BR112012018797A2 - instrumento de corte cirúrgico que analisa a espessura do tecido - Google Patents
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- A—HUMAN NECESSITIES
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- A61B17/32—Surgical cutting instruments
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- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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- A61B17/32—Surgical cutting instruments
- A61B2017/320052—Guides for cutting instruments
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- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/06—Measuring instruments not otherwise provided for
- A61B2090/061—Measuring instruments not otherwise provided for for measuring dimensions, e.g. length
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- A—HUMAN NECESSITIES
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Abstract
INSTRUMENTO DE CORTE CIRÚRGICO QUE ANALISA A ESPESSURA DO TECIDO.
A presente invenção refere-se a um instrumento cirúrgico (10) com um atuador de extremidade para fixação de tecido (12), em que atuação do instrumento (10) é travada quando a espessura do tecido fixado ao atuador de extremidade (12) não está dentro da faixa de espessura especificada. O atuador de extremidade (12) pode compreender um módulo de espessura do tecido (60) que detecta a espessura do tecido fixado ao atuador de extremidade (12). O instrumento cirúrgico (10) compreende, adicionalmente, um circuito de controle (100) em comunicação com o módulo de espessura do tecido (60). O circuito de controle (100) impede a atuação da porção de trabalho do atuador de extremidade (12) quando a espessura do tecido fixado ao atuador de extremidade (12) não está dentro da faixa de espessura especificada.
Description
- Relatõrio Descritivo da Patente de lnvenção para "INSTRU- MENTO DE CORTE CIRÚRGICO QUE ANALÍSA A ESPESSURA DO TE- CIDO". lnventores: Brett E. Swensgard, Bret W. Smith e Ryan J. Laurent 5 ANTECEDENTES DA INVENÇÃO Grampeadores cirúrgicos são usados para fazer uma incisão longitudinal no tecido e, simultaneamente, aplicar linhas de grampos em la- dos opostos da incisão. Tais instrumentos incluem comumente um atuador de extremidade tendo um par de membros de garra cooperadores que, se o 0 10 instrumento for destinado a aplicações endoscópicas ou laparoscópicas, é & capaz de passar através de uma passagem de cânula. Um dos membros de
W garra recebe um cartucho de grampos tendo pelo menos duas fileiras de grampos lateralmente espaçadas—uma em cada lado da canaleta do bisturi. O outro membro de garra define uma bigoma tendo bolsos formadores de 15 grampos alinhados às fileiras de grampos dentro do cartucho. O instrumento inclui uma pluralidade de cunhas reciprocantes que, quando acionadas dis- tafmente, passam através das aberturas no cartucho de grampos e engatam acionadores que suportam os grampos para realizar a descarga dos gram- pos em direção à bigoma. Simultaneamente, um instrumento de corte (ou 20 bisturi) é puxado distaimente ao longo do membro de garra, de modo que o 0 tecido fixado seja cortado e unido (por exemplo, grampeado) ao mesmo tempo. Um exemplo de um grampeador cirúrgico adequado para apli- cações endoscópicas é descrito na publicação do pedido de patente U.S. n° 25 2004/0232196 A1, intitulado "Surgical stapling instrument having separate distinct dosing arid firing systems", cuja descrição está aqui incorporada, a titulo de referência em sua totalidade. Em uso, um médico é capaz de fechar os membros de garra do grampeador sobre o tecido para posicioná-lo antes da descarga de grampos. Quando o médico determina que os rnembros de 30 garra estão prendendo apropriadamente o tecido, o médico pode então des- carregar o grampeador cirúrgico, seccionando e grampeando assim o tecido. As ações simuitâneas de seccionamento e grampeamento evítam complica-
ções que podem surgir durante a realização dessas ações em sequência com diferentes instmmentos cirúrgicos que, respectivamente, apenas sec- cionam ou grampeiam o tecido. lnstrumentos de autossutura endoscópica acionados por motor 5 são conhecidos na técnica- Nesses dispositivos, um motor elétrico impulsio- na a ação de corte e união do instrumento. Também é conhecido o uso de uma bateria a bordo, localizada no cabo do instrumento, para alimentação do motor. A publicação do pedido de patente U.S. n° 2007/0175952 A1, inti- tulado "Motor-driven surgical cutting and fastening instrument with loading 0 10 force feedback", cuja descrição está aqui incorporada, a título de referência > em sua totalidade, descreve um desses instrumentos cirúrgicos acionados por motor.
SUMÁRIO Em um aspecto geral, a presente invenção refere-se a um ins- 15 trumento cirúrgico com um atuador de extremidade de fixação de tecido, em que a atuação do instrumento é travada quando a espessura do tecido fixa- do ao atuador de extremidade não está dentro da faixa de espessura especi- ficada. De acordo com várias modalidades, o atuador de extremidade com- preende um módulo de espessura do tecido que detecta a espessura do te- 20 cido fixado ao atuador de extremidade- O in$trumento cirúrgico também 0 compreende um circuito de controle etn comunicação (por exemplo, comuni- cação sem fio) com o módulo de espessura do tecido. O circuito de controle impede a atuação da porção de trabalho do atuador de extremidade quando a espessura do tecido fixado ao atuador de extremidade não está dentro da 25 faixa de espessura especificada. Dessa forma, a atuação do instrumento po- de ser travada quando tecido em excesso ou insuficiente for fixado ao atua- dor de extrêmidade. lsso impede que o instrumento seja descarregado em situações nas quais não deveria sê-lo. De acordo com várias implantações, o atuador de extremidade 30 compreende: primeiro e segundo membros de garra opostos; e um cartucho descartávef (como um cartucho descartável de grampos) localizado no pri- meiro membro de garra. O módulo de espessura do tecido pode ser parte do
" cartucho descartável, e pode compreender um sensor de efeito Hall. O se- gundo membro de garra pode compreender um Ímã, sendo que o sensor de efeito Hall detecta a resistência do campo magnético do Ímã que é indicativa da espessura do tecido fixado ao atuador de extremidade, O módulo de es- 5 pessura do tecido comunica dados ao circuito de controle, sendo que os da- dos compreendem: (i) dados indicativos da espessura do tecido fixado ao atuador de extremidade; e (ii) dados indicativos do tipo de cartucho do cartu- cho descartável. O circuito de controle pode compreender uma unidade de processamento programada para determinar se o tecido fixado ao atuador 0 10 de extremidade está dentro da faixa de espessura especificada para o cartu- cho descartável com base nos dados comunicados ao circuito de controle pelo módulo de espessura do tecido. Nessa conexão, o circuito de controle ~ pode compreender memória de estado sólido que armazena dados de faixa de espessura para um ou mais tipos de cartuchos. A unidade de processa- 15 mento pode ser programada para determinar se o tecido fixado ao atuador de extremidade está dentro da faixa de espessura especificada para o cartu- cho descartável, com base nos dados comunicados ao circuito de controle pelo módulo de espessura do tecido mediante a comparação dos dados in- dicativos da espessura do tecido fixado ao atuador de extremidade com qs 20 dados armazenados de faixa de espessura para o tipo de cartucho do cartu- 0 cho descadável do atuador de extremidade.
FIGURAS Várias modalidades da presente invenção são aqui descritas a títub de exemplo, em conexão com as figuras apresentadas a seguir, em 25 que: as figuras 1-2 e 12 são vistas em perspectiva de um instrumen- to .cinirgico de acordo com várias modalidades da presente invenção; as figuras 3-5 são vistas explodidas do atuador de extremidade e da haste de um instrumento cirúrgico de acordo com várias modalidades 30 da presente invenção; as figuras 6-7 são vistas do atuador de extremidade de acordo cóm várias modalidades da presente invenção;
a figura 8 é um diagrama de blocos do módulo de espessura do tecido de acordo com várias modalidades da presente invenção; a figura 9 é um diagrama de blocos do circuito de controle do motor de acordo com várias niodalidades da presente invenção; 5 a figura 10 é um diagrama de blocos do módulo de rádio de acordo com várias modalidades da presente invençâo; e a figura 11 é um fluxograma do processo executado pejo circui- to de controle do motor de acordo com várias modalidades da presente in- venção. 10 DESCRIÇÃO 0 Determinadas modalidades da presente invenção serão agora
K descritas para proporcionar a compreensão geral dos principios da estrutura, função, fabricação e uso dos dispositivos e métodos descritos aqui. Um ou mais exemplos de três modalidades são ilustrados nos desenhos anexos. Os 15 elementos de habilidade comum na técnica entenderão que os dispositivos e os métodos especificamente aqui descritos e Ílustrados nos desenhos ane- xos são modalidades exemplares não limitadoras, e que q escopo das várias modalidades é definido somente pelas reivindicações. As características ilus- tradas ou descritas em relação a uma modalidade podem ser combinadas 20 com as características de outras modalidades. Essas modificações e varia- 0 ções são destinadas a estarem incluídas no escopo das reivindicações ane- xas. Em geral, as modalidades da presente invenção são dirigidas a um instrumento cirúrgico que impede a descarga do instrumento se a espes- 25 sura do tecido fixado ao atuador de extremidade do instrumento estiver fora dos limites aceitáveis (por exemplo, muito grossa ou muito fina). Dessa for- ma, o instrumento pode ser impedido de ser descarregado em situações em que não deve ser acionado. Se a espessura do tecido não estiver dentro dos limites aceitáveis para o instrumento, o operador (por exemplo, médico) po- 30 de ajustar a espessura do tecido ou trocar o cartucho, por exemplo. O instrumento pode ser um instrumento acionado por motor ou um instmmento acionado manualniente, de acordo com várias modalidades,
" As figuras 1 e 2 representam um instrumento cirúrgico de corte e união acio- nado por motor 10, de acordo com várias modalidades de presente inven- ção.
A moclalidade ilustrada é um instrumento endoscópico linear e, em ge- ral, as modalidades do instrumento 10 aqui descritas são instrumentos cirúr- 5 gicos endoscópicos de corte e união.
Deve-se notar, no entanto, que a in- venção não é tão limitada e qLle, de acordo com outras modalidades da pre- sente invenção, o instrumento pode ser um outro tipo de instrumento endos- cópico, tal como um instrumento de autossutura endoscópica circular ou cur- vo.
Além disso, o instrumento pode ser um instrumento cirúrgico de corte e 0 10 união não endoscópico, como um instrumento laparoscópico ou aberto.
O instrumento cirúrgico 10 representado nas figuras 1 e 2 com- preende um cabo 6, uma haste 8 e um atuador de extremidade 12 conecta- - do à haste 8. Em várias modalidades, o atuador de extremidade 12 pode ser articulado em tomo de um pivô de articulação 14. Um controle de articulação 15 16 pode ser fornecido adjacente ao cabo 6 para realizar a rotação do atua- dor de extremidade 12 sobre o pivô de articulação 14. Na modalidade ilus-- trada, o atuador de extremidade 12 é configurado para agir como um instru- mento de autossutura endoscópica para fixar, seccionar e grampear o teci- do, embora, em outras modaiidades, d iferentes tipos de atuadores de extre- 20 midade possam ser usados, como atuadores de extremidade para outros ti- 0 pos de dispositivos cirúrgicos, como garras, cottadores, grampos, aplicado- res de presilhas, dispositivos de acesso, dispositivos para fármacos/terapia gênica, ultrassom, dispositivos de RF ou laser, etc.
Mais detalhes referentes aos dispositivos de RF podem ser encontrados na patente U.S. 5.403.312 e 25 no pedido de patente U,S. n° de série 12/031.573, intitulado "Surgical cutting and fastening instrument having RF electrodes", depositado em 14 de feve- reiro de 2008, os quais estão aqui incorporados, a titulo de referência em sua totalidade.
O cabo 6 do instrumento 10 pode incluir um gatilho de fecha- 30 mento 18 e um gatilho de descarga 20 para acionar o atuador de extremida- de 12. Será reconhecido que os instrumentos que têm atuadores de extre- midade direcionados a diferentes tarefas cirúrgicas podem ter números ou
" tipos diferentes de gatilhos ou outros controles adequados para operar o a- tuador de extremidade 12, O atuador de extremidade 12 é mostrado separa- damente do cabo 6 por uma haste 8, de preferência, alongada.
Em uma mo- dalidade, um médico ou operador do instrumento 10 pode articular o atuador 5 de extremidade 12 em relação à haste 8 pelo uso do controle de articulação 16, conforme descrito em mais detalhes na publicação do pedido de patente U.S. n° 2007/0158385 A1, intitulado "Surgical lnstrument Having An Articula- ting End Effector", de Geoffrey C.
Hueil et al., aqui incorporado, a título de referência etn sua totalidade. 0 10 O atuador de extremidade 12 |nc|uj, nesse exemplo, entre ou- tras coisas, uma canaleta de grampos 22 e um membro de fixação transla- dável de modo articulado, tal como uma bigorna 24, que são marrtidos em ~ um espaçamento que assegura, quando a bigorna 24 está em sua posição fixada, o grampeamento efetivo ou o seccionamento do tecido fixado ao atu- 15 ador de extremidade 12. O cabo 6 inclui uma pega de pistola que se estende para baixo 26 em uma direção em que um gatilho de fechamento 18 é puxa- do de forma pivotante peló médico, para causar a fixação ou o fechamento da bigorna 24 em direção à canaleta de grampos 22 do atuador de extremi- dade 12 para, desse modo, fixar o tecido posicionado entre a bigorna 24 e a 20 canaleta 22. O gatilho de descarga 20 está mais afastado do gatilho de fe- O chamento 18. Uma vez que o gatilho de fechamento 18 está travado na po- sição de fechamento, o gatilho de descarga 20 pode girar levemente em di- reção à pega de pistola 26, de modo que o mesmo possa ser alcançado peb operador com o uso de uma só mão.
Em seguida, o operador pode puxar o 25 gatilho de descarga 20 de forma articulada em direção à pega de pistola 12 para causar o grampeamento e o seccionamento do tecido fixado ao atuador de extremidade 12. Em outras modalidades, podem ser usados tipos diferen- tes de membros de fixação, além da bigorna 24. O cabo 6 pode incluir tam- bém uma porção superior 28 que pode repousar no topo da mão do usuário 30 quando este segurar a porção de pega de pistola 26 com sua mão.
Será reconhecido que os termos "proximal" e "dista)" são usa- dos aqui com referência ao ato de segurar o cabo 6 de um instrumento 10
" pQr parte do médico.
Portanto, o atuador de extremidade 12 é distal em rela- ção ao cabo mais proximal 6. Será reconhecidQ ainda que, para conveniên- cia e cIareza, os termos espaciais corno "vertical" e "harizontal" são usados na presente invenção em relação aos desenhos.
Entretanto, os instrumentos 5 cirúrgicos podem ser usados em muitas orientações e posições, e não se pretende que esses termos sejam limitadores e absolutos.
Em uso operacionai, o gatilho de fechamento 18 pode ser acio- nado primeiro, Quando satisfeito com o posicionamento do atuador de ex- tremidade '1 2, o médico pode retrair o gatilho de fechamento 18 para a posi- 0 10 ção completamente fechada e travada adjacente à pega de pistola 26. O es- tiramento da parte posterior do gatilho de fechamento 18 faz com que a bi- gorna 24 gire para baixo, fíxando o tecido entre a bigorna 24 e a canaleta 27. . O gatilho de descarga 20 pode então ser atuado.
A atuação do gatilho de descarga 20 faz com que o instrumento de corte no atuador de extremidade 15 12 seccione o tecido fixado, e faz com que os elementos de união no atua- dor de extremidade unam o tecido seccionado.
O gatilho de descarga 20 re- toma à sua posição aberta (mostrada nas figuras 1 e 2) quando o médico remove a pressão.
Um botão de liberação 19 no cabo 6, quando abaixado, pode liberar o gatilho de fechamento travado 18. O botão de Iiberação 19 20 pode ser implantado de várias formas como, por exemplo, conforme apre- D sentado na publicação do pedido de patente n° 2007/0175955, intitulado "Surgical cutting and fastening instrument with closure trigger Iocking me- chanism", que é aqui incorporado, a título de referência em sua totalidade.
O atuador de extremidade 12 pode incluir um instrumento de 25 corte, como bisturi, para cortar o tecido fixado ao atuador de extremidade 12 quando o gatilho de descarga 20 é retraído por um usuário.
O atuador de ex- tremidade 12 pode compreender também meios para união do tecido sec- cionado pelo instrurnento de corte, como grampos, eletrodos de RF, adesi- vos, etc.
Mais detalhes referentes a possÍveis configurações do atuador de 30 extremidade 12 podem ser encontrados nas seguintes patentes e pedidos de patente publicados, que estão aqui incorporados, a títuio de referência em sua totalidade: patente n° 5.709.680; patente n° 5.688.270; patente n°
" 7.000.818; publicação n° 2005/0173490 Al; publicação n° 2006/0025809 Al; publicação U.S. n° 2007/0102453 Al; n° 2007/0102452 Al; publicação n° 2009/0206134 Al; e publicação n° 2009/0206124 Al. O instrumento 10 pode compreender também um sistema de 5 fechamento para fechar (ou fixar) o atuador de extremidade após o fecha- mento (ou retração) do gatilho de fechamento 18. Mais detalhes referentes às modalidades de um sistema de fechamento exemplificador para fecha- mento (ou fixação) da bigorna 24 do atuador de extremidade 12 pela retra- ção do gatilho de fechamento 18 são fornecidas nas seguintes referências 0 10 de patentes U-S-, que estão aqui incorporadas, a título de referência em sua totalidade: publicação n° 2004/0232196 AI: publicação n° 2007/0125956 Al; publicação n" 2007/0158385 AI; publicação n° 2007/01'75962 Al; patente n° ~
7.464.849; e as referências citadas no parágrafo acima. Uma haste de acionamento longitudinalmente móvel ou girató- 15 rià Iocalizada dentro da haste 8 do instrumento 10 pode conduzir/acionar o instrumento de corte e os meios de fixação no atuador final 12. Um motor elétrico, localizado na porção de pega de pistola 26 do cabo 6 do instrumen- to 10, pode ser usado para acionar, direta ou indiretamente (por um trem de engrenagem), a haste de acionamento. Em várias modalidades, o motor po- 20 de ser um motor de acionamento com escovas CC tendo uma rotação má- O xima de, aproximadamente, 25.000 RPM. Em outras modalidades, o motor pode incluir um motor sem escovas, um motor sem fios, um motor sÍncrono, um motor de passos, ou qualquer outro motor etétrico adequado. A bateria (ou "fonte de alimentação" ou "bateria"), como uma bateria de Íon de Li, po- 25 de ser fomecida na porção de pega de pistola 26 do cabo 6 adjacente ao motor. a bateria fornece energia elétrica ao motor por um circuito de controle do motor. De acordo com várias modalidades, podem ser usadas várias ba- terias conectadas em série como a fonte de alimentação para alimentar o motor. Além disso, a fonte de alimentação pode ser substituível e/ou recar- 30 regáveí. Como descrito com rnais detalhes abaixo, a operação do motor pode ser controlada por um processador ou circuito de controle com base gm
" em micrQcontro|adQr, que pode estar localizado na pega 6 do instrumento 10, próximo ao motor e ao conjunto de baterias.
O circuito de controle pode receber a entrada do atuador de extremidade 12 referente à espessura do tecido fixado entre as garras opostas (por exemplo, a canateta de grampos 5 22 e a bigorna 24) do atuador de extremidade 12. O circuito de controle pode estar em comunicação com o módulo de detecção da espessura do tecido do atuador de extremidade 12 sem fio ou por uma conexão com fio.
Se o cir- cuito de controle determina que o tecido fixado não está dentro dos limites aceitãveis (por exemplo, muito grosso ou mu ito fino) com base na entrada do 0 10 módulo de detecção da espessura do tecido, o circuito de controle pode tra- . var a operação do motor, impedindo assim a operação do instrumento.
Antes de descrever o circuito de controle, é fornecida uma descrição do atuador de . extremidade 12 e do módulo de detecção da espessura do tecido.
A figura 3 é um diagrama do atuador de extremidade 12 de a- 15 cor'do com várias modalidades da presente invenção.
Conforme mostrado na modalidade ilustrada, o atuador de extremidade 12 pode incluir, além da ca- naleta 22 e da bigorna 24 previamente mencionadas, um instrumento de cor- te 32, um trilho 33, um cartucho de grampos 34 que é assentado de modo removível na canaleta 22, e uma haste de parafuso helicoidal 36. O instru- 20 mento de corte 32 pode ser, por exemplo, uma faca.
A bigorna 24 pode ser 0 pivotadamente aberta e fechada nos pinos pivôs 25 conectados à extremi-
dade adjacente da canaleta 22. A bigorna 24 também pode incluir uma aba 27 em sua extremidade adjacente que é inserida dentro de um componente de um sistema de fechamento mecânico para abrir e fechar a bigorna 24. 25 Quando o gatilho de fechamento 18 é atuado, ou seja, é extraído por um u- suário do instrumento 10, a bigorna 24 pode pivotar ao redor dos pinos pivôs 25 parâ a posição fixada ou fechada, fixando assim o tecido entre a canaleta 22 e a bigorna 24. Se a fixação do atuador de extremidade 12 é satisfatória, o operador pode acionar o gatilho de descarga 20, o que faz com que o bis- 30 turi 32 e o trilho 33 corram longitudinalmente ao longo da canaleta 22, cor- tando desse modo o tecido fixado dentro do atuador de extremidade 12. O movimento do suporte deslizante 33 ao longo da canaleta 22 faz com que os
" grampos (não mostrados) do cartucho de grampo 34 sejam acionados atra- vés do tecida separado e em reiação à bigorna fechada 24, que vira os grampos para unir o tecido separado.
Em várias modalidades, o tràho 33 po- de ser um componente integral do cartucho 34. A patente U.S- n° 6-978.921, 5 intitulada "SURGICAL STAPLING INSTRUMENT 1NCORPORAT!NG AN E- BEAM FIRING MECHANISW, concedida à Shelton, lV et al., a qual está a- qui incorporada, a título de referência em sua totalidade, fomece mais deta- lhes sobre esses instrumentos de corte e união de dois cursos.
O trilho 33 pode ser parte do cartucho 34, de modo que quando a faca 32 retrai após a 0 10 operação de corte, o trilho 33 não retrai. " As figuras 4 -5 são vistas explodidas e a figura 6 é uma vista la- teral do atuador de extremidade 12 e da haste 8, de acordo com várias mo- . dalidades não limitadoras.
Conforme mostrado na modalidade ilustrada, a haste 8 pode incluir um tubo de fechamento adjacente 40 e um tubo de fe- 15 chamento distal 42 ligados de modo pivotanÉe por ligações de pivô 44. O tu- .bo de fechamento distal 42 inclui um sistema de abertura 45 dentro do qL!a| a aba 27 na bigorna 24 é inserida de modo a abrir e fechar a bigorna 24, con- forme descrito adicionalmente a seguir.
Disposto deritro dos tubos de fe- chamento 40, 42 pode estar um tubo estruturante adjacente 46. Disposto 20 dentro do tubo estruturante adjacente 46 pode estar um eixo de acionamento 0 rotacional principal (ôu adjacente) 48 que se comunica com um eixo de acio-
namento secundário (ou distal) 50 através de um conjunto de engrenagens chanfradas 52. O eixo de aciônamento secundário 50 está conectado a uma engrenagem propulsora 54 que engata uma engrenagem propulsora adja- 25 cente 56 da haste de parafuso helicoidal 36. A engrenagem chanfrada verti- cal 52b pode repousar e pivotar em uma abertura 57 na extremidade distal do tubo estruturante adjacente 46. Um tubo estruturante distal 58 pode ser usado para fechar o eixo de acionamento secundário 50 e as engrenagens propulsoras 54, 56. Coletivamente, a haste de acionamento principal 48, a 30 haste de acionamento secundãria 50 e o corijunto de articulação (por exem- . pjo, o conjurito de engrenagens chanfradas 52 a - C) são, algumas vezes, chamados na presente invenção de "conjunto de haste de acionamento prin-
cipal"..
Um rolamento 38, posicionado em uma extremidade distal da canaleta de grampos 22, recebe o parafuso heiicoidal 36, permitindo que o parafuso helicoidal 36 gire Iivremente em relação à canaleta 22. A haste de 5 parafuso helicoidal 36 pode interligar uma abertura rosqueada (não mostra- da) da faca 32 de modo que a rotação da haste 36 faz com que a faca 32 gire em posição distal Olj em direçâo proximal (dependendo da direção da rotação) através da canaleta de grampos 22- Consequentemente, quando o eixo de acionamento principal 48 é feito girar pela atuação do gatilho de 10 descarga 20, o conjunto de engrenagens chanfradas 52a - c faz com que o 0 eixo de acionamento secundário 50 gire, o que, por sua vez, devido ao enga- te das engrenagens propulsoras 54, 56, faz com que a haste de parafuso helicoidal 36 gire, o que faz com que o elemento de acionamento da faca 32 corra longitudinalmente ao longo da canaleta 22 para cortar qualquer tecido 15 fixado dentro do atuador de extremidade. O trilho 33 pode ser produzido a partir de, por exemplo, plástico, e pode ter uma superfície distal inclinada. À medida que o suporte deslizante 33 atravessa a canaleta 22, a superfície di- anteira inclinada pode empurrar para cima ou acionar os grampos no cartu- cho de grampo através do tecido fixado e contra a bigorna 24. A bigoma 24 20 vira os grampos, grampeando assim o teádo cortado. Quanda a faca 32 é 0 retraída, o bistljri 32 e o trilho 33 podem ficar desengatados, saindo assim do trilho 33 na extremidade distal da canaleta 22. Na modalidade ilustrada, o atuador de extremidade usa uma haste de parafuso heíicoidal giratória 36 para acionar o instrumento de corte 25 32. Esse parafuso helicoidal pode ser usado em modalidades em que é usa- do um membro de acionamento rotativo. Em outras modalidades, um mem- bro de acionamento longitudinalmente reciprocante pode ser usado para a- limentar o instmmento de corte. O atuador de extremidade 12 pode, conse- quentemente, ser modificado para adequar-se a esse membro de aciona- 30 mento longitudinalmente reciprocante. Mais detalhes referentes a esses atu- adores de extremidade podem ser encontrados nas patentes U.S. rt°
7.140.528 e n° 7.000.819, as quais estão aqui incorporadas, a titulo de refe-
" rência em sua totaíidade.
De acordo com várias modalidades, o cartucho de grampos substituível 34 pode compreender uma espessura do módulo de detecção do tecido que detecta a espessura do tecido fixado ao atuador de extremidade 5 12 entre a canaleta de grampos 22 (incluindo o cartucho de grampos 34) e a bigorna 24, De acordo com várias modalidades não limitadoras, conforme mostrado na figura 7, o módulo de detecção da espessura do tecido 60 pode estar localizado na extremidade distal 62 do cartucho de grampos 34, de . forma que esteja distante dos grampos do cartucha de grampos 34 quando 0 10 os grampos são acionados.
A figura 8 é urrt diagrama de blocos do módulo de detecção da espessura do tecido 60, de acordo com várias modalidades.
Conforme mostrado na figura 8, o módulo de detecção da espessura do te- cido 60 pode compreender um sensor de espessura do tecido 64, um contro- lador 65, um módulo de rádio 70 e uma fonte de alimentação 74. O controla- 15 dor 65 pode compreender uma unidade de processamento (CPU) 66 e uma unidade de memória 68. Em várias modalidades, o sensor de espessura do tecido 64 pode compreender um sensor de efeito Hall que detecta a espes- sura do tecido fixado ao atuador de extremidade 12 com base no campo magnético de um ímã 78 localizado, por exemplo, em uma extremidade dis- 20 tal 80 da bigorna 24, conforníe mostrado na figura 7. Quando o médico fecha 0 a bigorna 24 por meio da retração do gaÉilho de fechamento 18, o Ímã 78 gi- ra para baixo próximo ao sensor 64, variando assim o campo magnético de- tectado pelo sensor 64 quarido a bigorna 24 gira para a posição fechada (ou fixada). A resistência do campo magnético do Ímã 78 e detectada pelo sen- 25 sor 64 é indicativa da distância entre a canaleta 22 e a bigorna 24, a qual é indicativa da espessura do tecido fixado entre a canaleta 22 e a bigorna 24 quando o atuador de extremidade 12 está em uma posição fechada (ou fixa- da). A unidade de memória 68 do controlador 65 pode compreender 30 uma ou mais memórias de leitura em estado sólido (ROM) e/ou unidades de memória de acesso aleatório (RAM). Em várias modalidades, a CPU 66 e a(s) unidade(s) de memória 68 pode(m) ser integrada(s) a um circuito inte-
' grado unitárjok (jc), Qlj mYltiplos lCs. A(s) unidade(s) de memória ROM po- de(m) compreender memória flash. A(s) unidade(s) de memória ROM po- de(m) armazenar instruções codificadas para serem executadas pela CPU 66 do controlador 65. Além disso, a(s) unidade(s) de memória ROM pode(m) 5 armazenar dados indicativos do tipo de cartucho do cartucho 34. Ou seja, pot exemplo, a(s) unidade(s) de memória ROM 68 pode(m) armazenar da- dos indicativos do tipo de modeio do cartucho de grampos 34. Conforme ex- plicado adicionalmente abaixo, o circuito do motor de controle no cabo 6 do instrumento 10 pode utilizar as informações de espessura do tecido e o tipo 0 10 de modelo do cartucho de grampos 34 para determinar se o tecido fixado ao atuador de extremidade 12 é muito grosso ou muito fino, com base na faixa de espessura do tecido especificada para o cartucho de grampos 34 especí- . fico. O módulo de rádio 70 pode ser um módulo de rádio bidirecional de bai- xa energia que se comunica sem fio, com o uso de um protocolo de comuni- 15 cação sem fio, com o circuito de controle do motor no cabo 6 do instrumento
10. De acordo com várias modalidades, o módulo de rádio 70 pode se co- municar com o circuito de controle do motor com o uso de uma frequência de comunicação adequada para transmissão através do tecido humano. As comunicações entre o módulo de rádio 70 e o circuito de controle do motor 20 podem usar uma banda de frequência MICS (Serviços de Comunicação de 0 lmplante Medial) (402 a 405 MHz), uma faixa de rádio industriai, científica e médica (ISM) adequada (como a frequência central 433 MHz ou frequência central 915 MHz), ou qualquer outra banda de frequência permeável ao teci- do huniano adequada. A fonte de alimentação 74 pode compreender uma 25 bateria adequada para alimentar os componentes do módulo de detecção da espessura do tecido 60, como uma bateria de íon de JÍtio ou alguma outra célula de bateria adequada. A figura g é um diagrama do circuito de controle do motor 100 de acordo com várias modalidades não limitadoras. O circuito de controle do 30 motor 100 pode estar localizado no cabo 6 do instrumento 10, próximo do motor 104 e do conjunto de baterías 106, e distante do módulo de detecção da espessura do tecido 60 no atuador de extremidade 12 pela haste 8, por
" exemplo. Assim, o circuito de controle da motor 100 pode se comunicar sem fio com o módulo de detecção da espessura do tecido 60 conforme descrito na presente invenção, embora em outras modalidades, possa haver uma conexão com fio, com fios passando através da haste 8 entre o circuito de 5 controle do motor 100 e o módulo de detecção da espessura do tecido 60 para manipufar as comunicações entre os mesmos. Conforme mostrado na figura 9, o circuito de controle do motor 100 pode compreender, de acordo com várias modalidades, um circuito de chaveamento de alimentação 101, um controlador 108 e um módulo de rádio 0 10 110. O módulo de rádio 110 pode se comunicar com o módulo de rádio 70
G do módulo de detecção da espessura do tecido 60, Portanto, o módulo de rádio 100 pode ser um módulo de baixa energia que funciona na mesma fre- . quência do módulo de rádio 70 e usa o mesmo protocolo de comunicação. Os módulos de rádio 70, 100, conforme mostrado na figura 10, podem com- 15 preender, de acordo com várias modalidades, antenas de transmissão e re- cepção 200, 202, uma chave de antena 204, uma chave de transmis- são/recepção 206, modulador/demodulador de RF 208, um codifica- dor/decodificador (codec) 210 e um processador de banda base 212. As an- tenas 200, 2002 do circuito de controle do motor 100 e do módulo de detec- 20 ção da espessura do tecido 60 podem ser antenas de microfita, por exemplo. 0 O circuito de chaveamento de alimentação 101 pode compre- ender, de acordo com vhrias modalidades, uma chave de alimentação 103 e uma chave de avanço/retrocesso 102, que conectam coletivamente o motôr 104 e o conjurrto de baterias 106 a fim de conectar a alimentação do conjun- 25 to de baterias 106 ao motor 104. Em várias modalidades, a chave de avan- ço/retrocesso 102 pode compreender um relé de polo duplo/curso duplo que, dependendo de sua polaridade, determina se a rotação do motor 104 será para a frente ou para trás. O cordrolador 108 pode controlar a operação das chaves 102-103. Em várias modalidades, o controlador 108 pode ser implan- 30 tado como um microcontrolador que compreende uma unidade de proces- samento (CPU) 114 e uma memória 116. A memória 116 pode compreender unidade de memória ROM em estado sólido e/ou RAM. A(s) unidade(s) de
" memória ROM pode(m) compreender um código de instruções que é execu- tado pela unidade de processamento 114. A unidade de prôcessamento 114 e a memória 116 podem ser integradas em um único iC, ou podem ser usa- dos múltiplos lCs.
O controlador 108 e o módulo de rádio 112 do circuito de 5 controle do motor 100 podem ser alimentados pelo conjunto de baterias 106. Conforme mostrado na figura 9, o controlador 108 pode rece- ber várias entradas e, com base no processamento dessas entradas, pode controlar as chaves 102-103, para, dessa forma, controlar de forma apropri- ada o motor 104 do instrumento 10. As entradas do controlador 108 podem 0 10 incluir uma entrada de descarga 120, uma entrada de posição de instrumen- " to de corte 122, e quaisquer outras entradas adequadas.
A entrada de des- carga 120 pode indicar o estado do gatilho de descarga 20, como se o médi- . co retraiu o gatilho de descarga 20 para iniciar um curso de corte pelo bisturi no atuador de extremidade 12 e se o médico liberou o gatilho de descarga 15 20 para finalizar o curso de corte.
A entrada de descarga 120 pode ser a par- tir de um sensor, como uma chave proporcional, responsiva ao gatilho de descarga 20. A entrada da posição do instrumento de corte 122 pode indicar a posição do instrumento de corte 34 no atuador de extremidade 12 durante o curso de corte.
O controlador 108 pode usar essa entrada para determinar 20 a posição do instrumento de corte 34 no curso de corte, como se o instru- 0 mento de corte 34 está próximo da/na extremidade do curso de corte.
À me- dida que o instrumento de corte 34 se aproxima da extremidade do curso de corte, q controlador 108 pode reduzir a taxa de rotação do motor 104, e pode inverter a rotação do motor 104 quando o instrumento de corte 34 atinge a 25 extremidade do curso de corte.
O controlador 108 pode também reduzir a velocidade de rotação do motor 104 quando o instrumento de corte está per- to de sua posição de repouso inicial, na extremidade adjacente ao atuador de extremidade 12 quando o instrumento de corte é retraido, e pode parar o motor 104, quando o instrumento de corte está totalmente retraido Mais de- 30 talhes referentes a uma chave de gatilho de descarga proporcional são for- necidos nas seguintes referências de patentes U.S., que estão aqui incorpo- radas, a título de referência em sua totalidade: publicação n" 2007/0175957;
publicação ri" 2007/0175958; e publicação n° 2007/0175959. Mais detalhes referentes aos instrumentos com sensores de posição de instrumento de cor'te são fornecidos nas seguintes referências de patentes U.S., as quais estão aqui incorporadas, a título de referência em sua totalidade: pedido n° 5 de série 12/235.782; e pedido n° de série 12/235.972. Certamente, o controlador 108 também recebe dados de entra- 'da do módulo de detecção da espessura do tecido 60 pelo módulo de rádio
110. Os dados de entrada do módulo de detecção da espessura do tecido 60 podem incluir: (i) dados da espessura do tecido, con'forme detectados pelo 0 10 sensor 64 do módulo de detecção da espessura do tecido 60: e (ii) dados de
N modelo de cartucho indicativos do tipo de modelo do cartucho de grampos r 34, os quais são armazenados na memória 68 do módulo de detecção da espessura do tecido 60. Com base nesses dados, o controiador 108 do cir- cuito de controle do motor 100 pode determinar se o tecido fixado ao atuador 15 de extremidade 12 está dentro da faixa especificada para o cartucho de grampos específico 34. Se a espessura do tecido está dentro da faixa espe- cificada, o controlador 108 pode controlar as chaves 102-103, de forma que a alimentação é conectada ao motor 104 (presumindo que outros dados de entrada sejam adequados). Por outro lado, se a espessura do tecido não es- 20 tá deritro da faixa especificada, o controlador 108 pode controlar a chave 0 103 de forma que a aiimentação não seja conectada ao motor 104, bloque- ando assim o mator 104 com base na espessura do tecido e impedindo a operação do instrumento 10. A figura 11 é um fluxograma de um processo executado pelo 25 controlador 108, de acordo com várias modalidades. O processo pode ser executado pela unidade de processamento 114 mediante a execução do có- digo armazenado na memória 1 16. O processo pode ser iniciado na etapa 150, em que o controlador 108 determina se a espessura do tecido fixado ao atuador de extremidade 12 está dentro da faixa especificada para um cartu- 30 cho de grampos específico 34. O controlador 108 pode realizar a determina- ção cornparando os dados da espessura do tecido no sensor 64 com a faixa especificada de um cartucho de grampos específico 34. O controlador 108
" pode determinar a faixa de espessura especificada para o cartucho de grampos com o uso dos (i) dados do modelo de cartucho de grampos trans- mitidos pelo módulo de detecção da espessura do tecido 60 e (ii) uma tabela de consulta (ou outra estrutura de armazenamento de dados) na memória 5 116 do controlador, que armazena dados que indicam a faixa de espessura especificada para inúmeros tipos de modelos de cartucho de grampos.
A fai- xa de espessura especificada pode incluir uma espessura mínima e um es- pessura máxima para cada tipo de modelo.
Por exemplo, tipos de modelos de cartuchos diferentes podem ter grampos de comprimentos diferentes. 0 10 Grampos mais longos podem acomodar mais tecidos no atuador de extremi- . dade do que os cartuchos com comprimentos de grampos mais curtos.
Des-
m sa forma, o limite de espessura superior pode ser ma.ior para cartuchos com grampos mais longos, e o limite de espessura inferior pode ser inferior para cartuchos com grampos de comprimento mais curtos, Se a espessura do te- 15 cido fixado é menor que a espessura mínima ou maior que a espessura má- xima para o tipo de modelo do cartucho 34, a espessura do tecido está fora da faixa especificada.
Se a espessura do tecido estiver fora da faixa de espessura especificada para o cartucho de grampos 34, o processo avança para a eta- 20 pa 152, na qual o controlador 108 controla a chave de alimentação 103, de 0 forma que a chave de alimentação 103 esteja aberta, em um estado não condutivo, de forma que a alimentação do conjunto de baterias 106 não está acoplada ao motor 104. Dessa forma, o motor 104 não recebe alimentação e é mantido fora de operação, impedindo assim o acionamerito do atuador de 25 extremídade 12. Por outro lado, se a espessura do tecido está dentro da fai- xa de espessura especificada para o cartucho de grampos 34, o processo avança para a etapa 154, na qual o controlador 108 determina se o gatilho de descarga 20 é retraído com base na entrada de descarga 120. Se não estiver, o processo avança para a etapa 152 de fbrma que a alimentação do 30 conjunto de baterias 106 não é acoplada ao motor 104. Se, por outro lado, o gatilho de descarga 20 é retraído, o processo avança para a etapa 156, na qual o controlador 108 determina a posição do instrumento de corte 34 no
" curso de corte com base na entrada de posição do instrumento de corte 22. Se a posição do instrumento de corte está no curso de avanço, o processo avança para a etapa 158, na qual o controlador 108 gera um sinal de contro- le para a chave de avanço/retrocesso 102 para fazer com que a chave de 5 avanço/retrocesso 102 esteja em um estado que acople aiimentação ao mo- tor 104, de forma cjue o motor 104 gira para a frente. lnversamente, se a po- sição do instrumento de corte no curso de corte exige a rotação inversa do motor 104, o processo avança para a etapa 160, na qual o controlador 108 gera um sinal de controle para a chave de avanço/retrocesso 102 para fazer 0 10 com que a chave de avanço/retroc.esso 102 esteja em um estado que acople - alimentação ao motor 104 de forma que o motor 104 gira para trás.
O pro- cesso pode ser executado de forma contínua durante um procedimento ci- rúrgico que envolva o instrumento 10. Dessa forma, se por algum motivo, a espessura do tecido sai da faixa durante o procedimento, o controlador 108 15 pode tomar as medidas apropriadas em resposta aos dados em tempo real de espessura de tecido recebidos do módulo de espessura do tecido 60. Retomando à figura 9, o controlador 108 pode receber também retroinfonnações do motor 104 referentes às condições do motor 104, como taxa de rotação, direção de rotação, etc.
O controlador 108 pode usar os da- 20 dos no controle do motor 104, Adicionalmente, o controlador 108 pode libe- 0 rar sinais de controle para um ou mais dos dispositivos de saída 124. Os dispositivos de saída 124 podem compreender indicadores visuais, como i- luminadores (por exemplo, diodos emissores de luz) e/ou indicadores audí- veis, como alto-falantes.
Por exemplo, os dispositivos de saída 124 podem 25 compreender vários LEDs localizados do lado de fora do cabo 6 do instru- mento e visíveis ao operador do instrumento 10 quando o instrumento 10 es- tá em uso.
Um LED pode ser ligado quando a espessura do tecido fixado es- tiver na faixa de espessura especificada para o cartucho de grampos; um segundo LED pode ser ligado quando a espessura do tecido fixado estiver 30 fora da faixa de espessura especificada para o cartucho de grampos; um terceiro LED pode ser ligado quando o motor 104 estiver girando para a fren- te, um quarto LED pode ser Íigado quando o motor 104 estiver girando para trás,. etg Além disso, em outras modalidades, as transmissões do módu- Io de espessura do tecido 60 podem ser recebidas por um receptor diferente do circuito de controle do motor 100. Por exemplo, com referência à figura 12, as transmissões do módulo de espessura do tecido 60 podem ser rece- bidas por uma unidade de tela visual 160 e/ou por um sistema de computa- dor 170. A unidade de tela visual 160 pode compreender um módulo de rá- dio RF 162 para comunicação com o módulo de espessura do tecido 60. l- magens com base nos dados do módulo de espessura do tecido 60 podem 0 10 ser exibidas na tela 160. Dessa forma, o médico pode consultar em tempo real os dados referentes à espessura do tecido fixado durante todo o proce- dimento envolvendo o instrumento 10. A unidade de exibição visual 160 po- de compreender um monitor, como um monitor CRT, um monitor de plasma, um monitor de LCD, ou qualquer outro monitor de exibição adequado. De 15 modo similar, o sistema de computador 170 pode compreender um módulo de rádio RF 172 para comunicação com o módulo de espessura do tecido 60- O sistema de computador 170 pode armazenar os dados do módulo de espessura do tecido 60 em uma unidade de memória (por exemplo, uma ROM ou unidade de disco rígido) e pode processar os dados com um pro- 20 cessador.
0 Os instrumentos cirúrgicos aqui descritos podem também ser projetados para serem descartados após urn único uso, ou os mesmos po- dem ser projetados para serem usados múltiplas vezes. Em qualquer um dos casos, entretanto, o dispositivo pode ser recondicionado para reuso a- 25 pós pelo menos um uso- O recondicionamento pode incluir qualquer combi- nação das etapas de desmontagem do instrumento cirúrgico, seguido de limpeza ou substituição de peças particulares, e remontagem subsequente. Em particular, o instrumento cirúrgico pode ser desmontado, e qualquer nú- mero de peças particulares ou partes do dispositivo podem ser seletivamen- 30 te substituídas ou removidas, em qualquer combinação. Na Ihnpeza e/ou substituição de partes especificas, o instrumento cirúrgico pode ser remon- tado para uso subsequente na instatação de recondicionamento, ou por uma d equipe cirúrgica imediatamente antes de um procedimento cirúrgico.
Os e- Iementos versados na técnica irão reconhecer que o recondicionamento de um instrumento cirúrgico pode utilizar uma variedade de técnicas para des- montagem, fimpezalsubstituição e remontagem.
O uso de tais técnicas e o 5 instrumento cirúrgico recondicionado resultante estão no escopo do presente pedido.
De preferência, o instrumento cirúrgico descrito aqui será pro- cessado antes da cirurgia.
Primeiro, um instrumento novo ou usado é obtido . e, se necessário, Iimpo.
O instrumento pode ser então esterilizado.
Em uma
0 10 técnica de esterilização, Cj instrumento é disposto em um recipiente fechado e selado, tal como uma bolsa plástica ou de TYVEK.
O recipiente e o instru- mento são então colocados em um campo de radiação que pode penetrar no recipiente, tal como radiação gama, raios X ou elétrons de alta energia.
A radiação extermina bactérias no instrumento e no recipiente.
O instrumento 15 esterilizado pode então ser armazenado em um recipiente estéril.
O recipien- te estéril mantém o instrumento estéril até que seja aberto na instalação mé- dica.
Em várias modalidades, alguns componentes do instrumento 10 podem fazer parte de um conjunto substituivel e removivel que pode ser 20 inserido no instrumento 10 após o instrumento 10 ter sido esterilizado.
Por 0 exemplo, com referência à figura 9, em várias modalidades, o conjunto de baterias 106, o controlador 108 e o módulo de rádio 110 podem fazer parte de um conjunto substituível e removível 140 que pode ser inserido no cabo 6 do instrumento 10 após o instrumento ter sido esterilizado.
Por exemplo, o 25 conjunto substituível e removivel 140 pode ser transferido assepticamente para o instrumento 10 após o instrumento ter sido esterilizado.
Em tais mo- dalidades, o conjunto 140 pode ter conectores extemos adequados para co- nexão ao motor 104, ao circuito de chaveamento 101, às entradas 120, 122 e aos dispositivos de saída 124, etc, Em tal modalidade, portanto, o conjunto 30 140 pode ser reusado em múltiplos instrumentos 10. O cartLIcho 34 pode ser descartado após cada uso.
As modalidades acima foram descritas no contexto de disposi-
tivos de autossutura endoscópica lineares com a cartucho de grampos. Deve ser observado que o módulo de espessura do tecido 60 e o circuito de con- trole 100 correspondente podem ser usados em qualquer instrumento cirúr- gico que tenha um atuador de extremidade usado para fixar o tecido onde a 5 espessura do tecido fixado é uma importante consideração no procedimento. Por exemplo, o módulo de espessura do tecido 60 e o circuito de controle 100 correspondente podem ser usados em dispositivos de autossutura en- doscópica cimulares ou em outros tipos de dispositivos de dispositivos de corte/união, como dispositivos laparoscópicos. Adicionalmente, o módub de & 10 espessura do tecido 60 e o circuito de controle 100 correspondente não ne- cessitam ser usados em um dispositivo com o uso de grampos para unir o tecido seccionado, mas podem ser usados também em instrumentos com o uso de outros meios para unir o tecido seccionado, conforme observado a- cima. Além disso, o módulo de espessura do tecido 60 e o circuito de contro- 15 le 100 correspondente não precisam ser usados em instrumentos que têm um motor. Nessas modalidades, o instrumento 10 pode empregar um travaÁ- mento mecânico para impedir a descarga. Um desses mecanismos de tra- vamento é descrito na publicação de pedido de patente U.S. n° 2006/0025811, que está aqui incorporada, a titulo de referência em sua tota- 20 lidade.
0 Em várias modalidades, portanto, a presente invenção é dire- cionada a um instruniento cirúrgico 10 que compreende um atuador de ex- tremidade para fixação de tecido 12. Em várias modalidades, o atuador de extremidade 12 compreende um instrumento de trabalho móvel (por exem- 25 plo, um instrumento de corte) 34 e um módulo de espessura do tecido 60 que detecta a espessura do tecido fixado ao atuador de extremidade 12. O instrumento cirúrgico 10 também compreende um circuito de controle 100 em comunicação com o módulo de espessura do tecido, em que o circuito de controle impede a atuação do instrumento de trabalho quando a espessu- 30 ra do tecido fixado ao atuador de extremidade não está dentro da fáixa de espessura especificada, De acordo com várias implantações, o atuador de extremidade compreende: primeiro e segundo membros de garra opostos
22 '24; e um cartucho descartável 34 (como um cartucho descartável de grampos) localizado no primeiro membro de garra 22, sendo que o módulo de espessura do tecido é parte do cartucho descartável.
Adicionaimente, o módulo de espessura do tecido pode compreender um sensor de efeito Hall 5 64, e o segundo membro de garra compreende um Ímã 78, em que o sensor de efeito Hall detecta uma resistência de campo magnétíco do Ímã, que é indicativa da espessura do tecido fixado ao atuador de extremidade quando o atuador de extremidade está na posição fechada (ou fixada). Além disso, o móduio de espessura do tecido comunica dados ao circuito de controle, sen- 0 10 do que os dados compreendem: (i) dados indicativos da espessura do tecido fixado ao atuador de extremidade; e (ii) dados indicativos do tipo de cartucho m do cartucho descartável.
O árcuito de controle pode compreender uma unidade de pro- cessamento 114 programada para determinar se o tecido fixado ao atuador 15 de extremidade está dentro da faixa de espessura especificada para o cartu- cho descartável, com base nos dados comunicados ao circuito de controle pelo módufo de espessura do tecido, incluindo os dados indicativos da es- pessura do tecido fixado ao atuador de extremidade e qs dados indicativos do tipo de cartucho do cartucho descartável.
Adicionalmente, o circuito de 20 controle pode compreender memória de estado sólido 116 que armazena 0 dados de faixa de espessura para um ou mais tipos de cartuchos.
A unidade de processamento pode ser programada para determinar se o tecido fixado ao atuador de extremidade está dentro da faixa de espessura especificada para o cartucho descartável, com base nos dados comunicados ao circuito 25 de controle pelo módulo de espessura do tecido mediante a comparação dos dados indicativos da espessura do tecido fixado ao atuador de extremidade com os dados armazenados de faixa de espessura para o tlpo de cartucho do cartucho descartável do atuador de extremidade, Além disso, d instrumento cirúrgico pode compreender, ainda, 30 um motor elétrico 104 que atua a haste de acionamento 48, 50, e um conjun- to de baterias 106 que fomece energia elétrica ao motor elétrico.
O circuito de controle pode impedir a atuação do motor elétrico quando a espessura do u tecido fixado ao atuador de extremidade não estã dentro da faixa de espes- sura especificada. Adicionalmente, em várias modalidades, o módulo de espessu- ra do tecido está em comunicação sem fio com q circuito de controle. O mó- 5 dulo de espessura do tecido pode compreender um primeiro móduto de rádio e q circuito de controle pode compreender um segundo módulo de rádio, em que o primeiro módulo de rádio se comunica sem fio com o segundo módulo de tádio. Além disso, o módulo de espessura do tecido pode estar em co- mu'njcação com uma unidade de tela visual remota ou um sistema de com- 0 10 putador remoto. 4 Embora esta invenção tenha sido descrita como tendo dese- nhos exemplificadores, a µesente invenção pode ser adicionalmente modifi- . eada dentro do espírito e escopo da descrição. Pretende-se, pottanto, que este pedido cubra quaisquer variações, usos ou adaptações da invenção 15 com o uso de seus princípios gerais. Adicionalmente, este pedido destina-se a cobrir tais alterações da presente descrição, confome a prática conhecida ou costumeira na técnica à qual esta invenção pertence.
0
Claims (1)
- REIVINDICAÇÕES1. lnstrumento cirúrgico que compreende: um atuador de extremidade para fixação do tecido que com- preende: 5 uma porção de trabalho móvel; um módulo de espessura do tecido que detecta a espessura do tecido fixado ao atuador de extremidade; e um circuito de coritrole em comunicação com o módulo de es- pessura do tecido, em que o circuito de controle impede a atuação da porção 10 de trabalho móvel quando a espessura do tecido fixado ao atuador de ex- 0 tremidade não está dentro da faixa de espessura especificada.2. lnstrumento cirúrgico, de acordo corn a reivindicação 1, em que o atuador de extremidade compreende: primeiro e segundo membros de garra opostos; e 15 um cartucho descartávei situado no primeiro membro de garra, sendo que o módulo de espessura do tecido faz parte do cartucho descartá- vel..3. Instrumento cirúrgico, de acordo com a reivindicação 2, em que: 20 q módulo de espessura do tecido compreende um sensor de efeito Hall; e 0 o segundo membro de garra compreende um imã, sendo que o sensor de efeito Hall detecta a resistência do campo magnético do Ímã que é indicativa da espessura do tecido fixado ao atuador de extremidade. 25 4. lnstrumento cirúrgico, de acordo com a reivindicação 3, em que o módulo de espessura do tecido comunica os dados ao circuito de con- trole, sendo que os dados compreendem: dados indicativos da espessura do tecido fixado ao atuador de extremidade; e 30 dados indicativos do tipo de cartucho do cartucho descartável.5. Instrumento cirürgico, de acordo com a reivindicação 4, em que o circuito de controle compreende uma unidade de processamento pro-gmmada para determinar se o teádo fixado ao atuador de extremidade está dentro da faixa de espessura especificada para o cartucho descartável com base nos dados informados ao circuito de controle pelo módulo de espessu- ra do tecido, incluindo os dados indicativos da espessura do tecido fixado ao 5 atuador de extremidade e os dados indicativos do tipo de cartucho do cartu- cho descartável.6. lnstrumento cirúrgico, de acordo com a reivindicação 5, em que o circuito de controle compreende memória de estado sólido que arma- zena dados de faixa de espessura para um ou mais tipos de cartucho. 10 7. lnstrumento cirúrgico, de acordo com a reivindicação 6, em 0 que a unidade de processamento é programada para determinar se ô tecido fixado ao atuador de extremidade está dentro da faixa de espessura especi- ficada para o cartucho descartável, com base nos dados comunicados ao circuito de controle pelo módulo de espessura do tecido através da compa- 15 ração dos dados indicativos da espessura do tecido fixado ao atuador de ex- tremidade com os dados armazenados de faixa de espessura para o tipo de cartucho do cartucho descartável no atuador de extremidade. 8, lnstrumento cirúrgico, de acordo com a reivindicação 7, em gm 20 o instrumento cirúrgico compreende adicionalmente: uma haste de acionamento que aciona a porção de trabalho 0 móvel; um motor elétrico que atua a haste de acionamento; e um conjunto de baterias que fornece energia elétrica ao motor 25 elétrico; e o circuito de controle impede a atuação do motor elétrico quan- do a espessura do tecido fixado ao atuador de extremidade não está dentro da faixa de espessura especificada.9. lnstrumento cirúrgico, de acordo com a reívindicação 8, em 30 que o módulo de espessura do tecido está em comunicação sem fio com o circuito de controle.10. Instrumento cirúrgico, de acordo com a reivindicação 9, emWe que o módulo de espessura do tecido está em comunicação sem fio com uma unidade de tela visuai,11. lnstrumento cirúrgico, de acordo com a reivindicação 9, em que o módulo de espessura da tecido está em comunicação sem fio com um 5 sistema de computador remoto.12. lnstrumento cirúrgico, de acordo com a reivindicação 9, em que: o módulo de espessura do tecido compreende um primeiro módulo de rádio; e 10 o circuito de controle c'ompreende um segundo módulo de rá- 0 dio, sendo que o primeiro módulo de rádio se comunica sem fio com o se- gundo módulo de rádio.13. lnstrumento cirúrgico, de acordo com a reivindicação 2, em que o cartucho descartável compreende um cartucho descartável de gram- 15 pos.14. lnstrumento cirúrgico, de acordo com a reivindicação 1, em que a porção de trabalho móvel compreende um instrumento de corte.15. lnstrumento cirúrgico de corte e união que compreende: um atuador de extremidade, sendo que o atuador de extremi- 20 dade compreende: primeiro e segundo membros de garra móveis opostos entre a 0 posÍção aberta e fechada; Llm instrumento de corte móvel que secciona o tecido fixado entre o primeiro e o segundo membros de garra quando os membros de gar- 25 ra estão na posição fechada; um imã na extremidade distai do primeiro membro de garra; um cartucho descartável no segundo membro de garra, sendo que o cartucho descartável compreende um módulo de espessura do tecido que deteda a espessura do tecido fixado entre o primeiro e o segundo 30 membros de garra, sendo que o módulo de espessura do tecido compreende um sensor de efeito Halj que detecta uma resistência de campo magnético do imã, sendo que a resistência do campo magnético é indicativa da espes-ENÍ sura do tecido fixado entre o primeiro e o segundo membros de garra; uma haste de acionamento que aciana o instrumento de corte; e um circuito de controle em comunicação com o módulo de es- 5 pessura do tecido, sendo que o circuito de controle compreende uma unida- de de processamento programada para determinar se o tecido fixado ao a- tuador de extremidade está dentro da faixa de espessura especificada para o cartucho descartável, com base nos dados informados ao circuito de con- trole do motor pelo módulo de espessura do tecido, sendo que o circuito de 0 10 controle impede a atuação da haste de acionamento quando a espessura do tecido fixado ao atuador de extremidade não está dentro da faixa de espes-W sura especificada para o cartucho descartável.16. lnsttumento cirúrgico, de acordo com a reivindicação 15, em que o módulo de espessura do tecido comunica os dados ao círcuito de 15 controle, sendo que os dados compreendem: dados indicativos da espessura do tegido fixado ao ãtuador de extremidade; e dados indicativos do tipo de cartucho do cartucho descartável.17. instrumento cirúrgico, de acordo com a reivindícação 16, 20 em que o circuito de controle compreende memória de estado sólido que 0 armazena dados de faixa de espessura para um ou mais dos tipos de cartu- cho18. lnstrumento cirúrgico, de acordo com a reivindicação 17, em que a unidade de processamento é programada para determinar se o 25 tecido fixado ao atuador de extremidade está dentro da faixa de espessura especificada para o cartucho descartável, com base nos dados comunicados ao cimuito de controle pelo módulo de espessura do tecido mediante a com- paração dos dados indicativos da espessura do tecido fixado ao atuador de extremidade com os dados armazenados de faixa de espessura para o tipD 30 de cartucho do cartucho descartável no atuador de extremidade.19. lnstrumento cirúrgico, de acordo com a reivindicação 15, em que o módulo de espessura do tecido está em comunicação sem fio com o circuito de controle. 20, lnstrumento cirúrgico, de acordo com a reivindicação 15, que compreende adicionalmente: um motor elétrico que atua a haste de acionamento; e 5 uma bateria que fornece energia elétrica ao motor, e em que o cireuito de controle impede a atuação do motor quando a espessura do tecido fixado aó atuador de extremidade não está dentro da faixa de espessura especificada para o cartucho descartável.21. lnstrumento cirúrgico que compreende: 0 10 um atuador de extremidade para fixação de tecido que com- preende: primeiro e segundo membros de garra opostos; uma porção de trabalho móvel; um cartucho localizada no primeiro membro de garra; 15 um sensor de espessura no cartucho que detec.ta a espessura do tecido fixado entre o primeiro e segundo membros de garra; um microcontrolador em comunicação com q sensor de espes- sura, sendo que o microcontrolador armazena dados indicativos de um tipo de cartucho do cartucho; e 20 um módulo de rádio em comunicação com o microcontrolador; 0 e um circuito de controle em comunicação com o módulo de rá- dio, em que: o circuito de controle recebe dados do módulo de rádio, sendo 2'5 que os dados compreendem: dados indicativos da espessura do tecido fixado ao atuador de extremidade; e dados indicativos do tipo de cartucho do cartucho descartável; o circuito de controle determina se o tecido fixado ao atuador 30 de extremidade está dentro da faixa de espessura especificada para o cartu- chó descartável, com base nos dados comunicados ao circuito de controle; e o árcuito de controle impede a atuação da porção de trabalho móvel quando a espessura do tecido fixado ao atuador de extremídade não está dentro da faixa de espessura para o cartucho descartávet.0 01/1'2286'°" l/'/Ü, í,,' )/,,l\j: » J' 0"LY12',,. Á, 7 "',,"gr,rU FlG. 1CD O) r"N ===- , .. W )))J))::? r ~ \ è:j 4ÁY " ciLL \r-© 0 < r "~>- = 'Ç_ " là < NCN N m m ·J .0 « mS r,, 'O aj " " q 0 \ sq,.. IJ-T 2 q,, k /(J "' \ ,C\Ç, Tnl)):")jqá Y q$"!:'©?,»" " "K " ~\ » A } 'F\":J:>KJP C'C' "\ - /'N m r;""\, N3 m" 4 "r ",^ çjL \<? L "\,, - « \"\.\),à j 'í ¶T" "' " W K " ' \ """Ç Y\X "1"y j: \ g'"jX N \ '\S \"'\G; '\ \ \~ A \ X k ~ S\m <r" qà "\ , \\ ~-1>, '\, \\""<# f.i: ;_"\ \J, yY \ \ '\ ,\?\, \., íj'tj ,, n '1)\),))?)'))'":)j:b.,,, m l)),Á ,, gCD '1)j")T' .: C'JU Àítíj ^à !J"-3 C4 "LO <- © U) LD 0¢ N <N +QAI 9)"¶ _( 1 QO :"j'""" Ç ,r ! E 8 Êd l- fá > n_ 0 1 £.-N Y""'WW r + « l- V' "" t|,i:l \\(, ,,,, -J "v,<>.. r"' " ')')))'))))"))) "- \ \¢':Á0?\, 0 "!')'j/',)',)")j":j?}'H rè '"<:H J3 r ÓN OO r"O (Ç)II ICJ I [ N-I l [ I l [ 0 1 i ' f is\â A I ' í I.I ,S:j i : I N" [ l J' [ 1 O I i 'lI ) ( lhg { 'X) '< r—i l'j Z i=jMTT1)imE 1 i CL i <J I 0 lj'n| )q|ã|L ' J ! U8 Ú!) Llj F- 1 'I °CL 'III Z a- O i I Z F- ' I ál2" i ' , , i°l , O , =I t Q- iI 1 °i) ' 1 ! jI ) A-ji I [I I [I I [ I ~ dOJ ~ — — — ~ ~. — e Lí [ j [ I [ l - sá I j © j I CJ ~ I m r l l j ""SS f l I & f 0 I lJ I cn lI j j !9 á Èiià jjji, j —I CJ uj { GL CJ U) ! i Ei j ] i sii!I 1 I I F~I lI "~ § i , O | i ( < I i g ·t i % 'm [I f -J : Í <7J LljI CJ í:"íir ) i l [ ) 0 1I lIJI J f I I t I~ ~ ~ ~ JI I — ~ ~ ~—~$ |jl'_' s/ÊjK 10112 W, <CJ "áCD ¶ j; E " Ê! \ = !CJ LLJ Q a » m À- ?' q á" ?J g I ? 4 "' 8 I cti tt ' íí " i'i!\AiE¥:'° ~s:E^c=DA?i N'ão Sim 0, ) ,)M 1' ^ ,154 n jALiMENTAçö / GATILHO DE ~ PARA O I' ~ DESCARGA 1>W MOTOR I \ RETRAÍDO? .r- Sim Não 156 /POSIÇÂO DE~ CURSO COMPLETADO 'YURSO DE CORTE?,~|CURSÒ DERETRQCESSO 0 'A'V'!N°,:' lso,:s,| '"/ ':°iZ'° MOTOR DE 160 FlG. 11'))jí'UQ)) "W B' ,,,í y ,, J')) i" '\ 18 22^ 14 r~~_ y " " 'i ^ jj '1"> 1 72 W Lj ." j" r' RU0 '"-4,:ÍZ""'"")) ,.,, _)"' !") 160"j |! r.Y^í':Í ' j/i. ,6P" b. ,¢ ~1~ ,, i r . .N.""J !Íí>:<-.-·-j |m<'¢'q'¢','<'c'.'c'€'b ~ .m k'>" """ Sisíern:d"e canputador remotoFlG. 12
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2009
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2010
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CN102665575B (zh) | 2015-07-08 |
US20160183944A1 (en) | 2016-06-30 |
AU2010333868A1 (en) | 2012-05-31 |
WO2011078959A1 (en) | 2011-06-30 |
US8851354B2 (en) | 2014-10-07 |
US20190269407A1 (en) | 2019-09-05 |
CN102665575A (zh) | 2012-09-12 |
CA2784307C (en) | 2018-10-09 |
EP2515769B8 (en) | 2018-06-06 |
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