Abstract: A tissue thickness compensator comprising a first compensation layer, a second compensation layer, and a pocket situated between the compensation layers can be positioned in the end effector of a surgical instrument. A fastener cartridge positioned in the end effector can comprise a fastener moveable between an initial position and a fired position. When the fastener is moved from the initial position to the fired position, the fastener can move through the pocket and can compress a portion of the tissue thickness compensator. A support can be positioned between the first and second compensation layers. When the fastener compresses the tissue thickness compensator, at least one of the support, first compensation layer and second compensation layer can be deformed. The tissue thickness compensator can also comprise a tab and/or a limiting plate to control deformation of the compensation layers and/or the support.

Abstract: A surgical suturing system comprises a reusable shaft having a proximal end and a distal end, the distal end has a receiver and a rotary drive. A reusable actuator is connected to the proximal end of the shaft. A disposable cartridge is adapted to be attached to and detached from the receiver. The cartridge comprises an arced track, an arced needle positioned in the track having a leading end and a trailing end, a length of suture connected to the trailing end, a reciprocating needle driver operative to engage and move the needle in the arced circular track, and a transmission operatively connected to the needle driver having a rotary input adapted to couple to the rotary drive. The reusable shaft and actuator may be autoclavable.

Abstract: A device (100) includes a shaft (108), a coil (120), and a suture (106). The coil has a sharp tip (126) and is releasably coupled to the shaft. The suture is coupled to the coil and extends through the shaft.

Abstract: Described here are closure devices and methods for ligating tissue, such as the left atrial appendage. The closure devices may comprise a snare loop assembly comprising a snare and a suture loop releasably attached thereto. The snare may be releasable from an elongate body of the closure device. In some instances, the closure device may comprise one or more markers to allow a user to determine whether the snare loop assembly is twisted.

Abstract: An end effector for use with a surgical apparatus. The end effector comprising a staple cartridge having a tissue contacting surface defining a central longitudinal slot and an anvil plate having a tissue contacting surface defining a central longitudinal slot. A folded surgical buttress configured to overlie each of the tissue contacting surfaces of the staple cartridge and anvil plate and configured to retain the surgical buttress to the tissue contacting surfaces of each of the staple cartridge and anvil plate. The surgical buttress having a first longitudinal portion, a second longitudinal portion, and middle longitudinal portion between the first and second longitudinal portions, wherein the middle longitudinal portion is folded and configured to fit within the central longitudinal slot of each of the staple cartridge and anvil plate.

Abstract: In accordance with some embodiments of the present invention an automated injection device may be loaded with a standard type syringe and/or hypodermic needle. Optionally the syringe may be supplied loaded with medicine and/or covered with a sterile needle cover. The syringe may be loaded into the injector with in a sterile state with needle cover in place. Injector may include for example a fastener (for example an adhesive base). In some embodiments, the fastener may assist a user to hold injector steady on the skin of a patient for an extended period. For example, injector may be used to give injections of volume ranging between 0.5 and 3.0 ml over a time period ranging between 30 sec to 180 sec.

Abstract: The present disclosure provides annular support structures for use in conjunction with stapling devices. These annular support structures may be suitable for reducing occurrences of leaking, bleeding and/or stricture, as well as anastomotic tension, when anastomosing various body structures.

Abstract: A new and useful apparatus and method are provided for removing a foreign object from a rectal cavity. An anoscope is configured for insertion through the anus into a rectal cavity. The anoscope has a base and introducer with guides that route flexible members and a flexible sheath that are carried by actions of the operator through the anoscope beyond the guide and further into a rectal cavity and to expand about a foreign object in the rectal cavity. The anoscope also carries a noose that is manipulatable from outside the patient's rectal cavity to tighten and stricture the flexible sheath above the foreign object and capture the foreign object within the flexible sheath, so that the foreign object can be manipulated by the noose and the flexible sheath to remove the foreign object from the rectal cavity once the anoscope and flexible ribs are removed from the anus.

Abstract: The present disclosure relates to implantable medical devices which include at least one mesh and at least one film pivotably attached to the mesh.

Abstract: An apparatus for closing an opening in a body tissue. The apparatus includes a shaft, a plurality of arms, and an expander. The arms each extend between a proximal end and a distal end. The distal end of each arm is hingedly attached to or integrally formed with the shaft. The arms are laterally spaced apart from each other. The arms are movable between a retracted configuration, in which the arms are each aligned along the shaft, and a deployed configuration, in which the proximal end of each arm pivots respectively about the distal end of the arm so as to extend laterally away from the shaft. The expander is positioned within the shaft, and movement of the expander causes the arms to move between the retracted and deployed configurations. Methods of using the apparatus are also included.

Abstract: A surgical fastener applying instrument including a handle portion, an elongated portion, a pair of jaw members and a removable clamp. One of the jaw members contains a plurality of fasteners arranged in at least one row substantially transverse to a longitudinal axis of the elongated portion. At least one of the jaw members is movable with respect to the other between an open position and an approximated position for engaging body tissue therebetween. The removable clamp has an elongated member and a tissue clamping surface extending substantially transverse to a longitudinal axis of the elongated member. The clamp is movable from a proximal position to a distal position for engaging body tissue and is releasably mountable to the elongated portion of the instrument.

Abstract: A suture drive system configured to assist in attaching a suture to tissue within a patient, and in at least one application, repairing meniscal tears and shoulder tissue tears is disclosed. The suture drive system may be interchangeable in that the system can be adapted to insert different suture systems into tissue of a patient using the same device. In particular, in one embodiment configured to employ an inside-out suture delivery method, the suture drive system may advance two combinations of push rods and two swaged needles having one or more sutures attached thereto. In another embodiment configured to employ an outside-in suture delivery method, the suture drive system may advance two combinations of push rods and drive shafts to deliver two anchors releasably affixed to the distal ends of the drive shafts into tissue to close an opening in the tissue.

Abstract: A tissue thickness compensator can comprise a tissue contacting surface and a network of channels defined in the tissue contacting surface. In at least one embodiment, the channels can be configured to store at least one medicament therein. In certain embodiments, the channels can define gripping surfaces configured to grip tissue. In various embodiments, the tissue contacting surface can further comprise ridges extending therefrom.

Abstract: Stomach tissue is manipulated to form, for example, a restored flap of a gastroesophageal flap valve. The manipulation includes gripping stomach tissue from within the stomach while the stomach is inflated to promote visualization and stabilization of the gripped stomach tissue. Once the stomach tissue is gripped, the stomach is deflated and pulled into a mold. The molded tissue is then fastened with at least one fastener. The stomach is inflated to a first pressure during visualization and then to a second higher pressure during the stomach tissue gripping.

Abstract: A tool is described for deploying a sutureless vascular anastomosis connection, including a body, a sheath configured to house a connector, the connector being configured to couple a graft vessel to a main vessel, the sheath being removably coupled to a distal end of the body, a dial disposed on a proximal end of the body, a spring disposed within the body and coupled to the dial, a shaft extending from the distal end of the body into the sheath, the shaft having a shaft cannula, a plunger having a plunger head configured to be coupled with the spring at one end, the plunger coupled to the shaft at an opposite end, and a retractable needle coupled to the dial using a retraction mechanism, the retractable needle configured to fit within the shaft cannula, the retractable needle having a sharp end.

Abstract: A needle removal device is provided for removing needles from suturing systems. In an embodiment, the needle removal device may include a base member configured to be selectively positioned substantially adjacent a proximal portion of a suturing system. The proximal portion of the suturing system may include a plurality of needle lumens. The needle removal device may also include a plurality of needle receptacles at least partially defined by the base member. The needle receptacles may be positioned and configured to generally correspond to the needle lumens of the suturing system. The needle receptacles may be further configured to selectively receive and grasp onto one or more needles extending proximally from the needle lumens of the suturing system.

Abstract: An exemplary surgical method of treating tissue within the body of a patient, may include providing an endocutter having a knife, a staple holder along which the knife is slidable, feeder belts located on each side of the knife, staples having a first size, those staples integral with and breakable from at least one feeder belt, and staples having a second size different from the first size, those staples integral with and breakable from at least one feeder belt; engaging tissue of the patient with the staple holder; deploying at least two staples having a first size; disengaging tissue of the patient from the staple holder; once again engaging tissue of the patient with the same staple holder; and deploying at least two staples having a second size.

Abstract: A biopsy device includes a cutter defining a cutter lumen and a tissue sample holder for collecting tissue samples. In one example, the tissue sample holder includes a rotatable manifold, and has a plurality of chambers that are each configured to separately hold tissue samples. A tissue sample holder rotation mechanism is operable to rotate the manifold to successively align each of the chambers with the cutter lumen. A controller in communication with the rotation mechanism is configured to rotate the manifold to a presentation position to present a collected tissue sample within a chamber to a user (e.g., at an angular position approximately 90 degrees from the cutter lumen). The controller is further configured to rotate the manifold align the next, empty chamber with the cutter lumen in response to a user input instructing the biopsy device to obtain another tissue sample.

Abstract: Medical devices, systems and related methods for delivering a tissue anchor. The medical devices generally comprise a needle and a sheath that assist in retaining the tissue anchor at the distal end of the need during manipulation of the medical device. The medical systems include one or more tissue anchors in conjunction with one of the medical devices.

Abstract: A method for implanting a prosthetic valve apparatus in a novel location which replaces the function of a native diseased valve after an Alfieri procedure. The prosthetic valve apparatus includes a one way valve and an expandable valve seating. anchoring and securing apparatus in a newly created orifice near or at the center of the anterior valve leaflet. The prosthetic valve apparatus also causes the sealing of the native valve and thus results in a solution for paravalvular leakage and regurgitation.

Abstract: A single trigger system and associated method for manipulating tissues and anatomical or other structures in medical applications for the purpose of treating diseases or disorders or other purposes. In one aspect, the system includes a delivery device configured to deploy and implant anchor devices for such purposes.

Abstract: A method for treating rectal prolapse, the method comprising: inserting a rectum-gripping and advancement apparatus into a prolapsed rectum via the anus; maneuvering the rectum-gripping and advancement apparatus so that the rectum-gripping and advancement apparatus securely engages the rectum; advancing the rectum-gripping and advancement apparatus distally so as to return the prolapsed rectum to its normal, non-prolapsed state; and securing the rectum to supporting tissue whereby to retain the rectum in its normal, non-prolapsed state.

Abstract: A system and method for repairing a human heart uses a catheter with an extendable tip and multiple tissue fasteners. The catheter is advanced into a human heart with the extendable tip adjacent a first tissue portion. The extendable tip is extended to form a tissue-receiving opening, the first tissue portion is positioned within the tissue-receiving opening, and the extendable tip is withdrawn to mechanically hold the first tissue portion. A first tissue fastener is secured to the first tissue portion, which is then released from the tissue-receiving opening. A second tissue fastener may subsequently be passed through a second tissue portion.

Abstract: An adjustment assembly for an adjustable prosthetic valve device includes a gearbox housing formed from two gearbox shells coupled to one another and held together by two gearbox sleeves each having an internal cavity adapted to accommodate respective lateral portions of the gearbox shells when the gearbox shells are coupled to one another. A gear assembly, including a center gear and two driven gears, is supported within the gearbox housing. Gear teeth of each of the driven gears engage gear teeth of the center gear such that rotation of the center gear causes rotation of the driven gears. At least one of the driven gears is adapted to engage a transmission mechanism that transmits the rotation thereof to another part of the adjustable prosthetic valve device to accomplish an adjustment to the size and/or shape of the adjustable prosthetic valve device.

Abstract: In repairing soft tissue with a bone anchoring instrument (such as reattaching a tendon of a torn rotator cuff), the bone anchoring instrument may be used to anchor the soft tissue to a region of bone. The anchors inserted into the underlying bone may have one or more lengths of suture or wire attached thereto which may be tensioned independently of one another to affix the soft tissue to the bone by having a selector mechanism selectively engage and disengage ratcheted tensioning wheels from one another. Suture loading mechanisms may be employed for passing suture lengths into and/or through the anchors prior to deployment into the bone where such mechanisms may employ suture snares which are configured to reconfigure from an expanded shape through which suture lengths may be easily passed to a low-profile shape which secures the suture lengths within the snare.

Abstract: An apparatus (650) for inserting a distal ring (9) of a wound retractor device (2) through a wound opening comprises a bladeless tip (641) for creating the wound opening by forcing tissue apart, and a conveying device (5) for conveying the distal ring (9) through the wound opening. The conveying device (5) comprises a hook element (6) for engaging the distal ring (9) to convey the distal ring (9) through the wound opening, and a receiver housing (651) for receiving a seal (652) and a proximal ring (653) of the wound retractor device (2) to hold the seal (652) and the proximal ring (653) externally of the wound opening, and thus maintain a sleeve portion of the wound retractor device (2) in tension, during conveying of the distal ring (9) through the wound opening.

Abstract: Surgical instruments are disclosed that are couplable to or have an end effector or a disposable loading unit with an end effector, and at least one micro-electromechanical system (MEMS) device operatively connected to the surgical instrument for at least one of sensing a condition, measuring a parameter and controlling the condition and/or parameter.

Abstract: An insertion device includes an elongate member and a stylet. The elongate member has a proximal end portion, a distal end portion, and defines a lumen therethrough. The stylet has a proximal end portion, a distal end portion, and is slidably coupled to the elongate member. The stylet is configured to move from a first position to a second position with respect to the elongate member. The proximal end portion of the stylet is configured to removably couple a mesh carrier thereto. A portion of the proximal end portion of the stylet is disposed outside of the lumen of the elongate member when the stylet is in its first position and is disposed within the lumen when the stylet is in its second position.

Abstract: A staple cartridge, or fastener cartridge, for a surgical stapler, or fastening instrument, wherein the staple cartridge includes a distally-located cutting blade arranged to cut a distal end portion of a layer, such as a tissue thickness compensator and/or a buttress material, for example, attached to the staple cartridge. The distally-located cutting blade can extend out of a distal cavity of the staple cartridge. The distally-located cutting blade can move in a direction that is perpendicular to a staple deck of the staple cartridge. The distally-located cutting blade can also move in any suitable direction relative to the staple deck.

Abstract: A system for stapling tissue includes a stapling head and a control unit. The stapling head includes an endoscope receiving lumen extending therethrough and first and second jaws movable with respect to one another between a tissue receiving configuration and a tissue stapling configuration. The first jaw includes a staple firing mechanism and the second jaw includes a staple forming surface. The stapling head further includes gross and fine movement mechanisms controlling gross and fine movements, respectively, of one of the first and second jaws relative to the other of the first and second jaws. The control unit includes a first actuator controlling the gross and fine movement mechanisms and a second actuator operating the stapling mechanism.

Abstract: A suture anchor comprises a tubular body having an axial bore therethrough and having one or more purchase enhancements on an exterior surface of the body adapted to enhance purchase of the body within a bone hole, such as threads. A lateral port passes through the body from the bore to the exterior surface. A length of suture for attaching soft tissue to bone passes down along the exterior surface over the one or more purchase enhancements, over a distal end of the body, up into the bore through and then back out of the bore and up along the exterior surface over the one or more purchase enhancements.

Abstract: A medical device for delivering a staple formed from a shape memory material is disclosed. The staple includes a first tine and a second tine connected by a bridge. The staple may be disposed within the medical device in an open position. The medical device is configured to sequentially deliver the first tine and the second tine, respectively, to opposing body tissues. Upon warming up to a temperature at or above a transformation temperature of the shape memory material, the staple may assume a closed position, thus drawing together opposing body tissues and closing an incision.

Abstract: The invention encompasses devices and methods used to provide wound closure based on rings positioned within the tissue layers of the wound opening (with the rings regionally separate the wound depth tissue layers into 2 compartments), followed by suture transport through the rings and full-thickness tissue layers of both compartments. Upon suture transport via synchronous or asynchronous manner and device removal, wound closure is achieved by tying the 2 ends of the suture without incorporating tissue above the level of the rings such as skin. When the device is applied to abdominal or chest wall wound opening, all tissue layers except the skin are incorporated in the suture closure of the wound. The closure process can be performed in a simple, reliable, and expeditious manner.

Abstract: A system for transdermal repair of soft tissue includes an instrument comprising a proximal actuator portion, a fixed needle having a lumen and extending distally from the proximal actuator portion, and a movable needle having a lumen and extending distally from the proximal actuator portion. The movable needle is movable axially between an advanced position and a retracted position relative to the proximal actuator portion. A suture needle is disposed within the lumen of one of the fixed and movable needles, and has a length of suture connected thereto. Needle graspers are disposed in the lumen of each needle, for securing the suture needle and assisting in the transfer of the suture needle from one needle to the other to complete a suture passing step.

Abstract: An instrument for clamping a surgical clip has a handle assembly, a shaft assembly, and an end effector. The handle assembly has a trigger and an articulation knob. The shaft assembly has an outer ground tube, a middle articulation tube, and a push/pull tube disposed within the middle articulation tube. The trigger is operable to cause longitudinal translation of the push/pull tube. The outer ground tube and the middle articulation tube present mating angled faces sloped in opposing directions. Rotation of the articulation knob causes rotation of the middle articulation tube. Rotation of the middle articulation tube changes the orientation of the angled faces and thus causes articulation of the middle articulation tube and the push/pull tube. The end effector has a pair of jaws configured to apply a surgical clip to a vessel. Longitudinal translation of the push/pull tube causes closure of the pair of jaws.

Abstract: An implantation pin kit and a method for implanting an implantation pin includes a cannulated implantation pin having a channel and a heating device. The channel of the pin extends in a longitudinal direction of the pin and connects a proximal opening at a proximal end of the pin with a distal opening at a distal end of the pin. The channel of the pin and the heating device are adapted such that the heating device can be accommodated within at least a portion of the channel of the pin. The heating device is adapted to thermally heat material comprised in at least one of the pin and the heating device. Thereby, meltable material of the pin can be liquefied or additional liquefied meltable material can be inserted into the pin and the liquefied material can then be push towards and out of the distal opening in order to augment and fix the implantation pin in a target structure.

Abstract: A suture anchor and kit for anchoring a suture member to human bone in an interference fit. A suture anchor includes a threaded portion and has a head at the proximal end thereof, the head being generally circular. A tip is located at a distal end of the shank. The shank is at least partially threaded and includes walls defining a reel portion. The shank also includes walls for engaging a suture, the walls for engaging the suture typically adjacent walls defining the reel portion. The head typically includes walls for engaging a drive tool. The kit includes a drive tool for rotating the suture anchor when a suture member is engaged with the walls for engaging the suture such that rotation of the anchor causes the suture material to wrap around the reel portion of the shank.

Abstract: A surgical stapler is provided and comprises a handle assembly, an elongated body, an articulable tool assembly, and an articulation mechanism. The articulation mechanism has: a main shaft member connected to an articulation linkage; a retainer having an opening for receiving a shaft portion of the main shaft member; a cam lock having cam locking surfaces and a locking tab; a locking cover defining recesses for receiving the locking tab; an articulation handle having cam surfaces configured to engage the cam locking surfaces of the cam lock.

Abstract: An anvil assembly includes a circular anvil head that supports a crush ring, an anvil cap that supports an o-ring, and a circular anvil buttress member. The cap connects to the head and is movable relative to the head between approximated and unapproximated positions. The crush ring is spaced from the cap when the cap is in the approximated position and movable into engagement with the cap to move the cap to the unapproximated position. The buttress member includes a body portion and an extension portion. The body portion is supported on the head and the extension portion is secureable between the o-ring and the head when the cap is in the approximated position. The extension portion is releasable from between the o-ring and the head when the cap is disposed in the unapproximated position so that the body portion separates from the head.

Abstract: Various methods and devices are described for retaining a medical implant within a body cavity. According to one aspect, one or more plications are formed and the medical device is coupled to or seated against the plication(s).

Abstract: A minimally invasive surgical instrument includes a U-turn mechanism that transmits actuating forces around a U-turn. The U-turn mechanism is coupled between segments of the instrument and has a bend radius that is smaller than flexible arms having a similar cross section diameter. The actuating forces transmitted by the U-turn mechanism are used to move distal components of the instrument, such as an end effector and a wrist mechanism.

Abstract: An apparatus comprises a shaft, a needle throwing arm, and a needle receiving arm. The arms are movable asynchronously along planes that are substantially parallel to a longitudinal axis defined by the shaft. The arms selectively engage a surgical needle, such that the throwing arm may pass the surgical needle through tissue for receipt by the receiving arm, and the receiving arm may then pass the surgical needle back to the throwing arm for additional stitching. The arms may pivot about a common pivot. Such versions may include a single actuator for both arms or separate actuators for the arms. The arms may also pivot about their own respective axles, which may facilitate a forward reset motion for a needle, allowing the needle to continue travelling along a circular path in a single direction to create several stitches. The apparatus may also convert reciprocating movement of actuators into rotational motion.

Abstract: An apparatus for forming an anastomosis between adjacent intestinal sections is provided. The apparatus includes an anastomosis device having a cartridge assembly; and an anvil assembly having a shaft extending therefrom and a connection feature on the shaft. The apparatus further including a hub having a connection portion selectively attachable to the connection feature of the shaft, the connection portion defining a lumen for receiving the shaft; and an annular structure operatively connected to the hub and extending radially outwardly therefrom, the hub being arranged for locating the annular structure between the adjacent intestinal sections when connected to the shaft.

Abstract: Methods, instruments and systems are provided for separating opposite walls of the stomach by extragastric application of suction. Plication of the stomach can be performed between the separated walls after which the separate walls are brought back toward one another. In another aspect, methods, instruments, devices and systems are provided for reducing the effective volume of a stomach by performing one or more extragastric plications of the stomach.

Abstract: A medical implement particularly useful in arthroscopic surgery, includes: a handle having a proximal end configured for manual gripping by a user, a distal end for manipulation during the surgery, an internal passageway extending through the handle from the proximal end to the distal end thereof, and a longitudinally-extending slot extending longitudinally through the handle from its outer surface to the passageway for side-loading the handle with a manipulatable member to be manipulated during surgery. A shield is located within the passageway in the handle. The shield is secured along one edge to the inner surface of handle defining the passageway, and includes an elastic section normally covering the longitudinally-extending slot. The elastic section of the shield is yieldable to permit side-loading of the manipulatable member into the passageway, but to prevent a side-loaded manipulatable member from passing outwardly from the passageway.

Abstract: An applicator instrument for dispensing surgical fasteners includes a housing, a firing system disposed in the housing and being moveable in distal and proximal directions along a first axis, and an elongated shaft extending from the housing, the elongated shaft having a proximal section and a distal section that is oriented at an angle relative to the proximal section. A plurality of surgical fasteners are disposed in the elongated shaft. The applicator instrument has a handle that extends upwardly from the housing along a second axis that defines an acute angle with the first axis. A trigger is mounted on the handle, and a linkage couples the trigger with the handle and the firing system. When the trigger is squeezed, the linkage guides the trigger along a linear path of movement relative to the handle.

Abstract: A suture assembly comprising: a first suture having a generally O-shaped configuration comprising a first arm, a second arm, a first bridge connecting the first arm to the second arm, and a second bridge connecting the first arm to the second arm, the first bridge opposing the second bridge so that the first suture comprises a closed loop; a second suture comprising a first arm, a second arm and a bridge connecting the first arm to the second arm; the first arm of the second suture being wrapped around the first arm of the first suture in a first direction, and the second arm of the second suture being wrapped around the second arm of the first suture in a second, opposite direction; the suture assembly being capable of assuming (i) a longitudinally-extended, radially-contracted first configuration, and (ii) a longitudinally-contracted, radially-expanded second configuration.

Abstract: Systems of releasably connecting staple line buttress material to the jaws of a surgical stapling instrument are provided. The systems include retainers configured to engage the buttress material and releasably retain the buttress material on the jaws of the surgical stapling instrument prior to stapling tissue. In certain embodiments, the retainers remain with the jaws of the instrument after stapling of tissue. In alternative embodiments, the retainers remain with the buttress material after being stapled to tissue.

Abstract: Methods and systems for closing an opening or defect in tissue, closing a lumen or tubular structure, cinching or remodeling a cavity or repairing a valve preferably utilizing a purse string or elastic device. The preferred devices and methods are directed toward catheter-based percutaneous, transvascular techniques used to facilitate placement of the devices within lumens, such as blood vessels, or on or within the heart to perform structural defect repair, such as valvular or ventricular remodeling. In some methods, the catheter is positioned within the right ventricle, wherein the myocardial wall or left ventricle may be accessed through the septal wall to position a device configured to permit reshaping of the ventricle. The device may include a line or a plurality of anchors interconnected by a line. In one arrangement, the line is a coiled member.

Abstract: A surgical instrument includes a handle portion, a shaft housing a firing bar, an end effector comprising an anvil, a lower jaw, and a stapling and severing assembly responsive to a longitudinal closing motion produced by the handle portion and the shaft. The lower jaw is configured to receive a removable cartridge when in an open position. The cartridge includes a housing, a plurality of staples disposed in the housing, and a deck disposed over the plurality of staples. The deck defines apertures, with each aperture being substantially disposed over each staple. The instrument includes a movable buttress that is integral with the housing of the cartridge or integral with the lower jaw of the end effector. The buttress may attach to the anvil and include a portion to receive tissue. The receipt of tissue urges and moves the buttress proximally inwards to further encompass the tissue.