例如，第一外侧钉160b和第二内侧钉160c可同时击发，并且/或者例如，第二外侧钉160d和第三内侧钉160e可同时击发。例如，滑动件190的第一侧向部分191a和滑动件190的第二侧向部分191b之间的纵向偏移可对应于第一钉腔排中的钉160和第二、不同钉腔排中的钉160之间的纵向距离。在此类实施方案中，钉160的部署可被定时成使得第一钉腔排中的钉160与第二钉腔排中的钉160同时击发。钉部署的定时或定步可改善击发期间的组织定位和/或放置。例如，组织的节段可由端部执行器钳口123,124(图3)保持就位，并且该节段可同时缝合。但在其他实例中，191a和191b之间的偏移可不同于钉排中的钉之间的偏移。
钉部署的示例性实施方案进一步示于图22到图31中。例如，钉160a,160b,160c和160d可定位在仓狭槽140的两侧上，并且可以能够射出的方式定位在限定在仓体142中的钉腔144中。主要参照图22和图23，钉160a,160b,160c和160d可未击发，并且滑动件190可定位在仓体142近侧。滑动件190可与仓体142中的钉腔排144对齐。例如，第一滑动件190可与第一内侧钉腔排144中的钉160a,160c对齐并与第一外侧钉腔排144中的钉160b,160d对齐，并且第二滑动件190可与第二内侧钉腔排144中的钉160a,160c对齐并与第二外侧钉腔排144中的钉160b,160d对齐。例如，每个滑动件190的第一侧向部分191a可与外侧钉160b,160d对齐，并且每个滑动件190的第二侧向部分191b可与内侧钉160a,160c对齐。
主要参照图24和图25，第一内侧钉160a可相对于仓体142运动或提升到部分击发位置。例如，每个滑动件190的第二侧向部分191b可运动成与第一内侧钉160a接合。第二侧向部分191b的前表面194可将第一内侧钉160a提升第一距离。随后，后表面196可运动成与第一内侧钉160a接合，以进一步提升第一内侧钉160a。在各种实施方案中，可协调滑动件190的远侧平移，并且可例如同时击发狭槽143的每个侧上的第一内侧钉160a。当提升第一内侧钉160a时，每个钉160a的一部分可抵靠钉腔144的纵向引导表面150滑动或运动，并且纵向引导表面150可支撑和/或平衡由滑动件190生成的扭矩，如本文更详细地描述。
现在参照图26和图27，当滑动件190继续相对于仓140平移时，滑动件190可运动成与第一外侧钉160b和第二内侧钉160c接合。在各种实例中，滑动件190可同时接触第一外侧钉160b和第二内侧钉160c。例如，滑动件190的第一侧向部分191a可在滑动件190的第二侧向部分191b接触第二内侧钉160c时例如接触第一外侧钉160b。主要参照图27，滑动件190的第一侧向部分191a和第二侧向部分191b的前表面194可接合钉160b,160c的初始驱动表面180，并且可相对于仓体142提升钉160b,160c。另外，例如，滑动件190的第二侧向部分191b的后表面196可继续提升第一内侧钉160a。当第一内侧钉160a继续运动离开钉腔144时，砧座152(图18到图21)可开始使第一内侧钉160a变形。例如，钉成形凹坑154(图18到图21)可捕捉、转动和/或折曲第一内侧钉160a的腿部164,166。如本文所述，砧座152可例如使钉160a变形成修改的“B-形式”。
现在参照图28和图29，当滑动件190继续相对于钉仓140平移时，滑动件190的第二侧向部分191b可例如继续提升第一内侧钉160a，并且砧座152(图18到图21)可例如继续使第一内侧钉160a变形。在各种实例中，滑动件190还可继续提升第一外侧钉160b和第二内侧钉160c。例如，滑动件190的后表面196可运动成与第一外侧钉160b和第二内侧钉160c的辅助驱动表面182接合，并且可例如向上提升钉基部162，使得钉腿164,166继续运动离开仓体142。
现在参照图30和图31，当滑动件190继续相对于仓140平移时，滑动件190的第二侧向部分191b可继续同时提升第一内侧钉160a。例如，滑动件过驱动器198(图16和图17)可将第一内侧钉160a完全提升出仓体142，使得第一内侧钉160a从钉仓140完全射出。在各种实例中，砧座152(图18到图21)可例如继续使第一内侧钉160a变形，并且第一内侧钉160a可在完全提升出仓体142时完全变形。另外，滑动件190的后表面196还可继续同时提升第一外侧钉160b和第二内侧钉160c。例如，第一侧向部分191a的后表面196可提升或驱动第一外侧钉160b，并且例如第二侧向部分191b的后表面196可提升或驱动第二内侧钉160c。此外，当第一外侧钉160b和第二内侧钉160c继续运动离开钉腔144时，砧座152(图18到图21)可开始使第一外侧钉160b和第二内侧钉160c变形。例如，钉成形凹坑154(图18到图21)可捕捉、转动和/或折曲第一外侧钉160b和第二内侧钉160c的腿部164,166。在各种实例中，滑动件190可继续相对于仓体142平移，并且滑动件190的第一侧向部分191a和第二侧向部分191b可继续对钉160从相邻和/或邻近钉排的部署进行定步和/或定时。滑动件190可将钉160从钉仓140的近侧部分顺序地击发到钉仓140的远侧部分。在其他实施方案中，例如，滑动件190可朝近侧运动，并且可从钉仓140的远侧部分朝向钉仓140的近侧部分击发钉160。此外，在某些实例中，例如，钉和侧向滑动件部分之间的间距可影响钉的非同步部署。
现在参照图56到图64，在各种实例中，钉腔144可在滑动件190通过击发前进使钉160运动时引导钉160。例如，在各种实例中，滑动件190的前表面194可接触钉160的初始驱动表面180，并且可通过初始驱动表面180(图56到图58)对钉160施加驱动力D1(图58)。前表面194可沿着由轴线E(图57)和轴线F(图58)限定的平面向上提升钉160。如图57和图58所示，钉的质心(COM)可从轴线E和F偏移，并且在此类实施方案中，沿由轴线E和F限定的平面对初始驱动表面180施加的驱动力D1(图58)可生成扭矩Τ1(图58)。如本文更详细地描述，钉腔144可包括钉腔144的近侧端部146和远侧端部148之间的纵向侧壁150。在某些实施方案中，钉腔144可包括第一侧壁150a和第二侧壁150b。此外，如本文所述，侧壁150a,150b可抵抗钉160在击发期间的扭曲。例如，当滑动件190的前表面194沿由轴线E和F限定的平面驱动钉160的初始驱动表面180时，第二侧壁150b可抵抗对应于由滑动件190生成的驱动力D1的逆时针扭矩Τ1(图58)。当钉160由滑动件190的前表面194提升第一距离时，第二侧壁150b可引导和支撑钉基部162的中间部分172。例如，钉基部162的中间部分172的平坦表面173可沿第二侧壁150b滑动和/或抵靠第二侧壁150b运动。
现在参照图59到图61，当滑动件190在初始驱动表面180和辅助驱动表面182之间过渡时，如本文所述，滑动件190的后表面196可通过辅助驱动表面182对钉160施加驱动力D2(图61)。在各种实例中，滑动件190的后表面196可沿由轴线I(图60)和轴线J(图61)限定的平面向上提升钉160的基部162。如图60和图61所示，钉的质心(COM)可从由轴线I和J限定的平面偏移，并且在此类实施方案中，由滑动件190的后表面196对辅助驱动表面182施加的驱动力D2(图61)可生成扭矩Τ2(图61)。在对比图58和图61后，可以看出，驱动力D1在COM的第一侧上施加到钉160，并且驱动力D2在COM的相对侧上施加。在各种实例中，例如，扭矩Τ1可沿第一方向，并且扭矩Τ2可沿第二方向，并且第二方向可与第一方向相反。当后表面196沿由轴线I和J限定的平面驱动钉160的辅助驱动表面182时，第一侧壁150a可抵抗顺时针扭矩Τ2(图61)。当钉160由后表面194提升第二距离时，第一侧壁150a可引导和支撑钉基部162的近侧端部168和远侧端部170。例如，基部162的近侧端部168和远侧端部170可沿第一侧壁150a滑动和/或抵靠第一侧壁150a运动。
读者将理解，在某些实施方案中，本文参照钉的COM描述的各种钉和/或其特征结构可同样适用于钉的几何中心。在各种实例中，钉(例如诸如钉160)可包含单一材料和/或可具有均匀组合物。在此类实施方案中，钉的COM可对应于钉的几何中心。在其他实施方案中，钉可包含多种材料和/或非均匀组合物。例如，钉可由已焊接和/或以其他方式接合在一起的多个件和/或多种材料形成。在某些实施方案中，例如，由至少两种不同材料形成的多个片材可焊接在一起，并且钉可从包含多于一种材料的焊接片材的一部分切割而成。在其他实施方案中，由至少两种不同材料形成的多个片材可例如分层、轧制和/或密封在一起，并且钉可由包含多于一种材料的片材的一部分切割而成。在此类实施方案中，钉的COM可从钉的几何中心偏移。例如，钉的COM可从钉的几何中心侧向和/或纵向偏移。
如图58和图61所示，滑动件190可在部署期间对钉160施加竖直驱动力D1，D2。读者将理解，由滑动件190生成的驱动力还可包括水平分量。在各种实施方案中，当钉160由滑动件190提升时，钉腔144的近侧端部146和/或远侧端部148可引导和支撑钉腿164,166。在各种实施方案中，钉腔144的近侧端部146和/或远侧端部148可平衡由驱动力的水平分量生成的扭矩。例如，当滑动件190朝远侧运动时，钉腔144的远侧端部148可抵抗钉160在部署期间的旋转和/或扭曲。现在参照图62到图64，后表面196可继续将钉160提升出钉腔144。例如，滑动件过驱动器198可接触钉过驱动器188以将钉160的基部162提升出仓体140。
现在参照图45到图47，钉仓(例如诸如钉仓240)可加载到端部执行器120(图3)的细长通道122中。钉(例如诸如钉160)可以能够射出的方式定位在钉仓240中。例如，滑动件190(图14到图17)可平移穿过钉仓240，以将钉160从其射出。在各种实例中，钉仓240可包括仓体242和限定在仓体242中的腔244。例如，钉160能够可移除地定位在钉腔244中。例如，每个钉腔244能够可移除地储存单个钉160。此外，例如，每个钉腔244可具有近侧端部246和远侧端部248，并且纵向侧壁250可在每个钉腔244的近侧端部246和远侧端部248之间延伸。类似于本文所述的腔144，近侧端部246、远侧端部248和/或纵向侧壁250可在击发期间引导和/或支撑钉160。例如，纵向侧壁250可抗衡由平移的滑动件190对钉160施加的扭矩。在各种实例中，腔244还可包括侧壁250之间的对角引导表面251。例如，近侧对角引导表面251可在腔244的近侧端部246和腔244的侧壁250之间延伸。除此之外或另选地，远侧对角引导表面251b可在腔244的远侧端部248和腔244的侧壁250之间延伸。例如,当钉160在钉腔224内提升时，对角引导表面251a,251b可引导和/或支撑钉160的成型部分178(图6到图13)。例如，成型部分178的一部分可沿对角引导表面251a,251b滑动和/或抵靠对角引导表面251a,251b运动。在此类布置方式中，例如，对角引导表面251a,251b可平衡对钉160施加的扭矩。
现在参照图32A到图32C，钉(例如诸如钉160)可由材料片(例如诸如材料片130)切割而成、形成和/或模压而成。例如，材料片130可为金属的，并且可例如包含不锈钢和/或钛。在各种实例中，材料片130可为基本上平坦的和/或光滑的。此外，在某些实例中，材料片130可在各个区(例如诸如第一区134和第二区136)处折曲、折叠、成型和/或卷曲。例如，材料片130可使用冲压机和/或模压机折曲。例如，材料片130的平坦或基本上平坦部分135a,135b和135c可定位在区134,136中间。第一区134可例如位于平坦部分135a和135b中间，并且第二区136可例如在平坦部分135b和135c中间。在各种实例中，平坦部分135a和135c可例如为共面的，和/或平坦部分135b可例如平行于和/或基本上平行于平坦部分135a和/或135c。主要参照图32A，多个平坦片材130a,130b,130c,130d,130e,130f可堆叠，并且随后同时在区134和136处折曲。在其他实施方案中，例如，片材130a,130b,130c,130d,130e,130f可单个地折曲，并且随后堆叠。
在各种实例中，钉160可由折曲片材130切割而成、形成和/或模压而成。例如，主要参照图32B，钉轮廓132可被追踪、蚀刻和/或切割成折曲片材130。例如，钉轮廓132可被加工和/或激光切割成折曲片材130。在各种实例中，可使用电火花加工(EDM)线138来切割钉轮廓132。此外，在某些实例中，可同时切割多个堆叠片材130。在某些实施方案中，主要参照图32C，钉轮廓132可形成钉160的边界或周边。例如，钉轮廓132可形成钉160(图6到图13和图33到图36)，和/或例如可形成具有各种类似于钉160的特征结构的钉。在各种实例中，多个钉轮廓132可切入材料片130中，并且多个钉160可由单个材料片130形成。如图32B和图32C所示，电火花加工线138可一次穿过多于一个材料片130，以一次切割多于一个钉160。尽管电火花加工线138同时切割六个片材130，但可同时切割任何合适数目的片材130。例如，线138可同时切割少于六个片材130或同时切割多于六个片材130。
例如，参照图32C和图33到图36，钉轮廓132可例如形成基部162和/或钉腿164,166。此外，钉轮廓132可包括至少一个一体形成的钉驱动表面。例如，钉轮廓132可包括初始驱动表面180和/或辅助驱动表面182。换句话讲，初始驱动表面180和/或辅助驱动表面182可在钉160由材料片130切割而成时加工而成和/或形成。在某些实例中，片材130(图32A和图32B)的折曲或成型区134,136可形成钉160的成型部分178。此外，例如片材130(图32A和图32B)的侧向平坦部分135a和135c可对应于钉腿164和166，并且片材130(图32A和图32B)的中间平坦部分135b可对应于基部162的中间部分172。
在各种实例中，钉160的深度D1(图34和图36)可由材料片130的深度确定。例如，材料片130可基于其深度而选择，并且由材料片130形成的钉160可具有与材料片130相同的深度。此外，基部162和钉腿164,166的高度H1(图35)和宽度W1(图35)可由钉轮廓132确定。在各种实例中，钉轮廓132可提供钉部件的高度和/或宽度沿每个部件的长度的变型。例如，基部162的高度H1和/或钉腿164,166的宽度W1可沿其长度变化。此外，锥度、台阶和/或其他变型可由钉轮廓132限定，并且因此，钉160的几何形状可基于钉160和/或可与钉160一起使用的端部执行器120的用途、应用和/或设计而选择和/或调控。
主要参照图33到图36，在各种实例中，钉160可被切割成使得基部162的高度H1独立于和/或不同于钉腿164,166的深度D1。例如，钉腿164,166的深度D1可对应于材料片130的深度，并且基部162可例如被切割成可独立于材料片130的深度和/或对应于腿深度D1的适当高度H1。适当高度H1可例如基于钉160和/或可与钉160一起使用的端部执行器120(图3)的用途、应用和/或设计。此外，基部162的高度H1还可沿其长度变化。例如，高度H1可在钉160的驱动表面处和/或附近和/或例如在钉腿164,166中的一者和基部162之间的角撑板处变化。例如，钉轮廓132可提供沿基部162的长度的至少一个锥度和/或台阶。例如，钉轮廓132可包括锥度或斜坡，该锥度或斜坡可形成基部162的辅助驱动表面182。辅助驱动表面182的倾斜度可通过钉轮廓132来选择、设计和调控。在某些实施方案中，基部162的高度H1可大于钉腿164,166的深度D1。在其他实施方案中，基部162的高度H1可等于或小于钉腿164,166的深度D1。比较地，由折曲线形成的钉的几何形状可基于初始线的尺寸而受到约束和/或限制。例如，在线形成的钉中，钉基部的高度通常对应于钉腿的宽度，钉腿的宽度通常对应于线的直径。尽管拉动和/或卷动例如可修改线的直径，但材料体积限制和/或约束可允许的修改。
在各种实例中，例如，钉腿164,166的宽度W1还可独立于钉腿164,166的深度D1和基部162的高度H1。例如，钉腿164,166可基于钉160和/或可与钉160一起使用的端部执行器120(图3)的应用、用途和/或设计而被切割成适当宽度W1。在某些实施方案中，例如，钉腿164,166可包括不同的宽度，并且/或者钉腿164,166的宽度可渐缩、阶跃或以其他方式沿其长度变化。例如，钉腿164,166可在末端174处渐缩，以形成穿刺边缘或尖端。
现在参照图37到图40，钉轮廓232可被追踪、切割、蚀刻和/或加工成材料片130(图32A和图32B)，并且例如类似于钉160(图33到图36)的钉260可由材料片130形成。例如，钉260可包括基部262和从基部262延伸的钉腿264,266。在各种实施方案中，钉260可包括成型部分278，该成型部分可对应于用来形成钉260的材料片130(图32A和图32B)的折曲和/或成型区134,136。在某些实施方案中，例如，钉260可包括成型部分278之间的中间部分272。此外，至少一个驱动表面280,282可通过钉轮廓232沿着钉260的周边形成。
类似于钉160，钉腿264，266的深度D1可对应于材料片130的深度。此外，在各种实例中，钉基部262的高度H2可独立于钉腿264,266的深度D1和/或独立于材料片130的深度。例如，如图37到图40所示，钉基部262的高度H2小于钉基部162(图33到图36)的高度H1，并且例如，钉腿264,266的深度D2等于钉腿164,166的深度D1。在各种实施方案中，钉腿264，266的宽度W2还可独立于钉腿264,266的深度D2。钉基部262的高度H1和钉腿264，266的宽度W2可基于例如钉260和/或端部执行器120(图3)的用途、应用和/或设计而选择。
现在参照图41到图44，钉轮廓332可被追踪、切割、蚀刻和/或加工成材料片130(图32A和图32B)，并且例如类似于钉160和260(图33到图40)的钉360可由材料片130形成。例如，钉360可包括基部362和从基部362延伸的钉腿364,366。在各种实施方案中，钉360可包括成型部分378，该成型部分可对应于用来形成钉360的材料片130(图32A和图32B)的折曲和/或成型区134,136。在某些实施方案中，钉360可例如包括成型部分378之间的中间部分372。此外，至少一个驱动表面380和382可通过钉轮廓332沿钉360的周边形成。
类似于钉160和260，钉腿364,366的深度D3可对应于材料片130的深度。此外，在各种实例中，钉基部362的高度H3可独立于钉腿364，366的深度D3和/或独立于材料片130的深度。例如，如图41到图44所示，钉基部362的高度H3大于钉基部162(图33到图36)的高度H1并且大于钉基部262(图37到图40)的高度H2，并且例如钉腿364,366的深度D3等于钉腿164,166的深度D1并且等于钉腿264,266的深度D2。在各种实施方案中，钉腿364,366的宽度W3还可独立于钉腿364,366的深度D3。钉基部362的高度H3和钉腿364,366的宽度W3可基于例如钉360和/或端部执行器120(图3)的用途、应用和/或设计来选择。
现在参照图48到图51，例如诸如钉460的钉可用于例如诸如钉仓140(图3到图5)和/或钉仓240(图45到图47)的钉仓中。钉460可包括基部462，基部462具有近侧部分468和远侧部分470。中间基部部分472可例如定位在近侧部分468和远侧部分470之间。如图48到图51所示，第一钉腿464可从基部462的近侧部分468延伸，并且第二钉腿466可从基部的远侧部分470延伸。在各种实例中，钉腿464,466可为例如圆柱形的或基本上圆柱形的，并且可包括钉末端474，该钉末端可例如为渐缩的和/或包括用于穿刺组织的锋利边缘或尖端。在其他实施方案中，钉腿464,466可例如包括圆形和/或多边形周边。钉基部462的中间部分472可包括组织接触表面473，该组织接触表面473可例如为平坦的或基本上平坦的。在各种实例中，钉460可例如由线形成，该线可例如折曲、扭曲和/或以其他方式调控以形成钉腿464,466和/或钉基部462。在各种实施方案中，线的直径可例如限定钉腿464,466的宽度和深度。在一些实施方案中，线可被拉动和/或卷动以修改钉460的尺寸。在某些实例中，线基部462的中间部分462可被形成和/或平坦化以形成组织接触表面473。在各种实例中，基部462可例如被平坦化在两个平行或基本上平行的板之间，使得组织接触表面473和基部462的底表面475为平坦的或基本上平坦的和/或平行的或基本上平行的。对基部162的修改可例如受线材料的体积限制和/或约束。
仍参照图48到图51，钉460可包括斜面和/或角撑板。例如，斜面484可在第一钉腿464和基部462之间延伸，和/或斜面484可在第二钉腿466和基部462之间延伸。在某些实施方案中，例如，斜面484可相对于在第一钉腿464和第二钉腿466之间延伸的纵向轴线G(图49)和/或相对于沿钉腿464,466的长度延伸的竖直轴线H(图51)不对称。例如，斜面484可远离轴线G和/或轴线H延伸，并且因此，在某些实施方案中，基部462的中间部分472可从轴线G和/或轴线H偏移。例如，基部462的质心可从由轴线G和轴线H限定的平面偏移。在各种实例中，基部462的偏移中间部分472可形成用于接触捕获的组织的宽大和/或平坦表面，从而可提供用于对捕获的组织施加和/或分布压力的宽阔和/或平滑表面。在此类实施方案中，钉460内的组织撕裂和/或创伤可减轻和/或降到最低。此外，类似于本文所述的钉160,260和/或360，钉460可包括腿成形平面，例如由轴线G和轴线H限定的平面，该腿成形平面可例如从钉460的基部462的质心偏移。
现在参照图52到图55，例如诸如钉560的钉可用于例如诸如钉仓140(图3到图5)和/或钉仓240(图45到图47)的钉仓中。钉560可包括基部562，该基部具有近侧部分568和远侧部分570。中间基部部分572可例如定位在近侧部分568和远侧部分570之间。如图52到图55所示，第一钉腿564可从基部562的近侧部分568延伸，并且第二钉腿566可从基部562的远侧部分570延伸。在某些实施方案中，基部560的中间部分572可沿轴线D(图53)延伸，该轴线D可例如平行于和/或基本上平行于限定在第一钉腿564和第二钉腿566之间的轴线C(图53)。
在各种实例中，钉腿564,566可为例如圆柱形的或基本上圆柱形的，并且可包括钉末端574，该钉末端可为渐缩的和/或包括例如用于穿刺组织的锋利边缘或尖端。在各种实例中，钉560可由线形成。例如，线可折曲、扭曲和/或以其他方式调控以形成钉560。仍参照图52到图55，该线可在弯曲579a,579b,579c和/或579d处调控。例如，钉基部562可包括成角部分578，该成角部分可例如相对于钉基部562的中间部分572和/或相对于限定在第一钉腿和第二钉腿564,566之间的轴线C成角度取向。在各种实施方案中，例如，形成钉560的线可在第一钉腿564和成角部分578a之间的579a处弯曲，在成角部分578a和中间部分572之间的579b处弯曲，在中间部分572和成角部分578b之间的579c处弯曲，和/或在成角部分578b和第二钉腿566之间的579d处弯曲。例如，基部562的中间部分572可从在第一钉腿564和第二钉腿566之间延伸的轴线C(图53)侧向偏移。
在各种实施方案中，该线的直径可例如限定钉腿564,566和/或钉基部562的宽度和深度。在一些实施方案中，该线和/或其部分可被拉动和/或卷动以修改钉560和/或钉560的元件的尺寸。此外，该线可具有圆形和/或多边形周边。在某些实施方案中，该线可例如以某一角度切割以形成钉末端574。类似于本文所述的钉160,260,360和/或460，钉560可包括腿部成形平面，例如由轴线C限定的平面，该腿部成形平面可例如从钉560的基部562的质心偏移。
除上述以外，现在参照图65，端部执行器(例如诸如端部执行器120)还可包括定位在细长通道122内的钉仓240以及另外能够与钉仓240相对定位的砧座124。在各种实例中，仓240可包括多个钉腔244、定位在钉腔244中的每个钉腔中的紧固件(例如诸如钉460)、以及被构造成能够将刀158可滑动地接收于其中的纵向狭槽243。尽管钉460结合图65所示的实施方案而示出，但任何合适的钉或紧固件(例如诸如钉160)均可与此实施方案一起使用。大体参照图73和图74，端部执行器120可从轴114延伸，该轴可包括闭合管115。当闭合管115朝远侧推进时，闭合管115可接触砧座124并且使砧座124在打开位置(图73)和闭合位置(图74)之间旋转。一旦砧座124已闭合，则刀158可朝远侧推进以横切捕获在砧座124和仓240之间的组织。在本文所公开的某些端部执行器中，定位在端部执行器120内的仓还可包括紧固件击发致动器，例如诸如滑动件190，该致动器由刀158朝远侧推动，以在刀158横切组织的同时从仓部署钉。参照图65所示实施方案，钉仓可包括紧固件击发致动器，例如诸如滑动件组件790，该致动器可与刀158一起或并排朝远侧推进，以将钉460从仓240射出。例如，缝合器的轴114可包括被构造成能够推进刀158的击发杆157以及另外被构造成能够推进滑动件组件790的推动器杆159。尽管击发杆157和推动器杆159可同时推进，但在各种情况下，其操作可被定时成使得其初始远侧运动可相对于彼此交错，如下文进一步更详细地描述。除了击发杆157和推动器杆159之间的初始相对运动以外，滑动件组件790可包括可相对于彼此运动的两个或更多个部分，如下文还将进一步更详细地描述。
主要参照图66到图69，滑动件组件790可包括第一滑动件部分792和第二滑动件部分793。第一滑动件部分792可包括内斜坡部分791a和外斜坡部分791b。如图66和图67所示，外斜坡部分791b相对于内斜坡部分791a侧向地定位。外斜坡部分791b还相对于内斜坡部分791a朝远侧延伸。相似地，第二滑动件部分793可包括内斜坡部分794a和外斜坡部分794b。如图68和图69所示，外斜坡部分794b相对于内斜坡部分794a侧向地定位。外斜坡部分794b还相对于内斜坡部分794a朝远侧延伸。在各种实例中，内斜坡部分791a可被构造成能够提升或至少部分地提升内钉排，而外斜坡部分791b可被构造成能够提升或至少部分地提升外钉排。如图67主要示出，内斜坡部分791a和外斜坡部分791b可各自包括斜坡表面，诸如分别为斜坡表面795a和795b，所述斜坡表面可分别在内钉排和外钉排中的钉的下方滑动。内斜坡部分791a和外斜坡部分791b的斜坡表面795a和795b可被构造成能够将钉从未击发位置提升到至少部分击发位置。在各种实例中，内斜坡部分791a和外斜坡部分791b的斜坡表面795a和795b可例如各自包括至少一个倾斜表面、弯曲表面、致动表面、和/或凸形表面。
除上述以外，第二滑动件部分793的内斜坡部分794a可包括内斜坡表面796a，并且相似地，第二滑动件部分793的外斜坡部分794b可包括外斜坡表面796b。在各种实例中，第一滑动件部分792的内斜坡表面795a可被构造成能够与第二滑动件部分793的内斜坡表面796a协作，以将内钉排中的钉从其未击发位置和其完全击发位置提升。更具体地，例如，内斜坡部分791a可将内钉排中的钉从未击发位置提升到部分击发位置，在该部分击发位置中，内斜坡部分794a然后可将钉从其部分击发位置提升到完全击发位置。在这种情况下，内钉排中的钉的提升运动可由第一滑动件部分792的内斜坡部分791a发起，传递至第二斜坡部分793的内斜坡表面796a，并且随后由第二斜坡部分793完成。相似地，第一滑动件部分792的外斜坡表面795b可被构造成能够与第二滑动件部分793的外斜坡表面796b协作，以将外钉排中的钉从其未击发位置和其完全击发位置提升。更具体地，例如，外斜坡部分791b可将外钉排中的钉从未击发位置提升到部分击发位置，在该部分击发位置中，外斜坡部分794b然后可将钉从其部分击发位置提升到完全击发位置。在这种情况下，外钉排中的钉的提升运动可由第一滑动件部分792的外斜坡部分791b发起，传递至第二斜坡部分793的外斜坡表面796b，并且随后由第二斜坡部分793完成。内钉排中的钉的击发运动或提升运动可在内斜坡部分794a的顶点798一旦已从钉下方穿过便完成。相似地，外钉排中的钉的击发或提升运动可在外斜坡部分794b的顶点798一旦已从钉下方穿过便完成。
再次参照图65，滑动件组件790可包括多于一个第一滑动件部分792和/或多于一个第二滑动件部分793。在各种实例中，滑动件组件790可包括第一组滑动件部分和第二组滑动件部分，该第一组滑动件部分包括第一滑动件部分792和第二滑动件部分793，该第二组滑动件部分包括第一滑动件部分792和第二滑动件部分793。在某些实例中，第二组滑动件部分可构成第一组的镜像。为了简化本文对滑动件组件790的说明，可参考仅一组滑动件部分；然而，读者应当理解，关于一组滑动件部分的操作的说明也可适用于任何合适数目组滑动件部分的同时操作。
除上述以外，仓240的外钉排(即，离通道243最远的排)可在内钉排(即，离通道243最近的排)之前。换句话说，外侧排中的钉的变形可在或至少略微在内侧排中的侧向相邻的钉的变形之前开始。在其他实例中，仓240的外钉排(即，离通道243最远的排)可落后内钉排(即，离通道243最近的排)。换句话说，内侧排中的钉的变形可在或至少略微在外侧排中的侧向相邻的钉的变形之前开始。此外，尽管两个钉排公开于限定在仓240中的通道243的各侧上，但设想出其中多于两个钉排(例如诸如三个钉排)存在于通道243的各侧上的其他实施方案。在此类实施方案中，滑动件组件可被构造成能够与内钉排同时、与外钉排同时、和/或在相对于内钉排和外钉排顺序地进行的时间来部署另外的钉排。
如上所述，第一滑动件部分792能够相对于滑动件组件790的第二滑动件部分793运动。现在参见图70到图72，滑动件组件790能够在初始、未击发构型(图70)和第二、伸出构型(图71和图72)之间运动。在滑动件组件790的初始、未击发构型中，主要参照图70，第一滑动件部分792在第二部分793内塌缩或相对于第二部分793回缩。在至少一个此类实例中，第一滑动件部分792的远侧端部可能不会延伸超过第二滑动件部分793的远侧端部。在其他实例中，尽管未示出，但当第一滑动件部分792在第二部分793内塌缩时，第一滑动件部分792的远侧端部可延伸超过第二滑动件部分793的远侧端部。进一步参照图70，读者将进一步理解，钉460在其尚未朝向砧座124提升时处于未击发位置。在对比图70和图71后，读者将注意到，第一滑动件部分792已相对于第二滑动件部分793延伸。在这种情况下，第一滑动件部分792的远侧端部相对于第二滑动件部分793的远侧端部朝远侧定位。第一滑动件部分792从其初始、未击发位置到其伸出位置的运动可将第一滑动件部分792的内斜坡部分791a和/或外斜坡部分791b定位在一个或多个钉460下方。在其他构型中，第一滑动件部分792从其初始、未击发位置到其伸出位置的运动可不将内斜坡部分791a和/或外斜坡部分791b定位在一个或多个钉460下方。在任何情形中，如图71所示，第一滑动件部分792的延伸可朝向砧座124至少部分地提升至少一个钉460和/或使至少一个钉460抵靠砧座124至少部分地变形。在某些实例中，第一滑动件部分792的延伸可完全提升至少一个钉460或使至少一个钉460抵靠砧座124完全变形。在各种情况下，当第一滑动件部分792运动到其伸出位置中时，第二滑动件部分793可不朝远侧推进；然而，在某些情况下，当第一滑动件部分792运动到其伸出位置中时，可发生第二滑动件部分793的至少一些远侧运动。
在对比图71和图72后，可注意到，第一滑动件部分792和第二滑动件部分793已朝远侧推进，以朝向砧座124提升钉460。第一滑动件部分792和第二滑动件部分793随后可推进到端部执行器120的远侧端部，以完成端部执行器120的击发行程，该击发行程将在下文中进一步更详细地讨论。在任何情形中，滑动件组件790在端部执行器120的击发行程期间的初始前进示于图70到图72中。图70示出了处于回缩、未击发位置的滑动件组件790；图71示出了处于伸出、部分击发位置的滑动件组件790；并且图72示出了处于伸出、击发位置的滑动件组件790。如上所述，一个或多个推动器杆159可朝远侧运动，以便通过图70到图72所示的前进来推进滑动件组件790。参照图70，推动器杆159示为处于其中其与第一滑动件部分792的近侧端部接触的初始、未击发位置。在各种实施方案中，推动器杆159可包括从其远侧端部延伸的接触凸缘155，接触凸缘155可接合第一滑动件部分792。进一步参照图70，当推动器杆159处于其初始、未击发位置时，推动器杆159可不与第二滑动件部分793接触。当推动器杆159朝远侧推进时，推动器杆159可使第一滑动件部分792朝远侧运动，直到接触凸缘155与第二滑动件部分793的近侧端部接触，如图71所示。正是第一滑动件部分792和第二滑动件部分793之间的此相对运动使滑动件组件790延伸，如上文所讨论。然后，推动器杆159可朝远侧推进，以便同时朝远侧推进第一滑动件部分792和第二滑动件部分793，如图72所示。
如上文所讨论，端部执行器120可被构造成能够同时缝合和横切组织。再次参照图65，端部执行器120可包括击发构件或刀杆156，击发构件或刀杆156包括刀口158，该刀口被构造成能够在刀杆156朝远侧推进时横切组织。再次参照图70和图71，一个或多个推动器杆159的初始远侧运动可不传递至刀杆156。换句话说，刀杆156可保持静止，或至少基本上静止，而滑动件组件790在其回缩位置(图70)和其伸出位置(图71)之间运动。在这种情况下，至少在端部执行器击发行程的初始部分期间，可发生推动器杆159和刀杆156之间的相对运动。在对比图74和图77后，可以看出，其一：推动器杆159已朝远侧推进以使滑动件组件790延伸，以及其二：刀杆156尚未朝远侧推进。可特别注意刀杆156和推动器杆159的近侧端部。更具体地，推动器杆159可包括在它们之间延伸的驱动销759，该驱动销延伸穿过驱动狭槽757，该驱动狭槽限定在从刀杆156朝近侧延伸的驱动杆157中。当推动器杆159处于其近侧未击发位置时，如图74所示，驱动销759定位在驱动狭槽757的近侧端部中。当推动器杆159朝远侧推进时，如图77所示，驱动销759可在驱动狭槽757内朝远侧滑动，直到驱动销759到达驱动狭槽757的远侧端部。在此类位置中，滑动件790已完全延伸并且刀杆156尚未与推动器杆159一起朝远侧推进。一旦驱动销759与驱动狭槽757的远侧端部接触，如图78和图79所示，则推动器杆156和刀杆159可一起朝远侧推进。
除上述以外，刀杆156可包括凸缘153和155，凸缘153和155可被构造成能够分别接合砧座124和钉仓通道123。当刀杆156处于其近侧、未推进位置时，如图77所示，凸缘153可相对于限定在砧座124中的狭槽121朝近侧定位。在刀杆156的此类位置中，凸缘155既可定位在也可不定位在限定在仓通道123的外部内和/或中的狭槽内。当刀杆156朝远侧推进时，凸缘153可进入砧座狭槽121并且凸缘155可定位在仓通道狭槽内。在这种情况下，刀杆156可设定砧座124和定位在仓通道123内的钉仓之间的间隙或组织间隙距离。在各种情况下，当刀杆156朝远侧推进时，刀杆156可控制组织在端部执行器120内的成形高度和/或压缩。
其中在推动器杆159推进刀158之前推动器杆159使滑动件组件790运动的上述布置方式可在许多情况下是有利的。例如，常常需要在切入组织之前缝合组织，并且因此，钉的形成导致或至少足够导致刀杆156横切组织。滑动件790和刀杆156的交错部署可有利于钉成形和组织切入之间的此类相对前进。此外，滑动件790可以其回缩、未击发构型紧凑地储存在端部执行器120中，以便允许端部执行器120的较短的近侧到远侧长度或纵向长度。换句话说，可在至少部分塌缩状态下开始其击发行程的滑动件组件可能需要较少的纵向空间。此外，例如，由于滑动件组件790的纵向可扩展性，因此与一体的滑动件相比，滑动件组件790的钉提升表面可更长并且可包括更浅或较不尖锐的斜坡角。换句话说，滑动件组件790的机械优点可因可供用于滑动件组件790的斜坡的更长的纵向长度而得到改善。
现在参照图80到图82，滑动件组件790和刀杆156可朝远侧朝向端部执行器120的远侧端部推进，以完成端部执行器120的击发行程。当滑动件790接近端部执行器120的远侧端部时，在各种实例中，第一滑动件部分792可接触钉仓的远侧端部245并且相对于第二滑动件部分793和/或在第二滑动件部分793内回缩。更具体地，远侧端部245可阻止第一滑动件部分792的远侧运动，而第二滑动件部分793相对于第一滑动件部分792朝远侧推进以便完成击发行程。在各种实例中，第二滑动件部分793可朝远侧推进，直到它也接触钉仓的远侧端部245，而在其他实例中，击发行程可在第二滑动件部分793接触远侧端部245之前完成。在任一种情形中，在其中推动器杆159的远侧凸缘155朝向端部执行器120的远侧端部推动第一滑动件部分792和第二滑动件部分793的实施方案中，当第一滑动件部分792到达远侧端部时，第一滑动件部分792可变为与推动器杆159脱离接合，使得推动器杆159可相对于第一滑动件部分792推动第二滑动件部分793。在至少一个此类实例中，主要参照图77，钉仓的远侧端部可包括凸台241，该凸台可被构造成能够向上朝向砧座124提升第一滑动件部分792，使得推动器杆159可在第一滑动件部分792下方滑动。在这种情况下，第一滑动件部分792与第二滑动件部分793和推动器杆159可操作地脱离接合。在各种实例中，凸台241可被定位和布置成使得在钉仓的所有钉均已部署和/或传递至第二滑动件部分793之后，第一滑动件部分792向上提升，如上文所讨论。此外，除上述以外，钉仓的远侧端部可包括第一凸台241和第二凸台241，第一凸台241被构造成能够提升第一滑动件部分792，第二凸台241被构造成能够提升另外的第一滑动件部分792。在各种实例中，凸台241可被构造成能够同时同步地提升第一滑动件部分792。在一些实例中，凸台241可被构造成能够顺序地提升第一滑动件部分792。
现在参照图85到图88，图85示出处于其初始、未击发构型的滑动件组件790。除上述以外，推动器杆159可接触第一滑动件部分792的近侧端部789并朝远侧推动第一滑动件部分792，直到第一滑动件部分792的近侧端部789与第二滑动件部分793的近侧端部787齐平，如图86所示。在此处，第一滑动件部分792可相对于第二滑动件部分793完全延伸。然后，推动器杆156可同时推进近侧端部787和近侧端部789，以朝远侧推进滑动件组件790。还如上文所讨论，现在参照图87，例如，第一滑动件部分792可由钉仓的远侧端部245停止并由钉仓的凸台241向上提升。在此处，第一滑动件部分792可相对于第二滑动件部分793和远侧凸缘155升高，使得第二滑动件部分793可相对于第一滑动件部分792并且至少部分地在第一滑动件部分792下方滑动，以便使滑动件组件790塌缩，如图88所示。在对比图87和图88后，可以看出，第二滑动件部分793朝向限定在第一滑动件部分792的底表面中的凸边788运动得更靠近，并且第一滑动件部分792的远侧端部789不再与第二滑动件部分793的远侧端部787对齐。
在击发行程已完成之后，现在参照图83和图84，刀杆156和推动器杆159可朝近侧回缩。在各种情况下，刀杆156可由推动器杆159朝近侧牵拉。更具体地，推动器杆159可相对于刀杆159朝近侧回缩，直到驱动销759接触驱动狭槽759的近侧端部。在此处，推动器杆159可朝近侧牵拉刀杆156，直到刀杆156的凸缘153不再定位在砧座124的狭槽121内。然后，当闭合管115被朝近侧牵拉时，砧座124可运动到其打开位置中。在某些实例中，钉仓可包括可替换的钉仓。在这种实例中，用完的钉仓可从仓通道122移除，并且如果需要，未用完的钉仓可定位在仓通道122内，使得外科器械可再次使用。
如图83和图84所示，当刀杆156和推动器杆159回缩时，塌缩的滑动件组件790可留在端部执行器120的远侧端部中。在用完的钉仓从仓通道122移除的情况下，塌缩的滑动件组件790可与仓一起从端部执行器120移除。在某些实例中，在推动器杆159和刀杆回缩之前，钉仓可能还没有完全用完。在这种实例中，滑动件组件790可仅在钉仓内部分地推进并且可不塌缩回到其未伸出构型中。当钉仓随后从仓通道123移除时，一些钉可能仍定位在它们的钉腔内。
如本文所讨论，钉仓和/或缝合器械的击发致动器或滑动件可包括一个或多个倾斜斜坡表面，该一个或多个倾斜斜坡表面被构造成能够在未击发位置和击发位置之间提升或部署钉。例如，滑动件可包括第一倾斜斜坡表面和第二倾斜斜坡表面，该第一倾斜斜坡表面被构造成能够部署第一钉排，该第二倾斜斜坡表面被构造成能够部署第二钉排，等等。每个倾斜斜坡表面可包括连续表面，该连续表面被构造成能够接合对应钉排中的每个钉并且提升钉，直到它们已抵靠与钉仓相对定位的砧座完全变形。限定每个倾斜斜坡表面的连续表面可包括任何合适数目的轮廓，例如诸如一个或多个线性表面和/或一个或多个弯曲表面。在各种实例中，当连续表面从其未击发位置运动到其完全击发位置时，它可直接接合对应钉排中的每个钉并且可保持与该排中的钉连续接合。在钉已到达其完全击发位置之后，倾斜斜坡表面可变为与此钉脱离接合。此布置方式对于具有相对可移动部件(例如诸如滑动件部件790)的滑动件和/或不是由相对可移动部件构成的滑动件(例如诸如由一体材料件构成的滑动件)可为可行的。
在各种情况下，击发致动器或滑动件可包括一个或多个倾斜斜坡表面，其中每个倾斜斜坡表面由两个或更多个协作驱动表面构成。例如，现在参照图92，滑动件890可包括第一倾斜斜坡表面891a，该第一倾斜斜坡表面由初始或第一驱动表面895a和第二或最终驱动表面896a构成。第一倾斜斜坡表面891a的初始驱动表面895a和最终驱动表面896a可被构造成能够在未击发位置和击发位置之间协作地提升第一钉排中的钉。随着滑动件890朝远侧运动经过钉仓，参照图89到图92，初始驱动表面895a可例如接触钉160，并将钉160从其未击发位置(图89)提升到部分击发位置(图90)。然后，滑动件890可朝远侧推进，使得最终驱动表面896a可在钉160的部分击发位置和钉160的完全击发位置之间提升钉160。在各种实例中，初始驱动表面895a可接触钉160的初始驱动表面180，以将钉160提升到其部分击发位置中并且最终驱动表面896a可接触钉160的第二驱动表面182，以将钉160提升到其最终击发位置中。在这种实例中，钉160可从初始驱动表面895a传递至最终驱动表面896a，以完成其部署或击发。参照图92，钉160的部署或击发可在第一倾斜斜坡表面891a的顶点898一旦已从钉160的第二驱动表面182下方穿过便完成。
除上述以外，再次参照图92，第一倾斜斜坡表面891a的初始驱动表面895a和最终驱动表面896a可被构造成能够协作地部署第一钉排内的钉。滑动件890可包括另外的倾斜斜坡表面，以部署另外的钉排。例如，滑动件890可包括第二倾斜斜坡表面891b，该第二倾斜斜坡表面包括可被构造成能够协作地部署第二钉排内的钉的初始驱动表面895b和最终驱动表面896b。在各种实例中，滑动件890还可包括任何合适数目的倾斜斜坡表面，例如诸如被构造成能够部署第三钉排内的钉的类似于第一倾斜斜坡表面891a的第三倾斜斜坡表面以及被构造成能够部署第四钉排内的钉的类似于第二倾斜斜坡表面891b的第四倾斜斜坡表面。在任何情形中，倾斜驱动表面的驱动表面(例如诸如驱动表面895a,895b,896a和896b)可包括任何合适的构型，例如诸如线性外形和/或弯曲外形。进一步参照图92，第一倾斜斜坡表面891a可包括位于初始驱动表面895a和最终驱动表面896a中间的过渡驱动表面897a。相似地，第二倾斜斜坡表面891b可包括位于初始驱动表面895b和最终驱动表面896b中间的过渡驱动表面897b。在各种实例中，过渡驱动表面可包括一个驱动表面和另一个驱动表面之间的过渡。在一些实例中，过渡驱动表面可包括例如同时驱动钉160的初始驱动表面180和第二驱动表面182的表面。在各种实例中，倾斜斜坡表面可包括任何合适数目的驱动表面。
在各种实例中，除上述以外，初始驱动表面895a可相对于最终驱动表面896a侧向地定位。在某些实例中，初始驱动表面895a和最终驱动表面896a可连接至彼此。在其他实例中，初始驱动表面895a和最终驱动表面896a可不连接至彼此。在各种情况下，初始驱动表面895a可由第一高度限定，并且最终驱动表面896a可由高于第一高度的第二高度限定。在某些情况下，初始驱动表面895a可沿第一纵向轴线限定，并且最终驱动表面896a可沿第二纵向轴线限定。在某些实例中，第一纵向轴线和第二纵向轴线可为平行的。在一些实例中，初始驱动表面895a可由第一平面限定，并且最终驱动表面896a可由平行于第一平面的第二平面限定。在其他实例中，第一纵向轴线和第二纵向轴线可为不平行的。在一些实例中，第一纵向轴线和第二纵向轴线可沿会聚的方向延伸。在其他实例中，第一纵向轴线和第二纵向轴线可沿不会聚的方向延伸。在各种实例中，除上述以外，第一倾斜表面891a的过渡驱动表面897a可沿平行于第一纵向轴线和/或第二纵向轴线的轴线限定。在某些实例中，过渡驱动表面897a可沿不平行于第一纵向轴线和/或第二纵向轴线的轴线限定。在各种实例中，除上述以外，第一倾斜表面891a的过渡驱动表面897a可限定在平行于第一平面和/或第二平面的平面内。在一些实例中，过渡驱动表面897a可与初始驱动表面895a和/或最终驱动表面896a为共面的。在某些实例中，过渡驱动表面897a可限定在不同于第一平面和/或第二平面的平面内。在各种实例中，除上述以外，过渡驱动表面897a可将初始驱动表面895a连接至最终驱动表面896a。
例如，上文结合倾斜斜坡表面891a、初始驱动表面895a、最终驱动表面896a和过渡驱动表面897a所提供的讨论可同样适用于倾斜斜坡表面891b、初始驱动表面895b、最终驱动表面896b和过渡驱动表面897b。
在各种情况下，除上述以外，第一倾斜斜坡表面891a可平行于第二倾斜斜坡表面891b。在其他实例中，第一倾斜斜坡表面891a可不平行于第二倾斜斜坡表面891b。在各种实例中，第一倾斜斜坡表面891a可由第一高度限定，并且第二倾斜斜坡表面891b可由第二高度限定。在一些实例中，第一高度可与第二高度相同。在这种实例中，由第一倾斜斜坡表面891a形成的第一钉排和由第二倾斜斜坡表面891b形成的第二钉排可被形成为相同的高度。在其他实例中，第一高度可不同于第二高度。在这种实例中，由第一倾斜斜坡表面891a形成的第一钉排和由第二倾斜斜坡表面891b形成的第二钉排可被形成为不同的高度。公布于2012年11月27日的名称为“SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLESHAVING DIFFERENT LENGTHS”的美国专利8,317,070的公开内容全文以引用方式并入。
如上文所讨论，滑动件可直接驱动并部署钉和/或储存在仓内的任何其他合适的紧固件。换句话说，滑动件可直接接触钉，其中驱动器不存在于滑动件和钉中间。此类布置方式不同于包括支撑钉的多个驱动器的布置方式。在此类布置方式中，滑动件接合驱动器以提升钉。在这些布置方式中，驱动器常常被构造成能够将钉从它们储存在其中的钉腔完全射出。更具体地，驱动器被构造成能够提升钉，使得当钉处于其完全击发位置时，钉完全定位在钉仓的顶表面或平台上方。为了将钉完全提升到钉仓的平台上方，驱动器还可至少部分地提升到平台上方。此类布置方式可表征为过驱动钉。本文所讨论的许多教导内容可应用于包括直接驱动钉的一个或多个滑动件的实施方案，以及另外包括由一个或多个滑动件驱动以便驱动钉的多个驱动器的实施方案。例如，滑动件890结合其中其直接驱动钉160的实施方案而讨论；然而，滑动件890也可用于包括被构造成能够从钉腔部署钉的驱动器的实施方案。在此类实施方案中，每个驱动器可包括例如类似于第一驱动表面180的第一驱动表面和例如类似于第二驱动表面182的第二驱动表面，该第一驱动表面被构造成能够由初始驱动表面895a接合，该第二驱动表面被构造成能够由最终驱动表面896a接合。
在其中钉直接由滑动件驱动(即，不使用驱动器)的本文所公开的实施方案中，除上述以外，钉可由滑动件本身完全提升到平台上方或过驱动。现在参照图91到图94，滑动件890被构造成能够部分地延伸到仓142的平台表面141上方。更具体地，第一倾斜斜坡表面891a的顶点898和第二倾斜斜坡表面891b的顶点898可在倾斜斜坡表面891a和891b穿过腔144和/或从腔144之间穿过时延伸到平台表面141上方，以例如将钉160从钉腔144射出。在这种情况下，滑动件890被构造成能够部分地延伸到限定在平台表面141中的钉腔开口上方。在各种实例中，仓142还可包括定位在钉腔排144内和/或与钉腔排144对齐的多个覆盖物145。例如，覆盖物145可定位在钉腔排内的相邻钉腔144中间。在某些实例中，覆盖物145可相对于钉腔144朝近侧和/或朝远侧定位。在各种实例中，主要参照图94，倾斜斜坡表面891的顶点898可从覆盖物145下方穿过。在这种实例中，每个覆盖物145可包括底表面，例如诸如弓形底表面147，该底表面被构造成能够允许倾斜斜坡表面891从其下方穿过。进一步参照图94，例如，仓142可包括第一纵向狭槽149和第二纵向狭槽149，第一纵向狭槽149被构造成能够在其中可滑动地接收第一倾斜斜坡表面891a，第二纵向狭槽149被构造成能够接收第二倾斜斜坡表面891b。在各种实例中，仓142可包括被构造成能够接收滑动件890的倾斜斜坡表面的多个纵向狭槽149。在某些实例中，纵向狭槽149可由覆盖物145和钉腔144限定。在一些情况下，每个纵向狭槽149可对应于纵向钉腔排144，其中纵向狭槽149可将钉腔排内的钉腔144放置成彼此连通，使得穿过纵向狭槽149的倾斜斜坡表面可穿过钉腔144，如上所述。
在各种实例中，仓的平台可被构造成能够直接接触被紧固的组织和/或支撑被紧固的组织。在某些情况下，仓组件可包括定位在平台上的层，例如诸如组织厚度补偿件，该层公开于以下专利中：2010年9月30日提交的名称为“IMPLANTABLE FASTENER CARTRIDGECOMPRISING A SUPPORT RETAINER”的美国专利申请序列号12/894,369，现为美国专利申请公布2012/0080344；2011年4月29日提交的名称为“STAPLE CARTRIDGE COMPRISINGSTAPLES POSITIONED WITHIN A COMPRESSIBLE PORTION THEREOF”的美国专利申请序列号13/097,856，现为美国专利申请公布2012/0080336；和2011年9月23日提交的名称为“CURVED END EFFECTOR FOR A STAPLING INSTRUMENT”的美国专利申请序列号13/242,066，现为美国专利申请公布2012/0080498。以下专利的全部公开内容以引用方式并入本文：2010年9月30日提交的名称为“IMPLANTABLE FASTENER CARTRIDGE COMPRISING ASUPPORT RETAINER”的美国专利申请序列号12/894,369，现为美国专利申请公布2012/0080344；2011年4月29日提交的名称为“STAPLE CARTRIDGE COMPRISING STAPLESPOSITIONED WITHIN A COMPRESSIBLE PORTION THEREOF”的美国专利申请序列号13/097,856，现为美国专利申请公布2012/0080336；和2011年9月23日提交的名称为“CURVED ENDEFFECTOR FOR A STAPLING INSTRUMENT”的美国专利申请序列号13/242,066，现为美国专利申请公布2012/0080498。在各种实例中，再次参照图93，平台141和覆盖物145可被构造成能够直接接触组织。在这种实例中，覆盖物145可延伸到平台141上方，并且因此，平台141和覆盖物145可包括不平坦的支撑表面。在各种实例中，覆盖物145可对直接定位在每个纵向钉排上方和/或与每个纵向钉排相邻定位的组织施加另外的压缩压力。此另外的压缩压力可在钉成形过程之前、期间和/或之后远离钉线推动存在于组织中的流体，这因此可促进组织内的更好的钉成形和/或钉保持。覆盖物145还可被构造成能够夹持特别是沿其中发生钉成形的钉线定位在钉仓和砧座之间的组织。覆盖物还可被构造成能够在钉从钉凹坑射出时支撑钉，以提供对钉成形过程的局部控制。以下专利的全部公开内容以引用方式并入本文：2010年9月29日提交的名称为“STAPLE CARTRIDGE”的美国专利申请序列号12/893,461，现为美国专利申请公布2012/0074198；和2013年3月27日提交的名称为“TISSUE THICKNESSCOMPENSATOR COMPRISING A CUTTING MEMBER PATH”的美国专利申请序列号13/851,676。
如上文所讨论，主要参照图58、图61和图64，钉腔(例如诸如钉腔144)可包括第一侧壁150a和第二侧壁150b，第一侧壁150a和第二侧壁150b可被构造成能够在其在未击发位置和击发位置之间提升时引导钉，例如诸如钉160。在各种实例中，侧壁150a和150b可被构造和布置成使得当钉160处于其未击发位置时钉160的全部定位在侧壁150a,150b中间。在其他情况下，主要参照图22到图31，钉腔144的侧壁150可被构造成能够使得当钉160处于其未击发位置时少于钉160的全部定位在侧壁150中间。例如，当钉160处于其未击发位置时，限定在仓体142中的最外钉腔排144中的钉160的基部162可不由侧壁150中的至少一个侧壁支撑。然而，当钉160向上提升时，钉160的基部162则可由侧壁150中的两个侧壁支撑。现在参照图93和图94，仓142的钉腔144中的一些(例如诸如腔144a)可仅在其提升运动结束时支撑基部162的两侧。在任何情形中，即使限定在仓体142中的钉腔144的侧壁可不完全支撑处于其未击发位置的钉160，钳口122的仓通道123(再次参照图3和图65)也可至少部分地支撑钉160。换句话说，仓体142和仓通道123可协作以限定钉腔144，以便贯穿钉160的提升运动支撑和/或围绕钉160。例如，当钉160处于其未提升位置时，仓体142和仓通道123可协作以支撑和/或围绕钉160。在钉160的提升运动期间的某一时刻，在一些情况下，仓通道123可不再支撑和/或钉160，并且在这种情况下，仓体142可在提升运动的其余部分期间完全支撑钉160。在至少一个实施方案中，仓通道123和仓体142可协作以在提升运动的一半或大约一半期间支撑钉160。在其他实施方案中，仓通道123和仓体142可协作以在提升运动的不到一半或超过一半期间支撑钉160。在一些实例中，仓体142和仓通道123可贯穿钉160的整个提升运动协作地支撑和/或围绕钉160。
本文所述的各种实施方案是在线性端部执行器和/或线性紧固件仓的上下文中描述。此类实施方案及其教导内容可应用于非线性端部执行器和/或非线性紧固件仓，例如诸如圆形和/或成型端部执行器。例如，各种端部执行器，包括非线性端部执行器公开于以下专利中：2011年2月28日提交的名称为“SURGICAL STAPLING INSTRUMENT”的美国专利申请序列号13/036,647，现为美国专利申请公布2011/0226837，该专利全文据此以引用方式并入。另外，2012年9月29日提交的名称为“STAPLE CARTRIDGE”的美国专利申请序列号12/893,461，现为美国专利申请公布2012/0074198，全文据此以引用方式并入。2008年2月15日提交的名称为“END EFFECTORS FORA SURGICAL CUTTING AND STAPLING INSTRUMENT”的美国专利申请序列号12/031,873，现为美国专利7,980,443，全文据此以引用方式并入。公布于2010年12月7日的名称为“SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES”的美国专利7,845,537的全部公开内容以引用方式并入本文。2011年5月27日的提交的名称为“SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS”的美国专利申请序列号13/118,241，现为美国专利申请公布2012/0298719的全部公开内容以引用方式并入本文。
本文所公开的装置可被设计成在单次使用后废弃，或者其可被设计成使用多次。然而，不论是哪种情况，可再调整所述装置以在至少一次使用后再利用。再调整可包括拆卸装置之后清洁或更换特定件以及随后重新组装的步骤的任何组合。具体地，可拆卸所述装置，并且可选择性地以任何组合形式更换或移除所述装置的任何数目的特定件或零件。在清洁和/或更换特定零件后，可就在外科手术之前在再调整设施处或由手术团队重新组装所述装置以供随后使用。本领域的技术人员应当理解，再调整装置可利用各种用于拆卸、清洁/更换和重新组装的技术。这种技术的使用和所得再调整装置均在本申请的范围内。
优选地，本文所述的本发明将在外科手术之前处理。首先，获得并且如果必要的话清洁新的或已用器械。然后可对所述器械消毒。在一种消毒技术中，将所述器械放置在封闭和密封容器(诸如塑料或TYVEK袋)中。然后将容器和器械放置在可穿透容器的辐射场(诸如γ辐射、X射线或高能电子)中。辐射杀死器械上和容器中的细菌。然后可将无菌器械储存在无菌容器中。密封容器使器械保持无菌，直到其在医疗设施中被打开。
据称以引用的方式并入本文的任何专利、专利公布或其他公开材料，无论是全文或部分，仅在所并入的材料与本发明中所述的现有定义、陈述或者其他公开材料不冲突的范围内并入本文。同样地并且在必要的程度下，本文明确阐述的公开内容取代以引用方式并入本文的任何冲突材料。任何据称以引用方式并入本文但与本文所述的现有定义、陈述或其他公开材料相冲突的任何材料或其部分，仅在所并入的材料和现有的公开材料之间不产生冲突的程度下并入本文。
尽管本发明已被描述为具有示例性设计，但可在本发明的实质和范围内进一步修改本发明。本申请因此旨在涵盖本发明使用其一般原理的任何变型、使用或修改。此外，本申请旨在涵盖与归属于本发明所属领域的已知或习惯做法的本发明的这种背离。

Claims (22)

1.一种外科钉，包括：
基部，所述基部包括倾斜驱动表面；和
第一腿部，所述第一腿部从所述基部延伸；和
第二腿部，所述第二腿部从所述基部延伸，其中所述基部、所述第一腿部和所述第二腿部限定无缝一体件。
2.根据权利要求1所述的外科钉，其中所述倾斜驱动表面被定位在所述第一腿部和所述第二腿部中间。
3.根据权利要求1所述的外科钉，其中所述基部还包括：
第一部分，所述第一部分包括初始驱动表面，其中所述第一腿部从所述第一部分延伸；和
第二部分，其中所述第二腿部从所述第二部分延伸。
4.根据权利要求3所述的外科钉，其中所述倾斜驱动表面从所述初始驱动表面侧向偏移。
5.根据权利要求3所述的外科钉，其中所述初始驱动表面包括凸块。
6.根据权利要求1所述的外科钉，其中所述基部是不对称的。
7.一种外科钉，包括：
基部，所述基部包括驱动表面；
第一腿部，所述第一腿部从所述基部延伸；
第二腿部，所述第二腿部从所述基部延伸，其中所述第一腿部和所述第二腿部限定第一平面；并且
其中所述驱动表面在平行于所述第一平面的方向上沿所述基部的一部分延伸，并且其中所述驱动表面从所述第一平面侧向偏移。
8.根据权利要求7所述的外科钉，其中所述驱动表面还包括斜坡。
9.根据权利要求7所述的外科钉，其中所述基部还包括：
在所述驱动表面和所述第一腿部中间的第一轮廓；和
在所述驱动表面和所述第二腿部中间的第二轮廓。
10.根据权利要求7所述的外科钉，其中所述基部在所述第一腿部和所述第二腿部之间非线性地延伸。
11.根据权利要求7所述的外科钉，其中所述基部还包括近侧部分，其中所述第一腿部从所述近侧部分延伸，并且其中所述近侧部分还包括初始驱动表面。
12.根据权利要求11所述的外科钉，其中所述初始驱动表面定位在所述第一平面中。
13.根据权利要求11所述的外科钉，其中所述近侧部分还包括凸块。
14.根据权利要求7所述的外科钉，其中所述基部、所述第一腿部和所述第二腿部限定一体件。
15.一种系统，包括：
无缝钉，所述无缝钉包括：
腿部；和
整体驱动表面；和
滑动件，所述滑动件包括倾斜驱动表面，所述倾斜驱动表面被构造成能够直接接触所述无缝钉的整体驱动表面。
16.根据权利要求15所述的系统，其中所述整体驱动表面还包括倾斜表面。
17.根据权利要求15所述的系统，还包括多个无缝钉，其中所述滑动件被构造成能够接触所述多个无缝钉。
18.根据权利要求15所述的系统，其中所述滑动件还包括多个倾斜驱动表面。
19.根据权利要求18所述的系统，其中所述无缝钉还包括多个整体驱动表面。
20.根据权利要求15所述的系统，其中所述滑动件还包括过驱动部分。
21.一种用于形成紧固件的方法，包括以下步骤：
获得由片材平面限定的材料片；
引导所述材料片的中间部分侧向地远离所述片材平面；以及
从所述材料片提取紧固件结构，其中所述紧固件结构包括第一腿部、第二腿部以及连接所述第一腿部和所述第二腿部的基部区。
22.一种外科钉，包括：
整体基部；
第一可变形腿部，所述第一可变形腿部从所述基部无缝地延伸；和
第二可变形腿部，所述第二可变形腿部从所述基部无缝地延伸，其中所述基部在所述第一可变形腿部和所述第二可变形腿部中间包括可变高度。
CN201480076093.4A 2013-12-23 2014-12-09 外科钉、钉仓和外科端部执行器 Active CN106028967B (zh)

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US14/138,530 US9549735B2 (en) 2013-12-23 2013-12-23 Fastener cartridge comprising a firing member including fastener transfer surfaces
US14/138,465 US10265065B2 (en) 2013-12-23 2013-12-23 Surgical staples and staple cartridges
US14/138,505 US9585662B2 (en) 2013-12-23 2013-12-23 Fastener cartridge comprising an extendable firing member
US14/138,489 US9687232B2 (en) 2013-12-23 2013-12-23 Surgical staples
US14/138,489 2013-12-23
US14/138,481 US9968354B2 (en) 2013-12-23 2013-12-23 Surgical staples and methods for making the same
US14/138,518 US9763662B2 (en) 2013-12-23 2013-12-23 Fastener cartridge comprising a firing member configured to directly engage and eject fasteners from the fastener cartridge
US14/138,475 US20150173749A1 (en) 2013-12-23 2013-12-23 Surgical staples and staple cartridges
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