BR112013002148B1 - Aparelho prendedor cirúrgico - Google Patents
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Abstract
dispositivo de prendedor cirúrgico acionado a motor com mecanismo de reversão de elemento de corte. a presente invenção refere-se a um aparelho de prendedor cirúrgico que tem um cabo, uma haste alongada que tem uma extremidade proximal ligada ao cabo e uma extremidade distal estendendo-se do mesmo. e um efetor de extremidade que compreende uma bigorna que gira em uma extremidade proximal do mesmo e que é móvel entre uma posição aberta e uma posição fechada, e um cartucho que contém uma pluralidade de prendedores cirúrgicos, o cartucho sendo fixado ao efetor de extremidade. um atuador alimentado eletricamente para a implantação dos prendedores cirúrgicos, o cartucho sendo fixado ao efetor de extremidade. um atuador alimentado eletricamente para a implantação dos prendedores cirúrgicos. um mecanismo de reversão ativado eletricamente para mover o elemento alongado a partir de uma posição mais distal dentro do efetor de extremidade para uma posição proximal, o mecanismo de reversão ativado eletricamente move o elemento alongado proximalmente depois que o elemento alongado moveu-se para a posição mais distal através do movimento do acionador para a posição aberta, e sendo que depois da ativação do mescanismo de reversão o movimento proximal do elemento alongado pode ser interrompido através do retorno do dito acionador a sua posição fechada.
Description
Relatório Descritivo da Patente de Invenção para APARELHO PRENDEDOR CIRÚRGICO.
REFERÊNCIA REMISSIVA A PEDIDOS DE DEPÓSITO CORRELATOS
[0001] Esse pedido não provisório é o pedido da continuação-emparte do pedido de patente US n° de série 12/693.462, intitulado Driven Surgical Stapler Improvements, de autoria de Ryan J Laurent et al., depositado em 26 de janeiro de 2010, que reivindica o benefício do pedido provisório US de número de série 61/150.391 intitulado MotorDriven Surgical Stapler Improvements de autoria de Ryan J. Laurent depositado em 6 de fevereiro de 2009, as descrições inteiras de cada sendo aqui incorporadas por referência em suas respectivas totalidades.
ANTECEDENTES
[0002] Um exemplo de um grampeador cirúrgico adequado para aplicações endoscópicas está descrito na patente n° US 5.465.895, que está incorporada a título de referência no presente documento em sua totalidade. Tal dispositivo compreende um instrumento cirúrgico endoscópico que tem ações de travamento e descarga de prendedores distintas. Outro exemplo de um grampeador cirúrgico acionado por motor é apresentado na publicação de pedido de patente n° US 2007/0175958 A1, intitulada Motor-Driven Surgical Cutting and Fastening Instrument With User Feedback System, publicada em 2 de agosto de 2007, que é por meio desta aqui incorporado na íntegra, a título de referência. Trechos de tal publicação são apresentados aqui para detalhar suas funções básicas, aprimoramentos, antecedentes e componentes. Ao final, aperfeiçoamentos adicionais para o sistema são apresentados.
[0003] A publicação de pedido de patente n° US 2007/0175958 A1 prevê em parte que [um] médico que usa esse dispositivo é capaz de
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2/52 fechar os membros de garra sobre o tecido para posicionar o tecido antes do disparo de prendedores. Uma vez que o clínico tiver determinado que os membros de garra estão prendendo o tecido adequadamente, ele pode então disparar o grampeador cirúrgico com um único tempo de disparo ou com vários tempos de disparo, dependendo do dispositivo. O disparo do grampeador cirúrgico causa o corte e o grampeamento dos tecidos. O uso de seccionamento e grampeamento simultâneos evita complicações que podem surgir durante a realização sequencial dessas ações com diferentes instrumentos cirúrgicos que, respectivamente, apenas seccionam ou grampeiam o tecido.
[0004] Uma vantagem específica de ser capaz de fechar sobre o tecido antes de disparar é a que o clínico pode verificar via um endoscópio que a localização desejada para o corte foi alcançada, incluindo uma quantidade suficiente de tecido que foi capturada entre garras opostas. De outra maneira, as garras opostas podem ser puxadas muito próximas uma da outra, especificamente pinçando as extremidades distais das mesmas, e dessa forma não formando efetivamente grampos fechados no tecido separado. No outro extremo, uma quantidade excessiva de tecido preso pode causar ligação e um disparo incompleto.
[0005] Grampeadores/cortadores endoscópicos continuam a aumentar em complexidade e função com cada geração. Uma das principais razões para isso é a busca por menor força-de-disparo (FDD) para um nível que todos ou a maior parte dos cirurgiões possa lidar. Uma solução conhecida para baixar a FDD é o uso de C02 ou motores elétricos. Estes dispositivos não mostraram-se muito melhores do que dispositivos manuais tradicionais, porém por motivos diferentes. Cirurgiões tipicamente preferem experimentar distribuição de força proporcional àquela sendo experimentada pelo atuador de extremidade na formação do grampo para assegurá-los que o ciclo de corPetição 870190123898, de 27/11/2019, pág. 5/63
3/52 te/grampeamento está completo, com o limite superior nas capacidades da maioria dos cirurgiões (geralmente ao redor de 6,8-13,6 kg (1530 lbs)). Os mesmos também querem tipicamente manter o controle para implantar o grampo e serem capazes de interrompê-lo a qualquer momento se as forças percebidas no cabo do dispositivo forem muito grandes ou por outro motivo clínico. Estes efeitos de realimentação do usuário não são realizáveis adequadamente em bisturis endoscópicos acionados por motor atuais. Como resultado, há uma falta de aceitação generalizada por médicos de bisturis endoscópicos acionados por motor em que a operação de corte/grampeamento é ativada ao meramente apertar um botão.
[0006] A discussão anteriormente mencionada se destina somente a ilustrar algumas das desvantagens presentes no campo da invenção no momento, e não devem ser tomadas como uma negação do escopo das reivindicações.
SUMÁRIO
[0007] De acordo com um aspecto geral da presente invenção, é fornecido o aparelho de prendedor cirúrgico que inclui um cabo, uma haste alongada que tem uma extremidade proximal que é fixada ao cabo e uma extremidade distal que se estende do mesmo. Um efetor de extremidade é acoplado à haste alongada e compreende um par de garras que são pivotados a uma extremidade proximal das mesmas e são móveis entre uma posição fechada e uma posição aberta. Um cartucho que contém uma pluralidade de prendedores cirúrgicos é fixado ao efetor de extremidade. O aparelho inclui adicionalmente um atuador acionado eletricamente para implantar os prendedores cirúrgicos. Em várias modalidades, o atuador compreende uma fonte de energia e um motor e inclui um elemento alongado que se estende através da haste e é móvel em posição distal no efetor de extremidade para implantar os grampos. O elemento alongado podem também mover de maneira
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4/52 proximal para fora do efetor de extremidade. Em certas modalidades, um gatilho é fixado ao cabo e tem um posição aberta e uma posição fechada em que o gatilho ativa o atuador. O aparelho cirúrgico inclui, adicionalmente, um mecanismo de reversão eletricamente acionado para mover o elemento alongado a partir de uma posição mais distal no efetor de extremidade a uma posição proximal. O mecanismo de reversão eletricamente acionado move o elemento alongado de maneira proximal após o elemento alongado moveu a posição mais distal movimentando o gatilho à posição aberta. Após a ativação do mecanismo de reversão, movimento proximal do elemento alongado pode ser parado pelo retorno do gatilho a sua posição fechada.
[0008] Em conjunto com um outro aspecto geral da presente invenção, é fornecido um aparelho de prendedor cirúrgico que inclui um cabo que tem um efetor de extremidade acoplado de maneira operável a isso. Um atuador é móvel no efetor de extremidade entre uma posição não atuada a posições atuadas no dito efetor de extremidade. Um motor elétrico interage de maneira operável com o atuador para aplicar seletivamente um movimento de acionamento distal a isso para mover o atuador da posição não atuada para as posições atuadas e aplicar seletivamente um movimento de acionamento proximal ao atuador para retrair o mesmo para a posição não atuada a partir das posições atuadas. Em várias modalidades, o aparelho inclui, adicionalmente, um circuito de controle do motor para controlar o motor que compreende uma fonte de energia que é conectada ao motor para acionar o motor eletricamente. O aparelho inclui adicionalmente um circuito de controle de corrente que é conectado à fonte de energia para controlar a corrente fornecida ao motor a partir da fonte de energia. O circuito de controle da corrente é configurado para causar o motor aplicar o movimento distal de acionamento ao atuador ao receber um movimento de atuação e também causar o motor aplicar o movimento proximal de acio
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5/52 namento ao atuador ao receber um sinal de retração. O circuito de controle de corrente também é configurado para alterar a aplicação do movimento proximal de acionamento ao receber um pedido de um movimento de retração a isso.
[0009] De acordo com ainda outro aspecto geral da presente invenção, é fornecido o aparelho de prendedor cirúrgico que inclui um cabo e uma haste alongada que tem a extremidade proximal fixada ao cabo. Uma canaleta é acoplada à extremidade distal da haste alongada e é configurada para sustentar de maneira operável um cartucho de grampo cirúrgico ali. Um atuador é, de maneira móvel, sustentado para viagem distal e proximal na canaleta. Um gatilho de disparo é acoplado de maneira operável ao cabo. Um gatilho de retração é sustentado de maneira operável no gatilho de disparo. Um motor elétrico interage de maneira operável com o atuador para aplicar seletivamente um movimento distal de acionamento a isso para em posição distal mover o atuador a partir de uma posição não atuada para posições atuadas e seletivamente aplicar um movimento proximal de acionamento ao atuador para retrair o atuador à posição não atuada a partir de posições atuadas. O aparelho inclui adicionalmente um circuito de controle de motor para controlar o motor. Em várias modalidades, o circuito de controle de motor compreende uma fonte de energia que está conectada ao motor para acionar eletricamente o motor. O circuito de controle de motor compreende, também, um circuito de controle de motor que está conectado à fonte de energia para controlar a corrente fornecida ao motor a partir da fonte de energia. Em várias modalidades, o circuito de controle de motor compreende uma chave de controle de partida de motor que está conectada à fonte de energia e é operada pelo gatilho de disparo de modo que mediante a aplicação do movimento de atuação ao gatilho de disparo, a chave de controle de partida de motor permite a corrente fluir ao motor em uma primeira direção pa
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6/52 ra fazer com que o motor aplique o movimento distal de acionamento ao atuador. O circuito de controle da corrente inclui adicionalmente uma chave de motor reverso que está conectada à fonte de energia de modo que quando o atuador moveu-se a uma posição atuada mais distal, a chave de motor reverso permite a corrente fluir ao motor em uma segunda direção para fazer com que o motor aplique o movimento proximal de acionamento ao atuador. A chave de retração conectada à fonte de energia e operada pelo gatilho de retração de modo que mediante a aplicação de movimento de retração ao gatilho de retração, a chave de retração altera o fluxo da corrente na segunda direção ao motor.
[0010] Em um aspecto geral, a presente invenção é direcionada à um instrumento cirúrgico motorizado de corte e fixação que fornece retroinformação ao usuário em relação a posição, força e/ou posicionamento do efetor de extremidade. O instrumento, em várias modalidades, também permite que o operador para controlar o efetor de extremidade, incluindo a capacidade de parar as implantações, se assim for desejado. O instrumento pode incluir dois gatilhos no cabo do mesmo - um gatilho de fechamento e um gatilho de disparo --com movimentos de atuação separados. Quando um operador do instrumento retrai o gatilho de fechamento, o tecido posicionado no efetor de extremidade pode ser fixado pelo efetor de extremidade. Então, quando o operador retrai o gatilho de disparo, um motor pode acionar, via trens de acionamento de engrenagens, um conjunto de eixos de acionamento principal rotacional, o que faz com que o instrumento de corte no efetor de extremidade corte o tecido preso.
[0011] Em várias modalidades, o instrumento pode compreender um sistema de assistência de acionamento com retroinformação de força de carregamento e controle para reduzir a força de disparo necessária para ser exercida pelo operador a fim de terminar a operação
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7/52 de corte. Em tais modalidades, o gatilho de disparo pode ser engrenado ao trem de acionamento de engrenagens do conjunto do eixo de acionamento principal. Desta forma, o operador pode experimentar retroinformação em relação à força que é aplicada ao instrumento de corte. Isto é, a força de carregamento no gatilho de disparo pode ser relacionada a força de carregamento experimentada pelo instrumento de corte. Além disso, em tais modalidades, como o gatilho de disparo é engrenado ao trem de acionamento da engrenagem, a força aplicada pelo operador pode ser adicionada à força aplicada ao motor.
[0012] De acordo com várias modalidades, quando o gatilho de disparo é retraído em uma quantidade adequada (por exemplo, cinco graus), um comutador para ligar e desligar pode ser ativado, que envia um sinal ao motor para girar a uma taxa específica, dessa forma iniciando a atuação do conjunto de eixos de acionamento e do efetor de extremidade. De acordo com outras modalidades, um sensor proporcional pode ser usado. O sensor proporcional pode enviar um sinal ao motor para girar a uma taxa proporcional à força aplicada ao gatilho de disparo pelo operador. Desta forma, a posição rotacional do gatilho de disparo é, em geral, proporcional ao local em que o instrumento de corte está no efetor de extremidade (por exemplo, completamente distribuído ou completamente retraído). Mais ainda, o operador poderia parar a retração do gatilho de disparo em algum momento no percurso para parar o motor, e por meio disso parar os movimentos de corte. Além disso, sensores podem ser usados para detectar o início do percurso do efetor de extremidade (por exemplo, posição completamente retraída) e o final do percurso (por exemplo, posição completamente distribuída), respectivamente. Consequentemente, os sensores podem proporcionar um sistema de controle adaptável para controlar o posicionamento do efetor de extremidade que está do lado de fora do sistema de circuito fechado do motor, trem de acionamento de engrenaPetição 870190123898, de 27/11/2019, pág. 10/63
8/52 gem, e efetor de extremidade.
[0013] Em outras modalidades, o gatilho de disparo pode não ser diretamente engrenado no trem de acionamento de engrenagem usado para atuar no efetor de extremidade. Em tais modalidades, um segundo motor pode ser usado para aplicar forças ao gatilho de disparo para simular o posicionamento do instrumento de corte no efetor de extremidade. O segundo motor pode ser controlado à base de rotações adicionais do conjunto de eixo de acionamento principal, que pode ser medido por um codificador giratório. Em tais modalidades, a posição da posição rotacional do gatilho de disparo pode ser relacionado à posição do instrumento de corte no efetor de extremidade. Adicionalmente, um comutador para ligar e desligar ou um comutador proporcional pode ser usado para controlar o motor principal (isto é, o motor que aciona o eixo de acionamento principal).
[0014] Em várias implementações, o efetor de extremidade pode usar um parafuso helicoidal na base do efetor de extremidade para acionar o instrumento de corte (por exemplo, lâminas). Além disso, o efetor de extremidade pode incluir um cartucho de grampos para grampeamento do tecido separado. De acordo com outras modalidades, outros meios para fixação (ou vedação) do tecido separado podem ser usados, incluindo energia de RF e adesivos.
[0015] Ademais, o instrumento pode incluir um sistema de fechamento mecânico. O sistema de fechamento mecânico pode incluir um canal alongado que tem um elemento de fixação, como uma bigorna, conectada de maneira rotatória no canal para o tecido fixado posicionado no efetor de extremidade. O usuário pode ativar a ação de fixação do efetor de extremidade ao retrair o gatilho mais próximo, que, através de um sistema de fechamento mecânico, faz com que a ação de fixação do efetor de extremidade. Uma vez que o elemento de fixação esteja preso no lugar, o operador pode ativar a operação de corte
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9/52 ao retrair o gatilho de disparo separado. Isto pode fazer com que o instrumento de corte mover-se longitudinalmente ao longo do canal a fim de cortar o tecido preso pelo efetor de extremidade.
[0016] Em várias implementações, o instrumento pode incluir um conjunto de eixo de acionamento principal rotacional para acionar o efetor de extremidade. Além disto, o eixo de acionamento principal pode compreender uma junta de articulação de maneira que o efetor de extremidade possa ser articulado. A junta de articulação pode compreender, por exemplo, um conjunto de engrenagem de chanfro, uma junta universal, ou um cabo de torção flexível capaz de transmitir força de torção para o efetor de extremidade.
[0017] Outros aspectos da presente invenção são direcionados para vários mecanismos para travar o gatilho de fechamento em uma porção de pistola, inferior, do cabo. Tais modalidades liberam espaço no cabo diretamente acima e atrás dos gatilhos para outros componentes do instrumento, incluindo componentes do trem de acionamento de engrenagem e o sistema de fechamento mecânico.
[0018] As descrições da presente invenção mostram como uma pessoa poderia incorporar um dispositivo de grampeamento endoscópico autocontido acionado por engrenagem alimentada por bateria. BREVE DESCRIÇÃO DOS DESENHOS
[0019] As características acima mencionadas e outras características e vantagens desta invenção, e a maneira de obtenção das mesmas, se tornarão mais aparentes e a invenção em si será melhor compreendida por referência à seguinte descrição de modalidades da invenção, tomada em conjunto com os desenhos em anexo, sendo que: [0020] As Figuras 1 e 2 são vistas perspectivas de um instrumento cirúrgico de corte e união de acordo com várias modalidades da presente invenção;
[0021] As Figuras 3-5 são vistas explodidas de um efetor de ex
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10/52 tremidade e haste do instrumento de acordo com várias modalidades da presente invenção;
[0022] A Figura 6 é uma vista lateral do efetor de extremidade de acordo com várias modalidades da presente invenção;
[0023] A Figura 7 é uma vista explodida do cabo do instrumento de acordo com várias modalidades da presente invenção;
[0024] As Figuras 8 e 9 são vistas de perspectiva parcial do cabo de acordo com várias modalidades da presente invenção;
[0025] A Figura 10 é uma vista lateral do cabo de acordo com várias modalidades da presente invenção;
[0026] As Figuras 10A-10B ilustram um sensor ou chave proporcionais que podem ser usados de acordo com várias modalidades da presente invenção;
[0027] A Figura 11 é um diagrama esquemático de um circuito de controle de corrente usado no instrumento de acordo com várias modalidades da presente invenção;
[0028] A Figura 12 é uma vista lateral de um cabo de acordo com várias modalidades da presente invenção;
[0029] A Figura 13 é um diagrama esquemático de um circuito de controle de corrente usado no instrumento de acordo com várias modalidades da presente invenção;
[0030] A Figura 14 é um diagrama esquemático de um outro circuito de controle de corrente usado no instrumento de acordo com várias modalidades da presente invenção;
[0031] A Figura 15 é um diagrama esquemático de um outro circuito usado no instrumento de acordo com várias modalidades da presente invenção;
[0032] A Figura 15A é um diagrama esquemático de um outro circuito de controle de corrente usado no instrumento de acordo com várias modalidades da presente invenção;
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[0033] A Figura 15B é uma diagrama esquemático de um outro circuito de controle de corrente usado no instrumento de acordo com várias modalidades da presente invenção;
[0034] As Figuras 16-17 ilustram diferentes mecanismos para travar o gatilho de fechamento de acordo com várias modalidades da presente invenção;
[0035] A Figura 18 é um diagrama esquemático de um outro circuito de controle de corrente usado no instrumento de acordo com várias modalidades da presente invenção;
[0036] A Figura 19 uma vista em seção transversal de uma modalidade de efetor de extremidade da presente invenção;
[0037] A Figura 20 é uma vista em elevação lateral de um conjunto de lâminas ou modalidade de atuador da presente invenção;
[0038] A Figura 21 é uma vista em elevação lateral de um outro conjunto de lâminas ou modalidade de atuador da presente invenção;
[0039] A Figura 22 é uma vista em elevação lateral de um outro conjunto de lâminas ou modalidade de atuador da presente invenção;
[0040] A Figura 23 é uma vista em perspectiva da extremidade distal de um grampeador cirúrgico, de acordo com uma modalidade da presente invenção.
[0041] A Figura 24 é uma vista em perspectiva de uma extremidade distal de grampeador cirúrgico, de acordo com uma modalidade da presente invenção, com cartucho removido da canaleta;
[0042] A Figura 25 é uma vista de uma extremidade distal de grampeador cirúrgico, de acordo com uma modalidade da presente invenção, similar à Figura 1 mostrando um indicador de travamento; e [0043] A Figura 26 é uma vista em perspectiva da extremidade proximal de um grampeador cirúrgico, de acordo com uma modalidade da presente invenção.
DESCRIÇÃO DETALHADA DA INVENÇÃO
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[0044] O proprietário do pedido em questão também é proprietário dos seguintes pedidos de patente US que foram depositadas na mesma data do presente pedido e que estão aqui incorporados, a título de referência em suas respectivas totalidades:
[0045] Pedido de patente US intitulado Motor Driven Surgical Fastener Device With Cutting Member Lockout Arrangements, n° de registro legal END6547USCIP1/100270CIP1; e
[0046] Pedido de patente US intitulado Motor Driven Surgical Fastener Device With Mechanisms For Adjusting a Tissue Gap Within the End Effector, n° de registro Legal END6548USCIP1/100271CIP1.
[0047] Determinadas modalidades exemplificadoras serão agora descritas para proporcionar o entendimento geral dos princípios da estrutura, função, fabricação e uso dos dispositivos e métodos descritos aqui. proporcional Um ou mais exemplos de três modalidades são ilustrados nos desenhos anexos. Aqueles de habilidade comum na técnica entenderão que os dispositivos e os métodos especificamente aqui descritos e ilustrados nos desenhos em anexo são modalidades exemplares não limitadoras, e que o escopo das várias modalidades da presente invenção é definido somente pelas reivindicações. Os aspectos ilustrados ou descritos em conexão com uma modalidade exemplificadora podem ser combinados com os aspectos de outras modalidades. Essas modificações e variações são destinadas a estarem incluídas no escopo da presente invenção.
[0048] A referência do início ao fim do relatório descritivo de várias modalidades, algumas modalidades, uma modalidade, ou a modalidade, uma implementação ou várias implementações ou similares, significa que um atributo, estrutura, ou características descrita em conjunto com a modalidade é incluída em pelo menos uma modalidade. Portanto, a aparição das frases em várias modalidades, em algumas modalidades, em uma modalidade ou na modalida
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13/52 de, uma implementação ou várias implementações ou similares, em lugares do início ao fim do relatório descritivo não estão necessariamente todos se referindo à mesma modalidade ou posicionamento. Além disso, os atributos, estruturas, ou características particulares podem ser combinados em qualquer maneira adequada em uma ou mais modalidades ou implementações. Portanto, os atributos, estruturas, ou características particulares ilustrados ou descritos em conjunto com uma modalidade podem ser combinados, no todo ou em parte, com as estruturas dos atributos, ou características de uma ou mais outras modalidades sem limitação. Essas modificações e variações são destinadas a estarem incluídas no escopo da presente invenção.
[0049] Os termos proximal e distal são usados na presente invenção com referência a um clínico manipulando a porção de cabo do instrumento cirúrgico. O termo proximal refere-se à porção mais próxima ao clínico, e o termo distal refere-se à porção situada mais distante do clínico. Será também entendido que, por uma questão de conveniência e clareza, termos espaciais como vertical, horizontal, para cima e para baixo podem ser usados na presente invenção com relação aos desenhos. Entretanto, instrumentos cirúrgicos podem ser usados em muitas orientações e posições, e não se pretende que esses termos sejam limitadores e absolutos.
[0050] As Figuras 1 e 2 representam um instrumento cirúrgico de corte e união 10 de acordo com várias modalidades da presente invenção. A modalidade ilustrada é um instrumento cirúrgico endoscópico 10 e, em geral, as modalidades do instrumento 10 aqui descritas são instrumentos cirúrgicos endoscópicos de corte e união. Deve ser observado, entretanto, de acordo com outras modalidades da presente invenção, que o instrumento 10 pode ser um instrumento de corte cirúrgico não endoscópico, como um instrumento laparoscópico.
[0051] O instrumento cirúrgico 10 representado nas Figuras 1 e 2
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14/52 compreende um cabo 6, uma haste 8, e um efetor de extremidade articulado 12 conectado de forma articulada à haste 8 a um pivô de articulação 14. Um controle de articulação 16 pode ser fornecido adjacente ao cabo 6 para realizar a rotação do atuador de extremidade 12 sobre o pivô de articulação 14. Ficará entendido que várias modalidades podem incluir um efetor de extremidade não pivotante e, consequentemente, podem não ter um pivô de articulação 14 ou controle de articulação 16. Ademais, na modalidade ilustrada, o efetor de extremidade 12 é configurado para atuar como um instrumento cirúrgico endoscópico para prender, separar e grampear tecido, embora, em outras modalidades, diferentes tipos de efetores de extremidade podem ser usados, como efetores de extremidade para outros tipos de dispositivos cirúrgicos, como pinças, cortadores, grampeadores, aplicadores de presilha, dispositivos de acesso, dispositivos de terapia de gene/fármaco, ultrassom, RF ou dispositivos a laser, etc.
[0052] O cabo 6 do instrumento 10 pode incluir um gatilho de fechamento 18 e um gatilho de descarga 20 para acionar o atuador de extremidade 12. Será reconhecido que os instrumentos que têm atuadores de extremidade direcionados a diferentes tarefas cirúrgicas podem ter números ou tipos diferentes de gatilhos ou outros controles adequados para operar o atuador de extremidade 12. O atuador de extremidade 12 é mostrado separadamente do cabo 6 por uma haste 8, de preferência, alongada. Em uma modalidade, um médico ou operador do instrumento 10 pode articular o efetor de extremidade 12 em relação à haste 8 pelo uso do controle de articulação 16, conforme descrito em mais detalhes na patente n° US 7.670.334, intitulada Surgical Instrument Having An Articulating End Effector, de Geoffrey C. Hueil et al., aqui incorporada a título de referência em sua totalidade.
[0053] O efetor de extremidade 12 inclui nesse exemplo, entre outras coisas, uma canaleta alongada 22 configurada para suportar de
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15/52 modo operacional um cartucho de grampo 34 na mesma e um membro de garra transponível de maneira articulada, como uma bigorna 24, que são mantidos em um espaçamento que garante grampeamento eficaz e seccionamento do tecido fixado no efetor de extremidade 12. O cabo 6 inclui uma pega de pistola 26 em direção ao qual um gatilho de fechamento 18 é puxado de forma articulada pelo médico para levar à fixação ou fechamento da bigorna 24 em direção à canaleta alongada 22 do efetor de extremidade 12 para desse modo fixar o tecido posicionado entre a garra da bigorna 24 e a canaleta alongada 22. O gatilho de descarga 20 está mais afastado do gatilho de fechamento 18. Quando o gatilho de fechamento 18 está travado na posição de fechamento, como descrito em mais detalhes a seguir, o gatilho de disparo 20 pode girar levemente em direção à pega de pistola 26 de modo que ele possa ser alcançado pelo operador com o uso de uma mão. Então o operador pode puxar o gatilho de descarga 20 de forma articulada em direção à pega de pistola 26 para causar o grampeamento e seccionamento de tecido fixado no atuador de extremidade 12. Em outras modalidades, diferentes tipos de membros de fixação além da garra de garra fixa 24 podem ser usados, como, por exemplo, uma garra de oposição, etc.
[0054] O gatilho de fechamento 18 pode ser acionado primeiro.
Quando satisfeito com o posicionamento do atuador de extremidade 12, o médico pode retrair o gatilho de fechamento 18 para a posição completamente fechada e travada adjacente à pega de pistola 26. O gatilho de descarga 20 pode então ser atuado. O gatilho de disparo 20 retorna à posição aberta (mostrada nas Figuras 1 e 2) quando o clínico remove a pressão, conforme descrito abaixo, com mais detalhes. Um botão de liberação presente no cabo 6 pode, quando pressionado, liberar a trava do gatilho de fechamento 18. O botão de liberação pode ser implementado de várias formas, como, por exemplo, um botão de
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16/52 liberação deslizante 160 mostrado na Figura 16, e/ou o botão 172 mostrado na Figura 17.
[0055] As Figuras 3-6 mostram modalidades de efetor de extremidade giratório 12 e haste 8 de acordo com várias modalidades. A Figura 3 é uma vista explodida do atuador de extremidade 12, de acordo com várias modalidades. Conforme mostrado na modalidade ilustrada, o atuador de extremidade 12 pode incluir, em adição à canaleta 22 e à garra fixa 24 previamente mencionadas, um instrumento de corte 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 instrumento de corte 32 pode ser, por exemplo, uma lâmina. Para uso na presente invenção que diz respeito a pelo menos uma modalidade, o termo atuador pode se referir à lâmina e/ou trilho. A bigorna 24 pode ser pivotadamente aberta e fechada nos pinos pivôs 25 conectados à extremidade adjacente da canaleta 22. A garra de garra fixa 24 também pode incluir uma aba 27 em sua extremidade adjacente que é inserida dentro de um componente de um sistema de fechamento mecânico (descrito adicionalmente abaixo) para abrir e fechar a garra de garra fixa 24. Quando o gatilho de fechamento 18 é atuado, isto é, extraído por um usuário do instrumento 10, a bigorna 24 pode se pivotar em torno dos pinos pivôs 25 formando uma posição fechada ou presa. Se a fixação do atuador de extremidade é 12 for satisfatória, o operador pode acionar o gatilho de disparo 20 que, como explicado em mais detalhes acima, faz com que a lâmina 32 e o trilho 33 corram longitudinalmente ao longo da canaleta 22, cortando 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 através do tecido separado e em relação à bigorna fechada 24, que vira os grampos para unir o tecido separado. Em várias modalidades, o trilho 33
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17/52 pode ser um componente integral do cartucho 34. A patente n° US 6.978.921, intitulada Surgical Stapling Instrument Incorporating an Ebeam Firing Mechanism, concedida à Shelton, IV et al., a qual está aqui incorporada, a título de referência, fornece mais detalhes sobre esses instrumentos de corte e união de dois movimentos. O trilho 33 pode ser parte do cartucho 34, de modo que quando a lâmina 32 retrai após a operação de corte, o trilho 33 não retrai.
[0056] As Figuras 4 e 5 são vistas explodidas e a Figura 6 é uma vista lateral do efetor de extremidade 12 e haste 8 de acordo com várias modalidades. Conforme mostrado na modalidade ilustrada, a haste 8 pode incluir um tubo de fechamento adjacente 40 e um tubo de fechamento distal 42 pivotadamente ligado por uma ligação de pivô 44. O tubo de fechamento distal 42 inclui um sistema de abertura 45 dentro do qual a aba 27 na bigorna 24 é inserida de modo a abrir e fechar a bigorna 24, conforme descrito adicionalmente a seguir. Disposto dentro dos tubos de fechamento 40, 42 pode estar um tubo estruturante adjacente 46. Disposto dentro do tubo estruturante adjacente 46 pode estar um eixo de acionamento rotacional principal (ou adjacente) 48 que se comunica com um eixo de acionamento secundário (ou distal) 50 através de um conjunto de engrenagens chanfradas 52. O eixo de acionamento secundário 50 está conectado a uma engrenagem propulsora 54 que engata uma engrenagem propulsora adjacente 56 da haste de parafuso helicoidal 36. A engrenagem chanfrada vertical 52b pode assentar 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, o eixo de acionamento principal 48, o eixo de acionamento secundário 50, e o conjunto de articulação (por exemplo, o conjunto de engrenagens chanfradas 52a-c) são algumas vezes chamados na presente invenção como o conjunto
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18/52 do eixo de acionamento principal.
[0057] Um rolamento 38, posicionado em uma extremidade distal da canaleta de grampos 22, recebe o parafuso helicoidal 36, permitindo que o parafuso helicoidal 36 gire livremente em relação à canaleta 22. A haste de parafuso helicoidal 36 pode interligar uma abertura rosqueada (não mostrada) da lâmina 32 de modo que a rotação da haste 36 faz com que a lâmina 32 gire em posição distal ou em direção proximal (dependendo da direção da rotação) através da canaleta de grampos 22. Consequentemente, quando se faz com que a haste de acionamento principal 48 gire mediante a aplicação de um movimento de atuação no gatilho de disparo 20 (conforme explicado em maiores detalhes abaixo), o conjunto de engrenagem de chanfro 52a a c faz com que a haste de acionamento secundária 50 gire, que, por sua vez, por causa do engate das engrenagens de acionamento 54, 56, faz a haste de parafuso helicoidal 36 girar, o que faz com que o membro de acionamento de lâmina 32 percorra longitudinalmente ao longo da canaleta 22 para cortar qualquer tecido preso dentro do efetor de extremidade 12. 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 dianteira inclinada pode empurrar para cima ou acionar os grampos no cartucho de grampo através do tecido fixado e contra a bigorna 24. A bigorna 24 forma ou vira os grampos, grampeando assim o tecido cortado. Quando a lâmina 32 é retraída, o bisturi 32 e o trilho 33 podem ficar desengatados, saindo assim do trilho 33 na extremidade distal da canaleta 22.
[0058] As Figuras 7-10 ilustram uma modalidade exemplificadora de um instrumento cirúrgico endoscópico acionado a motor, e, em particular, o cabo do mesmo, que fornece retroinformação do usuário com relação à força de posicionamento e carregamento do instrumento de
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19/52 corte 32 no efetor de extremidade 12. Além disso, a modalidade pode usar a energia fornecida pelo usuário ao retrair o gatilho de disparo 20 para alimentar o dispositivo (um modo chamado esforço assistido). A modalidade pode ser usada com as modalidades descritas acima do efetor de extremidade acionado por rotação 12 e da haste 8. Conforme mostrado na modalidade ilustrada, o cabo 6 inclui peças laterais inferiores externas 59, 60 e peças laterais superiores externas 61, 62 que se encaixam para formar, em geral, o exterior do cabo 6. Em várias modalidades, o efetor de extremidade acionado giratório pode ser motorizado por um motor 65 que está disposto em uma porção superior da porção de pega da pistola 26 do cabo e motorizado por uma fonte de energia 64. A fonte de energia 64 pode compreender uma bateria ou um suprimento de corrente alternada. Em uma modalidade preferencial, a fonte de energia 64 compreende uma bateria de íon de Li que é sustentada na porção de pega da pistola 26 do cabo 6. De acordo com várias modalidades, o motor 65 pode ser um motor de corrente contínua com escova, que tem uma rotação máxima de aproximadamente 5000 RPM. O motor 65 pode direcionar um conjunto de engrenagens chanfradas a 90 graus 66 que compreende uma primeira engrenagem chanfrada 68 e uma segunda engrenagem chanfrada 70. O conjunto de engrenagens chanfradas 66 pode direcionar um conjunto de engrenagens planetárias 72. O conjunto de engrenagens planetárias 72 pode incluir uma engrenagem de pinhão 74 conectada a um eixo de acionamento 76. A engrenagem de pinhão 74 pode acionar uma engrenagem anular de acoplamento 78 que aciona um tambor de engrenagem helicoidal 80 por meio de uma haste de acionamento 82. Um anel 84 pode ser rosqueado sobre o tambor com engrenagem helicoidal 80. Portanto, quando o motor 65 gira, o anel 84 é forçado a se mover ao longo do tambor de engrenagem helicoidal 80, por meio do conjunto de engrenagens cônicas 66, do conjunto de engrenagens
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20/52 planetárias 72 e da engrenagem anular 78, ali interpostas.
[0059] O cabo 6 pode também incluir uma chave de motor de operação 110 (consulte Figura 10) em comunicação com o gatilho de disparo 20 para receber um movimento de atuação do gatilho de disparo 20, quando o gatilho de disparo foi retirado (ou fechado) em direção à porção de pega da pistola 26 do cabo 6 pelo operador para, por meio disso, atuar a operação de corte/grampeamento pelo efetor de extremidade 12. A chave de partida de motor 110 pode ser um sensor proporcional como, por exemplo, um reostato ou um resistor variável. Quando o gatilho de disparo 20 é encaixado, a chave de partida de motor 110 permite que a corrente flua da fonte de energia 64 para o motor 65. Quando a chave de partida de motor 110 é um resistor variável ou similar, a rotação do motor 65 pode ser geralmente proporcional à quantidade de movimento do gatilho de disparo 20. Isto é, se o operador puxar ou fechar o gatilho de disparo 20 apenas um pouco, a rotação do motor 65 é relativamente baixa. Quando o gatilho de disparo 20 é puxado completamente (ou está na posição completamente fechada), a rotação do motor 65 está no seu máximo. Em outras palavras, quanto mais forte o usuário puxa o gatilho de disparo 20, maior é a tensão aplicada ao motor 65, gerando maiores taxas de rotação.
[0060] O cabo 6 pode incluir uma peça intermediária do cabo 104 adjacente à porção superior do gatilho de disparo 20. O cabo 6 pode incluir também uma mola de polarização 112 que é conectada entre colunas na peça intermediária do cabo 104 e no gatilho de disparo 20. A mola de polarização 112 pode colocar o gatilho de disparo 20 na sua posição completamente aberta. Desse modo, quando o operador solta o gatilho de disparo 20, a mola de retorno 112 puxa o gatilho de disparo 20 para sua posição aberta, desativando assim a chave de partida de motor 110, para interromper a rotação do motor 65. Além disso, por causa da mola de polarização 112, a qualquer momento que um usuá
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21/52 rio fechar o gatilho de disparo 20, ele sentirá resistência à operação de fechamento fornecendo, assim, ao usuário retroinformação relacionada à quantidade de rotação exercida pelo motor 65. Adicionalmente, o operador pode interromper a retração do gatilho de disparo 20 para desativar por meio disso a chave de partida de motor 110 e interromper o motor 65. Assim, o usuário pode parar o posicionamento do atuador de extremidade 12, fornecendo, assim, uma medida de controle da operação corte/fixação ao operador.
[0061] A extremidade distal do tambor de engrenagem helicoidal inclui uma haste de acionamento distal 120 que aciona uma engrenagem de anel 122, que corresponde a uma engrenagem de pinhão 124. A engrenagem de pinhão 124 está conectada ao eixo de acionamento principal 48 do conjunto do eixo de acionamento principal. Desta forma, a rotação do motor 65 faz com que o conjunto do eixo de acionamento principal gire, o que causa a atuação do atuador de extremidade 12, conforme descrito acima.
[0062] O anel 84 rosqueado ao tambor com engrenagem helicoidal pode incluir uma coluna 86 que está disposta no interior de uma fenda 88 de um braço dotado de fendas 90. O braço dotado de fendas 90 possui uma abertura 92 na sua extremidade oposta 94 que recebe um pino pivô 96 que está conectado entre as peças laterais externas do cabo 59, 60. O pino pivô 96 também está disposto através de uma abertura 100 no gatilho de disparo 20 e uma abertura 102 na peça intermediária do cabo 104.
[0063] Além disso, o cabo 6 pode incluir uma chave de motor reverso (ou chave de final de percurso) 130 e uma chave de parada de motor (ou começo de percurso) 142. Em várias modalidades, a chave de reversão do motor 130 pode ser uma chave de limite situada na extremidade distal do tambor de engrenagem helicoidal 80, de modo que o anel 84 rosqueado sobre o tambor de engrenagem helicoidal 80 en
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22/52 tre em contato com, e acione, a chave de reversão do motor 130, quando o anel 84 atinge a extremidade distal do tambor de engrenagem helicoidal 80. A chave de reversão do motor 130, quando ativada, envia um sinal (isto é, permite que a corrente flua) ao motor 65 para reverter sua direção de rotação, recolhendo assim a lâmina 32 do atuador de extremidade 12 em seguida à operação de corte.
[0064] A chave de parada do motor 142 pode ser, por exemplo, uma chave de fim de curso normalmente fechada. Em várias modalidades, ele pode estar localizado na extremidade adjacente do tambor com engrenagem helicoidal 80 de modo que o anel 84 ative a chave 142 quando o anel 84 atingir a extremidade adjacente do tambor com engrenagem helicoidal 80.
[0065] Em funcionamento, quando um operador do instrumento 10 aplicar um movimento de atuação ao gatilho de disparo 20, a chave de partida de motor 110 detecta o posicionamento do gatilho de disparo 20 e envia um sinal (isto é, permite que a corrente flua) para o motor 65 para causar a rotação adiante do motor 65, por exemplo, em uma taxa proporcional à força usada pelo operador para puxar o gatilho de disparo 20. A rotação para diante do motor 65, por sua vez, faz girar a engrenagem anular 78 presente na extremidade distal do conjunto de engrenagens planetárias 72, fazendo assim girar o tambor de engrenagem helicoidal 80, e fazendo com que o anel 84 rosqueado no tambor de engrenagem helicoidal 80 se mova distalmente ao longo do dito tambor de engrenagem helicoidal 80. A rotação do tambor com engrenagem helicoidal 80 também direciona o conjunto do eixo de acionamento principal conforme descrito acima que, por sua vez, leva o posicionamento da lâmina 32 no atuador de extremidade 12. Isto é, a lâmina 32 e o trilho 33 são levados a cruzar de modo distal a canaleta 22 longitudinalmente, cortando, assim, o tecido fixado no atuador de extremidade 12. Além disso, a operação de grampeamento do efetor de
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23/52 extremidade 12 é ocasionada em modalidades nas quais é usado um efetor de extremidade 12 do tipo grampeador.
[0066] Quando a operação de corte/grampeamento do efetor de extremidade 12 estiver terminada, o anel 84 no tambor com engrenagem helicoidal 80 terá atingido a extremidade distal do tambor com engrenagem helicoidal 80 fazendo, assim, com que a chave de reversão do motor 130 seja ativada, o que envia um sinal (isto é, permite que a corrente flua) para o motor 65 para fazer com que o motor 65 reverta sua rotação. Por sua vez, isto faz com que a lâmina 32 retraia e também faz com que o anel 84 no tambor com engrenagem helicoidal 80 se movimentara para trás até a extremidade adjacente do tambor com engrenagem helicoidal 80.
[0067] A peça intermediária do cabo 104 inclui um ressalto na parte posterior 106 que se acopla ao braço com fenda 90, conforme é mais bem mostrado nas Figuras 8 e 9. A peça intermediária do cabo 104 tem, também, um bloqueio de movimento para frente 107 que se acopla ao gatilho de disparo 20. O movimento do braço fendido 90 é controlado, como explicado acima, pela rotação do motor 65. Quando o braço dotado de fendas 90 gira em sentido anti-horário conforme o anel 84 percorre a partir da extremidade adjacente do tambor de engrenagem helicoidal 80 para a extremidade distal, a peça de cabo mediana 104 será livre para girar em sentido anti-horário. Dessa forma, conforme o usuário retira o gatilho de disparo 20, o gatilho de disparo 20 irá se engatar no batente de movimento dianteiro 107 da peça de cabo mediana 104, fazendo com que a peça de cabo mediana 104 gire em sentido anti-horário. Devido ao anteparo da parte posterior 106 que engata o braço dotado de fendas 90, entretanto, a peça de cabo mediana 104 irá somente ser capaz de girar em sentido anti-horário o quão longe o braço dotado de fendas 90 permitir. Desse modo, se o motor 65 parar de girar por alguma razão, o braço dotado de fendas 90 irá
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24/52 para de rodar, e o usuário não será capaz de retirar ainda mais o gatilho de disparo 20, devido ao fato de a peça de cabo mediana 104 não estar livre para girar em sentido anti-horário devido aos braços dotados de fendas 90.
[0068] As Figuras 10A e 10B ilustram dois estados de chaves ou sensores variáveis que podem ser usados como a chave de partida de motor 110 de acordo com várias modalidades da presente invenção. A chave de partida de motor 110 pode incluir uma porção de face 280, um primeiro eletrodo (A) 282, um segundo eletrodo (B) 284, e um material dielétrico compressível 286 entre os eletrodos 282 e 284, como, por exemplo, um polímero eletroativo (EAP). A chave de partida de motor 110 pode ser posicionada de modo que a porção de face 280 entre em contato com o gatilho de disparo 20 quando retraída. Consequentemente, quando o gatilho de disparo 20 é retraído, o material dielétrico 286 é comprimido, como mostrado na Figura 10B, de modo que os eletrodos 282 e 284 estão mais próximos. Uma vez que a distância b entre os eletrodos 282 e 284 está diretamente relacionada com a impedância entre os eletrodos 282 e 284, quanto maior a distância, maior é a impedância, e quanto menor a distância, menor é a impedância. Desta forma, a quantidade de compressão do material dielétrico 286 causada pela retração do gatilho de disparo 20 (denotada como força F na Figura 10B) é proporcional à impedância entre os eletrodos 282 e 284, que pode ser usada para controlar proporcionalmente o motor 65.
[0069] Os componentes de um sistema de fechamento exemplificador para fechar (ou fixar) a bigorna 24 do efetor de extremidade 12 pela retração do gatilho de fechamento 18 também são mostrados nas Figuras 7 a 10. Na modalidade ilustrada, o sistema de fechamento inclui uma forquilha 250 conectada ao gatilho de fechamento 18 por um pino pivô 251 inserida através de aberturas alinhadas tanto no gatilho
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25/52 de fechamento 18 quanto na forquilha 250. Um pino pivô 252, em torno do qual o gatilho de fechamento 18 pivota, é inserido através de outra abertura no gatilho de fechamento 18 que está deslocada em relação a onde o pino 251 é inserido no gatilho de fechamento 18. Dessa forma, a retração do gatilho de fechamento 18 faz com que a parte superior do gatilho de fechamento 18, à qual a forquilha 250 é fixada através do pino 251, gire em sentido anti-horário. A extremidade distal da forquilha 250 está conectada, através de um pino 254, a um primeiro bráquete de fechamento 256. O primeiro bráquete de fechamento 256 se conecta a um segundo bráquete de fechamento 258. Coletivamente, os suportes de fechamento 256 e 258 definem uma abertura na qual a extremidade proximal do tubo de fechamento proximal 40 (consulte a Figura 4) é apoiado e mantido de modo que o movimento longitudinal dos suportes de fechamento 256 e 258 cause um movimento longitudinal do tubo de fechamento proximal 40. O instrumento 10 inclui, também, uma haste de fechamento 260 disposta dentro do tubo de fechamento adjacente 40. A haste de fechamento 260 pode incluir uma abertura 261 dentro da qual uma coluna 263 em uma das peças externas do cabo, tal como a peça lateral inferior externa 59 na modalidade ilustrada, está disposta para conectar de modo fixo a haste de fechamento 260 ao cabo 6. Desta forma, o tubo de fechamento adjacente 40 é capaz de se movimentar longitudinalmente em relação à haste de fechamento 260. A barra de fechamento 260 pode, também, incluir um colar distal 267 que se encaixa dentro de uma cavidade 269 no tubo estruturante adjacente 46 e é nele mantido por uma tampa 271 (vide Figura 4).
[0070] Em funcionamento, quando a forquilha 250 gira devido à retração do gatilho de fechamento 18, as braçadeiras de fechamento 256, 258 fazem com que o tubo de fechamento adjacente 40 se mova distalmente (isto é, na direção contrária à extremidade de cabo do ins
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26/52 trumento 10), que faz com que o tubo de fechamento distal 42 se mova distalmente, o que faz com que a bigorna 24 gire em torno dos pinos pivôs 25 para a posição fechada ou presa. Quando o gatilho de fechamento 18 é destravado da posição travada, o tubo de fechamento adjacente 40 é provocado a deslizar aproximadamente, o que faz com que o tubo de fechamento distal 42 deslize aproximadamente, que, em virtude da aba 27 que é inserida na janela 45 do tubo de fechamento distal 42, faz com que a bigorna 24 se pivote em torno dos pinos pivôs 25 para a posição aberta ou não presa. Desta forma, pela retração e travamento do gatilho de fechamento 18, um operador pode prender o tecido entre a garra fixa 24 e a canaleta 22, e pode soltar o tecido após a operação de corte/grampeamento por destravar o gatilho de fechamento 20 da posição travada.
[0071] A Figura 11 é um diagrama esquemático de um circuito de controle de corrente do instrumento 10 de acordo com várias modalidades da presente invenção. Quando um operador puxa inicialmente o gatilho de disparo 20 após o travamento do gatilho de fechamento 18, a chave de partida de motor 110 é ativada, permitindo que a corrente flua através da mesma. Se a chave normalmente aberta 130 do sensor de reversão do motor estiver aberta (significando que não foi atingido o final do percurso do atuador de extremidade), a corrente fluirá para um relé de polo único e duplo acionamento 132. Como a chave do sensor de reversão do motor 130 não está fechada, o indutor 134 do relé 132 não estará energizada, portanto o relé 132 estará em seu estado não energizado. O circuito inclui, também, uma chave de travamento do cartucho 136. Se o atuador de extremidade 12 incluir um cartucho de grampos 34, a chave 136 estará no estado fechado, permitindo que a corrente flua. De outro modo, se o atuador de extremidade 12 não incluir um cartucho de grampos 34, a chave 136 estará aberta, impedindo assim que a bateria 64 alimente o motor 65.
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27/52
[0072] Quando o cartucho de grampos 34 está presente, a chave
136 é fechada, o que energiza um relé de polo único e acionamento único 138. Quando o relé 138 é energizado, a corrente flui pelo relé 136, através da chave (de partida de motor) de resistor variável 110, até o motor 65 através de um relé de polo duplo e acionamento duplo 140 energizando, assim, o motor 65 e permitindo que ele gire em direção progressiva.
[0073] Quando o atuador de extremidade 12 atinge a extremidade do seu percurso, a chave de reversão do motor 130 será ativada fechando, assim, a chave de reversão do motor 130 e energizando o relé 134. Isso faz com que o relé 134 assuma seu estado energizado, o que faz com que a corrente se desvie da chave de travamento do cartucho 136 e do resistor variável 110 e passe, em vez disso, tanto para o relé de polo duplo e duplo acionamento 142 normalmente fechado como de volta para o motor 65, porém de um modo que, via relé 140, faz o motor 65 reverter sua direção rotacional.
[0074] Pelo fato da chave de parada do motor 142 ser normalmente fechada, a corrente irá fluir de volta para o relé 134 para mantê-lo fechado até que a chave de parada do motor 142 abra. Quando a lâmina 32 é completamente retraída, a chave de parada do motor 142 é ativada, fazendo com que a chave de parada do motor 142 abra removendo, assim, a energia do motor 65.
[0075] Em outras modalidades, ao invés de uma chave de tipo proporcional 110, um sensor ou chave do tipo liga-desliga poderia ser usado. Em tais modalidades, a taxa de rotação do motor 65 não seria proporcional à força aplicada pelo operador. Em vez disso, o motor 65 giraria, geralmente, a uma taxa constante. Mas o operador ainda sentiria retroinformação de força porque o gatilho de disparo 20 está instalado no trem de acionamento da engrenagem.
[0076] Conforme indicado acima, há várias etapas dentro da fun
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28/52 ção de um grampeador que, em geral, devem ser realizadas em uma ordem estabelecida. Por exemplo, uma vez que o gatilho de fechamento esteja bloqueado, o ciclo de disparo pode ser atuado. Após a lâmina ter sido completamente instalada, então a retração do sistema é a próxima etapa sequencial. Com a inclusão de uma fonte de energia além do usuário (isto é, baterias ou pneumáticos) a habilidade de reduzir as etapas iniciadas pelo usuário (e, portanto, a complexidade do dispositivo) o próprio sistema, conforme foi discutido acima, pode começar a completar estas etapas por si só.
[0077] Pode ser desejável, entretanto, para o usuário ser capaz de intuitivamente atrasar, retardar ou interromper essas atuações de outro modo automáticas. Por exemplo, o mesmo botão de atuação que permitiria o início do disparo em um dispositivo de retroinformação tátil, como os dispositivos apresentados no pedido de patente n° de série US 11/344.035, agora patente n° US 7.422.139, cuja descrição é aqui incorporada a título de referência, em sua totalidade, poderia ser usado para retardar ou interromper um sistema de retorno automático pelo usuário que pressiona o botão durante a retração.
[0078] Por exemplo, as Figuras 12 e 13 ilustram outra modalidade da presente invenção em que um gatilho de retração 121 é sustentado no gatilho de disparo 20 para percorrer no mesmo. Mais especificamente, o gatilho de retração 121 é sustentado de maneira articulada no pino do gatilho de disparo 96 e se salienta através de uma ranhura (não mostrado) no gatilho de disparo 20. Uma mola 125 é fixada entre uma porção de acoplamento 123 do gatilho de disparo 100 e uma porção de montagem 127 do gatilho de retração 121 para inclinar o gatilho de retração 121 em uma posição não atuada. Uma segunda chave de retração normalmente fechada 131 é montada no interior do cabo e é orientada de modo que, conforme o gatilho de disparo 20 é movido entre uma posição completamente atuada para uma posição comple
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29/52 tamente não atuada, uma porção de ativação 129 do gatilho de retração 121 não ativa a chave de retração 131. Entretanto, a porção de montagem 127 e porção de ativação 129 do gatilho de retração 121 são assim configurados de modo que a porção de ativação 129 possa ser colocada em contato de ativação com a chave de retração 131 ao pressionar o gatilho de retração 121 em direção ao gatilho de disparo 20 independentemente de onde o gatilho de disparo 20 está situado durante o processo de retração.
[0079] Conforme foi discutido acima, quando o efetor de extremidade 12 alcança o fim de seu percurso, a chave de final de percurso 130 será ativada. Como mostrado no exemplo da Figura 13, a chave de retração 131 está em série com a chave de fim-de-percurso 130. Como a chave de retração 131 é, normalmente, fechada, o relé 134 será energizado quando ambas as chaves 130, 131 estiverem fechadas. Isso faz com que o relé 134 assuma seu estado energizado, o que faz com que a corrente desvie o sensor de travamento cartucho 136 e resistor variável 110. A corrente flui para o relé de polo duplo, duplo movimento 140 e para o motor 65, mas de uma maneira que, através do relé 140, faz com que o motor 65 reverta sua direção rotacional. Pelo fato da chave de início-de-percurso 142 estar fechada, a corrente irá fluir de volta para o relé 134 para mantê-lo fechado até que a chave 142 abra. Quando a lâmina 32 é completamente retraída, a chave de início-de-percurso 142 é aberta, removendo por meio disso a potência do motor 65. Se, entretanto, o usuário deseja retardar o processo de retração, o usuário pode pressionar o gatilho de retração 121 para ativar a porção de resistência variável 133 da chave de retração 131. Quando o gatilho de retração 121 não é pressionado, a resistência da porção de resistência variável 133 é a mínima. Quando o gatilho 121 é pressionado, a resistência da porção de resistência variável 133 aumenta em proporção à força de pressionamento do gatilho de
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30/52 retração 121 para reduzir a corrente para o motor 65. A depressão adicional do gatilho de retração 121 irá retardar o processo de retração até que a porção de contato 135 normalmente fechado da chave de retração 131 abra e interrompa a passagem de corrente para o motor 65. Em várias modalidades, uma vez que o usuário libera o gatilho de retração 121, a mola 125 irá mover o gatilho de retração 121 para uma posição não atuada e a porção de contato 135 da chave 131 irá retornar para a posição normalmente fechada e permitir, por meio disso, que a corrente flua novamente para o motor 65 para completar o processo de retração.
[0080] As características exclusivas e inovadoras das disposições de chave de retração e gatilho de retração descritas acima também podem ser empregadas em conjunto com as várias modalidades apresentadas na publicação de pedido de patente n° US 2010/007674 A1, e patente n° US 7.422.139, que têm sido, ambas, aqui incorporadas por referência em suas respectivas totalidades. Por exemplo, a Figura 14 mostra outra modalidade de uma modalidade da presente invenção de circuito de controle da corrente. Quando (i) a chave de partida de motor (ou disparo) 110 é fechada (é mostrada em um estado aberto na Figura 14), (ii) a chave de segurança 240 é fechada (é mostrada aberta na Figura 14) indicando que a segurança do dispositivo está ajustada, e (iii) a chave de travamento normalmente-fechada 242 é aberta, indicando que o instrumento não está em uma condição de travamento, a corrente flui através da chave de segurança 240, através do indicador de travamento 244 (que pode ser um LED, como mostrado na Figura 14) para o motor 65. Quando o fim do percurso de corte é alcançado, a chave de fim-de-percurso ou direção 130 é acionada, revertendo a direção do motor 65 (com a chave de disparo 110 também sendo liberada). Nesse estado, a corrente também flui através de um indicador de direção reversa 246, como um LED, fornecendo uma indiPetição 870190123898, de 27/11/2019, pág. 33/63
31/52 cação visual de que a direção do motor foi revertida.
[0081] Como mostrado na Figura 14, o circuito pode também compreender uma chave de retorno manual 248. O operador pode atuar manualmente essa chave se o instrumento corte 32 tiver sido apenas parcialmente disparado. Acionando a chave de retorno manual 248 pode fazer com que o motor 65 inverta a rotação, fazendo com que o instrumento de corte 32 retorne à sua posição original. Se o usuário deseja retardar ou interromper o processo de retração, o usuário pressiona o gatilho de retração 121 para ativar a porção de resistência variável 133 da chave de retração 131. Quando o gatilho 121 é pressionado, a resistência aumenta em porção em relação à força de pressionamento para reduzir a corrente para o motor 65. A depressão adicional do gatilho de retração 121 irá retardar o processo de retração até que a porção de contato 135 normalmente fechado da chave de retração 131 abra e interrompa a passagem de corrente para o motor 65. Em várias modalidades, uma vez que o usuário libera o gatilho de retração 121, a mola 125 irá mover o gatilho de retração 121 para uma posição não atuada e a porção de contato 135 da chave 131 irá retornar para a posição normalmente fechada e permitir, por meio disso, que a corrente flua novamente para o motor 65 para completar o processo de retração.
[0082] Configurações adicionais para instrumentos cirúrgicos motorizados são apresentadas na publicação de pedido de patente n° US 2010/0076474 A1, intitulada Motor-Driven Surgical Cutting Instrument, que está aqui integralmente incorporada, por referência. Por exemplo, a Figura 15 é um diagrama esquemático de outro circuito de controle de acordo com várias modalidades da presente invenção. Em várias modalidades, o circuito de controle de motor pode incluir um ou mais circuitos integrados (CIs), como, por exemplo, um processador, memória, microcontroladora, circuitos de tempo, etc. Em outras moda
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32/52 lidades, o circuito de controle de motor pode não compreender quaisquer CIs. Tal circuito de controle de corrente de não CI pode ser vantajoso, visto que o mesmo é com frequência difícil, complicado, e custoso para esterilizar um instrumento cirúrgico, incluindo CIs.
[0083] Quando um operador inicialmente aplica um movimento de atuação no gatilho de disparo 20 após travar o gatilho de fechamento 18, a chave de partida de motor 110 é ativada (ou fechada), permitindo que a corrente flua através da mesma. Se a chave normalmente aberta 130 do sensor de reversão do motor estiver aberta (significando que não foi atingido o final da atuação do efetor de extremidade), a corrente fluirá para um relé de polo único e duplo movimento 132. Quando a chave do sensor de reversão do motor 130 não está fechada, uma bobina 134 do relé 132 não estará energizada, portanto, o relé 132 estará em seu estado não energizado.
[0084] Como mostrado na Figura 15, o circuito pode também incluir um elemento resistivo 144 e uma chave 146 conectados em paralelo, com os elementos em paralelo conectados em série com o relé 132. O elemento resistivo 144 e a chave 146 também são conectados à fonte de energia 64. A chave 146 pode ser controlada por um circuito de controle 148 que é responsivo ao sensor de posição de instrumento de corte 150. De acordo com várias modalidades, o circuito de controle 148 pode abrir a chave 146 quando o instrumento de corte 32 está (i) muito próximo ao início de seu percurso e (ii) muito próximo ao fim de seu percurso. Por exemplo, o circuito de controle pode abrir a chave quando o instrumento de corte 32 é (i) 0,025 milímetro (0,001 polegada) a partir do ponto do começo de seu percurso e (ii) 0,025 milímetro (0,001 polegada) a partir do fim de seu percurso, conforme determinado pelo sensor de posição do instrumento corte 150. Com a chave 146 aberta, a corrente flui através do elemento resistivo 144, e, então, através do relé 132, do relé 138, da chave de sensor de partida de mo
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33/52 tor 110, para o motor 65. A corrente que flui através do elemento resistivo 144 reduz a magnitude da corrente entregue ao motor 65, reduzindo, desse modo, a potência entregue pelo motor 65. Dessa forma, quando o instrumento de corte 32 está (i) muito próximo do início de seu percurso ou (ii) muito próximo do fim de seu percurso, a potência liberada para o motor 65 é reduzida. Inversamente, uma vez que o instrumento de corte 32 se move para longe o suficiente de seu ponto de início ou fim do ponto de movimento, o circuito de controle 148 pode fechar a chave 146, encurtando, desse modo, o elemento resistivo 144, aumentando assim a corrente para o motor 65, aumentando assim a potência entregue pelo motor.
[0085] De acordo com várias modalidades, o circuito de controle de corrente inclui adicionalmente chaves de sensor de travamento 136a a d que definem coletivamente um circuito de intertravamento 137 através do qual a corrente do relé 132, quando desenergizada, passa a fim de que a operação elétrica do motor 65 seja iniciada. Cada chave de sensor de travamento 136a a d pode ser configurada para manter um estado de chave aberta (isto é, não condutivo) ou um estado de chave fechada (isto é, condutivo) responsivo à presença ou ausência, respectivamente, de uma condição correspondente. Qualquer uma das condições correspondentes, caso estejam presentes quando o instrumento 10 é disparado, pode resultar em uma operação de corte e grampeamento insatisfatória e/ou dano ao instrumento 10. As condições às quais as chaves de sensor de travamento 136a a-d podem responder incluem, por exemplo, (a) a ausência do cartucho de grampos 34 na canaleta 22, (b) a presença de um cartucho de grampos gasto (por exemplo, anteriormente disparado) 34 na canaleta 22, e (c) uma posição aberta (ou de outro modo insuficientemente fechada) da bigorna 24 em relação à canaleta 22. Outras condições às quais as chaves de sensor de travamento 136a a-d podem responder, como
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34/52 desgaste de componente, podem ser inferidas com base em um número acumulado de operações de disparo produzidas pelo instrumento
10. Consequentemente, em várias modalidades, se qualquer uma dessas condições existir, as chaves de sensor de travamento 136a a-d correspondentes mantêm um estado de chave aberta, evitando dessa forma a passagem da corrente necessária para iniciar a operação do motor 65. A passagem da corrente pelos sensores de travamento 136a a-d é permitida, em várias modalidades, apenas após todas as condições terem sido remediadas. Será entendido que as condições descritas acima são fornecidas somente a título de exemplo, e que chaves de sensor de travamento adicionais para responder a outras condições prejudiciais à operação do instrumento 10 podem ser fornecidas. Será similarmente entendido que, para modalidades nas quais uma ou mais das condições descritas acima possa não existir ou que não suscitem preocupações, o número de chaves de sensor de travamento pode ser menor do que aquele mostrado.
[0086] Como mostrado na Figura 15, a chave de sensor de travamento 136a pode ser implementada com o uso de uma configuração de chave normalmente aberta de modo que um estado de chave fechada é mantido quando o cartucho de grampos 34 está em uma posição correspondente ao seu recebimento apropriado pela canaleta 22. Quando o cartucho de grampos 34 não está instalado na canaleta 22, ou está instalado de maneira imprópria (por exemplo, desalinhado), a chave de sensor de travamento 136a mantém um estado de chave aberta. A chave de sensor de travamento 136b pode ser implementada com o uso de uma configuração de chave normalmente aberta de modo que um estado de chave fechada seja mantido apenas quando um cartucho de grampos não usado 34 (isto é, um cartucho de grampos 34 que tem um trilho 33 na posição não disparada) está presente na canaleta 22. A presença de um cartucho de grampos gasto 34 na caPetição 870190123898, de 27/11/2019, pág. 37/63
35/52 naleta 22 faz com que a chave de sensor de travamento 136b mantenha um estado de chave aberta. A chave de sensor de travamento 136c pode ser implementada com o uso de uma configuração de chave normalmente aberta de modo que um estado de chave fechada seja mantido quando a bigorna 24 está em uma posição fechada em relação à canaleta 22. A chave de sensor de travamento 136c pode ser controlada, de acordo com um reacionamento de atraso, em que um estado de chave fechada é mantido apenas após a bigorna 24 estar na posição fechada por um período de tempo predeterminado.
[0087] A chave de sensor de travamento 136d pode ser implementada com o uso de uma configuração de chave normalmente fechada de modo que um estado de chave fechada é mantido apenas quando um número acumulado de disparos produzidos pelo instrumento 10 é menor que um número predeterminado. A chave de sensor de travamento 136d pode estar em comunicação com um contador 139 configurado para manter uma contagem representativa do número acumulado de operações de disparo desempenhadas pelo instrumento 10, em comparação à contagem do número predeterminado, e controlar o estado de chave da chave de sensor de travamento 136d com base na comparação. Embora mostrado separadamente na Figura 15, será entendido que o contador 139 pode ser integral com a chave de sensor de travamento 136d de modo a formar um dispositivo comum. De preferência, o contador 139 é implementado como um dispositivo eletrônico que tem uma entrada para incrementar a contagem mantida com base na transição de um sinal elétrico distinto fornecido ao mesmo. Será entendido que um contador mecânico configurado para manter a contagem com base em uma entrada mecânica (por exemplo, retração do gatilho de disparo 20) pode ser usado em vez disso. Quando implementado como um dispositivo eletrônico, qualquer sinal distinto presente no circuito elétrico que transita uma vez para cada operação
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36/52 de disparo pode ser utilizado para a entrada do contador 139. Como mostrado na Figura 15, por exemplo, o sinal elétrico distinto resultante da atuação do sensor de fim-de-percurso 130 pode ser utilizado. O contador 139 pode controlar o estado de chave da chave de sensor de travamento 136d de modo que um estado de chave fechada seja mantido quando a contagem mantida for menor que um número predeterminado armazenado no contador 139. Quando a contagem mantida é igual ao número predeterminado, o contador 139 faz com que a chave de sensor de travamento 136d mantenha um estado de chave aberta, evitando dessa forma a passagem de corrente através da mesma. Será entendido que o número predeterminado armazenado pelo contador 139 pode ser seletivamente ajustado conforme for necessário. De acordo com várias modalidades, o contador 304 pode estar em comunicação com uma tela externa (não mostrado), como uma tela de LCD, integral com o instrumento 10 para indicar a um usuário a contagem mantida ou a diferença entre o número predeterminado e a contagem mantida.
[0088] De acordo com várias modalidades, o circuito de intertravamento 137 pode compreender uma ou mais indicadores visíveis ao usuário do instrumento 10 para exibir uma situação de pelo menos uma das chaves de sensor de travamento 136a a-d. Mais detalhes em relação a tais indicadores podem ser encontrados na publicação de pedido de patente n° US 2007/0175956, intitulada Electronic Lockouts and Surgical Instrument Including Same, que está aqui integralmente incorporada, por referência. Este pedido inclui, também disposições e configurações de montagens exemplificadores para as chaves de sensor de travamento 136a a-d.
[0089] Na modalidade ilustrada, quando as chaves de sensor de travamento 136a a-d mantêm coletivamente um estado de chave fechada, um relé de único polo e acionamento único 138 é energizado.
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Quando o relé 138 é energizado, a corrente flui pelo relé 138, através do sensor de chave de partida de motor 110, até o motor 65 através de um relé de polo duplo e acionamento duplo 140 energizando, assim, o motor 65 e permitindo que ele gire em direção progressiva. De acordo com várias modalidades, como a saída do relé 138, uma vez energizado, mantém o relé 138 em um estado energizado até que o relé 132 seja energizado, o circuito de intertravamento 137 não funcionará para evitar a operação do motor 165 uma vez iniciado, mesmo se uma ou mais das chaves de sensor de intertravamento 136a a-d mantiver subsequentemente um estado de chave aberta. Em outras modalidades, entretanto, pode ser necessário, ou de outro modo desejável, conectar o circuito de intertravamento 137 e o relé 138 de modo que uma ou mais das chaves de sensor de travamento 136a a-d precisem manter um estado de chave fechada a fim de sustentar a operação do motor 165 uma vez iniciado.
[0090] A rotação do motor na direção para frente faz com que o anel se mova distalmente e desative, assim, a chave de sensor de parada de motor 142 em várias modalidades. Como a chave 142 é, normalmente, fechada, um solenoide 141 conectado à chave 142 pode ser energizado. O solenoide 141 pode ser um solenoide do tipo de pressionamento convencional que, quando energizado, faz com que um êmbolo (não mostrado) seja axialmente estendido. A extensão do êmbolo pode operar para reter o gatilho de fechamento 18 na posição retraída, evitando assim que a bigorna 24 se abra enquanto uma operação de disparo estiver em progresso (isto é, enquanto a chave 142 não é atuada). Mediante a desenergização do solenoide 141, o êmbolo é retraído, de modo que a liberação manual do gatilho de fechamento 18 é possível.
[0091] Quando a porção de membro de atuação atinge a extremidade mais distal do seu percurso, a chave de reversão do motor 130
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38/52 será ativada fechando, assim, a chave 130 e energizando o relé 132. Isto faz com que o relé 132 assuma seu estado energizado (não mostrado na Figura 11) que faz com que a corrente contorne o circuito de intertravamento 137 e a chave de sensor de partida de motor 110, e em vez disso faz com que a corrente flua para o relé de polo duplo e acionamento duplo normalmente fechado 140 e de volta para o motor 65, mas através do relé 140, o que faz com que o motor 65 reverta sua direção rotacional. Pelo fato da chave do sensor de parada de motor 142 ser normalmente fechada, a corrente irá fluir de volta para o relé 132 para mantê-lo energizado até que a chave 142 abra. Quando a lâmina 32 é completamente retraída, a chave de sensor de parada de motor 142 é ativada, fazendo com que a chave 142 abra, removendo, assim, potência do motor 65, e desenergizando o solenoide 141.
[0092] Na modalidade representada na Figura 15, uma chave de retração normalmente fechada 137 é empregada, que faz interface com o gatilho de retração 121 (não mostrado na Figura 15). Quando a chave de retração 137 é ativada, a mesma abre para interromper o fluxo de corrente para o motor 65. Em modalidades alternativas (figura 15A), a chave de retração normalmente fechada 137 poderia ser substituída com um resistor variável 137' que interage com o gatilho de retração 121. Em tal modalidade, quando o gatilho de retração 121 não é pressionado, a resistência do resistor variável é mínima, para permitir que a corrente máxima flua para o motor 65. Quando pressionada, a resistência aumenta em proporção em relação à força de pressionamento, para reduzir a corrente para o motor. Tal resistor variável também pode ser substituído pela chave de retração 131, conforme descrito acima (vide Figura 15B).
[0093] Prevenção de atuação acidental para um instrumento cirúrgico endoscópico equipado com motor: Com a introdução de sistemas equipados com motor que não mais limitam a função do dispositivo
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39/52 nas capacidades de força do usuário, iniciação inadvertida do ciclo de disparo pode tornar-se uma questão muito mais prevalente. Será mais fácil impactar o controle de ativação e fazer com que o instrumento inicie o disparo, impedindo, portanto, o travamento do cartucho ou mesmo congestionando o mesmo no tecido, pois o usuário não percebeu que o mesmo já começou os disparos. A fim de eliminar esta questão, comutadores ou botões ativadores de destravamento secundários poderiam ser usados para destravar o mecanismo de disparo. Várias disposições de travamento são apresentadas na patente n° US 7.644.848, intitulada Electronic Lockouts and Surgical Instrument Including Same junto à Swayze et al., cuja descrição é aqui incorporada a título de referência, em sua totalidade. Isto é muito parecido com os dois sistemas comutadores usados na indústria de serras elétricas, assim como na indústria bélica para proteger contra atuação acidental. O comutador secundário pode tanto liberar a trava no gatilho de disparo quanto meramente energizar o acionamento no controle.
[0094] Conforme mencionado acima, ao usar um instrumento motorizado de dois tempos, o operador primeiro puxa de volta e trava o gatilho de fechamento 18. As Figuras 16 e 17 mostram uma modalidade de uma forma de travar o gatilho de fechamento 18 à porção de pega de pistola 26 do cabo 6. Na modalidade ilustrada, a porção de pega de pistola 26 inclui um gancho 150 que é tracionado para girar em sentindo anti-horário em redor de um ponto pivô 151 por uma mola de torção 152. Além disso, o gatilho de fechamento 18 inclui uma barra de fechamento 154. Na medida em que o operador puxa o gatilho de fechamento 18, a barra de fechamento 154 engata uma porção inclinada 156 do gancho 150 girando, assim, o gancho 150 para cima (ou em sentido horário nas Figuras 16 e 17) até que a barra de fechamento 154 passe completamente pela porção inclinada 156, passe para dentro de um entalhe rebaixado 158 do gancho 150, que trava o gati
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Iho de fechamento 18 no lugar. O operador pode liberar o gatilho de fechamento 18 ao pressionar um botão deslizante de liberação 160 no lado de trás ou oposto da porção de pega de pistola 26. A pressão do botão deslizante de liberação 160 gira o gancho 150 em sentido horário de modo que a barra de fechamento 154 é liberada do entalhe rebaixado 158. Outras disposições para travar de modo liberável o gatilho de fechamento 18 são apresentadas na patente n° US 7.422.139 que foi aqui incorporada por referência.
[0095] Como pode ser visto nas Figuras 16 e 17, em várias modalidades, uma chave de trava de fechamento 151 pode ser montada no gancho 150 de modo que seja ativada apenas quando o gancho 150 estiver trancado no lugar. Entretanto, a chave de trava de fechamento 151 pode ser montada na porção de pega da pistola 26 para a ativação pelo gatilho de fechamento 18 quando o gatilho de fechamento 18 estiver travado em posição. Em ainda outras modalidades alternativas, a chave de trava de fechamento 151 é montada no efetor de extremidade de modo que seja ativada apenas quando a bigorna ou outra porção móvel estiver na posição fechada. Independentemente do local específico da chave de trava de fechamento 151, em várias modalidades, a chave de trava de fechamento é uma chave normalmente aberta que será fechada mediante o travamento do gatilho de fechamento 18 ou manipulando de outro modo o efetor de extremidade para uma posição fechada.
[0096] A Figura 18 é um diagrama esquemático de um circuito elétrico do instrumento 10 de acordo com várias modalidades da presente invenção ilustrando o uso da chave da trava de fechamento 151. Conforme pode ser visto naquela Figura, a corrente não será permitida a fluir da bateria 64 para o motor 65 mesmo se um cartucho estiver presente, a não ser que a chave de trava de fechamento 151 esteja fechada. Dessa forma, o motor 65 não pode ser operado a não ser que o
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41/52 gatilho de fechamento esteja na posição travada fechada, o que também reflete que o efetor de extremidade esteja no estado fechado. [0097] Várias modalidades podem incluir, também, uma chave de partida 153 que deve ser ativada pelo cirurgião antes da corrente ser permitida a fluir da bateria 64 para os outros componentes de circuito e, por fim, para o motor 65. A chave de partida 153 é, normalmente, aberta e pode estar situada em um local conveniente no cabo 6. Vide Figura 1. Dessa forma, nessas modalidades, mesmo se o efetor de extremidade contiver um cartucho e o gatilho de fechamento 18 estiver travado em uma posição fechada, a corrente não será permitida a fluir para o motor 65 até que a chave de partida 153 seja fechada pelo cirurgião. Em modalidades alternativas, a chave de partida 153 pode compreender uma chave mecânica que evita que o gatilho de disparo 20 seja fisicamente girado em direção à porção de pega da pistola, a não ser que a chave 153 seja movida para uma posição atuada.
[0098] Altura de grampo ajustável ativa para um instrumento cirúrgico endoscópico equipado com motor: A altura de grampo que é ajustável à espessura e tipo do tecido tem sido procurada por muitos anos. Mais recentemente, o pedido de patente n° de série US 11/231.456, depositado em 21 de setembro de 2005, agora patente n° US 7.407.078 e pedido de patente n° de série US 11/540.735, depositado em 29 de setembro de 2006, agora patente n° US 7.467.740, cujas descrições são, cada uma, por meio desta incorporadas por referência em suas totalidades respectivas, em geral envolvem um suporte ou membro de acoplamento flexível que permitiria que o vão do instrumento aumentasse com cargas induzidas por tecido mais espesso no dispositivo. Esta altura de grampo variável passiva permite que a espessura do tecido crie formas de grampo maiores.
[0099] Com a introdução da fonte de energia dentro do instrumento, o mesmo permite o uso de eletricidade para alterar a altura de um
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42/52 elemento interno dentro do elemento de acoplamento dinâmico que alteraria a altura do grampo ativamente pelo cirurgião ou configurar o instrumento na altura desejada. Este elemento interno poderia ser um material com memória de forma e a eletricidade altera a temperatura do mesmo e, portanto, permite que o mesmo altere sua altura física devido a presente configuração. Outro método viável seria a inclusão de um polímero eletroativo (EAP) que através da introdução de um campo elétrico permite que o mesmo altere sua altura e largura. Ainda assim, uma terceira modalidade seria a utilização de um elemento escalonador linear tradicional elétrico que pode ajustar o elemento de rosca ajustável pequeno dentro da trave de acoplamento que iria ajustar sua altura.
[00100] Mais especificamente e com referência às Figuras 19 e 20, um efetor de extremidade 12 de várias modalidades da presente invenção é mostrado em seção transversal com a bigorna 24 em uma posição fechada ou bloqueada. Conforme pode ser visto, o instrumento de corte ou lâmina 32 tem uma porção de atuador inferior 37 que tem uma luva rosqueada ou porção de porca 37' que é configurada para engatar de maneira rosqueável a haste de rosca helicoidal 36. Além disso, uma aleta 39 se salienta lateralmente de cada lado da porção de porca 37 para confrontar porções de corrediça correspondentes 23 da canaleta 22. Conforme pode também ser visto na Figura 19, a lâmina 32 tem uma porção de atuador superior 41 que é dimensionada para ser recebida dentro de uma ranhura em formato de T longitudinal 43 na bigorna 24. Como pode ser visto na Figura 19, um par de pinos retentores superiores 41' se salientam lateralmente de cada lado da porção de atuador superior 41 da lâmina 32. Cada pino retentor superior 41' é configurado para se estender em uma porção correspondente da ranhura em formato de T 43 fornecida na bigorna 24. Dessa forma, conforme a lâmina 32 é guiada distalmente através do efetor de ex
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43/52 tremidade 12, as aletas 39 e os pinos retentores 41' servem para limitar a quantidade de espaço entre a bigorna 24 e o cartucho 34 até uma quantidade máxima de espaço predeterminado.
[00101] Várias modalidades da presente invenção são dotadas de meios para ajustar a quantidade de espaço entre a bigorna 24 e o cartucho 34 instalado dentro da canaleta 22. Por exemplo, em algumas modalidades, cada aleta 39 suporta um contato de trilho 45 para contato deslizante com contatos elétricos correspondentes 47 que são montados dentro de cada porção de corrediça 23 da canaleta 22. Os contatos elétricos 47 são alongados e estendidos dentro da canaleta 22 de modo que os contatos de trilho 45 estejam sempre em contato com seu contato elétrico correspondente 47 conforme a lâmina 32 é guiada dentro da canaleta 22. Os contatos elétricos 47 são conectados à fonte de energia ou bateria 64 e são configurados para receber corrente da mesma quando o motor 65 é equipado com motor para guiar a lâmina 32 distalmente. Também em certas modalidades, um membro de ajuste de altura eletricamente responsivo 49 é montado em cada pino retentor 41', como mostrado na Figura 19. Os membros de ajuste de altura 49 são acoplados eletricamente aos contatos de trilho 45 para receber corrente elétrica dos mesmos. Em várias modalidades, os membros de ajuste de altura 49 podem compreender material com memória de forma que, quando eletrificado, altera sua altura física devido a uma configuração pré-ajustada. Dessa forma, dependendo da quantidade de corrente recebida, os membros de membro de ajuste de altura 49 podem se expandir e forçar a bigorna 24 em direção ao cartucho 34 para reduzir, assim, a quantidade de espaço entre os mesmos. A quantidade de tal material é proporcional à quantidade de corrente recebida e é conhecida. Um circuito de controle (não mostrado) pode ser empregado para controlar a quantidade de expansão e, portanto, a quantidade de espaço entre a bigorna 24 e o cartucho 34. Em
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44/52 outras modalidades, o material de ajuste de altura compreende um polímero eletroativo (EAP) que é retido dentro de um bolso no pino 41 ou é de outro modo fixado ao mesmo.
[00102] A Figura 21 ilustra outra modalidade que é similar à modalidade representada na Figura 19. Entretanto, nessa modalidade, os membros de ajuste de altura 49 são montados na bigorna 24 e recebem corrente da fonte de energia através de condutores fixados diretamente nos mesmos. Dessa forma, nessa modalidade, os contatos 43 e 45, conforme descrito acima, não são necessários.
[00103] A Figura 22 ilustra um conjunto de lâminas alternativas 32' que é substancialmente idêntico ao conjunto de lâminas 32 descrito acima, exceto que os pinos de retentor 41' são montados a uma porção de atuador superior separada 302 que é seletivamente móvel em uma direção vertical VD em relação à porção inferior 300 do conjunto de lâminas 32'. Um segundo motor 304 pode ser montado na porção inferior 300 e ter uma rosca de chumbo 306 que engata de maneira rosqueável uma porção de porca 308 da porção de retentor superior 302. A porção de retentor superior tem uma porção de língua em formato de T 310 que se estende de maneira deslizante em uma ranhura de formato correspondente 312 na porção inferior 300 para evitar a rotação da porção de retentor superior 302 em relação à porção de retentor inferior 300 enquanto permite que a porção de retentor superior 302 se mova verticalmente em relação à mesma. Dessa forma, a distância entre as porções de retentor superior e inferior 302, 300 pode ser ajustável ao acionar o segundo motor 304. Consequentemente, se o cirurgião deseja reduzir a quantidade de espaço entre a bigorna 24 e o cartucho 34, o segundo motor 304 é equipado com motor para girar em uma primeira direção para atrair a porção de retentor superior 302 em direção à porção de retentor inferior 300. Se, entretanto, o cirurgião deseja aumentar a quantidade de espaço entre a bigorna 24 e o cartuPetição 870190123898, de 27/11/2019, pág. 47/63
45/52 cho 34, o segundo motor 304 é girado em uma direção oposta.
[00104] Várias modalidades da presente invenção incluem métodos de iluminação de efetor de extremidade e métodos para iluminar o local cirúrgico quando do emprego de um instrumento cirúrgico endoscópico equipado com motor. Atualmente, quando o efetor de extremidade está em ou próximo a posição de posicionamento do mesmo, pode ser difícil para o cirurgião visualizar o local de tratamento pois há sombras lançadas por estruturas adjacentes assim como o efetor de extremidade pode até mesmo estar inteiramente atrás de uma estrutura. A Figura 23 ilustra de forma geral, uma extremidade distal 402 de um grampeador cirúrgico 400 de várias modalidades da presente invenção, que inclui uma bigorna 404, um corpo do cartucho 406, e canaleta 408. Conforme visto na Figura mencionada, uma fonte de luz adicional 410 pode ser posicionada na extremidade do corpo do cartucho 406 para iluminar o tecido 401. Essa fonte de luz 410 poderia ser qualquer combinação de meios práticos que convertem energia elétrica em luz, incluindo, mas não se limitando a semicondutor (como LED), uma lâmpada convencional incandescente ou de filamento, eletroluminescente ou laser que pode ser equipado com motor a partir de uma bateria suportada no cabo do instrumento ou em outras modalidades, equipado com motor por corrente alternada. Tais disposições permitiriam ao cirurgião não apenas iluminar o local de tratamento diretamente, como também permitiria a iluminação de fundo de estruturas para ver os componentes internos, como vasculatura, e facilitar o uso de um ponteiro laser através de um escopo tradicional para destacar áreas de interesse a outros.
[00105] Em várias modalidades, um ou mais contatos 420 são fornecidos na parte posterior do corpo do cartucho 406 que são configurados para engatar contatos 422 dentro da canaleta 408. Consulte a Figura 24. Isto permitiria ao cirurgião energizar as luzes 410 conforme
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46/52 necessário ao energizar o contato ajustado via uma chave posicionado no cabo 430. Este comutador pode até mesmo ter intensidade variável, como um descrito anteriormente poderia controlar a velocidade de atuação do dispositivo principal. Outras disposições de iluminação para iluminar a extremidade de uma bigorna fixada em um grampeador cirúrgico circular são apresentadas na publicação de pedido de patente n° US 2010/0096435 A1, intitulada Surgical Stapling Instrument With Apparatus For Providing Anvil Position Feedback, publicada em 22 de abril de 2010, cuja descrição completa está aqui incorporada, por referência.
[00106] A publicação de pedido de patente n° US 2007/0175949 A1, intitulada Surgical Instrument Having a Feedback System, publicada em 2 de agosto de 2007, cuja descrição completa está aqui incorporada, por referência, apresenta adicionalmente nas Figuras 45 a 47 daquela Publicação visores de saída que poderiam mostrar, entre outras coisas, essa retroinformação de posição do atuador de extremidade, situação de travamento, número de disparos, etc. Isso iria minimizar uma das questões mais difíceis para o usuário, que é a identificação da situação de um dispositivo, especificamente a situação de travamento do dispositivo sem atuar o dispositivo. Uma retroinformação adicional que seria de muita ajuda ao usuário seria retroinformação imediata sobre as situação do cartucho quando o mesmo está carregado. Assim como na aplicação acima, o mesmo poderia ser enrolado na indicação de travamento no cabo 430. Um indicador 432 (como um LED, lâmpada de vidro, LCD, enunciador sônico, vibrador, etc.) poderia ser unicamente associado à situação de um meio de travamento do cartucho ou mecanismo de tal maneira que o mesmo forneça esta informação ao cirurgião. Este LED poderia ser localizado no cabo 430. Vide a Figura 26. Alternativamente, um indicador 434 poderia ser localizado próximo a extremidade distal 402 que iria fornecer
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47/52 informação imediata para o cirurgião e carregador se o cartucho está pronto para uso ou não. Vide a Figura 25. Isto pode ser alcançado com um comutador ou conjunto de contatos associados diretamente com o travamento mecânico. O comutador ou contatos completam um circuito de tal maneira que o indicador fornece informações adequadas. Este ajuste de contato completo poderia se dar através de um elemento condutivo dentro do suporte deslizante (parte 33 na publicação de pedido de patente n° US 2007/0175958) e os dois contatos poderiam estar na posição proximal do canal (parte 22). Uma maneira de detectar o estado de travamento é indiretamente através do estado do instrumento(exemplo I: cartucho carregado e nenhuma tentativa para disparar indicam que o travamento não está acionado; Exemplo 2: instrumento disparado e nenhum cartucho novo instalado indicaria que o travamento está engatado; etc.). Outra modalidade seria a de colocar o LED ou indicação visual no próprio cartucho. Quando o cartucho é encaixado no lugar o mesmo cria um contato que fornece acionamento ao cartucho. Caso o cartucho seja disparado, não apenas o travamento mecânico para o avanço da lâminas, como o circuito do cartucho ilumina o LED no cartucho informando ao cirurgião no monitor de escopo que o cartucho está travado. Isto poderia ser mais expandido ao colocar uma pequena bateria ou outro acumulador de carga dentro do próprio cartucho para eliminar a necessidade de uma conexão de acionamento com o dispositivo principal. Além disso, o circuito do cartucho poderia ser ajustado para iluminar a luz de travamento sempre que o dispositivo estiver fechado para informar o usuário que há um cartucho gasto no dispositivo.
[00107] A retroinformação de indicação para articulação equipada com motor e cor de cartucho: A indicação do tipo de cartucho instalado (cor) e ângulo de articulação é considerada útil ao cirurgião. A indicação de ângulo de articulação poderia ser indicada de várias formas in
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48/52 cluindo numericamente ou graficamente como em um arco de LEDs. A localização desta indicação poderia ser no cabo em um local conveniente ou no eixo do dispositivo mais proximal ao efetor de extremidade. A retroinformação do efetor de extremidade poderia ser passiva ou ativa. A ativa acenderia LEDs adicionais para mostrar o ângulo. A passiva poderia simplesmente mostrar uma meia circunferência acesa de maneira que o cirurgião poderia intuir o quão articulado o efetor de extremidade está. Conforme explora-se mais a fundo os procedimentos cirúrgicos, os mesmos tornam-se mais e mais óbvios para o fato de que os olhos do cirurgião precisam estar focados nos sítios cirúrgicos e não no cabo do instrumento. Também começa-se a perceber a necessidade do cirurgião de retroinformações completas da situação pelo dispositivo. O ângulo de articulação poderia ser iluminado como parte da própria junta de articulação. Com luzes, LEDs, etc. denotando os ângulos divergentes ou mesmo um pequeno LCD denotando os ângulos em graus. Isto permitiria ao cirurgião ter alguma retroinformação sobre os ângulos fora da reta de maneira que o mesmo possa facilmente navegar de volta ao ângulo correto após a remoção e reinserção. Outra questão é a indicação óbvia de qual cartucho de cor está no dispositivo. Isso pode ser realizado através de uma matriz de luz codificada por cor no atuador de extremidade ou no cartucho. Esta informação poderia ser também transmitida de volta para o cabo para exibir um visor redundante para assegurar que há confusão mínima quanto a qual cartucho está nas garras. Outro aprimoramento poderia incluir um pequeno contato de feixe de molas conectado a plataforma proximal do cartucho que indica se uma pressão de tecido mínima foi alcançada entre as garras. Esta pressão mínima iria, no mínimo, indicar se um cartucho de tecido espesso está sendo usado em aplicações de tecido fino, pois o mesmo não acenderia se pressão de tecido insuficiente na plataforma estiver presente.
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49/52
[00108] Há uma possível necessidade de um método para a introdução de baterias não estéreis (possivelmente com os eletrônicos integrais com as baterias se a lógica programável tornar-se uma necessidade-chave para o cliente). Já existe uma patente dentro da indústria de broca ortopédica para a inserção de baterias não estéreis dentro de um dispositivo esterilizado re-utilizável separadamente. Esta inovação é prevista para otimizar este conceito ao utilizar a embalagem estéril de dispositivo descartável para proteger a esterilidade do instrumento durante a inserção de baterias não estéreis. Um outro aprimoramento seria a inclusões de uma porta de incubação projetada dentro do instrumento e que pode ser fechada após o pacote ter sido inserido mas antes do dispositivo ser removido da embalagem estéril final. Esta incubação poderia então conter a bateria não estéril que poderia contaminar o campo cirúrgico estéril. Os métodos da presente invenção poderiam incluir uma camada adicional de embalagem que teria uma área perfurada em que a bateria poderia ser empurrada através, tanto rompendo a camada extra e permitindo que a bateria atravessada quanto indo com o conjunto de eletrodos da bateria apenas para serem rompidos pelas pontas de pino expostas da bateria na inserção completa. Uma alternativa para isto seria ter terminais internos da pistola (profundamente dentro da cavidade de proteção da bateria) romperem a barreira estéril e assento dentro dos orifícios de pinos nas baterias. A incubação poderia então ser fechada através do pacote estéril que veda o sistema. A pistola poderia então ser utilizada no campo estéril normalmente, assim como qualquer outro dispositivo estéril.
[00109] Modalidades de Localizador de Posição I codificador linear e controle de carga de parâmetros de motor: As patentes de n° US
6.646.307 e de n° 6.716.223 apresentam os mecanismos para a medição de rotação e torque relacionados para controlar parâmetro do motor e otimização dos parâmetros baseados na identificação de configu
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50/52 rações e carregamento de efetor de extremidade. A publicação de pedido de patente n° US 2007/0175958 mostra um método através do uso de um comprimento rosqueado do eixo primário nas Figuras 8 a 13 como este tipo de controle de movimento linear poderia ser usado para controlar os locais de gatilhos. O mesmo tipos de método poderia ser usado para métodos de controle linear eletrônico. O efetor de extremidade poderia identificar o comprimento e tipos mecanicamente ao comprimir pelo menos um êmbolo ativado por mola, que poderia identificar para o cabo o tipo, e comprimento o mesmo permitiria ao motor para funcionar. A rotação do motor poderia ser convertida de movimentos rotatórios para armação linear ou movimentos a cabo, que poderia então ser usado para ajustar a tensão do motor, corrente, e velocidade a fim de afetar o movimento linear desejado da lâmina de controle. A lâmina de controle poderia então ser diretamente acoplada aos movimento acionador de lâmina. Esta lâmina de controle poderia ter locais de parada descontínuos ou contínuos que o êmbolo identificador marca conforme o deslocamento linear ir para máximo antes da retração.
[00110] A identificação de recargas modulares com acionamento linear: Um reacionamento útil para um instrumento cirúrgico é a habilidade de identificar qual efetor de extremidade foi fixado no instrumento. No caso de um grampeador cirúrgico equipado com motor, vários tipos diferentes de efetor de extremidade poderiam ser fixados. Adicionalmente, um tipo de efetor de extremidade pode ter pelo menos uma função e/ou recurso que é seletivamente utilizado ou habilitado. Os meios para identificação de efetor de extremidade aqui apresentados estão anexados. Note-se que o tipo de efetor de extremidade referido abaixo não se limita a atuadores de extremidades mecânico, pneumático ou hidraulicamente acoplados. O instrumento pode tomar diferentes ações, parâmetros de operação de ajuste, indicação de funções
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51/52 disponíveis etc., como resultado da detecção deste efetor de extremidade.
[00111] O efetor de extremidade tem uma conexão elétrica que é feita quando o mesmo é anexado no instrumento. O instrumento comunica-se com o efetor de extremidade e lê pelo menos um de vários tipos de sinais. Uma posição de comutador ou posição de contato indica qual tipo de efetor de extremidade é presente. Um elemento passivo é medido por impedância e o resultado indica qual tipo de efetor de extremidade é presente.
[00112] O efetor de extremidade tem uma ligação de frequência de rádio com o instrumento e dados são transferidos em pelo menos uma direção entre o efetor de extremidade e o instrumento.
[00113] O efetor de extremidade tem uma ligação acústica com o instrumento e dados são transferidos em pelo menos uma direção entre o efetor de extremidade e o instrumento.
[00114] O efetor de extremidade tem uma ligação ótica com o instrumento e dados são transferidos em pelo menos uma direção entre o efetor de extremidade e o instrumento.
[00115] O efetor de extremidade tem uma ligação mecânica que engata elementos (como comutadores ou contatos) no instrumento que o identifica e por meio disso dados são transferidos em pelo menos uma direção entre o efetor de extremidade e o instrumento.
[00116] Embora a presente invenção tenha sido ilustrada pela descrição de várias modalidades e embora as modalidades ilustrativas tenham sido descritas em detalhes consideráveis, não é intenção dos requerentes restringir ou de qualquer forma limitar o escopo das reivindicações em anexo a tais detalhes. Vantagens e modificações adicionais podem mostrar-se facilmente disponíveis para os versados na técnica.
[00117] Por exemplo, embora as modalidades descritas acima te
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52/52 nham vantagens para um instrumento de grampeamento e corte cirúrgico endoscopicamente empregado 10, modalidades similares podem ser usadas em outros procedimentos médicos. Em geral, é aceito que procedimentos endoscópicos sejam mais comuns do que procedimentos laparoscópicos. Consequentemente, a presente invenção foi discutida em termos de procedimentos e aparelhos endoscópicos. Entretanto, termos como endoscópico não devem ser interpretados de modo a limitar a presente invenção a um instrumento cirúrgico para uso apenas em conjunto com um tubo endoscópico (isto é, um trocarte). Ao contrário, acredita-se que a presente invenção possa ter uso em qualquer procedimento onde o acesso é limitado a uma pequena incisão, incluindo, mas não se limitando a, procedimentos laparoscópicos, bem como procedimentos abertos.
[00118] Qualquer patente, pedido, ou outras informações, no todo ou em parte, que seja citado como aqui incorporado por referência, é incorporado apenas até o ponto em que o material incorporado não entre em conflito com as definições e declarações existentes, ou com qualquer outro material descritivo apresentado nesta descrição. Desse modo, a descrição como explicitamente aqui determinada substitui qualquer material conflitante incorporado aqui a título de referência. [00119] Embora esta invenção tenha sido descrita como tendo desenhos exemplificadores, a presente invenção pode ser adicionalmente modificada dentro do espírito e escopo da descrição. Pretende-se, portanto, que este pedido cubra quaisquer variações, usos ou adaptações da invenção com o uso de seus princípios gerais. Adicionalmente, este pedido destina-se a cobrir tais alterações da presente descrição, conforme a prática conhecida ou costumeira na técnica à qual esta invenção pertence.
Claims (7)
1. Aparelho prendedor cirúrgico (10) caracterizado pelo fato de que compreende:
um cabo (6);
uma haste alongada (8) que tem uma extremidade proximal ligada ao cabo (6);
uma canaleta (22) acoplada a uma extremidade distal da haste alongada (8) e configurada para suportar de modo operacional um cartucho de grampo cirúrgico (34) no mesmo;
um atuador suportado de maneira móvel para deslocamento distal e proximal dentro da canaleta (22);
um gatilho de disparo (20) acoplado de modo operacional ao cabo (6);
um gatilho de retração (121) suportado de modo operacional no gatilho de disparo (20) um motor elétrico (65) interfaceando de modo operacional com o atuador para aplicar seletivamente um movimento de acionamento distal ao mesmo para mover distalmente o atuador de uma posição não atuada para posições atuadas e aplicar seletivamente um movimento de acionamento proximal ao atuador para retrair o atuador para a posição não atuada a partir das posições acionadas; e um circuito de controle do motor para controlar o motor (65), o circuito de controle do motor compreende:
uma fonte de alimentação (64) conectada ao motor (65) para alimentar eletricamente o motor (65); e um circuito de controle de corrente conectado à fonte de alimentação (64) para controlar a corrente fornecida ao motor a partir da fonte de alimentação (64), o circuito de controle de corrente compreende:
uma chave de controle de partida de motor (110) conectado
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2/3 à fonte de alimentação (64) e operado pelo gatilho de disparo (20), de modo que, após a aplicação do movimento de atuação ao gatilho de disparo (20), a chave de controle de partida de motor (110) permite que a corrente flua para o motor (65) em uma primeira direção para fazer com que o motor (65) aplique o movimento de acionamento distal ao atuador;
uma chave de motor reverso (130) conectado à fonte de alimentação (64) de modo que, quando o atuador se move para uma posição distal mais atuada, o chave de motor reverso (130) permite que a corrente flua para o motor (65) em uma segunda direção para fazer com que o motor (65) aplique o movimento de acionamento proximal ao atuador; e uma chave de retração (131; 137) conectado à fonte de alimentação (64) e operado pelo gatilho de retração (121) de modo que, após a aplicação do movimento de retração ao gatilho de retração (121), a chave de retração altera o fluxo de corrente em uma segunda direção para o motor (65).
2. Aparelho prendedor cirúrgico (10), de acordo com a reivindicação 1, caracterizado pelo fato de que a retração em que a chave de retração (131; 137) compreende um resistor variável (133; 137').
3. Aparelho prendedor cirúrgico (10), de acordo com a reivindicação 2, caracterizado pelo fato de que a chave de retração (131) ainda compreende uma porção de contato normalmente fechada (135).
4. Aparelho prendedor cirúrgico (10), de acordo com reivindicação 1, caracterizado pelo fato de que o gatilho de retração (121) é suportado de maneira móvel no gatilho de disparo (20).
5. Aparelho prendedor cirúrgico (10), de acordo com reivindicação 4, caracterizado pelo fato de que o gatilho de retração (121)
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3/3 é seletivamente móvel de uma posição não atuada para uma posição atuada no gatilho de disparo (20).
6. Aparelho prendedor cirúrgico (10), de acordo com reivindicação 5, caracterizado pelo fato de que o gatilho de retração (121) é inclinado para a posição não atuada.
7. Aparelho prendedor cirúrgico (10), de acordo com reivindicação 1, caracterizado pelo fato de que após a aplicação do movimento de retração ao gatilho de retração (121), a chave de retração interrompe o fluxo de corrente em uma segunda direção para o motor (65).
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2010
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- 2010-07-29 US US12/846,249 patent/US8453907B2/en active Active
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2011
- 2011-07-26 CA CA2806429A patent/CA2806429C/en not_active Expired - Fee Related
- 2011-07-26 PL PL11738145T patent/PL2598048T3/pl unknown
- 2011-07-26 AU AU2011282840A patent/AU2011282840B2/en not_active Ceased
- 2011-07-26 EP EP18166741.1A patent/EP3366230B1/en active Active
- 2011-07-26 WO PCT/US2011/045319 patent/WO2012015799A1/en active Application Filing
- 2011-07-26 AU AU2011282921A patent/AU2011282921B2/en not_active Ceased
- 2011-07-26 EP EP11738145.9A patent/EP2598048B1/en active Active
- 2011-07-26 PL PL11738146T patent/PL2598049T3/pl unknown
- 2011-07-26 EP EP11738146.7A patent/EP2598049B8/en active Active
- 2011-07-26 CA CA2806435A patent/CA2806435C/en not_active Expired - Fee Related
- 2011-07-26 BR BR112013002171-3A patent/BR112013002171B1/pt active IP Right Grant
- 2011-07-26 JP JP2013521891A patent/JP5940533B2/ja active Active
- 2011-07-26 WO PCT/US2011/045311 patent/WO2012015794A1/en active Application Filing
- 2011-07-26 JP JP2013521895A patent/JP5788511B2/ja active Active
- 2011-07-26 CN CN201180036978.8A patent/CN103037779B/zh active Active
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