BR112016018567B1 - Atuador de extremidade - Google Patents
Atuador de extremidade Download PDFInfo
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- BR112016018567B1 BR112016018567B1 BR112016018567-6A BR112016018567A BR112016018567B1 BR 112016018567 B1 BR112016018567 B1 BR 112016018567B1 BR 112016018567 A BR112016018567 A BR 112016018567A BR 112016018567 B1 BR112016018567 B1 BR 112016018567B1
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- anvil
- end actuator
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- 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
- 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
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- 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
- A61B17/07292—Reinforcements for staple line, e.g. pledgets
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- 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
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/3209—Incision instruments
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/00336—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means with a protective sleeve, e.g. retractable or slidable
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- 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
- A61B2017/07214—Stapler heads
- A61B2017/07242—Stapler heads achieving different staple heights during the same shot, e.g. using an anvil anvil having different heights or staples of different sizes
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- 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
- A61B2017/07214—Stapler heads
- A61B2017/07257—Stapler heads characterised by its anvil
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- 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
- A61B2017/07214—Stapler heads
- A61B2017/07271—Stapler heads characterised by its cartridge
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- 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
- A61B2017/07214—Stapler heads
- A61B2017/07285—Stapler heads characterised by its cutter
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
- A61B2017/2933—Transmission of forces to jaw members camming or guiding means
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/03—Automatic limiting or abutting means, e.g. for safety
- A61B2090/037—Automatic limiting or abutting means, e.g. for safety with a frangible part, e.g. by reduced diameter
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0807—Indication means
Abstract
INSTRUMENTO CIRÚRGICO APLICÁVEL. Em várias modalidades, é revelado um atuador de extremidade sem eixo. O atuador de extremidade pode compreender um conjunto de bigorna que inclui uma superfície de formação de grampo. O atuador de extremidade pode também compreender uma canaleta de cartucho de grampos configurada para receber um cartucho de grampos na mesma. O atuador de extremidade pode incluir um sistema de fechamento configu-rado para fechar a bigorna. Em vários exemplos, o sistema de fechamento pode tam-bém formar os grampos contidos no cartucho de grampos. O atuador de extremidade pode também incluir um membro de corte configurado para cortar tecido posicionado entre a bigorna e o cartucho de grampos. Em vários exemplos, o membro de corte pode ser atuado pelo sistema de fechamento. Em outros exemplos, o atuador de ex-tremidade pode incluir um sistema independente para atuar o membro de corte. Em vários exemplos, o atuador de extremidade pode ser aplicado em um sítio cirúrgico através de um trocarte e, então, operado por um ou mais atuadores que são monta-dos no atuador de extremidade.
Description
[001] O presente pedido refere-se a instrumentos cirúrgicos e, em várias modalidades, a instrumentos cirúrgicos de grampeamento e/ou de corte e a cartuchos de grampos para uso com os mesmos.
[002] As características e vantagens desta invenção, e a maneira de obtê-las, se tornarão mais evidentes, e a invenção em si será mais bem compreendida, mediante referência à descrição das modalidades da invenção apresentada a seguir, considerada em conjunto com os desenhos em anexo, nos quais:
[003] A Figura 1 é uma vista em seção transversal de um sistema cirúrgico sem eixo incluindo um atuador de extremidade sem eixo de acordo com ao menos uma modalidade;
[004] As Figuras 2 a 6 ilustram várias vistas em seção transversal do sistema cirúrgico sem eixo da Figura 1;
[005] A Figura 7 é uma vista em seção transversal do atuador de extremidade da Figura 1 em uma condição aberta, em que o atuador de extremidade inclui uma bigorna em uma posição aberta;
[006] A Figura 8 é uma vista em seção transversal do atuador de extremidade da Figura 1 em uma condição fechada;
[007] A Figura 9 é uma vista em seção transversal do atuador de extremidade da Figura 1 que ilustra um sistema de fechamento do atuador de extremidade engatado à bigorna;
[008] A Figura 10 é uma vista em seção transversal do atuador de extremidade da Figura 1 em uma condição disparada;
[009] A Figura 11 é uma vista em seção transversal de um atua- dor de extremidade sem eixo de acordo com ao menos uma modalidade alternativa e uma pinça configurada para manipular o atuador de extremidade;
[0010] A Figura 12 é uma vista em seção transversal de um atua- dor de extremidade sem eixo de acordo com ao menos uma modalidade alternativa e um atuador configurado para manipular o atuador de extremidade;
[0011] A Figura 13 ilustra o atuador da Figura 12 destacado do atuador de extremidade da Figura 12;
[0012] A Figura 14 é uma vista em seção transversal de um atuador de extremidade de acordo com ao menos uma modalidade que compreende um cabo-guia destacável;
[0013] A Figura 15 é uma vista detalhada de uma seção frangível que conecta o cabo-guia da Figura 14 ao atuador de extremidade da Figura 14;
[0014] A Figura 16 ilustra o cabo-guia destacável da Figura 14 em um estado destacado;
[0015] A Figura 17 é uma vista em seção transversal de um atuador de extremidade sem eixo de acordo com ao menos uma modalidade alternativa incluindo um sistema de acionamento giratório;
[0016] A Figura 18 é uma vista em seção transversal de um membro de faca do atuador de extremidade da Figura 17;
[0017] A Figura 19 é uma vista em seção transversal do atuador de extremidade da Figura 17 ilustrado em uma condição disparada;
[0018] A Figura 20 é uma vista de extremidade em seção transversal do atuador de extremidade da Figura 17;
[0019] A Figura 21 é uma vista em seção transversal do atuador de extremidade da Figura 17 ilustrado com o membro de faca da Figu- ra 18 em uma posição completamente atuada;
[0020] A Figura 22 é uma vista em seção transversal de um atuador de extremidade sem eixo de acordo com ao menos uma modalidade alternativa que compreende um sistema de fechamento giratório e um sistema de disparo;
[0021] A Figura 23 é uma vista em seção transversal de um membro de faca do atuador de extremidade da Figura 22;
[0022] A Figura 24 é uma vista de extremidade em seção transversal do atuador de extremidade da Figura 22;
[0023] A Figura 25 é uma vista em seção transversal do atuador de extremidade da Figura 22 ilustrado em uma condição fechada e completamente disparada;
[0024] A Figura 26 é uma vista em seção transversal do atuador de extremidade da Figura 22 ilustrado em uma condição completamente atuada;
[0025] A Figura 27 ilustra uma modalidade de um mecanismo de fechamento e disparo integrado para fazer interface com um atuador de extremidade sem eixo;
[0026] A Figura 28 ilustra uma modalidade de um atuador de extremidade sem eixo configurado para ser engatado de modo operacional ao mecanismo de fechamento e disparo integrado da Figura 27;
[0027] A Figura 29 ilustra o mecanismo de fechamento e disparo integrado da Figura 27 fixado ao atuador de extremidade da Figura 28;
[0028] A Figura 30 ilustra o atuador de extremidade sem eixo da Figura 28 em uma condição fechada;
[0029] As Figuras 31 e 32 ilustram várias vistas em seção transversal do atuador de extremidade sem eixo da Figura 28; e
[0030] A Figura 33 ilustra o atuador de extremidade da Figura 28 em uma condição parcialmente atuada.
[0031] O Requerente do presente pedido também detém os direitos dos Pedidos de Patente U.S. identificados abaixo, os quais estão incorporados no presente documento, cada um, a título de referência em suas respectivas totalidades:
[0032] Pedido de Patente U.S. n° de série 12/894.311, intitulado SURGICAL INSTRUMENTS WITH RECONFIGURABLE SHAFT SEGMENTS; atualmente publicação de patente U.S. n° 2012/0080496;
[0033] Pedido de Patente U.S. n° de série 12/894.340, intitulado SURGICAL STAPLE CARTRIDGES SUPPORTING NON-LINEARLY ARRANGED STAPLES AND SURGICAL STAPLING INSTRUMENTS WITH COMMON STAPLE-FORMING POCKETS; atualmente publicação de patente U.S. n° 2012/0080482;
[0034] Pedido de Patente U.S. n° de série 12/894.327, intitulado JAW CLOSURE ARRANGEMENTS FOR SURGICAL INSTRUMENTS; atualmente publicação de patente U.S. n° 2012/0080499;
[0035] Pedido de Patente U.S. n° de série 12/894.351, intitulado SURGICAL CUTTING AND FASTENING INSTRUMENTS WITH SEPARATE AND DISTINCT FASTENER DEPLOYMENT AND TISSUE CUTTING SYSTEMS; atualmente publicação de patente U.S. n° 2012/0080502:
[0036] Pedido de Patente U.S. n° de série 12/894.338, intitulado IMPLANTABLE FASTENER CARTRIDGE HAVING A NON-UNIFORM ARRANGEMENT; atualmente publicação de patente U.S. n° 2012/0080481;
[0037] Pedido de Patente U.S. n° de série 12/894.369, intitulado IMPLANTABLE FASTENER CARTRIDGE COMPRISING A SUPPORT RETAINER; atualmente publicação de patente U.S. n° 2012/0080344;
[0038] Pedido de Patente U.S. n° de série 12/894.312 intitulado IMPLANTABLE FASTENER CARTRIDGE COMPRISING MULTIPLE LAYERS; atualmente publicação de patente U.S. n° 2012/0080479;
[0039] Pedido de Patente U.S. nD de série 12/894.377 intitulado SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE; atualmente patente U.S. n° 8.393.514;
[0040] Pedido de Patente U.S. nD de série 12/894.339, intitulado SURGICAL STAPLING INSTRUMENT WITH COMPACT ARTICULATION CONTROL ARRANGEMENT; atualmente publicação de patente U.S. n° 2012/0080500;
[0041] Pedido de Patente U.S. n° de série 12/894.360, intitulado SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAPLE FORMING SYSTEM; atualmente publicação de patente U.S. n° 2012/0080484;
[0042] Pedido de Patente U.S. n° de série 12/894.322, intitulado SURGICAL STAPLING INSTRUMENT WITH INTERCHANGEABLE STAPLE CARTRIDGE ARRANGEMENTS; atualmente publicação de patente U.S. n° 2012/0080501;
[0043] Pedido de Patente U.S. n° de série 12/894.350, intitulado SURGICAL STAPLE CARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES; atualmente publicação de patente U.S. n" 2012/0080478;
[0044] Pedido de Patente U.S. n“ de série 12/894.383, intitulado IMPLANTABLE FASTENER CARTRIDGE COMPRISING BIOABSORBABLE LAYERS; atualmente publicação de patente U.S. n° 2012/0080345;
[0045] Pedido de Patente U.S n° de série 12/894.389, intitulado COMPRESSIBLE FASTENER CARTRIDGE; atualmente publicação de patente U.S. n° 2012/0080335;
[0046] Pedido de Patente U.S. n° de série 12/894.345, intitulado FASTENERS SUPPORTED BY A FASTENER CARTRIDGE SUPPORT; atualmente publicação de patente U.S, n° 2012/0080483;
[0047] Pedido de Patente U.S. n° de série 12/894 306, intitulado COLLAPSIBLE FASTENER CARTRIDGE; atualmente publicação de patente U.S. n° 2012/0080332;
[0048] Pedido de Patente U.S. n° de série 12/894 318, intitulado FASTENER SYSTEM COMPRISING A PLURALITY OF CONNECTED RETENTION MATRIX ELEMENTS; atualmente publicação de patente U.S. n° 2012/0080480;
[0049] Pedido de Patente U.S. nα de série 12/894.330, intitulado FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND AN ALIGNMENT MATRIX; atualmente publicação de patente U.S. n° 2012/0080503;
[0050] Pedido de Patente U.S. n° de série 12/894.361, intitulado FASTENER SYSTEM COMPRISING A RETENTION MATRIX; atualmente patente U.S. n° 8.529.600;
[0051] Pedido de Patente U.S. n° de série 12/894.367, intitulado FASTENING INSTRUMENT FOR DEPLOYING A FASTENER SYSTEM COMPRISING A RETENTION MATRIX; atualmente publicação de patente U.S. n° 2012/0080485;
[0052] Pedido de Patente U.S. n° de série 12/894.388, intitulado FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND A COVER; atualmente patente U.S. n° 8.474.677;
[0053] Pedido de Patente U.S. nD de série 12/894.376, intitulado FASTENER SYSTEM COMPRISING A PLURALITY OF FASTENER CARTRIDGES; atualmente publicação de patente U.S. n° 2012/0080486;
[0054] Pedido de Patente U.S. n° de série 13/097.865, intitulado SURGICAL STAPLER ANVIL COMPRISING A PLURALITY OF FORMING POCKETS; atualmente publicação de patente U.S. n° 2012/0080488;
[0055] Pedido de Patente U.S. n° de série 13/097.936, intitulado TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER; atualmente publicação de patente U.S. π° 2012/0080339;
[0056] Pedido de Patente U.S. n° de série 13/097.954, intitulado STAPLE CARTRIDGE COMPRISING A VARIABLE THICKNESS COMPRESSIBLE PORTION; atualmente publicação de patente U.S. n° 2012/0080340;
[0057] Pedido de Patente U.S. n” de série 13/097.856, intitulado STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN A COMPRESSIBLE PORTION THEREOF; atualmente publicação de patente U.S. n° 2012/0080336;
[0058] Pedido de Patente U.S. n° de série 13/097.928, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING DETACHABLE PORTIONS; atualmente publicação de patente U.S. n° 2012/0080490;
[0059] Pedido de Patente U.S. n° de série 13/097.891, intitulado TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISING AN ADJUSTABLE ANVIL; atualmente publicação de patente U.S. n° 2012/0080489;
[0060] Pedido de Patente U.S. n° de série 13/097.948, intitulado STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISTAL PORTION; atualmente publicação de patente U.S. n° 2012/0083836;
[0061] Pedido de Patente U.S. n° de série 13/097.907, intitulado COMPRESSIBLE STAPLE CARTRIDGE ASSEMBLY; atualmente publicação de patente U.S. n° 2012/0080338;
[0062] Pedido de Patente U.S. n° de série 13/097.861, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING PORTIONS HAVING DIFFERENT PROPERTIES; atualmente publicação de patente U.S. n° 2012/0080337;
[0063] Pedido de Patente U.S. n° de série 13/097.869, intitulado STAPLE CARTRIDGE LOADING ASSEMBLY; atualmente publicação de patente U.S. n° 2012/0160721;
[0064] Pedido de Patente U.S. n° de série 13/097.917, intitulado COMPRESSIBLE STAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS; atualmente publicaçã' de patente U.S. n° 2012/0083834;
[0065] Pedido de Patente U.S. n° de série 13/097.873, intitulado STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTION, atualmente publicação de patente U.S. n° 2012/0083833;
[0066] Pedido de Patente U.S. n° de série 13/097.938, intitulado STAPLE CARTRIDGE COMPRISING COMPRESSIBLE DISTORTION RESISTANT COMPONENTS; atualmente publicação de patente U.S. n° 2012/0080491;
[0067] Pedido de Patente U.S. n° de série 13/097.924, intitulado STAPLE CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR; atualmente publicação de patente U.S. n° 2012/0083835;
[0068] Pedido de Patente U.S. n° de série 13/242.029, intitulado SURGICAL STAPLER WITH FLOATING ANVIL; atualmente publicação de patente U.S. n° 2012/0080493;
[0069] Pedido de Patente U.S. n° de série 13/242.066, intitulado CURVED END EFFECTOR FOR A STAPLING INSTRUMENT; atualmente publicação de patente U.S n° 2012/0080498;
[0070] Pedido de Patente U.S. n° de série 13/242.086, intitulado STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK; atualmente publicação de patente U.S. n° 2013/0075450;
[0071] Pedido de Patente U.S. n° de série 13/241.912, intitulado STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT; atualmente publicação de patente U.S. n° 2013/0075448;
[0072] Pedido de Patente U.S. nα de série 13/241.922, intitulado SURGICAL STAPLER WITH STATIONARY STAPLE DRIVERS; atu almente publicação de patente U.S. n° 2013/0075449;
[0073] Pedido de Patente U.S n° de série 13/241.637, intitulado SURGICAL INSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING MULTIPLE ACTUATION MOTIONS; atualmente publicação de patente U.S. n° 2012/0074201;
[0074] Pedido de Patente U.S. n° de série 13/241.629, intitulado SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLE END EFFECTOR; atualmente publicação de patente U.S. n° 2012/0074200;
[0075] Pedido U.S. n° de série 13/433.096, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF CAPSULES; atualmente publicação de patente U.S. nD 2012/0241496;
[0076] Pedido U.S. n° de série 13/433.103, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF LAYERS; atualmente publicação de patente U.S. n° 2012/0241498;
[0077] Pedido U.S. n° de série 13/433.098, intitulado EXPANDABLE TISSUE THICKNESS COMPENSATOR; atualmente publicação de patente U.S. n° 2012/0241491;
[0078] Pedido U.S. n° de série 13/433.102, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING A RESERVOIR; atualmente publicação de patente U.S. n° 2012/0241497;
[0079] Pedido U.S. n° de série 13/433.114, intitulado RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR; atualmente publicação de patente U.S. n° 2012/0241499;
[0080] Pedido U.S. n° de série 13/433.136 intitulado TISSUE THICKNESS COMPENSATOR COMPRISING AT LEAST ONE MEDICAMENT; atualmente publicação de patente U.S. n° 2012/0241492;
[0081] Pedido U.S. n° de série 13/433.141, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING CONTROLLED RELEASE AND EXPANSION; atualmente publicação de patente U.S n° 2012/0241493;
[0082] Pedido U.S. n° de série 13/433.144, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING FIBERS TO PRODUCE A RESILIENT LOAD; atualmente publicação de patente U.S. n° 2012/0241500;
[0083] Pedido U.S. n° de série 13/433.148, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING STRUCTURE TO PRODUCE A RESILIENT LOAD; atualmente publicação de patente U.S. n° 2012/0241501;
[0084] Pedido U.S. n° de série 13/433.155, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING RESILIENT MEMBERS; atualmente publicação de patente U.S. n° 2012/0241502;
[0085] Pedido U.S. n° de série 13/433.163, intitulado METHODS FOR FORMING TISSUE THICKNESS COMPENSATOR ARRANGEMENTS FOR SURGICAL STAPLERS; atualmente publicação de patente U.S. n° 2012/0248169;
[0086] Pedido U.S. n° de série 13/433.167, intitulado TISSUE THICKNESS COMPENSATORS; atualmente publicação de patente U.S. n° 2012/0241503;
[0087] Pedido U.S. n° de série 13/433.175, intitulado LAYERED TISSUE THICKNESS COMPENSATOR; atualmente publicação de patente U.S. n° 2012/0253298;
[0088] Pedido U.S. n° de série 13/433.179, intitulado TISSUE THICKNESS COMPENSATORS FOR CIRCULAR SURGICAL STAPLERS; atualmente publicação de patente U.S n° 2012/0241505;
[0089] Pedido U.S. n° de série 13/763.028, intitulado ADHESIVE FILM LAMINATE; atualmente publicação de patente U.S. n° 2013/0146643;
[0090] Pedido U.S. n“ de série 13/433.115, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING CAPSULES DEFINING A LOW PRESSURE ENVIRONMENT, atualmente publicação de patente U.S. n° 2013/0256372;
[0091] Pedido U.S. n° de série 13/433.118, intitulado TISSUE THICKNESS COMPENSATOR COMPRISED OF A PLURALITY OF MATERIALS; atualmente publicação de patente U.S. n° 2013/0256365;
[0092] Pedido U.S. n° de série 13/433.135, intitulado MOVABLE MEMBER FOR USE WITH A TISSUE THICKNESS COMPENSATOR; atualmente publicação de patente U.S. n° 2013/0256382;
[0093] Pedido U.S. n° de série 13/433.140, intitulado TISSUE THICKNESS COMPENSATOR AND METHOD FOR MAKING THE SAME; atualmente publicação de patente U.S. nG 2013/0256368;
[0094] Pedido U.S. n° de série 13/433.129, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF MEDICAMENTS; atualmente publicação de patente U.S. n° 2013/0256367;
[0095] Pedido U.S. n° de série 11/216.562, intitulado STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS, agora Patente U.S. n° 7.669.746;
[0096] Pedido U.S. n° de série 11/714.049, intitulado SURGICAL STAPLING DEVICE WITH ANVIL HAVING STAPLE FORMING POCKETS OF VARYING DEPTHS, agora Publicação de Patente U.S. n° 2007/0194082;
[0097] Pedido U.S. n° de série 11/711.979, intitulado SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS, agora Patente U.S. n° 8.317.070;
[0098] Pedido U.S. n° de série 11/711.975, intitulado SURGICAL STAPLING DEVICE WITH STAPLE DRIVERS OF DIFFERENT HEIGHTS agora Publicação de Patente U.S. n’ 2007/0194079;
[0099] Pedido U.S. nD de série 11/711.977, intitulado SURGICAL STAPLING DEVICE WITH STAPLE DRIVER THAT SUPPORTS MULTIPLE WIRE DIAMETER STAPLES, agora Patente U.S. n" 7.673.781;
[00100] Pedido U.S. n° de série 11/712.315, intitulado SURGICAL STAPLING DEVICE WITH MULTIPLE STACKED ACTUATOR WEDGE CAMS FOR DRIVING STAPLE DRIVERS, agora Patente U.S. n° 7.500.979;
[00101] Pedido U.S. n° de série 12/038.939, intitulado STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS, agora Patente U.S. n° 7.934.630;
[00102] Pedido U.S. n° de série 13/020.263, intitulado SURGICAL STAPLING SYSTEMS THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS, agora Publicação de Patente U.S. n° 2011/0147434;
[00103] Pedido U.S. n° de série 13/118.278, intitulado ROBOTICALLY-CONTROLLED SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS, agora Publicação de Patente U.S. n° 2011/0290851;
[00104] Pedido U.S. n° de série 13/369.629, intitulado ROBOTICALLY-CONTROLLED CABLE-BASED SURGICAL END EFFECTORS, agora Publicação de Patente U.S. n° 2012/0138660;
[00105] Pedido U.S. nα de série 12/695.359, intitulado SURGICAL STAPLING DEVICES FOR FORMING STAPLES WITH DIFFERENT FORMED HEIGHTS, atualmente patente U.S. n° 8.464 923;
[00106] Pedido U.S. n° de série 13/072.923, intitulado STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS, atualmente patente U.S. n° 8.567.656;
[00107] Pedido U.S. n° de série 13/766.325, intitulado LAYER OF MATERIAL FOR A SURGICAL END EFFECTOR; atualmente publicação de patente U.S. n° 2013/0256380;
[00108] Pedido U.S n° de série 13/763.078, intitulado ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTOR; atualmente publicação de patente U.S. n° 2013/0256383;
[00109] Pedido U.S n° de série 13/763.094, intitulado LAYER COMPRISING DEPLOYABLE ATTACHMENT MEMBERS; atualmente publicação de patente U.S. n° 2013/0256377;
[00110] Pedido U.S. n° de série 13/763.106, intitulado END EFFECTOR COMPRISING A DISTAL TISSUE ABUTMENT MEMBER; atualmente publicação de patente U.S. n° 2013/0256378;
[00111] Pedido U.S. n° de série 13/433.147, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS; atualmente publicação de patente U.S. n° 2013/0256369;
[00112] Pedido U.S. n° de série 13/763.112, intitulado SURGICAL STAPLING CARTRIDGE WITH LAYER RETENTION FEATURES; atualmente publicação de patente U.S. n° 2013/0256379;
[00113] Pedido U.S. n° de série 13/763.035, intitulado ACTUATOR FOR RELEASING A TISSUE THICKNESS COMPENSATOR FROM A FASTENER CARTRIDGE; atualmente publicação de patente U.S. n° 2013/0214030;
[00114] Pedido U.S. n° de série 13/763.042. intitulado RELEASABLE TISSUE THICKNESS COMPENSATOR AND FASTENER CARTRIDGE HAVING THE SAME; atualmente publicação de patente U.S. n° 2013/0221063:
[00115] Pedido U.S. n° de série 13/763.048, intitulado FASTENER CARTRIDGE COMPRISING A RELEASABLE TISSUE THICKNESS COMPENSATOR; atualmente publicação de patente U.S. n° 2013/0221064;
[00116] Pedido U.S. n° de série 13/763.054, intitulado FASTENER CARTRIDGE COMPRISING A CUTTING MEMBER FOR RELEASING A TISSUE THICKNESS COMPENSATOR;
[00117] Pedido U.S. n° de série 13/763.065, intitulado FASTENER CARTRIDGE COMPRISING A RELEASABLY ATTACHED TISSUE THICKNESS COMPENSATOR; atualmente publicação de patente U.S. n° 2013/0221065;
[00118] Pedido U.S, n° de série 13/763.021, intitulado STAPLE CARTRIDGE COMPRISING A RELEASABLE COVER;
[00119] Pedido U.S. n° de série 13/763.078, intitulado ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTOR; atualmente publicação de patente U.S. n° 2013/0256383;
[00120] Pedido U.S. n° de série 13/763.095, intitulado LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES; atualmente publicação de patente U.S. n° 2013/0161374;
[00121] Pedido U.S. n° de série 13/463.147, intitulado IMPLANTABLE ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES; atualmente publicação de patente U.S. n° 2013/0292398;
[00122] Pedido U.S. n° de série 13/763.192, intitulado MULTIPLE THICKNESS IMPLANTABLE LAYERS FOR SURGICAL STAPLING DEVICES; atualmente publicação de patente U.S. n° 2013/0146642;
[00123] Pedido U.S. n° de série 13/763.161, intitulado RELEASABLE LAYER OF MATERIAL AND SURGICAL END EFFECTOR HAVING THE SAME; atualmente publicação de patente U.S. n° 2013/0153641;
[00124] Pedido U.S. n° de série 13/763.177, intitulado ACTUATOR FOR RELEASING A LAYER OF MATERIAL FROM A SURGICAL END EFFECTOR, atualmente publicação de patente U.S. n° 2013/0146641;
[00125] Pedido U.S. n° de série 13/763.037, intitulado STAPLE CARTRIDGE COMPRISING A COMPRESSIBLE PORTION;
[00126] Pedido U.S n° de série 13/433.126, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING TISSUE INGROWTH FEATURES; atualmente publicação de patente U.S. n° 2013/0256366
[00127] Pedido U.S. nβ de série 13/433.132, intitulado DEVICES AND METHODS FOR ATTACHING TISSUE THICKNESS COMPENSATING MATERIALS TO SURGICAL STAPLING INSTRUMENTS; atualmente publicação de patente U.S. n° 2013/0256373.
[00128] Pedido U.S. n° de série 13/851.703, intitulado FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR INCLUDING OPENINGS THEREIN;
[00129] Pedido U.S. n° de série 13/851.676, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING A CUTTING MEMBER PATH;
[00130] Pedido U.S. n° de série 13/851.693, intitulado FASTENER CARTRIDGE ASSEMBLIES; e
[00131] Pedido U.S. n° de série 13/851.684, intitulado FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR AND A GAP SETTING ELEMENT.
[00132] Certas modalidades exemplificadoras serão agora descritas para propiciar o entendimento geral dos princípios da estrutura, da função, da fabricação e do uso dos dispositivos e métodos aqui revelados. Um ou mais exemplos dessas modalidades estão ilustrados nos desenhos em anexo. Os versados na técnica entenderão que os dispositivos e os métodos especificamente aqui descritos e ilustrados nos desenhos em anexo são modalidades exemplificadoras não limitadoras, e que o escopo das várias modalidades da presente invenção é definido somente pelas reivindicações. As características ilustradas ou descritas em relação a uma modalidade exemplificadora podem ser combinadas com as características de outras modalidades. Tais modificações e variações destinam-se a estar incluídas no escopo da presente invenção.
[00133] Ao longo de todo este relatório descritivo, os termos "várias modalidades", "algumas modalidades", "uma modalidade" ou "a modalidade", ou similares, significam que um recurso, uma estrutura ou uma característica específicos descritos em conjunto com a modalidade está incluído em pelo menos uma modalidade. Dessa forma, o aparecimento das expressões "em várias modalidades", "em algumas modali- dades", "em uma modalidade" ou "na modalidade", ou similares, em lugares ao longo de todo o relatório descritivo não estão necessariamente se referindo à mesma modalidade. Além disso, os recursos, estruturas ou características específicos(as) podem ser combinados de qualquer maneira adequada em uma ou mais modalidades. Portanto, os recursos, estruturas ou características específicos ilustrados ou descritos em conjunto com uma modalidade podem ser combinados, no todo ou em parte, com as estruturas dos recursos ou das características de uma ou mais outras modalidades, sem limitação. Tais modificações e variações destinam-se a estar incluídas no escopo da presente invenção.
[00134] Os termos "proximal" e "distai" são usados na presente invenção com referência a um clinico manipulando o instrumento cirúrgico. O termo "proximal" refere-se à porção mais próxima ao médico, e o termo "distai" refere-se à porção situada na direção oposta ao médico. Também será entendido que, por uma questão de conveniência e clareza, termos espaciais como "vertical", "horizontal", "para cima" e "para baixo" podem ser usados na presente invenção com relação aos desenhos. Entretanto, instrumentos cirúrgicos podem ser usados em muitas orientações e posições, e esses termos não se destinam a ser limitadores e/ou absolutos.
[00135] São fornecidos vários dispositivos e métodos exemplifica- dores para a realização de procedimentos cirúrgicos laparoscópicos e minimamente invasivos. Entretanto, o versado na técnica entenderá prontamente que os vários métodos e dispositivos aqui revelados podem ser usados em inúmeros procedimentos e aplicações cirúrgicos inclusive, por exemplo, aqueles em conjunto com procedimentos cirúr-gicos abertos. Com o avanço da presente Descrição Detalhada, aqueles de habilidade comum na técnica apreciarão adicionalmente que os vários instrumentos aqui revelados podem ser inseridos em um corpo de qualquer maneira, como através de um orifício natural, através de uma incisão ou perfuração formada em tecido, etc. As porções funcionais ou porções do atuador de extremidade dos instrumentos podem ser inseridas diretamente no corpo de um paciente ou podem ser inseridas por meio de um dispositivo de acesso que tenha uma canaleta de trabalho através da qual o atuador de extremidade e a haste alongada de um instrumento cirúrgico podem ser avançados.
[00136] Com referência aos desenhos nos quais numerais similares denotam componentes similares ao longo das várias vistas, a Figura 1 representa um sistema cirúrgico sem eixo 2. O sistema cirúrgico sem eixo 2 compreende um trocarte 4 e um atuador de extremidade sem eixo 6. Em uso, o trocarte 4 é inserido através de uma um ou mais aberturas formadas em um paciente, como, por exemplo, uma abertura de orifício natural, uma abertura transluminal, uma abertura cirúrgica e/ou qualquer outra abertura adequada. Em algumas modalidades, o trocarte 4 compreende um instrumento encioscópico e/ou laparoscópi- co. O atuador de extremidade 6 pode estar situado no trocarte 4 quando o trocarte 4 for introduzido em um sítio cirúrgico. Em certas modalidades, o atuador de extremidade 6 pode ser inserido no trocarte 4 após o trocarte 4 ter sido introduzido no sitio cirúrgico. Em algumas modalidades, um atuador é introduzido na extremidade proximal do trocarte 4 para empurrar o atuador de extremidade 6 para fora do trocarte 4. Em outras modalidades, um atuador é introduzido na extremidade distal do trocarte para empurrar o atuador de exbemidade 6 para fora do trocarte 4.
[00137] Em várias modalidades, o atuador de extremidade sem eixo 6 compreende um primeiro membro de garra 8a e um segundo membro de garra 8b. O primeiro membro de garra 8a compreende uma bigorna 10 que tem uma superfície de formação de grampo. A superfície de formação de grampo pode compreender uma pluralidade de bolsos de formação de grampo na mesma. O primeiro membro de garra 8a é acoplado de maneira móvel a um segundo membro de garra 8b. O segundo membro de garra 8b compreende uma canaleta longitudinal 42 configurada para receber um cartucho de grampos 12. O cartucho de grampos 12 compreende uma pluralidade de grampos 14 dispostos no mesmo. Um pino 15 que se estende do primeiro membro de garra 8a é recebido em uma fenda 16 formada no segundo membro de garra 8b. O pino 15 e a fenda 16 são configurados para permitir a pivotação (rotação) e/ou o movimento vertical (translação) do primeiro membro de garra 8a em relação ao segundo membro de garra 8b. Em várias modalidades, o segundo membro de garra 8b pode ser fabricado a partir de, por exemplo, aço inoxidável Série 300 & 400 Series, 17-4 & 17-7, titânio, etc., e pode ser formado com paredes laterais espaçadas. O primeiro membro de garra 8a pode ser fabricado a partir de, por exemplo, aço inoxidável Série 300 & 400 Series, 17-4 & 17-7, titânio, etc., e têm uma superfície inferior de formação de grampo que compreende uma pluralidade de bolsos de formação de grampo formados na mesma.
[00138] Várias formas de cartuchos de grampos podem ser empregadas com as várias modalidades do atuador de extremidade 6 revelado na presente invenção. Em algumas modalidades, pode ser usado um cartucho de grampos implantável 12. Em ao menos uma modalidade, o cartucho de grampos 12 compreende uma porção de corpo 18 que compreende um material compressível como, por exemplo, um material hemoestático, celulose regenerada oxidada ("ORC" - oxidized regenerated cellulose) e/ou uma espuma bioabsorvível na qual linhas de grampos de metal não formado 14, por exemplo, são apoiados. Em ao menos algumas modalidades, a fim de evitar que o alinhamento dos grampos 14 no corpo de cartucho 18 seja afetado e/ou que o material hemoestático seja ativado durante a introdução e o posiciona-mento do atuador de extremidade 6 ern um sítio cirúrgico, todo o car- tucho de grampos 12 pode ser revestido ou embalado em um filme biodegradável, como, por exemplo, um filme de polidioxanona comercializado sob a marca registrada PDS®, um filme de sebecato de Poli- glicerol (PGS), um filme biodegradável formado a partir de PGA (ácido poliglicólico, comercializado sob a marca registrada Vicryl), PCL (Poli- caprolactona), PLA ou PLLA (ácido polilático), PHA (poli- hidroxialcanoato), PGCL (poliglecaprona 25, comercializado sob a marca registrada Monocryl), e/ou um compósito de PGA, PCL, PLA e/ou PDS que seria impermeável até a ruptura. A porção de corpo 18 do cartucho de grampos 12 é dimensionada para ser apoiada na cana- leta longitudinal 42 do membro de garra inferior 8b de modo que cada grampo 14 fique alinhado a um bolso de formação de grampo corres-pondente na bigorna 10 quando a bigorna 10 for acionada no contato de formação com o cartucho de grampos 12. Em vários exemplos, o cartucho de grampos 12 pode ser removível do atuador de extremidade 6 e, em outros exemplos, o cartucho de grampos 12 pode não ser removível do atuador de extremidade 6.
[00139] Em uso, o atuador de extremidade 6 é posicionado adjacente ao tecido-alvo. O atuador de extremidade 6 é manipulado para capturar ou segurar o tecido-alvo entre a bigorna 10 e o cartucho de grampos 12. Com referência à Figura 7, a bigorna 10 é ilustrada em uma posição aberta. A bigorna 10 pode ser girada para baixo na direção do tecido T para uma posição fechada, ou presa, conforme ilustrado na Figura 8. Um sistema de fechamento configurado para mover a bigorna 10 para uma posição fechada é discutido em mais detalhes abaixo. Os grampos 14 são formados movimentando-se a bigorna 10 verticalmente, ou para baixo, na direção do cartucho de grampos 12 enquanto mantém a bigorna 10 em uma orientação paralela, ou uma orientação ao menos substancialmente paralela, em relação ao cartucho de grampos 12 a fim de colocar a superfície de formação de grampo e os bolsos de formação de grampo da bigorna 10 em contato com o cartucho de grampos 12, conforme ilustrado na Figura 9. Conforme a bigorna 10 continua a se mover para o cartucho de grampos 12, com referência à Figura 10, as pernas dos grampos 14 entram em contato com um bolso de formação de grampo correspondente na bigorna 10 que serve para dobrar as pernas do grampo 14 e para dar aos grampos 14 um formato de "B", por exemplo. O movimento adicional da bigorna 10 na direção do cartucho de grampos 12 irá comprimir ainda mais e formar os grampos 14 com uma altura formada final desejada.
[00140] Além do que foi disposto acima, o atuador de extremidade 6 pode compreender um sistema de fechamento configurado para fechar a bigorna 10. A Figura 1 ilustra um sistema de fechamento 20 que compreende um elemento deslizante de extremidade proximal 22a e um elemento deslizante de extremidade distai 22b. O elemento deslizante de extremidade proximal 22a e o elemento deslizante de extre-midade distai 22b podem compreender, cada um, uma cavidade 24 para receber uma porção do primeiro membro de garra 8a e uma porção do segundo membro de garra 8b no mesmo. O elemento deslizante proximal 22a compreende uma porção de elemento deslizante 26a que se estende longitudinalmente do mesmo e o elemento deslizante distal 22b compreende uma porção de elemento deslizante 26b que se estende longitudinalmente do mesmo. As porções de elemento desli zante 26a, 26b são recebíveis de modo deslizável em uma abertura longitudinal 28 formada no membro de garra inferior 8b. As Figuras 2 a 6 ilustram várias vistas em seção transversal do sistema cirúrgico sem eixo 2 ilustrado na Figura 1. A Figura 2 ilustra uma vista em seção transversal do sistema cirúrgico sem eixo 2 mostrando o trocarte 4 e c elemento deslizante distal 22b. A Figura 3 ilustra uma vista em seção transversal do sistema cirúrgico sem eixo 2 mostrando o elemento deslizante distal 22b e a cavidade 24 definida no mesmo para receber uma extremidade distal do primeiro membro de garra 8a e uma extremidade distal do segundo membro de garra 8b. A Figura 4 ilustra uma vista em seção transversal do sistema cirúrgico sem eixo 2 mostrando o primeiro membro de garra 8a que compreende uma reentrância configurada para receber uma porção do elemento deslizante distai 22b, conforme descrito em mais detalhes abaixo. Em algumas modalidades, a reentrância compreende uma pluralidade de características de calibre de profundidade e/ou retenção 38, que também serão descritos em mais detalhes abaixo. A porção de elemento deslizante 26b do elemento deslizante distai 22b é adicionalmente ilustrada na Figura 4 e é posicionada na abertura longitudinal 28 definida no segundo membro de garra 8b. A Figura 5 ilustra uma vista em seção transversal do sis-tema cirúrgico sem eixo 2 mostrando o primeiro membro de garra 8a e o segundo membro de garra 8b em um local entre o elemento deslizante proximal 22a e o elemento deslizante distai 22b. A Figura 6 ilustra uma vista em seção transversal do sistema cirúrgico sem eixo 2 mostrando o pino 15 e a fenda 16 acoplando o primeiro membro de garra 8a e o segundo membro de garra 8b. A Figura 6 ilustra adicionalmente o elemento deslizante proximal 22a e a porção de elemento deslizante proximal 26a. A porção de elemento deslizante proximal 26a é recebida de modo deslizável na abertura longitudinal 28 definida na segunda garra 8b. Em vários exemplos, a porção de elemento deslizante 26a e/ou a porção de elemento deslizante 26b pode apoiar a segunda garra 8b conforme a primeira garra 8a é empurrada na direção da segunda garra 8b para deformar os grampos conforme discuti-do acima.
[00141] A Figura 7 ilustra o atuador de extremidade 6 em uma posição implantada, isto é, uma posição em um paciente Conforme apresentado acima, o atuador de extremidade 6 pode ser implantado a par- tir do trocarte 4, por exemplo, mediante a inserção de uma haste de empuxo no trocarte 4 a fim de empurrar o atuador de extremidade sem eixo 6 para fora do trocarte 4. Quando implantado a partir do trocarte 4, o primeiro membro de garra 8a e o segundo membro de garra 8b podem assumir uma posição aberta e/ou podem ser manipulados para assumir uma posição aberta. Em ao menos uma modalidade, a bigorna 10 é forçada para uma posição aberta por uma mola de bigorna (não mostrado) e/ou outra disposição forçante. A mola de bigorna força o primeiro membro de garra 8a e o segundo membro de garra 8b para uma posição aberta de modo que, quando o atuador de extremidade sem eixo 6 for implantado a partir do trocarte 4, o atuador de extremidade sem eixo 6 assume a posição aberta ilustrada na Figura 7.
[00142] As Figuras 7 a 10 ilustram um processo de preensão de tecido e de formação de grampo. Na Figura 7, um tecido-alvo "T" é posicionado entre a bigorna 10 e o cartucho de grampos 12. A bigorna 10 é pivotada em relação ao membro de garra inferior 8b para uma posição de preensão inicial, ou parcialmente fechada, ilustrada na Figura 8. Em algumas modalidades, uma pinça e/ou outro instrumento pode ser inserido através do trocarte 4, e/ou através de outro trocarte, por exemplo, para empurrar o elemento deslizante proximal 22a e o elemento deslizante distal 22b um na direção do outro, isto é, na direção do centro do aíuadoí de extremidade 6 é usado para fazer a transição da bigorna 10 para uma posição parcialmente fechada. Em vários exemplos, o elemento deslizante proximal 22a pode ser configurado para entrar em contato com a primeira garra 8a e para mover a primeira garra 8a de sua posição aberta para uma posição parcialmente fechada. Uma vez que a primeira garra 8a alcançou uma posição parcialmente fechada, o elemento deslizante distal 22b pode ser movido para o contato com a primeira garra 8a. Em seguida, os elementos deslizantes slides 22a e 22b podem ser empurrados um na direção do outro ao mesmo tempo e/ou sequencialmente a fim de comprimir a bigorna 10 sobre o tecido-alvo "T" e prender o tecido-alvo "T" entre a bigorna 10 e o cartucho de grampos 12. A Figura 9 ilustra a formação de grampo inicial em que a bigorna 10 entrou em contato com o cartucho de grampos 12. A Figura 10 ilustra os grampos 14 em sua posição formada final.
[00143] Além do que foi disposto acima, os elementos deslizantes de extremidade 22a; 22b podem definir, cada um, uma cavidade 24 para receber o primeiro membro de garra 8a e o segundo membro de garra 8b nos mesmos. A superfície interna da cavidade 24 definida em cada um dentre os elementos deslizantes de extremidade 22a, 22b pode compreender uma superfície de carne, como a superfície de ca-rne 30, por exemplo. Em vários exemplos, cada superfície de carne 30 pode compreender uma superfície angulada, por exemplo. Em certos exemplos, as superfícies anguladas podem ser configuradas para engatar-se a superfícies anguladas na primeira garra 8a. Por exemplo, a extremidade proximal da primeira garra 8a pode compreender uma superfície de seguidor 32 que pode ser engatada pela superfície de came 30 definida no elemento deslizante de extremidade proximal 22a conforme o elemento deslizante de extremidade proximal 22a é movido distalmente na direção do elemento deslizante de extremidade distai 22b. De modo similar, a extremidade distal da primeira garra 8a pode compreender uma superfície de seguidor 32 que pode ser engatada pela superfície de came 30 definida no elemento deslizante de extremidade distai 22b conforme o elemento deslizante de extremidade distai 22b é movido proximalmente na direção do elemento deslizante de extremidade distai 22a. Em vários exemplos, o ângulo da superfície de came 30 pode corresponder a um ângulo da superfície de seguidor 32 enquanto, em outros exemplos, o ângulo da superfície de came 30 pode ser diferente de um ângulo da superfície de seguidor 32. Em certos exemplos, um conjunto de superfícies 30, 32, como o conjunto proximal de superfícies, pode ser definido por um primeiro ângulo correspondente e o outro conjunto de superfícies 30, 32, como o conjunto distai de superfícies, pode ser definido por um segundo ângulo correspondente que é diferente do primeiro ângulo correspondente. Em várias modalidades, as configurações das superfícies de carne 30 e das superfícies de seguidor 32 podem ser selecionadas para permitir que a bigorna 10 mantenha uma orientação ao menos substancialmente paralela em relação ao cartucho de grampos 12 a fim de formar todo o grampo 14 simultaneamente.
[00144] Em algumas modalidades, o atuador de extremidade 6 pode compreender ao menos um calibre configurado para indicar a altura formada dos grampos. Em vários exemplos, a extremidade proximal do atuador de extremidade 6 pode incluir um calibre de altura formada 31 e/ou a extremidade distal do atuador de extremidade 6 pode incluir um calibre de altura formada 31, por exemplo. Em certos exemplos, o elemento deslizante de extremidade proximal 22a e/ou o elemento deslizante de extremidade distai 22b compreende um elemento de calibre configurado para indicar a altura formada dos grampos 14. Em vários exemplos, um calibre pode incluir uma série ou uma matriz de demarcações definidas na extremidade distai da segunda garra 8a e, além disso, um elemento de calibre estendendo-se do elemento deslizante de extremidade distai 22b. Em ao menos urna tal modalidade, o elemento de calibre pode compreender um braço 34 incluindo uma cabeça 36 e a matriz de demarcações pode compreender uma pluralidade de dentes 38, em que a posição da cabeça 36 em relação aos dentes 38 pode indicar a distância na qual a bigorna 10 foi empurrada para baixo. De modo similar, um calibre pode incluir uma série ou uma matriz de demarcações definidas na extremidade proximal da segunda garra 8a e um elemento de calibre estendendo-se do elemento desli- zante de extremidade proximal 22a. Além disso, similares ao que foi disposto acima, o elemento de calibre pode compreender um braço 34 incluindo uma cabeça 36 e a matriz de demarcações pode compreender uma pluralidade de dentes 38, em que a posição da cabeça 36 em relação aos dentes 38 pode indicar a distância na qual a bigorna 10 foi empurrada para baixo. Novamente com referência à Figura 9, a bigorna 10 foi posicionada contra o cartucho de grampos 12 e, em tal posição, a cabeça 36 do elemento de calibre estendendo-se do elemento deslizante de extremidade proximal 22a deslizou sobre o dente mais externo 38 na matriz de dentes proximal 38 e a cabeça 36 do elemento de calibre estendendo-se do elemento deslizante de extremidade distai 22b deslizou sobre o dente mais externo 38 na matriz de dentes distai 38. Esse posicionamento relativo das cabeças de calibre 36 em relação às matrizes de dentes 38 pode indicar a um médico que os grampos 14 ainda não foram deformados pela bigorna 10. Conforme o elemento deslizante de extremidade proximal 22a é movido para dentro, o elemento deslizante de extremidade proximal 22a pode acionar a extremidade proximal da primeira garra 8a para baixo e a cabeça 36 estendendo-se do mesmo pode deslizar sobre um ou mais dentes adicionais 38. De modo similar, conforme o elemento deslizante de ex-tremidade distai 22b é movido para dentro, o elemento deslizante de extremidade distai 22b pode acionar a extremidade distai da primeira garra 8a para baixo e a cabeça 36 que se estende do mesmo pode deslizar sobre um ou mais dentes adicionais 38. Quando as cabeças 36 deslizar sobre todos os dentes 38, conforme ilustrado na Figura 10, o médico pode presumir que os grampos 14 se formaram completamente.
[00145] Várias modalidades reveladas na presente invenção empregam um cartucho de grampos compressível 12 que apoia grampos em uma posição substancialmente estacionária para formar contato pela bigorna 10. Em várias modalidades, a bigorna 10 é acionada para os grampos não formados 14 em que, em ao menos uma tal modalidade, o grau de formação do grampo atingido depende de até aonde a bigorna 10 é acionada para dentro dos grampos. Tal disposição fornece ao cirurgião a capacidade de ajustar a quantidade de pressão de formação ou de disparo aplicada aos grampos e, dessa forma, alterar a altura formada final dos grampos.
[00146] Além do que foi disposto acima, os elementos de calibre que se estendem dos elementos deslizantes de extremidade 22a e 22b podem compreender membros de retenção que podem ser configurados para reter e/ou travar os elementos deslizantes de extremidade 22a e 22b na posição. Em vários exemplos, as cabeças 36 dos elementos de calibre e/ou os dentes 38 podem incluir anteparos de trava configurados para, um, permitir que os elementos deslizantes de extremidade 22a e 22b sejam movidos para dentro e, dois, resistir ao movimento para fora dos elementos deslizantes de extremidade 22a e 22b. Em várias modalidades, os calibres podem compreender sistemas de catraca que permitem movimento em uma direção, mas que proíbem o movimento na direção oposta. A fim de superar os efeitos de travamento dos elementos de calibre, as cabeças 36 dos elementos de calibre podem ser elevadas e/ou defletidas na direção contrária às matrizes de dentes 38. Uma vez que os elementos de calibre se desengataram da primeira garra 8a, os elementos deslizantes de extremidade 22a, 22b podem ser movidos para fora para permitir que a primeira garra 8a abra. Conforme discutido acima, a primeira garra 8a pode ser movida para sua posição aberta por uma mola e/ou pode ser aberta por empuxo por uma pinça, como a pinça 154 (Figura 11), por exemplo
[00147] Efetores de extremidade anteriores estendidos de um eixo de um instrumento cirúrgico em que um ou mais membros de aciona- mento estendendo-se através do eixo foram utilizados para operar o atuador de extremidade. Conforme o leitor vai entender, o atuador de extremidade 6 não é fixado ao eixo de um instrumento cirúrgico e, dessa forma, é sem eixo. Em vários exemplos, conforme discutido acima, uma pinça, por exemplo, pode ser utilizada para empurrar os elementos deslizantes de extremidade 22a, 22b do atuador de extre-midade 6 para dentro. A pinça pode ser configurada para mover os elementos deslizantes de extremidade 22a, 22b um por vez ou simultaneamente. Em vários exemplos, um mecanismo de fechamento, como, por exemplo, uma pinça (não mostrado) é acoplado ao sistema de fechamento sem eixo 20. Em certos exemplos, a pinça é aberta e o atuador de extremidade sem eixo 6 é posicionado entre dois braços da pinça. A pinça é transicionada de uma posição aberta para uma posição fechada para fazer com que o elemento deslizante proximal 22a e o elemento deslizante distal 22b deslizem na direção de um ponto médio do atuador de extremidade sem eixo 6. As superfícies de carne 30 do elemento deslizante proximal 22a e do elemento deslizante distal 22b fazem interface com as superfícies de seguidor 32 definidas na bi-gorna 10, fazendo com que a bigorna 10 se comprima na direção do cartucho de grampos 12. Conforme discutido acima, a bigorna 10 pode comprimir o tecido-alvo "T" e implantar os grampos 14 no tecido-alvo "T". Uma vez que os grampos 14 foram formados e presos ao tecido- alvo "T", além do que foi disposto acima, o cirurgião pode abrir a pinça e remover a mesma do sítio cirúrgico. A bigorna 10 pode, então, ser aberta para liberar o tecido grampeado "T" e o atuador de extremidade 6 pode ser removido do sitio cirúrgico. Conforme o leitor irá entender, o corpo de grampo 18 esmagado ou capturado pelos grampos 14 pode permanecer para trás, ou implantado. O corpo de grampo "esmagado" remanescente 18 pode atuar como um material hemoestático, um reforço de linha de grampo e/ou um compensador para variações na es- pessura de tecido. Como usado aqui, o termo "implantável" significa que, além dos grampos 14, ao menos uma porção do corpo de cartucho de grampos 18 capturada pelos grampos 14 também irá permanecer no paciente. O corpo de cartucho implantado 18 pode, ou não, ser eventualmente absorvido pelo corpo do paciente. Embora as várias modalidades sejam descritas na presente invenção com referência a cartuchos de grampos implantáveis, o versado na técnica irá reconhecer que cartuchos não implantáveis, isto é, cartuchos nos quais o car-tucho de grampos permanece posicionado no atuador de extremidade sem eixo após ser disparado, podem também ser usados. Em vários exemplos, tais disposições de grampeamento cirúrgico podem empregar elementos de acionamento que podem erguer os grampos na direção da bigorna.
[00148] Embora o atuador de extremidade sem eixo 6 seja ilustrado compreendendo um elemento deslizante proximal 22a e um elemento deslizante distai 22b, o leitor irá reconhecer que o elemento deslizante proximal 22a e/ou o elemento deslizante distai 22b pode ser omitido Em algumas modalidades, após os grampos terem sido formados ou disparados no tecido-alvo, o atuador de extremidade sem eixo 6 pode ser liberado, por exemplo, mediante a atuação de um mecanismo de liberação. O mecanismo de liberação pode liberar o elemento deslizante proximal 22a e/ou o elemento deslizante distai 22b fazendo com que a bigorna 10 assuma uma posição aberta
[00149] Em certas modalidades, o atuador de extremidade sem eixo 6 pode ser usado apenas como um dispositivo de grampeamento de tecido Entretanto, em várias modalidades, o atuador de extremidade sem eixo 6 compreende um membro de corte 40. O membro de corte 40 é configurado para cortar o tecido-alvo "T" ao longo de um eixo longitudinal do atuador de extremidade 6 Em algumas modalidades, o membro de corte 40 compreende uma lâmina fixa. Em ao menos uma modalidade, o membro de garra inferior 8b compreende um membro de corte afiado 40 configurado para fazer interface com um membro correspondente formado na bigorna 10. Quando a bigorna 10 é comprimida na direção do cartucho de grampos 12, a bigorna 10 empurra o tecido T contra o membro de corte 40 que, então, corta o tecido-alvo T. Em outras modalidades, o membro de corte pode compreender um membro de corte deslizável implantável de uma posição não atuada adjacente à extremidade proximal do atuador de extremidade sem eixo 6 para uma posição atuada adjacente à extremidade distai, por exemplo. EM ao menos um tal exemplo, o membro de corte pode ser configurado para estender-se de modo deslizável através de uma fenda na bigorna 10 e de uma fenda centralmente disposta no cartucho de grampos 12. Um membro de corte deslizável pode ser implantado, por exemplo, por um eixo giratório, que é descrito em mais detalhes abaixo. Em algumas modalidades, o membro de corte deslizável compreende um componente deslizante para implantar os giampos 14.
[00150] A Figura 11 ilustra uma modalidade de um atuador de extremidade sem eixo 106. O atuador de extremidade sem eixo 106 é similar ao atuador de extremidade sem eixo 6 ilustrado nas Figuras 1 a 10. O atuador de extremidade sem eixo 106 compreende um primeiro membro de garra 108a e um segundo membro de garra 108b. O primeiro membro de garra 108a compreende uma bigorna 110 que tem uma pluralidade de bolsos de formação de grampo no mesmo. O segundo membro de garra 108b compreende uma canaleta 142 configu-rada para receber um cartucho de grampos, como, por exemplo, um cartucho de grampos implantável. Urn sistema de fechamento sem eixo 120 é configurado para fazer a transição do atuador de extremidade 106 de uma posição aberta para uma posição fechada e para implantar os grampos de um cartucho de grampos situado na canaleta 142. O sistema de fechamento sem eixo compreende um elemento desli- zante proximal 122a e um elemento deslizante distal 122b. O elemento deslizante proximal 122a e o elemento deslizante distal 122b são configurados para fazer interface de modo deslizante com o primeiro membro de garra 108a e com o segundo membro de garra 108b para acionar a bigorna 110 em contato com, e para formar os grampos em, um cartucho de grampos. O elemento deslizante proximal 122a compreende uma porção de preensão angulada que se estende em uma direção que é transversal a um eixo longitudinal do atuador de extremidade 106. Em vários exemplos, a porção de preensão angulada pode compreender uma ponta de esqui 150. A ponta de esqui 150 pode ser configurada para facilitar a inserção do atuador de extremidade 106 em relação a ou abaixo de um certo tecido. A ponta de esqui 150 compreende uma seção de preensão 152 configurada para fazer interface com uma pinça 154. A pinça 154 pode compreender qualquer pinça adequada, como, por exemplo, um dispositivo de preensão configurado para inserção através do trocarte 4. A ponta de esqui 150 pode facilitar a colocação do atuador de extremidade sem eixo 106 sob um vaso ou tecido-alvo, por exemplo. Em algumas modalidades, após o posicionamento do atuador de e xtremidade sem eixo 106 sob o tecido-alvo.. a pinça 154 é usada para fazer a transição do atuador de extremidade sem eixo 106 da posição aberta ilustrada na Figura 11 para uma posição parcialmente fechada. A pinça 154 e/ou um atuador mecânico adicional faz interface com o sistema de fechamento sem eixo 120 para fazer a transição do atuador de extremidade sem eixo 106 de uma posição parcialmente fechada para uma posição disparada empurrando os elementos deslizantes 122a e 122b um na direção do outro. Embora a ponta de esqui 150 seja ilustrada como acoplada ao elemento deslizante proximal 122a, uma ponta de esqui 150 pode se estender do elemento deslizante distai 122b.
[00151] As Figuras 12 e 13 ilustram uma modalidade de um atuador de extremidade sem eixo 206. O atuador de extremidade sem eixo 206 compreende um primeiro membro de garra 208a e um segundo membro de garra 208b. O primeiro membro de garra 208a compreende uma bigorna 210 que tem uma pluralidade de bolsos de formação de grampo no mesmo. O segundo membro de garra 208b compreende uma canaleta longitudinal 242 configurada para receber um cartucho de grampos, como, por exemplo, um cartucho de grampos implantável. O primeiro membro de garra 208a e o segundo membro de garra 208b são acoplados por um pino 215 e uma fenda 216. O pino 215 permite movimento pivotante e vertical da bigorna 210 em relação ao segundo membro de garra 208b. Um sistema de fechamento sem eixo 220 é configurado para fazer a transição do atuador de extremidade sem eixo 206 de uma posição aberta para uma posição fechada. O sistema de fechamento sem eixo compreende um elemento deslizante proximal 222a e um elemento deslizante distal 222b. O elemento deslizante proximal 222a e o elemento deslizante distal 222b compreendem, cada um, um carne formado nos mesmos configurado para fazer interface com um chanfro formado na bigorna 210. A interface entre os ca-rnes do elemento deslizante proximal 222a e do elemento deslizante distal 222b e os chanfros da primeira garra 208a pode acionar a bigorna 210 em contato com o cartucho de grampos enquanto mantém a bigorna 210 em uma configuração substancialmente paralela em relação ao segundo membro de garra 208b. O elemento deslizante proximal 222a pode compreender um mecanismo de asoplamento 258 configurado para acoplar um cabo-guia destacável 256 ao atuador de extremidade sem eixo 206. Em algumas modalidades, o cabo-guia 256 compreende um plano angulado 260. O plano angulado 260 se estende em um ângulo em relação ao plano longitudinal do segundo membro de garra 208b. O plano angulado 260 pode compreender, por exemplo, uma ponta de esqui. O cabo-guia 256 pode ser manipulado por um cirurgião para posicionar o atuador de extremidade sem eixo 206 em um sítio de tratamento. Por exemplo, em uma modalidade, o cabo-guia destacável 256 se estende proxímalmente através de um trocarte e para fora do paciente e pode ser puxado pelo cirurgião para posicionar o atuador de extremidade sem eixo 206. Uma vez que o atuador de extremidade sem eixo 206 foi posicionado, o cabo-guia 256 pode ser destacado do atuador de extremidade sem eixo 206 conforme ilustrado na Figura 13. Embora o cabo-guia 256 seja ilustrado fixado ao elemento deslizante proximal 222a, o leitor irá entender que um mecanismo de acoplamento 258 pode ser formado no elemento deslizante distai 222b e o cabo-guia 256 pode ser acoplado ao elemento deslizante distai 222b. Em qualquer caso, o cabo-guia 256 pode ser usado como um atuador para girar a bigorna 210 para uma posição parcialmente fechada empurrando o componente deslizante 222a e/ou o componente deslizante 222b para dentro
[00152] A Figura 14 ilustra uma modalidade de um atuador de extremidade sem eixo 306 que compreende um cabo-guia rasgável 356. O atuador de extremidade sem eixo 306 compreende um primeiro membro de garra 308a e um segundo membro de garra 308b O primeiro membro de garra 308a compreende uma bigorna 310 que tem uma pluralidade de bolsos de formação de grampo no mesmo. O segundo membro de garra 308b compreende uma canaleta longitudinal 342 configurada para receber um cartucho de grampos, como, por exemplo, um cartucho de grampos implantável. O primeiro membro de garra 308a e o segundo membro de garra 308b são acoplados por um pino 315 e uma fenda 316. O pino 315 permite movimento pivotante e vertical da bigorna 310 em relação ao segundo membro de garra 308b. Um sistema de fechamento sem eixo 320 é configurado para fazer a transição do atuador de extremidade sem eixo 306 de uma posição aberta para uma posição fechada. O sistema de fechamento sem eixo compreende um elemento deslizante proximal 322a e um elemento deslizante distal 322b. O elemento deslizante proximal 322a e o elemento deslizante distal 322b compreendem, cada um, um carne formado nos mesmos e configurado para fazer interface com chanfros formados na bigorna 310. A interface entre os carnes do elemento des-lizante proximal 322a e do elemento deslizante distal 322b e os chanfros na bigorna 310 acionam a bigorna 310 em contato com o cartucho de grampos enquanto mantém a bigorna 310 em uma configuração substancialmente paralela em relação ao segundo membro de garra 308b. O elemento deslizante proximal 322a é acoplado a um cabo- guia 356 por uma seção rasgável 358. O cabo-guia 356 pode se estender proximalmente através de um trocarte 4 e pode ser manipulado por um cirurgião para posicionar o atuador de extremidade sem eixo 306 em um sítio-alvo. Após o posicionamento do atuador de extremidade sem eixo 306, o cabo-guia 356 pode ser liberado do atuador de extremidade sem eixo 306 mediante o rasgamento da seção rasgável 358. A Figura 15 ilustra a seção rasgável 358 do cabo-guia 356 acoplada ao atuador de extremidade sem eixo 306 A Figura 16 ilustra a seção rasgável 358 após o cabo 356 ser separado do atuador de extremidade sem eixo 306.
[00153] A Figura 17 ilustra uma modalidade de um atuador de extremidade sem eixo 406 que compreende um sistema de acionamento 420. O atuador de extremidade sem eixo 406 compreende um primeiro membro de garra 408a e um segundo membro de garra 408b. O primeiro membro de garra 408a compreende uma bigorna 410 que tem uma pluralidade de bolsos de formação de grampo formados no mesmo O segundo membro de garra 408b compreende uma canaleta lon-gitudinal 442 configurada para receber um cartucho de grampos 412 no mesmo. O cartuchr de grampos 412 compreende uma pluralidade de grampos 14. O primeiro membro de garra 408a e o segundo mem- bro de garra 408b são acoplados de modo pivotante. Um pino 415 acoplado ao primeiro membro de garra 408a é retido de modo deslizá- vel em uma fenda 416 formada no segundo membro de garra 408b. O pino 415 e a fenda 416 permitem que a bigorna 410 pivote em relação ao segundo membro de garra 408b e se mova verticalmente na direção do segundo membro de garra 408b.
[00154] Um eixo giratório 464 se estende longitudinalmente através do segundo membro de garra 408b. O eixo giratório 464 é engatado de modo operacional a um elemento deslizante proximal 422a e a um elemento deslizante distal 422b do sistema de acionamento 420. O elemento deslizante proximal 422a e o elemento deslizante distai 422b podem compreender, cada um, um carne 430. Um e/ou ambos os carnes 430 são configurados para engatar-se à bigorna 410, para girar a bigorna 410 para uma posição fechada e para transladar a bigorna 410 para baixo na direção do cartucho 412. O eixo 464 compreende uma extremidade de acionamento proximal 466 que se estende do elemento deslizante proximal 422a. Em vários exemplos, uma entrada giratória, como um mecanismo de rotação 468, por exemplo, pode ser acoplada à extremidade de acionamento proximal 466 para girar o eixo giratório 464. O eixo 464 pode compreender adicionalmente uma primeira porção rosqueada 465a, uma segunda porção rosqueada 465b e uma terceira porção rosqueada 465c. A primeira porção rosqueada 465a pode ser engatada de modo rosqueável a uma abertura longitudinal rosqueada definida no elemento deslizante proximal 422a. Quando o eixo 464 é girado em uma primeira direção, a primeira porção rosqueada 465a pode deslocar o elemento deslizante proximal 422a na direção do elemento deslizante distai 422b. A segunda porção rosqueada 465b pode ser engatada de modo rosqueável a uma abertura longitudinal rosqueada definida no elemento deslizante distai 422b. Quando o eixo 464 é girado na primeira direção, a segunda porção rosqueada 465b pode deslocar o elemento deslizante distai 422b na direção do elemento deslizante proximal 422a. A fim de alcançar tal movimento relativo, em várias modalidades, a primeira porção rosqueada 465a pode compreender roscas de direção à direita enquanto a segunda porção rosqueada 465b pode compreender roscas de direção à esquerda, por exemplo. Quando o elemento deslizante proximal 422a e o elemento deslizante distai 422b são movidos um na direção do outro, um e/ou ambos os elementos deslizantes 422a e 422b podem girar a bigorna 410 para uma posição fechada e empurrar a bigorna 410 para baixo para esmagar os grampos 14.
[00155] As Figuras 17, 19 e 21 ilustram a operação do atuador de extremidade sem eixo 406 transitando de uma condição aberta para uma condição disparada. Conforme mostrado na Figura 17, um tecido- alvo "T" é posicionado entre a bigorna 410 e o cartucho de grampos 412 quando a bigorna 410 estiver em uma posição aberta. O atuador de extremidade sem e xo 406 faz a transição para uma posição parcialmente fechada mediante a pivotagem da bigorna 410 em relação ao segundo membro de garra 408b. Em alguns exemplos, a bigorna 410 pode ser pivotada mediante, por exemplo, a aplicação de uma força à bigorna 410 com uma pinça inserida através de um trocarte 4. Em outros exemplos, a bigorna 410 pode ser movida para uma posição ao menos parcialmente fechada pelo elemento deslizante proximal 422a. Em qualquer caso, o eixo giratório 464 é girado para fazer com que o elemento deslizante proximal 422a e o elemento deslizante distai 422b se movam longitudinalmente na direção de um ponto central do atuador de extremidade sem eixo 406. O eixo 464 pode ser girado até que o elemento deslizante proximal 422a e o elemento deslizante distai 422b comprimam completamente a bigorna 410 contra o cartucho 412 e configurem o atuador de extremidade sem eixo 406 em uma condição disparada, conforme ilustrado na Figura 19. Em outras situações, o eixo 464 pode ser girado para comprimir parcialmente o cartucho 412 e parcialmente formar os grampos 14. Em vários exemplos, o elemento deslizante proximal 422a e o elemento deslizante distai 422b podem entrar em contato com a primeira garra 408a ao mesmo tempo ou em instantes diferentes. Em ao menos um exemplo, o elemento deslizante proximal 422a pode entrar em contato com a primeira garra 408a antes de o elemento deslizante distai 422b entrar em contato com a primeira garra 408a.
[00156] Novamente com referência à Figura 17, o atuador de extremidade 406 pode incluir, ainda, um membro de corte, como o membro de corte 440, por exemplo. Quando o atuador de extremidade 406 está em uma condição aberta, conforme ilustrado na Figura 17, o membro de corte 440 pode ser posicionado em uma posição não avançada proximal. Conforme ilustrado na Figura 18, o membro de corte 440 pode incluir uma abertura longitudinal rosqueada 470 definida no mesmo, em que o eixo 464 pode se estender através da abertu-ra longitudinal 470. Na posição não avançada proximal do membro de corte 440, a abertura rosqueada 470 pode não ser engatada de modo rosqueável ao eixo 464. Mais particularmente, o eixo 464 pode incluir uma porção não rosqueada 467 que se estende entre a primeira porção rosqueada 465a e a terceira porção rosqueada 465c e, quando o membro de corte 440 está em sua posição não avançada proximal, a porção não rosqueada 467 do eixo 464 pode ser posicionada na abertura rosqueada 470 Em tais circunstâncias, o eixo 464 pode não mover diretamente o membro de corte 440 quando o eixo 464 for girado; entretanto, com referência às Figuras 17 e 19, o membro de corte 440 pode ser avançado distalmente, ao menos inícialmente, pelo elemento deslizante proximal 422a. Estabelecido de outra forma, o elemento deslizante proximal 422a pode empurrar o membro de corte 440 na direção do cartucho 412 quando o elemento deslizante proximal 422a for movido para dentro pela rotação do eixo 464, conforme discutido acima. Em vários exemplos, o elemento deslizante proximal 422a pode mover o membro de corte 440 para uma posição pré-estágio, isto é, uma posição na qual o membro de corte 440 está prestes a cortar transversalmente, mas ainda não cortou transversalmente, o cartucho 412 e/ou o tecido T capturado entre o cartucho 412 e a bigorna 410. Em vários exemplos, o elemento deslizante proximal 422a pode mover o membro de corte 440 para sua posição pré-estágio quando o elemento deslizante proximal 422a tiver alcançado sua posição fechada, conforme ilustrado na Figura 19. Em outros exemplos, o elemento deslizante proximal 422a pode mover o membro de corte 440 para sua posição pré-estágio antes de o elemento deslizante proximal 422a ter alcançado sua posição fechada. Em qualquer caso, o membro de corte 440 pode se engatar de modo operacional ao eixo 464 quando o membro de corte 440 tiver alcançado sua posição pré-estágio. Mais particularmente, o elemento deslizante proximal 422a pode empurrar o membro de corte 440 distalmente até que a abertura rosqueada 470 definida no membro de corte 440 se engate de modo rosqueável à posição rosqueada 465c. Uma vez que o membro de corte 440 engatou de modo rosqueável ao eixo 464, a rotação adicional do eixo 464 na primeira direção pode avançar o membro de corte 440 distalmente, conforme ilustrado na Figura 21.
[00157] Conforme apresentado acima, a primeira porção rosqueada 465a pode avançar o elemento deslizante proximal 422a de sua posição não atuada (Figura 17) para sua posição totalmente atuada (Figura 19). Conforme o eixo 464 é girado, o elemento deslizante proximal 422a irá avançar ao longo do comprimento' da primeira porção rosqueada 465a. Uma vez que o elemento deslizante proximal 422a foi movido para sua posição totalmente atuada, o elemento deslizante proximal 422a pode não mais se engatar ao eixo 464 e a rotação adi- cional do eixo 464 na primeira direção pode não avançar adicionalmente o elemento deslizante proximal 422a. Estabelecido de outra forma, a primeira porção rosqueada 465a pode empurrar o elemento deslizante proximal 422a para um ponto em que a primeira porção rosqueada 465a não mais se engata de modo rosqueável à abertura rosqueada definida no elemento deslizante proximal 422a e, nesse ponto, uma porção não rosqueada 467 do eixo 464 pode ser posicionada na abertura rosqueada. De modo similar, a segunda porção rosqueada 465b pode avançar o elemento deslizante distai 422b de sua posição não atuada (Figura 17) para sua posição totalmente atuada (Figura 19). Conforme o eixo 464 é girado, o elemento deslizante distai 422b irá avançar ao longo do comprimento da segunda porção rosqueada 465b. Uma vez que o elemento deslizante distai 422b foi movido para sua posição totalmente atuada, o elemento deslizante distai 422b pode não mais se engatar ao eixo 464 e a rotação adicional do eixo 464 na primeira direção pode não avançar adicionalmente o elemento deslizante distai 422b. Estabelecido de outra forma, a segunda porção rosqueada 465b pode empurrar o elemento deslizante distai 422b para um ponto em que a segunda porção rosqueada 465b não mais se engata de modo rosqueável à abertura rosqueada definida no elemento deslizante distai 422b e, nesse ponto, uma porção não rosqueada 467 do eixo 464 pode ser posicionada na abertura rosqueada 470. Em vários exemplos, o elemento deslizante proximal 422a pode se desengatar da primeira porção rosqueada 465a ao mesmo tempo, ou ao menos substancialmente ao mesmo tempo, que o elemento deslizante distai 422b se desengata da segunda porção rosqueada 465b Em alguns exemplos, o elemento deslizante proximal 422a pode se desengatar da primeira porção rosqueada 465a antes ou após o elemento deslizante distai 422b se desengatar da segunda porção rosqueada 465b. Em vários exemplos, o elemento deslizante proximal 422a pode se desengatar da primeira porção rosqueada 465a ao mesmo tempo, ou substancialmente ao mesmo tempo, que o membro de corte 440 se engata à terceira porção rosqueada 465c. Em outros exemplos, o elemento deslizante proximal 422a pode se desengatar da primeira porção rosqueada 465a antes ou após o membro de corte 440 se engatar à terceira porção rosqueada 465c.
[00158] Após a faca 440 ter sido avançada suficientemente pelo eixo 464 para incisar o tecido T e/ou incisar o cartucho 412, a faca 440 pode ser retraída mediante a rotação do eixo 464 em uma segunda direção ou em uma direção oposta. Em alguns exemplos, a faca 440 pode retornar ao longo da terceira porção rosqueada 465c até retornar para sua posição de pré-estágio na qual não mais se engata de modo rosqueável à terceira porção rosqueada 465c. De modo similar, a rotação do eixo 464 na segunda direção pode devolver o elemento desli-zante proximal 422a e o elemento deslizante distal 422b para suas posições não atuadas e permite que a bigorna 410 seja reaberta. Em certos exemplos, o membro de corte 440 pode entrar em contato com o elemento deslizante proximal 422a conforme o membro de corte 440 se retrai a fim de empurrar o elemento deslizante proximal 422a de volta para a primeira porção rosqueada 465a. Em vários exemplos, o atuador de extremidade 406 pode incluir, ainda, um membro rosquea- do configurado para percorrer sobre o eixo 464 e para empurrar o elemento deslizante distal 422b de volta para a segunda porção rosqueada 465b. Em qualquer caso, as porções rosqueadas do eixo 464 pode ter o mesmo passo de rosca. Em alguns exemplos, as porções do atuador de extremidade 406 deslocadas pelo eixo 464 podem se mover na mesma velocidade. Em outros exemplos, uma ou mais dentre as porções rosqueadas do eixo 464 podem ter um passo de rosca diferente, em que, como resultado, um ou mais dentre os componentes do atuador de extremidade 406 podem se mover em velocidades diferentes para uma dada velocidade de rotação do eixo 464.
[00159] Conforme o leitor irá entender, o atuador de extremidade 406 inclui uma única entrada de acionamento giratório que pode fechar a bigorna 410 em um primeiro estágio, deformar os grampos 14 em um segundo estágio e avançar a faca 440 em um terceiro estágio. Em certos exemplos, um ou mais desses estágios podem ocorrer consecu-tivamente. Em ao menos um exemplo, um ou mais desses estágios podem não se sobrepor. Em vários exemplos, um ou mais desses estágios podem ocorrer simultaneamente. Em ao menos um exemplo, um ou mais desses estágios podem sobrepor ao menos parcialmente um ou mais outros estágios. Em alguns exemplos, pode ser desejado que o estágio de formação de grampo ocorra ao menos parcialmente antes do estágio de corte. Em outros exemplos, pode ser desejado que o estágio de formação de grampo seja concluído antes de o está-gio de corte começar. Tal modalidade pode ser desejada a fim de evitar que o tecido T seja cortado antes de ser grampeado. Conforme descrito com mais detalhes abaixo, certas modalidades podem incluir dois ou mais sistemas de acionamento realizem os vários estágios operacionais de um atuador de extremidade.
[00160] A Figura 22 ilustra uma modalidade de um atuador de extremidade sem eixo 506 que compreende um mecanismo de fechamento sem eixo e um mecanismo de disparo sem eixo. O atuador de extremidade sem eixo 506 compreende um primeiro membro de garra 508a e um segundo membro de garra 508b. O primeiro membro de garra 508a compreende uma bigorna 510 que tem uma superfície de formação de grampo que compreende uma pluralidade de bolsos de formação de grampo na mesma. O segundo membro de garra 508b compreende uma canaleta longitudinal 542 configurada para receber um cartucho de grampos 512 no mesmo O primeiro membro de garra 508a e o segundo membro de garra 508b são acoplados de modo pi- votante. O primeiro membro de garra 508a compreende um pino 515 acoplado a uma fenda 516 formada no membro de garra inferior 508b. O pino 515 permite que o primeiro membro de garra 508a se mova de modo pivotante e verticalmente em relação ao segundo membro de garra 508b.
[00161] Um eixo giratório 564 se estende longitudinalmente através do membro de garra inferior 508b. O eixo giratório 564 é acoplado a um elemento deslizante proximal 522a e a um elemento deslizante distal 522b do mecanismo de fechamento 520. O elemento deslizante proximal 522a e o elemento deslizante distal 522b podem compreender, cada um, um carne 530. Cada carne 530 pode compreender um ângulo configurado para fazer interface com um ou mais superfícies chanfradas formadas na primeira garra 8a. O eixo giratório 564 compreende uma extremidade de acionamento 566 que pode ser fixada a uma entrada de acionamento giratório, como a entrada de acionamento giratório 568, por exemplo. Similar ao que foi disposto acima, a entrada de acionamento giratório 568 pode girar o eixo 564 que pode, por sua vez, mover o elemento deslizante proximal 522a e o elemento deslizante distal 522b longitudinalmente na direção de um ponto central do atuador de extremidade 506. O movimento do elemento deslizante proximal 522a e do elemento deslizante distal 522b longitudinalmente na direção do ponto central do atuador de extremidade sem eixo 506 coloca os carnes 530 em contato com a primeira garra 8a a fim de acionar a bigorna 510 em contato com o cartucho de grampos 512. A bigorna 510 pode comprimir o cartucho de grampos 512 e implantar os grampos 14 através do tecido-alvo "T“, conforme ilustrado na Figura 25. Tal sistema pode compreender um primeiro sistema de acionamento do atuador de extremidade 506 configurado para fechar a bigorna 510 e para disparar os grampos 14 no atuador de extremidade 506.
[00162] Além do que foi disposto acima, o atuador de extremidade 506 pode incluir um segundo sistema de acionamento configurado para incisar o tecido T e/ou o cartucho de grampos 512. Referindo-se principalmente às Figuras 23 e 26, o atuador de extremidade sem eixo 506 pode compreender um membro de corte, como o membro de corte 540, por exemplo. O membro de corte 540 pode ser longitudinalmente implantável em uma canaleta formada no segundo membro de garra 508b e/ou no cartucho de grampos 512. Em vários exemplos, o membro de corte 540 pode incluir uma abertura longitudinal, ou abertura de separação, 570 estendendo-se através do mesmo. O eixo de acionamento 564 pode se estender através da abertura de separação 570 e o eixo de acionamento 564 pode não se engatar de modo operacional ao membro de corte 540. Em vários exemplos, o elemento deslizante proximal 522a pode incluir um conector de acionamento 576 que se estende do mesmo. A conexão de acionamento 576 pode incluir uma abertura 571 definida na mesma que pode ser configurada para receber uma haste 580. A haste 580 pode ser posicionada em uma entrada de acionamento 578, em que a entrada de acionamento 578 pode ser fixada ao conector de acionamento 576. Uma vez que a entrada de acionamento 578 foi montada no conector de acionamento 576, a haste 580 pode ser avançada no atuador de extremidade 506 a fim de engatar o membro de corte 540, e/ou um membro empurrador 541 posicionado entre a haste 580 e o membro de corte 540. Em vários exemplos, a haste 580 e/ou o membro empurrador 541 podem estar em posição contígua com o membro de corte 540 e avançar o membro de corte 540 distalmente para incisar o cartucho 512 e/ou o tecido T cap-turado entre o cartucho 512 e a bigorna 510. Em certos exemplos, a haste 580 pode ser retraída e o membro de corte 540 pode ser deixado em sua posição avançada. Em outros exemplos, a haste 580 pode compreender uma porção de fixação distai que pode ser configurada para engatar o membro de corte 540. para acionar o membro de corte 540 distalmente e, então, para puxar o membro de corte 540 proxi- malmente para sua posição não disparada, por exemplo. Em ao menos uma tal modalidade, o membro de corte 540 pode incluir um so- quete definido no mesmo configurado para receber a porção de fixação da haste 580. Após o membro de corte 540 ter se retraído, a haste 580 pode se destacar do membro de corte 540 mediante a aplicação de uma força suficiente ao mesmo.
[00163] Conforme o leitor pode observar, o primeiro sistema de acionamento do atuador de extremidade 506 pode ser configurado para fechar a bigorna 510 e para disparar os grampos 14 enquanto o segundo sistema de acionamento do atuador de extremidade 506 pode ser configurado para incisar o tecido T capturado no atuador de extremidade 506. O primeiro sistema de acionamento e o segundo sistema de acionamento podem ser operados independentemente um do outro. Por exemplo, o primeiro sistema de acionamento pode ser operado por um médico, em que o médico pode decidir a possibilidade de operação e/ou quando operar o segundo sistema de acionamento. As Figuras 22, 25 e 26 ilustram o atuador de extremidade sem eixo 506 em transição entre uma posição aberta e uma posição disparada. A Figura 22 ilustra o atuador de extremidade sem eixo 506 em uma posição aberta. O tecido-alvo "T" é posicionado entre a bigorna 510 e o cartucho de grampos 512. A bigorna 510 é pivotada de uma posição aberta para uma posição parcialmente fechada mediante o movimento da bigorna 510 com uma pinça, por exemplo. A entrada de acionamento 568 pode ser fixada à extremidade de acionamento 566 do eixo 564 e a entrada de acionamento 578 pode ser fixada ao conector de acionamento 576 em qualquer momento adequado durante o uso do instrumento cirúrgico. Em alguns exemplos, uma ou ambas dentre a entrada de acionamento 568 e a entrada de acionamento 578 podem ser fixadas ao a- tuador de extremidade 506 antes de o atuador de extremidade 506 ser posicionado em um sítio cirúrgico. Em vários exemplos, uma ou ambas dentre a entrada de acionamento 568 e a entrada de acionamento 578 podem ser fixadas ao atuador de extremidade 506 depois de o atuador de extremidade 506 ter sido posicionado em um sítio cirúrgico. Em certos exemplos, a entrada de acionamento 568 pode ser montada na extremidade de acionamento 566 independentemente de a entrada de acionamento 578 sendo montada na extremidade de acionamento 576. Em outros exemplos, a entrada de acionamento 568 e a entrada de acionamento 578 podem compreender um conjunto de atuador que pode permitir que a entrada de acionamento 568 e a entrada de acionamento 578 sejam montadas no atuador de extremidade 506 simul-taneamente. Em uso, a entrada de acionamento 568 é atuada a fim de girar o eixo giratório 564 e acionar o elemento deslizante proximal 522a e o elemento deslizante distal 522b longitudinalmente na direção de um ponto central do atuador de extremidade 506. Conforme discutido acima, os carnes 530 no elemento deslizante proximal 522a e no elemento deslizante distal 522b podem entrar em contato com a primeira garra 8a para mover a bigorna 510 na direção do cartucho de grampos 512 para formar os grampos conforme ilustrado na Figura 25 Além disso em uso, a entrada de acionamento 578 é atuada a fim de avançar o membro de disparo 540. Em certos exemplos, a entrada de acionamento 568 e a entrada de acionamento 578 podem ser operadas sequencialmente. Em ao menos um exemplo, a entrada de acionamento 568 pode ser operada e, então, a entrada de acionamento 578 pode ser operada Em certos exemplos, a entrada de acionamento 578 pode não ser operada até após a operação da entrada de acio-namento 568 ter sido concluída. Em ao menos um exemplo, a entrada de acionamento 568 pode ser operada para formar completamente, ou para formar adequadamente os grampos 14 antes de a entrada de acionamento 578 ser operada para avançar a faca 540. Em vários exemplos, a operação da entrada de acionamento 568 e da entrada de acionamento 578 pode se sobrepor ao menos parcialmente. Em ao menos um exemplo, a entrada de acionamento 568 pode ser operada e, durante a operação da entrada de acionamento 568, a entrada de acionamento 578 pode ser operada.
[00164] A Figura 27 ilustra uma modalidade de um mecanismo de fechamento e disparo integrado 680 para fazer interface com um sistema de fechamento 620 do atuador de extremidade sem eixo 606 ilustrado na Figura 28. O atuador de extremidade 606 compreende um primeiro membro de garra 608a, um segundo membro de garra 608b e um quadro 694. O primeiro membro de garra 608a compreende uma bigorna 610. O segundo membro de garra 608b compreende uma canaleta longitudinal 642 configurada para receber um cartucho de grampos 612 no mesmo. Com referência às Figuras 28, 30 e 32, o primeiro membro de garra 608a e o segundo membro de garra 608b são acoplados de modo pivotante por um pino pivô 615. Referindo-se principalmente à Figura 32, o pino 615 se estende do quadro 694 e o primeiro e o segundo membros de garra 608a, 608b são acoplados de modo giratório ao quadro 694 pelo pino 615, O primeiro membro de garra 608a e o segundo membro de garra 608b são móveis de modo pivotante em relação a um eixo central "A". Um sistema de fechamento sem eixo 620 está situado na extremidade proximal do atuador de extremidade sem eixo 606. O sistema de fechamento sem eixo 620 compreende um colar giratório 690 que compreende uma ou mais roscas 698 configuradas para fazer interface de modo giratório com urna ou mais roscas 696 formadas no primeiro membro de garra 608a e no segundo membro de garra 608b. Em ao menos um exemplo, as roscas 696 podem compreender um conjunto contínuo de roscas que se estendem ao redor de um perímetro definido pelo primeiro membro de garra 608a e pelo segundo membro de garra 608b. A rotação do colar giratório 690 em uma primeira direção pivota o primeiro membro de garra 608a e/ou o segundo membro de garra 608b na direção do eixo central "A", conforme ilustrado na Figura 30. A rotação do colar 690 em uma segunda direção, ou oposta, pivota o primeiro membro de garra 608a e/ou o segundo membro de garra 608b na direção contrária ao eixo "A", conforme ilustrado na Figura 30. Conforme descrito com mais detalhes abaixo, o colar 690 pode incluir uma porção de conexão que pode ser fixada de modo operacional a uma entrada de acionamento. O atuador de extremidade 606 pode incluir, ainda, um membro de corte 640 configurado para incisar o cartucho de grampos 612 e/ou o tecido capturado entre o cartucho 612 e a bigorna 610. O membro de corte 640 pode incluir uma porção de conexão, como o membro de conexão 643, por exemplo, que se estende proximalmente da porção de corte 672 do membro de corte 640. Conforme descrito com mais detalhes abaixo, o membro de conexão 643 pode ser fixado de modo operacional a uma entrada de acionamento. Em vários exemplos, o quadro 694 pode incluir uma abertura longitudinal 693 definida no mesmo, em que o membro de conexão 643 pode ser recebido de modo deslizável na abertura 693.
[00165] Referindo-se principalmente à Figura 27, o mecanismo de disparo 680 pode incluir a quadro 682, um acionamento externo giratório 686 e um acionamento interno transladável 688. Com referência às Figuras 28 a 30, o colar giratório 690 pode incluir uma abertura 695 definida no mesmo que pode ser configurada para receber o quadro 682 do mecanismo de disparo 680. Em vários exemplos, o quadro 682 pode ser recebida de modo justo na abertura 695. Em certos exemplos, o quadro 682 pode incluir uma abertura longitudinal 681 definida no mesmo que pode ser configurada para receber ao menos uma porção do quadro 694 do atuador de extremidade 604. Similar ao que foi disposto acima, o quadro 694 pode ser recebido de maneira justa na abertura 681 do quadro 682. Em vários exemplos, o quadro 694 e o quadro 682 podem ser unidos por encaixe por pressão. Em certos exemplos, o quadro 682 pode ser encaixado por pressão entre o quadro 694 e o colar 690. Em alguns exemplos, uma conexão tipo baioneta pode ser formada entre o quadro 682 e o quadro 694. Em ao menos uma modalidade, o quadro 694 pode incluir uma ou mais fendas tipo baioneta 692 definidas no mesmo que podem ser, cada uma, configuradas para receber uma coluna 699 que se estende para dentro do quadro 682. A fim de montar o quadro 682 no quadro 694, as colunas 699 podem ser posicionadas nas fendas 692 e empurradas distalmen- te até que alcancem uma volta ou uma dobra nas fendas 692. Nesse ponto, o quadro 682 pode ser girado ou torcido a fim de travar as colunas 699 nas fendas 692. A fim de desconectar o quadro 682 do quadro 694, o quadro 682 pode ser girado na direção oposta para mover as colunas 699 para uma posição destravada de modo que o quadro 682 possa ser, então, puxado empurrado na direção contrária ao quadro 694.
[00166] Conforme discutido acima, o colar 690 pode compreender uma porção de conexão. Em vários exemplos, o colar 690 pode compreender uma ou mais fendas de acionamento 691 definidas no mesmo que podem ser configuradas para receber ao menos uma porção do acionamento externo giratório 686 do mecanismo de disparo 680 Em certos exemplos, o acionamento externo giratório 686 pode incluir uma ou mais abas de acionamento 687 que podem ser posicionadas nas fendas de acionamento 691. Em ao menos um exemplo, o colar 690 pode incluir uma primeira fenda de acionamento 691 situada em um primeiro lado do colar 690 e uma segunda fenda de acionamento 691 situada em um segundo lado, ou oposto, do colar 690 e, de modo correspondente, o acionamento externo giratório 686 pode incluir uma primeira aba de acionamento 687 posicionável na primeira fenda de acionamento 691 e uma segunda aba de acionamento 687 posicioná- vel na segunda fenda de acionamento 691. Em uso, as abas de acionamento 687 podem transmitir movimento giratório do acionamento externo giratório 686 para o colar giratório 690. Em vários exemplos, as abas de acionamento 687 podem ser recebidas de modo justo nas fendas de acionamento 691 de modo que as abas de acionamento 687 possam engatar-se às paredes laterais das fendas de acionamento 691 que estão posicionadas nas mesmas. Em uso, o acionamento externo 686 pode ser girado em uma primeira direção a fim de girar o colar 690 em uma primeira direção e fechar o atuador de extremidade 606. Conforme apresentado acima, o acionamento externo 686 pode ser utilizado para fechar o atuador de extremidade 606, comprimir o cartucho 612 e deformar os grampos 14. Em qualquer ponto adequado durante o uso do atuador de extremidade 606, o acionamento externo 686 pode ser girado em uma segunda direção a fim de girar o colar em uma segunda direção, ou oposta, e abrir o atuador de extremidade 606
[00167] Conforme discutido acima, o membro de corte 640 pode incluir um membro de conexão 643. Em vários exemplos, o membro de conexão 643 pode incluir uma fenda de conexão 644 definida no mesmo que pode ser configurada para receber ao menos uma porção do acionamento interno transladável 688 do mecanismo de disparo 680. Em certas modalidades, o acionamento interno 688 pode incluir uma extremidade de acionamento 684 que pode ser retida de modo liberável na fenda de conexão 644. Conforme ilustrado nas Figuras 29 e 30, o acionamento interno 688 pode ser inserido na abertura de quadro 693 para conectar a extremidade de acionamento 684 ao membro de corte 640. Em uso, o acionamento interno 688 pode ser empurrado distalmente a fim de empurrar o membro de corte 640 distalmente e cortar transversalmente o cartucho de grampos 612 e/ou o tecido posi- cionado entre o cartucho de grampos 612 e a bigorna 610. Em vários exemplos, o acionamento interno 688 pode ser operado após o acionamento externo 686 ser operado. Em ao menos um exemplo, os grampos 14 podem ser completamente formados antes de o membro de corte 640 ser avançado. Em outros exemplos, o acionamento interno 688 e o acionamento externo 686 podem ser operados simultaneamente.
[00168] Em uso, o colar giratório 690 pode, ou não, ter a capacidade de pivotar as garras 608a e 608b para suas posições completamente fechadas. Tais exemplos podem ocorrer tipicamente quando o tecido capturado entre as garras 608a e 608b for espesso. Em várias modalidades, o membro de corte 640 pode incluir um ou mais flanges de ajuste de vão, como os flanges 641a e 641b, por exemplo, que podem facilitar o fechamento das garras 608a e 608b. Mais particularmente, o membro de corte 640 pode incluir um primeiro flange de ajuste de vão 641a que pode ser configurado para engatar-se à primeira garra 608a conforme o membro de corte 640 é avançado distalmente. Em vários exemplos, o primeiro flange 641a, o segundo flange 641b e a porção de corte podem compreender uma configuração com formato em I ou de feixe I, por exemplo. Referindo-se principalmente à Figura 31, o primeiro flange 641a pode deslizar em uma fenda definida na superfície de topo da primeira garra 608a. De modo similar, o membro de corte 640 pode incluir um segundo flange de ajuste de vão 641b que pode ser configurado para engatar-se à segunda garra 608b conforme o membro de corte 640 é avançado distalmente. Referindo-se principalmente à Figura 31, o segundo flange 641b pode deslizar em uma fenda definida na superfície de topo da segunda garra 608b. Conforme o membro de corte 640 é avançado distalmente, os flanges 641a e 641b podem controlar, ou ajustar, a distância entre a primeira garra 608a e a segunda garra 608b. Em vários exemplos, o tecido capturado no atua- dor de extremidade 606, o cartucho de grampos 612 e/ou uma mola de inclinação do atuador de extremidade 606 pode inclinar as garras 608a e 608b para fora contra os flanges 641a e 641b, respectivamente. Em alguns exemplos, o membro de corte 640 pode mover as garras 608a e 608b para suas posições completamente fechadas. São contempladas modalidades nas quais o avanço do membro de corte 640 pode ser suficiente para fechar as garras 608a e 608b, disparar os grampos 14 e incisar o tecido T, por exemplo.
[00169] Os dispositivos aqui descritos podem ser projetados para que sejam descartados após um único uso, ou podem ser projetados para que sejam usados múltiplas vezes. Em qualquer 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, seguida de limpeza ou substituição de peças específicas e subsequente remontagem. Em particular, o dispositivo pode ser desmontado e qualquer número de peças ou partes específicas do dispositivo podem ser seletivamente substituídas ou removidas, em qualquer combinação. Mediante a limpeza e/ou substituição de partes específicas, o dispositivo pode ser remontado para uso subsequente na instalação de recondicionamento ou por uma equipe cirúrgica, imediatamente antes de um procedimento cirúrgico. Os versados na técnica entenderão que o recondicionamento de um dispositivo pode usar uma variedade de técnicas para desmontar, limpar/substituir e remontar. O uso de tais técnicas e o dispositivo recondicionado resultante estão dentro do escopo do presente pedido.
[00170] De preferência, a invenção aqui descrita será processada antes da cirurgia. Primeiramente, 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, 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, como radiação gama, raios X ou elétrons de alta energia. A radiação extermina bactérias no instrumento e no recipiente. O instrumento esterilizado pode ser, então, armazenado no recipiente estéril. O recipiente vedado mantém o instrumento estéril até que o mesmo seja aberto na unidade médica.
[00171] Qualquer patente, publicação ou outro material de revelação, no todo ou em parte, que seja tido como incorporado a título de referência à presente invenção, é incorporado à presente invenção apenas até o ponto em que os materiais incorporados não entrem em conflito com definições, declarações ou outro material de revelação existentes apresentados nesta revelação. Desse modo, e na medida em que for necessário, a revelação como explicítamente aqui apresen-tada substitui qualquer material conflitante incorporado à presente invenção a título de referência. Qualquer material, ou porção do mesmo, tido como aqui incorporado a título de referência, mas que entre em conflito com as definições, declarações ou outro material de revelação existentes aqui apresentados estará aqui incorporado apenas na medida em que não haja conflito entre o material incorporado e o material de revelação existente.
[00172] Embora esta invenção tenha sido descrita como tendo designs exemplificadores, a presente invenção pode ser adicionalmente modificada dentro do espírito e do escopo da revelação. Pretende-se, portanto, que este pedido cubra quaisquer variações, usos ou adaptações da invenção com o uso de seus princípios gerais Adicionalmente, este pedido tem por objetivo abranger esses desvios da presente revelação que possam ocorrer com a prática conhecida ou costumeira na técnica à qual esta invenção está relacionada
Claims (17)
1. Atuador de extremidade (6) que não está ligado à haste de um instrumento cirúrgico compreendendo: um conjunto de bigorna compreendendo: um primeiro membro de garra (8a) compreendendo uma bigorna (10); e um segundo membro de garra na forma de um quadro de bigorna (8b) compreendendo uma canaleta de cartucho de grampos (42) configurada para receber um cartucho de grampos (12) na mesma; em que a bigorna compreende: uma extremidade proximal de pivô acoplada de modo giratório ao quadro de bigorna; uma extremidade distal móvel; e uma superfície de formação de grampo; caracterizado pelo fato de que o atuador de extremidade ainda compreende: um sistema de fechamento (20) configurado para engatar a segunda extremidade da bigorna; e um sistema de acionamento incluindo um conector de entrada, em que o sistema de acionamento é configurado para operar o sistema de fechamento e para fazer a transição da bigorna de uma posição aberta para uma posição fechada, e em que um atuador pode ser acoplado ao sistema de acionamento após o atuador de extremidade ser inserido em um local de tratamento.
2. Atuador de extremidade, de acordo com a reivindicação 1, caracterizado pelo fato de que o sistema de fechamento compreende um elemento deslizante de extremidade proximal (22a) configurado para fazer interface de modo deslizante com uma extremidade proximal do quadro de bigorna para fazer a transição da bigorna da posição aberta para a posição fechada.
3. Atuador de extremidade, de acordo com a reivindicação 2, caracterizado pelo fato de que o sistema de fechamento compreende um elemento deslizante de extremidade distal (22b) configurado para fazer interface de modo deslizante com uma extremidade distal do quadro de bigorna para fazer a transição da bigorna da posição aberta para a posição fechada.
4. Atuador de extremidade, de acordo com a reivindicação 3, caracterizado pelo fato de que ainda compreende: um eixo proximal (26a) acoplado de modo deslizante à extremidade proximal do quadro de bigorna, em que o elemento deslizante de extremidade proximal é acoplado ao eixo proximal; um eixo distal (26b) acoplado de modo deslizante à extremidade distal do quadro de bigorna, em que o elemento deslizante de extremidade distal é acoplado ao eixo distal, e em que o sistema de fechamento é configurado para deslizar o elemento deslizante de extremidade proximal e o elemento deslizante de extremidade distal um na direção do outro para fazer a transição da bigorna da posição aberta para a posição fechada.
5. Atuador de extremidade, de acordo com a reivindicação 4, caracterizado pelo fato de que o elemento deslizante de extremidade proximal e o elemento deslizante de extremidade distal são configurados para fazer interface com uma pinça, e em que o atuador compreende uma pinça (154).
6. Atuador de extremidade, de acordo com a reivindicação 3, caracterizado pelo fato de que ainda compreende um eixo giratório (464) acoplado ao elemento deslizante de extremidade proximal e ao elemento deslizante de extremidade distal, em que a rotação do eixo giratório em uma primeira direção move o elemento deslizante de extremidade proximal e o elemento deslizante de extremidade distal na direção de um centro do quadro de bigorna, e em que a rotação do eixo giratório em uma direção oposta move o elemento deslizante de extremidade proximal e o elemento deslizante de extremidade distal na direção contrária ao centro do quadro de bigorna.
7. Atuador de extremidade, de acordo com a reivindicação 1, caracterizado pelo fato de que ainda compreende um instrumento de corte (40), em que o instrumento de corte é configurado para cortar uma seção de tecido (T) situada entre a bigorna e a canaleta de cartucho de grampos quando a bigorna fizer a transição para a posição fechada.
8. Atuador de extremidade, de acordo com a reivindicação 1, caracterizado pelo fato de que ainda compreende: um eixo giratório (464) situado dentro do quadro de bigorna; um instrumento de corte (440) engatado de modo operacional ao eixo giratório, em que a rotação do eixo giratório é configurada para mover o instrumento de corte entre a extremidade de pivô e a extremidade distal da bigorna.
9. Atuador de extremidade, de acordo com a reivindicação 1, caracterizado pelo fato de que ainda compreende uma pluralidade de dentes (38) correspondendo a uma pluralidade de alturas da bigorna, em que a pluralidade de dentes é configurada para fornecer uma indicação de uma altura atual da bigorna em relação ao quadro de bigorna.
10. Atuador de extremidade, de acordo com a reivindicação 1, caracterizado pelo fato de que um quadro de bigorna compreende uma primeira extremidade e uma segunda extremidade; em que a bigorna é acoplada ao quadro de bigorna entre uma posição aberta e uma posição fechada; em que o quadro de bigorna ainda compreende um cartucho de grampos compreendendo: um corpo de cartucho (18) compreendendo uma pluralidade de cavidades de grampo; e uma pluralidade de grampos (14) posicionados de modo removível nas cavidades de grampo; em que o sistema de fechamento compreende um primeiro came (22a) móvel em relação à primeira extremidade do quadro de bigorna e um segundo came (22b) móvel em relação à segunda extremidade do quadro de bigorna, em que o movimento do primeiro came em relação a primeira extremidade do quadro de bigorna e o segundo came em relação à segunda extremidade do quadro de bigorna faz a transição da bigorna entre a posição aberta e a posição fechada.
11. Atuador de extremidade, de acordo com a reivindicação 10, caracterizado pelo fato de que a bigorna compreende um primeiro chanfro (32) e um segundo chanfro (32), em que o primeiro came compreende uma primeira rampa (30), em que o segundo came compreende uma segunda rampa (30), e em que a primeira rampa é configurada para fazer interface com o primeiro chanfro e a segunda rampa é configurada para fazer interface com o segundo chanfro para fechar a bigorna em um movimento paralelo.
12. Atuador de extremidade, de acordo com a reivindicação 11, caracterizado pelo fato de que ainda compreende um eixo giratório (464) apoiado de modo giratório pelo quadro de bigorna, em que o eixo giratório é engatado de modo operacional ao primeiro came e ao segundo came, e em que a rotação do eixo giratório faz com que o primeiro came e o segundo came se movam um na direção do outro e faz a transição da bigorna entre a posição aberta e a posição fechada.
13. Atuador de extremidade, de acordo com a reivindicação 12, caracterizado pelo fato de que ainda compreende um instrumento de corte (440) acoplado ao eixo giratório, em que a rotação do eixo giratório avança o instrumento de corte a partir da primeira extremida- de na direção da segunda extremidade do quadro de bigorna.
14. Atuador de extremidade, de acordo com a reivindicação 10, caracterizado pelo fato de que o primeiro came compreende uma primeira superfície de empuxo, em que o segundo came compreende uma segunda superfície de empuxo, e em que a primeira superfície de empuxo e a segunda superfície de empuxo são configuradas para fazer interface com uma pinça.
15. Atuador de extremidade, de acordo com a reivindicação 10, caracterizado pelo fato de que ainda compreende um instrumento de corte (40), em que o instrumento de corte é configurado para cortar uma seção de tecido situada entre a bigorna e a canaleta de cartucho de grampos quando a bigorna fizer a transição para a posição fechada.
16. Atuador de extremidade, de acordo com a reivindicação 10, caracterizado pelo fato de que ainda compreende um instrumento de corte (440), em que o instrumento de corte é configurado para cortar uma seção de tecido situada entre a bigorna e a canaleta de cartucho de grampos após a bigorna fazer a transição para uma posição fechada.
17. Atuador de extremidade, de acordo com a reivindicação 10, caracterizado pelo fato de que o primeiro came e o segundo came compreendem, cada um, um fechamento regulável, em que cada fechamento regulável compreende uma pluralidade de endentações de calibração (38) configuradas para indicar uma quantidade de fechamento da bigorna, e em que o primeiro came e o segundo came são independentemente móveis para ajustar a quantidade de fechamento.
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2014
- 2014-02-12 US US14/178,840 patent/US9962161B2/en active Active
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2015
- 2015-01-21 CN CN201580008291.1A patent/CN106061406B/zh active Active
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US20180161034A1 (en) | 2018-06-14 |
JP2017505674A (ja) | 2017-02-23 |
CN106061406B (zh) | 2019-08-16 |
JP6472811B2 (ja) | 2019-02-20 |
CN106061406A (zh) | 2016-10-26 |
EP3536251A1 (en) | 2019-09-11 |
EP2907455A2 (en) | 2015-08-19 |
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