BR112013007613B1 - cartucho de grampos - Google Patents
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- A—HUMAN NECESSITIES
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
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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
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- A—HUMAN NECESSITIES
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- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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Abstract
CARTUCHO DE GRAMPOS. A presente invenção refere-se a um cartucho de grampos que pode compreender uma pluralidade de grampos posicionados no interior de um corpo do cartucho, em que o corpo do cartucho pode compreender um deque de contato com tecido e uma pluralidade de cristas que se estendem a partir do deque de contato com tecido. As cristas podem ser configuradas para evitar ou reduzir a possibilidade do tecido se mover em relação ao cartucho de grampos durante o uso. O cartucho de grampos pode compreender adicionalmente uma pluralidade de cavidades de grampos, em que cada cavidade de grampo pode compreender uma abertura no deque que é ao menos parcialmente circundada por uma crista. As cristas podem compreender uma altura uniforme ou uma altura que varia ao longo do comprimento das mesmas. A altura pode variar em relação a uma extremidade proximal e a uma extremidade distal do corpo do cartucho e/ou entre o centro e o lado do corpo do cartucho.
Description
[001] A presente invenção refere-se a instrumentos de grampea- mento e, em várias modalidades, a um instrumento de grampeamento cirúrgico para produzir uma ou mais fileiras de grampos.
[002] Um instrumento de grampeamento pode incluir um par de elementos de garra alongados cooperantes, sendo que cada elemento de garra pode ser adaptado para ser inserido em um paciente e posicionado em relação ao tecido que será grampeado e/ou cortado. Em várias modalidades, um dos elementos de garra pode sustentar um cartucho de grampos com pelo menos duas fileiras de grampos espaçadas lateralmente e ali contidas, e o outro elemento de garra pode sustentar uma bigorna com bolsos formadores de grampos alinhada com as fileiras de grampos no cartucho de grampos. Em geral, o ins-trumento de grampeamento pode incluir adicionalmente uma barra propulsora e uma lâmina da faca que são deslizantes em relação ao elemento de garra para ejetar sequencialmente os grampos do cartucho de grampos através de superfícies de came na barra propulsora e/ou superfícies de came sobre um trilho de cunha que é empurrado pela barra propulsora. Em pelo menos uma modalidade, as superfícies de came podem ser configuradas para ativar uma pluralidade de acio- nadores de grampo carregados pelo cartucho e associados aos grampos a fim de empurrar os grampos contra a bigorna e formar fileiras espaçadas lateralmente de grampos deformados no tecido preso entre os elementos de garra. Em pelo menos uma modalidade, a lâmina da faca pode seguir as superfícies de came e cortar o tecido ao longo de uma linha entre as fileiras de grampo. Exemplos de tais instrumentos de grampeamento são apresentados na patente US n° 7 .794.475, intitulada "SURGICAL STAPLES HAVING COMPRESSIBLE OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME", a inteira descrição da qual está aqui incorporada, a título de referência.
[003] A discussão anteriormente mencionada se destina somente a ilustrar vários aspectos da técnica relacionada no campo da invenção no momento, e não deve ser tomada como uma negação do escopo das reivindicações.
[004] Em ao menos uma forma, um cartucho de grampos pode compreender uma pluralidade de grampos e um corpo do cartucho. O corpo do cartucho pode compreender um deque de contato com o tecido, uma pluralidade de cavidades de grampos, sendo que cada cavidade de grampo compreende uma abertura no deque, e sendo que um grampo é posicionado em cada cavidade de grampo. O corpo do cartucho pode compreender adicionalmente uma pluralidade de cristas que estendem-se a partir do deque de contato com tecido, sendo que cada abertura é ao menos parcialmente circundada por uma crista.
[005] Em ao menos uma forma, um cartucho de grampos pode compreender uma pluralidade de grampos e um corpo do cartucho. O corpo do cartucho pode compreender uma porção média, uma porção lateral, um deque de contato com tecido, uma pluralidade de cavidades de grampos, sendo que um grampo é posicionado em cada cavidade de grampo, e uma pluralidade de cristas que estendem-se a partir do deque de contato com tecido, sendo que cada crista estende-se entre a porção média e a porção lateral do corpo do cartucho.
[006] Em ao menos uma forma, um cartucho de grampos pode compreender uma pluralidade de grampos e um corpo do cartucho. O corpo do cartucho pode compreender uma extremidade proximal, uma extremidade distal, um deque de contato com tecido, uma pluralidade de cavidades de grampos, sendo que um grampo é posicionado em cada cavidade de grampo, e uma pluralidade de cristas que estendem- se a partir do deque de contato com tecido, sendo que cada crista compreende uma altura que varia entre uma altura proximal e uma altura distal, e sendo que a altura proximal está mais próxima da extremidade proximal que a altura distal.
[007] A discussão anteriormente mencionada não deve ser considerada como uma contradição do escopo da reivindicação.
[008] Várias características das modalidades aqui descritas são demonstradas com particularidade nas reivindicações em anexo. As várias modalidades, porém, no que se refere tanto à organização como aos métodos de operação, juntamente com as vantagens dos mesmos, podem ser mais compreendidas de acordo com a descrição apresentada a seguir tomada em conjunto com os desenhos em anexo, conforme exposto.
[009] A figura 1 é uma vista em elevação de um instrumento de grampeamento cirúrgico.
[0010] A figura 2 é uma vista em seção transversal de um atuador de extremidade do instrumento de grampeamento cirúrgico da figura 1 ao longo da linha 2-2 na figura 1.
[0011] A figura 3 é uma vista em perspectiva e em seção transversal do atuador de extremidade da figura 1.
[0012] A figura 4 é uma vista em seção transversal do atuador de extremidade da figura 1 que ilustra os grampos ali contidos em uma configuração não disparada.
[0013] A figura 5 é um diagrama que ilustra os grampos da figura 4 em uma configuração disparada.
[0014] A figura 6 é um diagrama que ilustra o atuador de extremi- dade da figura 1 sendo usado para grampear e cortar através do tecido.
[0015] A figura 7 é uma vista em perspectiva de um cartucho de grampos de acordo com ao menos uma modalidade que compreende uma pluralidade de cristas que estendem-se a partir de um corpo do cartucho.
[0016] A figura 8 é uma vista em detalhe do cartucho de grampos da figura 7.
[0017] A figura 8A é uma vista em seção transversal do cartucho de grampos da figura 7.
[0018] A figura 9 é uma vista em detalhe que ilustra grampos posicionados no interior das cavidades de grampos definidas no cartucho de grampos da figura 7.
[0019] A figura 10 é uma vista em perspectiva parcial de um cartucho de grampos de acordo com ao menos uma modalidade alternativa que compreende uma pluralidade de cristas transversais que estendem-se a partir de um corpo do cartucho.
[0020] A figura 11 é uma vista em perspectiva parcial de um cartucho de grampos de acordo com ao menos uma modalidade alternativa que compreende uma pluralidade de cristas transversais que estendem-se a partir de um corpo do cartucho.
[0021] A figura 12 é uma vista em perspectiva parcial de um cartucho de grampos de acordo com ao menos uma modalidade alternativa que compreende uma pluralidade de cristas que circundam as extremidades proximais e distais das aberturas das cavidades de grampos definidas em um corpo do cartucho.
[0022] A figura 13 é uma vista em perspectiva parcial de um cartucho de grampos de acordo com ao menos uma modalidade alternativa que compreende uma pluralidade de cristas que circundam as extremidades proximais e distais das aberturas das cavidades de grampos definidas em um corpo do cartucho.
[0023] A figura 14 é uma vista em perspectiva parcial de um cartucho de grampos de acordo com ao menos uma modalidade alternativa que compreende uma pluralidade de cristas denteadas que estendem- se a partir de um corpo do cartucho.
[0024] A figura 15 é uma vista em perspectiva parcial de um cartucho de grampos de acordo com ao menos uma modalidade alternativa que compreende uma pluralidade de cristas denteadas que estendem- se a partir de um corpo do cartucho.
[0025] A figura 15A é uma vista em perspectiva de um dente piramidal de acordo com ao menos uma modalidade.
[0026] A figura 15B é uma vista em perspectiva de um dente frus- tocônico de acordo com ao menos uma modalidade.
[0027] A figura 15C é uma vista em perspectiva de um dente triangular de acordo com ao menos uma modalidade.
[0028] A figura 16 é uma vista em perspectiva parcial de um cartucho de grampos de acordo com ao menos uma modalidade alternativa que compreende uma pluralidade de cristas que circundam inteiramente as aberturas das cavidades de grampos definidas em um corpo do cartucho.
[0029] A figura 16A é uma vista em perspectiva parcial de um cartucho de grampos de acordo com ao menos uma modalidade alternativa que compreende uma pluralidade de cristas que circundam totalmente as aberturas das cavidades de grampos definidas em um corpo do cartucho.
[0030] A figura 17 é uma vista em perspectiva de um cartucho de grampos de acordo com ao menos uma modalidade alternativa que compreende uma pluralidade de cristas longitudinais que estendem-se a partir de um corpo do cartucho.
[0031] A figura 18 é uma vista em detalhe do cartucho de grampos da figura 17.
[0032] Os caracteres de referência correspondentes indicam as partes correspondentes através das várias vistas. As exemplificações aqui descritas ilustram várias modalidades da invenção, em uma forma, e tais exemplificações não devem ser consideradas como limitadoras do escopo da invenção em qualquer modo.
[0033] Numerosos detalhes específicos são apresentados para fornecer um completo entendimento da estrutura como um todo, função, fabricação e uso das modalidades conforme descrito no relatório descritivo e ilustrado nos desenhos em anexo. Será entendido pelos versados na técnica, entretanto, que as modalidades podem ser praticadas sem esses detalhes específicos. Em outras instâncias, operações, componentes, e elementos bem conhecidos foram descritos em detalhe de modo a não obscurecer as modalidades descritas no relatório descritivo. Os elementos versados na técnica entenderão que as modalidades descritas e ilustradas na presente invenção são exemplos não limitadores e, portanto, pode-se entender que os detalhes estruturais e funcionais específicos apresentados na presente invenção podem ser representativos e ilustrativos. Podem ser feitas variações e alterações a isso, sem se desviar do escopo das reivindicações.
[0034] A referência do início ao fim do relatório descritivo de "várias modalidades", "algumas modalidades", "uma modalidade", ou "a modalidade", ou similares, significa que um atributo, estrutura, ou característica 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 modalidade", ou similares, em lugares do início ao fim do relatório descritivo não estão necessariamente todas referindo-se à mesma modalidade. Além disso, os atributos, estruturas, ou características particulares podem ser combinados em qualquer maneira adequada em uma ou mais modalidades. 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. Além disso, deve-se considerar que para exatidão e clareza, termos espaciais como "vertical", "horizontal", "para cima" e "para baixo", por exemplo, podem ser usados na presente invenção com respeito às modalidades ilustradas. Entretanto, esses termos são usados para ajudar o leitor e não se destinam a ser limitadores e absolutos.
[0035] Voltando para a figura 1, um instrumento cirúrgico de gram- peamento e corte 10 pode incluir uma porção de cabo 12 que pode ser manipulada a fim de posicionar uma porção de implemento 14 em um local cirúrgico. Em várias modalidades, a porção de implemento 14 pode incluir um atuador de extremidade 16 fixado a uma haste alongada 18. Em várias circunstâncias, a porção de implemento 14 pode ser dimensionada e configurada para ser inserida através de uma cânula de um trocarte (não mostrado) para dentro do local cirúrgico a fim de executar um procedimento endoscópico ou laparoscópico, por exemplo. O atuador de extremidade 16 pode compreender uma mandíbula superior, ou bigorna 20 e uma mandíbula inferior 22, sendo que a bigorna 20 pode ser movida entre uma posição aberta e uma posição fechada quando o gatilho de fechamento 24 da porção de cabo 12 é movido, ou pressionado, em direção da pega de pistola 26 da porção de cabo 12. Em várias modalidades, a pressão do gatilho de fechamento 24 pode avançar um encaixe cilíndrico de fechamento externo 28 da haste alongada 18 sendo que o encaixe cilíndrico de fechamento externo 28 pode entrar em contato com a bigorna 20 e pivotar a bigorna 20 para sua posição fechada. Em determinadas circunstâncias, o cirurgião pode girar a porção de implemento 14 em seu eixo longitudinal torcendo o botão de rotação da haste 30. Em qualquer evento, quando o atuador de extremidade 16 tiver sido inserido em uma cavidade de corpo insuflada, por exemplo, o gatilho de fechamento 24 pode ser liberado, permitindo, assim, que a bigorna 20 seja aberta de maneira tracionada por uma mola (não mostrado) e posicionada em relação ao tecido intencionado. Em várias modalidades, o gatilho de fechamento 24 pode ser travado em sua condição pressionada e, em ao menos uma modalidade, a porção de cabo 12 pode compreender adicionalmente um atuador de liberação de trava 44 que pode ser pressionado para destravar o gatilho de fechamento 24. Quando a bi-gorna 20 e a mandíbula inferior 22 tiverem sido posicionadas adequadamente em relação ao tecido em um local cirúrgico, o gatilho de fechamento 24 pode ser pressionado mais uma vez a fim de fechar a bigorna 20 e comprimir o tecido contra o cartucho de grampos 42 fixado à garra inferior 22.
[0036] Quando a bigorna 20 tiver sido fechada, um gatilho de disparo 32 pode ser extraído, ou pressionado, em direção ao gatilho de fechamento 24 e à pega de pistola 26 a fim de aplicar uma força ou movimento de disparo a um de elemento de disparo e fazer avançar o elemento de disparo a partir de uma posição não disparada. Em várias modalidades, o elemento de disparo pode compreender uma haste de descarga de prendedores proximal 34 que é fixada a uma barra de disparo distal 36. Em ao menos uma de tais modalidades, a haste de descarga de prendedores 34 e/ou a barra de disparo 36 podem ser sustentadas dentro de uma estrutura 38 em uma haste 18 que pode se estender entre a porção de cabo 12 e o atuador de extremidade 16. Em resultado do movimento de disparo aplicado ao elemento de disparo, a barra de disparo 36 pode ser avançada em posição distal no interior de um canal de cartucho de grampos alongado 40 da mandíbula inferior 22 e de um cartucho de grampos 42 posicionado no interior do canal de cartucho 40. Em várias modalidades, com referência à figura 2, a barra de disparo 36 pode compreender uma porção de fixação 48 que é fixada a um feixe eletrônico 50 que pode transladar dentro do atuador de extremidade 16. O feixe eletrônico 50 pode compreender uma porção vertical 52 que pode passar através de uma fenda longitudinal e estreita da bigorna 58 estendendo-se através de uma superfície de contato com tecido 60 na bigorna 20, uma fenda vertical estreita 62 no cartucho de grampos 42, e uma fenda do canal longitudinal e estreita 64 no canal de grampos alongado 40 quando o feixe eletrônico 50 é avançado distalmente. Agora com referência às figuras 2 e 3, a fenda da bigorna 58 pode se estender para cima e para dentro da bigorna 20 e pode compreender uma extremidade que se abre em um canal longitudinal lateralmente expandido 66, dimensionado e configurado para receber um pino superior 54 que estende-se lateralmente a partir da porção vertical 52. De modo similar, a fenda do canal 64 pode se estender para baixo e para dentro do canal 40 e pode compreender uma extremidade que se abre em um canal longitudinal lateralmente expandido 68, dimensionado e configurado para receber um ou mais pés inferiores 70 que se estendem lateralmente a partir da porção vertical 52.
[0037] Em várias modalidades, além do exposto acima, o feixe eletrônico 50 pode compreender adicionalmente um ou mais pinos médios 72 que podem se estender lateralmente a partir da porção vertical 52 e que podem ser configurados para deslizar ao longo de uma superfície de topo de uma bandeja inferior 74 do cartucho de grampos 42. Em certas modalidades, os pinos médios 72 podem ser configurados para assentar o cartucho de grampos 42, ou assegurar que o cartucho de grampos 42 permaneça assentado, no canal 40. Um recesso de disparo longitudinal 75 formado no cartucho de grampos 42 acima da bandeja inferior 74 é dimensionado para permitir que os pinos médios 72 transladem através do cartucho de grampos 42. Em várias modalidades, o feixe eletrônico 50 pode compreender adicionalmente uma superfície de acionamento distal 76 que pode ser configurada para transladar através da fenda vertical 62 no cartucho de grampos 42 e conduzir um trilho de cunha 78 distalmente através do cartucho de grampos 42. Em certas modalidades, o trilho de cunha 78 pode ser integralmente formado no interior do feixe eletrônico 50 enquanto que, em outras modalidades, o trilho de cunha 78 pode residir no cartucho de grampos 42 e pode ser contatado pela superfície de acionamento 76 à medida que o feixe eletrônico 50 é avançado distalmente. A porção vertical 52 do feixe eletrônico 50 pode compreender adicionalmente uma superfície de corte 80 que estende-se ao longo de uma borda distal acima da superfície de acionamento distal 76 e abaixo do pino superior 54 que separa o tecido fixado 46 à medida que o tecido 46 está sendo grampeado. Agora com referência à figura 4, o trilho de cunha 78 pode ser configurado para acoplar um ou mais acionadores de grampos 82 e conduzir os acionadores de grampos 82 para cima em direção à bigorna 20. Em várias modalidades, os grampos, como os grampos 83, por exemplo, podem ser assentados sobre e/ou de outro modo sustentados pelos acionadores de grampos 82 de modo que, à medida que os acionadores de grampos 82 são levantados para cima, os grampos 83 podem também ser levantados para cima. Em ao menos uma de tais modalidades, os grampos 83 também podem ser ao menos parcialmente posicionados no interior das cavidades, ou bolsos, de grampo 84 em um corpo do cartucho de grampos 85 do cartucho de grampos 42, sendo que, à medida que os grampos 83 são levantados para cima, os grampos 83 podem entrar em contato com a bigorna 20 e podem ser ejetados a partir das cavidades de grampos 84. Em ao menos uma modalidade, novamente com referência à figura 4, a bandeja inferior 74 pode ser fixada ao corpo do cartucho 85 a fim de prender os acionadores de grampo 82 e os grampos 83 dentro do cartucho de grampos 42 até que os grampos 83 sejam instalados dali, conforme descrito acima.
[0038] Em uso, agora com referência às figuras 5 e 6, a bigorna 20 pode ser posicionada em um lado do tecido 46 e a garra inferior 22 pode ser posicionada no lado oposto do tecido 46, de modo que quando a bigorna 20 for fechada sobre o tecido, a superfície de contato com tecido 60 da bigorna 20 e o deque de contato com tecido 90 do cartucho de grampos 42 possam comprimir o tecido 46 entre uma espessura não comprimida 91 e uma espessura comprimida 92. A fim de grampear e cortar através do tecido 46, conforme descrito acima, o trilho de cunha 78 pode ser avançado distalmente no interior do cartucho de grampos 42, a fim de levantar os acionadores de grampos 82 em direção à bigorna 20 e deformar os grampos 83. Em várias modalidades, cada acionador de grampos 82 pode compreender uma ou mais fendas ali definidas que podem ser configuradas para receber e segurar de modo liberável as bases 87 dos grampos 83 em posição. Em ao menos uma de tais modalidades, cada grampo 83 pode compreender uma ou mais pernas dos grampos 88 estendendo-se a partir da base 87, sendo que as pernas dos grampos 88 podem se estender para cima e para dentro das cavidades de grampos 84. Em várias modalidades, as pontas das pernas dos grampos 88 podem ser rebaixadas no que diz respeito ao deque, ou superfície de contato com tecido, 90 do corpo do cartucho 85 quando os grampos 83 estão em sua posição não disparada. À medida que os grampos 83 estão sendo levantados para cima pelos acionadores 82, as pontas das pernas dos grampos 88 podem emergir das cavidades de grampos 84, penetrar no tecido 46 e entrar em contato com a bigorna que forma os bolsos 89 posicionada em frente às cavidades de grampos 84. A bigorna que forma os bolsos 89 pode ser configurada para deformar os grampos 83 para qualquer formato adequado, como o formato em B representado na figura 5, por exemplo. À medida que os grampos 83 são instalados, agora com referência à figura 6, o gume cortante 80 pode cortar através do tecido 46 em porções grampeadas 94.
[0039] Conforme descrito acima, os elementos de garra de um a- tuador de extremidade podem ser configurados para aplicar uma pressão, ou força, compressiva ao tecido que está sendo grampeado. Em várias circunstâncias, entretanto, o tecido pode ser escorregadio, por exemplo, e pelo menos uma porção de tecido pode deslizar em relação aos elementos de garra. Em determinadas circunstâncias, o tecido pode deslizar para fora da extremidade distal do atuador de extremidade em uma direção longitudinal e/ou deslizar para fora dos lados do atuador de extremidade em uma direção que é transversal à direção longitudinal. Em algumas circunstâncias, porções do tecido podem escorrer para fora da extremidade distal do atuador de extremidade e/ou dos lados do atuador de extremidade quando o tecido é comprimido. Em várias modalidades apresentadas na presente invenção, um cartucho de grampos pode compreender uma ou mais características de re-tenção de tecido que podem ser configuradas para evitar que ou ao menos reduzir a possibilidade de o tecido posicionado no interior do atuador de extremidade se mover em relação ao atuador de extremidade.
[0040] Em várias modalidades, agora com referência às figuras 7 e 8, um cartucho de grampos, como um cartucho de grampos 142, por exemplo, pode compreender um corpo do cartucho 185 e uma pluralidade de grampos, como os grampos 187 (figura 9), por exemplo, posicionados no interior do corpo do cartucho 185. O corpo do cartucho 185 pode compreender uma extremidade proximal 141 e uma extremidade distal 143, sendo que a extremidade proximal 141 pode ser con- figurada para ser inserida em uma extremidade proximal de um canal de cartucho de grampos e uma extremidade distal 143 pode ser configurada para ser inserida em uma extremidade distal do canal de cartucho de grampos. Em ao menos uma modalidade, o corpo do cartucho 185 pode compreender uma pluralidade de cavidades de grampos 184 que podem, cada uma, ser configuradas para receber um grampo 187 ali. Em certas modalidades alternativas, embora não ilustrado, uma cavidade de grampo pode compreender mais de um grampo ali posicionado. Em qualquer evento, as cavidades de grampos 184 podem ser dispostas em uma pluralidade de fileiras no interior do corpo do cartucho 185. Mais particularmente, em ao menos uma modalidade, as cavidades de grampos 184 podem ser dispostas em três fileiras de grampos, por exemplo, em um primeiro lado 145 do corpo do cartucho 185 e três fileiras de grampos, por exemplo, em um segundo lado 147 do corpo do cartucho 185. Em ao menos uma de tais modalidades, o primeiro lado 145 e o segundo lado 147 do corpo do cartucho 185 podem ser separados por uma fenda de facas 162 que pode ser configurada para receber ali um elemento de corte de maneira deslizante. Em várias outras modalidades, um cartucho pode compreender qualquer outro número adequado de fileiras de grampos, como duas fileiras de grampos ou quatro fileiras de grampos, por exemplo, em cada lado da fenda de facas 162. Com referência à figura 9, em várias modalidades, o cartucho de grampos 142 pode compreender adicionalmente uma pluralidade de acionadores de grampos 182 configurados para sustentar os grampos 187 e/ou ejetar os grampos 187 das cavidades de grampos 184. Em certas modalidades, cada cavidade de grampo 184 pode compreender uma extremidade aberta, ou abertura, 110 no deque 190 do corpo do cartucho 185 através da qual os grampos 187 podem ser ejetados.
[0041] Em várias modalidades, com referência primariamente à figura 8, as cavidades de grampos 184 podem ser dispostas de modo a ficarem desalinhadas longitudinalmente uma em relação à outra. Por exemplo, as cavidades de grampos 184 no primeiro lado 145 do corpo do cartucho 185, por exemplo, podem ser dispostas em uma fileira mais interna das cavidades de grampos 184, uma fileira intermediária de cavidades de grampos 184 e uma fileira mais externa de cavidades de grampos 184, sendo que as cavidades de grampos 184 em uma fileira pode não estar alinhada transversalmente com as cavidades de grampos 184 em uma ou ambas das outras fileiras. Em ao menos uma modalidade, cada cavidade de grampo 184 pode compreender uma extremidade proximal 111 e uma extremidade distal 112, sendo que a extremidade proximal 111 de cada cavidade de grampo 184 pode ser posicionada mais próxima à extremidade proximal 141 do corpo do cartucho 185 do que a extremidade distal 112. De modo semelhante, a extremidade distal 112 de cada cavidade 184 pode ser posicionada mais próxima à extremidade distal 143 do corpo do cartucho 185 do que a extremidade proximal 111. Em várias modalidades, a fileira mais interna de cavidades de grampos 184 pode ser posicionada de modo que as extremidades distais 112 das cavidades de grampos 184 no interior da fileira mais interna sejam posicionadas distalmente no que diz respeito às extremidades distais 112 das cavidades de grampos 184 na fileira intermediária de cavidades de grampos 184. De modo similar, a fileira mais externa de cavidades de grampos 184 pode ser posicionada de modo que as extremidades distais 112 das cavidades de grampos 184 no interior da fileira mais externa sejam posicionadas dis- talmente no que diz respeito às extremidades distais 112 das cavidades de grampos na fileira intermediária de cavidades de grampos 184. Por exemplo, a cavidade de grampo mais distal 184 na fileira mais interna pode ser posicionada distalmente no que diz respeito à cavidade de grampo mais distal 184 na fileira intermediária e, de modo similar, a cavidade de grampo mais distal 184 na fileira mais externa pode ser posicionada distalmente no que diz respeito à cavidade de grampo mais distal 184 na fileira intermediária. Em certas modalidades, as cavidades de grampos 184 da fileira mais interna e as cavidades de grampos 184 da fileira mais externa podem ser alinhadas transversalmente uma com a outra de modo que, um, as extremidades distais 112 das cavidades de grampos mais internas 184 são alinhadas com as extremidades distais 112 das cavidades de grampos 184 e, dois, as extremidades proximais 111 das cavidades de grampos mais internas 184 são alinhadas com as extremidades proximais 111 das cavidades de grampos mais externas 184. Em várias modalidades, cada cavidade de grampo 184, e suas aberturas 110, podem ter a mesma, ou ao menos aproximadamente a mesma, configuração e, em ao menos uma modalidade, as cavidades de grampos 184 podem ser espaçadas equidistantemente, ou ao menos substancialmente equidistantemente, uma em relação à outra em uma fileira de grampos.
[0042] Em várias modalidades, novamente com referência às figuras 7 e 8, o corpo do cartucho 185 do cartucho de grampos 142 pode compreender adicionalmente uma ou mais cristas, como as cristas 113, 114 e 115, por exemplo, que podem ser configuradas para entrar em contato e comprimir os tecidos intencionados. Mais particularmente, agora com referência à figura 8A, a bigorna 120 de um atuador de extremidade pode ser fechada a fim de comprimir o tecido T contra o cartucho de grampos 142 sendo que, em tais circunstâncias, o deque de contato com tecido 190 e as cristas 113, 114 e 115 que se estendem a partir dali podem acoplar ao tecido. À medida que a bigorna 120 é fechada, em determinadas circunstâncias, a bigorna 120 pode empurrar o tecido em direção ao cartucho de grampos 142, de modo que o tecido entra em contato primeiro com as cristas 113, 114 e 115 e, então, entra em contato com o deque de cartucho 190. Em outras cir- cunstâncias, o cartucho de grampos 142 pode ser posicionado contra o tecido de modo que as cristas 113, 114 e 115 entrem em contato com o tecido antes de o tecido ser contatado pelo deque de cartucho 190. Em qualquer evento, as cristas 113, 114 e 115, quando em contato com o tecido, podem evitar, ou ao menos limitar, o movimento relativo entre o tecido e o cartucho de grampos 142. Em certas modalidades, as cristas 113, 114 e 115 podem se estender para cima a partir de um deque de cartucho plano, ou ao menos substancialmente plano, 190 e podem definir um ou mais bolsos ou canais, por exemplo, que podem ser configurados para receber uma porção de tecido neles e, como resultado, inibir o movimento relativo do tecido na direção longi-tudinal e/ou na direção transversal do atuador de extremidade, especi-ficamente quando o tecido é ao menos parcialmente comprimido entre a bigorna 120 e as cristas 113, 114 e 115. Em várias modalidades, à medida que as cristas 113, 114 e 115 se estendem acima do deque de cartucho 190, o tecido posicionado de maneira intermediária à bigorna 120 e às cristas 113, 114 e 115 pode ser comprimido antes de o tecido posicionado de maneira intermediária à bigorna 120 e ao deque de cartucho 190 ser comprimido. Em algumas de tais circunstâncias, como resultado, o tecido posicionado entre a bigorna 120 e as cristas 113, 114 e 115 pode ser pré-comprimido, isto é, ao menos parcialmente comprimido antes de outras porções do tecido posicionadas entre a bigorna 120 e o deque de cartucho 190 serem comprimidas. Devido a essa pré-compressão, em várias circunstâncias, porções do tecido podem ser controladas ou impedidas de escorregarem para fora do atua- dor de extremidade antes que o tecido seja totalmente comprimido conforme descrito em mais detalhes abaixo.
[0043] Em várias modalidades, novamente com referência às figuras 7 e 8, as cristas 113 que se estendem a partir do deque de cartucho 190 podem se estender ao redor das extremidades proximais 111 das aberturas das cavidades de grampos 110. De modo similar, as cristas 114 que se estendem a partir do deque de cartucho 190 podem se estender ao redor das extremidades distais 112 das aberturas das cavidades de grampos 110. Essas cristas proximais 113 e cristas distais 114, em várias modalidades, podem ser configuradas para acoplar o tecido posicionado acima e/ou ao redor das cavidades de grampos 184 e manter essas porções de tecido em posição à medida que o tecido está sendo comprimido e/ou grampeado. Dito de outra maneira, manter o tecido posicionado acima e/ou ao redor das cavidades de grampos 184 pode fornecer controle localizado sobre as porções do tecido que serão grampeadas e, como resultado, evitar, ou ao menos limitar, o movimento relativo entre essas porções de tecido e o cartu-cho de grampos 142. Em várias modalidades, as cristas 113 e 114 podem ser posicionadas ao redor das aberturas 110 de todas as cavidades de grampos 184 ou apenas algumas das cavidades de grampos 184. Em ao menos uma modalidade, um corpo do cartucho pode compreender as cristas 113 e 114 circundar apenas as cavidades de grampos 184 nas fileiras mais externas do primeiro e do segundo lado 145 e 147. Em tais modalidades, as cristas que circundam as fileiras mais externas das cavidades de grampos 184 podem ser suficientes para bloquear o movimento lateral do tecido no interior do atuador de extremidade. Em certas modalidades, um corpo do cartucho pode apenas compreender as cristas proximais 113 que circundam as extremidades proximais 111 das cavidades de grampos mais proximais 184 e/ou as cristas distais 114 que circundam as extremidades distais 112 das cavidades de grampos mais distais 184. Em tais modalidades, as cristas que circundam as cavidades de grampos mais proximais e mais distais 184 podem ser suficientes para bloquear o movimento longitudinal do tecido no interior do atuador de extremidade.
[0044] Em várias modalidades, além do exposto acima, cada crista proximal 113 pode compreender um perfil arqueado ou curvo, por exemplo, que circunda uma extremidade proximal 111 de uma abertura 110. O perfil arqueado de cada crista proximal 113 pode ser definido por um raio de curvatura ou por mais que um raio de curvatura. De modo similar, cada crista distal 114 pode compreender um perfil arqueado ou curvo, por exemplo, que circunda uma extremidade distal 112 de uma abertura 110. O perfil arqueado de cada crista distal 114 pode ser definido por um raio de curvatura ou por mais que um raio de curvatura. Em certas modalidades, além do exposto acima, cada crista 113 e 114 pode formar um bolso que pode receber uma porção de tecido que está sendo comprimido e evita que aquela porção de tecido se mova longitudinalmente e/ou transversalmente em relação ao car-tucho de grampos 142. Em várias modalidades, o cartucho de grampos 142 pode compreender adicionalmente cristas intermediárias 115 que podem se estender entre e/ou conectar as cristas adjacentes 113 e 114 em fileiras adjacentes de cavidades de grampos 184. Em ao menos uma de tais modalidades, uma ou mais cristas 113, 114 e 115 podem formar cooperacionalmente uma crista ondulante que estende- se através do primeiro lado 145 ou do segundo lado 147 do corpo do cartucho 185 sendo que, em ao menos uma modalidade, a crista ondulante pode estender-se entre uma porção central e uma porção lateral do corpo do cartucho 142. Em várias modalidades, cada crista ondulante pode compreender uma pluralidade de porções ondulares que se enrolam ao redor das extremidades distais e proximais das cavidades de grampos 184, por exemplo. Em várias modalidades, cada crista 113, 114 e 115 pode compreender uma altura definida a partir do deque de cartucho 190 sendo que, em certas modalidades, a altura de cada crista 113, 114 e 115 pode ser uniforme, ou ao menos substancialmente uniforme, através do comprimento das mesmas. Em ao me-nos uma modalidade, cada crista 113, 114 e 115 pode ter a mesma, ou ao menos substancialmente a mesma, altura.
[0045] Em várias modalidades, conforme descrito acima, as cavidades de grampos definidas em um corpo do cartucho de grampos podem compreender um grampo ali posicionado sendo que a inteireza do grampo pode ser posicionada abaixo da superfície de topo, ou da superfície de contato com tecido, do deque de cartucho quando o grampo está em sua posição não disparada. Em certas outras modalidades, ao menos uma porção do grampo, como as pontas das pernas dos grampos, por exemplo, pode se estender acima da superfície de topo, ou da superfície de contato com tecido, do deque de cartucho quando os grampos estão em sua posição não disparada. Em algumas modalidades, as pontas dos grampos podem se projetar do deque e podem esbarrar no tecido à medida que o cartucho de grampos é inserido em um lugar cirúrgico. Em ao menos uma modalidade, agora com referência à figura 9, as cristas 113 e 114, por exemplo, que estendem-se acima do deque de cartucho de contato com tecido 190, podem ao menos parcialmente circundar e proteger as pernas dos grampos 183 dos grampos 187 quando eles se estendem acima do deque de cartucho 190 em sua posição não disparada. Embora as cristas 113 e 114 podem não se estender totalmente ao redor de cada abertura 110, em várias modalidades, a crista proximal 113 pode suficientemente circundar uma das pontas das pernas dos grampos e a crista distal 114 pode suficientemente circundar a outra ponta das pernas dos grampos de modo que as pontas das pernas dos grampos não entram em contato com o tecido antes de serem comprimidas contra o cartucho de grampos 142 e/ou de os grampos 187 serem ejetados do cartucho de grampos 142. Em ao menos uma modalidade, as pontas das pernas dos grampos podem ser posicionadas abaixo das superfícies de topo 116 das cristas 113 e 114. Em certas modalidades, as pontas das pernas dos grampos podem estar situadas em um plano comum com as superfícies de topo 116 das cristas 113 e 114. Em várias modalidades, como resultado da proteção fornecida pelas cristas 113 e 114, por exemplo, grampos que têm uma altura de grampo mais alta podem ser usados sem as pontas dos grampos se projetando a partir do cartucho de grampos 142 em sua posição não disparada. Em certas modalidades, novamente com referência à figura 9, as cristas 113 e 114 podem se estender ou aumentar o comprimento no qual as pernas dos grampos 183 dos grampos 187 podem ser controladas e/ou sustentadas. Em ao menos uma de tais modalidades, cada crista 113 e 114 pode se estender ou aumentar o comprimento no qual as pernas dos grampos 183 são sustentadas sobre três lados dos mesmos. Tais modalidades podem evitar que, ou ao menos reduzir a possibilidade das pernas dos grampos 183 ficarem presas quando eles são inseridos através de tecido denso, como o tecido dos brônquios, por exemplo.
[0046] Em várias modalidades, novamente com referência à figura 4, o corpo do cartucho 85 pode compreender cavidades 84, uma fenda 62, e canais 86, por exemplo, ali definidos e que podem reduzir a resistência do corpo do cartucho 85. Em várias circunstâncias, especificamente quando o corpo do cartucho 85 é comprimido pela bigorna 20, por exemplo, o corpo do cartucho 85 pode defletir em resultado da carga aplicada a isso. Em ao menos uma de tais modalidades, as porções do deque de cartucho 90 que estende-se por cima dos canais 86, por exemplo, podem ser especificamente finas e podem estar especificamente sujeitas à deflexão e/ou ruptura. Em certas modalidades, novamente com referência às figuras 7 e 8, as cristas 113, 114 e/ou 115 podem ser configuradas para fortalecer e/ou enrijecer o corpo do car-tucho 185. Em ao menos uma de tais modalidades, as cristas 113 e 114, por exemplo, podem se estender ao redor das aberturas 110 para fortalecer e/ou enrijecer as porções do corpo do cartucho 185 que cir- cundam as cavidades de grampos 184. Em certas modalidades, as cristas 115, por exemplo, podem se estender transversalmente por cima dos canais 86, ou similares, definidos no interior do corpo do cartucho 185 de modo que as cristas 115 podem fortalecer e/ou enrijecer o corpo do cartucho 185 que circunda os canais 86. Em várias outras modalidades, o corpo do cartucho 185 pode compreender qualquer número e configuração de cristas adequados que se estendem a partir dali para atingir as vantagens aqui descritas.
[0047] Em várias modalidades, um corpo do cartucho de grampos 185 pode consistir em materiais plásticos, materiais metálicos e/ou materiais cerâmicos, por exemplo. Alguns de tais materiais podem compreender polímeros de cristal líquido, como Vectra, por exemplo, polímeros termoplásticos, como policarbonato, sulfonato de alquilben- zeno (ABS), Noryl, poliamidas (náilons), polietersulfonas, polieterimi- das, como Ultem, por exemplo, e/ou misturas de polímero de dois ou mais dos polímeros termoplásticos supracitados, por exemplo, sendo que, em várias modalidades, o corpo do cartucho 185 pode ser formado por um processo de modelagem por injeção, por exemplo. Alguns de tais materiais podem compreender polímeros termofixos, como po- liésteres termofixos, por exemplo, aços inoxidáveis moldados por investimento, como 17-4 PH, por exemplo, e/ou aços inoxidáveis moldados por injeção de metal, como 17-4 PH, por exemplo. Em ao menos uma de tais modalidades, as cristas 113, 114 e/ou 115 podem ser in-tegralmente formadas com o deque de cartucho 190 do corpo do cartucho 185. Em certas modalidades, as cristas 113, 114 e/ou 115 podem ser fixadas ao deque de cartucho 190 por ao menos um adesivo, por exemplo.
[0048] Em várias modalidades, agora com referência à figura 12, um cartucho de grampos, como o cartucho de grampos 342, por exemplo, pode compreender um corpo do cartucho 385, uma pluralida- de de cavidades de grampos 384 definidas no corpo do cartucho 385 e um grampo posicionado em cada uma das cavidades de grampos 384. Em certas modalidades, o corpo do cartucho 385 pode compreender adicionalmente um primeiro lado 345 que compreende um primeiro grupo de cavidades de grampos 384, um segundo lado 347 que compreende um segundo grupo de cavidades de grampos 384 e um deque de cartucho 390. Em várias modalidades, o corpo do cartucho 385 pode compreender adicionalmente uma pluralidade de cristas 315 que se estendem a partir do deque de cartucho 390 que podem ser posicionadas no meio e adjacentes às cavidades de grampos 384 em uma fileira de cavidades de grampos 384. Em ao menos uma modalidade, cada crista 315 pode compreender uma configuração em formato transversal ou formato de X, por exemplo. Em ao menos uma de tais modalidades, por exemplo, cada crista 315 pode compreender uma porção em formato de V 313 que pode ao menos parcialmente circundar uma extremidade proximal 311 de uma abertura da cavidade de grampo 310 e, além disso, uma porção em formato de V 314 que pode ao menos parcialmente circundar uma extremidade distal 312 de outra abertura da cavidade de grampo 310. Em certas modalidades, apenas as fileiras mais externas das cavidades de grampos 384 no corpo do cartucho 385 podem ser ao menos parcialmente circundadas por cristas 315. Em certas outras modalidades, agora com referência à figura 13, um corpo do cartucho de grampos 385’ pode compreender as cristas 315 que ao menos parcialmente circundam a abertura 310 de cada cavidade de grampo 384 no corpo do cartucho. Em qualquer evento, em várias modalidades, cada crista 315 pode ser configurada para comprimir e controlar o tecido posicionado contra o cartucho de grampos 342, conforme descrito acima, e/ou circundar as pernas dos grampos dos grampos que estendem-se acima do deque 390.
[0049] Em várias modalidades, agora com referência à figura 16, um cartucho de grampos, como o cartucho de grampos 542, por exemplo, pode compreender um corpo do cartucho 585, uma pluralidade de cavidades de grampos 584 definidas no corpo do cartucho 585 e um grampo posicionado em cada uma das cavidades de grampos 584. Em certas modalidades, o corpo do cartucho 585 pode compreender adicionalmente um primeiro lado 545 que compreende um primeiro grupo de cavidades de grampos 584, um segundo lado 547 que compreende um segundo grupo de cavidades de grampos 584 e um deque de cartucho 590. Em várias modalidades, o corpo do cartucho 585 pode compreender adicionalmente uma pluralidade de cristas 515 que estendem-se a partir do deque de cartucho 590, sendo que cada crista 515 pode circundar ou abranger totalmente uma abertura da cavidade de grampo 510. Como ilustrado na figura 16, algumas aberturas das cavidades 510 no corpo do cartucho 585 podem não ser circundadas por uma crista 515; enquanto que, em várias modalidades alternativas, agora com referência à figura 16A, cada abertura da cavidade 510 em um corpo do cartucho 585’ pode ser circundada por uma crista 515. Várias modalidades são contempladas onde um corpo do cartucho compreende um primeiro grupo de cavidades de grampos 584 que são circundadas por uma crista 515 e um segundo grupo de cavidades de grampos 584 que não são circundadas por uma crista 515, sendo que os grampos que têm uma altura de grampo mais alta podem ser posicionados no primeiro grupo de cavidades de grampos 584 e sendo que os grampos que têm uma altura de grampo mais curta podem ser posicionados no segundo grupo de cavidades de grampos 584 de modo que nem os grampos mais altos nem os grampos mais curtos se projetam do cartucho de grampos 542. Em ao menos uma de tais modali-dades, por exemplo, o corpo do cartucho pode ser configurado para utilizar os grampos mais altos em uma fileira de cavidades de grampos 584 e os grampos mais curtos em uma outra fileira de cavidades de grampos 584. Em certas modalidades, as cristas 515 podem circundar todas as cavidades de grampos 584 nas fileiras mais externas das cavidades de grampos 584 no corpo do cartucho, de modo que os grampos mais altos podem ser utilizados nas fileiras mais externas e os grampos mais curtos podem ser utilizados nas fileiras mais internas e/ou nas fileiras intermediárias das cavidades de grampos 584, por exemplo.
[0050] Em várias modalidades, agora com referência à figura 14, um cartucho de grampos, como o cartucho de grampos 442, por exemplo, pode compreender um corpo do cartucho 485, uma pluralidade de cavidades de grampos 484 definidas no corpo do cartucho 485 e um grampo posicionado em cada uma das cavidades de grampos 484. Em certas modalidades, o corpo do cartucho 485 pode compreender adicionalmente um primeiro lado 445 que compreende um primeiro grupo de cavidades de grampos 484, um segundo lado 447 que compreende um segundo grupo de cavidades de grampos 484 e um deque de cartucho 490. Em várias modalidades, o corpo do cartucho 445 pode compreender adicionalmente uma pluralidade de cristas 415 que estendem-se a partir do deque de cartucho 490, sendo que cada crista 415 pode compreender uma pluralidade, ou um conjunto, de dentes. Em uso, uma bigorna pode ser utilizada para posicionar o tecido contra os dentes, de modo que o tecido se conforma ao contorno dos dentes. Em várias modalidades, cada crista 415 pode compreender uma pluralidade de dentes em forma piramidal ou em forma de diamantes, por exemplo, ao menos parcialmente circundando uma ou mais aberturas das cavidades de grampos 410, sendo que em ao menos uma modalidade, os dentes em forma piramidal podem apontar para cima a partir do deque de cartucho 490. Em ao menos uma modalidade, cada dente piramidal pode compreender quatro lados triangulares que podem convergir para formar um ponto agudo. Em certas modalidades, com referência à figura 15A, os dentes piramidais das cristas 415 podem ser truncados, sendo que o topo de cada dente pode compreender uma superfície de topo plana circundado por lados inclinados. Embora dentes piramidais de quatro lados possam ser utilizados, agora com referência à figura 15C, outros formatos piramidais que têm menos que quatro lados ou mais que quatro lados, como três lados, por exemplo, são contemplados. Em várias modalidades, uma ou mais cristas 415 podem compreender uma pluralidade de dentes em formato de cone, sendo que cada dente em formato de cone pode compreender uma base circular, ou ao menos substancialmente circular, que se afunila para cima para formar um ponto agudo. Em certas modalidades, agora com referência à figura 15B, os dentes em formato de cone podem ser truncados, sendo que o topo de cada dente pode compreender uma superfície de topo plana circundada por um lado anular. Em várias modalidades, novamente com referência à figura 14, os dentes das cristas 415 podem se estender ao longo dos lados laterais das aberturas das cavidades de grampos 410 e/ou entre as aberturas adjacentes das cavidades de grampos 410. Em ao menos uma modalidade, os dentes podem se estender ao redor das extremidades proximais 411 e/ou das extremidades distais 412 das aberturas das cavidades de grampos 410. Em certas modalidades, os dentes das cristas 415 podem apenas circundar algumas das cavidades de grampos 484, ao passo que, em certas outras modalidades, com referência à figura 15, os dentes das cristas 415 podem cobrir a totalidade, ou ao menos a totalidade substancial, do deque de cartucho 490, por exemplo.
[0051] Em várias modalidades, agora com referência à figura 10, um cartucho de grampos, como o cartucho de grampos 242, por exemplo, pode compreender um corpo do cartucho 285, uma pluralidade de cavidades de grampos 284 definidas no corpo do cartucho 285 e um grampo posicionado em cada uma das cavidades de grampos 284. Em certas modalidades, o corpo do cartucho 285 pode compreender adicionalmente um primeiro lado 245 que compreende um primeiro grupo de cavidades de grampos 284, um segundo lado 247 que compreende um segundo grupo de cavidades de grampos 284 e um deque de cartucho 290. Em várias modalidades, o corpo do cartucho 285 pode compreender adicionalmente uma pluralidade de cristas, ou protuberâncias, 215 que estendem-se a partir do deque de cartucho 290. Em ao menos uma de tais modalidades, cada crista 215 pode se estender transversalmente entre uma porção central, ou média, do corpo do cartucho 245 posicionada adjacente à fenda de facas 262 e uma porção lateral do corpo do cartucho 245. Mais particularmente, com referência especificamente ao primeiro lado 245 do corpo do cartucho 285, cada crista 215 pode compreender uma primeira extremidade 213 posicionada adjacente à fenda de facas 262 e uma segunda extremidade 214 posicionada adjacente ao primeiro lado 261 do corpo do cartucho 285. De modo similar, agora com referência ao segundo lado 247 do corpo do cartucho 285, cada crista 215 pode compreender uma primeira extremidade 213 posicionada adjacente à fenda de facas 262 e uma segunda extremidade 214 posicionada adjacente ao segundo lado 263 do corpo do cartucho 285. Em ao menos uma de tais modalidades, cada crista 215 pode compreender uma altura medida a partir do deque 290, sendo que, em ao menos uma de tais modalidades, a altura de cada crista 215 pode variar ao longo do comprimento das mesmas. Em certas modalidades, a segunda extremidade 214 pode ser mais alta que a primeira extremidade 213 e a altura de cada crista 215 pode estreitar entre a segunda extremidade 214 e a primeira extremidade 213. Em certas modalidades alternativas, embora não ilustrado, a primeira extremidade 213 da crista 215 pode ser mais alta do que a segunda extremidade 214. Em ao menos uma modalidade, a altura de cada crista 215 pode estreitar linearmente, ou ao menos subs- tancialmente linearmente, entre as extremidades 213 e 214. Em ao menos uma de tais modalidades, a altura de cada crista 215 pode estreitar entre uma altura máxima na segunda extremidade 214 para até nenhuma altura na primeira extremidade 213. Em certas modalidades, a altura de cada crista 215 pode variar geometricamente entre as extremidades 213 e 214. Em certas modalidades alternativas, agora com referência à figura 11, cada crista 215’ pode compreender uma altura uniforme através do comprimento das mesmas.
[0052] Conforme descrito acima, as extremidades internas 213 das cristas 215 podem ser mais curtas que as extremidades externas 214 das cristas 215. Em várias circunstâncias, como resultado, as extremidades internas 213 podem aplicar menos pressão ao tecido fixado entre uma bigorna e o cartucho de grampos 242 em comparação com as extremidades externas 214. Em várias modalidades, conforme descrito acima, cada crista 215 pode se estender transversalmente através do deque de cartucho 290. Em certas modalidades, cada crista 215 pode se estender ao longo de um eixo da crista que corta através de um eixo longitudinal 299 do corpo do cartucho 285. Em ao menos uma de tais modalidades, os eixos da crista podem ser perpendicular, ou ao menos substancialmente perpendicular, ao eixo longitudinal 299. Em várias modalidades, as cavidades de grampos 284 podem ser dispostas em uma pluralidade de fileiras, sendo que cada fileira de cavidades de grampos 284 pode ser definida ao longo de um eixo longitudinal que pode ser paralelo, ou ao menos substancialmente paralelo, ao eixo longitudinal 299. Em ao menos uma modalidade, os eixos da crista das cristas 215 podem se estender em uma direção que corta através dos eixos longitudinais das cavidades de grampos 284. Em ao menos uma de tais modalidades, os eixos da crista das cristas 215 podem se estender em uma direção que é perpendicular, ou ao menos substancialmente perpendicular, aos eixos longitudinais das cavidades de grampos 284. Em várias modalidades, novamente com referência à figura 10, cada crista 215 pode compreender um cume 209 e, além disso, superfícies inclinadas 208 que estendem-se entre o cume 209 e o deque de cartucho 290. Em certas modalidades, cada superfície inclinada 208 pode compreender uma ou mais superfícies planas, superfícies curvadas, superfícies côncavas e/ou superfícies convexas, por exemplo. Em várias modalidades, cada crista 215 pode se estender ao longo de uma trajetória que se estende por uma ou mais aberturas 210 das cavidades de grampos 284. Em ao menos uma de tais modalidades, tais aberturas 210 podem se estender para cima através das cristas 215. À medida que as cristas 215 se estendem transversalmente pelo deque de cartucho 290, as cristas 215, similares às cristas 115, podem aumentar a resistência e/ou a dureza do corpo do cartucho 285.
[0053] Em várias modalidades, agora com referência às figuras 17 e 18, um cartucho de grampos, como o cartucho de grampos 642, por exemplo, pode compreender um corpo do cartucho 685, uma pluralidade de cavidades de grampos 684 definidas no corpo do cartucho 685 e um grampo posicionado em cada uma das cavidades de grampos 684. Em certas modalidades, o corpo do cartucho 685 pode compreender adicionalmente um primeiro lado 645 que compreende um primeiro grupo de cavidades de grampos 684, um segundo lado 647 que compreende um segundo grupo de cavidades de grampos 684 e um deque de cartucho 690. Em várias modalidades, o corpo do cartucho 685 pode compreender adicionalmente uma pluralidade de cristas, ou protuberâncias, 615 que estendem-se a partir do deque de cartucho 690. Em ao menos uma de tais modalidades, cada crista 615 pode se estender em uma direção longitudinal, sendo que cada crista 615 pode compreender uma extremidade distal 613 e uma extremidade proximal 614, sendo que a extremidade distal 613 da crista 615 pode ser posi- cionada mais próxima à extremidade distal 643 do corpo do cartucho 685, e sendo que a extremidade proximal 614 da crista 615 pode ser posicionada mais próxima à extremidade proximal 641. Em ao menos uma de tais modalidades, cada crista 615 pode compreender uma altura medida a partir do deque 690, sendo que, em ao menos uma de tais modalidades, a altura de cada crista 615 pode variar ao longo do comprimento das mesmas. Em certas modalidades, a extremidade proximal 614 pode ser mais alta que a extremidade distal 613 e a altura de cada crista 615 pode estreitar entre a extremidade proximal 614 e a extremidade distal 613. Em certas modalidades alternativas, embora não ilustrado, a extremidade distal 613 da crista 615 pode ser mais alta que a extremidade proximal 614. Em ao menos uma modalidade, a altura de cada crista 615 pode estreitar linearmente, ou ao menos substancialmente linearmente, entre as extremidades 613 e 614. Em ao menos uma de tais modalidades, a altura de cada crista 615 pode estreitar entre uma altura máxima na extremidade proximal 614 para até nenhuma altura na extremidade distal 613. Em certas modalidades, a altura de cada crista 615 pode variar geometricamente entre as extremidades 613 e 614. Em certas modalidades alternativas, cada crista 615 pode compreender uma altura uniforme através do comprimento das mesmas.
[0054] Conforme descrito acima, as extremidades distais 613 das cristas 615 podem ser mais curtas que as extremidades proximais 614 das cristas 615. Em várias circunstâncias, como resultado, as extremidades distais 613 podem aplicar menos pressão ao tecido fixado entre uma bigorna e o cartucho de grampos 642 em comparação com as extremidades proximais 614. Em várias modalidades, conforme descrito acima, cada crista 615 pode ser estender longitudinalmente através do deque de cartucho 690. Em certas modalidades, cada crista 615 pode se estender ao longo do eixo da crista que é paralelo, ou ao menos substancialmente paralelo, a um eixo longitudinal 699 do corpo do cartucho 685. Em várias modalidades, as cavidades de grampos 684 podem ser dispostas em uma pluralidade de fileiras, sendo que cada fileira de cavidades de grampos 684 pode ser definida ao longo de um eixo longitudinal que pode ser paralelo, ou ao menos substancialmente paralelo, aos eixos das cristas das cristas 615. Em ao menos uma modalidade, novamente com referência à figura 18, cada crista 615 pode compreender uma superfície rampeada que pode compreender uma ou mais superfícies planas, superfícies curvadas, superfícies côncavas, e/ou superfícies convexas, por exemplo. Em ao menos uma de tais modalidades, o fundo da superfície rampeada pode apresentar-se distalmente, o que pode facilitar o deslizamento do tecido pelo cartucho de grampos 642 quando o tecido é posicionado no atuador de extremidade. Em várias modalidades, cada crista 615 pode se estender ao longo de uma trajetória que se estende por uma ou mais aberturas 610 das cavidades de grampos 684. Em ao menos uma de tais modalidades, tais aberturas 610 podem se estender para cima através das cristas 615. À medida que as cristas 615 se estendem transversalmente pelo deque de cartucho 690, as cristas 615 podem aumentar a resistência e/ou a dureza do corpo do cartucho 685.
[0055] Em várias modalidades, além do exposto acima, um grampo cirúrgico pode consistir em titânio, como fio de titânio, por exemplo. Em certas modalidades, um grampo cirúrgico pode consistir em uma liga compreendendo titânio, alumínio, e/ou vanádio, por exemplo. Em pelo menos uma modalidade, o grampo cirúrgico pode consistir em aço inoxidável cirúrgico e/ou uma liga que compreende cobalto e cromo, por exemplo. Em todo caso, o grampo cirúrgico pode consistir em metal, como titânio, e uma superfície externa de óxido metálico, como óxido de titânio, por exemplo. Em várias modalidades, a superfície externa de óxido metálico pode ser revestida com um material. Em certas modalidades, o material de revestimento pode consistir em politetraflu- oro etileno (PTFE), como Teflon®, e/ou tetrafluoroetileno (TFE) como etileno-tetrafluoroetileno (ETFE), perfluroralcoxietileno- tetrafluoroetileno (PFA), e/ou etileno propileno fluorado (FEP), por exemplo. Determinados revestimentos podem compreender silício. Em várias modalidades, tais materiais de revestimento podem evitar, ou pelo menos inibir, oxidação adicional do metal. Em certas modalidades, os materiais de revestimento podem fornecer uma ou mais superfícies escorregadias contra as quais a bigorna, ou bolsos para grampos, podem entrar em contato com os grampos de modo a reduzir a força de atrito entre eles. Em várias circunstâncias, forças de atrito menores entre os grampos e os bolsos para grampos podem reduzir a força necessária para deformar os grampos.
[0056] Embora várias modalidades dos dispositivos tenham sido aqui descritas em conexão com determinadas modalidades apresentadas, podem ser implementadas muitas modificações e variações dessas modalidades. Também, onde os materiais são revelados para determinados componentes, outros materiais podem ser usados. Além disso, de acordo com várias modalidades, um único componente pode ser substituído por múltiplos componentes e múltiplos componentes podem ser substituídos por um único componente, para realizar uma ou mais funções determinadas. A descrição mencionada anteriormente e as reivindicações seguintes são destinadas a abranger todas essas modificações e variações.
[0057] 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, o dispositivo pode ser recondicionado para reuso após pelo menos um uso. O recondicionamento pode incluir qualquer combinação das etapas de desmontagem do dispositivo, seguido de limpeza ou substituição de peças particulares, e remontagem subsequente. Em particular, o dispositivo pode ser desmontado, em qualquer número de peças particulares ou partes do dispositivo podem ser seletivamente substituídas ou removidas, em qualquer combinação. Na limpeza e/ou substituição de partes particulares, o dispositivo pode ser remontado para uso subsequente em uma instalação de recondicionamento ou por uma equipe cirúrgica imediatamente antes de um procedimento cirúrgico. Aqueles versados na técnica apreciarão que o recondiciona- mento de um dispositivo pode utilizar uma variedade de técnicas 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.
[0058] De forma preferencial, a presente invenção descrita aqui será processada 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 uma bolsa plástica ou de TYVEK. O recipiente e o instrumento são então colocados em um campo de radiação que pode penetrar no recipiente, tal como radiação gama, raios X ou elétrons de alta energia. A radiação extermina bactérias no instrumento e no recipiente. O instrumento esterilizado pode então ser armazenado em um recipiente estéril. O recipiente estéril mantém o instrumento estéril até que seja aberto na instalação médica.
[0059] 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 descri- ção, conforme a prática conhecida ou costumeira na técnica à qual esta invenção pertence.
[0060] Qualquer patente, publicação ou outro material de descrição, no todo ou em parte, que diz-se ser incorporado à presente invenção a título de referência, é incorporado à presente invenção somente até o ponto em que os materiais incorporados não entrem em conflito com definições, declarações ou outro material de descrição existentes apresentados 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 são tidos como incorporados 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 surgirá entre o material incorporado e o material de descrição existente.
Claims (7)
1. Cartucho de grampos (142,342,542), compreendendo: uma pluralidade de grampos (187); e um corpo de cartucho (185,385,585) que compreende: um deque de contato com tecido (190,390,590); uma pluralidade de cavidades de grampos (184,384,584), em que cada cavidade de grampo compreende uma abertura (110,310,510) no deque, e em que um grampo é posicionado em cada cavidade de grampo; e uma pluralidade de cristas (113-115,315,515) que se estendem a partir do deque de contato de tecido (190,390,590), em que cada abertura (110,310,510) compreende uma extremidade proximal (111,311,511) e uma extremidade distal (112,312,512) e caracterizado pelo fato de que cada uma das extremidade distal e proximal é circundada por uma respetiva crista.
2. Cartucho de grampos, de acordo com a reivindicação 1, caracterizado pelo fato de que cada abertura (510) é inteiramente circundada por uma respectiva crista (515).
3. Cartucho de grampos, de acordo com a reivindicação 1, caracterizado pelo fato de que ainda compreende uma pluralidade de acionadores de grampos (182) configurados para ejetar os grampos (187) das cavidades de grampos (184,384,584), em que cada grampo é sustentado por um acionador de grampo, em que cada grampo compreende pelo menos uma ponta e em que as pontas dos grampos são posicionadas acima do deque de contato com tecido (190,390,590).
4. Cartucho de grampos, de acordo com a reivindicação 3, caracterizado pelo fato de que cada crista compreende uma superfície de topo (116), e em que as pontas são posicionadas abaixo das superfícies de topo.
5. Cartucho de grampos, de acordo com a reivindicação 1, caracterizado pelo fato de que a pluralidade de cavidades de grampos (184) compreende uma primeira fileira de cavidades de grampos que abriga uma primeira fileira de grampos e uma segunda fileira de cavidades de grampos que abriga uma segunda fileira de grampos, e em que as cristas (113-115) que circundam as extremidade proximal e distal das aberturas (110) da primeira fileira de cavidades de grampos são conectadas às cristas que circundam as extremidades distal e proximal das aberturas da segunda fileira de cavidades de grampos.
6. Cartucho de grampos, de acordo com a reivindicação 1, caracterizado pelo fato de que a pluralidade de cavidades de grampos (184) compreende uma fileira de cavidades de grampos que abrigam uma fileira de grampos, e em que as cristas (315) são posicionadas de maneira intermediária às cavidades de grampos na fileira de cavidades de grampos.
7. Cartucho de grampos, de acordo com a reivindicação 6, caracterizado pelo fato de que cada crista (315) compreende uma configuração em formato de X.
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US9649110B2 (en) | 2013-04-16 | 2017-05-16 | Ethicon Llc | Surgical instrument comprising a closing drive and a firing drive operated from the same rotatable output |
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US20150053737A1 (en) | 2013-08-23 | 2015-02-26 | Ethicon Endo-Surgery, Inc. | End effector detection systems for surgical instruments |
JP6007357B2 (ja) | 2013-11-18 | 2016-10-12 | 日信工業株式会社 | 電子制御装置および車両用ブレーキ液圧制御装置 |
US9839428B2 (en) | 2013-12-23 | 2017-12-12 | Ethicon Llc | Surgical cutting and stapling instruments with independent jaw control features |
US9642620B2 (en) | 2013-12-23 | 2017-05-09 | Ethicon Endo-Surgery, Llc | Surgical cutting and stapling instruments with articulatable end effectors |
US9763662B2 (en) | 2013-12-23 | 2017-09-19 | Ethicon Llc | Fastener cartridge comprising a firing member configured to directly engage and eject fasteners from the fastener cartridge |
US20150173789A1 (en) | 2013-12-23 | 2015-06-25 | Ethicon Endo-Surgery, Inc. | Surgical instruments with articulatable shaft arrangements |
US9681870B2 (en) | 2013-12-23 | 2017-06-20 | Ethicon Llc | Articulatable surgical instruments with separate and distinct closing and firing systems |
US20150173756A1 (en) | 2013-12-23 | 2015-06-25 | Ethicon Endo-Surgery, Inc. | Surgical cutting and stapling methods |
US9724092B2 (en) | 2013-12-23 | 2017-08-08 | Ethicon Llc | Modular surgical instruments |
US9884456B2 (en) | 2014-02-24 | 2018-02-06 | Ethicon Llc | Implantable layers and methods for altering one or more properties of implantable layers for use with fastening instruments |
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2010
- 2010-09-29 US US12/893,461 patent/US8733613B2/en active Active
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WO2012050798A1 (en) | 2012-04-19 |
JP5902176B2 (ja) | 2016-04-13 |
BR112013007613A2 (pt) | 2016-08-09 |
EP2621360B1 (en) | 2019-10-23 |
EP3689262C0 (en) | 2023-11-08 |
CA2811950A1 (en) | 2012-04-19 |
RU2579738C2 (ru) | 2016-04-10 |
CN103140180B (zh) | 2015-08-26 |
US10130363B2 (en) | 2018-11-20 |
US8733613B2 (en) | 2014-05-27 |
JP2013540519A (ja) | 2013-11-07 |
AU2011314209A1 (en) | 2013-02-21 |
US20190105042A1 (en) | 2019-04-11 |
US20220378429A1 (en) | 2022-12-01 |
PL3689262T3 (pl) | 2024-05-13 |
CA2811950C (en) | 2018-12-18 |
US9131940B2 (en) | 2015-09-15 |
CN103140180A (zh) | 2013-06-05 |
US20130161375A1 (en) | 2013-06-27 |
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Free format text: PRAZO DE VALIDADE: 20 (VINTE) ANOS CONTADOS A PARTIR DE 23/09/2011, OBSERVADAS AS CONDICOES LEGAIS. |