BR112017005356B1 - Aparelho com atuador do acionador de grampo cirúrgico - Google Patents
Aparelho com atuador do acionador de grampo cirúrgico Download PDFInfo
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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
- A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
- A61B17/105—Wound clamp magazines
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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
-
- 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
- A61B17/068—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
-
- 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
- A61B2017/07278—Stapler heads characterised by its sled or its staple holder
-
- 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
Abstract
"grampeador cirúrgico com uma pluralidade de elementos de corte. a presente invenção refere-se a um aparelho que compreende um corpo, um conjunto de eixo de acionamento, um atuador de extremidade, um cartucho e um atuador do acionador de grampos. o atuador de extremidade é operável para manipular tecido. o atuador de extremidade compreende uma garra inferior, uma bigorna pivotante e um cortador transladante. o cortador transladante é operável para transladar em relação à garra inferior e a bigorna quando a bigorna é pivotada em direção à garra inferior, para manipular o tecido. o cartucho é inserível na garra inferior e inclui uma pluralidade de grampos. o atuador do acionador de grampos é disposto dentro do cartucho. o atuador do acionador de grampos compreende um elemento de corte secundário. o cortador transladante do atuador de extremidade é operável para acionar o atuador do acionador de grampos distalmente para grampear e cortar o tecido de maneira substancialmente simultânea.
Description
[0001] Em alguns casos, instrumentos cirúrgicos endoscópicospodem ser preferenciais em relação aos dispositivos para cirurgias abertas tradicionais, já que uma incisão menor pode reduzir o tempo de recuperação e as complicações no período pós-operatório. Consequentemente, alguns instrumentos cirúrgicos endoscópicos podem ser adequados para colocação de um atuador de extremidade distal em um sítio cirúrgico desejado por meio da cânula de um trocarte. Estes atuadores de extremidade distal podem engatar o tecido de várias formas para obter um efeito diagnóstico ou terapêutico (por exemplo, endocortador, garra, cortador, grampeador, aplicador de clipes, dispositivo de acesso, dispositivo de aplicação de fármaco/terapia gênica e dispositivo para aplicação de energia através do uso de vibração ultrassônica, RF, laser, etc.). Os instrumentos cirúrgicos endoscópicos podem compreender uma haste entre o atuador de extremidade e uma porção de cabo, que é manipulada pelo médico. Essa haste pode permitir inserção até uma profundidade desejada e rotação em torno do eixo longitudinal da própria haste, facilitando assim o posicionamento do atuador de extremidade no paciente. O posicionamento de um atuador de extremidade pode ser adicionalmente facilitado através da inclusão de uma ou mais juntas ou elementos de articulação, permitindo que o atuador de extremidade seja seletivamente articulado ou de outro modo defletido em relação ao eixo longitudinal da haste.
[0002] Exemplos de instrumentos cirúrgicos endoscópicos incluemgrampeadores cirúrgicos. Alguns desses grampeadores funcionam de modo a prender camadas de tecido, cortar através das camadas de tecido presas e fazer com que os grampos atravessem as camadas de tecido para selar substancialmente as camadas cortadas de tecido umas às outras, próximo a suas extremidades cortadas. Grampeadores cirúrgicos meramente exemplares são apresentados na patente US N° 4.805.823, intitulada "Pocket Configuration for Internal Organ Staplers", concedida em 21 de fevereiro de 1989; na patente US N° 5.415.334, intitulada "Surgical Stapler and Staple Cartridge", concedida em 16 de maio de 1995; na patente US N° 5.465.895, intitulada "Surgical Stapler Instrument", concedida em 14 de novembro de 1995; na patente US N° 5.597.107, intitulada "Surgical Stapler Instrument", concedida em terça-feira, 28 de janeiro de 1997; na patente US N° 5.632.432, intitulada "Surgical Instrument", concedida em 27 de maio de 1997; na patente US N° 5.673.840, intitulada "Surgical Instrument", concedida em terça-feira, 7 de outubro de 1997; na patente US N° 5.704.534, intitulada "Articulation Assembly for Surgical Instruments", concedida em 6 de janeiro de 1998; na patente US N° 5.814.055, intitulada "Surgical Clamping Mechanism", concedida em 29 de setembro de 1998; na patente US N° 6.978.921, intitulada "Surgical Stapling Instrument Incorporating an E-Beam Firing Mechanism", concedida em 27 de dezembro de 2005; na patente US N° 7.000.818, intitulada "Surgical Stapling Instrument Having Separate Distinct Closing and Firing Systems", concedida em 21 de fevereiro de 2006; na patente US N° 7.143.923, intitulada "Surgical Stapling Instrument Having a Firing Lockout for an Unclosed Anvil", concedida em 5 de dezembro de 2006; na patente US N° 7.303.108, intitulada "Surgical Stapling Instrument Incorporating a Multi-Stroke Firing Mechanism with a Flexible Rack", concedida em 4 de dezembro de 2007; na patente US N° 7.367.485, intitulada "Surgical Stapling Instrument Incorporating a Multistroke Firing Mechanism Having a Rotary Transmission", concedida em 6 de maio de 2008; na patente US N° 7.380.695, intitulada "Surgical Stapling Instrument Having a Single Lockout Mechanism for Prevention of Firing", concedida em 3 de junho de 2008; na patente US N° 7.380.696, intitulada "Articulating Surgical Stapling Instrument Incorporating a Two-Piece E-Beam Firing Mechanism", concedida em 3 de junho de 2008; na patente US N° 7.404.508, intitulada "Surgical Stapling and Cutting Device", concedida em 29 de julho de 2008; na patente US N° 7.434.715, intitulada "Surgical Stapling Instrument Having Multistroke Firing with Opening Lockout", concedida em 14 de outubro de 2008; na patente US N° 7.721.930, intitulada "Disposable Cartridge with Adhesive for Use with a Stapling Device", concedida em 25 de maio de 2010; na patente US N° 8.408.439, intitulada "Surgical Stapling Instrument with An Articulatable End Effector", concedida em 2 de abril de 2013; e na patente US N° 8.453.914, intitulada "Motor- Driven Surgical Cutting Instrument with Electric Actuator Directional Control Assembly", concedida 4 de junho de 2013. A descrição de cada uma das patentes US supracitadas está incorporada na presente invenção a título de referência.
[0003] Embora os grampeadores cirúrgicos supracitados sejamdescritos como usados em procedimentos endoscópicos, deve-se compreender que esses grampeadores cirúrgicos também podem ser usados em procedimentos abertos e/ou outros procedimentos não- endoscópicos. Somente a título de exemplo, um grampeador cirúrgico pode ser inserido através de uma toracotomia e, assim, entre as costelas do paciente, para alcançar um ou mais órgãos em um procedimento cirúrgico torácico que não utiliza um trocarte como conduto para o grampeador. Tais procedimentos podem incluir o uso do grampeador para cortar e fechar um vaso sanguíneo que leva a um pulmão. Por exemplo, os vasos que levam a um órgão podem ser cortados e fechados por um grampeador antes da remoção do órgão da cavidade torácica. Naturalmente, grampeadores cirúrgicos podem ser usados em vários outros cenários e procedimentos.
[0004] Exemplos de grampeadores cirúrgicos que podem serparticularmente adequados ou usados através de uma toracotomia são revelados na publicação de patente US N° 2014/0243801, intitulada "Surgical Instrument End Effector Articulation Drive with Pinion and Opposing Racks", publicada em 28 de agosto de 2014; publicação de patente US N° 2014/0239041, intitulada "Lockout Feature for Movable Cutting Member of Surgical Instrument", publicada em 28 de agosto de 2014; publicação de patente US N° 2014/0239042, intitulada "Integrated Tissue Positioning and Jaw Alignment Features for Surgical Stapler", publicada em 28 de agosto de 2014; publicação de patente US N° 2014/0239036, intitulada "Jaw Closure Feature for End Effector of Surgical Instrument", publicada em 28 de agosto de 2014; publicação de patente US N° 2014/0239040, intitulada "Surgical Instrument with Articulation Lock having a Detenting Binary Spring", publicada em 28 de agosto de 2014; publicação de patente US N° 2014/0239043, intitulada "Distal Tip Features for End Effector of Surgical Instrument", publicada em 28 de agosto de 2014; publicação de patente US N° 2014/0239037, intitulada "Staple Forming Features for Surgical Stapling Instrument", publicada em 28 de agosto de 2014; publicação de patente US N° 2014/0239038, intitulada "Surgical Instrument with Multi-Diameter Shaft", publicada em 28 de agosto de 2014; e/ou da publicação de patente US N° 2014/0239044, intitulada "Installation Features for Surgical Instrument End Effector Cartridge", publicada em 28 de agosto de 2014. A divulgação de cada um dos Pedidos de Patente US supracitados está incorporada na presente invenção a título de referência.
[0005] Apesar de vários tipos de instrumentos de grampeamentocirúrgico e componentes associados terem sido produzidos e usados, acredita-se que ninguém antes do(s) inventor(es) tenha produzido ou usado a invenção descrita nas reivindicações em anexo.
[0006] Os desenhos em anexo, que estão incorporados a esterelatório descritivo e que constituem parte do mesmo, ilustram modalidades da invenção e, junto com a descrição geral fornecida acima, e a descrição detalhada das modalidades fornecidas abaixo, servem para explicar os princípios da presente invenção.
[0007] A Figura 1 mostra uma vista em perspectiva de uminstrumento de grampeamento cirúrgico exemplificador;
[0008] A Figura 2 representa uma vista em elevação lateral doinstrumento da Figura 1;
[0009] A Figura 3 representa uma vista em perspectiva do atuadorde extremidade do instrumento da Figura 1, com o atuador de extremidade em uma configuração fechada;
[0010] A Figura 4 representa uma vista em perspectiva do atuadorde extremidade da Figura 3, com o atuador de extremidade em uma configuração aberta;
[0011] A Figura 5 representa uma vista em perspectiva explodidado atuador de extremidade da Figura 3;
[0012] A Figura 6 representa uma vista em seção transversal daextremidade do atuador de extremidade da Figura 3, tomada ao longo da linha 6-6 da Figura 4;
[0013] A Figura 7A representa uma vista lateral em seçãotransversal do atuador de extremidade da Figura 3, tomada ao longo da linha 7-7 da Figura 4, com uma barra de disparo em uma posição proximal;
[0014] A Figura 7B representa uma vista lateral em seçãotransversal do atuador de extremidade da Figura 3, tomada ao longo da linha 7-7 da Figura 4, com a barra de disparo em uma posição distal;
[0015] A Figura 8 representa uma vista em perspectiva do atuadorde extremidade da Figura 3, posicionado no tecido e após ser acionado uma vez no tecido;
[0016] A Figura 9 descreve uma vista esquemática de um circuitode controle exemplar para uso no instrumento da Figura 1;
[0017] A Figura 10 descreve uma vista em perspectiva do conjuntodo cabo do instrumento da Figura 1, com um compartimento removido pela metade e alguns componentes internos removidos;
[0018] A Figura 11 descreve uma vista em perspectiva doscomponentes do conjunto de acionamento do conjunto de cabo da Figura 10;
[0019] A Figura 12 representa uma vista em perspectiva de ummembro alongado do conjunto de acionamento da Figura 11, acoplado à barra de disparo;
[0020] A Figura 13 representa uma vista em perspectiva parcial deum cartucho de grampos exemplificador do atuador de extremidade da Figura 3 com um suporte exemplificador disposto acima e sobre uma superfície de topo exterior do cartucho de grampos;
[0021] A Figura 14 representa uma vista em elevação do atuadorde extremidade da Figura 3 e do suporte da Figura 13 disposto sobre e entre um lado inferior da bigorna e a superfície de topo exterior do cartucho de grampos;
[0022] A Figura 15 representa uma vista em perspectiva de umatuador de extremidade com o suporte da Figura 13, o atuador de extremidade tendo grampos disparados e liberados e o suporte da Figura 13 em e sobre o tecido;
[0023] A Figura 16 representa uma vista em perspectiva parcial deuma variação exemplificadora do atuador de extremidade da Figura 3, com uma porção do atuador de extremidade cortada para revelar um deslizador em cunha equipado com uma lâmina de corte giratória secundária;
[0024] A Figura 17 representa uma vista em elevação lateral dodeslizador em cunha da Figura 16 com a lâmina de corte secundária em uma posição estendida;
[0025] A Figura 18 representa uma vista em perspectiva parcial deuma outra variação exemplificadora do atuador de extremidade da Figura 3, com uma porção do atuador de extremidade recortada para revelar um deslizador em cunha equipado com uma lâmina de corte fixa secundária;
[0026] A Figura 19 representa uma vista em seção transversallateral do deslizador em cunha da Figura 18, tomada ao longo da linha 19-19 da Figura 18, com o deslizador em cunha em uma posição proximal;
[0027] A Figura 20 representa uma vista em seção transversallateral do deslizador em cunha da Figura 18, tomada ao longo da linha 19-19 da Figura 18, com o deslizador em cunha em uma posição distal;
[0028] A Figura 21 representa uma vista lateral em seçãotransversal de uma variação exemplificadora do deslizador em cunha da Figura 18;
[0029] A Figura 22 representa uma vista em perspectiva de umoutro deslizador em cunha exemplificador para uso com o atuador de extremidade da Figura 3, o deslizador em cunha tendo uma lâmina de corte secundária transladável para cima;
[0030] A Figura 23 representa uma vista em seção transversallateral do atuador de extremidade da Figura 22, tomada ao longo da linha 23-23 da Figura 22, com a lâmina de corte secundária em uma posição retraída;
[0031] A Figura 24 representa uma vista em seção transversallateral do deslizador em cunha da Figura 22, tomada ao longo da linha 23-23 da Figura 22, com a lâmina de corte secundária em uma posição estendida;
[0032] A Figura 25 representa uma vista em perspectiva de umoutro deslizador em cunha exemplificador para uso com o atuador de extremidade da Figura 3, o deslizador em cunha tendo uma lâmina de corte secundária fixa com um nariz estabilizante; e
[0033] A Figura 26 representa uma vista em seção transversallateral do deslizador em cunha da Figura 25, tomada ao longo da linha 26-26 da Figura 25, com a lâmina de corte secundária avançando distalmente;
[0034] De algum modo, os desenhos destinam-se a ser limitantese contempla-se que várias modalidades da invenção possam ser executadas em uma variedade de outras maneiras, incluindo aquelas não necessariamente representadas nos desenhos. Os desenhos em anexo incorporados e que constituem uma parte do relatório descritivo ilustram vários aspectos da presente invenção e, juntamente com a descrição, servem para explicar os princípios da invenção; entendendo-se, entretanto, que esta invenção não se limita especificamente às disposições mostradas.
[0035] A descrição a seguir de exemplos específicos da invençãonão deve ser usada para limitar o escopo da presente invenção. Outros exemplos, características, aspectos, modalidades e vantagens da invenção ficarão evidentes aos versados na técnica a partir da descrição a seguir, que é, a título de ilustração, um dos melhores modos contemplados para executar a invenção. Conforme será compreendido, a invenção pode ter outros aspectos diferentes e óbvios, todos sem que se afaste da invenção. Consequentemente, os desenhos e as descrições devem ser considerados como de natureza ilustrativa e não restritiva.
[0036] A Figura 1 representa um instrumento de grampeamento ecorte cirúrgico 10 exemplificador que inclui um conjunto de cabo 20, um conjunto de haste 30, e um atuador de extremidade 40. O atuador de extremidade 40 e a porção distal do conjunto de eixo 30 são dimensionados para inserção, em um estado não articulado como representado na Figura 1, através de uma cânula de trocarte para um local cirúrgico em um paciente para realizar um procedimento cirúrgico. Somente a título de exemplo, tal trocarte pode ser inserido no abdômen do paciente, entre duas das costelas do paciente, ou em outra parte. Em alguns casos, o instrumento 10 é usado sem um trocarte. Por exemplo, o atuador de extremidade 40 e a porção distal do conjunto de eixo 30 podem ser inseridos diretamente através de uma toracotomia ou outro tipo de incisão. Deve-se compreender que termos como "proximal" e "distal" são usados na presente invenção com referência a um médico segurando o conjunto de cabo 20 do instrumento 10. Dessa forma, o atuador de extremidade 40 é distal em relação ao conjunto de cabo 20 mais proximal. Será entendido ainda que, para conveniência e clareza, os termos espaciais como "vertical" e "horizontal" são usados na presente invenção em relação aos desenhos. Entretanto, os instrumentos cirúrgicos são usados em muitas orientações e posições, e tais termos não se destinam a serem limitadores e absolutos.A. Conjunto de cabo e conjunto de eixo exemplificadores
[0037] Conforme representado nas Figuras 1-2, o conjunto decabo 20 do presente exemplo compreende uma empunhadura de pistola 22, um gatilho de fechamento 24 e um gatilho de disparo 26. Cada gatilho 24, 26 pode ser seletivamente pivotante em direção e para longe da empunhadura de pistola 22 como será descrito com mais detalhes abaixo. O conjunto de cabo 20 inclui, ainda, um botão de liberação de bigorna 25, uma chave inversa da barra de disparo 27, e um conjunto de bateria removível 28. Estes componentes serão também descritos com mais detalhes abaixo. Naturalmente, o conjunto de cabo 20 pode ter uma variedade de outros componentes, recursos e funcionalidades, além de, ou em vez de, qualquer um dos elementos mencionados acima. Outras configurações adequadas para o conjunto de cabo 20 se tornarão evidentes para os versados na técnica considerando os ensinamentos da presente invenção.
[0038] Conforme representado nas Figuras 1-3, a conjunto de eixo30 do presente exemplo compreende um tubo de fechamento externo 32, uma seção de articulação 34, e um anel de fechamento 36, que é ainda acoplado a um atuador de extremidade 40. O tubo de fechamento 32 estende-se ao longo do comprimento do conjunto de eixo 30. O anel de fechamento 36 está posicionado distal à seção de articulação 34. O tubo de fechamento 32 e o anel de fechamento 36 são configurados para transladar longitudinalmente em relação ao conjunto de cabo 20. A translação longitudinal do tubo de fechamento 32 é comunicada ao anel de fechamento 36 através da seção de articulação 34. Os recursos exemplificadores que podem ser usados para fornecer a translação longitudinal do tubo de fechamento 32 e do anel de fechamento 36 serão descritos com mais detalhes abaixo.
[0039] A seção de articulação 34 é operável para defletirlateralmente o anel de fechamento 36 e o atuador de extremidade 40 lateralmente para longe do eixo longitudinal LA do conjunto de eixo 30 em um ângulo desejado α. Assim, atuador de extremidade 40 pode alcançar a parte de trás de um órgão, ou se aproximar do tecido a partir de um ângulo desejado ou por outras razões. Em algumas versões, a seção de articulação 34 permite deflexão do atuador de extremidade 40 ao longo de um único plano. Em algumas outras versões, a seção de articulação 34 permite deflexão do atuador de extremidade ao longo de mais de um plano. No presente exemplo, a articulação é controlada através de um botão de controle de articulação 35 que está localizado na extremidade proximal do conjunto de eixo 30. O botão 35 é giratório em torno de um eixo que é perpendicular ao eixo longitudinal LA do conjunto de eixo 30. O anel de fechamento 36 e o atuador de extremidade 40 articulam-se em torno de um eixo que é perpendicular ao eixo longitudinal LA do conjunto de eixo 30 em resposta à rotação do botão 35. Apenas a título de exemplo, a rotação do botão 35 no sentido horário pode causar a rotação no sentido horário correspondente do anel de fechamento 36 e do atuador de extremidade 40 na seção de articulação 34. A seção de articulação 34 está configurada para comunicar a translação longitudinal do tubo de fechamento 32 para o anel de fechamento 36, independente da possibilidade de a seção de articulação 34 estar em uma configuração reta ou em uma configuração articulada.
[0040] Em algumas versões, a seção de articulação 34 e/ou ocontrole de articulação 35 é/são construído(s) e operável(is) de acordo com pelo menos alguns dos ensinamentos do Pedido de Patente US N° 13/780.067, intitulado "Surgical Instrument with Sensor and Powered Control", depositado em 28 de fevereiro de 2013, cuja descrição está aqui incorporada a título de referência. A seção de articulação 34 pode também ser construída e operável de acordo com pelo menos alguns dos ensinamentos do pedido de patente US N° 14/314.125, intitulado "Articulation Drive Features for Surgical Stapler", depositado em 25 de junho de 2014, cuja descrição está aqui incorporada a título de referência. e/ou de acordo com os vários ensinamentos abaixo. Outras formas adequadas que a seção de articulação 34 e o botão de articulação 35 podem tomar serão aparentes aos versados na técnica, tendo em vista os ensinamentos da presente invenção.
[0041] Conforme mostrado nas Figuras 1 a 2, o conjunto de eixo30 do presente exemplo inclui, ainda, um botão de rotação 31. O botão de rotação 31 é operável para girar todo o conjunto de eixo 30 e o atuador de extremidade 40, em relação ao conjunto do cabo 20 em torno do eixo longitudinal LA definido pelo conjunto de eixo 30. Em algumas versões, o botão de rotação 31 é operável para travar seletivamente a posição angular do conjunto de eixo 30 e o atuador de extremidade 40, em relação ao conjunto do cabo 20 em torno do eixo longitudinal LA do conjunto de eixo 30. Por exemplo, o botão de rotação 31 pode ser transladável entre uma primeira posiçãolongitudinal, em que o conjunto de eixo 30 e o atuador de extremidade40 são giratórios em relação ao conjunto de cabo 20 em torno do eixo longitudinal LA do conjunto de eixo 30; e uma segunda posiçãolongitudinal, em que o conjunto de eixo 30 e o atuador de extremidade40 não são giratórios em relação ao conjunto de cabo 20 em torno do eixo longitudinal LA do conjunto de eixo 30. Naturalmente, o conjunto de eixo 30 pode ter uma variedade de outros componentes, recursos e funcionalidades, além de, ou em vez de, qualquer um dos elementos mencionados acima. Somente a título de exemplo, pelo menos parte do conjunto de eixo 30 é construída de acordo com pelo menos alguns dos ensinamentos do Pedido de Patente US N° 13/780.402, intitulado "Surgical Instrument with Multi-Diameter Shaft", publicado em 28 de fevereiro de 2013, cuja descrição está aqui incorporada a título de referência. Outras configurações adequadas para o conjunto de eixo 30 serão evidentes aos versados na técnica em vista dos ensinamentos aqui apresentados.B. Atuador de extremidade exemplificador
[0042] Como também representado nas Figuras 1 a 3, o atuadorde extremidade 40 do presente exemplo inclui uma garra inferior 50 e uma bigorna articulada 60. A bigorna 60 inclui um par de pinos 66 integrais que se estendem para fora que estão dispostos em fendas curvas correspondentes 54 da garra inferior 50. Pinos 66 e fendas 54 são mostrados na Figura 5. A bigorna 60 é pivotante em direção e para longe da garra inferior 50 entre uma posição aberta (mostrada nas Figuras 2 e 4) e uma posição fechada (mostrada nas Figuras 1, 3 e 7A a 7B). O uso do termo "pivotante" (e termos similares com "pivô" como a base) não devem ser lidos como necessariamente necessitando de movimento pivotante em torno de um eixo fixo. Por exemplo, no presente exemplo, a bigorna 60 gira em torno de um eixo que é definido pelos pinos 66, que deslizam ao longo das fendas curvas 54 da garra inferior 50 à medida que a bigorna 60 se move para a garra inferior 50. Em tais versões, o eixo de pivô traslada ao longo da trajetória definida pelas fendas 54 enquanto a bigorna 60 gira simultaneamente em torno deste eixo. Além disso ou de maneira alternativa, o eixo de pivô pode deslizar ao longo das fendas 54, com a bigorna 60 então pivotando em torno do eixo de pivô depois que o eixo de pivô deslizou até uma certa distância ao longo das fendas 54. Deve-se compreender que tal movimento pivotante deslizante/traslado é abrangido dentro de termos como "pivô", "pivôs", "pivotante". "giratório", "articulado" e similares. Naturalmente, algumas versões podem proporcionar movimento pivotante da bigorna 60 em torno de um eixo que permanece fixo e não traslada dentro de uma fenda ou canaleta, etc.
[0043] Como melhor visto na Figura 5, a garra inferior 50 dopresente exemplo define uma canaleta 52 que é configurada para receber um cartucho de grampos 70. O cartucho de grampos 70 pode ser inserido na canaleta 52, o atuador de extremidade 40 pode ser atuado e, em seguida, o cartucho de grampos 70 pode ser removido e substituído por um outro cartucho de grampos 70. A garra inferior 50, assim retém de modo liberável o cartucho de grampos 70 em alinhamento com a bigorna 60 para a atuação do atuador de extremidade 40. Em algumas versões, a garra inferior 50 é construída de acordo com pelo menos alguns dos ensinamentos do Pedido de Patente US N° 13/780.417, intitulado "Installation Features for Surgical Instrument End Effector Cartridge", depositado em 28 de fevereiro de 2013, cuja descrição está aqui incorporada a título de referência. Outras formas adequadas que a garra inferior 50 pode tomar serão evidentes para os versados na técnica com base nos ensinamentos da presente invenção.
[0044] Como melhor visto nas Figuras 4 a 6, cartucho de grampos70 do presente exemplo, compreende um corpo de cartucho 71 e uma bandeja 76 presa ao lado inferior do corpo do cartucho 71. O lado superior do corpo do cartucho 71 apresenta uma plataforma 73, contra a qual o tecido pode ser comprimido quando a bigorna 60 está em uma posição fechada. O corpo de cartucho 71 define, ainda, uma canaleta que se estende longitudinalmente 72 e uma pluralidade de bolsos de grampos 74. Um grampo 77 está posicionado em cada bolso de grampos 74. Um acionador de grampos 75 também está posicionado em cada bolso de grampos 74, sob um grampo correspondente 77, e acima da bandeja 76. Como será descrito com mais detalhes abaixo, os acionadores de grampos 75 são operáveis para transladar para cima em bolsos de grampos 74 para, assim, acionar grampos 77 para cima através dos bolsos de grampos 74 e para engate com a bigorna 60. Os acionadores de grampos 75 são movidos para cima por um deslizador em cunha 78, que é capturado entre o corpo de cartucho 71 e a bandeja 76, e que se traduz longitudinalmente através do corpo de cartucho 71. O deslizador em cunha 78 inclui um par de superfícies de came obliquamente anguladas 79, que são configuradas para engatar acionadores de grampos 75 e, desse modo, acionar os acionadores de grampos 75 para cima, à medida que o deslizador em cunha 78 translada longitudinalmente através do cartucho 70. Por exemplo, quando o deslizador em cunha 78 está em uma posição proximal, como mostrado na Figura 7A, os acionadores de grampos 75 estão em posições descendentes e os grampos 77 estão localizados em bolsos de grampos 74. À medida que o deslizador em cunha 78 é acionado para a posição distal mostrada na Figura 7B através de uma translação do membro de faca 80, o deslizador em cunha 78 aciona os acionadores de grampos 75 para cima, assim, acionando os grampos 77 para fora dos bolsos de grampos 74 e nos bolsos de formação de grampos 64. Dessa forma, os acionadores de grampos 75 transladam ao longo de uma dimensão vertical à medida que o deslizador em cunha 78 translada ao longo de uma dimensão horizontal.
[0045] Deve-se compreender que a configuração do cartucho degrampos 70 pode ser variada de inúmeras maneiras. Por exemplo, o cartucho de grampos 70 do presente exemplo inclui duas linhas que se estendem longitudinalmente de bolsos de grampos 74 de um lado da canaleta 72; e um outro conjunto de duas linhas que se estendem longitudinalmente de bolsos de grampos 74 sobre o outro lado da canaleta 72. No entanto, em algumas outras versões, o cartucho de grampos 70 inclui três, um, ou algum outro número de bolsos de grampos 74 em cada lado da canaleta 72. Em algumas versões, o cartucho de grampos 70 é construído e operável de acordo com pelo menos alguns dos ensinamentos do Pedido de Patente US N° 13/780.106, intitulado "Integrated Tissue Positioning and Jaw Alignment Features for Surgical Stapler", depositado em 28 de fevereiro de 2013, cuja descrição está aqui incorporada a título de referência; Além disso ou em alternativa, o cartucho de grampos 70 pode ser construído e operável de acordo com pelo menos alguns dos ensinamentos do Pedido de Patente US N° 13/780.417, intitulado "Installation Features for Surgical Instrument End Effector Cartridge", depositado em 28 de fevereiro de 2013, cuja descrição está aqui incorporada a título de referência. Outras formas adequadas que o cartucho de grampos 70 pode assumir serão evidentes aos versados na técnica, tendo em vista os ensinamentos da presente invenção.
[0046] Como melhor visto na Figura 4, a bigorna 60 do presenteexemplo compreende uma canaleta que se estende longitudinalmente 62 e uma pluralidade de bolsos de formação de grampos 64. A canaleta 62 está configurada para se alinhar com a canaleta 72 do cartucho de grampos 70 quando a bigorna 60 está em uma posição fechada. Cada bolso de formação de grampos 64 está posicionado para se situar sobre um bolso de grampos correspondente 74 de cartucho de grampos 70 quando a bigorna 60 está em uma posição fechada. Os bolsos de formação de grampos 64 estão configurados para deformar as pernas de grampos 77 quando os grampos 77 são acionados através do tecido e para dentro da bigorna 60. Em particular, os bolsos de formação de grampos 64 estão configurados para flexionar as pernas de grampos 77 para prender os grampos 77 formados no tecido. A bigorna 60 pode ser construída de acordo com pelo menos alguns dos ensinamentos do Pedido de Patente US N° 13/780.106, intitulado "Integrated Tissue Positioning and Jaw Alignment Features for Surgical Stapler", depositado em 28 de Fevereiro de 2013; pelo menos alguns dos ensinamentos do Pedido de Patente US N° 13/780.120, intitulado "Jaw Closure Feature for End Effector of Surgical Instrument", depositado em 28 de Fevereiro de 2013; e/ou pelo menos alguns dos ensinamentos do Pedido de Patente US N° 13/780.379, intitulado "Staple Forming Features for Surgical Stapling Instrument", depositado em 28 de fevereiro de 2013, cuja descrição está aqui incorporada a título de referência. Outras formas adequadas que a bigorna 60 pode adquirir serão evidentes para os versados na técnica em vista dos ensinamentos da presente invenção.
[0047] No presente exemplo, um membro de faca 80 estáconfigurado para transladar através do atuador de extremidade 40. Como melhor visto nas Figuras 5 e 7A-7B, um membro de faca 80 é preso à extremidade distal de uma barra de disparo 82, que se estende através de uma porção de conjunto de eixo 30. Como melhor visto nas Figuras 4 e 6, um membro de faca 80 está posicionado em canaletas 62, 72 da bigorna 60 e do cartucho de grampos 70. O elemento de faca 80 inclui um gume cortante distalmente apresentado 84 que é configurado para cortar o tecido que é comprimido entre a bigorna 60 e a plataforma 73 do cartucho de grampos 70 à medida que o elemento de faca 80 traslada distalmente através do atuador de extremidade 40. Conforme observado acima e conforme mostrado nas Figuras 7A-7B, o membro de faca 80 também aciona o deslizador em cunha 78 distalmente à medida que o membro de faca 80 translada distalmente através do atuador de extremidade 40, assim, acionando os grampos 77 através do tecido e contra a bigorna 60 para a formação. Vários recursos que podem ser usados para acionar o membro de faca 80 distalmente através do atuador de extremidade 40 serão descritos com mais detalhes abaixo.
[0048] Em algumas versões, o atuador de extremidade 40 incluirecursos de travamento que estão configurados para impedir que o membro de faca 80 avance distalmente através do atuador de extremidade 40, quando um cartucho de grampos 70 não é inserido na garra inferior 50. Além disso ou alternativamente, o atuador de extremidade 40 pode incluir recursos de travamento que são configuradas para impedir que o membro de faca 80 avance distalmente através do atuador de extremidade 40, quando o cartucho de grampos 70 que já foi atuado uma vez por exemplo, com todos os grampos 77 implantados a partir do mesmo é inserido na garra inferior 50. Somente a título de exemplo, tais recursos de travamento podem ser configurados de acordo com pelo menos alguns dos ensinamentos do Pedido de Patente US N° 13/780.082, intitulado "Lockout Feature for Movable Cutting Member of Surgical Instrument", depositado em 28 de fevereiro de 2013, cuja descrição está aqui incorporada a título de referência; e/ou ao menos alguns dos ensinamentos do pedido de patente US N° 14/314.108, intitulado "Method of Using Lockout Features for Surgical Stapler Cartridge", depositado em 25 de junho de 2014, cuja descrição está aqui incorporada a título de referência. Outras formas adequadas que os recursos de travamento podem adquirir serão evidentes para os versados na técnica em vista dos ensinamentos da presente invenção. Alternativamente, o atuador de extremidade 40 pode simplesmente omitir tais recursos de travamento. C. Atuação de bigorna exemplificadora
[0049] No presente exemplo, a bigorna 60 é acionada para a garrainferior 50 através do avanço do anel de fechamento 36 distalmente em relação ao atuador de extremidade 40. O anel de fechamento 36 coopera com a bigorna 60 através de uma ação de came 60 em direção à garra inferior 50 em resposta à translação distal do anel de fechamento 36 em relação ao atuador de extremidade 40. Do mesmo modo, o anel de fechamento 36 pode cooperar com a bigorna 60 para abrir a bigorna 60 para longe da garra inferior 50 em resposta à translação proximal do anel de fechamento 36 em relação ao atuador de extremidade 40. A título de exemplo apenas, o anel de fechamento 36 e a bigorna 60 podem interagir de acordo com pelo menos alguns dos ensinamentos do Pedido de Patente US N° 13/780.120, intitulado "Jaw Closure Feature for End Effector of Surgical Instrument", depositado em 28 de fevereiro de 2013, cuja descrição está aqui incorporada a título de referência; e/ou pode ser configurado de acordo com pelo menos alguns dos ensinamentos do Pedido de Patente US N° 14/314.108, intitulado "Jaw Opening Feature for Surgical Stapler", depositado em 25 de junho de 2014, cuja descrição está aqui incorporada a título de referência. Recursos exemplificadores que podem ser usados para fornecer a translação longitudinal do anel de fechamento 36 em relação ao atuador de extremidade 40 vão ser descritos com mais detalhes abaixo.
[0050] Como observado acima, conjunto de cabo 20 inclui umaempunhadura de pistola 22 e um gatilho de fechamento 24. Como também observado acima, a bigorna 60 é fechada em direção à garra inferior 50 em resposta ao avanço distal do anel de fechamento 36. No presente exemplo, o gatilho de fechamento 24 é pivotante em direção à empunhadura de pistola 22 para acionar o tubo de fechamento 32 e o anel de fechamento 36 distalmente. Vários componentes adequados que podem ser usados para converter o movimento pivotante do gatilho de fechamento 24 em direção à empunhadura da pistola 22 para a translação distal do tubo de fechamento 32 e o anel de fechamento 36 em relação ao conjunto de cabo 20 serão evidentes para aqueles versados na técnica tendo em vista os ensinamentos aqui contidos. Quando o gatilho de fechamento 24 atinge um estado completamente pivotado, de modo que bigorna 60 esteja em uma posição completamente fechada em relação à garra inferior 50, os recursos de travamento no conjunto de cabo 20 travam a posição do gatilho 24 e o tubo de fechamento 32, travando, assim, a bigorna 60 em uma posição completamente fechada em relação à garra inferior 50. Esses recursos de travamento são liberados pela atuação do botão de liberação da bigorna 25. O botão de liberação da bigorna 25 é configurado e posicionado para ser atuado pelo polegar da mão do operador que segura a empunhadura de pistola 22. Em outras palavras, o operador pode segurar a empunhadura de pistola 22 com uma mão, atuar o gatilho de fechamento 24 com um ou mais dedos da mesma mão e, em seguida, atuar o botão de liberação de bigorna 25 com o polegar da mesma mão, sem precisar liberar o aperto da empunhadura de pistola 22 com a mesma mão. Outros recursos adequados que podem ser usados para atuar a bigorna 60 serão evidentes para os versados na técnica em vista dos ensinamentos da presente invenção.D. Atuação da barra de disparo exemplificadora
[0051] No presente exemplo, o instrumento 10 fornece controlemotorizado da barra de disparo 82. As Figuras de 9 a 12 mostram componentes exemplificadores que podem ser usados para fornecer controle motorizado da barra de disparo 82. Em particular, a Figura 9 mostra um circuito de controle exemplificador 100 que pode ser usado para alimentar um motor elétrico 102 através da energia elétrica de uma bateria 28 (também mostrado nas Figuras 1 e 2). O motor elétrico 102 é operado para trasladar a barra de disparo 82 longitudinalmente conforme será descrito com mais detalhes abaixo. Deve-se compreender que todo o circuito de controle 100, incluindo o motor 102 e o conjunto de bateria 28, pode ser alojado no conjunto de cabo 20. A Figura 9 mostra o gatilho de disparo 26 como uma chave aberta, embora deva-se compreender que esta chave é fechada quando o gatilho de disparo 26 é acionado. O circuito 100 deste exemplo inclui também uma chave de segurança 106 que deve ser fechada a fim de se completar o circuito 100, embora deva-se compreender que a chave de segurança 106 é meramente opcional. A chave de segurança 106 pode ser fechada pela atuação de um botão, elemento deslizante, ou outro recurso separado no conjunto de cabo 20. A chave de segurança 106 pode também fornecer um travamento mecânico do gatilho de disparo 26, de modo que o gatilho de disparo 26 seja mecanicamente impedido de atuação até que a chave de segurança 106 seja atuada.
[0052] O circuito 100 do presente exemplo inclui também umachave de travamento 108, que é configurada para ser fechada por padrão, mas é automaticamente aberta em resposta a uma condição de travamento. Somente a título de exemplo, uma condição de travamento pode incluir uma ou mais dentre as seguintes: a ausência de um cartucho 70 na garra inferior 50, a presença de um cartucho consumido 70 (por exemplo, anteriormente disparado) na garra inferior 50, uma bigorna 60 insuficientemente fechada, uma determinação de que o instrumento 10 foi disparado vezes demais, e/ou quaisquer outras condições adequadas. Vários sensores, algorítimos, e outros recursos que podem ser usados para detectar condições de travamento serão aparentes aos versados na técnica, tendo em vista os ensinamentos da presente invenção. De modo similar, outros tipos adequados de condições de travamento serão aparentes aos versados na técnica, tendo em vista os ensinamentos da presente invenção. Deve-se compreender que o circuito 100 é aberto e, dessa forma, o motor 102 é inoperável quando a chave de travamento 108 está aberta. Um indicador de travamento 110 (por exemplo, um LED, etc.) é operado para fornecer uma indicação visual do estado da chave de travamento 108. Somente a título de exemplo, a chave de travamento 108, o indicador de travamento 110, e componentes/funcionalidade associados podem ser configurados de acordo com ao menos alguns dos ensinamentos da patente US N° 7.644.848, intitulada "Electronic Lockouts and Surgical Instrument Including Same", depositada em 12 de janeiro de 2010, a descrição da mesma estando aqui incorporada a título de referência.
[0053] Uma vez que a barra de disparo 82 alcança uma posição mais distal (por exemplo, na final de uma passada de corte), uma chave de final de passada 112 é automaticamente comutada para uma posição fechada, revertendo a polaridade da tensão aplicada ao motor 102. Isto reverte a direção de rotação do motor 102, devendo-se entender que o operador terá liberado o gatilho de disparo 26 neste estágio da operação. Neste estado operacional, uma corrente flui através de uma direção reversa do indicador 114 (por exemplo, um LED, etc.) para fornecer uma indicação visual ao operador de que a rotação do motor 102 foi revertida. No presente exemplo, e como melhor visto na Figura 12, um braço de atuação de chave 134 se estende lateralmente a partir do membro de cremalheira 130, e está posicionado para engatar a chave de final de passada 112 quando a barra de disparo 82 alcança uma posição mais distal (por exemplo, depois que o tecido 90 foi cortado e os grampos 77 atravessaram o tecido 90). Várias outras formas adequadas, nas quais a chave de final de passada 112 pode ser automaticamente comutada para uma posição fechada quando a barra de disparo 82 alcança uma posição mais distal, serão aparentes aos versados na técnica, tendo e vista os ensinamentos da presente invenção. De modo similar, várias formas adequadas que o indicador de direção reversa 114 pode tomar serão aparentes aos versados na técnica, tendo em vista os ensinamentos da presente invenção.
[0054] O conjunto de cabo 20 do presente exemplo inclui tambémuma chave de retorno manual 116, que também é mostrada no circuito 100. No presente exemplo, a chave de retorno é ativada atuando-se a chave inversa 27, que é mostrada no conjunto de cabo 20 na Figura 1. A chave de retorno manual 116 pode proporcionar uma funcionalidade similar a da chave de final de passada 112, revertendo a polaridade da tensão aplicada ao motor 102 para reverter assim a direção de rotação do motor 102. Novamente, esta reversão pode ser indica visualmente através do indicador de direção reversa 114. Em algumas versões, o conjunto de cabo 20 inclui, ainda, um recurso de retorno mecânico que permite que o operador inverta manualmente a barra de disparo 82 e, deste modo, retraia a barra de disparo 82 mecanicamente. No presente exemplo, esse recurso de retorno manual compreende uma alavanca que é coberta por um painel removível 21, conforme mostrado na Figura 1. A chave de retorno manual 116 e o recurso de retorno mecânico são, cada um, configurados para atuar como um recurso de "resgate", permitindo que o operador comece a retrair rapidamente a barra de disparo 82 de maneira proximal durante um curso de disparo. Em outras palavras, a chave de retorno manual 116 ou o recurso de retorno mecânico pode ser atuado manualmente quando a barra de disparo 82 foi apenas parcialmente avançada distalmente.
[0055] Em algumas versões, uma ou mais chaves 26, 106, 108,112, 116 são apresentadas sob a forma de microchaves. Outrasformas adequadas serão aparentes aos versados na técnica, tendo em vista os ensinamentos da presente invenção. Em adição a ou no lugar do que foi anteriormente mencionado, ao menos parte do circuito 100 pode ser configurada de acordo com ao menos alguns dos ensinamentos da patente US N° 8.210.411, intitulada "Motor-Driven Surgical Instrument", depositada em 3 de julho de 2012, a descrição da mesma estando aqui incorporada a título de referência.
[0056] Em particular, a Figura 10 mostra um motor 102posicionado no interior da empunhadura de pistola 22 do conjunto de cabo 20. Alternativamente, o motor 102 pode ser posicionado em outro local no interior do conjunto de cabo 20. O motor 102 tem um eixo de acionamento 120 que é acoplado a um conjunto de engrenagem 122. Deste modo, quando motor 102 é ativado, o eixo de acionamento 120 atua o conjunto de engrenagem 122. Conforme mostrado na Figura 11, o conjunto de engrenagem 122 está em comunicação com uma engrenagem de acionamento 124, que engrena com um pinhão intermediário 126. O pinhão 126 está disposto sobre um eixo 128 que é suportado no interior do conjunto de cabo 20 e que está orientado paralelamente ao eixo de acionamento 120 do motor 102. O pinhão 126 é ainda engatado com um membro de cremalheira 130. Em particular, o pinhão 126 engrena com os dentes 132 na extremidade proximal do membro de cremalheira 130. O membro de cremalheira 130 é suportado de forma deslizante no conjunto de cabo 20. Deve ser compreendido a partir do exposto acima que, quando o motor 102 é ativado, a rotação correspondente do eixo de acionamento 120 é comunicada ao pinhão 126 através do conjunto de engrenagens 122, e a rotação correspondente do pinhão 126 é convertida para translação do membro de cremalheira 130 pelos dentes 132. Conforme representado nas Figuras 10 a 12, um membro alongado 136 estende- se distalmente a partir de membro de cremalheira 130. Como mostrado na Figura 12, um membro de acoplamento 138 junta a barra de disparo 82 com o membro alongado 136. O membro de cremalheira 130, o membro alongado 136, o membro de acoplamento 138, a barra de disparo 82 e o membro de faca 80, todos transladam em conjunto em relação ao conjunto de cabo 20 em resposta à ativação do motor 102. Em outras palavras, a ativação do motor 102 finalmente faz com que a barra de disparo 82 translade longitudinalmente, na direção de tal translação, dependendo da direção de rotação do eixo de acionamento 120.
[0057] Deve ser entendido que uma porção distal do membroalongado 136, do membro de acoplamento 138 e da barra de disparo 82 estendem-se através do conjunto de eixo 30. Uma porção da barra de disparo 82 também se estende através da seção de articulação 34. Em algumas versões, o membro de cremalheira 130, o membro alongado 136 e o membro de acoplamento 138 são todos substancialmente lineares e rígidos; enquanto a barra de disparo 82 tem flexibilidade suficiente para flexionar a seção de articulação 34 e transladar longitudinalmente através da seção de articulação 34, quando a seção de articulação 34 está em um estado flexionado ou articulado.
[0058] De forma adicional ou no lugar da anteriormentemencionada, os recursos operáveis para acionar a barra de disparo 82 podem ser configurados de acordo com pelo menos alguns dos ensinamentos da Patente US N° 8.453.914, cuja descrição está aqui incorporada a título de referência. Outros componentes, recursos, e configurações adequados para fornecer motorização da barra de disparo 82 serão aparentes aos versados na técnica, tendo em vista os ensinamentos da presente invenção. Deve-se compreender também que algumas outras versões podem proporcionar acionamento manual da barra de disparo 82, de modo que um motor pode ser omitido. Somente a título de exemplo, a barra de disparo 82 pode ser atuada de acordo com pelo menos alguns dos ensinamentos de qualquer outra referência citada aqui.
[0059] A Figura 8 mostra o atuador de extremidade 40 após tersido acionado através de uma única passada através do tecido 90. Conforme mostrado, o gume cortante 84 (omitido na Figura 8) corta através do tecido 90, enquanto os acionadores de grampos 75 conduzem duas fileiras alternadas de grampos 77 através do tecido 90 em cada lado da linha de corte produzida pelo gume cortante 84. Os grampos 77 são todos orientados substancialmente paralelos à linha de corte neste exemplo, embora deve-se compreender que os grampos 77 podem ser posicionados em quaisquer orientações adequadas. No presente exemplo, o atuador de extremidade 40 é removido do trocarte depois de o primeiro curso ser completado, o cartucho de grampos consumido 70 é substituído por um novo cartucho de grampos 70, e o atuador de extremidade 40 é, então, novamente inserido através do trocarte para alcançar o local do grampeamento para corte e grampeamento adicionais. Esse processo pode ser repetido até que a quantidade desejada de cortes e grampos 77 tenha sido fornecida. Pode ser necessário fechar a garra fixa 60 para facilitar a inserção e a remoção através do trocarte; e pode ser necessário abrir a garra fixa 60 para facilitar a substituição do cartucho de grampos 70.
[0060] Deve-se compreender que o gume cortante 84 pode cortaro tecido de modo substancialmente contemporâneo à condução dos grampos 77 através do tecido durante cada curso de acionamento. No presente exemplo, o gume cortante 84 tem um pequeno atraso em relação à condução dos grampos 77, de modo que um grampo 47 é conduzido através do tecido pouco antes do gume cortante 84 passar pela mesma região do tecido, embora deva-se compreender que essa ordem pode ser revertida ou que o gume cortante 84 pode estar diretamente sincronizado com os grampos 77 adjacentes. Enquanto a Figura 8 mostra o atuador de extremidade 40 sendo atuado em duas camadas 92 e 94 de tecido 90, deve-se compreender que o atuador de extremidade 40 pode ser atuado através de uma camada única de tecido 90 ou mais que duas camadas 92 e 94 de tecido. Deve-se compreender também que a formação e posicionamento dos grampos 77 adjacentes à linha de corte produzida pelo gume cortante 84 pode selar substancialmente o tecido na linha de corte, reduzindo ou evitando, assim, sangramento e/ou vazamento de outros fluidos corporais na linha de corte. Além disso, embora a Figura 8 mostre o atuador de extremidade 40 sendo atuado em duas camadas substancialmente horizontais justapostas planas 92, 94 de tecido, deve- se compreender que o atuador de extremidade 40 pode também ser atuado ao longo de uma estrutura tubular como um vaso sanguíneo, uma seção do trato gastrointestinal, etc. A Figura 8 não deve, portanto, ser vista como uma demonstração de qualquer limitação dos usos contemplados para o atuador de extremidade 40. Vários cenários e procedimentos adequados nos quais o instrumento 10 pode ser usado serão aparentes aos versados na técnica com base nos ensinamentos da presente invenção.
[0061] Deve também ser compreendido que outros componentesou recursos do instrumento 10 podem ser configurados e operados de acordo com as várias referências citadas na presente invenção. Modificações exemplificadoras adicionais que podem ser fornecidas para o instrumento 10 serão descritas com mais detalhes abaixo. Várias formas adequadas através das quais os ensinamentos abaixo podem ser incorporados ao instrumento 10 serão aparentes aos versados na técnica. De modo similar, várias formas adequadas através das quais os ensinamentos abaixo podem ser combinados com os vários ensinamentos das referências citadas na presente invenção serão aparentes aos versados na técnica. Deve-se entender também que os ensinamentos abaixo não se limitam ao instrumento 10 ou aos dispositivos ensinados nas referências citadas na presente invenção. Os ensinamentos abaixo podem ser prontamente aplicados a vários outros tipos de instrumentos, incluindo instrumentos que não seriam classificados como grampeadores cirúrgicos. Vários outros dispositivos e cenários adequados aos quais os ensinamentos abaixo podem ser aplicados serão aparentes aos versados na técnica com base nos ensinamentos da presente invenção.
[0062] As Figuras 13 e 14 mostram um cartucho de grampos 270exemplificador alternativo que pode ser inserido na garra inferior 50 do atuador de extremidade 40. Além do descrito abaixo, o cartucho de grampos 270 deste exemplo é substancialmente similar ao cartucho de grampos 70, conforme descrito acima. Por exemplo, o cartucho 270, como o cartucho 70 compreende um corpo do cartucho 271 e bandeja (não mostrada) presa ao lado inferior do corpo do cartucho 271. De modo similar, o lado superior do corpo do cartucho 271 apresenta uma plataforma 273, contra a qual o tecido pode ser comprimido quando a bigorna 60 está em uma posição fechada.
[0063] Ao contrário do cartucho 70, o cartucho 270 é equipadocom um suporte 280 disposto sobre uma plataforma 273 do corpo do cartucho 271. No presente exemplo, o suporte 280 compreende um material forte, porém, flexível configurado para suportar estruturalmente uma linha de grampos. Adicional ou alternativamente, o suporte 280 pode ser compreendido de um material que inclui, por exemplo, um agente hemostático, como fibrina, para auxiliar na coagulação do sangue e reduzir o sangramento no sítio cirúrgico cortado e/ou grampeado ao longo do tecido 90.
[0064] Em outros exemplos, o suporte 280 pode compreenderoutros materiais além dos discutidos acima. Por exemplo, outros compostos auxiliares ou agentes hemostáticos, como trombina, podem ser usados, de modo que o suporte 280 possa auxiliar a coagular o sangue e reduzir a quantidade de sangramento no sítio cirúrgico. As capacidades hemostáticas desses compostos auxiliares podem também contribuir para o uso desses compostos auxiliares como adesivos e selantes. Os agentes podem ajudar a coagular o sangue no sítio cirúrgico, o que permite que o tecido circundante ao sangue permaneça unido e impeça vazamentos ao longo do sítio de tecido grampeado, por exemplo. Outros compostos auxiliares ou reagentes que podem ser incorporados no suporte 280 podem ainda incluir, mas não se limitam a, componentes de fluido medicinal ou de matriz. Somente a título de exemplo, o suporte 280 pode incluir polímeros absorvíveis naturais ou geneticamente modificados ou polímeros absorvíveis sintéticos ou misturas dos mesmos. Exemplos meramente ilustrativos de polímeros naturais ou geneticamente modificados são proteínas, polissacarídeos e combinações dos mesmos. Exemplos meramente ilustrativos de proteínas que podem ser usadas incluem protrombina, trombina, fibrinogênio, fibrina, fibronectina, heparinase, fator X/Xa, fator VII/VIla, fator IX/IXa, fator XI/XIa, fator XII/XIIa, fator tecidual, batroxobina, ancrod, ecarina, fator de von Willebrand, colágeno, elastina, albumina, gelatina, glicoproteínas de superfície de plaqueta, vasopressina e análogos da vasopressina, epinefrina, selectina, veneno procoagulante, inibidor do ativador de plasminogênio, agentes de ativação de plaquetas, peptídeos que possuem atividade hemostática, e/ou combinação dos mesmos. Polissacarídeos incluem, mas não se limitam a, celulose, alquila celulose, por exemplo, metilcelulose, alquila hidróxi alquila celulose, hidróxi alquila celulose, sulfato de celulose, sais de carbóxi metil celulose, carbóxi metil celulose, carbóxi etil celulose, quitina, carbóxi metil quitina, ácido hialurônico, sais de ácido hialurônico, alginato, ácido algínico, alginato de propileno glicol, glicogênio, dextrana, sulfato de dextrana, curdlana, pectina, pululana, xantana, condroitina, sulfatos de condroitina, carbóxi metil dextrana, carbóxi metil quitosana, quitosana, heparina, sulfato de heparina, heparana, sulfato de heparana, sulfato de dermatana, sulfato de queratana, carragenas, quitosana, amido, amilose, amilopectina, poli-N-glucosamina, ácido polimanurônico, ácido poliglucurônico, ácido poligulurônico, e derivados de quaisquer destes. Exemplos de polímeros absorvíveis sintéticos são polímeros de poliéster alifático, copolímeros, e/ou combinações dos mesmos. Os poliésteres alifáticos são tipicamente sintetizados em uma polimerização por abertura de anel de monômeros que incluem, mas não se limitam a, ácido láctico, lactídeo (L-, D-, meso e misturas de D e L), ácido glicólico, glicolídeo, ε-caprolactona, p-dioxanona (1,4-dioxan-2-ona) e trimetileno carbonato (1,3-dioxan-2-ona). Outros componentes, materiais, substâncias etc. adequados que podem ser usados em um fluido medicinal ou matriz serão aparentes para os versados na técnica em vista dos ensinamentos aqui contidos.
[0065] O suporte 280 inclui uma porção do cartucho 282, umaporção de bigorna 284 e uma porção intermediária 286 disposta entre as extremidades proximais da porção do cartucho 282 e da porção de bigorna 284. A porção de bigorna 284 inclui uma aba 288 que envolve a extremidade distal da bigorna 60, conforme mostrado na Figura. 14. A aba 288, por exemplo, define um bolso (não mostrado) dimensionado para receber a extremidade distal da bigorna 60, para fixar, assim, a porção de bigorna 284 do suporte 280 à bigorna 60. A porção intermediária 286 do suporte 280 pode compreender uma curva pré-formada para facilitar o carregamento do cartucho 270 na garra inferior e a inserção da bigorna 60 no bolso definido pela aba 288.
[0066] O cartucho 270 inclui adicionalmente prendedores, comoganchos 290, que seguram o suporte 280. Os ganchos 290 e o suporte 280 podem fornecer uma relação de fixação, como uma relação de fixação gancho e laço na qual os ganchos 290 se conectam aos laços formados no interior do material de suporte 280. Embora o presente exemplo seja mostrado como tendo ganchos 290, deve ser entendido que quaisquer outros meios adequados podem ser usados para fixar uma porção de cartucho 282 do suporte 280 à plataforma 273 do cartucho 270.
[0067] Em uso, o cartucho 270 com o suporte 280 é recebido deforma removível na garra inferior 50 do atuador de extremidade 40, conforme mostrado na Figura 13. Quando o atuador de extremidade 40, incluindo o cartucho 270 e o suporte 280, é usado, conforme mostrado na Figura 15, os grampos 277 são acionados para dentro do tecido 90, simultaneamente ou um pouco antes da barra de disparo 82 cortar o tecido 90, enquanto também corta o suporte 280. Além disso, os grampos 277 podem capturar porções do suporte 280 e cravar essas porções no tecido 90 ou, pelo menos, prender o suporte 280 ao tecido 90. A barra de disparo 82 secciona através do suporte 280 enquanto corta o tecido 90 em uso, aplicando material do suporte 280 sobre o tecido cortado.
[0068] Enquanto o suporte 280 é mostrado tendo umaconfiguração determinada, deve-se compreender que a configuração exata do suporte 280 pode ser variada. Por exemplo, em algumas versões, um fluido medicinal pode ser suspenso em um veículo biocompatível. Veículos adequados podem incluir, por exemplo, uma solução tampão fisiológica, uma solução de gel de alto escoamento, solução salina, e água. No caso de soluções de gel, a composição para reparo de tecido pode estar em uma forma de gel de alto escoamento antes da liberação ao sítio alvo, ou pode formar um gel e permanecer no local após a liberação ao sítio alvo. Soluções de gel de alto escoamento podem compreender um ou mais materiais gelificantes com ou sem adição de água, solução salina, ou solução tampão fisiológica. Os materiais de gelificação incluem proteínas, polissacarídeos, polinucleotídeos e outros materiais como alginato, alginato reticulado, poli(N-isopropil acrilamida), poli(oxialquileno), copolímeros de poli(óxido de etileno)-poli(óxido de propileno), poli(álcool vinílico), poliacrilato, ou copolímeros de monostearoil glicerol co-succinato/polietileno glicol (MGSA/PEG) e combinações de qualquer um dos antecedentes.
[0069] O suporte 280 pode, alternativamente, compreender umbloco fibroso, uma espuma, uma malha, ou outra estrutura capaz de conter um adesivo ou outro tipo de fluido medicinal. Somente a título de exemplo, o cartucho 270 e/ou o suporte 280 podem ser construídos de acordo com os ensinamentos da publicação de patente US N° 20013/0068816, intitulada "Surgical Instrument and Buttress Material", publicada em 21 de março de 2013; publicação de patente US N° 2013/0062391, intitulada "Surgical Instrument with Fluid Fillable Buttress", publicada em 14 de março de 2013; publicação de patente US N° 2013/0068820, intitulada "Fibrin Pad Matrix with Suspended Heat Activated Beads of Adhesive", publicada em 21 de março de 2013; publicação de patente US N° 2013/0082086, intitulada "Attachment of Surgical Staple Buttress to Cartridge", publicada em 4 de abril de 2013; publicação de patente US N° 2013/0037596, intitulada "Device for Applying Adjunct in Endoscopic Procedure", publicada em 14 de fevereiro 2013; publicação de patente US N° 2013/0062393, intitulada "Resistive Heated Surgical Staple Cartridge with Phase Change Sealant", publicada em 14 de março de 2013; publicação de patente US N° 2013/0075446, intitulada "Surgical Staple Assembly with Hemostatic Feature", publicada em 28 de março de 2013; publicação de patente US N° 2013/0062394, intitulada "Surgical Staple Cartridge with Self-Dispensing Staple Buttress", depositada em 14 de março de 2013; publicação de patente US N° 2013/0075445, intitulada "Anvil Cartridge for Surgical Fastening Device", publicada em 28 de março de 2013; e/ou da publicação de patente US N° 2013/0075447, intitulada "Adjunct Therapy for Applying Hemostatic Agent", publicada em 28 de março de 2013, cuja descrição está aqui incorporada a título de referência.
[0070] Em alguns casos, pode ser desejável fornecer estruturasalternativas e/ou adicionais e para corte de tecido e suportes 280. Por exemplo, em alguns exemplos, o próprio instrumento 10 pode ser reutilizável enquanto o cartucho 70, 270 pode ser descartável. Por causa disso, o uso repetido do instrumento 10 pode fazer com que o gume cortante 84 da barra de disparo 82 fique cego. Essa lentidão pode ser intensificada pelo uso de um cartucho 270 que inclui um suporte 280 similar àqueles discutidos acima. Adicional ou alternativamente, o gume cortante 84 e/ou outras porções da barra de disparo 82 podem se deparar com um acúmulo de material que forma o suporte 280 à medida que a mesma barra de disparo 82 é disparada através de uma pluralidade de suportes 280. Tal acúmulo de material pode afetar adversamente a capacidade da barra de disparo 82 de cortar o tecido e/ou suportes 280 adicionais. Adicional ou alternativamente, esse acúmulo de material pode proporcionar maior atrito ou interferência que exige força adicional para acionar a barra de disparo 82 distalmente. Vários exemplos de estruturas adicionais e/ou alternativas que podem ser usadas para fornecer ao menos algum recurso de corte descartável serão descritos com mais detalhes abaixo, enquanto exemplos adicionais ficarão evidentes para os elementos versados na técnica tendo em vista os ensinamentos da presente invenção.A. Deslizador em cunha com lâmina giratória exemplificador
[0071] A Figura 16 mostra uma vista em perspectiva em recorte dagarra inferior 50 e um cartucho de grampos alternativo 370. O cartucho de grampos 370 pode ser usado como um substituto para o cartucho de grampos 70. Adicional ou alternativamente, o cartucho de grampos 370 pode incluir um suporte 280 do tipo cartucho de grampos 270 ou qualquer outro tipo de suporte, incluindo, mas não se limitando aos vários suportes descritos nas várias referências citadas na presente invenção. O cartucho de grampos 370 é substancialmente similar ao cartucho de grampos 70, 270 descrito acima em que a diferença principal é que o cartucho de grampos 370 é equipado com um deslizador em cunha 378 alternativo exemplificador. O deslizador em cunha 378 é similar ao deslizador em cunha 78 descrito acima. No presente exemplo, o deslizador em cunha 378 foi modificado em relação ao deslizador em cunha 78 para acomodar uma lâmina de corte secundária 380 que é giratória no deslizador em cunha 378. Em particular, conforme mostrado nas Figuras 16 e 17, o deslizador em cunha 378 inclui um corpo 377 e uma pluralidade de superfícies de came 379. O corpo 377 define uma fenda de lâmina 382. O corpo e as superfícies de came 379 são mais curtos em relação à superfície de came 79 do deslizador em cunha 78, ainda assim o corpo 377 e as superfícies de came 379 são orientadas em um ângulo que é mais íngreme que o ângulo da superfície de came 79 do deslizador em cunha 78. Consequentemente, o deslizador em cunha 378 ocupa a mesma quantidade de espaço longitudinal no interior do cartucho 370 que o deslizador em cunha 78 no cartucho 70, 270, tornando o deslizador em cunha 378 substancialmente intercambiável com o deslizador em cunha 78. O ângulo das superfícies de came 379 permite que o deslizador em cunha 378 acione múltiplos acionadores de grampo 75 para cima simultaneamente e/ou em uma certa sequência predeterminada.
[0072] A fenda da lâmina 382 é configurada para acomodar arotação da lâmina 380 dentro do deslizador em cunha 378. Como pode ser melhor visto na Figura 17, a fenda da lâmina 382 tem um formato aproximadamente correspondente ao formato definido pela lâmina 380 que gira entre uma posição retraída (mostrada em linha tracejada) e uma posição estendida. Adicionalmente, a fenda da lâmina 382 define um recurso de bloqueio 383 que, conforme será descrito com mais detalhes abaixo, impede a lâmina de girar proximalmente além da posição estendida. O formato da fenda da lâmina 382 define adicionalmente uma abertura proximal 384 no deslizador em cunha 378. Conforme será descrito com mais detalhes abaixo, a abertura proximal fornece acesso à lâmina 380, de modo que a lâmina possa ser atuada pela barra de disparo 82, a partir de uma posição retraída para uma posição estendida. Em outros exemplos, a fenda da lâmina 382 pode ter qualquer outro formato adequado, conforme ficará evidente para os versados na técnica tendo em vista os ensinamentos do presente documento.
[0073] Como pode ser visto na Figura 17, o deslizador em cunha378 compreende adicionalmente um pino ou eixo 385, que se estende através da fenda da lâmina 382. Um furo passante 386 na lâmina 380 permite que a lâmina 380 se acople de modo articulado ao deslizador em cunha 378 de modo que a lâmina 380 possa girar distalmente para a posição retraída. Embora não seja mostrado na Figura 17, deve ficar entendido que o eixo de rotação 385 pode ser equipado com coxins, mancais ou outros componentes ou características adequados para auxiliar a rotação da lâmina 380. Adicionalmente, o eixo de rotação 385 pode ser equipado com componentes ou elementos como molas adequadas para resilientemente inclinarem a lâmina 380 para a posição retraída ou estendida.
[0074] A lâmina 380 tem um formato em seção transversal similarao de uma faca. Em particular, com referência à lâmina 380 na posição estendida, a lâmina 380 possui uma porção de corte superior 388 e uma porção de fixação inferior 394. A porção de corte superior 388 compreende um gume cortante angular voltado distalmente 390 e uma porção plana voltada proximalmente 392. O gume cortante 390 se estende em um ângulo para cima a partir da porção de fixação 394. Embora o gume cortante 390 compreenda uma borda reta que se estende em um ângulo, deve ser entendido que o gume cortante 390 pode ter qualquer outro formato adequado. Por exemplo, o gume cortante 390 pode ser curvo serrilhado, dentado e/ou configurado de outro modo. O gume cortante 390 pode, ainda, ser angulado de modo diferente em relação ao ângulo mostrado.
[0075] A porção plana 392 se estende para cima a partir da porçãode fixação 394. Como com o gume cortante 390, a porção plana 392 não precisa estar limitada ao formato aqui descrito. Conforme será descrito com mais detalhes abaixo, a porção plana 392 provê uma superfície que pode engatar-se ao recurso de bloqueio 383 do deslizador em cunha 378.
[0076] A porção de corte superior 388 da lâmina 380 se estendepara cima a uma certa altura acima do deslizador em cunha 378. No presente exemplo, a altura da porção de corte superior 388 é configurada para cortar através de um suporte 280 e do tecido 90. Em outros exemplos, a porção de corte superior 388 pode ter uma altura que é menor que a altura representada de modo que a porção de corte superior 388 corte apenas um suporte 280 imediatamente adjacente ao cartucho 370, sem necessariamente cortar o tecido 90 que fica posicionado acima do suporte 280. Deve-se compreender que a porção de corte superior 388, ou outros elementos da porção de corte 388 descritos acima, pode ser de qualquer outro formato, altura ou configuração adequados, como ficará evidente para aqueles versados na técnica em vista dos ensinamentos da presente invenção.
[0077] Em um modo de operação exemplificador, a lâmina 380está na posição retraída, antes da inserção do cartucho 370 na garra inferior 50. Na posição retraída, a lâmina 380 é rebaixada inteiramente dentro do cartucho 370 e do deslizador em cunha 378. Consequentemente, um operador é protegido contra contato inadvertido com a lâmina 380 durante a inserção do cartucho 70, 270 na garra inferior 50.
[0078] Depois que um operador insere o cartucho 370 na garrainferior 50, a lâmina 380 permanece retraída até que o operador dê início à sequência de disparo. Depois que a sequência de disparos é iniciada, a barra de disparo 82 é acionada distalmente de modo que o membro de faca 80 entre em contato com o deslizador em cunha 378. O membro de faca 80 pode incluir um ou mais elementos que se projetam (não mostrados) configurados para engatar a lâmina 380 de modo que a lâmina possa ser atuada na posição estendida, com elemento de bloqueio 383 interrompendo a rotação adicional. Alternativamente, o deslizador em cunha 378 pode ser equipado com elementos adequados para acionar a lâmina 380 sobre o membro de faca 80 em contato com o deslizador em cunha 378. Na posição estendida, a lâmina 380 se estende através de uma plataforma 373 do cartucho 370.
[0079] Com a lâmina 380 na posição estendida, a barra de disparo82 continua a avançar distalmente, acionando o gume cortante 390 da lâmina 380 através de um suporte 280 (se provido) e do tecido 90. O gume cortante 84 do membro de faca 80 pode seguir imediatamente atrás da lâmina 380, de modo que o gume cortante 84 corte qualquer tecido 90 ou suporte 280 de material não cortado pela lâmina 380. Deve-se compreender que o gume cortante 84 do membro de faca 80 e o gume cortante 390 da lâmina 380 seguem uma trajetória que é substancialmente idêntica. Tal trajetória pode, em geral, ser definida por uma canaleta que se estende longitudinalmente 372 do cartucho 370. Ao fazer o primeiro corte passar através do suporte 280 (e, em algumas versões, do tecido também 90), a lâmina 380 pode reduzir o desgaste e/ou acúmulo no membro de faca 80, prolongando, assim, a vida útil do membro de faca 80. Adicionalmente, deve-se compreender que ambas a lâmina 380 e o membro de faca 80 podem seguir as superfícies de came 379, de modo que o deslizador em cunha 378 acione os grampos 77 através de uma dada região de tecido antes que essa região específica de tecido seja cortada por uma lâmina 380 ou elemento de faca 80. A ação de grampeamento e corte pode ainda ser considerada, de maneira substancialmente simultânea na região de tecido porque o deslizador em cunha 378 é configurado de modo que a diferença do tempo entre grampeamento e o corte é substancialmente curta.
[0080] Depois que o instrumento 10 é disparado, o cartucho 370pode ser removido juntamente com a lâmina 380, de modo que um novo cartucho 370 e/ou lâmina 380 possam ser inseridos na garra inferior 50. Deve-se compreender que o cartucho 370 pode ser substituído por um cartucho idêntico 370 ou por um cartucho diferente 70, 270, 370. Por exemplo, alguns cartuchos 370 podem serequipados com lâminas 380 configuradas para diferentes procedimentos. Somente a título de exemplo, o cartucho 370 pode incluir uma lâmina mais afiada 380 para uso em tecido pulmonar. Alternativamente, o cartucho 370 pode incluir uma lâmina 380 mais robusta para uso com tecido do estômago. Obviamente, o cartucho 370 pode incluir uma lâmina 380 para cortar qualquer tecido, conforme ficará evidente aos elementos versados na técnica em vista dos ensinamentos da presente invenção.B. Deslizador em cunha com lâmina fixa exemplificador
[0081] A Figura 18 mostra uma vista em perspectiva em recorte deum outro cartucho de grampos 470 exemplificador alternativo que é equipado com um deslizador em cunha 478 exemplificador alternativo. No presente exemplo, o cartucho 470 é substancialmente igual ao cartucho 70, 270 descrito acima, exceto que o cartucho 470 inclui um anteparo que se projeta para cima 469 que é acoplado de forma unitária a uma plataforma 473 do cartucho 470. Como o cartucho 70, 270, o cartucho 470 inclui um canal estendendo-se longitudinalmente 472 na plataforma 473, que também se estende através do anteparo 469. Conforme será discutido em mais detalhes abaixo, o anteparo 469 é configurado para cobrir uma lâmina 480, que é presa por fixação ao deslizador em cunha 478.
[0082] O deslizador em cunha 478 é similar ao deslizador emcunha 78, 378 descrito acima. No presente exemplo, como odeslizador em cunha 378, o deslizador em cunha 478 foi modificado em relação ao deslizador em cunha 78 para acomodar uma lâmina de corte secundária 480 que é presa por fixação ao deslizador em cunha 478. Em particular, conforme pode ser melhor visto na Figura 19, o deslizador em cunha 478 inclui um corpo 477 que define uma abertura para lâminas 482. O corpo 477 pode também incluir uma pluralidade de superfícies de came não mostradas adequadas para acionar os grampos 77, por meio de acionadores de grampos, para dentro do tecido. O corpo 477 é mais curto em relação à superfície de came 79 do deslizador em cunha 78, mas ainda assim o corpo 477 e as superfícies de came são orientadas em um ângulo mais íngreme que o ângulo da superfície de came 79 do deslizador em cunha 78. Consequentemente, o deslizador em cunha 478 ocupa a mesma quantidade de espaço longitudinalmente no interior do cartucho 470 que o deslizador em cunha 78 tornando o deslizador em cunha 478 substancialmente intercambiável com o deslizador em cunha 78. O ângulo do deslizador em cunha 478 permite que o deslizador em cunha 478 acione múltiplos deslizadores em cunha (não mostrados) para cima simultaneamente e/ou em uma determinada sequência predeterminada.
[0083] A fenda da lâmina 482 é configurada para acomodar alâmina 480 no deslizador em cunha 478. Como pode ser melhor visto na Figura 19, a fenda da lâmina 482 tem um formato que corresponde aproximadamente a um formato definido por uma região inferior da lâmina 480. Ao contrário da lâmina 380 do deslizador em cunha 378, a lâmina 480 do deslizador em cunha 478 é fixada em relação ao deslizador em cunha 478. Assim, a fenda da lâmina 482 não precisa ser configurada para acomodar a rotação ou articulação da lâmina 480. Em outros exemplos, a fenda da lâmina 482 pode ter qualquer outro formato adequado, conforme ficará evidente para os versados na técnica tendo em vista os ensinamentos do presente documento.
[0084] Como pode ser visto na Figura 19, o deslizador em cunha478 compreende adicionalmente um pino ou haste 485, que se estende através da fenda da lâmina 482. Um furo passante 486 na lâmina 480, permite que a lâmina 480 seja presa por fixação ao deslizador em cunha 478 de modo que a lâmina 480 seja substancialmente fixa em relação ao deslizador em cunha 478.
[0085] A lâmina 480 tem um formato em seção transversal similarà lâmina 380. Em particular, a lâmina 480 tem uma porção de corte superior 488 e uma porção de fixação inferior 494. A porção de corte superior 488 compreende um gume cortante angular voltado distalmente 490 e uma porção plana voltada proximalmente 492. O gume cortante 490 se estende em um ângulo para cima a partir da porção de fixação 494. Como com o gume cortante 390 e a porção plana 394 descritos acima, o gume cortante 490 e a porção plana 494 podem compreender qualquer configuração alternativa adequada, como ficará evidente para aqueles versados na técnica em vista dos ensinamentos da presente invenção.
[0086] A porção de corte superior 488 da lâmina 480 se estendepara cima a uma certa altura acima do deslizador em cunha 478. No presente exemplo, a altura da porção de corte superior 488 é configurada para cortar através de um suporte 280 e do tecido 90. No entanto, como com a porção de corte superior 388 descrita acima, a altura da porção de corte superior 488 pode ser variada para cortar através de qualquer combinação desejada de suporte 280 e/ou tecido 90, como ficará evidente para aqueles versados na técnica em vista dos ensinamentos da presente invenção.
[0087] Em um modo de funcionamento exemplificador, e conformemostrado na Figura 19, a lâmina 480 é retraída para o anteparo 469 antes da inserção do cartucho 470 na garra inferior 50. Quando a lâmina 480 é retraída para o anteparo 469, a lâmina 480 fica inteiramente dentro do cartucho 470. Consequentemente, um operador é protegido do contato inadvertido com a lâmina 480 enquanto o operador manipula o cartucho 470 e insere o cartucho 470 na garra inferior 50. Adicionalmente, o anteparo 469 pode evitar o contato prematuro entre o tecido e a lâmina 480 durante o fechamento da bigorna 60 em direção à plataforma 473, até que uma sequência de disparo seja iniciada (por exemplo, até que o membro de faca 80 seja deslocado distalmente). Por exemplo, na ausência do anteparo 469, a ação de fechamento da bigorna 60 pode tender a direcionar o tecido proximalmente em direção à lâmina 480 quando a bigorna 60 comprime o tecido contra a plataforma 473. Se tal ação de "ordenha" proximal do tecido ocorre, o anteparo 469 bloqueia o tecido acionado proximalmente do engate da lâmina 480.
[0088] Depois que um operador insere o cartucho 470 na garrainferior 50, a lâmina 480 permanece retraída até que o operador dê início à sequência de disparo. Depois que a sequência de disparo é iniciada, a barra de disparo 82 é acionada distalmente para entrar em contato com o deslizador em cunha 478. Conforme mostrado na Figura 20, a barra de disparo 82 continua a avançar distalmente, acionando o deslizador em cunha 478 distalmente e, assim, acionando a lâmina 480 para fora do anteparo 469 de modo que o gume cortante 490 da lâmina 480 possa cortar um suporte 280 se equipados e o tecido 90. O gume cortante 84 do membro de faca 80 pode seguir imediatamente atrás da lâmina 480, de modo que o gume cortante 84 corte qualquer tecido 90 ou suporte 280 de material não cortado pela lâmina 480. Deve-se compreender que o gume cortante 84 do membro de faca 80 e o gume cortante 490 da lâmina 480 seguem uma trajetória que é substancialmente idêntica. Tal trajetória pode, em geral, ser definida por uma canaleta que se estende longitudinalmente 470 do cartucho 770. Ao fazer o primeiro corte passar através do suporte 280 (e, em algumas versões, do tecido também 90), a lâmina 480 pode reduzir o desgaste e/ou acúmulo no membro de faca 80, prolongando, assim, a vida útil do membro de faca 80. Adicionalmente, deve-se compreender que ambas a lâmina 480 e o membro de faca 80 podem seguir as superfícies de came 479, de modo que o deslizador em cunha 478 acione os grampos 77 através de uma dada região de tecido antes que essa região específica de tecido seja cortada por uma lâmina 480 ou elemento de faca 80. A ação de grampeamento e corte pode ainda ser considerada, de maneira substancialmente simultânea na região de tecido porque o deslizador em cunha 478 é configurado de modo que a diferença do tempo entre grampeamento e o corte é substancialmente curta.
[0089] Depois que o instrumento 10 é disparado, o cartucho 470pode ser removido juntamente com a lâmina 480, de modo que um novo cartucho 70, 370, 470 e/ou lâmina 480 possam ser inseridos na garra inferior 50. Deve-se compreender que o cartucho 470 pode ser substituído por um cartucho idêntico 470 ou por um cartucho diferente 70, 270, 370. Por exemplo, como com o cartucho 370 discutido acima, alguns cartuchos 470 podem ser equipados com lâminas 480 configuradas para diferentes procedimentos como aqueles descritos acima.
[0090] A Figura 21 mostra um deslizador em cunha alternativo 578que pode ser usado com o cartucho 70, 270, 470. O deslizador em cunha 578 é funcional e estruturalmente igual ao deslizador em cunha 478 discutido acima, exceto onde especificado em contrário. Ao contrário do deslizador em cunha 478, o deslizador em cunha 578 compreende uma lâmina de corte secundária diferente 580. Em particular, a lâmina 580 é mais curta em relação à lâmina 480, de modo que a lâmina 580 é configurada para cortar apenas o material de suporte 280, sem também atingir o tecido 90 posicionado acima do suporte 280.
[0091] Em algumas circunstâncias, o material de suporte 280 podeser de uma espessura diferente da espessura representada específica. Consequentemente, deve ser entendido que a lâmina de corte 580 não é limitada para cortar apenas o suporte 280 ou cortar através de todo o suporte 280. De fato, em algumas circunstâncias, a lâmina 580 pode consequentemente cortar uma porção do tecido 90. Em ainda outros casos, a lâmina 580 pode cortar apenas uma porção do suporte 280, deixando o material de suporte 280 restante para ser cortado pelo gume cortante 84 do membro de faca 80.C. Deslizador em cunha com lâmina secundária polarizada exemplificador
[0092] A Figura 22 mostra uma vista em perspectiva de um outrodeslizador em cunha alternativo exemplificador 678 que pode ser usado com o cartucho 670, que é uma versão modificada do cartucho 70, 270. Em muitos aspectos, o deslizador em cunha 678 desse exemplo é similar ao deslizador em cunha 78, 378, 478, 578 descrito acima. No presente exemplo, como o deslizador em cunha 378, 478, 578, o deslizador em cunha 678 foi modificado em relação ao deslizador em cunha 78 para acomodar uma lâmina de corte secundária 680. Em particular, conforme pode ser melhor visto na Figura 23, o deslizador em cunha 678 inclui um corpo 677 e uma pluralidade de superfícies de came 679. O corpo 677 compreende uma fenda da lâmina 682, que é configurada para acomodar uma lâmina 680, conforme será descrito com mais detalhes a seguir. O corpo 677 e as superfícies de came 679 são mais curtos em relação à superfície de came 79 do deslizador em cunha 78, mas as superfícies de came 679 são orientadas em um ângulo que é mais íngreme que o ângulo da superfície de came 79 do deslizador em cunha 78. Consequentemente, o deslizador em cunha 678 ocupa a mesma quantidade de espaço longitudinalmente no interior do cartucho 70, 270 que o deslizador em cunha 78, tornando o deslizador em cunha 678 substancialmente intercambiável com o deslizador em cunha 78. O ângulo das superfícies de came 679 permite que o deslizador em cunha 678 acione múltiplos acionadores de grampos (não mostrados) para cima simultaneamente e/ou em uma certa sequência predeterminada.
[0093] A fenda da lâmina 682 é configurada de modo a acomodara lâmina 680 dentro do deslizador em cunha 678. Conforme pode ser visto melhor na Figura 23, a fenda da lâmina 682 compreende uma fenda de translação 683 e uma cavidade de atuação 684. A fenda de translação 683 corresponde a um deslizador de translação 692 da lâmina 680. Conforme será descrito com mais detalhes abaixo, o deslizador de translação 692 é configurado para cooperar com um membro de faca 80 para transladar a lâmina 680 de uma posição retraída para uma posição estendida por meio da fenda de translação 683.
[0094] A cavidade de atuação 684 define um espaço para certoscomponentes da lâmina 680 (descrito abaixo) e um membro resiliente 686 do deslizador em cunha 678. O membro resiliente 686 compreende um feixe de molas que se estende proximalmente a partir de um elemento de fixação distal 688 que é de construção unitária com o deslizador em cunha 678. Conforme será descrito com mais detalhes abaixo, o membro resiliente 686 é operável para ser flexionado para cima e para baixo dentro da cavidade de atuação 684 para forçar resilientemente a lâmina 680 em direção à posição retraída. Consequentemente, a cavidade de atuação 684 é ao menos parcialmente definida pela faixa do movimento de flexão do elemento resiliente 686. Embora a cavidade de atuação 684 seja mostrada como tendo um formato específico, deve-se compreender que o formato da cavidade de atuação 684 pode ser variado de acordo com o formato e a faixa de movimento do membro resiliente 686. Adicional ou alternativamente, conforme será entendido a partir da descrição abaixo, o formato da cavidade de atuação 684 pode também ser variado de acordo com o formato ou trajetória de translação da lâmina 680.
[0095] A lâmina 680 compreende uma porção de corte superior690, o deslizador de translação 692 e um elemento de retenção 694. A porção de corte 690 compreende um gume cortante afiado distalmente orientado 691, que é configurado para cortar através do suporte 280 e/ou do tecido 90. Como com o gume cortante 390, 490 descrito acima, o gume cortante 691 pode ter uma variedade de configurações alternativas que podem ser configuradas para cortar através de uma variedade de materiais.
[0096] O deslizador de translação 692 é de construção unitáriacom a lâmina 680 e se estende para fora a partir da lâmina 680. Em um outro exemplo, o deslizador de translação 692 pode ser separado de, e preso por fixação, à lâmina 680. O deslizador de translação 692 é, em geral, integrado à lâmina 680, e se estende distalmente e para fora a partir dos lados frontal, direito e esquerdo da lâmina 680. Como pode ser melhor visto na Figura 22, o deslizador de translação 692 é, em geral, de formato retangular com extremidades distal e proximal arredondadas. A porção longitudinal de formato retangular do deslizador de translação 692, em geral, define um plano que é orientado em um ângulo oblíquo em relação ao eixo geométrico longitudinal do cartucho 670. Conforme será descrito com mais detalhes abaixo, o deslizador de translação 692 é disposto de maneira deslizante na fenda de translação 683 que é formada no corpo do deslizador em cunha 680. A fenda de translação 683 fornece uma superfície de came para o deslizador de translação 692, de modo que a fenda de translação 693 e o deslizador de translação 692 proporcionem um movimento para cima da lâmina 680 em relação ao deslizador em cunha 678 quando a lâmina 680 é acionada distalmente em relação ao deslizador em cunha 678. Embora o deslizador de translação 692 seja mostrado como sendo orientado em um ângulo específico em relação à lâmina 680, deve ser entendido que o deslizador de translação 692 pode ser orientado em qualquer ângulo adequado, como ficará evidente para aqueles versados na técnica em vista dos ensinamentos da presente invenção.
[0097] O elemento de retenção 694 se estende distalmente dalâmina 680. Em particular, o elemento de retenção 694 inicialmente se estende substancialmente perpendicular a um eixo geométrico longitudinal da lâmina 680. À medida que o elemento de retenção 694 se estende distalmente, o elemento de retenção 694 se curva para baixo em um ângulo. Conforme será compreendido, o formato do elemento de retenção 694 é configurado para engatar o membro resiliente 686 para forçar resilientemente a lâmina 680 em direção à posição retraída. Dessa forma, o elemento de retenção 694 pode assumir uma variedade de formatos alternativos, dependendo da relação específica entre o deslizador em cunha 678 e a lâmina 680 e outros sub componentes dos mesmos.
[0098] Ao contrário da lâmina 380, 480, 580 do deslizador emcunha 378, 478, 578, a lâmina 680 do deslizador em cunha 678 é configurado para transladar obliquamente em relação ao deslizador em cunha 478. Em particular, a fenda de translação 683 do deslizador em cunha 678 é configurada para se acoplar ao deslizador em cunha 692 da lâmina 680. A fenda de translação 683 e o deslizador de translação 692 são ambos orientados em um ângulo de tal modo que a fenda de translação 683 e a fenda de translação 692 sejam operáveis para transladar cooperativamente a lâmina de translação 680 para cima à medida que a lâmina 680 é avançada distalmente. Dessa forma, a fenda de translação 683 e a fenda de translação 692 são operáveis para fazer a transição da lâmina 680 da posição retraída para a posição estendida quando a lâmina 680 é avançada distalmente.
[0099] Como pode ser melhor visto na Figura 23, o membroresiliente 686 do deslizador em cunha 678 e do elemento de retenção 694 da lâmina 680 são configurados para engatar um ao outro de modo que o membro resiliente 686 exerça uma força que tem um componente para baixo e um componente proximal sobre o elemento de retenção 694. Essa força faz com que o deslizador em cunha 692 da lâmina 680 seja forçado até a extremidade proximal da fenda de translação 683 do deslizador em cunha 678, forçando, assim, resilientemente a lâmina 680 em direção à posição retraída. Em algumas versões, a borda distal da projeção distal 83 é orientada em um ângulo entre 75 graus e 90 graus em relação a um plano horizontal. Tal ângulo pode fornecer uma ação de came que ajuda a superar a polarização do membro resiliente 686 para retrair a lâmina 680 proximalmente.
[0100] Em um modo de operação exemplificador, a lâmina 680 éretraída inicialmente na posição retraída para inserção do cartucho 670 na garra inferior 50. Quando a lâmina 680 estiver na posição retraída, a lâmina 680 está totalmente dentro do cartucho 670. Consequentemente, um operador é protegido contra contato inadvertido com a lâmina 680 durante a inserção do cartucho 670 na garra inferior 50.
[0101] Depois que um operador insere o cartucho 670 na garrainferior 50, a lâmina 680 permanece retraída até que o operador dê início à sequência de disparo. Depois que a sequência de disparo é iniciada, a barra de disparo 82 é acionada distalmente de modo que o membro de faca 80 entre em contato com a lâmina 680 para primeiro acionar a lâmina 680 para a posição estendida e, então, para acionar a lâmina 680 e o deslizador em cunha 678 proximalmente. Conforme mostrado nas Figuras 23 e 24, o membro de faca 80 compreende uma projeção distal 83 que é configurada para entrar em contato com a lâmina 680. Dessa forma, à medida que a barra de disparo 82 é acionada distalmente, a lâmina 680 é correspondentemente acionada distalmente em relação ao deslizador em cunha 678 pela projeção distal 83 do membro de faca 80. À medida que a lâmina 680 é acionada distalmente, a fenda de translação 683 do deslizador em cunha 678 e do deslizador de translação 692 da lâmina 680 acionam simultaneamente e cooperativamente a lâmina 680 na posição estendida, conforme pode ser observado na transição do estado mostrado na Figura 23 para o estado mostrado na Figura 24. Deve-se compreender que, como a lâmina 680 é resilientemente forçada em direção à posição retraída, a lâmina 680 é estendida apenas quando ativada pelo membro de faca 80. O avanço contínuo da barra de disparo 82 avança o deslizador em cunha 678 distalmente e aciona o gume cortante 691 da lâmina 680 através do suporte 280 e/ou tecido 90. O gume cortante 84 do membro de faca 80 pode seguir imediatamente atrás da lâmina 680, de modo que o gume cortante 84 corte qualquer tecido 90 ou suporte 280 de material não cortado pela lâmina 680.
[0102] Deve-se compreender que o gume cortante 84 do membrode faca 80 e o gume cortante 690 da lâmina 680 seguem uma trajetória que é substancialmente idêntica. Tal trajetória pode ser, em geral, definida por uma canaleta que se estende longitudinalmente (não mostrada) do cartucho 670. Ao fazer o primeiro corte passar através do suporte 280 (e, em algumas versões, do tecido também 90), a lâmina 680 pode reduzir o desgaste e/ou acúmulo no membro de faca 80, prolongando, assim, a vida útil do membro de faca 80. Adicionalmente, deve-se compreender que ambas a lâmina 680 e o membro de faca 80 podem seguir as superfícies de came 379, de modo que o deslizador em cunha 678 acione os grampos 77 através de uma dada região de tecido antes que essa região específica de tecido seja cortada por uma lâmina 680 ou elemento de faca 80. A ação de grampeamento e corte pode ainda ser considerada, de maneira substancialmente simultânea na região de tecido porque o deslizador em cunha 678 é configurado de modo que a diferença do tempo entre grampeamento e o corte é substancialmente curta.
[0103] Depois que o instrumento 10 for disparado, o membro defaca 80 pode ser proximalmente retraído. A retração proximal do membro de faca 80 permite que o membro resiliente 686 acione a lâmina 680 de volta para a posição retraída. A lâmina 680 é, assim, retraída em um cartucho gasto 670 protegendo o operador contra o contato indesejado com o gume cortante 691 quando operador remove o cartucho gasto 670 para substituir o cartucho gasto 670 ou, de outro modo, para descartar o cartucho gasto 670. O cartucho pode ser removido 670 juntamente com a lâmina 680 de modo que um novo cartucho 70, 270, 370, 470, 570, equipado com a lâmina 380, 480, 580, 680, possa ser inserido na garra inferior 50. Deve-secompreender que o cartucho 670 pode ser substituído por um cartucho idêntico 670 ou um cartucho diferente 70, 270, 370, 470, 570. Por exemplo, como com o deslizador em cunha 378, 478, 578 discutido acima, alguns cartuchos 70, 270, 370, 470, 570 podem ser equipados com lâminas 680 configuradas para diferentes procedimentos como aqueles descritos acima.D. Deslizador em cunha com lâmina transladável exemplificador
[0104] As Figuras 25 e 26 mostram um outro alternativo deslizadorem cunha alternativo exemplificador 778 para uso com o cartucho 770, que é uma versão modificada do cartucho 70, 270. Em muitosaspectos, o deslizador em cunha 778 deste exemplo é similar ao deslizador em cunha 78, 378, 478, 578, 678 descrito acima. Como o deslizador em cunha 378, 478, 578, 678, o deslizador em cunha 778 foi modificado em relação ao deslizador em cunha 78 para incluir uma lâmina cortante secundária integral 780. Em particular, como pode ser melhor visto na Figura 25, o deslizador em cunha 778 inclui um corpo 777 e uma superfície de came 779. O corpo 777 e a superfície de came 779 são mais curtos em relação à superfície de came 79 do deslizador em cunha 78, ainda assim a superfície de came 779 é orientada em um ângulo que é mais íngreme que o ângulo de superfície de came 79 do deslizador em cunha 78. Consequentemente, o deslizador em cunha 778 ocupa a mesma quantidade de espaço longitudinalmente no interior do cartucho 70, 270 que o deslizador em cunha 78, tornando o deslizador em cunha 778 substancialmente intercambiável com o deslizador em cunha 78. O ângulo das superfícies de came 779 permite que o deslizador em cunha 778 acione múltiplos acionadores de grampo 75 para cima simultaneamente e/ou em uma certa sequência predeterminada.
[0105] A lâmina 780 compreende uma porção de corte superior790, uma porção de corpo 792 e um membro de estabilização 794. A porção de corte 790 compreende um gume cortante 791 distalmente orientado, que é configurado para cortar através do suporte 280 e/ou tecido 90. Como com o gume cortante 390, 490, 590, 691 descrito acima o gume cortante 791, pode ter uma variedade de configurações alternativas que podem ser configurados para cortar através de uma variedade de materiais.
[0106] A porção do corpo 792 unitária acopla a lâmina 780 com odeslizador em cunha 778. Em outras palavras, o deslizador em cunha 778 e a lâmina 780 compreendem um único componente unitário nesse exemplo. Em um outro exemplo, a lâmina 780 pode ser separada de, e, presa por fixação ao deslizador em cunha 778. A porção de corpo 792 é dimensionada para elevar a porção de corte 790 até a altura adequada para cortar o suporte 280. Embora a porção de corpo 792 seja mostrada como tendo uma altura específica, deve- se compreender que a altura da porção de corpo 792 pode ser variada de acordo com inúmeros fatores, como altura da plataforma 773, suporte 280, espessura, etc.
[0107] O elemento estabilizador 794 é posicionado acima do gumecortante 791 e se estende distalmente a partir da lâmina 780. Como pode ser melhor visto na Figura 26, o elemento estabilizador 794 é posicionado para alinhar-se com a superfície de topo do suporte 280. Consequentemente, o elemento estabilizador 794 é operável para acionar o suporte 280 até o gume cortante 791 e pode adicionalmente ajudar em evitar que o suporte 280 se separe da plataforma 773 na região adjacente à lâmina 780, conforme será descrito com mais detalhes abaixo. Adicionalmente, o elemento estabilizador 794 atua como um anteparo para evitar o contato inadvertido do operador com o gume cortante 791. Embora o elemento estabilizador 794 seja mostrado como tendo um formato genericamente retangular que se estende em uma distância específica, deve-se compreender que o elemento estabilizador 794 pode ter qualquer tamanho ou formato adequados. Por exemplo, em outros exemplos o elemento estabilizador 794 pode se estender distalmente além do mostrado. Em ainda outros exemplos, o elemento estabilizador 794 pode se afunilar para fora ou para dentro até uma largura que é maior ou menor que a lâmina 780, respectivamente. Obviamente, o elemento estabilizador 794 pode compreender qualquer outra configuração, tamanho e/ou formato adequados conforme ficará evidente para os versados na técnica tendo em vista os ensinamentos do presente documento.
[0108] Em um modo de operação exemplificador, a lâmina 780inicialmente se projeta para fora do cartucho 70, 270 na extremidade proximal do cartucho 70, 270. O elemento estabilizador 794 éconfigurado para proteger um operador contra o contato indesejado com o gume cortante 791 enquanto o cartucho 70, 270 é inserido na garra inferior 50. Consequentemente, um operador é protegido contra o contato inadvertido com a lâmina 780 mesmo que a lâmina 780 se projete para fora do cartucho 70, 270.
[0109] Depois que um usuário inserir o cartucho 70, 270 na garrainferior 50, a sequência de disparo pode ser iniciada. Depois que a sequência de disparos é iniciada, a barra de disparo 82 é acionada distalmente de modo que o membro de faca 80 entre em contato com o deslizador em cunha 778. Conforme mostrado na Figura 26, o elemento de faca 80 entra em contato com o deslizador em cunha 778 e começa a acionar 778 o deslizador em cunha 780 e a lâmina distalmente. À medida que a lâmina 780 é acionada distalmente, o elemento estabilizador 794 do deslizador em cunha 778 se desloca sobre a superfície superior do suporte 280 para estabilizar o processo de corte. Deve-se compreender que, como o elemento estabilizador 794 se desloca no topo do suporte 280, a lâmina 780 corta apenas o suporte 280. Em outros exemplos, o gume cortante 791 da lâmina 780 pode ser configurado para ser verticalmente mais alto. Em alguns desses exemplos, o elemento estabilizador 794 pode se deslocar sobre o tecido 90 ou um suporte 280 que é adjacente à bigorna 60. Dessa forma, em um outro exemplo, a lâmina 780 pode ser configurada para cortar outros materiais além do suporte 280, como um tecido 90 ou outros suportes adicionais 280. O gume cortante 84 do membro de faca 80 pode seguir imediatamente atrás da lâmina 780, de modo que o gume cortante 84 corte qualquer tecido 90 ou suporte 280 de material não cortado pela lâmina 780.
[0110] Deve-se compreender que o gume cortante 84 do membrode faca 80 e o gume cortante 790 da lâmina 780 seguem uma trajetória que é substancialmente idêntica. Tal trajetória pode ser, em geral, definida por uma canaleta que se estende longitudinalmente (não mostrada) do cartucho 770. Ao fazer o primeiro corte passar através do suporte 280 (e, em algumas versões, do tecido também 90), a lâmina 780 pode reduzir o desgaste e/ou acúmulo no membro de faca 80, prolongando, assim, a vida útil do membro de faca 80. Adicionalmente, deve-se compreender que ambos a lâmina 780 e o membro de faca 80 podem seguir as superfícies de came 779, de modo que o deslizador em cunha 778 acione os grampos 77 através de uma dada região de tecido antes que essa região específica de tecido seja cortada por uma lâmina 480 ou elemento de faca 80. A ação de grampeamento e corte pode ainda ser substancialmente simultânea na região de tecido porque o deslizador em cunha 778 é configurado de modo que a diferença do tempo entre grampeamento e o corte seja substancialmente curta.
[0111] Depois que o instrumento 10 é disparado, o cartucho 70,270 pode ser removido juntamente com a lâmina 780, de modo que um novo cartucho 70, 270, 470, 570 possa ser inserido na garra inferior 50. Deve-se compreender que o cartucho 70, 270 pode ser substituído por um cartucho idêntico 70, 270 ou um cartucho diferente 70, 270, 470, 570. Por exemplo, como com o deslizador em cunha 378, 478, 578, 678 discutido acima, alguns cartuchos 570 podem ser equipados com lâminas 780 configuradas para diferentes procedimentos como aqueles descritos acima.
[0112] Deve ser entendido que em vários exemplos descritosacima, uma junta de articulação é configurada para permitir que um atuador de extremidade seja articulado ao longo de um primeiro plano e, portanto, seja defletido na direção contrária ao eixo longitudinal de um conjunto de haste. Um conjunto de travamento é operável para travar, de forma seletiva, a junta de articulação. O conjunto de travamento inclui um membro de travamento que é móvel ao longo de um segundo plano para engatar seletivamente o primeiro membro de travamento e, desse modo, travar a junta de articulação. O segundo plano é deslocado em relação ao primeiro plano. O segundo plano também é não paralelo ao primeiro plano. Em alguns casos, o segundo membro de travamento é móvel ao longo de um segundo eixo que é perpendicular ao eixo longitudinal do conjunto de haste. Um membro de destravamento pode destravar seletivamente o membro de travamento. O membro de destravamento pode se mover ao longo de um terceiro plano, o qual pode ser deslocado de e/ou estar em uma relação não paralela com o primeiro e/ou segundo planos. O membro de destravamento pode se mover ao longo de um terceiro eixo, que pode ser perpendicular ao eixo longitudinal do conjunto de haste e/ou ao segundo eixo.
[0113] Deve-se compreender que qualquer um ou mais dosensinamentos, expressões, modalidades, exemplos, etc. aqui descritos podem ser combinados com qualquer um ou mais dos outros ensinamentos, expressões, modalidades, exemplos, etc. que são descritos na presente invenção. Os ensinamentos, expressões, modalidades, exemplos, etc. descritos acima não devem, portanto, ser vistos isolados uns dos outros. Várias maneiras adequadas, pelas quais os ensinamentos da presente invenção podem ser combinados, se tornarão prontamente evidentes aos versados na técnica tendo em vista dos ensinamentos da presente invenção. Essas modificações e variações são destinadas a serem incluídas no escopo das reivindicações anexas. Deve-se compreender que os vários ensinamentos da presente invenção podem ser prontamente combinados com os ensinamentos das várias referências que são citadas na presente invenção.
[0114] Deve-se compreender que qualquer patente, publicação, ououtro material de revelação tidos como incorporados à presente invenção a título de referência, total ou parcialmente, estão incorporados à presente invenção somente na medida em que o material incorporado não entrar em conflito com as definições, declarações ou outro material revelado apresentados nesta revelação. Desse modo, e na medida em que for necessário, a revelação como explicitamente aqui apresentada 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 outros materiais 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.
[0115] Versões dos dispositivos descritos acima podem teraplicação em tratamentos médicos convencionais e procedimentos conduzidos por um profissional médico, bem como aplicação em tratamentos e procedimentos médicos assistidos por robótica. Somente a título de exemplo, vários ensinamentos da presente invenção podem ser prontamente incorporados a um sistema cirúrgico robótico como o sistema DAVINCI™ pelo Intuitive Surgical, Inc., de Sunnyvale, Califórnia, EUA. De modo similar, os versados na técnica reconhecerão que vários ensinamentos aqui podem ser prontamente combinados com vários ensinamentos de qualquer uma das seguintes: Patente US N° 5.792.135, intitulada "Articulated Surgical Instrument For Performing Minimally Invasive Surgery With Enhanced Dexterity and Sensitivity", concedida em 11 de agosto de 1998, cuja descrição está aqui incorporada a título de referência; Patente US N° 5.817.084, intitulada "Remote Center Positioning Device with Flexible Drive", concedida em 6 de outubro de 1998, cuja descrição está aqui incorporada a título de referência; Patente U.S. N° 5.878.193, intitulada "Automated Endoscope System for Optimal Positioning", concedida em 2 de março de 1999, cuja descrição está aqui incorporada a título de referência; Patente U.S. N° 6.231.565, intitulada "Robotic Arm DLUS for Performing Surgical Tasks", concedida em 15 de maio de 2001, cuja descrição está aqui incorporada a título de referência; patente US N° 6.783.524, intitulada "Robotic Surgical Tool with Ultrasound Cauterizing and Cutting Instrument", concedida em 31 de agosto de 2004, cuja descrição está aqui incorporada a título de referência; Patente US N° 6.364.888, intitulada "Alignment of Master and Slave in a Minimally Invasive Surgical Apparatus", concedida em 2 de abril de 2002, cuja descrição está aqui incorporada a título de referência; Patente US N° 7.524.320, intitulada "Mechanical Actuator Interface System for Robotic Surgical Tools", concedida em 28 de abril de 2009, cuja descrição está aqui incorporada a título de referência; Patente US N° 7.691.098, intitulada "Platform Link Wrist Mechanism", concedida em 6 de abril de 2010, cuja descrição está aqui incorporada a título de referência; Patente US N° 7.806.891, intitulada "Repositioning and Reorientation of Master/Slave Relationship in Minimally Invasive Telesurgery," concedida em 5 de outubro de 2010, cuja revelação está aqui incorporada a título de referência; publicação de patente US N° 2013/0012957, intitulada "Automated End Effector Component Reloading System for Use with a Robotic System", publicada em 10 de janeiro de 2013, cuja descrição está aqui incorporada a título de referência; publicação de patente US N° 2012/0199630, intitulada "Robotically-Controlled Surgical Instrument with Force-Feedback Capabilities", publicada em 9 de agosto de 2012, cuja descrição está aqui incorporada a título de referência; publicação de patente US N° 2012/0132450, intitulada "Shiftable Drive Interface for Robotically- Controlled Surgical Tool", publicada em 31 de maio de 2012, cuja descrição está aqui incorporada a título de referência; publicação de patente US N° 2012/0199633, intitulada "Surgical Stapling Instruments with Cam-Driven Staple Deployment Arrangements", publicada em 9 de agosto de 2012, cuja descrição está aqui incorporada a título de referência; publicação de patente US N° 2012/0199631, intitulada "Robotically-Controlled Motorized Surgical End Effector System with Rotary Actuated Closure Systems Having Variable Actuation Speeds", publicada em 9 de agosto de 2012, cuja descrição está aqui incorporada a título de referência; publicação de patente US N° 2012/0199632, intitulada "Robotically-Controlled Surgical Instrument with Selectively Articulatable End Effector", publicada em 9 de agosto de 2012, cuja descrição está aqui incorporada a título de referência; publicação de patente US N° 2012/0203247, intitulada "Robotically- Controlled Surgical End Effector System", publicada em 9 de agosto de 2012, cuja descrição está aqui incorporada a título de referência; publicação de patente US N° 2012/0211546, intitulada "Drive Interface for Operably Coupling a Manipulatable Surgical Tool to a Robot", publicada em 23 de agosto de 2012; publicação de patente US N° 2012/0138660, intitulada "Robotically-Controlled Cable-Based Surgical End Effectors", publicada em 7 de junho de 2012, cuja descrição está aqui incorporada a título de referência; e/ou da Publicação US N° 2012/0205421 intitulada "Robotically-Controlled Surgical End Effector System with Rotary Actuated Closure Systems", publicada em 16 de agosto de 2012, cuja revelação está aqui incorporada a título de referência.
[0116] Versões do dispositivo descrito acima podem ser projetadaspara serem descartadas após um único uso, ou as mesmas podem ser projetadas para serem usadas múltiplas vezes. As versões podem, em qualquer um ou em ambos os casos, ser recondicionadas para reutilização após ao menos uma utilização. O recondicionamento pode incluir qualquer combinação das etapas de desmontagem do dispositivo, seguida de limpeza ou substituição de peças específicas e a subsequente remontagem. Especificamente, algumas versões do dispositivo podem ser desmontadas em qualquer número de peças particulares ou partes do dispositivo podem ser seletivamente substituídas ou removidas em qualquer combinação. Com a limpeza e/ou substituição de partes particulares, algumas versões do dispositivo podem ser remontadas para uso subsequente em uma instalação de recondicionamento ou por um usuário imediatamente antes de um procedimento cirúrgico. Os versados na técnica compreenderão que o recondicionamento de um dispositivo pode usar uma variedade de técnicas de desmontagem, limpeza/substituição e remontagem. O uso de tais técnicas e o dispositivo recondicionado resultante estão dentro do escopo do presente pedido.
[0117] Apenas a título de exemplo, as versões aqui descritaspodem ser esterilizadas antes e/ou depois de um procedimento. Em uma técnica de esterilização, o dispositivo é colocado em um recipiente fechado e vedado, como um saco plástico ou de TYVEK. O recipiente e o dispositivo podem então ser colocados em um campo de radiação, como radiação gama, raios X ou elétrons de alta energia, que pode penetrar no recipiente. A radiação pode exterminar bactérias no dispositivo e no recipiente. O dispositivo esterilizado pode, então, ser guardado em um recipiente estéril para uso posterior. O dispositivo pode também ser esterilizado com o uso de qualquer outra técnica conhecida, incluindo, mas não se limitando a, radiação beta ou gama, óxido de etileno ou vapor d'água.
[0118] Tendo mostrado e descrito várias modalidades da presenteinvenção, outras adaptações dos métodos e sistemas descritos na presente invenção podem ser realizadas por meio de modificações adequadas por uma pessoa versada na técnica sem se afastar do escopo da presente invenção. Várias dessas possíveis modificações foram mencionadas, e outras se tornarão evidentes àqueles versados na técnica. Por exemplo, os exemplos, modalidades, geometria, materiais, dimensões, proporções, etapas e similares discutidos acima são ilustrativos e não são obrigatórios. Consequentemente, o escopo da presente invenção deve ser considerado de acordo com os termos das concretizações a seguir e entende-se que o mesmo não está limitado aos detalhes da estrutura e operação mostrados e descritos no relatório descritivo e nos desenhos.
Claims (17)
1. Aparelho que compreende:(a) um corpo;(b) um conjunto de eixo (30) que se estende distalmente do corpo, em que o conjunto de eixo define um eixo longitudinal, em que o conjunto de eixo tem uma extremidade distal;(c) um atuador de extremidade (40) posicionado na extremidade distal do conjunto de eixo, em que o atuador de extremidade compreende uma garra inferior, uma bigorna pivotante e um cortador transladante, em que o cortador transladante é operável para transladar em relação à garra inferior e à bigorna;(d) um cartucho (370), em que o cartucho é inserível na garra inferior, em que o cartucho inclui uma pluralidade de grampos; e(e) um atuador do acionador de grampos (378) disposto no cartucho, em que o atuador do acionador de grampos compreende um elemento de corte secundário, sendo que o cortador transladante do atuador de extremidade é operável para cortar o tecido e direcionar o atuador do acionador de grampos distalmente para inserir grampos no tecido;caracterizado pelo fato de queo atuador do acionador de grampos (378) ainda compreende um elemento de corte secundário (380) que se move distalmente com o atuador do acionador de grampos, enquanto aciona os grampos no tecido.
2. Aparelho, de acordo com a reivindicação 1, caracterizado pelo fato de que o elemento de corte secundário (380) compreende um gume cortante reto orientado em um ângulo oblíquo em relação ao cartucho.
3. Aparelho, de acordo com a reivindicação 1, caracterizado pelo fato de que o elemento de corte secundário (380) compreende um gume cortante curvo.
4. Aparelho, de acordo com a reivindicação 1, caracterizado pelo fato de que o elemento de corte secundário (380) compreende um gume cortante configurado para cortar tecido mole.
5. Aparelho, de acordo com a reivindicação 1, carac-terizado pelo fato de que o elemento de corte secundário (380)compreende um gume cortante configurado para cortar tecido denso.
6. Aparelho, de acordo com a reivindicação 1, caracterizado pelo fato de que o elemento de corte secundário (380) éconfigurado para se mover seletivamente entre uma posição retraída e uma posição estendida, sendo que o elemento de corte secundário é disposto no cartucho quando o elemento de corte secundário está na posição retraída, em que pelo menos uma porção do elemento de corte secundário se estende através de uma canaleta que se estende longitudinalmente no cartucho quando o elemento de corte secundário está na posição estendida.
7. Aparelho, de acordo com a reivindicação 6, caracterizado pelo fato de que o elemento de corte secundário (380) é resilientemente forçado em direção à posição retraída.
8. Aparelho, de acordo com a reivindicação 7, caracterizado pelo fato de que o elemento de corte secundário (380) é operável para girar entre a posição retraída e a posição estendida.
9. Aparelho, de acordo com a reivindicação 7, caracterizado pelo fato de que o elemento de corte secundário (380) é operável para transladar em ângulo oblíquo em relação ao cartucho para fazer a transição entre a posição retraída e a posição estendida.
10. Aparelho, de acordo com a reivindicação 9, caracterizado pelo fato de que o elemento de corte secundário (380) inclui um deslizador de translação, em que o atuador do acionador de grampos compreende uma fenda de translação, em que o deslizador de translação e a fenda de translação são configurados para se acoplarem para fazer a transição do elemento de corte secundário entre a posição retraída e a posição estendida.
11. Aparelho, de acordo com a reivindicação 10, caracterizado pelo fato de que o atuador do acionador de grampos compreende um membro resiliente (686), em que o elemento de corte secundário (380) ainda compreende um membro que se estende distalmente, em que o membro que se estende distalmente está configurado para engatar o membro resiliente do atuador do acionador de grampos para forçar resilientemente o elemento de corte secundário em direção à posição retraída.
12. Aparelho, de acordo com a reivindicação 1, caracterizado pelo fato de que o elemento de corte secundário (380) é fixo em relação ao atuador do acionador de grampos.
13. Aparelho, de acordo com a reivindicação 12, caracterizado pelo fato de que o cartucho inclui um protetor (469) que se projeta a partir do cartucho, em que o protetor é posicionado proximalmente no cartucho, em que o elemento de corte secundário é operável para se mover seletivamente para dentro e para fora do protetor.
14. Aparelho, de acordo com a reivindicação 12, caracterizado pelo fato de que o elemento de corte secundário (380) inclui uma projeção distal e um gume cortante distalmente orientado, em que a projeção distal é orientada acima do gume cortante.
15. Aparelho, de acordo com qualquer uma das reivindicações 1 a 14, caracterizado pelo fato de que ainda compreende um suporte, sendo que pelo menos uma porção do suporte é orientada em posição adjacente ao cartucho, sendo que o elemento de corte secundário (380) é configurado para cortar através de pelo menos uma porção do suporte.
16. Aparelho, de acordo com a reivindicação 1, caracterizado pelo fato de que o cartucho é um cartucho removível e compreende:(i) um alojamento,(ii) uma pluralidade de grampos dispostos no alojamento,(iii) uma plataforma disposta sobre a pluralidade de grampos, a plataforma definindo aberturas, cada abertura sendo disposta sobre um respectivo grampo,(iv) um suporte (280) pelo menos parcialmente disposto sobre a plataforma eo elemento de corte secundário tem uma borda afiada configurada para separar ao menos uma porção do suporte.
17. Aparelho, de acordo com a reivindicação 1, caracterizado pelo fato de que o cartucho é um dentre uma pluralidade de cartuchos de grampos, em que cada cartucho da pluralidade de cartuchos de grampos está configurado para ser intercambiávelmente inserível no atuador de extremidade, em que cada cartucho de grampos da pluralidade de cartuchos de grampos está configurado para um procedimento cirúrgico diferente.
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US14/489,746 | 2014-09-18 | ||
US14/489,746 US10105142B2 (en) | 2014-09-18 | 2014-09-18 | Surgical stapler with plurality of cutting elements |
PCT/US2015/048852 WO2016043999A1 (en) | 2014-09-18 | 2015-09-08 | Surgical stapler with plurality of cutting elements |
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2014
- 2014-09-18 US US14/489,746 patent/US10105142B2/en active Active
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2015
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- 2015-09-08 JP JP2017515079A patent/JP6625619B2/ja active Active
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US11109864B2 (en) | 2021-09-07 |
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JP6625619B2 (ja) | 2019-12-25 |
US20220233194A1 (en) | 2022-07-28 |
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US20190365384A1 (en) | 2019-12-05 |
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CN107106171A (zh) | 2017-08-29 |
JP2017529159A (ja) | 2017-10-05 |
WO2016043999A1 (en) | 2016-03-24 |
US20160081690A1 (en) | 2016-03-24 |
US20200015821A1 (en) | 2020-01-16 |
US11123069B2 (en) | 2021-09-21 |
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