Extensible Buttress Assembly for Surgical

(19) *EP003162388B1*

(11) EP 3 162 388 B1

(12) EUROPEAN PATENT SPECIFICATION

(45) Date of publication and mention (51) Int Cl.: of the grant of the patent: A61L 31/06 (2006.01) A61L 31/14 (2006.01) (2006.01) (2006.01) 01.01.2020 Bulletin 2020/01 A61B 17/00 A61B 17/072

(21) Application number: 16196387.1

(22) Date of filing: 28.10.2016

(54) EXTENSIBLE BUTTRESS ASSEMBLY FOR SURGICAL STAPLER ERWEITERBARE VERSTEIFUNGSANORDNUNG FÜR CHIRURGISCHES KLAMMERGERÄT ENSEMBLE RENFORT EXTENSIBLE POUR AGRAFEUSE CHIRURGICALE

(84) Designated Contracting States: • DALESSANDRO, Victoria AL AT BE BG CH CY CZ DE DK EE ES FI FR GB Cincinnati, OH 45242 (US) GR HR HU IE IS IT LI LT LU LV MC MK MT NL NO PL PT RO RS SE SI SK SM TR (74) Representative: Carpmaels & Ransford LLP One Southampton Row (30) Priority: 29.10.2015 US 201514926194 London WC1B 5HA (GB)

(43) Date of publication of application: (56) References cited: 03.05.2017 Bulletin 2017/18 EP-A2- 2 724 734 US-A1- 2002 165 559 US-A1- 2012 241 492 (73) Proprietor: Ethicon LLC 00969 Guaynabo (PR) • Peter P. Pott ET AL: "Mechanical Properties of Mesh Materials Used for Hernia Repair and Soft (72) Inventors: Tissue Augmentation", PLoS ONE, vol. 7, no. 10, • VENDELY, Michael J. 12 October 2012 (2012-10-12), page e46978, Cincinnati, OH 45242 (US) XP055459401, DOI: • HARRIS, Jason L. 10.1371/journal.pone.0046978 Cincinnati, OH 45242 (US)

Note: Within nine months of the publication of the mention of the grant of the European patent in the European Patent Bulletin, any person may give notice to the European Patent Office of opposition to that patent, in accordance with the Implementing Regulations. Notice of opposition shall not be deemed to have been filed until the opposition fee has been paid. (Art. 99(1) European Patent Convention). EP 3 162 388 B1

Printed by Jouve, 75001 PARIS (FR) 1 EP 3 162 388 B1 2

Description Instrument Incorporating a Multistroke Firing Mechanism Having a Rotary Transmission," issued May 6, 2008; U.S. BACKGROUND Pat. No. 7,380,695, entitled "Surgical Stapling Instrument Having a Single Lockout Mechanism for Prevention of [0001] In some settings, endoscopic surgical instru- 5 Firing," issued June 3, 2008; U.S. Pat. No. 7,380,696, ments may be preferred over traditional open surgical entitled "Articulating Surgical Stapling Instrument Incor- devices since a smaller incision may reduce the post- porating a Two-Piece E-Beam Firing Mechanism," is- operative recovery time and complications. Consequent- sued June 3, 2008; U.S. Pat. No. 7,404,508, entitled "Sur- ly, some endoscopic surgical instruments may be suita- gical Stapling and Cutting Device," issued July 29, 2008; ble for placement of a distal end effector at a desired 10 U.S. Pat. No. 7,434,715, entitled "Surgical Stapling In- surgical site through the cannula of a trocar. These distal strument Having Multistroke Firing with Opening Lock- end effectors may engage tissue in a number of ways to out," issued October 14, 2008; U.S. Pat. No. 7,721,930, achieve a diagnostic or therapeutic effect (e.g., endoc- entitled "Disposable Cartridge with Adhesive for Use with utter, grasper, cutter, stapler, clip applier, access device, a Stapling Device," issued May 25, 2010; U.S. Pat. No. drug/gene therapy delivery device, and energy delivery 15 8,408,439, entitled "Surgical Stapling Instrument with An device using ultrasonic vibration, RF, laser, etc.). Endo- Articulatable End Effector," issued April 2, 2013; and U.S. scopic surgical instruments may include a shaft between Pat. No. 8,453,914, entitled "Motor-Driven Surgical Cut- the end effector and a handle portion, which is manipu- ting Instrument with Electric Actuator Directional Control lated by the clinician. Such a shaft may enable insertion Assembly," issued June 4, 2013. to a desired depth and rotation about the longitudinal axis 20 [0003] While the surgical staplers referred to above are of the shaft, thereby facilitating positioning of the end described as being used in endoscopic procedures, it effector within the patient. Positioning of an end effector should be understood that such surgical staplers may may be further facilitated through inclusion of one or more also be used in open procedures and/or other non-en- articulation joints or features, enabling the end effector doscopic procedures. By way of example only, a surgical to be selectively articulated or otherwise deflected rela- 25 stapler may be inserted through a thoracotomy, and tive to the longitudinal axis of the shaft. thereby between a patient’s ribs, to reach one or more [0002] Examples of endoscopic surgical instruments organs in a thoracic surgical procedure that does not use include surgical staplers. Some such staplers are oper- a trocar as a conduit for the stapler. Such procedures able to clamp down on layers of tissue, cut through the may include the use of the stapler to sever and close a clamped layers of tissue, and drive staples through the 30 vessel leading to a lung. For instance, the vessels leading layers of tissue to substantially seal the severed layers to an organ may be severed and closed by a stapler be- of tissue together near the severed ends of the tissue fore removal of the organ from the thoracic cavity. Of layers. Merely exemplary surgical staplers are disclosed course, surgical staplers may be used in various other in U.S. Pat. No. 4,805,823, entitled "Pocket Configuration settings and procedures. for Internal Organ Staplers," issued February 21, 1989; 35 [0004] Examples of surgical staplers that may be par- U.S. Pat. No. 5,415,334, entitled "Surgical Stapler and ticularly suited for use through a thoracotomy are dis- Staple Cartridge," issued May 16, 1995; U.S. Pat. No. closed in U.S. Patent Pub. No. 2014/0243801, entitled 5,465,895, entitled "Surgical Stapler Instrument," issued "Surgical Instrument End Effector Articulation Drive with November 14, 1995; U.S. Pat. No. 5,597,107, entitled Pinion and Opposing Racks," published August 28, 2014; "Surgical Stapler Instrument," issued January 28, 1997; 40 U.S. Patent Pub. No. 2014/0239041, entitled "Lockout U.S. Pat. No. 5,632,432, entitled "Surgical Instrument," Feature for Movable Cutting Member of Surgical Instru- issued May 27, 1997; U.S. Pat. No. 5,673,840, entitled ment," published August 28, 2014; U.S. Patent Pub. No. "Surgical Instrument," issued October 7, 1997; U.S. Pat. 2014/0239042, entitled "Integrated Tissue Positioning No. 5,704,534, entitled "Articulation Assembly for Surgi- and Jaw Alignment Features for Surgical Stapler," pub- cal Instruments," issued January 6, 1998; U.S. Pat. No. 45 lished August 28, 2014; U.S. Patent Pub. No. 5,814,055, entitled "Surgical Clamping Mechanism," is- 2014/0239036, entitled "Jaw Closure Feature for End Ef- sued September 29, 1998; U.S. Pat. No. 6,978,921, en- fector of Surgical Instrument," published August 28, titled "Surgical Stapling Instrument Incorporating an E- 2014; U.S. Patent Pub. No. 2014/0239040, entitled "Sur- Beam Firing Mechanism," issued December 27, 2005; gical Instrument with Articulation Lock having a Detenting U.S. Pat. No. 7,000,818, entitled "Surgical Stapling In- 50 Binary Spring," published August 28, 2014; U.S. Patent strument Having Separate Distinct Closing and Firing Pub. No. 2014/0239043, entitled "Distal Tip Features for Systems," issued February 21, 2006; U.S. Pat. No. End Effector of Surgical Instrument," published August 7,143,923, entitled "Surgical Stapling Instrument Having 28, 2014; U.S. Patent Pub. No. 2014/0239037, entitled a Firing Lockout for an Unclosed Anvil," issued December "Staple Forming Features for Surgical Stapling Instru- 5, 2006; U.S. Pat. No. 7,303,108, entitled "Surgical Sta- 55 ment," published August 28, 2014; U.S. Patent Pub. No. pling Instrument Incorporating a Multi-Stroke Firing 2014/0239038, entitled "Surgical Instrument with Multi- Mechanism with a Flexible Rack," issued December 4, Diameter Shaft," published August 28, 2014; and U.S. 2007; U.S. Pat. No. 7,367,485, entitled "Surgical Stapling Patent Pub. No. 2014/0239044, entitled "Installation Fea-

2 3 EP 3 162 388 B1 4 tures for Surgical Instrument End Effector Cartridge," the general description of the invention given above, and published August 28, 2014. the detailed description of the embodiments given below, [0005] Additional surgical stapling instruments are dis- serve to explain the principles of the present invention. closed in U.S. Pat. No. 8,801,735, entitled "Surgical Cir- cular Stapler with Tissue Retention Arrangements," is- 5 FIG. 1 depicts a perspective view of an exemplary sued August 12, 2014; U.S. Pat. No. 8,141,762, entitled articulating surgical stapling instrument; "Surgical Stapler Comprising a Staple Pocket," issued March 27, 2012; U.S. Pat. No. 8,371,491, entitled "Sur- FIG. 2 depicts a perspective view of an end effector gical End Effector Having Buttress Retention Features," of the instrument of FIG. 1, with the end effector in issued February 12, 2013; U.S. Pub. No. 2014/0263563, 10 an open configuration; entitled "Method and Apparatus for Sealing End-to-End Anastomosis" published September 18, 2014; U.S. Pub. FIG. 3 depicts an exploded perspective view of the No. 2014/0246473, entitled "Rotary Powered Surgical In- end effector of FIG. 2; struments with Multiple Degrees of Freedom," published September 4, 2014; U.S. Pub. No. 2013/0206813, enti- 15 FIG. 4 depicts a perspective view of an exemplary tled "Linear Stapler," published August 15, 2013; U.S. upper buttress and an exemplary lower buttress, Pub. No. 2008/0169328, entitled "Buttress Material for each of which may be applied to the end effector of Use with a Surgical Stapler," published July 17, 2008; FIG. 2; U.S. Pat. App. No. 14/300,804, entitled "Woven and Fi- brous Materials for Reinforcing a Staple Line," filed June 20 FIG. 5A depicts a cross-sectional end view of a por- 10, 2014; U.S. Pat. App. No. 14/300,811, entitled "De- tion of the end effector of FIG. 2 with a buttress as- vices and Methods for Sealing Staples in Tissue"; and sembly formed by the buttresses of FIG. 4 applied U.S. Pat. App. No. 14/498,070, entitled "Radically Ex- to the end effector, with tissue positioned between pandable Staple Line" filed September 26, 2014. the buttresses in the end effector, and with the anvil [0006] In some instances, it may be desirable to equip 25 in an open position; a surgical stapling instrument with a buttress material to reinforce the mechanical fastening of tissue provided by FIG. 5B depicts a cross-sectional end view of the staples. Such a buttress may prevent the applied staples combined end effector and buttress assembly of FIG. from pulling through tissue and may otherwise reduce a 5A, with tissue positioned between the buttresses in risk of tissue tearing at or near the site of applied staples. 30 the end effector, and with the anvil in a closed posi- US2012241492 A1 relates to an end assembly of a sur- tion; gical stapler that has an anvil, a cartridge and a tissue thickness compensator that is removably attached to a FIG. 5C depicts a cross-sectional view of a staple support portion of the cartridge by adhesive, where the and the buttress assembly of FIG. 5A having been tissue thickness compensator has a body of woven or 35 secured to the tissue by the end effector of FIG. 2; knitted mesh and the fibers can be parallel to the staple line or perpendicular to the staple line, or a random fibers FIG. 6 depicts a perspective view of staples and the mesh. EP2724734 A2 relates to an absorbent surgical buttress assembly of FIG. 5A having been secured buttress in which the fibers can be weft-knitted or warp to the tissue by the end effector of FIG. 2; knitted and has isotropic or near-isotropic strength and 40 elasticity. US2002165559 A1 relates to method for re- FIG. 7 depicts an enlarged schematic view of an ex- leasing buttress material from a stapling instrument when emplary planar fabric comprising fibers knitted in a a strip of buttress material is releasably attached to a tricot pattern, suitable for incorporation into the but- tissue clamping member of the stapling instrument by an tresses of FIG. 4; adhesive, where the adhesive is applied onto the surface 45 of the tissue clamping member prior to applying the but- FIG. 8 depicts an enlarged schematic view of an ex- tress. emplary planar fabric comprising fibers knitted in a [0007] While various kinds of surgical stapling instru- weft insertion pattern, suitable for incorporation into ments and associated components have been made and the buttresses of FIG. 4; used, it is believed that no one prior to the inventor(s) 50 has made or used the invention described in the append- FIG. 9 depicts an enlarged schematic view of an ex- ed claims. emplary planar fabric comprising fibers knitted in a weft pattern, suitable for incorporation into the but- BRIEF DESCRIPTION OF THE DRAWINGS tresses of FIG. 4; 55 [0008] The accompanying drawings, which are incor- FIG. 10 depicts an enlarged schematic view of an porated in and constitute a part of this specification, il- exemplary planar fabric comprising knitted fibers, lustrate embodiments of the invention, and, together with suitable for incorporation into the buttresses of FIG.

3 5 EP 3 162 388 B1 6

4; Closure ring (36) is positioned distal to articulation section (34). Closure tube (32) and closure ring (36) are con- FIG. 11 depicts two top plan views showing a woven figured to translate longitudinally relative to handle as- planar fabric in a stretched state and the woven pla- sembly (20). Longitudinal translation of closure tube (32) nar fabric in a relaxed state; and 5 is communicated to closure ring (36) via articulation section (34). Exemplary features that may be used to provide FIG. 12 depicts two top plan views showing a but- longitudinal translation of closure tube (32) and closure tress body in a stretched state and the buttress body ring (36) will be described in greater detail below. in a relaxed state. [0012] Articulation section (34) is operable to laterally 10 deflect closure ring (36) and end effector (40) laterally DETAILED DESCRIPTION away from the longitudinal axis (LA) of shaft assembly (30) at a desired angle (α). In the present example, ar- I. Exemplary Surgical Stapler ticulation is controlled through an articulation control knob (35) which is located at the proximal end of shaft [0009] FIG. 1 depicts an exemplary surgical stapling 15 assembly (30). Closure ring (36) and end effector (40) and severing instrument (10) that includes a handle as- pivot about an axis that is perpendicular to the longitudi- sembly (20), a shaft assembly (30), and an end effector nal axis (LA) of shaft assembly (30) in response to rota- (40). End effector (40) and the distal portion of shaft as- tion of knob (35). Articulation section (34) is configured sembly (30) are sized for insertion, in a nonarticulated to communicate longitudinal translation of closure tube state as depicted in FIG. 1, through a trocar cannula to 20 (32) to closure ring (36), regardless of whether articula- a surgical site in a patient for performing a surgical pro- tion section (34) is in a straight configuration or an artic- cedure. By way of example only, such a trocar may be ulated configuration. By way of example only, articulation inserted in a patient’s abdomen, between two of the pa- section (34) and/or articulation control knob (35) may be tient’s ribs, or elsewhere. In some settings, instrument constructed and operable in accordance with at least (10) is used without a trocar. For instance, end effector 25 some of the teachings of U.S. Pub. No. 2014/0243801, (40) and the distal portion of shaft assembly (30) may be entitled "Surgical Instrument End Effector Articulation inserted directly through a thoracotomy or other type of Drive with Pinion and Opposing Racks," published Au- incision. It should be understood that terms such as gust 28, 2014; and/or U.S. Pat. App. No. 14/314,125, "proximal" and "distal" are used herein with reference to entitled "Articulation Drive Features for Surgical Stapler," a clinician gripping handle assembly (20) of instrument 30 filed June 25, 2014; and/or in accordance with the various (10). Thus, end effector (40) is distal with respect to the teachings below. Other suitable forms that articulation more proximal handle assembly (20). It will be further section (34) and articulation knob (35) may take will be appreciated that for convenience and clarity, spatial apparent to those of ordinary skill in the art in view of the terms such as "vertical" and "horizontal" are used herein teachings herein. with respect to the drawings. However, surgical instru- 35 [0013] As shown in FIG. 1, shaft assembly (30) of the ments are used in many orientations and positions, and present example further includes a rotation knob (31). these terms are not intended to be limiting and absolute. Rotation knob (31) is operable to rotate the entire shaft assembly (30) and end effector (40) relative to handle A. Exemplary Handle Assembly and Shaft Assembly assembly (20) about the longitudinal axis (LA) of shaft 40 assembly (30). Of course, shaft assembly (30) may have [0010] As shown in FIG. 1, handle assembly (20) of a variety of other components, features, and operabili- the present example comprises pistol grip (22), a closure ties, in addition to or in lieu of any of those noted above. trigger (24), and a firing trigger (26). Each trigger (24, 26) By way of example only, at least part of shaft assembly is selectively pivotable toward and away from pistol grip (30) is constructed in accordance with at least some of (22) as will be described in greater detail below. Handle 45 the teachings of U.S. Pub. No. 2014/0239038, entitled assembly (20) further includes a removable battery pack "Surgical Instrument with Multi-Diameter Shaft," pub- (28). These components will also be described in greater lished August 28, 2014. Other suitable configurations for detail below. Of course, handle assembly (20) may have shaft assembly (30) will be apparent to those of ordinary a variety of other components, features, and operabili- skill in the art in view of the teachings herein. ties, in addition to or in lieu of any of those noted above. 50 Other suitable configurations for handle assembly (20) B. Exemplary End Effector will be apparent to those of ordinary skill in the art in view of the teachings herein. [0014] As also shown in FIGS. 1-3, end effector (40) [0011] As shown in FIGS. 1-2, shaft assembly (30) of of the present example includes a lower jaw (50) and a the present example comprises an outer closure tube 55 pivotable anvil (60). Anvil (60) includes a pair of integral, (32), an articulation section (34), and a closure ring (36), outwardly extending pins (66) that are disposed in cor- which is further coupled with end effector (40). Closure responding curved slots (54) of lower jaw (50). Anvil (60) tube (32) extends along the length of shaft assembly (30). is pivotable toward and away from lower jaw (50) between

4 7 EP 3 162 388 B1 8 an open position (shown in FIG. 2) and a closed position through cartridge (70). For instance, when wedge sled (shown in FIG. 1). Use of the term "pivotable" (and similar (78) is in a proximal position, staple drivers (75) are in terms with "pivot" as a base) should not be read as nec- downward positions and staples (90) are located in staple essarily requiring pivotal movement about a fixed axis. pockets (74). As wedge sled (78) is driven to the distal For instance, in the present example, anvil (60) pivots 5 position by a translating knife member (80), wedge sled about an axis that is defined by pins (66), which slide (78) drives staple drivers (75) upwardly, thereby driving along curved slots (54) of lower jaw (50) as anvil (60) staples (90) out of staple pockets (74) and into staple moves toward lower jaw (50). In such versions, the pivot forming pockets (64) that are formed in the underside axis translates along the path defined by slots (54) while (65) of anvil (60). Thus, staple drivers (75) translate along anvil (60) simultaneously pivots about that axis. In addi- 10 a vertical dimension as wedge sled (78) translates along tion or in the alternative, the pivot axis may slide along a horizontal dimension. slots (54) first, with anvil (60) then pivoting about the pivot [0018] In some versions, staple cartridge (70) is con- axis after the pivot axis has slid a certain distance along structed and operable in accordance with at least some the slots (54). It should be understood that such slid- of the teachings of U. U.S. Pub. No. 2014/0239042, en- ing/translating pivotal movement is encompassed within 15 titled "Integrated Tissue Positioning and Jaw Alignment terms such as "pivot," "pivots," "pivotal," "pivotable," "piv- Features for Surgical Stapler," published August 28, oting," and the like. Of course, some versions may pro- 2014. In addition or in the alternative, staple cartridge vide pivotal movement of anvil (60) about an axis that (70) may be constructed and operable in accordance with remains fixed and does not translate within a slot or chan- at least some of the teachings of U.S. Pub. No. nel, etc. 20 2014/0239044, entitled "Installation Features for Surgi- [0015] As best seen in FIG. 3, lower jaw (50) of the cal Instrument End Effector Cartridge," published August present example defines a channel (52) that is configured 28, 2014. Other suitable forms that staple cartridge (70) to receive a staple cartridge (70). Staple cartridge (70) may take will be apparent to those of ordinary skill in the may be inserted into channel (52), end effector (40) may art in view of the teachings herein. be actuated, and then staple cartridge (70) may be re- 25 [0019] As best seen in FIG. 2, anvil (60) of the present moved and replaced with another staple cartridge (70). example comprises a longitudinally extending channel Lower jaw (50) thus releasably retains staple cartridge (62) and a plurality of staple forming pockets (64). Chan- (70) in alignment with anvil (60) for actuation of end ef- nel (62) is configured to align with channel (72) of staple fector (40). In some versions, lower jaw (50) is construct- cartridge (70) when anvil (60) is in a closed position. Each ed in accordance with at least some of the teachings of 30 staple forming pocket (64) is positioned to lie over a cor- U.S. Pub. No. 2014/0239044, entitled "Installation Fea- responding staple pocket (74) of staple cartridge (70) tures for Surgical Instrument End Effector Cartridge," when anvil (60) is in a closed position. Staple forming published August 28, 2014. Other suitable forms that low- pockets (64) are configured to deform the legs of staples er jaw (50) may take will be apparent to those of ordinary (90) when staples (90) are driven through tissue and into skill in the art in view of the teachings herein. 35 anvil (60). In particular, staple forming pockets (64) are [0016] As best seen in FIGS. 2-3, staple cartridge (70) configured to bend the legs of staples (90) to secure the of the present example comprises a cartridge body (71) formed staples (90) in the tissue. Anvil (60) may be con- and a tray (76) secured to the underside of cartridge body structed in accordance with at least some of the teachings (71). The upper side of cartridge body (71) presents a of U.S. Pub. No. 2014/0239042, entitled "Integrated Tis- deck (73), against which tissue may be compressed 40 sue Positioning and Jaw Alignment Features for Surgical when anvil (60) is in a closed position. Cartridge body Stapler," published August 28, 2014; at least some of the (71) further defines a longitudinally extending channel teachings of U.S. Pub. No. 2014/0239036, entitled "Jaw (72) and a plurality of staple pockets (74). A staple (90) Closure Feature for End Effector of Surgical Instrument," is positioned in each staple pocket (74). A staple driver published August 28, 2014; and/or at least some of the (75) is also positioned in each staple pocket (74), under- 45 teachings of U.S. Pub. No. 2014/0239037, entitled "Sta- neath a corresponding staple (90), and above tray (76). ple Forming Features for Surgical Stapling Instrument," As will be described in greater detail below, staple drivers published August 28, 2014. Other suitable forms that an- (75) are operable to translate upwardly in staple pockets vil (60) may take will be apparent to those of ordinary skill (74) to thereby drive staples (90) upwardly through staple in the art in view of the teachings herein. pockets (74) and into engagement with anvil (60). Staple 50 [0020] In the present example, a knife member (80) is drivers (75) are driven upwardly by a wedge sled (78), configured to translate through end effector (40). As best which is captured between cartridge body (71) and tray seen in FIG. 3, knife member (80) is secured to the distal (76), and which translates longitudinally through car- end of a firing beam (82), which extends through a portion tridge body (71). of shaft assembly (30). As best seen in FIG. 2, knife mem- [0017] Wedge sled (78) includes a pair of obliquely an- 55 ber (80) is positioned in channels (62, 72) of anvil (60) gled cam surfaces (79), which are configured to engage and staple cartridge (70). Knife member (80) includes a staple drivers (75) and thereby drive staple drivers (75) distally presented cutting edge (84) that is configured to upwardly as wedge sled (78) translates longitudinally sever tissue that is compressed between anvil (60) and

5 9 EP 3 162 388 B1 10 deck (73) of staple cartridge (70) as knife member (80) [0024] It should also be understood that any other com- translates distally through end effector (40). As noted ponents or features of instrument (10) may be configured above, knife member (80) also drives wedge sled (78) and operable in accordance with any of the various ref- distally as knife member (80) translates distally through erences cited herein. Additional exemplary modifications end effector (40), thereby driving staples (90) through 5 that may be provided for instrument (10) will be described tissue and against anvil (60) into formation. in greater detail below. Various suitable ways in which the below teachings may be incorporated into instrument C. Exemplary Actuation of End Effector (10) will be apparent to those of ordinary skill in the art. Similarly, various suitable ways in which the below teach- [0021] In the present example, anvil (60) is driven to- 10 ings may be combined with various teachings of the ref- ward lower jaw (50) by advancing closure ring (36) distally erences cited herein will be apparent to those of ordinary relative to end effector (40). Closure ring (36) cooperates skill in the art. It should therefore be understood that the with anvil (60) through a camming action to drive anvil teachings below may be readily incorporated into the var- (60) toward lower jaw (50) in response to distal translation ious instruments taught in the various references that are of closure ring (36) relative to end effector (40). Similarly, 15 cited herein. It should also be understood that the below closure ring (36) may cooperate with anvil (60) to open teachings are not limited to instrument (10) or devices anvil (60) away from lower jaw (50) in response to prox- taught in the references cited herein. The below teach- imal translation of closure ring (36) relative to end effector ings may be readily applied to various other kinds of in- (40). By way of example only, closure ring (36) and anvil struments, including instruments that would not be clas- (60) may interact in accordance with at least some of the 20 sified as surgical staplers. Various other suitable devices teachings of U.S. Pub. No. 2014/0239036, entitled "Jaw and settings in which the below teachings may be applied Closure Feature for End Effector of Surgical Instrument," will be apparent to those of ordinary skill in the art in view published August 28, 2014; and/or in accordance with at of the teachings herein. least some of the teachings of U.S. Patent App. No. 14/314,108, entitled "Jaw Opening Feature for Surgical 25 II. Exemplary Buttress Assembly for Surgical Stapler Stapler," filed on June 25, 2014. [0022] As noted above, handle assembly (20) includes [0025] In some instances, it may be desirable to equip a pistol grip (22) and a closure trigger (24). As also noted end effector (40) with a buttress material to reinforce the above, anvil (60) is closed toward lower jaw (50) in re- mechanical fastening of tissue provided by staples (90). sponse to distal advancement of closure ring (36). In the 30 Such a buttress may prevent the applied staples (90) present example, closure trigger (24) is pivotable toward from pulling through the tissue and may otherwise reduce pistol grip (22) to drive closure tube (32) and closure ring a risk of tissue tearing at or near the site of applied staples (36) distally. Various suitable components that may be (90). In addition to or as an alternative to providing struc- used to convert pivotal movement of closure trigger (24) tural support and integrity to a line of staples (90), a but- toward pistol grip (22) into distal translation of closure 35 tress may provide various other kinds of effects such as tube (32) and closure ring (36) relative to handle assem- spacing or gap-filling, administration of therapeutic bly (20) will be apparent to those of ordinary skill in the agents, and/or other effects. In some instances, a but- art in view of the teachings herein. tress may be provided on deck (73) of staple cartridge [0023] Also in the present example, instrument (10) (70). In some other instances, a buttress may be provided provides motorized control of firing beam (82). In partic- 40 on the surface of anvil (60) that faces staple cartridge ular, instrument (10) includes motorized components that (70). It should also be understood that a first buttress are configured to drive firing beam (82) distally in re- may be provided on deck (73) of staple cartridge (70) sponse to pivoting of firing trigger (26) toward pistol grip while a second buttress is provided on anvil (60) of the (22). In some versions, a motor (not shown) is contained same end effector (40). Various examples of forms that in pistol grip (22) and receives power from battery pack 45 a buttress may take will be described in greater detail (28). This motor is coupled with a transmission assembly below. Various ways in which a buttress may be secured (not shown) that converts rotary motion of a drive shaft to a staple cartridge (70) or an anvil (60) will also be of the motor into linear translation of firing beam (82). By described in greater detail below. way of example only, the features that are operable to provide motorized actuation of firing beam (82) may be 50 A. Exemplary Composition of Buttress Assembly for Sur- configured and operable in accordance with at least gical Stapler some of the teachings of U.S. Pat. No. 8,210,411, entitled "Motor-Driven Surgical Instrument," issued July 3, 2012; [0026] FIG. 4 shows an exemplary pair of buttress as- U.S. Pat. No. 8,453,914, entitled "Motor-Driven Surgical semblies (100, 110) with a basic composition. Buttress Cutting Instrument with Electric Actuator Directional Con- 55 assembly (100) of this example comprises a buttress trol Assembly," issued June 4, 2013; and/or U.S. Patent body (102) and an upper adhesive layer (104). Similarly, App. No. 14/226,142, entitled "Surgical Instrument Com- buttress assembly (110) comprises a buttress body (112) prising a Sensor System," filed March 26, 2014. and a lower adhesive layer (114). In the present example,

6 11 EP 3 162 388 B1 12 each buttress body (102, 112) comprises a strong yet 2013/0082086, entitled "Attachment of Surgical Staple flexible material configured to structurally support a line Buttress to Cartridge," published April 4, 2013; U.S. Pat- of staples (90). By way of example only, each buttress ent Pub. No. 2013/0037596, entitled "Device for Applying body (102, 112) may comprise a woven mesh of poly- Adjunct in Endoscopic Procedure," published February glactin 910 material by Ethicon, Inc. of Somerville, New 5 14, 2013; U.S. Patent Pub. No. 2013/0062393, entitled Jersey. Alternatively, any other suitable materials or com- "Resistive Heated Surgical Staple Cartridge with Phase binations of materials may be used in addition to or as Change Sealant," published March 14, 2013; U.S. Patent an alternative to polyglactin 910 material to form each Pub. No. 2013/0075446, entitled "Surgical Staple As- buttress body (102, 112). Each buttress body (102, 112) sembly with Hemostatic Feature," published March 28, may take any other suitable form and may be constructed 10 2013; U.S. Patent Pub. No. 2013/0062394, entitled "Sur- of any other suitable material(s). By way of further exam- gical Staple Cartridge with Self-Dispensing Staple But- ple only, each buttress body (102, 112) may comprise tress," published March 14, 2013; U.S. Patent Pub. No. one or more of the following: NEOVEIL absorbable PGA 2013/0075445, entitled "Anvil Cartridge for Surgical Fas- felt by Gunze Limited, of Kyoto, Japan; SEAMGUARD tening Device," published March 28, 2013; U.S. Patent polyglycolic acid:trimethylene carbonate (PGA:TMC) re- 15 Pub. No. 2013/0075447, entitled "Adjunct Therapy for inforcement material by W.L. Gore & Associates, Inc., of Applying Hemostatic Agent," published March 28, 2013; Flagstaff, Arizona; PERI-STRIPS DRY with VERITAS U.S. Patent Pub. No. 2013/0256367, entitled "Tissue Collagen Matrix (PSDV) reinforcement material, by Bax- Thickness Compensator Comprising a Plurality of Med- ter Healthcare Corporation of Deerfield, Illinois; BIODE- icaments," published October 3, 2013; U.S. Patent Ap- SIGN biologic graft material by Cook Medical, Blooming- 20 plication No. 14/300,954, entitled "Adjunct Materials and ton, Indiana; and/or SURGICEL NU-KNIT hemostat ma- Methods of Using Same in Surgical Methods for Tissue terial by Ethicon, Inc. of Somerville, New Jersey. Still oth- Sealing," filed June 10, 2014; U.S. Patent App. No. er suitable materials that may be used to form each but- 14/827,856, entitled "Implantable Layers for a Surgical tress body (102, 112) will be apparent to those of ordinary Instrument," filed August 17, 2015; U.S. Patent Applica- skill in the art in view of the teachings herein. 25 tion No. 14/840,613, entitled "Drug Eluting Adjuncts and [0027] In addition or in the alternative, each buttress Methods of Using Drug Eluting Adjuncts," filed August body (102, 112) may comprise a material including, for 31, 2015; U.S. Patent App. No. 14/871,071, entitled example, a hemostatic agent such as fibrin to assist in "Compressible Adjunct with Crossing Spacer Fibers," coagulating blood and reduce bleeding at the severed filed September 30, 2015; and/or U.S. Patent App. No. and/or stapled surgical site along tissue (90). As another 30 14/871,131, entitled "Method for Applying an Implantable merely illustrative example, each buttress body (102, Layer to a Fastener Cartridge," filed September 30, 2015. 112) may comprise other adjuncts or hemostatic agents [0029] In the present example, adhesive layer (104) is such as thrombin may be used such that each buttress provided on buttress body (102) in order to adhere but- body (102, 112) may assist to coagulate blood and re- tress body (102) to underside (65) of anvil (60). Similarly, duce the amount of bleeding at the surgical site. Other 35 adhesive layer (114) is provided on buttress body (112) adjuncts or reagents that may be incorporated into each in order to adhere buttress body (112) to deck (73) of buttress body (102, 112) may further include but are not staple cartridge (70). Adherence of the buttress body limited to medical fluid or matrix components. Merely il- (102) to underside (65) of anvil (60) or to deck (73) of lustrative examples of materials that may be used to form staple cartridge (70) can occur through a variety of mech- each buttress body (102, 112), as well as materials that 40 anisms including but not limited to a pressure sensitive may be otherwise incorporated into each buttress body adhesive. In some versions, each adhesive layer (104, (102, 112), are disclosed in U.S. Patent App. No. 114) comprise a pressure sensitive adhesive material. 14/667,842, entitled "Method of Applying a Buttress to a Examples of various suitable materials that may be used Surgical Stapler," filed March 25, 2015. Alternatively, any to form adhesive layers (104, 114) are disclosed in U.S. other suitable materials may be used. 45 Patent App. No. 14/667,842, entitled "Method of Applying [0028] By way of further example only, each buttress a Buttress to a Surgical Stapler," filed March 25, 2015. body (102, 112) may be constructed in accordance with Alternatively, any other suitable materials may be used. at least some of the teachings of U.S. Patent Pub. No. It should be understood that the term "adhesive," as used 2012/0241493, entitled "Tissue Thickness Compensator herein, may include (but is not limited to) tacky materials Comprising Controlled Release and Expansion," pub- 50 and also materials that are pliable or wax-like and adhere lished September 27, 2012; U.S. Patent Pub. No. to a complex geometry via deformation and conform- 2013/0068816, entitled "Surgical Instrument and But- ance. Some suitable adhesives may provide such plia- tress Material," published March 21, 2013; U.S. Patent bility to adhere to a complex geometry via deformation Pub. No. 2013/0062391, entitled "Surgical Instrument and conformance without necessarily providing a high with Fluid Fillable Buttress," published March 14, 2013; 55 initial tack. In some instances, adhesives with lower tack- U.S. Patent Pub. No. 2013/0068820, entitled "Fibrin Pad iness may be removed more cleanly from surfaces. Var- Matrix with Suspended Heat Activated Beads of Adhe- ious suitable materials that may be used to form adhesive sive," published March 21, 2013; U.S. Patent Pub. No. layers (104, 114) will be apparent to those of ordinary

7 13 EP 3 162 388 B1 14 skill in the art in view of the teachings herein. mains secured to a respective severed region of tissue (T1, T2). B. Exemplary Materials and Techniques for Providing Ad- [0033] In the foregoing example, buttress assembly hesion of Buttress to Surgical Stapler (100) is sized to span across the full width of underside 5 (65), such that buttress assembly (100) spans across [0030] As noted above, a buttress assembly (100, 110) channel (62). Thus, knife member (80) cuts through but- may include a layer (104, 114) of adhesive material (or tress assembly (100) during actuation of end effector (40) other form of adhesive material) that adheres buttress as described above. In some other examples, such as body (102, 112) to either underside (65) of anvil (60) or those described below, buttress assembly (100) is pro- deck (73) of staple cartridge (70). Such an adhesive ma- 10 vided in two separate, laterally spaced apart portions, terial may provide proper positioning of buttress body with one portion being disposed on underside (65) on (102, 112) before and during actuation of end effector one side of channel (62) and another portion being dis- (40); then allow buttress body (102, 112) to separate from posed on underside (65) on the other side of channel end effector (40) after end effector (40) has been actu- (62). In such versions, buttress assembly (100) does not ated, without causing damage to buttress body (102, 112) 15 span across channel (62), such that knife member (80) that is substantial enough to compromise the proper sub- does not cut through buttress assembly (100) during ac- sequent functioning of buttress body (102, 112). tuation of end effector (40). [0031] FIGS. 5A-5C show a sequence where an end [0034] Likewise, buttress assembly (110) may be sized effector (40) that has been loaded with buttress assem- to span across the full width of deck (73), such that but- blies (100, 110) is actuated to drive staples (90) through 20 tress assembly (110) spans across channel (72), and two apposed layers of tissue (T1, T2), with buttress as- such that knife member (80) cuts through buttress assemblies (100, 110) being secured to the same layers of sembly (110) during actuation of end effector (40) as de- tissue (T1, T2) by staples (90). In particular, FIG. 5A scribed above. Alternatively, buttress assembly (110) shows layers of tissue (T1, T2) positioned between anvil may be provided in two separate, laterally spaced apart (60) and staple cartridge (70), with anvil (60) in the open 25 portions, with one portion being disposed on deck (73) position. Buttress assembly (100) is adhered to the un- on one side of channel (72) and another portion being derside (65) of anvil (60) via adhesive layer (104); while disposed on deck (73) on the other side of channel (72), buttress assembly (110) is adhered to deck (73) of staple such that buttress assembly (110) does not span across cartridge (70) via adhesive layer (114). Layers of tissue channel (72), and such that knife member (80) does not 30 (T1, T2) are thus interposed between buttress assemblies cut through buttress assembly (110) during actuation of (100, 110). Next, trigger (24) is pivoted toward pistol grip end effector (40). (22) to drive closure tube (32) and closure ring (36) distally. This drives anvil (60) to the closed position as shown III. Exemplary Stretchable Buttress Assembly for Surgi- in FIG. 5B. At this stage, layers of tissue (T1, T2) are cal Stapler compressed between anvil (60) and staple cartridge (70), 35 with buttress assemblies (100, 110) engaging opposite [0035] In some instances, it may be desirable to equip surfaces of tissue layers (T1, T2). End effector (40) is then end effector (40) with a buttress assembly (100, 110) actuated as described above, driving staple (90) through comprising an adhesive layer (104, 114) in combination buttress assemblies (100, 110) and tissue (90). As shown with a buttress body (102, 112) that is constructed from in FIG. 5C, crown (92) of driven staple (90) captures and 40 an elastic material that is substantially stretchable in at retains buttress assembly (110) against layer of tissue least one direction and that will substantially recover its (T2). Deformed legs (94) of staple (90) capture and retain original shape. The resulting buttress assemblies (100, buttress assembly (100) against layer of tissue (T1). 110) may advantageously reinforce the mechanical fas- [0032] It should be understood that a series of staples tening of tissue provided by staples (90), while moving (90) will similarly capture and retain buttress assemblies 45 with, rather than restraining, the underlying tissue. Such (100, 110) against layers of tissue (T1, T2), thereby se- buttress assemblies (100, 110) may be particularly useful curing buttress assemblies (100, 110) to tissue (T1, T2) in applications in which the tissue that is fastened may as shown in FIG. 6. As end effector (40) is pulled away subsequently expand and/or contract. For example, from tissue (90) after deploying staples (90) and buttress stretchable buttress assemblies (100, 110) may be of assemblies (100, 110), buttress assemblies (100, 110) 50 use to reinforce the mechanical fastening of a collapsed disengage end effector), such that buttress assemblies lung that is then re-inflated, and expands and contracts (100, 110) remain secured to tissue (T1, T2) with staples with the lung during the breathing process. (90). Buttress tissue (T1, T2) thus provide structural re- [0036] In illustrative examples of stretchable buttress- inforcement to the lines of staples (90). As can also be es assemblies (100, 110), the buttress bodies (102, 112) seen in FIG. 6, knife member (80) also cuts through a 55 may comprise fibrous, planar fabric. "Fiber" as used here- centerline of buttress tissue assemblies (100, 110), sep- in means continuous fibers, which are sometimes re- arating each buttress assemblies (100, 110) into a cor- ferred to in the art as "substantially continuous filaments," responding pair of sections, such that each section re- "filaments," or "yarn," or staple fibers having an average

8 15 EP 3 162 388 B1 16 length that is sufficient so that the staple fibers may be to make stretchable buttress assemblies (100, 110) com- knitted and/or woven together. Fibers that are useful may prise fibers that are substantially aligned in one or more be selected from the group consisting of: monocompo- preferred directions, such as in the fabric’s machine di- nent fibers; multicomponent fibers; bicomponent fibers; rection, cross-machine direction, or combinations there- biconstituent fibers; and combinations thereof. 5 of. Useful fabrics may be distinguished from fabric that [0037] "Monocomponent fiber" as used herein, refers comprises fibers in random orientations, including but to a fiber formed from using one or more extruders from not limited to, melt blown, hydroentangled, and electro- only one polymer; this is not meant to exclude fibers spun fabrics. The following provides several merely illus- formed from one polymer to which small amounts of ad- trative examples of fiber arrangements that may be read- ditives have been added. Additives may be added to the 10 ily incorporated into buttress assemblies (100, 110). It polymer for the purposes of providing the resulting fiber should therefore be understood that the following teach- with coloration, antistatic properties, lubrication, hy- ings may be readily combined with the teachings above. drophilicity, and/or other properties. Monocomponent fibers may be multifilament or monofilament fibers. A. Exemplary Stretchable Buttress Assemblies that Do [0038] "Multicomponent fiber" as used herein, refers 15 Not Substantially Stretch Along the Longitudinal Axis of to a fiber formed from two or more different polymers that an End Effector are extruded from separate extruders and spun together to form one fiber. [0044] In some surgical applications, it may be desir- [0039] "Bicomponent fibers" are one type of multicom- able to utilize buttress assemblies (100, 110) comprising ponent fiber, and are formed from two different polymers. 20 buttress bodies (102, 112) that do not substantially Bicomponent fibers may sometimes be referred to in the stretch along the longitudinal axis (LA) of end effector art as "conjugate fibers." Bicomponent fibers may be (40) (along which the length of each buttress body (102, comprised of polymers that are substantially continuous- 112) runs); but that do stretch laterally along the plane ly positioned in distinct zones, both across the cross- defined by each buttress body (102, 112). In other words, section of the bicomponent fibers and along their length. 25 it may be desirable to provide buttress bodies (102, 112) Non-limiting examples of such bicomponent fibers in- that stretch along the dimension of the width of buttress clude, but are not limited to: sheath/core arrangements, bodies (102, 112). For example, a surgeon may wish to wherein one polymer is surrounded by another; side-by- staple an anatomical structure that is not intended to side arrangements; segmented pie arrangements; or stretch once fastened with an extensible staple line. How- even "islands-in-the-sea" arrangements. Each of the 30 ever, the surgeon may not wish to stop mid-surgery and aforementioned polymer arrangements is known in the exchange instrument (10) and/or shaft assembly (30). art of multicomponent (including bicomponent) fibers. By applying to the anatomical structure a buttress as- [0040] Bicomponent fibers can be splittable fibers. sembly (100, 110) that does not substantially stretch Such fibers are capable of being split lengthwise before along the longitudinal axis (LA) of end effector (40), the or during processing into multiple fibers with each of the 35 stretch of the staple line may be minimized or even elim- multiple fibers having a smaller cross-sectional dimen- inated. In an illustrative example, during a lobectomy, a sion than that of the original bicomponent fiber. Splittable surgeon may wish to apply an extensible staple line (e.g., fibers may provide softer fabrics due to their reduced as taught in U.S. Patent App. No. 14/498,145, entitled cross-sectional dimensions. "Method for Creating a Flexible Staple Line," filed Sep- [0041] "Biconstituent fibers" as used herein, refers to 40 tember 26, 2014; and/or U.S. Patent App. No. fibers which have been formed from at least two starting 14/498,070, entitled "Radically Expandable Staple Line," polymers extruded as a blend from the same extruder. filed September 26, 2014) to the lung parenchyma but Biconstituent fibers may have the various polymer com- apply a non-extensible staple line to the bronchus. In ponents arranged in relatively constantly positioned dis- such settings, the surgeon may apply an extensible sta- tinct zones across the cross-sectional area of the fiber, 45 ple line without buttress assembly (100, 110) to the pa- and the various polymers are usually not continuous renchyma; then apply an extensible staple line with but- along the entire length of the fiber. In the alternative, bi- tress assembly (100, 110) to the bronchus. The presence constituent fibers may comprise a blend, that may be of the applied, non-longitudinally-exensible buttress as- homogeneous or otherwise, of the at least two starting sembly (100, 110) will essentially convert an otherwise polymers. For example, a bicomponent fiber may be 50 extensible staple line into a non-extensible staple line as formed from starting polymers which differ only in molec- applied to the bronchus. ular weight. [0045] The following examples relate to various knit or [0042] Biconstituent fibers may form fibrils, which may woven configurations that may be provided in fabrics that begin and end at random along the length of the fiber. are used to form buttress bodies (102, 112). In the fol- Biconstituent fibers may sometimes be referred to as 55 lowing examples, such buttress assemblies (100, 110) multiconstituent fibers. comprise buttress bodies (102, 112) formed by planar [0043] In illustrative examples of stretchable buttress- fabric that is constructed from fibers that are substantially es assemblies (100, 110), planar fabrics that are useful unaligned with longitudinal axis (LA) of end effector (40).

9 17 EP 3 162 388 B1 18

1. Exemplary Buttress Assemblies Comprising Warp fabric, but may not be substantially stretchable in the ma- Knitted Planar Fabric chine direction of the fabric. In some instances, after the resulting planar fabric is stretched, it may substantially [0046] Planar fabric may comprise looped fiber struc- recover its original shape. tures that are obtained through warp knitting. In addition 5 [0050] Warp knitted planar fabric (750, 850) may be to being substantially stretchable in one direction, warp formed into buttress bodies (102, 112) such that the but- knitted fabrics may tend not to unravel or curl, particularly tress bodies (102, 112) will not substantially stretch along as compared to weft knitted fabrics (discussed below). longitudinal axis (LA) of end effector (40). However, such In some versions, planar fabric that is warp knitted com- buttress bodies (102, 112) may nevertheless stretch in prises fibers that are delivered to the fabric knitting zone 10 directions that are transverse to longitudinal axis (LA) of in parallel to each other and the edge of the fabric. The end effector (40) along the planes defined by buttress edge of the fabric is created as a result of the fibers being bodies (102, 112). Such buttress bodies (102, 112) may delivered in the fabric machine direction (i.e., the "shog") be useful when a surgeon wishes to staple an anatomical to form loops, the edge being formed by the fibers as structure that will naturally stretch in directions that are they move laterally. In addition to moving laterally across 15 transverse to longitudinal axis of the staple line. It may the machine direction, the fibers may move in front of also be beneficial to permit stretching in directions that and behind the fabric plane (i.e., the "swing") or between are transverse to longitudinal axis of the staple line in multiple fabric planes (as in a spacer fabric construction) cases where there is a series of staple lines arranged to connect stitches and form fabric loops. generally end-to-end, where the longitudinal axes of the [0047] In some examples, warp knitted planar fabric 20 staple lines are not perfectly aligned with each other. may preferably comprise monocomponent fibers that are either multi-filament or mono-filament and of relatively 2. Exemplary Buttress Assemblies Comprising Weft Knit- fine denier with a low denier per filament (DPF). In some ted Planar Fabric examples, both multifilament and monofilament fibers may be used in the same warp knit buttress body (102, 25 [0051] Planar fabric may comprise looped fiber struc- 112). In some examples, two or more monocomponent tures that are obtained through weft knitting. As com- fibers of different polymer compositions may be used to pared to warp knitted fabrics, weft knitted fabrics may by achieve desired buttress body (102, 112) properties. characterized by greater stretch and recoverability, and [0048] In some illustrative examples, the warp knitted may also be made utilizing fewer fiber spools, even a fabric is warp knitted using tricot and/or Raschel knitting 30 single fiber spool. In some versions, planar fabric that is machines using needle bed and guide bar configurations weft knitted comprises fibers that are delivered to the known to those skilled in the art, to provide a warp knitted fabric knitting zone in a horizontal, cross-machine and fabric comprising one or more knitted patterns. When circular direction. In some versions, the weft knitted fabric utilizing one or more of the aforementioned machines, is knitted in a ribbed pattern. the resulting warp knit fabric may be formed by a series 35 [0052] In some examples, weft knitted planar fabric of overlaps and underlaps which may be arranged in var- may preferably comprise monocomponent fibers that are ious combinations. In addition, or in the alternative, open either multifilament or monofilament and of relatively fine and closed stitches may be formed as a result of the average denier with a low average denier per filament direction of the overlaps and underlaps. Useful lapping (DPF). In some examples, both multifilament and mono- patterns include but are not limited to: pillar lap, 1&1 lap 40 filament fibers may be used in the same warp knit buttress (tricot lap), 2&1 lap, 3&1 lap, 4&1 lap, atlas lap and com- body (102, 112) construct. In some examples, two or binations thereof. Since some Raschel knitting machines more monocomponent fibers of different polymer com- comprise a greater number of guide bars than tricot knit- position may be used to achieve desired buttress body ting machines, they may provide for a greater number of (102, 112) properties. possible knitting patterns. In some examples in which 45 [0053] FIG. 8 is a diagram depicting an exemplary weft spacer fabrics are desired, a double needle bar Raschel knit planar fabric (850) that comprises fibers (851) knitted machine may be used such that a unique secondary knit- in a weft-insertion pattern using a Raschel knitting ma- ted fabric layer is being simultaneously produced and chine. As can be seen in FIG. 8, the fibers (851) zigzag connected to a first fabric layer. along the cross-machine direction of the fabric to connect [0049] FIG. 7 is a diagram depicting a knit pattern of 50 stitches and form fiber loops (852). The resulting planar an exemplary planar fabric (750) that comprises fibers fabric (850) may be substantially stretchable in the cross- (751) knitted in a tricot pattern using two guide bars, al- machine direction of the fabric, but may not be substan- though up to four guide bars could be utilized to increase tially stretchable in the machine direction of the fabric. In the complexity of the tricot pattern. As can be seen in some instances, after the resulting planar fabric is FIG. 7, fibers (751) zigzag along the cross-machine di- 55 stretched, it may substantially recover its original shape. rection of the fabric to connect stitches and form fiber [0054] FIG. 9 is a diagram depicting a knit pattern of loops (752). The resulting planar fabric may be substan- another exemplary planar fabric (950) that comprises fib- tially stretchable in the cross-machine direction of the ers (951) knitted in a weft pattern. As can be seen in FIG.

10 19 EP 3 162 388 B1 20

9, each fiber loop (952) is formed from the previous fiber stantially stable in both the machine direction (MD) and loop (952). The resulting planar fabric (950) may be char- cross-machine direction (CD), unless the weft fibers acterized by stretchability in the cross-machine direction (1051b) are elastomeric, in which case, the resulting pla- of the fabric and good recoverability of its original shape. nar fabric (1050) will substantially stretch in the cross [0055] Weft knitted planar fabrics (950) may be formed 5 machine direction (CD). In other words, if the weft fibers into buttress bodies (102, 112) such that the buttress (1051b) are elastomeric, the stretch axis (SA) of the pla- bodies (102, 112) will not substantially stretch along lon- nar fabric (1050) may be perpendicular to its machine gitudinal axis (LA) of end effector (40). However, such direction (MD). In some versions, the planar fabric (1050) buttress bodies (102, 112) may nevertheless stretch in may substantially recover its original shape after it has directions that are transverse to longitudinal axis (LA) of 10 been stretched. In still other variations of the planar fabric end effector (40) along the planes defined by buttress (1050) depicted in FIG. 10, a non-elastic fiber is wrapped bodies (102, 112). Such buttress bodies (102, 112) may around an elastic fiber to form a coil-like spring around be useful when a surgeon wishes to staple an anatomical a stretchable center. The resulting combination of fibers structure that will naturally stretch in directions that are may then be used as the weft fibers (1051b) that are laid transverse to longitudinal axis of the staple line. It may 15 in to form the design and connect the columns of pillars also be beneficial to permit stretching in directions that of warp fibers (1051a) together as shown in FIG. 10. are transverse to longitudinal axis of the staple line in [0060] An illustrative example of the stretchability of cases where there is a series of staple lines arranged woven planar fabric is depicted in FIG. 11. In particular, generally end-to-end, where the longitudinal axes of the a woven planar fabric (1150) comprises warp fibers staple lines are not perfectly aligned with each other. 20 (1151a) and weft fibers (1151b) that intersect at angles of about 90°. The woven planar fabric (1150) is oriented 3. Exemplary Buttress Assemblies Comprising Woven in such a way that the longitudinal axis of the fabric (1150) Planar Fabric is at about an angle of 45° relative to the warp fibers (1151a) and weft fibers (1151b). When the planar fabric [0056] Planar fabric may comprise woven fiber struc- 25 is in its unstretched or relaxed state (1150a), the warp tures. Woven fiber structures comprise crossed warp and fibers and weft fibers intersect at a first angle, A1, and weft fibers. The warp and weft fibers are perpendicular the fabric is characterized by a first width, W1, and first to each other, such that they intersect at about a 90° length, L1. When the planar fabric is in its stretched state angle. (1150b), the warp fibers and weft fibers intersect at a 30 [0057] In some examples, woven fiber structures may second angle, A2, which is greater than A1, but which is preferably comprise monocomponent fibers that are ei- still not equal to 90°. In addition, when the planar fabric ther multifilament or monofilament and of relatively fine is in its stretched state (1150b), it is further characterized denier with a low denier per filament (DPF). In some ex- by a width, W2, that is greater than W1, and a length, L2 amples, both multifilament and monofilament fibers may that is greater than L1. When forces that cause the planar be used in the same warp knit buttress body (102, 112) 35 fabric to be in its stretched state (1150b) are removed, construct. In some examples, two or more monocompo- the planar fabric may substantially return to its relaxed nent fibers of different polymer composition may be used state (1150a), or to a state that is somewhere in between to achieve desired buttress body (102, 112) properties. the stretched state (1150a) and the relaxed state [0058] Useful planar fabrics may be woven in any pat- (1150b). tern that provides for substantial stretchability in at least 40 [0061] Woven planar fabric (1050, 1150) may be one direction and substantial recovery of the fabric’s orig- formed into a buttress body (102, 112) such that the pla- inal shape after being stretched. By way of example only, nar fabric that does not substantially stretch along longi- the planar fabric may be woven in a pattern selected from tudinal axis (LA) of end effector (40). However, such but- the group consisting of: twill weave; plain weave; and tress bodies (102, 112) may nevertheless stretch in di- combinations thereof. In further examples, planar fabric 45 rections that are transverse to longitudinal axis (LA) of may comprise more than one woven pattern, indeed end effector (40) along the planes defined by buttress while the twill pattern, plain weave pattern, etc. comprise bodies (102, 112). Such buttress bodies (102, 112) may basic arrangements of warp and fill yarns, any number be useful when a surgeon wishes to staple an anatomical of desirable designs can be produced by altering the lo- structure that will naturally stretch in directions that are cation and frequency of interlacing. 50 transverse to longitudinal axis of the staple line. It may [0059] FIG. 10 is a diagram depicting an exemplary also be beneficial to permit stretching in directions that planar fabric (1050) having a Raschel weft-insertion pat- are transverse to longitudinal axis of the staple line in tern of fibers. Planar fabric (1050) comprises warp fibers cases where there is a series of staple lines arranged (1051a) that have been formed into columns of pillars generally end-to-end, where the longitudinal axes of the produced by interlooping the warp fibers (1051a) to form 55 staple lines are not perfectly aligned with each other. a chain stitch, and by laying in weft fibers (1051b) to con- [0062] An illustrative example of a buttress body (1202) nect the columns of pillars together and form the fabric that comprises the woven planar fabric (1150) of FIG. 11 design. The resulting planar fabric (1050) may be sub- is shown in FIG. 12. The buttress body (1202) is shown

11 21 EP 3 162 388 B1 22 in a both a relaxed state (1202a) and a stretched state selected from the group consisting of: poly(caprolac- (1202b). tone)-co-poly(glycolide) (PCL/PGA); poly(caprolactone)-co-poly(lactide) (PCL/PLA); poly(lactide)-co-tri- B. Exemplary Stretchable Buttress Assemblies that Sub- methylene carbonate (PCL/TMC); and combinations stantially Stretch Along the Longitudinal Axis of an End 5 thereof. Effector [0066] In some examples, the elastic fibers comprising either multifilament or monofilament fibers (depending [0063] In some other surgical applications, it may be on the degree of fabric stiffness, strength and elongation desirable to utilize buttress assemblies (100, 110) com- that is desired) may be utilized. In some examples, the prising buttress bodies (102, 112) that do stretch along 10 elastic fibers are bicomponent fibers comprising non- the longitudinal axis (LA) of end effector (40); but that do elastic fibers that are wrapped around elastic fibers to not substantially stretch laterally along the plane defined form a coil-like spring around a stretchable center. Planar by each buttress body (102, 112). In other words, it may fabric comprising elastic fibers may be formed into a but- be desirable to provide buttress bodies (102, 112) that tress body (102, 112) such that the planar fabric that sub- stretch along the dimension of the length of buttress bod- 15 stantially stretches along the longitudinal axis (LA) of end ies (102, 112). Referring back to the example of a lung effector (40). lobectomy, the lung may be in a collapsed state when [0067] In addition to the foregoing, it should also be the surgeon actuates end effector (40) on the parenchy- understood that any of the various buttress assemblies ma of the lung. When the lung is later reinflated, the re- described herein may be further constructed and opera- sulting expansion of the lunch will apply tension in the 20 ble in accordance with at least some of the teachings of parenchyma, thereby providing extension along the sta- U.S. Patent App. No. 14/667,842, entitled "Method of Ap- ple line. An extensible staple line (e.g., as taught in U.S. plying a Buttress to a Surgical Stapler," filed March 25, Patent App. No. 14/498,145, entitled "Method for Creat- 2015. ing a Flexible Staple Line," filed September 26, 2014; and/or U.S. Patent App. No. 14/498,070, entitled "Radi- 25 IV. Exemplary Combinations cally Expandable Staple Line," filed September 26, 2014) may thus accommodate such extension. In settings Example 1 where the surgeon wishes for that staple line to be rein- forced by a buttress assembly (100, 110), that buttress [0068] A stretchable buttress assembly associated assembly (100, 110) may need to be extensible along 30 with surgical staples deployable into tissue from a surgi- the longitudinal axis in order to accommodate the expan- cal stapler having a longitudinal axis, the buttress assem- sion of the lung during reinflation. Otherwise, a non-ex- bly comprising: (a) a planar fabric having a first side and tensible buttress assembly (100, 110) may create stress a second side opposite the first side, the planar fabric at the staple line during reinflation, possibly tearing tis- comprising fibers that are either: (i) substantially una- sue, compromising the integrity of the staple line, result- 35 ligned with the longitudinal axis of the surgical stapler, or ing in leaks, and/or providing other adverse results. Thus, (ii) substantially aligned with the longitudinal axis of the buttress bodies (102, 112) that substantially stretch along surgical stapler; and (b) bioabsorbable adhesive, where- the longitudinal axis (LA) of end effector (40) may be in the bioabsorbable adhesive is applied to the first side needed. and/or the second side of the planar fabric and is config- [0064] In some versions, the stretchability of the but- 40 ured to adhere the stretchable buttress assembly to an tress bodies (100, 110) may be manipulated based upon end effector of the surgical stapler; wherein the buttress the choice of fiber material, the orientation of the fibers, assembly is substantially stretchable in one direction. tension on the fibers during fabric production, and combinations thereof. Orientation of the fibers may refer to Example 2 the way that warp fibers are threaded through the needles 45 (called the threading pattern - each guide bar can be fully [0069] The stretchable buttress assembly of Example threaded or partially threaded), which can affect the den- 1, wherein the planar fabric comprises fibers that are sub- sity of the fabric and therefore its extensibility. In warp stantially unaligned with the longitudinal axis of the sur- and weft knit constructs, elasticity or "stretchability" of gical stapler, wherein the planar fabric is selected from the fabric may be impacted by the tension on both the 50 the group consisting of: warp knitted fabric; weft knitted fiber systems and the fabric (being taken up onto a roll fabric; woven fabric; and combinations thereof. after knitting) during the fabric forming process. Tension may impact the size of the loops that are formed. Slight Example 3 adjustments in tension and the resulting impact on fiber loop size may allow for more extensibility and recovery. 55 [0070] The stretchable buttress assembly of any one [0065] Elastic fibers may be utilized in the construction or more of Examples 1 through 2, wherein the fibers are of the planar fabric. By way of example only, the planar monocomponent fibers selected from the group consist- fabric may comprise elastic fibers made from copolymers ing of: multi-filament monocomponent fibers; mono-fila-

12 23 EP 3 162 388 B1 24 ment monocomponent fibers; and combinations thereof. axis and comprising an end effector, the end effector comprising an anvil and staple cartridge, the method Example 4 comprising the steps of: providing a stretchable buttress assembly comprising: a planar fabric having a first side [0071] The stretchable buttress assembly of any one 5 and a second side opposite the first side and comprising or more of Examples 1 through 3, wherein the fabric is fibers that are either: substantially unaligned with the lon- woven fabric and is woven in a pattern selected from the gitudinal axis of the surgical stapler, or (B) substantially group consisting of: twill; plain weave; and combinations aligned with the longitudinal axis of the surgical stapler, thereof. and (ii) bioabsorbable adhesive, wherein the bioabsorb- 10 able adhesive is applied to the first side and/or second Example 5 side of the planar fabric and is configured to adhere the stretchable buttress assembly to the anvil or staple car- [0072] The stretchable buttress assembly of any one tridge; (b) adhering the stretchable buttress assembly to or more of Examples 1 through 4, wherein the fabric is the anvil or to the staple cartridge; (c) engaging the issue warp knitted fabric comprising lapping patterns selected 15 between the anvil and the staple cartridge of the end from the group consisting of: pillar lap; 1&1 lap (tricot effector; (d) deploying the staples from the staple car- lap); 2&1 lap; 3&1 lap; 4&1 lap; atlas lap; and combina- tridge through the stretchable buttress assembly and tis- tions thereof. sue; and (e) disengaging the end effector such that the stretchable buttress assembly remains secured to the Example 6 20 tissue by the staples.

[0073] The stretchable buttress assembly of any one Example 11 or more of Examples 1 through 5, wherein the planar fabric comprises fibers that are substantially aligned with [0078] The method of Example 10, wherein the planar the longitudinal axis of the surgical stapler. 25 fabric comprises fibers that are substantially unaligned with the longitudinal axis of the surgical stapler, wherein Example 7 the planar fabric is selected from the group consisting of: warp knitted fabric; weft knitted fabric; woven fabric; and [0074] The stretchable buttress assembly of any one combinations thereof. or more of Examples 1 through 6, wherein the planar 30 fabric comprises elastic fibers made from co-polymers Example 12 selected from the group consisting of: poly(caprolactone)-co-poly(glycolide) (PCL/PGA); poly(caprolac- [0079] The method of any one or more of Examples tone)-co-poly(lactide) (PCL/PLA); poly(lactide)-co-tri- 10 through 11, wherein the fibers are monocomponent methylene carbonate (PCL/TMC); and combinations 35 fibers selected from the group consisting of: multi-fila- thereof. ment monocomponent fibers; mono-filament monocomponent fibers; and combinations thereof. Example 8 Example 13 [0075] The stretchable buttress assembly of any one 40 or more of Examples 1 through 7, further comprising a [0080] The method of any one or more of Examples staple cartridge having a deck, wherein the planar fabric 10 through 12, wherein the fabric is woven fabric and is is secured to the deck of the staple cartridge via the bi- woven in a pattern selected from the group consisting of: oabsorbable adhesive. twill; plain weave; and combinations thereof. 45 Example 9 Example 14

[0076] The stretchable buttress assembly of Example [0081] The method of any one or more of Examples 8, wherein the deck includes a plurality of openings, 10 through 13, wherein the fabric is warp knitted fabric wherein the staple cartridge further comprises a plurality 50 comprising lapping patterns selected from the group con- of staples, wherein the staples are configured to pass sisting of: pillar lap; 1&1 lap (tricot lap); 2&1 lap; 3&1 lap; through the openings, wherein the planar fabric is posi- 4&1 lap; atlas lap; and combinations thereof. tioned over the openings. Example 15 Example 10 55 [0082] The method of any one or more of Examples [0077] A method of operating a surgical stapler to apply 10 through 14, wherein the planar fabric is configured to staples to tissue, the surgical stapler having a longitudinal stretch in directions transverse to the longitudinal axis of

13 25 EP 3 162 388 B1 26 the surgical stapler. V. Miscellaneous

Example 16 [0088] Various suitable ways in which the teachings herein may be combined will be readily apparent to those [0083] The method of any one or more of Examples 5 of ordinary skill in the art in view of the teachings herein. 10 through 15, wherein the planar fabric comprises elas- Such modifications and variations are intended to be in- tic fibers made from co-polymers selected from the group cluded within the scope of the claims. consisting of: poly(caprolactone)-co-poly(glycolide) [0089] In addition to the foregoing, it should also be (PCL/PGA); poly(caprolactone)-co-poly(lactide) understood that any of the various buttress assemblies (PCL/PLA); poly(lactide)-co-trimethylene carbonate 10 described herein may be further constructed and opera- (PCL/TMC); and combinations thereof. ble in accordance with at least some of the teachings of U.S. Patent App. No. 14/667,842, entitled "Method of Ap- Example 17 plying a Buttress to a Surgical Stapler," filed March 25, 2015; U.S. Patent App. No. 14/827,856, entitled "Implant- [0084] The method of any one or more of Examples 15 able Layers for a Surgical Instrument," filed August 17, 10 through 16, further comprising: (a) removing the staple 2015; U.S. Patent App. No. 14/871,071, entitled "Com- cartridge from the end effector; (b) securing a new staple pressible Adjunct with Crossing Spacer Fibers," filed cartridge in the end effector; and (c) adhering a new September 30, 2015; and U.S. Patent App. No. stretchable buttress assembly to the anvil or to the new 14/871,131, entitled "Method for Applying an Implantable staple cartridge. 20 Layer to a Fastener Cartridge," filed September 30, 2015. Furthermore, in addition to the methods described here- Example 18 in, any of the various buttress assemblies described herein may be applied to end effector (40) in accordance [0085] A stretchable buttress assembly for supple- with at least some of the teachings of U.S. Provisional menting the mechanical fastening of tissue by surgical 25 Patent App. No. 62/209,041, entitled "Method and Appa- staples deployable from a surgical stapler having a pri- ratus for Applying a Buttress to End Effector of a Surgical mary axis, the buttress assembly comprising: (a) a planar Stapler," filed August 24, 2015; and/or U.S. Patent App. fabric having a first side and a second side opposite the No. 14/871,131, entitled "Method for Applying an Im- first side, the planar fabric comprising fibers that are sub- plantable Layer to a Fastener Cartridge," filed September stantially unaligned with the primary axis of the surgical 30 30, 2015. Various suitable ways in which the teachings stapler, wherein the planar fabric is selected from the herein may be combined with various teachings of the group consisting of: warp knitted fabric; weft knitted fab- above-cited references will be apparent to those of ordi- ric; woven fabric; and combinations thereof; and (b) bio- nary skill in the art. absorbable adhesive, wherein the bioabsorbable adhe- [0090] Versions of the devices described above may sive is applied to the first side and/or second side of the 35 have application in conventional medical treatments and planar fabric and is configured to adhere the stretchable procedures conducted by a medical professional, as well buttress assembly to an end effector of the surgical sta- as application in robotic-assisted medical treatments and pler. procedures. By way of example only, various teachings herein may be readily incorporated into a robotic surgical Example 19 40 system such as the DAVINCI™ system by Intuitive Sur- gical, Inc., of Sunnyvale, California. Similarly, those of [0086] The stretchable buttress assembly of Example ordinary skill in the art will recognize that various teach- 18, wherein the fibers are monocomponent fibers select- ings herein may be readily combined with various teach- ed from the group consisting of: multi-filament monocom- ings of any of the following: U.S. Pat. No. 5,792,135, en- ponent fibers; mono-filament monocomponent fibers; 45 titled "Articulated Surgical Instrument For Performing and combinations thereof. Minimally Invasive Surgery With Enhanced Dexterity and Sensitivity," issued August 11, 1998; U.S. Pat. No. Example 20 5,817,084, entitled "Remote Center Positioning Device with Flexible Drive," issued October 6, 1998; U.S. Pat. [0087] The stretchable buttress assembly of any one 50 No. 5,878,193, entitled "Automated Endoscope System or more of Examples 18 through 19, wherein the planar for Optimal Positioning," issued March 2, 1999; U.S. Pat. fabric comprises elastic fibers made from co-polymers No. 6,231,565, entitled "Robotic Arm DLUS for Perform- selected from the group consisting of: poly(caprolac- ing Surgical Tasks," issued May 15,2001; U.S. Pat. No. tone)-co-poly(glycolide) (PCL/PGA); poly(caprolac- 6,783,524, entitled "Robotic Surgical Tool with Ultra- tone)-co-poly(lactide) (PCL/PLA); poly(lactide)-co-tri- 55 sound Cauterizing and Cutting Instrument," issued Au- methylene carbonate (PCL/TMC); and combinations gust 31, 2004; U.S. Pat. No. 6,364,888, entitled "Align- thereof. ment of Master and Slave in a Minimally Invasive Surgical Apparatus," issued April 2, 2002; U.S. Pat. No.

14 27 EP 3 162 388 B1 28

7,524,320, entitled "Mechanical Actuator Interface Sys- In one sterilization technique, the device is placed in a tem for Robotic Surgical Tools," issued April 28, 2009; closed and sealed container, such as a plastic or TYVEK U.S. Pat. No. 7,691,098, entitled "Platform Link Wrist bag. The container and device may then be placed in a Mechanism," issued April 6, 2010; U.S. Pat. No. field of radiation that can penetrate the container, such 7,806,891, entitled "Repositioning and Reorientation of 5 as gamma radiation, x-rays, or high-energy electrons. Master/Slave Relationship in Minimally Invasive Telesur- The radiation may kill bacteria on the device and in the gery," issued October 5, 2010; U.S. Pub. No. container. The sterilized device may then be stored in 2013/0012957, entitled "Automated End Effector Com- the sterile container for later use. A device may also be ponent Reloading System for Use with a Robotic System, sterilized using any other technique known in the art, in- published January 10, 2013; U.S. Pub. No. 10 cluding but not limited to beta or gamma radiation, eth- 2012/0199630, entitled "Robotically-Controlled Surgical ylene oxide, or steam. Instrument with Force-Feedback [0093] Having shown and described various embodi- Capabilities," published August 9, 2012; U.S. Pub. No. ments of the present invention, further adaptations of the 2012/0132450, entitled "Shiftable Drive Interface for Ro- methods and systems described herein may be accom- botically-Controlled Surgical Tool," published May 31, 15 plished by appropriate modifications by one of ordinary 2012; U.S. Pub. No. 2012/0199633, entitled "Surgical skill in the art without departing from the scope of the Stapling Instruments with Cam-Driven Staple Deploy- present invention. Several of such potential modifications ment Arrangements," published August 9, 2012; U.S. have been mentioned, and others will be apparent to Pub. No. 2012/0199631, entitled "Robotically-Controlled those skilled in the art. For instance, the examples, em- Motorized Surgical End Effector System with Rotary Ac- 20 bodiments, geometries, materials, dimensions, ratios, tuated Closure Systems Having Variable Actuation steps, and the like discussed above are illustrative and Speeds," published August 9, 2012; U.S. Pub. No. are not required. Accordingly, the scope of the present 2012/0199632, entitled "Robotically-Controlled Surgical invention should be considered in terms of the following Instrument with Selectively Articulatable End claims and is understood not to be limited to the details Effector," published August 9, 2012; U.S. Pub. No. 25 of structure and operation shown and described in the 2012/0203247, entitled "Robotically-Controlled Surgical specification and drawings. End Effector System," published August 9, 2012; U.S. Pub. No. 2012/0211546, entitled "Drive Interface for Op- erably Coupling a Manipulatable Surgical Tool to a Claims Robot," published August 23, 2012; U.S. Pub. No. 30 2012/0138660, entitled "Robotically-Controlled Cable- 1. A stretchable buttress assembly (100, 110) for use Based Surgical End Effectors," published June 7, 2012; with a surgical stapler (10) having a longitudinal axis, and/or U.S. Pub. No. 2012/0205421, the buttress assembly comprising: entitled "Robotically-Controlled Surgical End Effector System with Rotary Actuated Closure 35 (a) a buttress body (102) formed by a planar Systems," published August 16, 2012. fabric having a first side and a second side op- [0091] Versions of the devices described above may posite the first side, the planar fabric comprising be designed to be disposed of after a single use, or they fibers that are either: can be designed to be used multiple times. Versions may, in either or both cases, be reconditioned for reuse after 40 (i) substantially unaligned with the longitu- at least one use. Reconditioning may include any com- dinal axis of the surgical stapler, or bination of the steps of disassembly of the device, fol- (ii) substantially aligned with the longitudinal lowed by cleaning or replacement of particular pieces, axis of the surgical stapler; and and subsequent reassembly. In particular, some versions of the device may be disassembled, and any 45 (b) bioabsorbable adhesive (104), wherein the number of the particular pieces or parts of the device may bioabsorbable adhesive is provided on the first be selectively replaced or removed in any combination. side and/or the second side of the planar fabric Upon cleaning and/or replacement of particular parts, and is configured to adhere the stretchable but- some versions of the device may be reassembled for tress assembly to an end effector (40) of the subsequent use either at a reconditioning facility, or by 50 surgical stapler; a user immediately prior to a procedure. Those skilled in the art will appreciate that reconditioning of a device may wherein the buttress assembly is substantially utilize a variety of techniques for disassembly, clean- stretchable in one direction. ing/replacement, and reassembly. Use of such techniques, and the resulting reconditioned device, are all 55 2. The stretchable buttress assembly of claim 1, where- within the scope of the present application. in the planar fabric comprises fibers that are sub- [0092] By way of example only, versions described stantially unaligned with the longitudinal axis of the herein may be sterilized before and/or after a procedure. surgical stapler, wherein the planar fabric is selected

15 29 EP 3 162 388 B1 30

from the group consisting of: warp knitted fabric; weft eine erste Seite und eine zweite Seite gegenü- knitted fabric; woven fabric; and combinations there- ber der ersten Seite aufweist, wobei das eben- of. flächige Textilmaterial Fasern umfasst, die ent- weder: 3. The stretchable buttress assembly of claim 1 or claim 5 2, wherein the fibers are monocomponent fibers se- (i) im Wesentlichen nicht zur Längsachse lected from the group consisting of: multi-filament des chirurgischen Klammergeräts ausge- monocomponent fibers; mono-filament monocom- richtet sind, oder ponent fibers; and combinations thereof. (ii) im Wesentlichen zur Längsachse des 10 chirurgischen Klammergeräts ausgerichtet 4. The stretchable buttress assembly of any one of sind; und claims 1 to 3, wherein the fabric is woven fabric and is woven in a pattern selected from the group con- (b) einen bioresorbierbaren Klebstoff (104), wo- sisting of: twill; plain weave; and combinations there- bei der bioresorbierbare Klebstoff auf der ersten of. 15 Seite und/oder der zweiten Seite des ebenflä- chigen Textilmaterials vorgesehen ist und dazu 5. The stretchable buttress assembly of any one of ausgelegt ist, die dehnbare Versteifungsanord- claims 1 to 4, wherein the fabric is warp knitted fabric nung an einem Endeffektor (40) des chirurgi- comprising lapping patterns selected from the group schen Klammergeräts anzukleben; consisting of: pillar lap; 1&1 lap (tricot lap); 2&1 lap; 20 3&1 lap; 4&1 lap; atlas lap; and combinations there- wobei die Versteifungsanordnung im Wesentlichen of. in einer Richtung dehnbar ist.

6. The stretchable buttress assembly of claim 1, where- 2. Dehnbare Versteifungsanordnung nach Anspruch 1, in the planar fabric comprises fibers that are sub- 25 wobei das ebenflächige Textilmaterial Fasern um- stantially aligned with the longitudinal axis of the sur- fasst, die im Wesentlichen nicht zur Längsachse des gical stapler. chirurgischen Klammergeräts ausgerichtet sind, wobei das ebenflächige Textilmaterial aus der aus fol- 7. The stretchable buttress assembly of any one of genden bestehenden Gruppe ausgewählt ist: Ket- claims 1 to 6, wherein the planar fabric comprises 30 tengewirk; Kuliergewirk; Gewebe; und Kombinatio- elastic fibers made from co-polymers selected from nen davon. the group consisting of: poly(caprolactone)-co-poly(glycolide) (PCL/PGA); poly(caprolactone)-co-po- 3. Dehnbare Versteifungsanordnung nach Anspruch 1 ly(lactide) (PCL/PLA); poly(lactide)-co-trimethylene oder Anspruch 2, wobei die Fasern Einkomponen- carbonate (PCL/TMC); and combinations thereof. 35 tenfasern sind, die aus der aus folgenden bestehenden Gruppe ausgewählt sind: Multifilament-Einkom- 8. The stretchable buttress assembly of any one of ponentenfasern; Monofilament-Einkomponentenfa- claims 1 to 7, wherein the planar fabric is securable sern; und Kombinationen davon. to a deck (73) of a staple cartridge (70) via the bioabsorbable adhesive. 40 4. Dehnbare Versteifungsanordnung nach einem der Ansprüche 1 bis 3, wobei das Textilmaterial ein Ge- 9. The stretchable buttress assembly of claim 8, where- webe ist und in einem Muster gewebt ist, das aus in the deck includes a plurality of openings (74), der aus folgenden bestehenden Gruppe ausgewählt wherein the staple cartridge further comprises a plu- ist: Twill; Leinwandbindung; und Kombinationen da- rality of staples (90), wherein the staples are config- 45 von. ured to pass through the openings, wherein the planar fabric is positioned over the openings. 5. Dehnbare Versteifungsanordnung nach einem der Ansprüche 1 bis 4, wobei das Textilmaterial ein Ket- tengewirk ist, das Lapping-Muster umfasst, die aus Patentansprüche 50 der aus folgenden bestehenden Gruppe ausgewählt sind: Säulen- (Pillar-) Lap; 1&1 Lap (Trikot Lap); 2&1 1. Dehnbare Versteifungsanordnung (100, 110) zur Lap; 3&1 Lap; 4&1 Lap; Atlas Lap; und Kombinatio- Verwendung mit einem chirurgischen Klammergerät nen davon. (10), das eine Längsachse aufweist, wobei die Ver- steifungsanordnung das Folgende umfasst: 55 6. Dehnbare Versteifungsanordnung nach Anspruch 1, wobei das ebenflächige Textilmaterial Fasern um- (a) ein Versteifungskörper (102), der von einem fasst, die im Wesentlichen zur Längsachse des chi- ebenflächigen Textilmaterial gebildet wird, das rurgischen Klammergeräts ausgerichtet sind.

16 31 EP 3 162 388 B1 32

7. Dehnbare Versteifungsanordnung nach einem der 3. Ensemble renfort étirable selon la revendication 1 Ansprüche 1 bis 6, wobei das ebenflächige Textilm- ou la revendication 2, dans lequel les fibres sont des aterial elastische Fasern umfasst, die aus Copoly- fibres à un seul composant sélectionnées dans le meren gefertigt sind, die aus der folgenden Gruppe groupe constitué par : des fibres à un seul compo- ausgewählt sind: Poly(caprolacton)-co-poly(glyco- 5 sant multifilament ; des fibres à un seul composant lid) (PCL/PGA); Poly(caprolacton)-co-poly(lactid) monofilament ; et des combinaisons de ceux-ci. (PCL/PLA); Poly(lactid)-co-trimethylencarbonat (PCL/TMC); und Kombinationen davon. 4. Ensemble renfort étirable selon l’une quelconque des revendications 1 à 3, dans lequel le tissu est 8. Dehnbare Versteifungsanordnung nach einem der 10 tissé selon un motif choisi dans le groupe constitué Ansprüche 1 bis 7, wobei das ebenflächige Textilm- par : croisé ; armure toile ; et des combinaisons de aterial mittels des bioresorbierbaren Klebstoffs an ceux-ci. einem Deck (73) einer Klammerkassette (70) befes- tigbar ist. 5. Ensemble renfort étirable selon l’une quelconque 15 des revendications 1 à 4, dans lequel le tissu est un 9. Dehnbare Versteifungsanordnung nach Anspruch 8, tricot à mailles jetées comprenant des motifs en jeté wobei das Deck eine Vielzahl von Öffnungen (74) choisis dans le groupe consistant en : jeté chaînette ; aufweist, wobei die Klammerkassette ferner eine jeté 1&1 (jeté tricot) ; jeté 2&1 ; jeté 3&1 ; jeté 4&1 ; Vielzahl von Klammern (90) umfasst, wobei die jeté atlas ; et des combinaisons de ceux-ci. Klammern dazu ausgelegt sind, die Öffnungen zu 20 passieren, wobei das ebenflächige Textilmaterial 6. Ensemble renfort étirable selon la revendication 1, über den Öffnungen angeordnet ist. dans lequel le tissu plan comprend des fibres qui sont sensiblement alignées sur l’axe longitudinal de l’agrafeuse chirurgicale. Revendications 25 7. Ensemble renfort étirable selon l’une quelconque 1. Ensemble renfort étirable (100, 110) destiné à être des revendications 1 à 6, dans lequel le tissu plan utilisé avec une agrafeuse chirurgicale (10) possé- comprend des fibres élastiques fabriquées en copo- dant un axe longitudinal, l’ensemble renfort lymères choisis dans le groupe consistant en : po- comprenant : 30 ly(caprolactone)-co-poly(glycolide) (PCL/PGA) ; poly(caprolactone)-co-poly(lactide) (PCL/PLA) ; car- (a) un corps de renfort (102) formé par un tissu bonate de poly(lactide)-co-triméthylène plan possédant un premier côté et un second (PCL/TMC) ; et des combinaisons de ceux-ci. côté en regard du premier côté, le tissu plan comprenant des fibres qui sont soit : 35 8. Ensemble renfort étirable selon l’une quelconque des revendications 1 à 7, dans lequel le tissu plan (i) sensiblement non alignées sur l’axe lon- peut être fixé à un pont (73) d’une cartouche (70) gitudinal de l’agrafeuse chirurgicale, soit d’agrafes par l’intermédiaire de l’adhésif biorésorba- (ii) sensiblement alignées sur l’axe longitu- ble. dinal de l’agrafeuse chirurgicale ; et 40 9. Ensemble renfort étirable selon la revendication 8, (b) un adhésif biorésorbable (104), l’adhésif bio- dans lequel le pont comprend une pluralité d’ouver- résorbable étant disposé sur le premier côté tures (74), dans lequel la cartouche comprend en et/ou le second côté du tissu plan et étant conçu outre une pluralité d’agrafes (90), dans lequel les pour faire adhérer l’ensemble renfort étirable à 45 agrafes sont conçues pour passer à travers les un effecteur terminal (40) de l’agrafeuse ouvertures, dans lequel le tissu plan est positionné chirurgicale ; sur les ouvertures.

dans lequel l’ensemble renfort est sensiblement éti- rable dans une direction. 50

2. Ensemble renfort étirable selon la revendication 1, dans lequel le tissu plan comprend des fibres qui ne sont sensiblement pas alignées sur l’axe longitudinal de l’agrafeuse chirurgicale, dans lequel le tissu plan 55 est sélectionné dans le groupe constitué par : un tricot à mailles jetées ; un tricot à mailles cueillies ; un tissu ; et des combinaisons de ceux-ci.

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19 EP 3 162 388 B1

20 EP 3 162 388 B1

21 EP 3 162 388 B1

22 EP 3 162 388 B1

23 EP 3 162 388 B1

24 EP 3 162 388 B1

25 EP 3 162 388 B1

26 EP 3 162 388 B1

27 EP 3 162 388 B1

28 EP 3 162 388 B1

REFERENCES CITED IN THE DESCRIPTION

This list of references cited by the applicant is for the reader’s convenience only. It does not form part of the European patent document. Even though great care has been taken in compiling the references, errors or omissions cannot be excluded and the EPO disclaims all liability in this regard.

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