BR112013005685B1 - conjunto de cabeça de grampeamento cirúrgico e grampeador cirúrgico - Google Patents
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- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
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- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07257—Stapler heads characterised by its anvil
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Abstract
CONJUNTO DE CABEÇA DE GRAMPEAMENTO CIRÚRGICO COM TRAVAMENTO DE DISPARO PARA UM GRAMPEADOR CIRÚRGICO. A presente invenção refere-se a uma cabeça de grampeamento cirúrgico que é fornecida, a qual pode compreender um cartucho de grampos para sustentar um ou mais grampos, um núcleo móvel em relação ao cartucho de grampos, pelo menos um acionador de grampos estendendo-se a partir do núcleo, e um compartimento configurado apra conter ao menos parcialmente o cartucho de grampos e receber de forma móvel o núcleo e o(s) acionador(es) de grampos. O compartimento pode compreender, adicionalmente, pelo menos um elemento de retenção que é configurado para se mover de uma primeira posição para uma segunda posição quando força externa suficiente é aplicada ao elemento de retenção, tal como aquela fornecida por uma haste de um grampeador cirúrgico durante a inserção do conjunto de cabeça de grampeamento na haste. Quando o(s) elemento(s) de retenção está(ão) na segunda posição, o(s) acionador(es) de grampos pode(m) ser impedido (s) de acionar grampos do cartucho de grampos fornecendo, assim, um elemento de travamento de disparo ao conjunto de cabeça de grampeamento durante a inserção em pelo menos uma porção de (...).
Description
[0001] As modalidades referem-se em geral, a grampeadores cirúrgicos, e, mais particularmente, a um grampeador circular que inclui um ajuste de altura do grampo descontínuo.
[0002] Em certos tipos de procedimentos cirúrgicos, o uso de grampos cirúrgicos se tornou o método preferencial para união de tecidos e, por essa razão, grampeadores cirúrgicos especialmente configurados foram desenvolvidos para essas aplicações. Por exemplo, grampeadores intraluminais ou circulares foram desenvolvidos para uso em um procedimento cirúrgico conhecido como anastomose. Os grampeadores circulares úteis para executar uma anastomose são apresentados, por exemplo, nas patentes US n°s 5.104.025; 5.205.459; 5.285.945; e 5.309.927 e no pedido de patente U.S. n° de série No. 12/408.905, que estão, cada um, aqui incorporados por refe-rência nas suas respectivas totalidades.
[0003] Uma forma de anastomose compreende um procedimento cirúrgico no qual as seções de intestino são unidas uma a outra após a excisão de uma porção doente. O procedimento requer a reconexão das extremidades uma a outra das duas seções tubulares para formar uma trajetória tubular contínua. Anteriormente, esse procedimento cirúrgico era uma operação laboriosa e demorada. O cirurgião tinha que cortar e alinhar com precisão as extremidades do intestino, e manter o alinhamento ao unir as extremidades com numerosos pontos de sutura. O desenvolvimento de grampeadores circulares simplificou muito o procedimento de anastomose e também reduziu o tempo necessário para realizar uma anastomose.
[0004] Em geral, um grampeador circular convencional tipicamente consiste em uma haste alongada que tem um mecanismo de acionamento proximal e um mecanismo de grampeamento distai montado na haste. O mecanismo de grampeamento distai comumente consiste em um cartucho de grampeamento fixo que contém uma pluralidade de grampos configurados em um conjunto circular concêntrico. Uma face de corte redonda está montada no interior do cartucho concentrica- mente aos grampos para deslocamento axial no mesmo. Estendendo- se axialmente a partir do centro do cartucho está uma haste de trocar- te móvel, adaptada para ter uma bigorna para grampos acoplada à mesma de maneira removível. A bigorna é configurada para formar as extremidades dos grampos conforme estes são conduzidos para a mesma. A distância entre uma face distal do cartucho de grampos e a bigorna para grampos é controlada por um mecanismo de ajuste montado na extremidade proximal da haste do grampeador para controlar o movimento axial do trocarte. Os tecidos pinçados entre o cartucho de grampos e a bigorna para grampos são simultaneamente grampeados e cortados quando o mecanismo de acionamento é ativado pelo cirurgião.
[0005] Em geral, na execugao de uma operagao cirurgica de grampeamento anastomotico, dois pedagos de lumen ou tecido tubular, por exemplo, tecido intestinal, sao fixados juntos por um anel de grampos. Os dois pedagos de tecido tubular podem ser fixados extremidade a extremidade ou um pedago de tecido tubular pode ser fixado lateralmente ao redor de uma abertura formada no lado do outra pedago de tecido tubular. Ao realizar a anastomose com um instrumento de grampeamento, os dois pedagos de tecido tubular sao fixados juntos entre a garra e o cartucho de grampo. Um propulsor de grampos e avangado para conduzir os grampos para dentro do tecido e formar os grampos contra a bigorna. Alem disso, a faca circular e avangada para cortar o excesso de tecido preso entre a bigorna e o suporte do gram- po. Como resultado, uma segao de tecido em forma de anel e separa-da de cada lumen e permanece sobre a haste da bigorna. O tecido tubular unido pelo anel circular de grampos e solto por avangar a haste da bigorna em posigao distal para mover a bigorna para longe do su-porte do grampo. O instrumento de grampeamento e removido por pu-xar a bigorna atraves da abertura circular entre os pedagos de tecido tubular fixados ao anel de grampos.
[0006] Além disso, quando se realiza um procedimento no baixo cólon usando um grampeador circular, o intestino é tipicamente grampeado com o uso de um grampeador cirúrgico convencional, com fileiras duplas de grampos sendo colocadas em cada um dos lados da porção doente de intestino a ser removida. A porção-alvo é simultaneamente cortada conforme a extremidade contígua é grampeada. Após a remoção da porção doente, o cirurgião tipicamente insere a bigorna na extremidade proximal do lúmen, junto à linha de grampeamento. Isso é feito mediante a inserção da cabeça da bigorna em uma porta de entrada cortada pelo cirurgião no lúmen proximal. Em certos casos, a bigorna pode ser posicionada transanalmente, colocando-se o cabe-çote da bigorna na extremidade distal do grampeador, e inserindo-se o instrumento através do reto. O cirurgião então amarra a extremidade proximal do intestino à haste da bigorna usando uma sutura ou outro dispositivo de amarração convencional. Em seguida, o cirurgião corta o excesso de tecido adjacente à amarra e prende a bigorna à haste do trocarte do grampeador. O cirurgião fecha, então, o vão entre a bigorna e o cartucho, pinçando assim as extremidades proximal e distal do intestino no vão. Em seguida, o cirurgião ativa o grampeador, fazendo com que várias fileiras de grampos sejam conduzidas através de ambas as extremidades do intestino e formadas, unindo, assim, as extremidades e formando uma trajetória tubular. Simultaneamente, conforme os grampos são conduzidos e formados, a lâmina da faca circular concêntrica é conduzida através das extremidades do tecido intestinal, cortando as extremidades adjacentes à fileira interna de grampos. O cirurgião remove, então, o grampeador do intestino e o procedimento está completo.
[0007] Durante os procedimentos cirúrgicos acima descritos, é desejável formar grampos devidamente dentro de uma faixa de alturas de grampos de modo que eles sejam retidos no tecido e evitem vazamentos e sangramentos bem como para obter contato "tecido a tecido" que promove cicatrização do tecido. Em geral, controlando a distância ou vão entre a bigorna e o cartucho, podem ser obtidos melhores resultados de grampeamento e de cicatrização. Embora alguns grampeadores cirúrgicos sejam equipados com uma leitura visual indicando a altura do grampo, um cirurgião pode precisar se concentrar em muitos itens diferentes durante a cirurgia. Além disso, uma vez que a bigorna tiver sido corretamente posicionada, é necessário que a bigorna não se mova durante o disparo, de outro modo formação adequada do grampo poderia ser afetada adversamente.
[0008] A discussão supracitada tem intenção apenas de ilustrar o presente campo e não deve ser tomada como uma contradição do escopo da concretização.
[0009] Em várias modalidades, um conjunto de cabeça de grampeamento cirúrgico é fornecido. Em pelo menos uma modalidade, o conjunto de cabeça de grampeamento cirúrgico pode compreender um cartucho de grampos para sustentar um ou mais grampos cirúrgicos, um núcleo móvel em relação ao cartucho de grampos, pelo menos um acionador de grampos para interconectar e acionar os grampos do cartucho de grampos, e um compartimento configurado para conter ao menos parcialmente o cartucho de grampos e receber de modo móvel o núcleo e o pelo menos um acionador de grampos. Nestas modalida des, o pelo menos um acionador de grampos pode se estender a partir do núcleo. Adicionalmente, nestas modalidades, o compartimento pode compreender adicionalmente pelo menos um elemento de retenção que é configurado para se mover de uma primeira posição para uma segunda posição quando força externa suficiente é aplicada ao elemento de retenção. Além disso, nestas modalidades, quando o pelo menos um elemento de retenção está na segunda posição, o pelo menos um acionador de grampos é impedido de acionar os grampos do cartucho de grampos.
[00010] Em várias modalidades, um grampeador cirúrgico é fornecido. Em pelo menos uma modalidade, o grampeador cirúrgico pode compreender um corpo, um conjunto de cabeça de grampeamento, um sistema de acionamento, uma bigorna e um conjunto de ajuste da bigorna. Nestas modalidades, o corpo pode compreender uma porção de cabo e uma porção de haste estendendo-se a partir da porção de cabo. Adicionalmente, nestas modalidades, o conjunto de cabeça de grampeamento pode ser acoplado de modo liberável à porção de haste. Adicionalmente, nestas modalidades, o conjunto de cabeça de grampeamento pode compreender um cartucho de grampos para sustentar um ou mais grampos cirúrgicos, um núcleo móvel em relação ao cartucho de grampos, pelo menos um acionador de grampos para in- terconectar e acionar os grampos do cartucho de grampos, e um compartimento configurado para conter ao menos parcialmente o cartucho de grampos e receber de modo móvel o núcleo e o pelo menos um acionador de grampos. Além disso, nestas modalidades, o pelo menos um acionador de grampos pode se estender a partir do núcleo. Adicionalmente, nestas modalidades, o compartimento pode compreender adicionalmente pelo menos um elemento de retenção que é configurado para se mover de uma primeira posição para uma segunda posição quando força externa suficiente é aplicada ao elemento de retenção. Além disso, nestas modalidades, quando o pelo menos um elemento de retenção está na segunda posição, o pelo menos um acionador de grampos é impedido de acionar os grampos do cartucho de grampos. Adicionalmente, nestas modalidades, o sistema de acionamento pode ser configurado para aplicar movimentos de acionamento ao acionador de grampos. Adicionalmente, nestas modalidades, a bigorna pode ser sustentada de forma móvel em relação ao cartucho de grampos para movimento axial em direção e para longe do cartucho de grampos. Também, nestas modalidades, o conjunto de ajuste da bigorna pode ser configurado para ajustar seletivamente uma posição axial da bigorna em relação ao cartucho de grampo.
[00011] Em pelo menos uma modalidade, um conjunto de cabeça de grampeamento cirúrgico é fornecido, o qual pode compreender um cartucho de grampos para sustentar um ou mais grampos cirúrgicos, um núcleo móvel em relação ao cartucho de grampos, pelo menos um acionador de grampos estendendo-se a partir do núcleo e para inter- conectar e acionar os grampos do cartucho de grampos, um compartimento configurado para conter ao menos parcialmente o cartucho de grampos e receber de forma móvel o núcleo e o pelo menos um acionador de grampos, e meios de travamento para impedir o pelo menos um acionador de grampos de acionar grampos a partir do cartucho de grampos.
[00012] As características inovadoras das modalidades aqui descritas são apresentadas com particularidade nas concretizações. As modalidades, entretanto, tanto com relação à organização quanto aos métodos de operação podem ser melhor compreendidas por referência à descrição a seguir, tomada em conjunto com os desenhos em anexo da seguinte forma.
[00013] A FIG. 1 é uma vista em perspectiva de uma modalidade não-limitadora de um grampeador cirúrgico incluindo uma cabeça de grampeamento circular e uma bigorna em uma primeira posição.
[00014] A FIG. 2 é uma vista em perspectiva do grampeador cirúrgico da FIG. 1 com a bigorna mostrada em uma segunda posição.
[00015] A FIG. 3 é uma vista explodida do grampeador cirúrgico da FIG. 1.
[00016] A FIG. 4 é uma vista em perspectiva do grampeador cirúrgico da FIG. 1 com o corpo do grampeador mostrado em linhas pontilhadas para ilustrar melhor os componentes do grampeador dentro do corpo.
[00017] A FIG. 5 é uma vista em seção transversal do grampeador cirúrgico da FIG. 1.
[00018] A FIG. 6 é uma vista em perspectiva posterior da bigorna do grampeador cirúrgico da FIG. 1.
[00019] A FIG. 7A é uma vista em perspectiva anterior de um conjunto de cabeça de grampeamento do grampeador cirúrgico da FIG. 1.
[00020] A FIG. 7B é uma vista em perspectiva posterior de um cartucho de grampos do conjunto de cabeça de grampeamento de 7A; dois grampos são mostrados removidos das cavidades para grampos do cartucho.
[00021] A FIG. 7C é uma vista em perspectiva anterior de um elemento de corte e dos acionadores de grampo do conjunto da cabeça de grampeamento da FIG. 7A.
[00022] A FIG. 8 é uma vista lateral de uma haste de ajuste da bigorna do grampeador cirúrgico da FIG. 1.
[00023] A FIG. 9 é uma vista em perspectiva de uma porção da haste de ajuste da bigorna da FIG. 8.
[00024] As FIGS. 10A a 10C são uma série de vistas laterais de uma porção da haste de ajuste da bigorna da FIG. 8, cada uma mostrando uma progressão de uma superfície da rosca quando a haste é girada ao redor de seu eixo longitudinal.
[00025] As FIGS. 11A a 11C são uma série de vistas laterais da bigorna e do conjunto de cabeça de grampeamento do grampeador cirúrgico da FIG. 1, cada uma mostrando uma altura de formação do grampo descontínua que se correlaciona com as posições da haste mostradas nas FIGS. 10Aa 10C, respectivamente.
[00026] A FIG. 12 ilustra uma modalidade não-limitadora de uma porção de uma haste de ajuste da bigorna incluindo sinais de referência.
[00027] A FIG. 13 ilustra três sinais de referência da porção da haste de ajuste da FIG. 12.
[00028] A FIG. 14 é uma vista em perspectiva posterior de um disparador do grampeador cirúrgico da FIG. 1; o disparador inclui uma haste de travamento.
[00029] A FIG. 15 é uma vista em perspectiva anterior de uma porção do grampeador cirúrgico da FIG. 3, mostrando o disparador e a haste de travamento interconectados com a faixa de acionamento e a haste de ajuste, respectivamente.
[00030] A FIG. 16 é uma vista em perspectiva de uma modalidade não-limitadora de um grampeador cirúrgico incluindo uma porção de haste reta.
[00031] A FIG. 17 é uma vista lateral de uma haste de ajuste da bigorna do grampeador cirúrgico da FIG. 16.
[00032] A FIG. 18 é uma vista em perspectiva de uma barra de acionamento do grampeador cirúrgico da FIG. 16.
[00033] A FIG. 19 é uma vista em perspectiva de uma modalidade não-limitadora de um conjunto de cabeça de grampeamento com um compartimento do conjunto mostrado em linhas pontilhadas para ilustrar melhor os elementos dentro do compartimento.
[00034] A FIG. 20 é uma vista lateral do conjunto de cabeça de grampeamento da FIG. 19.
[00035] A FIG. 21 é uma vista em perspectiva de um núcleo do acionador de grampos do conjunto de cabeça de grampeamento da FIG. 19.
[00036] A FIG. 22 é uma vista lateral parcial do conjunto de cabeça de grampeamento da FIG. 19 sendo inserido inicialmente em um corpo do grampeador da FIG. 1 com um corpo do grampeador mostrado em linhas pontilhadas para ilustrar melhor a porção do conjunto de cabeça de grampeamento posicionada dentro do corpo do grampeador.
[00037] A FIG. 23 é uma vista em perspectiva parcial do conjunto de cabeça de grampeamento da FIG. 19 sendo inserida adicionalmente no corpo do grampeador da FIG. 1 com o corpo do grampeador e o compartimento do conjunto de cabeça de grampeamento mostrados em linhas pontilhadas para ilustrar melhor os vários elementos ali contidos.
[00038] A FIG. 24 é uma vista em perspectiva parcial do conjunto de cabeça de grampeamento da FIG. 19 totalmente inserido no corpo do grampeador da FIG. 1 com o corpo do grampeador mostrado em linhas pontilhadas para ilustrar melhor os componentes ali contidos.
[00039] A FIG. 25 é uma vista em perspectiva de uma modalidade não-limitadora de um conjunto de cabeça de grampeamento que inclui um elemento de corte com um compartimento do conjunto mostrado em linhas pontilhadas para ilustrar melhor os elementos dentro do compartimento.
[00040] A FIG. 26 é uma vista lateral do conjunto de cabeça de grampeamento da FIG. 25.
[00041] Certas modalidades serão descritas agora para fornecer um entendimento geral dos princípios de estrutura, função, fabricação e uso dos dispositivos e métodos apresentados na presente invenção. Um ou mais exemplos de três modalidades são ilustrados nos desenhos em anexo. Os elementos versados na técnica entenderão que os dispositivos e métodos especificamente aqui descritos e ilustrados nos desenhos anexos são modalidades exemplificadoras não limitadoras, e que o escopo das várias modalidades é definido somente pelas concretizações. As características ilustradas ou descritas em relação a uma modalidade podem ser combinadas com as características de outras modalidades. Além disso, quando uma ordem de etapas em um processo é indicada, essas ordens podem ser rearranjadas ou as etapas podem ser executadas contemporaneamente conforme desejado a menos que seja ilógico ou se a ordem mencionada for explicitamente necessária. Essas modificações e variações são destinadas a estarem incluídas no escopo das concretizações.
[00042] Na seguinte descrição, os caracteres de referência iguais designam partes correspondentes ou iguais ao longo de várias vistas. Também na descrição a seguir, deve ser entendido que termos como "adiante", "traseira", "parte frontal", "parte posterior", "direita", "esquerda", "superior", "inferior", "para cima", "para baixo", "proximalmente", "distalmente", e similares são palavras usadas por conveniência e não devem ser interpretados como termos limitadores. A descrição abaixo tem o propósito de descrever várias modalidades e não se destina a limitar as concretizações.
[00043] As várias modalidades em geral se referem a vários grampeadores cirúrgicos configurados para vedação de tecido e, em pelo menos uma modalidade, também cortar o tecido. Esses grampeadores cirúrgicos podem ser configurados para funcionar através de um orifício natural, como o ânus, boca e/ou vagina, ou através de uma incisão em uma parede do corpo. Além disso, esses grampeadores cirúrgicos podem ser projetados como ferramentas endoscópicas, incluindo ferramentas laparoscópicas. Um tipo exemplificador de grampeador ci rúrgico pode ser encontrado no pedido co-pendente U.S. n° de série 12/635.415, intitulado CIRCULAR SURGICAL STAPLER WITH DISCRETE STAPLE HEIGHT ADJUSTMENT, e depositado em 10 de dezembro de 2009, aqui incorporado na íntegra, a título de referência.
[00044] Concentra ndo-se agora em uma modalidade não- limitadora, como pode ser visto nas FIGS. 1 a 4, é fornecido um grampeador circular 1 que inclui um corpo tubular ou circular 10, uma cabeça de grampeamento 30 operacionalmente acoplada ao corpo 10, uma bigorna 50, uma haste de ajuste da bigorna 70 suportada pelo corpo 10 e um disparador 90 acoplado de modo móvel ao corpo 10. A bigorna 50 pode ser sustentada de modo móvel em relação ao conjunto da cabeça de grampeamento para passagem seletiva em direção à cabeça de grampeamento ou para longe dela 30. Além disso, a haste de ajuste da bigorna 70 pode ser suportada pelo corpo 10 para ajustar de modo seletivo uma posição da bigorna em relação à cabeça de grampeamento. Portanto, como será explicado em mais detalhes abaixo, a haste de ajuste 70 pode ser operacionalmente acoplada à bigorna 50 para efetuar o movimento da mesma. Por exemplo, a haste de ajuste 70 pode ser girada, através de um botão 79 da haste de ajuste, ao redor de seu eixo longitudinal, em uma primeira direção de rotação, como por exemplo, no sentido horário "CW", para fazer com que a haste 70 e a bigorna 50 se movam ou transladem em na direção distai "DD", em relação ao corpo 10, a partir de uma primeira posição mostrada na FIG. 1 para uma segunda posição mostrada na FIG. 2. De modo semelhante, a haste de ajuste 70 pode ser girada em uma segunda direção rotacional, como por exemplo, em sentido anti-horário "CCW", para fazer com que a haste 70 e a bigorna 50 se movam ou trasladem em uma direção proximal "PD" em relação ao corpo 10, a partir da segunda posição mostrada na FIG. 2 até a primeira posição mostrada na FIG. 1. Entende-se que a bigorna 50 pode ser posicionada em qual- quer lugar entre ou fora das posições mostradas nas FIGS. 1 e 2, conforme permitido pelo grampeador cirúrgico 1. Além disso, em pelo menos uma modalidade, conforme explicado em mais detalhes abaixo, a haste de ajuste 70 pode ser configurada para mover a bigorna 50 para pelo menos uma distância predeterminada a partir da cabeça de grampeamento e/ou para fornecer retroinformação tátil a um usuário.
[00045] Quando o disparador 90 é ativado, um sistema de acionamento pode ser ativado dentro do corpo 10 de modo que os grampos 31 (vide FIGS. 3 e 7B) podem ser expelidos da cabeça de grampeamento 30 para o interior do contato de conformação da bigorna 50. Simultaneamente, um elemento de corte 32 (vide FIG. 7C), que é operacionalmente sustentado dentro do cabeçote 30, atua cortando os tecidos mantidos dentro da circunferência dos tecidos grampeados. O grampeador 10 é, então, puxado através do tecido, deixando em seu lugar o tecido grampeado. Além disso, o disparador 90 pode incluir uma mola 91 que se estende a partir da alavanca 92 de modo que quando a alavanca 92 é apertada, ou movida de outro modo em direção ao corpo 10 ao redor do pino da dobradiça 93, a alavanca 91 é tracionada de volta para longe do corpo 10 e a faca 70 é automaticamente retraída mediante liberação da alavanca 92.
[00046] Com referência à FIG. 3, o corpo 10 pode incluir uma porção de cabo 11 e uma porção de haste curva 12. Embora a presente modalidade ilustre uma porção de haste curva 12, a porção de haste pode também ser reta ou linear (vide, por exemplo, a FIG. 16, discutida abaixo). A porção de cabo 11 pode ser adaptada para receber o disparador 90 através de uma fixação de parte côncava 13 que pode incluir, também, orifícios 16 (vide FIG. 3) com os quais receber o pino da dobradiça 93 que pode também ser recebido nos orifícios 96 do disparador 90. A porção de cabo 11 pode ainda definir uma abertura 14 no topo do corpo 10 através do qual uma porção do disparador 90 pode ser posicionada. Por exemplo, as superfícies de carne 94 e uma haste de travamento 95 podem se estender através da abertura 14. Conforme será explicado em mais detalhes abaixo, as superfície de carne 94 pode ser configurada para atuar no sistema de acionamento quando o disparador 90 é movido em relação à porção do cabo 11, e a haste de travamento 95 pode evitar o disparo inadvertido do elemento de corte 32 e/ou dos grampos 31 antes de a bigorna 50 estar em uma posição adequada de modo que os grampos possam ser formados entre a bigorna 50 e a cabeça de grampeamento 30.
[00047] Com referência às FIGS. 3 e 4, o sistema de acionamento pode compreender uma faixa de acionamento 80 que se estende axialmente entre a superfície de carne 94 do disparador e as abas 36 da cabeça de grampeamento 30 dentro da porção da haste do corpo 12. A faixa de acionamento 80 pode incluir as superfícies de acionamento proximal 81 e superfícies de acionamento distai 82. Desse modo, a atuação do disparador pode fazer com que as superfícies de carne 94 girem e empurrem as superfícies de acionamento proximais 81 de modo que a faixa de acionamento 80 se mova em uma direção axial em direção à bigorna 50 ou para longe dela. As abas 36 da cabeça de grampeamento podem ser acopladas dentro das superfícies de acionamento distais 82 da faixa de acionamento, que podem assumir a forma de entalhes para receber de modo liberável as abas 36.
[00048] Com referência às FIGS. 4 e 7A a 7C, a cabeça de grampeamento 30 pode incluir um conjunto que compreende um cartucho de grampo 33 para sustentar um ou mais grampos 31, pelo menos um acionador de grampo 34 para interconectar e acionar os grampos 31 a partir do cartucho 33, e um elemento de corte 32, por exemplo, uma faca, suportada de modo móvel na cabeça de grampeamento 30. Em pelo menos uma modalidade, os acionadores de grampos 34 e o elemento de corte 32 podem ser integralmente conectados e/ou forma dos. Por exemplo, os acionadores de grampos 34 e o elemento de corte 33 podem se estender a partir de um núcleo 35, cada um dos quais pode ser formado do mesmo material. Em todo caso, a atuação da faixa de acionamento 80 em direção do cartucho de grampo 33 e/ou da bigorna 50 pode fazer com que as abas 36 da cabeça de grampeamento, que podem se estender do núcleo 35, e, dessa forma, o elemento de corte 32 e os acionadores de grampo 34, se movam em direção à bigorna 50. Além disso, a cabeça de grampeamento 30 pode também compreender um compartimento 39 que está configurado para conter o cartucho de grampos 33 e receber de modo móvel os acionadores de grampos 34, o elemento de corte 32 e/ou o núcleo 35 atra-vés do mesmo. O compartimento 39 pode incluir adicionalmente botões de liberação 37 que são configurados para defletir flexivelmente e permitir que a cabeça de grampeamento 30 seja fixada de modo libe- rável à porção da haste do corpo 12 nos orifícios correspondentes 15 (vide FIG. 3) formados nela. Consequentemente, com referência à FIG. 4, a cabeça de grampeamento 30 pode ser removida por pressionar os botões 37, e então girar a cabeça 30 de modo que as abas 36 sejam liberadas dos entalhes formados pelas superfícies de acionamento distais 82 da faixa de acionamento 80, e finalmente puxar a cabeça de grampeamento 30 para longe do corpo 10.
[00049] Concentrando-se agora no ajuste da bigorna 50 e com referência à FIG. 3, em várias modalidades e conforme observado acima, a bigorna 50 pode ser suportada de modo móvel em relação ao cartucho de grampo 33 de modo que a bigorna pode ser movida axialmente na direção do cartucho de grampo e para longe dele 33. Em mais detalhes, o grampeador cirúrgico 1 pode compreender um conjunto de ajuste da bigorna para ajustar seletivamente uma posição axial da bigorna 50 em relação ao cartucho de grampo 33. O conjunto de ajuste da bigorna pode compreender uma haste de ajuste 70 e um trocarte 73 acoplado à haste de ajuste 70 para mover-se com o mesmo. A haste de ajuste 70 pode compreender uma porção proximal 70a e uma porção distai 70b, que podem ser conectadas juntas para formar a haste 70. Alternativamente, as porções proximais e distais 70a, 70b podem ser unitárias e integralmente formadas do mesmo pedaço de material (consulte, por exemplo, haste de ajuste 170 representada na FIG. 17 e discutida abaixo). Adicionalmente, a haste de ajuste 70 pode compreender, ainda um sulco anular 71 localizado na porção distai 70b que pode ser unido ou de outro modo livremente conectado a uma extremidade proximal de uma faixa de ajuste da bigorna 72. Por co-nectado livremente, deve ser compreendido que a faixa de ajuste 72 pode não girar enquanto a haste de ajuste 70 gira; entretanto, a faixa de ajuste 72 pode ainda transladar junto com a haste 70. Uma extremidade distal da faixa de ajuste 72 também pode ser fixada ao trocarte 73. Consequentemente, o movimento axial ou de translação da haste de ajuste 70 em relação ao corpo 10 pode fazer com que o trocarte 73 também se mova axialmente ou translade em relação ao corpo 10.
[00050] Com referência às FIGS. 3 e 4, uma ou ambas as faixas de ajuste da bigorna 72 e a faixa de acionamento 80 podem incluir abas 83 e 84, respectivamente, que são inclinadas ou se projetam de outro modo na direção do corpo 10. As abas 83 e 84 podem ajudar em permitir que as faixas 72 e 80 se movam através da porção de haste curvada do corpo 12 enquanto preenche o espaço e mantém uma posição axial adequada nisso.
[00051] Além disso, com referência às FIGS. 3 e 6, tal como é conhecido na área, o trocarte 73 pode ser fixado de modo removível à bigorna 50 por uma lâmina ou por grampos com mola 55 acoplados à bigorna e/ou ao trocarte. Em outras palavras, a bigorna pode ser removida do trocarte por pressão, tração ou manipulação de outro modo dos grampos com mola 55. Contrariamente, o trocarte pode ser encai- xado na bigorna por movimentar o trocarte dentro da bigorna de modo que os grampos com mola 55 prendam de modo de modo liberável a bigorna no trocarte. Dessa forma, o movimento axial da haste de ajuste da bigorna 70 em relação ao corpo 10 pode, também se mover axialmente ou transladar a bigorna 50 em relação ao corpo 10. Além disso, a bigorna pode também incluir um invólucro 53 acoplado ao corpo da bigorna 52 (vide FIG. 3) e uma arruela 54 que é cisalhada durante o disparo do elemento de corte 32, conforme discutido acima. A arruela 54 pode ser feita de plástico e pode servir com uma superfície de corte contra a qual o tecido pode ser cortado.
[00052] Agora com referência às FIGS. 3 a 5, a haste de ajuste da bigorna 70 pode ser configurada para ser girada, conforme explicado acima, de modo que a haste 70 translade em relação ao corpo 10. Em mais detalhes e em pelo menos uma modalidade, a haste de ajuste da bigorna 70 pode compreender uma superfície de rosca 74 que engata funcionalmente uma porção de engate do corpo 10, como um pino de rosca 75 fixo ao corpo 10 através de um orifício no mesmo. A superfície de rosca 74 pode ser definida por uma canaleta formada na haste de ajuste 70 que é dimensionada e configurada para receber nela pelo menos uma porção do pino 75. A haste de ajuste da bigorna 70 pode ser girada ao redor de seu eixo longitudinal L (vide FIG. 8) de modo que a superfície de rosca 74 entre em contato e seja movida sobre o pino 75, fazendo assim com que a haste de ajuste da bigorna 70 translade em relação ao corpo 10. Embora o pino 75 seja descrito na presente modalidade, qualquer outra porção ou componente de acoplamento da rosca adequado, como uma protuberância, rosca e similares, pode ser usado para engatar a superfície de rosca no lugar de, ou em adição ao pino 75. Em todo caso, o giro da haste de ajuste 70 ao redor de seu eixo longitudinal pode fazer com que a haste 70 e, então, o trocarte 73 e a bigorna 50 também se transladem axialmente em relação ao corpo 10 e/ou cabeça de grampeamento 30.
[00053] Conforme mencionado acima, em várias modalidades, a haste de ajuste 70 pode ser configurada para mover a bigorna 50 para pelo menos uma distância predeterminada a partir da cabeça de grampeamento 30. Em mais detalhes, e concentrando-se agora na FIG. 8, que mostra somente a haste de ajuste 70, a superfície de rosca 74 da haste de ajuste pode incluir pelo menos uma porção inclinada e pelo menos uma porção de contato. Por exemplo, a superfície de rosca 74 pode compreender uma primeira, porção inclinada 74a e uma segunda, porção ou porções de contato 74b. Pelo menos um delimitador, como o delimitador 76, pode também separar a porção inclinada 74a da porção de contato 74b. Como será discutido em mais detalhes abaixo, a porção inclinada 74a pode permitir que a haste de ajuste translade em relação ao corpo 10 (vide FIG. 4), a porção de contato 74b pode fornecer uma distância predeterminada para manter a posição da bigorna 50 a partir da cabeça de grampeamento 30 (vide FIG. 2), e o delimitador 76 pode proporcionar retroinformação tátil para um usuário girar a haste de ajuste da bigorna 70 bem como uma transição entre a rampa e as porções de contato. Além disso, em pelo menos uma modalidade, a porção inclinada 74a pode ser ter formato pelo menos parcialmente helicoidal.
[00054] Continuando, o círculo desenhado em linhas tracejadas na FIG. 8 representa a porção aproximada da haste de ajuste da bigorna 70 que é mostrada nas FIGS. 9 e 10A a 10C. Concentrando-se agora na FIG. 9, a porção inclinada 74a da superfície de rosca 74 pode levar a pelo menos uma porção de contato. Conforme ilustrado e em pelo menos uma modalidade, a superfície de rosca 74 pode compreender, ainda três porções de contato, a primeira porção de contato 74b', a segunda porção de contato 74b" e a terceira porção de contato 74b'". O giro da haste de ajuste da bigorna 70 ao redor de seu eixo longitudi- nal pode fazer com que a superfície de rosca 74 passe ao longo do pino 75 (vide FIG. 5) de modo que a haste 70 translade em relação ao corpo 10 (novamente, vide FIG. 5). Além disso, conforme a haste 70 é girada no sentido horário CW, por exemplo, a superfície de rosca 74 pode se mover ao longo do pino 75 de modo que o pino 75 entre em contato com a porção inclinada e, então, com a primeira porção de contato 74b'. Em seguida, quando a haste 70 é girada novamente no sentido horário CW, o pino pode entrar em contato com a segunda porção de contato 74b". Consequentemente, a rotação adicional da haste 70 no sentido horário CW pode mover o pino para entrar em contato com a terceira porção de contato 74b'". Conforme será explicado em mais detalhes abaixo, cada porção de contato pode ter uma configuração angular diferente em comparação à porção inclinada 74a.
[00055] Além disso, cada porção de contato 74b', 74b" e 74b'" pode estar em uma posição longitudinal diferente ao longo da haste de ajuste da bigorna 70 para fornecer alturas de formação de grampo descontínuas predeterminadas. Por exemplo, com referência à FIG. 10A, a primeira porção de contato 74b' pode estar em uma primeira distância L1 de uma saliência transversal 77 do conjunto da haste. A segunda porção de contato 74b" pode estar em uma segunda distância L2 de uma saliência transversal 77 e a terceira porção de contato 74b'" pode estar em uma terceira distância L3 de uma saliência transversal 77. Qualquer ponto ou plano de referência, incluindo a saliência transversal 77 pode ser usado para estabelecer as distâncias supracitadas. Em todo caso, a primeira distância L1 pode ser maior que a segunda distância L2, que pode ser maior que a terceira distância L3, ou L1 > L2 > L3. Alternativamente, embora não seja mostrado, as distâncias podem ser em outras ordens comparativas, como L1 > L3 > L2, L2 > L1 > L3, L2 > L3 > L1, L3 > L2 > L1, ou L3 > L1 > L2. Além disso, cada uma das distâncias de contato L1, L2, e L3 pode ser uniforme em rela ção às suas respectivas porções de contato 74b', 74b", e 74b'". Em outras palavras, com referência à FIG. 10B, por exemplo, enquanto a porção inclinada da superfície de rosca 74a pode se inclinar a um ângulo de inclinação ou hélice α menor que 90 graus em relação ao eixo longitudinal da haste de ajuste L, cada porção de contato (por exemplo, 74b" na FIG. 10B) pode ser substancialmente perpendicular ao eixo longitudinal L, ou definir um ângulo θ que é de aproximadamente 90 graus com relação ao eixo L. Adicionalmente, com referência às FIGS. 9 e 10A-10C, as porções de contato 74b', 74b", 74b'" podem ser de outro modo etapas que definem alturas de grampo distintas e predeterminadas, como discutido abaixo. Ao medir os ângulos supracitados em relação ao eixo longitudinal L, deve-se compreender que essas medições podem ser feitas em relação a um plano que é tangencial a uma porção da superfície de rosca 74 e a intersecção do plano com o eixo longitudinal L, que, para propósitos de clareza, é mostrada longo do comprimento da haste de ajuste da bigorna mostrada nas FIGS. 10Aa 10C. Por exemplo, com referência à FIG. 10B novamente, o ângulo da hélice α é definido entre o plano tangencial "TP", que é perpendicular ao plano da página da FIG. 10B, e o eixo longitudinal L.
[00056] Concentrando-se agora nas FIGS. 11A a 11C, a cabeça de grampeamento 30 e a bigorna 50 são mostradas em várias posições que se correlacionam com as porções de contato 74b', 74b" e 74b'" da superfície de rosca da haste. Por exemplo, as alturas de formação de grampo descontínuas D1, D2 e D3 podem ser definidas entre uma superfície de formação do grampo 51 da bigorna 50 e uma superfície de ejeção do grampo 38 do cartucho de grampo 33. A primeira altura D1 pode ser maior que a segunda altura D2, que pode ser maior que a terceira distância D3, ou D1 > D2 > D3. Referindo-se coletivamente às FIGS. 10A a 10C e 11A a 11C, cada porção de contato 74b', 74b" e/ou 74b'" pode permitir que a bigorna 50 seja mantida na respectiva altura de formação de grampo D1, D2 e/ou D3 enquanto a haste de ajuste 70 está sendo girada de modo que a uma porção de contato se mova ao longo do pino 75 (vide FIG. 5). Por exemplo, cada porção de contato 74b', 74b", 74b'" pode ser projetada para manter a posição da bigorna durante um período de rotação da haste de cerca de 60 graus. Em outras palavras, um arco que corre ao longo de cada superfície da porção de contato pode se estender por um ângulo de aproximadamente 60 graus.
[00057] Com referência às FIGS. 9 e 10A a 10C, em várias modalidades, pelo menos uma transição pode separar cada porção de contato 74b', 74b" e/ou 74b'" para assim permitir que a haste de ajuste da bigorna 70 seja avançada para outra posição em relação ao pino 75 (vide FIG. 5). Em pelo menos uma modalidade, a transição pode compreender outra porção inclinada e/ou uma superfície helicoidal parcial. Entretanto, em pelo menos uma outra modalidade, a transição pode também compreender pelo menos um delimitador. Como pode ser visto nas FIGS. 10A a 10C, um primeiro delimitador 76' pode separar uma porção inclinada da superfície de rosca 74a da primeira porção de contato 74b', um segundo delimitador 76" pode separar a primeira porção de contato 74b' da segunda porção de contato 74b" e um terceiro delimitador 76"' pode separar a segunda porção de contato 74b" da terceira porção de contato 74b'". Conforme acima mencionado, cada delimitador 76', 76" e/ou 76'" pode proporcionar retroinformação tátil a um usuário enquanto o usuário gira a haste de ajuste da bigorna.
[00058] Em mais detalhes, referindo-se novamente às FIGS. 9 e 10A a 10C, cada delimitador 76', 76" e/ou 76'" pode compreender um ressalto ou uma protuberância na superfície de rosca. Em outras palavras, a superfície de rosca 74 pode definir uma topografia superficial que inclui a porção inclinada 74a e as porções de contato 74b', 74b" e 74b'", e cada delimitador 76', 76" e/ou 76'" pode ter uma interrupção na topografia superficial, entre as porções supracitadas, respectivamente. Também, com exceção dos delimitadores 76', 76" e/ou 76'", a topografia superficial em qualquer porção de superfície de rosca 74 pode ser lisa. Por exemplo, com referência às FIGS. 5, 9 e 10A a 10C, a porção inclinada da superfície de rosca 74a pode incluir uma topografia lisa de modo que a superfície de rosca 74 possa se mover de modo relativamente suave após o pino 75 quando a haste de ajuste da bigorna 70 é girada em relação ao corpo 10. Entretanto, quando o pino 75 atinge a extremidade da porção inclinada 74a, a topografia superficial pode ser interrompida pelo primeiro delimitador 76'. Consequentemente, quando a superfície de rosca 74 é avançada sobre o pino 75, a haste de ajuste 70, que pode estar se estendendo proximalmente do corpo 10 de um modo suave quando a haste 70 está sendo girada, pode pular, empurrar ou puxar de um modo abrupto ou descontínuo ou fornecer de outro modo retrainformação tátil a um usuário, quando o primeiro delimitador 76' entra em contato com o pino 75, devido a interrupção na topografia superficial da superfície de rosca 74 no delimitador 76'. A ação do primeiro delimitador 76' que passa sobre o pino 75 pode proporcionar a um usuário girando a haste 70 uma indicação de que a primeira altura de formação do grampo descontínua D1 (vide FIG. 11 A) foi alcançada já que o pino 75 é agora recebido na primeira porção de contato 74b'. A rotação contínua da haste 70 durante o período de contato, que, conforme acima mencionado, pode ser de aproximadamente 60 graus, pode não ajustar a primeira altura de formação do grampo D1. Consequentemente, o usuário não precisa necessariamente se concentrar na exata posição rotacional na qual a haste de ajuste da bigorna 70 está situada, já que o usuário sabe que a primeira altura de formação de grampo D1 não será alterada até que a haste 70 seja girada adicionalmente para colocar mais um delimitador em contato com o pino 75. Além disso, o usuário pode girar a haste de ajuste da bigorna 70 para trás e para frente de modo que o pino 75 seja relativamente movido ao longo da primeira porção de contato 74b', entre o primeiro delimitador 76' e o segundo delimitador 76". Quando os delimitadores se projetam da superfície da primeira porção de contato 74b', o usuário, através da haste de ajuste da bigorna 70, pode sentir quando o pino 75 entra em contato com o primeiro ou segundo delimitador 76', 76" nas respectivas extremidades da primeira porção de contato 74b', desta forma proporcionando confiança ao usuário de que a primeira altura de formação do grampo D1 foi atingida.
[00059] Com referência às FIGS. 5, 9, e 10A a 10C, se o usuário desejar alterar a altura de formação do grampo a partir da primeira altura de formação do grampo D1 para a segunda altura de formação do grampo D2 (vide FIGS. 11A a 11B), o usuário pode, ainda, girar a haste de ajuste da bigorna 70 de modo que o segundo delimitador 76" entre em contato com o pino 75. Quando o pino 75 atinge a extremidade da primeira porção de contato 74b', a topografia superficial pode ser interrompida pelo segundo delimitador 76". Consequentemente, quando a superfície de rosca 74 avança sobre o pino 75, a haste de ajuste 70, que pode ser girada de modo suave enquanto o pino 75 está em contato com a primeira porção de contato 74b', pode pular, empurrar ou puxar de um modo abrupto ou descontínuo ou fornecer de outro modo retroinformação tátil a um usuário, quando o segundo delimitador 76" entra em contato com o pino 75, devido à interrupção na topografia superficial da superfície de rosca 74 no delimitador 76'". A ação do segundo delimitador 76" que passa sobre o pino 75 pode proporcionar a um usuário girando a haste 70 uma indicação de que a segunda altura de formação do grampo descontínua D2 (vide FIG. 11 A) foi alcançada já que o pino 75 agora é recebido na segunda porção de contato 74b". A rotação contínua da haste 70 durante o período de contato, que conforme acima mencionado, pode ser de aproximada- mente 60 graus, pode não ajustar a segunda altura de formação do grampo D2. Consequentemente, o usuário não precisa necessariamente se concentrar na exata posição rotacional na qual a haste de ajuste da bigorna 70 está situada, já que o usuário sabe que a segunda altura de formação do grampo D2 não será alterada até que a haste 70 seja adicional mente girada para trazer mais um delimitador em contato com o pino 75. Além disso, o usuário pode girar a haste de ajuste da bigorna 70 para trás de modo que o pino 75 seja movido relativamente junto com a segunda porção de contato 74b", entre o segundo delimitador 76" e o terceiro delimitador 76'". Quando os delimitadores se projetam da superfície da segunda porção de contato 74b", o usuário, através da haste de ajuste da bigorna 70, pode sentir quando o pino 75 entra em contato com o segundo ou terceiro delimitador 76", 76"' nas respectivas extremidades da segunda porção de contato 74b", proporcionando confiança ao usuário de que a segunda altura de formação do grampo D2 foi atingida.
[00060] De modo similar, ainda se referindo às FIGS. 5, 9, e 10A a 10C, se o usuário desejar alterar a altura de formação do grampo a partir da segunda altura de formação do grampo D2 para a terceira altura de formação do grampo D3 (vide FIGS. 11B a 11C), o usuário pode, ainda, girar a haste de ajuste da bigorna 70 de modo que o terceiro delimitador 76'" entre em contato com o pino 75. Quando o pino 75 atinge a extremidade da segunda porção de contato 74b", a topografia superficial pode ser interrompida pelo terceiro delimitador 76'". Consequentemente, quando a superfície de rosca 74 é avançada sobre o pino 75, a haste de ajuste 70, que pode ser girada de modo suave enquanto o pino 75 está em contato com a segunda porção de contato 74b", pode pular, empurrar ou puxar de um modo abrupto ou descontínuo ou fornecer de outro modo retroinformação tátil a um usuário, quando o terceiro delimitador 76'" entra em contato com o pino 75, de- vido à interrupção na topografia superficial da superfície de rosca 74 no delimitador 76"'. A ação do terceiro delimitador 76"' que passa sobre o pino 75 pode proporcionar a um usuário girando a haste 70 uma indicação de que a terceira altura de formação do grampo descontínua D3 (vide FIG. 11C) foi alcançada já que o pino 75 é agora recebido na terceira porção de contato 74b'". A rotação contínua da haste 70 durante o período de contato, que conforme acima mencionado, pode ser de aproximadamente 60 graus, pode não ajustar a terceira altura de formação do grampo D3. Consequentemente, o usuário não precisa necessariamente se concentrar na exata posição rotacional na qual a haste de ajuste da bigorna 70 está situada, já que o usuário sabe que a terceira altura de formação do grampo D3 não será alterada até que a haste 70 seja girada adicionalmente para colocar um batente 78 em contato com o pino 75, evitando assim movimento adicional do pino 75 em relação à superfície de rosca 74, em direção do batente 78. O ba-tente 78 pode ser uma parede formada na extremidade da terceira porção do delimitador 74b'". Além disso, o usuário pode girar a haste de ajuste da bigorna 70 para trás e para frente de modo que o pino 75 seja movido relativamente ao longo da terceira porção de contato 74b'", entre o terceiro delimitador 76'" e o batente 78. Conforme o batente e o delimitador 76"' se projetam da superfície da terceira porção de contato 74b", o usuário, através da haste de ajuste da bigorna 70, pode sentir quando o pino 75 entra em contato com o terceiro delimitador 76'" ou batente 78 nas respectivas extremidades da terceira porção de contato 74b'", desta forma, proporcionando confiança ao usuário de que a terceira altura de formação do grampo D3 foi atingida.
[00061] Em várias modalidades, com referência às FIGS. 9 e 15, por exemplo, a superfície de rosca 74 pode ser fechada sobre a porção inclinada 74a e aberta sobre as porções de contato 74b', 74b", 74b'". Em outras palavras, a porção inclinada da superfície de rosca pode incluir paredes proximais e distais enquanto que as porções de contato da superfície de rosca podem incluir apenas paredes proximais. Em uso, o pino 75 pode ser tracionado contra as porções de contato devido ao tecido que está sendo fixado entre a bigorna 50 e a cabeça de grampeamento 30 quando a bigorna 50 está em uma altura de formação de grampo adequada a partir da cabeça 30, conforme discutido acima (vide FIGS. 11Aa 11C).
[00062] Embora pelo menos uma modalidade descrita acima mostre os delimitadores 76', 76" e/ou 76'" sendo formados como ressaltos ou protuberâncias na superfície da rosca 74, os delimitadores podem também assumir a forma de indentações na superfície da rosca. Além disso, os delimitadores também podem estar em uma peça separada da haste de ajuste 70 de modo que eles possam ser fixados a isso. Em todo caso, os delimitadores podem fornecer retroinformação tátil ao usuário quando o usuário gira a haste 70. Além disso, embora um delimitador seja mostrado separando a porção inclinada 74a da primeira porção de contato 74b', e assim por diante, a superfície de rosca pode não incluir uma porção de contato ou porções de contato. Nessas modalidades, a superfície de rosca pode compreender múltiplas porções inclinadas separadas, em intervalos desejados, por pelo me-nos um delimitador. Consequentemente, um usuário pode ser informado, através de retroinformação tátil, quando uma altura de formação de grampo adequada entre a bigorna 50 e o cartucho de grampo 33 (vide, por exemplo, a FIG. 11 A) foi obtida.
[00063] Em adição a retroinformação tátil, o grampeador cirúrgico 1 pode incluir sinais de referência visual para fornecer ao usuário uma indicação de quando a(s) altura(s) de formação de grampo supracita- da(s) foi/foram atingida(s). Por exemplo, agora com referência às FIGS. 12 a 13, a haste de ajuste da bigorna 70 pode incluir um sinal de referência 85 estampado ou formado na superfície da haste que, atra vés de uma marcação 86 no corpo 10, fornece uma indicação de quando uma altura de formação de grampo descontínua foi atingida, como D1, D2, D3 (vide FIGS. 11A a 110). Em pelo menos uma modalidade, as respectivas alturas de formação de grampo podem ser 2,5 mm, 1,8 mm e 1,0 mm, e o sinal de referência 85 pode indicar o mesmo. Em todo caso, a incorporação de sinais de referência visuais, delimitadores e/ou porções de contato, conforme discutido acima, na haste de ajuste da bigorna 70 pode eliminar a necessidade de um mecanismo indicador de altura do grampo separado da haste.
[00064] Adicionalmente, embora pelo menos uma modalidade descrita acima tenha ilustrado a superfície da rosca 74 conforme definido por uma canaleta formada na haste de ajuste da bigorna 70, a superfície da rosca pode, em pelo menos uma modalidade, ser alternativamente definida por uma rosca que se projeta a partir da haste de ajuste da bigorna 70. Nessas modalidades, o pino 75 pode ser empregado ou outro componente de acoplamento da rosca pode ser usado para engatar a superfície da rosca, como uma forquilha projetada a partir do interior do corpo 10.
[00065] Além disso, embora a superfície da rosca 74 discutida acima seja descrita como sendo uma parte da haste de ajuste da bigorna 70, entende-se que essa superfície de rosca poderia ser alternativamente uma parte do corpo 10. Nessas modalidades, a porção de engate, como um pino ou outro componente de interconexão da rosca, poderia ser fixado de modo semelhante à haste de ajuste 70 ao invés do corpo 10. Em todo caso, a rotação da haste 70 pode fazer com que uma superfície de rosca gire em relação a uma porção de engate de modo que a haste 70 e, portanto, a bigorna 50 transladem em relação ao corpo 10 e/ou cabeça de grampeamento 30.
[00066] Em várias modalidades, conforme mencionado acima e com referência à FIG. 5, antes de a bigorna 50 estar a uma distância adequada do cartucho de grampo 33, o disparador 90 pode cooperar com a haste de ajuste 70 para evitar que o disparador 90 se mova substancialmente na direção do corpo 10 ou de outro modo faça com que os acionadores de grampo 34 e/ou elemento de corte 32 sejam acionados, evitando assim o disparo não intencional do grampeador cirúrgico 1. Em outras palavras, o acionador pode incluir uma trava. Por exemplo, em pelo menos uma modalidade e com referência à FIG. 8, a haste de atuação 70 pode compreender a primeira porção proximal 70a definindo uma primeira largura W1, e a segunda porção distai 70b definindo uma segunda largura W2. Adicionalmente, com referência à FIG. 14, o disparador 90 pode compreender a haste de travamento 95 estendendo-se a partir da alavanca 92, a haste 95 definindo uma abertura 97 que tem um tamanho S. A haste de travamento pode parecer uma forquilha com dois dentes ou um garfo. Em todo caso, o tamanho S da abertura 97 pode ser menor que a primeira largura W1 da porção proximal 70a, mas o tamanho S da abertura 97 pode ser maior que ou igual à segunda largura W2 da porção distai 70b, ou W1 > S > W2.
[00067] Agora com referência à FIG. 15, a haste de travamento 95 pode ser posicionada através de abertura no corpo 14 de modo que a haste 95 tenha por finalidade engatar tanto a porção proximal da haste 70a como a porção distai da haste 70b. Se a haste de travamento 95 estiver posicionada longitudinalmente sobre a porção proximal 70a, pode-se impedir que a alavanca do disparador 92 se movimente substancialmente em direção ao corpo 10 devido à interferência entre a haste de travamento 95 e a porção proximal da haste 70a. Em outras palavras, devido à largura da porção proximal W1 (vide FIG. 8) ser maior que a dimensão S da abertura da haste de travamento 97 (vide FIG. 14), a alavanca do disparador 92 pode ser impedida de fazer com que a faixa de acionamento 80 seja ativada, conforme descrito acima, evitando assim disparo inadvertido de grampos 31 e/ou do elemento de corte 32 (vide FIG. 3). Entretanto, se a haste de travamento 95 estiver posicionada longitudinalmente sobre a porção distai 70b, a alavanca do disparador 92 pode ser deixada mover substancialmente em direção ao corpo 10 devido a uma falta de interferência entre a haste de travamento 95 e a porção distal da haste 70b. Em outras palavras, devido à largura da porção distai W2 (vide FIG. 8) ser menor ou igual ao tamanho S da abertura da haste de travamento 97 (vide FIG. 14), pode-se deixar que a alavanca do disparador 92 se mova e faça com que a faixa de acionamento 80 seja ativada, conforme descrito acima, dis-parando assim grampos 31 e/ou o elemento de corte 32 (vide FIG. 3). Nessas modalidades, a abertura 97 pode receber a porção distal da haste 70b e permitir que a alavanca 92 se mova em direção ao corpo 10 até que a porção distai 70b atinja a extremidade da abertura 97.
[00068] Além disso, com referência à FIG. 15, a porção distal da haste 70b pode estar posicionada ao longo da haste de ajuste da bigorna 70 de modo que a porção distai 70b se correlacione com uma altura de formação de grampo adequada. Por exemplo, a porção distai 70b pode estar posicionada axialmente ao longo da haste 70 de modo que a haste de travamento 95 esteja posicionada longitudinalmente sobre a porção distai 70b quando o pino 75 é recebido em uma porção de contato, como a primeira porção de contato 74b'. Consequentemente, a haste de travamento 95 pode apenas permitir que o acionador de grampo 34 e/ou elemento de corte 32 (vide FIG. 3) seja disparado quando uma altura de formação de grampo desejada for atingida, sem a necessidade de uma alavanca ou mecanismo de bloqueio separada do disparador 90. Além disso, com referência à FIG. 14, a haste de travamento 95 pode ser unitária e integralmente formada a partir do mesmo pedaço de material como mola do acionador 91. Entretanto, em pelo menos uma modalidade, a haste de travamento 95, a mola do acionador 91, e alavanca 92 podem ser unitários e integralmente formados a partir do mesmo pedaço de material.
[00069] Em várias modalidades, e conforme mencionado acima, o grampeador cirúrgico pode ser reto ao invés de curvo, conforme descrito acima. Consequentemente, agora com referência à FIG. 16, é mostrado um grampeador cirúrgico 101. O grampeador cirúrgico 101 pode incluir um corpo 110, um cabeça de grampeamento 130, uma bigorna 150, uma haste de ajuste da bigorna 170, e um disparador 190, similar àquele descrito acima. Entretanto, a porção da haste 112 do corpo 110 pode ser reta. Além disso, a cabeça de grampeamento 130 e a bigorna 150 podem ser lineares e se projetam axialmente longe a partir do corpo 110. Deve notar-se que, referindo-se aos grampeadores cirúrgicos 1 e 101 representados nas FIGS. 1 e 16, respectivamente, pelo fato de cada cabeça de grampeamento 30, 130 poder ser removida do corpo do grampeador cirúrgico 10, 110 como discutido acima, as cabeças de grampeamento 30,130 e as bigornas 50,150 podem ser intercambiáveis umas com as outras, por exemplo. Além disso, outras configurações de cabeças de grampeamento e bigornas podem ser empregadas em adição às cabeças acima descritas 30, 130 e bigornas 50, 150.
[00070] Também, agora com referência à FIG. 17, a haste de ajuste da bigorna 170 e o trocarte 173 podem ser unitários e integralmente formados a partir do mesmo pedaço de material. Desse modo, a porção distal da haste 170b pode se projetar da porção proximal 170a e estar em posição limítrofe ao trocarte 173. Adicionalmente, com referência à FIG. 18, é mostrada uma barra de acionamento 180. A barra de acionamento pode permitir o movimento do disparador 190 (vide FIG. 16) para ativar a barra de acionamento 180 em direção à cabeça de grampeamento 130 para ejetar grampos e/ou ativar um elemento de corte (não mostrado). Brevemente, a barra de acionamento pode ser alongada e tem geralmente formato tubular e inclui superfícies de acionamento proximais 181 e superfícies de acionamento distais 182. Com referência às FIGS. 16 e 18, as superfícies de acionamento proximais 181 podem ser configuradas para receber movimentos de acionamento do disparador 190 e as superfícies de acionamento distais 182 podem ser configuradas para engatar acionadores de grampos e/ou um elemento de corte (não mostrado) dento da cabeça de grampeamento 130, como descrito acima. Além disso, barra de acionamento 180 também pode incluir uma passagem 187 adaptada para receber uma haste de ajuste da bigorna 170 (vide FIG. 17) através da mesma. Em pelo menos uma modalidade, o grampeador 101 pode não incluir um elemento de corte e pode funcionar principal mente para grampear ou vedar, mas não realiza transecção de tecido.
[00071] Deve ser entendido que o grampeador reto 101 e o grampeador curvo 1, discutidos acima (vide FIGS. 16 e 1, respectivamente) podem conter significativamente menos componentes do que grampeadores cirúrgicos atuais similares disponíveis no mercado. Por exemplo, referindo-se ao grampeador cirúrgico reto 101, e em particular à haste de ajuste da bigorna, a combinação de um botão 179, com uma tampa de rosca ou uma superfície de rosca 174, e um trocarte 173 em um componente integral, uma haste de ajuste da bigorna 170 reduz o número de peças de um grampeador cirúrgico. A redução adicional do número de componentes pode ser obtida pela combinação de uma porção inclinada 174a com uma porção de contato 174b na superfície da rosca 174. Como discutido acima, a porção inclinada da superfície da rosca 174a pode permitir o movimento axial curso inicial da haste 170 em relação ao corpo 110, e a(s) porção(ões) de contato 174b po- de(m) estabelecer pelo menos uma altura de formação de grampo predeterminada, descontínua, entre a bigorna 150 e a cabeça de grampeamento 130. Como um todo, ignorando a bigorna e os compo- nentes da cabeça de grampeamento, o grampeador cirúrgico 101 pode incluir apenas sete componentes em comparação aos mais de trinta em dispositivos atuais. Com referência às FIGS. 16 a 18, os sete componentes podem incluir o corpo 110, o disparador 190, um pino da dobradiça 193 acoplando de forma articulada o disparador 190 ao corpo 110, uma mola do disparador 191 integralmente formada com uma haste de travamento 195, a haste de ajuste da bigorna 170, um pino da rosca (não mostrado, consulte pino da rosca 75 visto na FIG. 3, por exemplo) interconectando funcionalmente a superfície de rosca da haste 174, e a barra de acionamento 180. Adicionalmente, o número de peças pode ser reduzido ainda mais. Por exemplo, o pino da dobradiça 193 pode ser eliminado pela combinação de um detentor de dobradiça ou aba flexível, por exemplo, dentro do disparador 190 em si. Além disso, a mola 191 e a haste de travamento 195 podem também ser integralmente formadas com o disparador 190. O pino da rosca (não mostrado) também pode ser eliminado pela incorporação de uma protuberância que se estende a partir de uma superfície interna do corpo 110 de modo que a protuberância da rosca pode engatar a superfície da rosca 174. Em todo caso, os componentes supracitados do grampeador cirúrgico 101 podem proporcionar funcionalidade similar àquelas descritas acima. Esta arquitetura simplificada do grampeador que usa apenas algumas técnicas de fabricação pode ser amplamente aplicável, e deve ser adequada para um dispositivo multiuso, esterilizável, que custe significativamente menos e exija menos tempo de fabricação que os grampeadores cirúrgicos similares, atualmente disponíveis. Consequentemente, em pelo menos uma modalidade, pode ser fornecido um grampeador reutilizável, que inclui os componentes acima mencionados, menos a bigorna e peças da cabeça de grampeamento. Além disso, em pelo menos uma modalidade, a bigorna e/ou a cabeça de grampeamento, incluindo um cartucho de gram- po, pode, ainda, ser descartável.
[00072] Em pelo menos um experimento exemplificador, a diminuição supracitada do número de peças foi realizada pela comparação de cada componente a uma lista de critérios de peças para ver se aquela peça era necessária. As únicas remanescentes foram aquelas mencionadas acima e necessárias por razões de montagem, ou porque possuíam propriedades de material únicas ou que se moveram em relação a outras partes no grampeador.
[00073] Em várias modalidades, um conjunto de cabeça de grampeamento pode ser configurado para incluir um elemento de travamento de modo que durante a inserção em uma porção de um grampeador cirúrgico, os acionadores de grampos são impedidos ou há uma resistência ao disparo ou acionamento acidental dos grampos a partir de um cartucho de grampos. Em mais detalhes, agora com referência às FIGS. 19 a 20, um conjunto de cabeça de grampeamento 230 pode ser geralmente similar à cabeça de grampeamento 30 e/ou 130 descrita acima, de modo que o conjunto de cabeça de grampeamento 230 pode ser usado como um componente do grampeador cirúrgico 1 e/ou 101, por exemplo. Em outras palavras, o conjunto de cabeça de grampeamento 230 pode ser inserido na haste 12 ou 112 conforme discutido acima com relação às cabeças de grampeamento 30 e 130, respectivamente.
[00074] Desta forma, em mais detalhes, o conjunto de cabeça de grampeamento 230 pode compreender um cartucho de grampos 233 para sustentar um ou mais grampos cirúrgicos (não mostrados; entretanto, vide os grampos 31 na FIG. 7B, por exemplo), um núcleo 235 móvel em relação ao cartucho de grampos 233, pelo menos um acionador de grampos 234 estendendo-se a partir do núcleo 235, e um compartimento 239 configurado para conter ao menos parcialmente o cartucho de grampos 233 e receber de forma móvel o núcleo 235 e os acionadores de grampos 234. Conforme discutido acima, os acionado- res de grampos 234 podem interconectar e acionar os grampos do cartucho de grampos.
[00075] Com referência à FIG. 21, em pelo menos uma modalidade, os acionadores de grampos 234 e o núcleo 235 podem ser conectados e/ou formados integralmente. Por exemplo, os acionadores de grampos 234 podem ser acoplados funcionalmente ao núcleo 235, e cada um dos quais pode ser feito do mesmo material, tal como um material plástico, por exemplo. Se projetando a partir do núcleo, podem haver abas 236 que podem ser configuradas para interconectar uma faixa de acionamento 80 ou barra de acionamento 180 (vide FIGS. 4 e 18, respectivamente). Em todo caso, assim como com a cabeça de grampeamento 30, discutida acima, por exemplo, a atuação da faixa de acionamento 80 ou acionador 180 pode fazer com que o núcleo 235 e, desta forma, os acionadores de grampos 234 disparem acionando ou ejetando, assim, os grampos do cartucho de grampos 233.
[00076] Conforme mostrado na FIG. 20, em pelo menos uma modalidade, o compartimento 239 pode, adicionalmente, compreender pelo menos um elemento de retenção 237 que é configurado para defletir resilientemente e/ou flexivelmente e permitir que a cabeça de grampeamento 30 seja fixada de modo liberável à porção de haste do corpo 12 em orifícios correspondentes 15 (vide FIG. 3) ali formados, por exemplo. Cada elemento de retenção 237 pode compreender adicionalmente um botão de liberação, conforme ilustrado nas FIGS. 19 e 20, por exemplo. Consequentemente, quando inserido na porção de haste 12 do corpo do grampeador 10 (FIG. 3), o conjunto de cabeça de grampeamento 230 (FIG. 19) pode ser removido por pressionar os respectivos botões dos elementos de retenção 237, e então girar a cabeça 30 de modo que as abas 36 sejam liberadas dos entalhes formados pelas superfícies de acionamento distais 82 da faixa de aciona- mento 80, e finalmente puxar o conjunto de cabeça de grampeamento 230 para longe do corpo 10.
[00077] Conforme discutido em mais detalhes abaixo, os elementos de retenção 237 podem ser configurados para se mover de uma primeira posição para uma segunda posição quando uma força externa suficiente é aplicada ao elemento de retenção, tal como aquela fornecida pela porção de haste 12 de um grampeador cirúrgico 1 (vide FIG. 4) durante a inserção do conjunto de cabeça de grampeamento na haste. A primeira posição pode ser uma posição não-deprimida e a segunda posição pode ser uma posição deprimida na qual os elementos de retenção 237 podem ou não estar em contato com o núcleo 235. Quando os elementos de retenção 237 estão na segunda posição, os acionadores de grampos 234 podem ser impedidos de acionar ou ejetar grampos do cartucho de grampos 233 fornecendo, assim, um elemento de travamento de disparo para o conjunto de cabeça de grampeamento 230 durante a inserção do mesmo em pelo menos uma porção de um grampeador cirúrgico.
[00078] Em pelo menos uma modalidade, para fornecer capacidade de travamento adicional ao conjunto de cabeça de grampeamento 230, o núcleo 235 pode compreender adicionalmente uma reentrância 240 dimensionada e configurada para receber os elementos de retenção 237 quando os elementos de retenção 237 estão na segunda posição. Por exemplo, com referência à FIG. 21, a reentrância 240 pode ser fornecida na superfície do núcleo 235 e a reentrância 240 pode ser definida entre as duas paredes laterais 241 e 242, por exemplo. Em tais modalidades, o núcleo 235 e, subsequentemente, os acionadores de grampos 234, podem ser impedidos de se mover em relação ao compartimento 239 (vide FIG. 19) quando os elementos de retenção 237 são rebaixados na reentrância 240 devido, pelo menos em parte, à interferência física entre os elementos de retenção rebaixados 237 e as paredes laterais 241, 242, e/ou devido, pelo menos em parte, ao atrito entre os elementos de retenção rebaixados 237 e a(s) superfí- cie(s) do núcleo 235.
[00079] Conforme observado acima, em várias modalidades, os elementos de retenção 237 podem ser resilientemente defletíveis. Em outras palavras, os elementos de retenção 237 podem ser configurados para defletir resilientemente de modo que após a deflexão causada por forças externas, eles possam saltar de volta ou retornar de outro modo para suas posições originais. Em mais detalhes, os elementos de retenção 237 podem compreender, cada, um braço fixo em can- tiléver formado no compartimento 239. Em tais modalidades, com referência à FIG. 19, o elemento de retenção fixo em cantiléver pode ser curvo em torno de um eixo longitudinal "L" definido pelo compartimento 235 para se correlacionar com a curvatura de um corpo tubular 10 de um grampeador cirúrgico 1 (vide FIG. 4), por exemplo. Em outras palavras, os elementos de retenção 237 podem ser curvos ou enrolados radialmente em torno do compartimento do cartucho, conforme mostrado na FIG. 19. Alternativamente, embora não mostrado, os elementos de retenção podem ser lineares ou podem se estender em uma direção que é paralela ao eixo longitudinal L definido pelo compartimento 239.
[00080] Em pelo menos uma modalidade, os elementos de retenção 237 podem ser unitários e formados integralmente com o compartimento 239 de modo que o compartimento 239 e os elementos de retenção 237 sejam formados e/ou moldados a partir do mesmo pedaço de material. Em tais modalidades, o compartimento 239 pode ser produzido a partir de um material plástico, como náilon, policarbonato, po- liéter imida (PEI) ou poliéter éter-cetona (PEEK), por exemplo. Adicionalmente, em pelo menos uma modalidade, o núcleo pode ser produzido a partir de um material plástico, como náilon, policarbonato, polié- ter imida (PEI) ou poliéter éter-cetona (PEEK), por exemplo.
[00081] Em pelo menos uma modalidade, o funcionamento dos elementos de retenção 237 que interagem com o núcleo 235 e/ou a reentrância 240 pode ser compreendido com referência às FIGS. 22 a 24. A FIG. 22 ilustra uma porção do conjunto de cabeça de grampeamento 230 sendo inicialmente inserida na porção de haste 12 do corpo circular do grampeador 10. O corpo 10 é mostrado em linhas tracejadas para ilustrar melhor a porção do conjunto de cabeça de grampeamento 230 que está posicionada dentro do corpo do grampeador. Como pode ser visto, os elementos de retenção 237, que podem incluir, cada, uma superfície inclinada 243, ainda estão em uma primeira não- defletida ou primeira posição imediatamente antes da porção de haste 12 fazer contato com a superfície inclinada 243 dos elementos de retenção 237. O deslocamento adicional do conjunto de cabeça de grampeamento na direção proximal "PD" pode fazer com que a porção de haste 12 entre em contato e assim comece a defletir os elementos de retenção 237 para dentro em direção ao núcleo 235. A FIG. 23 ilustra o conjunto de cabeça de grampeamento 230 sendo inserido adicionalmente no corpo circular do grampeador. Como pode ser visto, os elementos de retenção 237 estão sendo mantidos em uma posição deprimida ou segunda posição pelas paredes internas do corpo circu-lar 10. Na posição deprimida ou segunda posição, os elementos de retenção 237 podem ser recebidos dentro da reentrância 240 (vide FIG. 21) para impedir assim que o núcleo 235 se mova em uma direção distai "DD". Adicionalmente, os elementos de retenção 237 podem ser impedidos de se mover significativamente na direção distai DD pela parede lateral da reentrância 241, por exemplo. Movimentar adicionalmente o conjunto de cabeça de grampeamento na direção proximal PD (vide FIG. 22) e, então, alinhar os botões de liberação dos elementos de retenção 237 com os orifícios 15 no corpo 10 pode permitir aos elementos de retenção retornar resilientemente para uma posição não- deprimida de modo que os elementos de retenção 237 não apenas segurem o conjunto de cabeça de grampeamento 230 no corpo do grampeador circular 10, mas também liberem a reentrância 240 e/ou as paredes laterais 241, 242 para permitir ao núcleo 235 e aos acionadores de grampos 234 serem ativados e acionarem os grampos do cartucho de grampos 233 (vide FIG. 19). Por exemplo, a FIG. 24 ilustra o conjunto de cabeça de grampeamento 230 totalmente inserido no corpo do grampeador circular 10 com os elementos de retenção 237 em tal posição não-deprimida e localizados ao menos parcialmente no interior de orifícios 15. Adicionalmente, conforme mostrado na FIG. 24, as abas do núcleo 236 são recebidas em entalhes da faixa de aciona-mento 80 para receber movimentos de ativação a partir delas, de modo similar ao discutido acima no que diz respeito à cabeça de grampeamento 30 (vide FIG. 4), por exemplo.
[00082] Outros estilos de conjuntos de cabeça de grampeamento podem incluir vários elementos discutidos acima. Por exemplo, em pelo menos uma modalidade e com referência às FIGS. 25 e 26, um conjunto de cabeça de grampeamento 330 pode ser geralmente radialmente simétrico em torno de um eixo longitudinal "L". Entretanto, em tais modalidades, o conjunto de cabeça de grampeamento 330 pode ser similar em outros aspectos ao conjunto de cabeça de grampeamento 230 e/ou à cabeça de grampeamento 30 descrita acima, por exemplo. Por exemplo, o conjunto de cabeça de grampeamento 330 pode compreender um cartucho de grampos 333 para sustentar um ou mais grampos cirúrgicos, um núcleo 335 móvel em relação ao cartucho de grampos 333, pelo menos um acionador de grampos 334 es- tendendo-se a partir do núcleo 335, e um compartimento 339 configurado para conter ao menos parcialmente o cartucho de grampos 333 e receber de forma móvel o núcleo 335 e o pelo menos um acionador de grampos 334. Os acionadores de grampos 334 podem ser configurados para interconectar e acionar os grampos do cartucho de grampos 333. Adicionalmente, o compartimento pode compreender adicionalmente pelo menos um elemento de retenção 337 que é configurado para se mover de uma primeira posição para uma segunda posição quando força externa suficiente é aplicada ao elemento de retenção 337. Além disso os elementos de retenção 337 estão na segunda posição, o pelo menos um acionador de grampos pode ser impedido de acionar os grampos a partir do cartucho de grampos. Em pelo menos uma modalidade, o núcleo pode compreender adicionalmente uma re-entrância 340 dimensionada e configurada para receber os elementos de retenção 337 quando os elementos de retenção 337 estão na segunda posição. Adicionalmente, diferentemente do conjunto de cabeça de grampeamento 230, o conjunto 330 pode compreender adicionalmente o elemento de corte 332 acoplado funcionalmente ao núcleo 335. Consequentemente, quando os elementos de retenção estão em uma posição deprimida para que o núcleo 335 seja impedido de se mover em relação ao compartimento 339, o elemento de corte 332 e/ou os acionadores de grampos 334 podem ser impedidos de se mover também em relação ao compartimento 339, evitando assim o disparo acidental do elemento de corte 332 e/ou dos grampos do cartucho de grampos 333. Adicionalmente, o núcleo 335 pode incluir abas 336 que se projetam lateralmente dele para interconectar funcionalmente uma faixa de acionamento ou barra de acionamento de um grampeador cirúrgico, conforme discutido acima, com relação aos conjuntos de cabeça de grampeamento 30, 130, e/ou 230. Em ainda outras modalidades alternativas, o compartimento pode ser configurado para sustentar de maneira operável um ou mais grampos cirúrgicos. Em tais modalidades alternativas, não há cartucho de grampos separado necessário para sustentar de maneira operável os grampos cirúr- gicos. Em vez disso, o compartimento é configurado para sustentar os grampos de modo que mediante o contato com os acionadores de grampos, os grampos são direcionados para fora o compartimento.
[00083] Embora as modalidades tenham sido descritas, ficará evidente, contudo, que várias modificações, alterações e adaptações a essas modalidades podem ocorrer aos versados na técnica, a partir da obtenção de uma parte ou do todo das várias modalidades. Por exemplo, de acordo com várias modalidades, um componente único ou etapa pode ser substituído por múltiplos componentes ou etapas, e múltiplos componentes ou etapas podem ser substituídos por um componente único ou etapa, para executar uma determinada função ou funções ou realizar um determinado objetivo. Além disso, os vários componentes descritos acima podem ser produzidos a partir de uma variedade de materiais. Por exemplo, os componentes podem ser produzidos a partir de qualquer combinação de metal, plástico e/ou um mate-rial biocompatível. Além do mais, vários componentes, como o acionador, a faixa de acionamento e a faixa de ajuste da bigorna podem ser produzidos e curvados ou dobrados a partir de uma chapa metálica. Esse pedido se destina, portanto, a cobrir todas essas modificações, alterações e adaptações, sem se afastar o escopo e do espírito das concretizações.
[00084] Os dispositivos aqui descritos podem ser projetados para serem descartados após único uso, ou os mesmos podem ser projetados para serem usados múltiplas vezes. Em qualquer um dos casos, entretanto, os dispositivos podem ser recondicionados para a reutilização após pelo menos um uso. O recondicionamento pode incluir uma combinação das etapas de desmontagem do dispositivo, seguidas de limpeza ou substituição de peças específicas, e subsequente remon- tagem. Em particular, os dispositivos podem ser desmontados, e qualquer número específico de peças ou partes dos mesmos podem ser seletivamente substituídas ou removidas em qualquer combinação. Mediante a limpeza e/ou substituição de partes particulares, os dispositivos podem ser remontados para uso subsequente em uma instalação de recondicionamento, ou por uma equipe cirúrgica imediatamente antes de um procedimento cirúrgico. Os versados na técnica observarão que o recondicionamento de um dispositivo pode usar uma variedade de técnicas diferentes para desmontagem, limpeza/substituição e remontagem. O uso de tais técnicas, e o dispositivo recondicionado resultante, estão todos no escopo do presente pedido de patente.
[00085] Os dispositivos aqui descritos podem ser processados antes da cirurgia. Primeiro, um instrumento novo ou usado é obtido e, se necessário, limpo. O instrumento pode ser então esterilizado. Em uma técnica de esterilização, o instrumento é disposto em um recipiente fechado e selado, tal como um saco plástico ou de TYVEK®. O recipiente e o instrumento são, então, colocados em um campo de radiação que pode penetrar no recipiente, como radiação gama, raios X, ou elétrons de alta energia. A radiação extermina bactérias no instrumento e no recipiente. O instrumento esterilizado pode então ser armazenado em um recipiente estéril. O recipiente estéril mantém o instrumento estéril até que seja aberto na instalação médica.
[00086] Qualquer patente, pedido, ou outro material descritivo, 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, e até onde for necessária, a descrição como explicitamente aqui determinada substitui qualquer material conflitante incorporado aqui a título de referência. Qualquer material, ou porção do mesmo, que é tido como incorporado a título de referência na presente invenção, mas que entra em conflito com definições, declarações, ou outros materiais de descrição existentes aqui determinados serão aqui incorporados apenas até o ponto em que nenhum conflito surja entre o material incorporado e o material de descrição existente.
Claims (11)
1. Conjunto de cabeça de grampeamento cirúrgico (230, 330) liberável, compreendendo um compartimento (239, 339) configurado para sustentar um ou mais grampos cirúrgicos no mesmo, um núcleo (235, 335) e pelo menos um acionador de grampos (234, 334) recebido de forma móvel no compartimento (239, 339), sendo que o pelo menos um acionador de grampos (234, 334) se estende a partir do núcleo (235, 335), o compartimento (239, 339) tendo adicionalmente pelo menos um elemento de retenção (237, 337) que é configurado para fixar de maneira liberável o conjunto de cabeça de grampeamento (230, 330) a uma porção de haste (12) de um grampeador cirúrgico (1). caracterizado pelo fato de que o pelo menos um elemento de retenção (237, 337) ainda é configurado para se mover de uma primeira posição para uma segunda posição quando força externa suficiente é aplicada ao elemento de retenção (237, 337) pela porção de haste (12) do grampeador cirúrgico (1) durante inserção do conjunto de cabeça de grampeamento (230, 330) na porção de haste (12), em que o pelo menos um elemento de retenção (237, 337) é configurado ainda para se mover da segunda posição para a primeira posição quando a força externa não é mais aplicada ao elemento de retenção (237, 337) pela porção de haste (12) do grampeador cirúrgico (1) após a inserção do conjunto de cabeça de grampeamento (230, 330) na porção de haste (12), e em que quando o pelo menos um elemento de retenção (237, 337) está na segunda posição, o pelo menos um acionador de grampos (234, 334) é impedido de acionar os grampos do compartimento (239, 339), proporcionando assim um recurso de travamento de disparo durante a inserção do conjunto de cabeça de grampeamento (230, 330) na porção de haste (12).
2. Conjunto de cabeça de grampeamento cirúrgico (230, 330), de acordo com a reivindicação 1, caracterizado pelo fato de que o núcleo (235, 335) compreende, adicionalmente, uma reentrância (240, 340) dimensionada e configurada para receber o pelo menos um elemento de retenção (237, 337) quando o pelo menos um elemento de retenção (237, 337) está na segunda posição.
3. Conjunto de cabeça de grampeamento cirúrgico (230, 330), de acordo com a reivindicação 1, caracterizado pelo fato de que o elemento de retenção (237, 337) é resilientemente defletível.
4. Conjunto de cabeça de grampeamento cirúrgico (230, 330), de acordo com a reivindicação 3, caracterizado pelo fato de que o elemento de retenção (237, 337) compreende um braço fixo em cantiléver.
5. Conjunto de cabeça de grampeamento cirúrgico (230, 330), de acordo com a reivindicação 3, caracterizado pelo fato de que o braço fixo em cantiléver é curvo em torno de um eixo longitudinal definido pelo compartimento (239, 339).
6. Conjunto de cabeça de grampeamento cirúrgico (230, 330), de acordo com a reivindicação 3, caracterizado pelo fato de que o braço fixo em cantiléver se estende em uma direção que é paralela a um eixo longitudinal definido pelo compartimento (239, 339).
7. Conjunto de cabeça de grampeamento cirúrgico (230, 330), de acordo com a reivindicação 3, caracterizado pelo fato de que o elemento de retenção (237, 337) é unitário e integralmente formado com o compartimento (239, 339).
8. Conjunto de cabeça de grampeamento cirúrgico (230, 330), de acordo com a reivindicação 1, caracterizado pelo fato de que os um ou mais grampos cirúrgicos são sustentados em um cartucho de grampos (233, 333) sustentado no compartimento (239, 339).
9. Conjunto de cabeça de grampeamento cirúrgico (230, 330), de acordo com a reivindicação 1, caracterizado pelo fato de que o núcleo (235, 335) não inclui um elemento de corte acoplado funcionalmente a ele.
10. Conjunto de cabeça de grampeamento cirúrgico (330), de acordo com a reivindicação 1, caracterizado pelo fato de que compreende, ainda, um elemento de corte (332) acoplado funcionalmente ao núcleo (335).
11. Grampeador cirúrgico (1) caracterizado pelo fato de que compreende: um corpo (10) que compreende: uma porção de cabo (11); e porção de haste (12) estendendo-se a partir da porção de cabo (11); um conjunto de cabeça de grampeamento (230, 330) conforme definido em qualquer uma das reivindicações 1 a 10, acoplado de modo liberável à porção de haste (12); um sistema de acionamento para aplicar movimentos ao pelo menos um acionador de grampos (234, 334); uma bigorna sustentada de forma móvel em relação ao compartimento (239, 339) para movimento axial em direção e se afastando do compartimento (239, 339); e, um conjunto de ajuste de bigorna para ajustar seletivamente uma posição axial da bigorna em relação ao compartimento (239, 339).
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2010
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CA2810059C (en) | 2018-10-23 |
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US8794497B2 (en) | 2014-08-05 |
EP2613713A1 (en) | 2013-07-17 |
RU2013115743A (ru) | 2014-10-20 |
US8360296B2 (en) | 2013-01-29 |
EP2613713B1 (en) | 2018-07-04 |
AU2011299170A1 (en) | 2013-02-21 |
AU2011299170B2 (en) | 2014-08-21 |
JP2013537066A (ja) | 2013-09-30 |
CN103096817B (zh) | 2016-08-10 |
US20120061448A1 (en) | 2012-03-15 |
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