BR112017009435B1 - Aparelho de grampeamento cirúrgico para grampear tecido - Google Patents
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- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
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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
- A61B17/0682—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil
- A61B17/0686—Surgical staplers, e.g. containing multiple staples or clamps for applying U-shaped staples or clamps, e.g. without a forming anvil having a forming anvil staying below the tissue during stapling
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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
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- A—HUMAN NECESSITIES
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- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07257—Stapler heads characterised by its anvil
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- 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
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07285—Stapler heads characterised by its cutter
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Abstract
A presente invenção se refere a um aparelho de grampeamento cirúrgico que compreende um corpo de cartucho e uma camada. A camada é implantável contra o tecido por meio de grampos distribuídos a partir do corpo de cartucho e deformados por uma bigorna. O cartucho e a camada compreendem recursos cooperantes que reduzem o movimento relativo entre o cartucho e a camada. Tais recursos cooperantes podem também reter de modo liberável a camada ao corpo de cartucho. Além de ou em lugar do mencionado acima, a bigorna e a camada compreendem recursos cooperantes que reduzem o movimento relativo entre a bigorna e a camada. Tais recursos cooperantes podem também reter de modo liberável a camada ao corpo de cartucho. Em certas instâncias, a camada pode ser posicionada contra a bigorna, mas fixada de modo liberável ao cartucho. A camada pode compreender um material de suporte e/ou um compensador de espessura do tecido, por exemplo.
Description
[001] A presente invenção se refere a instrumentos de grampeamento e, em várias modalidades, a um instrumento de grampeamento cirúrgico para produzir uma ou mais fileiras de grampos.
[002] Um instrumento de grampeamento pode incluir um par de membros de garra alongados colaboradores, sendo que cada membro de garra pode ser adaptado para ser inserido em um paciente e posicionado em relação ao tecido que será grampeado e/ou cortado. Em várias modalidades, um dos membros de garra pode sustentar um cartucho de grampos com ao menos duas fileiras de grampos espaçadas lateralmente e contidas no mesmo, e o outro membro de garra pode sustentar uma bigorna com bolsos formadores de grampos alinhada com as fileiras de grampos no cartucho de grampos. Em geral, o instrumento de grampeamento pode incluir adicionalmente uma barra propulsora e uma lâmina da faca que são deslizantes em relação aos membros de garra para ejetar sequencialmente os grampos do cartucho de grampos através de superfícies de came na barra propulsora e/ou superfícies de came sobre um trilho de cunha que é empurrado pela barra propulsora. Em ao menos uma modalidade, as superfícies de came podem ser configuradas para ativar uma pluralidade de acionadores de grampos carregados pelo cartucho e associados aos grampos a fim de empurrar os grampos contra a bigorna e formar fileiras espaçadas lateralmente de grampos deformados no tecido preso entre os membros de garra. Em ao menos uma modalidade, a lâmina da faca pode seguir as superfícies de came e cortar o tecido ao longo de uma linha entre as fileiras de grampo. Exemplos de tais instrumentos de grampeamento são revelados na patente US n° 7.794.475, intitulada "SURGICAL STAPLES HAVING COMPRESSIBLE OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME", cuja inteira revelação está aqui incorporada, a título de referência.
[003] A discussão anteriormente mencionada se destina somente a ilustrar vários aspectos da técnica relacionada no campo da invenção no momento e não devem ser tomadas como uma negação do escopo das reivindicações.
[004] Vários recursos das modalidades aqui descritas são demonstrados com particularidade nas reivindicações anexas. As várias modalidades, porém, no que se refere tanto à organização como aos métodos de operação, juntamente com vantagens dos mesmos, podem ser compreendidas de acordo com a descrição apresentada a seguir, considerada em conjunto com os desenhos anexos, da seguinte forma:
[005] A Figura 1 é uma vista em perspectiva de um cartucho de grampos de acordo com ao menos uma modalidade que compreende um corpo de cartucho e uma camada fixada de modo liberável ao corpo de cartucho por membros de retenção retráteis;
[006] A Figura 2 é uma vista em seção transversal parcial do cartucho de grampos da Figura 1 que ilustra os membros de retenção em uma posição estendida;
[007] A Figura 3 é uma vista em seção transversal parcial do cartucho de grampos da Figura 1 que ilustra os membros de retenção em uma posição retraída;
[008] A Figura 4 é uma vista em perspectiva parcial de um cartucho de grampos de acordo com ao menos uma modalidade que compreende um corpo de cartucho e uma camada fixada de modo liberável ao corpo de cartucho por um membro de retenção levantável;
[009] A Figura 5 é uma vista em seção transversal parcial do cartucho de grampos da Figura 4 que ilustra o membro de retenção em uma posição de preensão;
[0010] A Figura 6 é uma vista em seção transversal parcial do cartucho de grampos da Figura 4 que ilustra o membro de retenção em uma posição levantada;
[0011] A Figura 7 é uma vista em perspectiva parcial de um conjunto de atuador de extremidade que inclui um cartucho de grampos compreendendo um corpo de cartucho e uma camada de cartucho fixada de modo liberável ao corpo de cartucho e, adicionalmente, uma camada de bigorna fixada de modo liberável ao corpo de cartucho;
[0012] A Figura 8 é uma vista em elevação em seção transversal do conjunto de atuador de extremidade da Figura 7;
[0013] A Figura 9 é uma vista plana em seção transversal parcial do conjunto de atuador de extremidade da Figura 7, que ilustra as extremidades proximais da camada de cartucho e da camada de bigorna fixada de modo liberável ao corpo do cartucho; e
[0014] A Figura 10 é uma vista plana em seção transversal parcial do conjunto de atuador de extremidade da Figura 7, que ilustra as extremidades proximais da camada de cartucho e da camada de bigorna liberada do corpo de cartucho.
[0015] Os caracteres de referência correspondentes indicam as partes correspondentes através das várias vistas. As exemplificações aqui descritas ilustram várias modalidades da invenção, em uma forma, e tais exemplificações não devem ser consideradas como limitadoras do escopo da invenção em qualquer modo.
[0016] O Requerente do presente pedido também detém os pedidos de patente US identificados abaixo, os quais estão aqui incorporados, cada um, por referência em suas respectivas totalidades:
[0017] Pedido de patente US n° de série 12/894.311, intitulado SURGICAL INSTRUMENTS WITH RECONFIGURABLE SHAFT SEGMENTS; agora patente US n° 8.763.877;
[0018] Pedido de patente US n° de série 12/894.340, intitulado SURGICAL STAPLE CARTRIDGES SUPPORTING NON-LINEARLY ARRANGED STAPLES AND SURGICAL STAPLING INSTRUMENTS WITH COMMON STAPLE-FORMING POCKETS; agora publicação de pedido de patente US n° 2012/0080482;
[0019] Pedido de patente US n° de série 12/894.327, intitulado JAW CLOSURE ARRANGEMENTS FOR SURGICAL INSTRUMENTS; agora publicação de pedido de patente US n° 2012/0080499;
[0020] Pedido de patente US n° de série 12/894.351, intitulado SURGICAL CUTTING AND FASTENING INSTRUMENTS WITH SEPARATE AND DISTINCT FASTENER DEPLOYMENT AND TISSUE CUTTING SYSTEMS; agora publicação de pedido de patente US n° 2012/0080502;
[0021] Pedido de patente US n° de série 12/894.338, intitulado IMPLANTABLE FASTENER CARTRIDGE HAVING A NON-UNIFORM ARRANGEMENT; agora patente US n° 8.864.007;
[0022] Pedido de patente US n° de série 12/894.369, intitulado IMPLANTABLE FASTENER CARTRIDGE COMPRISING A SUPPORT RETAINER; agora publicação de pedido de patente US n° 2012/0080344;
[0023] Pedido de patente US n° de série 12/894.312, intitulado IMPLANTABLE FASTENER CARTRIDGE COMPRISING MULTIPLE LAYERS; agora publicação de pedido de patente US n° 2012/0080479;
[0024] Pedido de patente US n° de série 12/894.377, intitulado SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE; agora patente US n° 8.393.514;
[0025] Pedido de patente US n° de série 12/894.339, intitulado SURGICAL STAPLING INSTRUMENT WITH COMPACT ARTICULATION CONTROL ARRANGEMENT; agora patente US n° 8.840.003;
[0026] Pedido de patente US n° de série 12/894.360, intitulado SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAPLE FORMING SYSTEM; agora publicação de pedido de patente US n° 2012/0080484;
[0027] Pedido de patente US n° de série 12/894.322, intitulado SURGICAL STAPLING INSTRUMENT WITH INTERCHANGEABLE STAPLE CARTRIDGE ARRANGEMENTS; agora patente US n° 8.740.034;
[0028] Pedido de patente US n° de série 12/894.350, intitulado SURGICAL STAPLE CARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES; agora publicação de pedido de patente US n° 2012/0080478;
[0029] Pedido de patente US n° de série 12/894.383, intitulado IMPLANTABLE FASTENER CARTRIDGE COMPRISING BIOABSORBABLE LAYERS; agora patente US n° 8.752.699;
[0030] Pedido de patente US n° de série 12/894.389, intitulado COMPRESSIBLE FASTENER CARTRIDGE; agora patente US n° 8.740.037;
[0031] Pedido de patente US n° de série 12/894.345, intitulado FASTENERS SUPPORTED BY A FASTENER CARTRIDGE SUPPORT; agora patente US n° 8.783.542;
[0032] Pedido de patente US n° de série 12/894.306, intitulado COLLAPSIBLE FASTENER CARTRIDGE; agora publicação de pedido de patente US n° 2012/0080332;
[0033] Pedido de patente US n° de série 12/894.318, intitulado FASTENER SYSTEM COMPRISING A PLURALITY OF CONNECTED RETENTION MATRIX ELEMENTS; agora patente US n° 8.814.024;
[0034] Pedido de patente US n° de série 12/894.330, intitulado FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND AN ALIGNMENT MATRIX; agora patente US n° 8.757.465;
[0035] Pedido de patente US n° de série 12/894.361, intitulado FASTENER SYSTEM COMPRISING A RETENTION MATRIX; agora patente US n° 8.529.600;
[0036] Pedido de patente US n° de série 12/894.367, intitulado FASTENING INSTRUMENT FOR DEPLOYING A FASTENER SYSTEM COMPRISING A RETENTION MATRIX; agora publicação de pedido de patente US n° 2012/0080485;
[0037] Pedido de patente US n° de série 12/894.388, intitulado FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND A COVER; agora patente US n° 8.474.677;
[0038] Pedido de patente US n° de série 12/894.376, intitulado FASTENER SYSTEM COMPRISING A PLURALITY OF FASTENER CARTRIDGES; agora publicação de pedido de patente US n° 2012/0080486;
[0039] Pedido de patente US n° de série 13/097.865, intitulado SURGICAL STAPLER ANVIL COMPRISING A PLURALITY OF FORMING POCKETS; agora publicação de pedido de patente US n° 2012/0080488;
[0040] Pedido de patente US n° de série 13/097.936, intitulado TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER; agora patente US n° 8.657.176;
[0041] Pedido de patente US n° de série 13/097.954, intitulado STAPLE CARTRIDGE COMPRISING A VARIABLE THICKNESS COMPRESSIBLE PORTION; agora publicação de pedido de patente US n° 2012/0080340;
[0042] Pedido de patente US n° de série 13/097.856, intitulado STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN A COMPRESSIBLE PORTION THEREOF; agora publicação de pedido de patente US n° 2012/0080336;
[0043] Pedido de patente US n° de série 13/097.928, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING DETACHABLE PORTIONS; agora patente US n° 8.746.535;
[0044] Pedido de patente US n° de série 13/097.891, intitulado TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISING AN ADJUSTABLE ANVIL; agora patente US n° 8.864.009;
[0045] Pedido de patente US n° de série 13/097.948, intitulado STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISTAL PORTION; agora publicação de pedido de patente US n° 2012/0083836;
[0046] Pedido de patente US n° de série 13/097.907, intitulado COMPRESSIBLE STAPLE CARTRIDGE ASSEMBLY; agora publicação de pedido de patente US n° 2012/0080338;
[0047] Pedido de patente US n° de série 13/097.861, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING PORTIONS HAVING DIFFERENT PROPERTIES; agora publicação de pedido de patente US n° 2012/0080337;
[0048] Pedido de patente US n° de série 13/097.869, intitulado STAPLE CARTRIDGE LOADING ASSEMBLY; agora patente US n° 8.857.694;
[0049] Pedido de patente US n° de série 13/097.917, intitulado COMPRESSIBLE STAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS; agora patente US n° 8.777.004;
[0050] Pedido de patente US n° de série 13/097.873, intitulado STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTION; agora patente US n° 8.740.038;
[0051] Pedido de patente US n° de série 13/097.938, intitulado STAPLE CARTRIDGE COMPRISING COMPRESSIBLE DISTORTION RESISTANT COMPONENTS; agora publicação de pedido de patente US n° 2012/0080491;
[0052] Pedido de patente US n° de série 13/097.924, intitulado STAPLE CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR; agora publicação de pedido de patente US n° 2012/0083835;
[0053] Pedido de patente US n° de série 13/242.029, intitulado SURGICAL STAPLER WITH FLOATING ANVIL; agora publicação de pedido de patente US n° 2012/0080493;
[0054] Pedido de patente US n° de série 13/242.066, intitulado CURVED END EFFECTOR FOR A STAPLING INSTRUMENT; agora publicação de pedido de patente US n° 2012/0080498;
[0055] Pedido de patente US n° de série 13/242.086, intitulado STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK; agora publicação de pedido de patente US n° 2013/0075450;
[0056] Pedido de patente US n° de série 13/241.912, intitulado STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT; agora publicação de pedido de patente US n° 2013/0075448;
[0057] Pedido de patente n° de série US 13/241.922, intitulado SURGICAL STAPLER WITH STATIONARY STAPLE DRIVERS; agora publicação de pedido de patente US n° 2013/0075449;
[0058] Pedido de patente US n° de série 13/241.637, intitulado SURGICAL INSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING MULTIPLE ACTUATION MOTIONS; agora patente US n° 8.789.741;
[0059] Pedido de patente US n° de série 13/241.629, intitulado SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLE END EFFECTOR; agora publicação de pedido de patente US n° 2012/0074200;
[0060] Pedido US n° de série 13/433.096, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF CAPSULES; agora publicação de pedido de patente US n°2012/0241496;
[0061] Pedido US n° de série 13/433.103, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF LAYERS; agora publicação de pedido de patente US n° 2012/0241498;
[0062] Pedido US n° de série 13/433.098, intitulado EXPANDABLE TISSUE THICKNESS COMPENSATOR; agora publicação de pedido de patente US n° 2012/0241491;
[0063] Pedido US n° de série 13/433.102, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING A RESERVOIR; agora publicação de pedido de patente US n° 2012/0241497;
[0064] Pedido US n° de série 13/433.114, intitulado RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR; agora publicação de pedido de patente US n° 2012/0241499;
[0065] Pedido US n° de série 13/433.136, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING AT LEAST ONE MEDICAMENT; agora publicação de pedido de patente US n° 2012/0241492;
[0066] Pedido US n° de série 13/433.141, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING CONTROLLED RELEASE AND EXPANSION; agora publicação de pedido de patente US n° 2012/0241493;
[0067] Pedido US n° de série 13/433.144, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING FIBERS TO PRODUCE A RESILIENT LOAD; agora publicação de pedido de patente US n° 2012/0241500;
[0068] Pedido US n° de série 13/433.148, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING STRUCTURE TO PRODUCE A RESILIENT LOAD; agora publicação de pedido de patente US n° 2012/0241501;
[0069] Pedido US n° de série 13/433.155, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING RESILIENT MEMBERS; agora publicação de pedido de patente US n° 2012/0241502;
[0070] Pedido US n° de série 13/433.163, intitulado METHODS FOR FORMING TISSUE THICKNESS COMPENSATOR ARRANGEMENTS FOR SURGICAL STAPLERS; agora publicação de pedido de patente US n° 2012/0248169;
[0071] Pedido US n° de série 13/433.167, intitulado TISSUE THICKNESS COMPENSATORS; agora publicação de pedido de patente US n° 2012/0241503;
[0072] Pedido US n° de série 13/433.175, intitulado LAYERED TISSUE THICKNESS COMPENSATOR; agora publicação de pedido de patente US n° 2012/0253298;
[0073] Pedido US n° de série 13/433.179, intitulado TISSUE THICKNESS COMPENSATORS FOR CIRCULAR SURGICAL STAPLERS; agora publicação de pedido de patente US n° 2012/0241505;
[0074] Pedido US n° de série 13/763.028, intitulado ADHESIVE FILM LAMINATE; agora publicação de pedido de patente US n° 2013/0146643;
[0075] Pedido US n° de série 13/433.115, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING CAPSULES DEFINING A LOW PRESSURE ENVIRONMENT; agora publicação de pedido de patente US n° 2013/0256372;
[0076] Pedido US n° de série 13/433.118, intitulado TISSUE THICKNESS COMPENSATOR COMPRISED OF A PLURALITY OF MATERIALS; agora publicação de pedido de patente US n° 2013/0256365;
[0077] Pedido US n° de série 13/433.135, intitulado MOVABLE MEMBER FOR USE WITH A TISSUE THICKNESS COMPENSATOR; agora publicação de pedido de patente US n° 2013/0256382;
[0078] Pedido de patente US n° de série 13/433.140, intitulado TISSUE THICKNESS COMPENSATOR AND METHOD FOR MAKING THE SAME; agora publicação de pedido de patente US n° 2013/0256368;
[0079] Pedido US n° de série 13/433.129, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF MEDICAMENTS; agora publicação de pedido de patente US n° 2013/0256367;
[0080] Pedido US n° de série 11/216.562, intitulado STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS, agora patente US n° 7.669.746;
[0081] Pedido US n° de série 11/714.049, intitulado SURGICAL STAPLING DEVICE WITH ANVIL HAVING STAPLE FORMING POCKETS OF VARYING DEPTHS, agora publicação de pedido de patente US n° 2007/0194082;
[0082] Pedido US n° de série 11/711.979, intitulado SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS, agora patente US n° 8.317.070;
[0083] Pedido US n° de série 11/711.975, intitulado SURGICAL STAPLING DEVICE WITH STAPLE DRIVERS OF DIFFERENT HEIGHT, agora publicação de pedido de patente US n° 2007/0194079;
[0084] Pedido US n° de série 11/711.977, intitulado SURGICAL STAPLING DEVICE WITH STAPLE DRIVER THAT SUPPORTS MULTIPLE WIRE DIAMETER STAPLES, agora patente US n° 7.673.781;
[0085] Pedido US n° de série 11/712.315, intitulado SURGICAL STAPLING DEVICE WITH MULTIPLE STACKED ACTUATOR WEDGE CAMS FOR DRIVING STAPLE DRIVERS, agora patente US n° 7.500.979;
[0086] Pedido US n° de série 12/038.939, intitulado STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS, agora patente US n° 7.934.630;
[0087] Pedido US n° de série 13/020.263, intitulado SURGICAL STAPLING SYSTEMS THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS, atualmente patente US n° 8.636.187;
[0088] Pedido US n° de série 13/118.278, intitulado ROBOTICALLY-CONTROLLED SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS, agora publicação de pedido de patente US n° 2011/0290851;
[0089] Pedido US n° de série 13/369.629, intitulado ROBOTICALLY-CONTROLLED CABLE-BASED SURGICAL END EFFECTORS, agora patente US n° 8.800.838;
[0090] Pedido US n° de série 12/695.359, intitulado SURGICAL STAPLING DEVICES FOR FORMING STAPLES WITH DIFFERENT FORMED HEIGHTS, agora patente US n° 8.464.923;
[0091] Pedido US n° de série 13/072.923, intitulado STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS, agora patente US n° 8.567.656;
[0092] Pedido US n° de série 13/766.325, intitulado LAYER OF MATERIAL FOR A SURGICAL END EFFECTOR; agora publicação de pedido de patente US n° 2013/0256380;
[0093] Pedido US n° de série 13/763.078, intitulado ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTOR; agora publicação de pedido de patente US n° 2013/0256383;
[0094] Pedido US n° de série 13/763.094, intitulado LAYER COMPRISING DEPLOYABLE ATTACHMENT MEMBERS; agora publicação de pedido de patente US n° 2013/0256377;
[0095] Pedido US n° de série 13/763.106, intitulado END EFFECTOR COMPRISING A DISTAL TISSUE ABUTMENT MEMBER; agora publicação de pedido de patente US n° 2013/0256378;
[0096] Pedido US n° de série 13/433.147, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS; agora publicação de pedido de patente US n° 2013/0256369;
[0097] Pedido US n° de série 13/763.112, intitulado SURGICAL STAPLING CARTRIDGE WITH LAYER RETENTION FEATURES; agora publicação de pedido de patente US n° 2013/0256379;
[0098] Pedido US n° de série 13/763.035, intitulado ACTUATOR FOR RELEASING A TISSUE THICKNESS COMPENSATOR FROM A FASTENER CARTRIDGE; agora publicação de pedido de patente US n° 2013/0214030;
[0099] Pedido US n° de série 13/763.042, intitulado RELEASABLE TISSUE THICKNESS COMPENSATOR AND FASTENER CARTRIDGE HAVING THE SAME; agora publicação de pedido de patente US n° 2013/0221063;
[00100] Pedido US n° de série 13/763.048, intitulado FASTENER CARTRIDGE COMPRISING A RELEASABLE TISSUE THICKNESS COMPENSATOR; agora publicação de pedido de patente US n° 2013/0221064;
[00101] Pedido US n° de série 13/763.054, intitulado FASTENER CARTRIDGE COMPRISING A CUTTING MEMBER FOR RELEASING A TISSUE THICKNESS COMPENSATOR; agora publicação de pedido de patente US n° 2014/0097227;
[00102] Pedido US n° de série 13/763.065, intitulado FASTENER CARTRIDGE COMPRISING A RELEASABLY ATTACHED TISSUE THICKNESS COMPENSATOR; agora publicação de pedido de patente US n° 2013/0221065;
[00103] Pedido US n° de série 13/763.021, intitulado STAPLE CARTRIDGE COMPRISING A RELEASABLE COVER; agora publicação de pedido de patente US n° 2014/0224686;
[00104] Pedido US n° de série 13/763.078, intitulado ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTOR; agora publicação de pedido de patente US n° 2013/0256383;
[00105] Pedido US n° de série 13/763.095, intitulado LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES; agora publicação de pedido de patente US n° 2013/0161374;
[00106] Pedido US n° de série 13/463.147, intitulado IMPLANTABLE ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES; agora publicação de pedido de patente US n° 2013/0292398;
[00107] Pedido US n° de série 13/763.192, intitulado MULTIPLE THICKNESS IMPLANTABLE LAYERS FOR SURGICAL STAPLING DEVICES; agora publicação de pedido de patente US n° 2013/0146642;
[00108] Pedido US n° de série 13/763.161, intitulado RELEASABLE LAYER OF MATERIAL AND SURGICAL END EFFECTOR HAVING THE SAME; agora publicação de pedido de patente US n° 2013/0153641;
[00109] Pedido US n° de série 13/763.177, intitulado ACTUATOR FOR RELEASING A LAYER OF MATERIAL FROM A SURGICAL END EFFECTOR; agora publicação de pedido de patente US n° 2013/0146641;
[00110] Pedido US n° de série 13/763.037, intitulado STAPLE CARTRIDGE COMPRISING A COMPRESSIBLE PORTION; agora publicação de pedido de patente US n° 2014/0224857;
[00111] Pedido US n° de série 13/433.126, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING TISSUE INGROWTH FEATURES; agora publicação de pedido de patente US n° 2013/0256366;
[00112] Pedido US n° de série 13/433.132, intitulado DEVICES AND METHODS FOR ATTACHING TISSUE THICKNESS COMPENSATING MATERIALS TO SURGICAL STAPLING INSTRUMENTS; agora publicação de pedido de patente US n° 2013/0256373.
[00113] Pedido US n° de série 13/851.703, intitulado FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR INCLUDING OPENINGS THEREIN; agora publicação de pedido de patente US n° 2014/0291382;
[00114] Pedido US n° de série 13/851.676, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING A CUTTING MEMBER PATH; agora publicação de pedido de patente US n° 2014/0291379;
[00115] Pedido US n° de série 13/851.693, intitulado FASTENER CARTRIDGE ASSEMBLIES; agora publicação de pedido de patente US n° 2014/0291381;
[00116] Pedido US n° de série 13/851.684, intitulado FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR AND A GAP SETTING ELEMENT; agora publicação de pedido de patente US n° 2014/0291380;
[00117] Pedido de patente US n° de série 14/187.383, intitulado IMPLANTABLE LAYERS AND METHODS FOR ALTERING IMPLANTABLE LAYERS FOR USE WITH SURGICAL FASTENING INSTRUMENTS;
[00118] Pedido de patente US n° de série 14/187.386, intitulado IMPLANTABLE LAYERS AND METHODS FOR ALTERING ONE OR MORE PROPERTIES OF IMPLANTABLE LAYERS FOR USE WITH FASTENING INSTRUMENTS;
[00119] Pedido de patente US n° de série 14/187.390, intitulado IMPLANTABLE LAYERS AND METHODS FOR MODIFYING THE SHAPE OF THE IMPLANTABLE LAYERS FOR USE WITH A SURGICAL FASTENING INSTRUMENT;
[00120] Pedido de patente US n° de série 14/187.389, intitulado IMPLANTABLE LAYER ASSEMBLIES;
[00121] Pedido de patente US n° de série 14/187.385, intitulado IMPLANTABLE LAYERS COMPRISING A PRESSED REGION;
[00122] Pedido de patente US n° de série 14/187.384, intitulado FASTENING SYSTEM COMPRISING A FIRING MEMBER LOCKOUT; e pedido de patente US n° de série 14/516.277, intitulado STAPLE CARTRIDGE COMPRISING AN ADJUNCT MATERIAL.
[00123] Numerosos detalhes específicos são apresentados para fornecer um completo entendimento da estrutura, função, fabricação e uso geral das modalidades conforme descrito no relatório descritivo e ilustrado nos desenhos anexos. Será entendido pelos versados na técnica, entretanto, que as modalidades podem ser praticadas sem esses detalhes específicos. Em outros casos, operações, componentes e elementos bem conhecidos foram descritos em detalhes de modo a não obscurecer as modalidades descritas no relatório descritivo. As pessoas versadas na técnica entenderão que as modalidades descritas e ilustradas na presente invenção são exemplos não limitadores e, portanto, pode-se entender que os detalhes estruturais e funcionais específicos revelados na presente invenção podem ser representativos e ilustrativos. Podem ser feitas variações e alterações a isso, sem se desviar do escopo das reivindicações.
[00124] Os termos "compreende" (e qualquer forma de compreende, como "compreende" e "que compreende"), "tem" (e qualquer forma de tem, como "tem" e "que tem"), "inclui" (e qualquer forma de inclui, como "inclui" e "que inclui") e "contém" (e qualquer forma de contém, como "contém" e "que contém") são verbos de ligação irrestritos. Como um resultado, um sistema, dispositivo ou aparelho cirúrgico que "compreende", "tem", "inclui" ou "contém" um ou mais elementos possui aqueles um ou mais elementos, mas não é limitado a possuir somente aqueles um ou mais elementos. Da mesma forma, um elemento de um sistema, dispositivo ou aparelho cirúrgico que "compreende", "tem", "inclui" ou "contém" um ou mais recursos possui aqueles um ou mais recurso, mas não é limitado a possuir somente aqueles um ou mais recursos.
[00125] Os termos "proximal" e "distal" são usados na presente invenção com referência a um médico que manipula a porção de cabo do instrumento cirúrgico. O termo "proximal" refere-se à porção mais próxima ao médico, e o termo "distal" refere-se à porção situada na direção oposta ao médico. Também será entendido que, por uma questão de conveniência e clareza, termos espaciais como "vertical", "horizontal", "para cima" e "para baixo" podem ser usados na presente invenção com relação aos desenhos. Entretanto, instrumentos cirúrgicos podem ser usados em muitas orientações e posições, e esses termos não se destinam a ser limitadores e/ou absolutos.
[00126] São fornecidos vários dispositivos e métodos exemplificadores para a realização de procedimentos cirúrgicos laparoscópicos e minimamente invasivos. Entretanto, o versado na técnica entenderá prontamente que os vários métodos e dispositivos aqui revelados podem ser usados em inúmeros procedimentos e aplicações cirúrgicos inclusive, por exemplo, aqueles em conjunto com procedimentos cirúrgicos abertos. Com o avanço da presente Descrição Detalhada, aqueles de habilidade comum na técnica entenderão adicionalmente que os vários instrumentos aqui revelados podem ser inseridos em um corpo de qualquer maneira, como através de um orifício natural, através de uma incisão ou perfuração formada em tecido, etc. As porções funcionais ou porções do atuador de extremidade dos instrumentos podem ser inseridas diretamente no corpo de um paciente ou podem ser inseridas por meio de um dispositivo de acesso que tenha uma canaleta de trabalho através da qual o atuador de extremidade e o eixo de acionamento alongado de um instrumento cirúrgico podem ser avançados.
[00127] Muitos dos pedidos de patente mencionados acima revelam várias camadas que são usadas em conjunto com um cartucho de grampos. Quando os grampos são distribuídos a partir do cartucho de grampos, os grampos podem capturar ao menos uma camada e implantar a camada de implante, ou camadas, contra o tecido. Abaixo é fornecida uma breve descrição de um sistema de grampeamento cirúrgico. Os cartuchos de grampos e as camadas reveladas no presente documento podem ser usados com esse sistema de grampeamento cirúrgico e/ou qualquer sistema de grampeamento adequado.
[00128] O sistema de grampeamento cirúrgico pode compreender um eixo de acionamento e um atuador de extremidade que se estende do eixo de acionamento. O atuador de extremidade compreende uma primeira garra e uma segunda garra. A primeira garra compreende um cartucho de grampos. O cartucho de grampos é inserível na e removível da primeira garra; entretanto, são previstas outras modalidades nas quais um cartucho de grampos não é removível, ou ao menos facilmente substituível, da primeira garra. A segunda garra compreende uma bigorna configurada para deformar grampos ejetados a partir do cartucho de grampos. A segunda garra é pivotante em relação à primeira garra ao redor de um eixo geométrico da tampa; entretanto, outras modalidades são previstas nas quais a primeira garra é pivotante em relação à segunda garra. O sistema de grampeamento cirúrgico compreende, adicionalmente, uma junta de articulação configurada para permitir que o atuador de extremidade seja girado ou articulado em relação ao eixo de acionamento. O atuador de extremidade é giratório em torno de um eixo geométrico de articulação que se estende através da junta de articulação. Outras modalidades são previstas que não incluem uma junta de articulação.
[00129] O cartucho de grampos compreende um corpo do cartucho. O corpo de cartucho inclui uma extremidade proximal, uma extremidade distal, e uma plataforma que se estende entre a extremidade proximal e a extremidade distal. Em uso, o cartucho de grampos é posicionado em um primeiro lado do tecido a ser grampeado e a bigorna é posicionada em um segundo lado do tecido. A bigorna é movida em direção ao cartucho de grampos para comprimir e prender o tecido contra a plataforma. Depois disso, os grampos armazenados de modo removível no corpo de cartucho podem ser distribuídos para o tecido. O corpo do cartucho inclui cavidades de grampo definidas no mesmo, sendo que os grampos são armazenados de modo removível nas cavidades de grampo. As cavidades de grampo são dispostas em seis fileiras longitudinais. Três fileiras de cavidades de grampo são posicionadas em um primeiro lado de uma fenda longitudinal e três fileiras de cavidades de grampos são posicionadas em um segundo lado da fenda longitudinal. Outras disposições de cavidades de grampo e grampos podem ser possíveis.
[00130] Os grampos são sustentados por acionadores de grampos no corpo de cartucho. Os acionadores são móveis entre uma primeira posição, ou uma posição não disparada, e uma segunda posição, ou uma posição disparada, para ejetar os grampos a partir de cavidades de grampo. Os acionadores são retidos no corpo de cartucho por um retentor que se estende em torno do fundo do corpo de cartucho e inclui membros resilientes configurados para prender o corpo de cartucho e reter o retentor no corpo de cartucho. Os acionadores são móveis entre suas posições não disparadas e suas posições disparadas por um deslizador. O deslizador é móvel entre uma posição proximal adjacente à extremidade proximal e uma posição distal adjacente à extremidade distal. O deslizador compreende uma pluralidade de superfícies inclinadas configuradas para deslizar sob os acionadores e levantar os acionadores, e os grampos sustentados no mesmo, em direção à bigorna.
[00131] Adicionalmente ao exposto acima, o deslizador é movido distalmente por um membro de disparo. O membro de disparo é configurado para estar em contato com o deslizador e empurrar o deslizador em direção à extremidade distal. A fenda longitudinal definida no corpo de cartucho é configurada para receber o membro de disparo. A bigorna inclui, também, uma fenda configurada para receber o membro de disparo. O membro de disparo compreende, adicionalmente, um primeiro came que se engata à primeira garra e um segundo came que se engata à segunda garra. Conforme o membro de disparo é avançado distalmente, o primeiro came e o segundo came podem controlar a distância, ou vão de tecido, entre a plataforma do cartucho de grampos e a bigorna. O membro de disparo compreende, também, uma faca configurada para fazer uma incisão no tecido capturado entre a bigorna e o cartucho de grampos. É desejável que a faca seja posicionada ao menos parcialmente proximal às superfícies inclinadas, de modo que os grampos sejam ejetados à frente da faca.
[00132] Um conjunto de atuador de extremidade 1000 está representado nas Figuras 1 a 3. O conjunto de atuador de extremidade 1000 compreende uma primeira garra 1001 e uma segunda garra 1002. A primeira garra 1001 compreende um cartucho de grampos 1005. O cartucho de grampos 1005 é prontamente removível da primeira garra 1001 e pode ser substituído por um outro cartucho de grampos. São previstas outras modalidades nas quais o cartucho de grampos 1005 não é prontamente removível da primeira garra 1001. O cartucho de grampos 1005 compreende um corpo de cartucho 1010 e uma camada implantável 1020. O corpo de cartucho 1010 compreende uma extremidade proximal 1011, uma extremidade distal 1012 e uma plataforma 1013 configurada para apoiar o tecido. Conforme discutido em mais detalhes abaixo, a camada 1020 é retida de maneira liberável na plataforma 1013. O corpo do cartucho 1010 compreende, ainda, uma fenda longitudinal 1014 e uma pluralidade de cavidades de grampo 1015 definidas na plataforma 1013. O cartucho de grampos 1005 compreende, ainda, grampos 1040 e/ou qualquer outro prendedor adequado, armazenado de modo removível nas cavidades de grampo 1015 e acionadores de grampo 1050 configurados para levantar os grampos 1040 em direção à plataforma 1013. Os acionadores 1050, e os grampos 1040 suportados no mesmo, são móveis entre uma posição não disparada (Figura 2) e uma posição disparada (Figura 3) por um membro de disparo, como o deslizador 1060, por exemplo. O deslizador 1060 pode ser empurrado para frente por uma barra de disparo 1061 (Figura 8) ou, alternativamente, o deslizador 1060 pode ser formado integralmente com uma barra de disparo. Em qualquer caso, o deslizador 1060 compreende superfícies inclinadas 1063 (Figura 3) configuradas para deslizar sob os acionadores de grampos 1050 e levantar os acionadores de grampo 1050 para cima à medida que o deslizador 1060 é avançado de uma posição proximal (Figuras 8 e 9) para uma posição distal (Figura 3).
[00133] A segunda garra 1002 compreende uma bigorna 1030 configurada para deformar grampos 1040. A segunda garra 1002 é girada em relação à primeira garra 1001 e, dessa forma, a bigorna 1030 é giratória em relação ao cartucho de grampo 1005; entretanto, são previstas determinadas modalidades nas quais o cartucho de grampos 1005 é giratório em relação à bigorna 1030. O deslizador 1060 e/ou a barra de disparo 1061 pode incluir um primeiro came 1067 (Figura 8) configurado para engatar a primeira garra 1001 e um segundo came 1069 (Figura 8) configurado para engatar a segunda garra 1002 conforme o deslizador 1060 e a barra de disparo 1061 são avançados distalmente. O primeiro came 1067 e o segundo came 1069 podem cooperar para posicionar a bigorna 1030 em relação ao cartucho de grampo 1005 e definir um vão de tecido entre os mesmos. A primeira garra 1001 compreende uma primeira fenda de came 1007 definida na mesma configurada para receber o primeiro came 1067 e a segunda garra 1002 compreende uma segunda fenda de came 1009 definida na mesma configurada para receber o segundo came 1069. O deslizador 1060 e/ou a barra de disparo 1061 pode compreender uma superfície de corte, como um gume de faca 1062 (Figura 8), por exemplo, configurado para cortar o tecido e a camada 1020 capturada entre a bigorna 1030 e o cartucho de grampo 1005.
[00134] Com referência novamente às Figuras 1 a 3, a camada 1020 é retida de modo liberável no corpo de cartucho 1010. A camada 1020 compreende uma extremidade proximal 1021 posicionada sobre a extremidade proximal 1011 do corpo do cartucho 1010 e uma extremidade distal 1022 posicionada sobre a extremidade distal 1012. O cartucho de grampos 1005 compreende, ainda, um retentor de camada 1070 que é móvel entre uma primeira posição na qual o retentor de camada 1070 retém de modo liberável a extremidade distal 1022 da camada 1020 à extremidade distal 1012 do corpo do cartucho 1010 (Figura 2) e uma segunda posição na qual a extremidade distal 1022 da camada 1020 é liberada da extremidade distal 1012 (Figura 3). O cartucho de grampos 1005 compreende dois retentores de camada 1070 - um primeiro retentor de camada 1070 posicionado em um primeiro lado da fenda longitudinal 1014 e um segundo retentor de camada 1070 posicionado em um segundo lado da fenda longitudinal 1014; entretanto, o cartucho de grampos pode compreender qualquer número de retentores camada. O primeiro retentor de camada 1070 está alinhado com uma primeira fileira de cavidades de grampo 1015 e/ou acionadores de grampo 1050 no corpo do cartucho 1010 e o segundo retentor 1070 está alinhado com uma segunda fileira de cavidades de grampos 1015 e/ou acionadores de grampo 1050. Cada retentor de camada 1070 compreende ao menos um de pino 1073 que é recebido dentro de uma abertura de pino 1023 definida na camada 1020 quando o retentor de camada 1070 está em sua primeira posição (Figura 2). Em várias instâncias, o pino 1073 e a abertura de pino 1023 podem ser dimensionados e configurados de modo que haja um ajuste por interferência entre os mesmos que pode reter a extremidade distal 1022 da camada 1020 à extremidade distal 1012 do corpo do cartucho 1010. Quando o retentor de camada 1070 é movido para sua segunda posição (Figura 3), o pino 1073 é removido, ou ao menos substancialmente removido, da abertura de pino 1023 e, como resultado, a camada 1020, ou ao menos a extremidade distal 1022 da camada 1020, pode não mais ser conectada ao corpo de cartucho 1010, conforme discutido em mais detalhes mais abaixo.
[00135] Cada retentor de camada 1070 é móvel de sua primeira posição, na qual ele é engatado com a camada 1020, para a sua segunda posição, na qual ele é desengatado da camada 1020, por um acionador de grampo 1050. Os acionadores de grampos 1050 estão dispostos de uma maneira proximal para distal entre a extremidade proximal 1011 e a extremidade distal 1012 do corpo do cartucho 1010, sendo que os acionadores de grampo mais distais, isto é, os acionadores de grampo 1050d, superam os retentores de camada 1070 quando os acionadores de grampos 1050d são levantados em direção à plataforma 1013 pelo deslizador 1060. Cada acionador de grampo distal 1050d compreende um atuador 1051 que se estende distalmente dele o qual é configurado para entrar em contato com um braço de comutação 1071 que se estende proximalmente do retentor de camada 1070 quando o acionador de grampo 1050d é movido entre sua posição não disparada (Figura 2) e sua posição disparada (Figura 3). O braço de comutação 1071 se estende a partir de um fulcro 1078 do retentor de camada 1070, sendo que o fulcro 1078 é posicionado, ou posicionável, contra uma superfície de pivô 1018 definida no corpo de cartucho 1010 e é configurado para permitir que o retentor de camada 1070 gire entre sua primeira posição (Figura 2) e sua segunda posição (Figura 3) quando o braço de comutação 1071 é acionado para cima pelo acionador de grampos 1050d. Embora o retentor de camada 1070 possa girar entre sua primeira posição e sua segunda posição, o pino 1073 do retentor de camada 1070 pode ser restrito de modo que ele translada ao longo de uma trajetória longitudinal. Em ao menos uma instância, o corpo do cartucho 1010 inclui, ainda, uma fenda de pino 1074 configurada para receber de maneira rente o pino 1073 que pode limitar o movimento do pino 1073 para movimento ao longo de um eixo vertical, por exemplo. O acionador distal 1050d pode girar o braço de comutação 1071 para cima até que o braço de comutação 1071 fique em posição contígua com a superfície de pivô 1078. Neste ponto, o acionador distal 1050d está em sua posição completamente disparada.
[00136] Conforme discutido acima, o retentor de camada 1070 é móvel entre uma primeira posição na qual ele prende a camada 1020 ao corpo de cartucho 1010 e uma segunda posição na qual a camada 1020 é liberada do corpo de cartucho 1010. Quando o retentor de camada 1070 está em sua primeira posição, o pino 1073 se estende acima da plataforma 1013 do corpo de cartucho 1010. Quando o retentor de camada 1070 é movido para sua segunda posição, o pino 1073 é abaixado em relação à plataforma 1013 e é posicionado nivelado com ou abaixo da plataforma 1013. Em tais circunstâncias, o pino 1073 pode ser completamente removido da abertura de pino 1023 definida na camada 1020. Outras modalidades são previstas nas quais o pino 1073 se estende acima da plataforma 1013 quando o retentor de camada 1070 está em sua segunda posição. Nessa posição, o pino 1073 pode ou não ser parcialmente posicionado dentro da abertura de pino 1023 definida na camada 1020. No caso de o pino 1073 ainda estiver parcialmente posicionado dentro da abertura de pino 1020 quando o retentor de camada 1070 está em sua segunda posição, a camada 1020 pode ainda deslizar dos pinos 1073 e permitir que a camada 1020 seja desprendida do corpo do cartucho 1010. Em várias instâncias, um encaixe com folga pode estar presente entre os pinos 1073 e as aberturas de camada 1023.
[00137] O cartucho de grampos 1005 pode incluir um membro de inclinação, como uma mola, por exemplo, configurado para forçar os retentores de camada 1070 para a sua primeira posição. Em algumas instâncias, o cartucho de grampos 1005 pode compreender um primeiro membro de inclinação que força o primeiro retentor de camada 1070 para a sua primeira porção e um segundo membro de inclinação que força o segundo retentor de camada 1070 para a sua primeira posição. Quando os acionadores distais 1050d empurram os retentores de camada 1070 para as suas segundas posições, os acionadores distais 1050d podem superar as forças de inclinação aplicadas pelos membros de inclinação.
[00138] Os retentores de camada 1070 prendem a camada 1020 ao corpo de cartucho 1010 antes do deslizador 1060 e da barra de disparo 1061 serem avançados distalmente durante um curso de disparo. Esta disposição pode ser útil para manter a camada 1020 em posição enquanto o cartucho de grampos 1005 está posicionado em relação ao tecido que está para ser grampeado. Após o cartucho de grampos 1005 ter sido adequadamente posicionado em relação ao tecido, a bigorna 1030 pode ser movida para uma posição fechada para prender o tecido contra a camada 1020. Neste ponto, o deslizador 1060 e a barra de disparo 1061 podem ser avançados distalmente através de seu curso de disparo. O retentor de camada 1070 pode prender a camada 1020 ao corpo 1010 durante a totalidade do curso de disparo ou, alternativamente, durante uma parte do curso de disparo. Em várias instâncias, a camada de retenção 1070 pode não ser liberada da camada 1020 a partir do corpo de cartucho 1010 até que, ou após, todos os grampos 1040 tenham sido completamente disparados. Em algumas instâncias, o retentor de camada 1070 pode liberar a camada 1020 antes, ou imediatamente antes, da conclusão do curso de disparo. Em qualquer instância, o retentor de camada 1070 pode impedir ou inibir a camada 1020 de ser empurrada distalmente pelo gume de faca 1062 quando o gume de faca 1062 é movido distalmente para fazer a transeção da camada 1020. No caso de o deslizador 1060 e a barra de disparo 1061 não serem avançados através de seu curso completo de disparo, os retentores de camada 1070 podem não ser superados pelos acionadores distais 1050d e, dessa forma, os retentores de camada 1070 podem continuar a prender a camada 1020 ao corpo de cartucho 1010. Os pinos 1073 dos retentores de camada 1070 e as aberturas de pino 1023 da camada 1020 podem ser dimensionados e configurados para fornecer uma determinada quantidade de força de retenção entre si a qual pode resistir ao movimento da camada 1020 antes e durante o curso de disparo, mas permitem que a camada 1020 seja retirada do corpo de cartucho 1010 no caso de o curso de disparo não ser completado.
[00139] Agora com referência às Figuras 4 a 6, um conjunto de atuador de extremidade 1100 compreende uma primeira garra 1001 e uma segunda garra 1002. A primeira garra 1001 compreende um cartucho de grampos 1105. O cartucho de grampos 1105 é prontamente removível da primeira garra 1001 e pode ser substituído por um outro cartucho de grampos. São previstas outras modalidades nas quais o cartucho de grampos 1105 não é prontamente removível da primeira garra 1001. O cartucho de grampos 1105 compreende um corpo de cartucho 1110 e uma camada implantável 1120. O corpo do cartucho 1110 compreende uma extremidade proximal 1111 (Figuras 9 e 10), uma extremidade distal 1112, e uma plataforma 1113 configurada para suportar o tecido. Conforme discutido em mais detalhes abaixo, a camada 1120 é retida de maneira liberável na plataforma 1113. O corpo do cartucho 1110 compreende, ainda, uma fenda longitudinal 1114 e uma pluralidade de cavidades de grampo 1015 definidas na plataforma 1113. O cartucho de grampos 1105 compreende, ainda, grampos 1040 e/ou qualquer outro prendedor adequado, armazenado de modo removível nas cavidades de grampo 1015 e acionadores de grampo 1150 configurados para levantar os grampos 1040 em direção à plataforma 1113. Os acionadores 1150, e os grampos 1040 suportados nos mesmos, são móveis entre uma posição não disparada (Figura 8) e uma posição disparada (Figuras 5 e 6) por um membro de disparo, como o deslizador 1060, por exemplo. O deslizador 1060 pode ser empurrado para frente por uma barra de disparo 1061 (Figura 8) ou, alternativamente, o deslizador 1060 pode ser formado integralmente com uma barra de disparo. Em qualquer caso, o deslizador 1060 compreende superfícies inclinadas 1063 (Figuras 5 e 6) configuradas para deslizar sob os acionadores de grampos 1150 e levantar os acionadores de grampo 1150 para cima à medida que o deslizador 1060 é avançado de uma posição proximal (Figuras 8 e 9) para uma posição distal (Figura 3).
[00140] A segunda garra 1002 compreende uma bigorna 1030 configurada para deformar grampos 1040. A segunda garra 1002 é girada em relação à primeira garra 1001 e, dessa forma, a bigorna 1030 é giratória em relação ao cartucho de grampo 1105; entretanto, são previstas determinadas modalidades nas quais o cartucho de grampos 1105 é giratório em relação à bigorna 1030. O deslizador 1060 e/ou a barra de disparo 1061 pode incluir um primeiro came 1067 (Figura 8) configurado para engatar a primeira garra 1001 e um segundo came 1069 (Figura 8) configurado para engatar a segunda garra 1002 conforme o deslizador 1060 e a barra de disparo 1061 são avançados distalmente. O primeiro came 1067 e o segundo came 1069 podem cooperar para posicionar a bigorna 1030 em relação ao cartucho de grampo 1105 e definir um vão de tecido entre os mesmos. A primeira garra 1001 compreende uma primeira fenda de came 1007 (Figuras 2 e 3) definida na mesma configurada para receber o primeiro came 1067 e a segunda garra 1002 compreende uma segunda fenda de came 1009 (Figuras 2 e 3) definida na mesma configurada para receber o segundo came 1069. O deslizador 1060 e/ou a barra de disparo 1061 pode compreender uma superfície de corte, como um gume de faca 1062 (Figura 8), por exemplo, configurado para cortar o tecido e a camada 1120 capturada entre a bigorna 1030 e o cartucho de grampo 1105.
[00141] Com referência novamente às Figuras 4 a 6, a camada 1120 é retida de modo liberável no corpo de cartucho 1110. A camada 1120 compreende uma extremidade proximal posicionada na extremidade proximal 1111 (Figuras 8 a 10) do corpo de cartucho 1110 e uma extremidade distal 1122 posicionada na extremidade distal 1112. O cartucho de grampos 1105 compreende, ainda, um retentor de camada 1170 que é móvel entre uma primeira posição na qual o retentor de camada 1170 retém de modo liberável a extremidade distal 1122 da camada 1120 na extremidade distal 1112 do corpo do cartucho 1110 (Figura 4 e 5) e uma segunda posição na qual a extremidade distal 1122 da camada 1120 é liberada da extremidade distal 1112 (Figura 6). O retentor de camada 1170 é alinhado com a fenda longitudinal 1114 definida no corpo do cartucho 1110. O retentor de camada 1170 compreende um clipe 1173 que é recebido em uma fenda de clipe 1123 definida no corpo de cartucho 1110 quando o retentor de camada 1170 está em sua primeira posição (Figura 5). Em várias instâncias, o clipe 1173 e a fenda de clipe 1123 podem ser dimensionados e configurados de modo que a extremidade distal 1122 da camada 1120 é cunhada entre os mesmos e, como resultado, a camada 1120 é retida de modo liberável na extremidade distal 1112 do corpo de cartucho 1110. Quando o retentor de camada 1170 é movido para sua segunda posição (Figura 6), o clipe é removido 1173, ou ao menos substancialmente removido, da fenda de clipe 1123 e, como resultado, a camada 1120, ou ao menos a extremidade distal 1122 da camada 1120, pode não mais ser conectada ao corpo 1110, conforme discutido em mais detalhes mais abaixo.
[00142] O retentor de camada 1170 é móvel de sua primeira posição, na qual ele é engatado com a camada 1120, para a sua segunda posição, na qual ele é desengatado da camada 1120, pelo deslizador 1060. O deslizador 1060 compreende uma porção central 1064 que translada na fenda longitudinal 1114 e inclui uma superfície de came configurada para engatar o retentor de camada 1170 e levantar o retentor de camada 1170 de sua primeira posição em direção à sua segunda posição. O retentor de camada 1170 inclui um braço de comutação 1171 que se estende proximalmente que é contactado pela porção central 1064 e empurrado para cima. O corpo do cartucho 1110 compreende uma fenda guia 1172 definida no mesmo que é configurada para receber de maneira rente o retentor de camada 1170 e guiar o retentor de camada 1170 ao longo de uma trajetória longitudinal de modo que, quando o braço de comutação 1171 é empurrado para cima pelo deslizador 1060, o clipe 1173 do retentor de camada 1170 é também empurrado para cima. Em várias modalidades alternativas, o retentor de camada 1170 pode ser empurrado para cima pelas superfícies em rampa 1063 definidas no deslizador 1060.
[00143] Conforme discutido acima, o retentor de camada 1170 é móvel entre uma primeira posição na qual ele prende a camada 1120 ao corpo de cartucho 1110 e uma segunda posição na qual a camada 1120 é liberada do corpo de cartucho 1110. Quando o retentor de camada 1170 está em sua primeira posição, um rebordo de clipe 1174 do clipe 1173 se estende para dentro da fenda de clipe 1123 definida no corpo de cartucho 1110. Em tal posição, a camada 1120 é aprisionada entre o rebordo de clipe 1174 e um rebordo de fenda de clipe 1124. Nessa posição, o clipe 1173 pode se estender acima da, ser rebaixado abaixo da, ou ser nivelado com a plataforma 1113 do corpo de cartucho 1110. Quando o retentor de camada 1170 é movido para sua segunda posição, o rebordo de clipe 1174 é levantado em relação a e/ou acima da plataforma 1113 e para fora do rebordo da fenda de clipe 1124. Em tal posição, a camada 1120 pode prontamente deslizar para fora entre o rebordo de clipe 1174 e o rebordo de fenda de clipe rebordo 1124. Em várias instâncias, a extremidade distal 1121 da camada 1120 pode compreender um material contínuo sem aberturas definidas no mesmo, por exemplo. Tal disposição pode reduzir o potencial de irritação do tecido.
[00144] Conforme discutido acima, o retentor de camada 1170 prende a camada 1120 ao corpo de cartucho 1110 antes do deslizador 1060 e da barra de disparo 1061 serem avançados distalmente durante um curso de disparo. Esta disposição pode ser útil para manter a camada 1120 em posição enquanto o cartucho de grampos 1105 está posicionado em relação ao tecido que está para ser grampeado. Após o cartucho de grampos 1105 ter sido adequadamente posicionado em relação ao tecido, a bigorna 1030 pode ser movida para uma posição fechada para prender o tecido contra a camada 1120. Neste ponto, o deslizador 1060 e a barra de disparo 1061 podem ser avançados distalmente através de seu curso de disparo. O retentor de camada 1170 pode prender a camada 1120 ao corpo 1110 durante a totalidade do curso de disparo ou, alternativamente, durante uma parte do curso de disparo. Em várias instâncias, a camada de retenção 1170 pode não ser liberada da camada 1120 a partir do corpo de cartucho 1110 até que, ou após, todos os grampos 1040 tenham sido completamente disparados. Em algumas instâncias, o retentor de camada 1170 pode liberar a camada 1120 antes, ou imediatamente antes, da conclusão do curso de disparo. Em qualquer instância, o retentor de camada 1170 pode impedir ou inibir a camada 1120 de ser empurrada distalmente pelo gume de faca 1062 quando o gume de faca 1062 é movido distalmente para fazer a transeção da camada 1120. No caso de o deslizador 1060 e a barra de disparo 1061 não serem avançados através de seu curso completo de disparo, o retentor de camada 1170 pode não ser superados pelo deslizador 1060 e, dessa forma, o retentor de camada 1170 pode continuar a prender a camada 1120 ao corpo de cartucho 1110. O clipe 1173 do retentor de camada 1170 e a fenda de clipe 1123 da camada 1120 podem ser dimensionados e configurados para fornecer uma determinada quantidade de forção de retenção entre os mesmos que pode resistir o movimento da camada 1120 antes e durante o curso de disparo mas permitem que a camada 1120 seja retirada do cartucho 1110 no caso de o curso de disparo não ser completado.
[00145] Conforme discutido acima, um cartucho de grampos pode incluir um retentor de camada posicionado na extremidade distal do mesmo para reter de modo liberável a camada ao cartucho de grampo. Além de ou em lugar do retentor da camada distal, um cartucho de grampos pode incluir um retentor de camada posicionado na extremidade distal do mesmo. Agora com referência às Figuras 7 a 10, um conjunto de atuador de extremidade 1200 compreende uma primeira garra 1001 e uma segunda garra 1002. A primeira garra 1001 compreende um cartucho de grampos 1205. O cartucho de grampos 1205 é prontamente removível da primeira garra 1001 e pode ser substituído por um outro cartucho de grampos. São previstas outras modalidades nas quais o cartucho de grampos 1205 não é prontamente removível da primeira garra 1001. O cartucho de grampos 1205 compreende um corpo de cartucho 1110 e uma camada implantável 1220. Conforme discutido em mais detalhes abaixo, a camada 1220 é retida de maneira liberável na plataforma 1113 do corpo de cartucho 1110.
[00146] A segunda garra 1002 é girada em relação à primeira garra 1001 e, dessa forma, a bigorna 1030 é giratória em relação ao cartucho de grampo 1205; entretanto, são previstas determinadas modalidades nas quais o cartucho de grampos 1205 é giratório em relação à bigorna 1030. O deslizador 1060 e/ou a barra de disparo 1061 pode incluir um primeiro came 1067 (Figura 8) configurado para engatar a primeira garra 1001 e um segundo came 1069 (Figura 8) configurado para engatar a segunda garra 1002 conforme o deslizador 1060 e a barra de disparo 1061 são avançados distalmente. O primeiro came 1067 e o segundo came 1069 podem cooperar para posicionar a bigorna 1030 em relação ao cartucho de grampo 1205 e definir um vão de tecido entre os mesmos. O deslizador 1060 e/ou a barra de disparo 1061 pode compreender uma superfície de corte, como um gume de faca 1062 (Figura 8), por exemplo, configurado para cortar o tecido e a camada 1220 capturada entre a bigorna 1030 e o cartucho de grampo 1205.
[00147] Com referência novamente às Figuras 7 a 10, a camada 1220 é retida de modo liberável no corpo de cartucho 1110. A camada 1220 compreende uma extremidade proximal 1221 posicionada sobre a extremidade proximal 1111 do corpo do cartucho 1110 e uma extremidade distal 1222 posicionada sobre a extremidade distal 1112. A extremidade proximal 1221 da camada 1220 compreende um retentor de camada 1225 que é preso de modo liberável ao cartucho de grampos 1205. O retentor de camada 1225 compreende uma porção traseira que é cunhada ou capturada entre o deslizador 1060 e o corpo de cartucho 1110 quando o corpo do cartucho 1060 está em sua posição proximal não disparada, conforme ilustrado nas Figura 7 a 9. Com referência principalmente à Figura 9, a porção traseira do retentor de camada 1225 é posicionada entre a porção central 1064 do deslizador 1060 e uma primeira parede lateral longitudinal 1114a da fenda 1114 e, devido a um encaixe por interferência entre eles, a extremidade proximal 1221 da camada 1220 é presa de maneira liberável à extremidade proximal 1111 do corpo de cartucho 1110. A primeira parede lateral 1114a compreende uma primeira reentrância 1226 definida na mesma configurada para receber uma aba ampliada 1227 definida na extremidade da porção traseira do retentor de camada 1225. A aba ampliada 1227 pode ser dimensionada e configurada de modo que ela é impedida, ou ao menos inibida, de ser puxada da primeira reentrância 1226 antes do primeiro deslizador 1060 ser avançado distalmente. Além de ou em lugar do mencionado acima, o deslizador 1060 pode incluir uma indentação que se estende do mesmo, configurada para prender o retentor de camada 1225 contra a primeira parede lateral 1114a da fenda longitudinal 1114. Também, além de ou em lugar do mencionado acima, a primeira parede lateral 1114a da fenda longitudinal 1114 pode incluir uma indentação que se estende da mesma, configurada para prender o retentor de camada 1225 contra o deslizador 1060. Em todo caso, com referência principalmente às Figuras 7 e 9, a porção central 1064 do deslizador 1060 inclui uma reentrância 1065 definida no interior da mesma através da qual o retentor de camada 1225 pode se estender quando o deslizador 1060 está em sua posição proximal, não disparada.
[00148] Quando o deslizador 1060 é avançado distalmente de sua posição proximal, com referência principalmente à Figura 10, o retentor de camada 1225 já não está preso entre o deslizador 1060 e a primeira parede lateral 1114a e, como resultado, a aba ampliada 1227 pode prontamente deslizar da primeira reentrância 1226 e da fenda longitudinal 1114. Nas modalidades onde o retentor proximal de camada 1225 é o único retentor de camada prendendo a camada 1220 ao corpo de cartucho, a liberação do retentor proximal de camada 1225 pode liberar a camada 1220 do corpo de cartucho 1110. Em tais casos, o início do curso de disparo do deslizador 1060 e da barra de disparo 1061 pode liberar a camada 1220 do corpo de cartucho 1110. Nas modalidades que compreendem um retentor distal de camada além do retentor proximal de camada, a extremidade distal 1222 da camada 1220 ainda está retida de maneira liberável no corpo de cartucho 1110, embora a extremidade proximal 1221 da camada 1220 tenha sido liberada.
[00149] Conforme discutido acima, um conjunto de atuador de extremidade pode incluir uma camada implantável fixada de modo liberável a um cartucho de grampos. Além de ou em lugar de uma camada de cartucho de grampos, um conjunto de atuador de extremidade pode incluir uma camada implantável fixada de modo liberável a uma bigorna do conjunto do atuador. Com referência novamente às Figuras 7 a 10, o conjunto de atuador de extremidade 1200 compreende uma camada de bigorna 1320 fixada de modo liberável ao mesmo. A camada de bigorna 1320 compreende uma extremidade proximal 1321 posicionada adjacente à extremidade proximal da bigorna 1030 e uma extremidade distal 1322 posicionada adjacente à extremidade distal da bigorna 1030. A extremidade proximal 1321 da camada 1320 compreende um retentor de camada 1325 que é preso de modo liberável ao cartucho de grampos 1205. O retentor de camada 1325 compreende uma porção traseira que é cunhada ou capturada entre o deslizador 1060 e o corpo de cartucho 1110 quando o corpo do cartucho 1060 está em sua posição proximal não disparada, conforme ilustrado nas Figura 7 a 9. Com referência principalmente à Figura 9, a porção traseira do retentor de camada 1325 é posicionada entre a porção central 1064 do deslizador 1060 e uma segunda parede lateral longitudinal 1114b da fenda 1114 e, devido a um encaixe por interferência entre eles, a extremidade proximal 1321 da camada 1320 é presa de maneira liberável à extremidade proximal 1111 do corpo de cartucho 1110. A segunda parede lateral 1114b compreende uma segunda reentrância 1326 definida na mesma configurada para receber uma aba ampliada 1327 definida na extremidade da cauda do retentor de camada 1325. A aba ampliada 1327 pode ser dimensionada e configurada de modo que ela é impedida, ou ao menos inibida, de ser puxada da segunda reentrância 1326 antes do primeiro deslizador 1060 ser avançado distalmente. Além de ou em lugar do mencionado acima, o deslizador 1060 pode incluir uma indentação que se estende do mesmo, configurada para prender o retentor de camada 1325 contra a segunda parede lateral 1114b da fenda longitudinal 1114. Também, além de ou em lugar do mencionado acima, a segunda parede lateral 1114b da fenda longitudinal 1114 pode incluir uma indentação que se estende a partir da mesma, configurada para prender o retentor de camada 1325 contra o deslizador 1060. Em todo caso, com referência principalmente às Figuras 7 e 9, a porção central 1064 do deslizador 1060 inclui uma reentrância 1065 definida no interior da mesma através da qual o retentor de camada 1325 pode se estender quando o deslizador 1060 está em sua posição proximal, não disparada.
[00150] Quando o deslizador 1060 é avançado distalmente de sua posição proximal, com referência principalmente à Figura 10, o retentor de camada 1325 já não está preso entre o deslizador 1060 e a segunda parede lateral 1114b e, como resultado, a aba ampliada 1327 pode prontamente deslizar da primeira reentrância 1326 e da fenda longitudinal 1114. Nas modalidades em que o retentor proximal de camada 1375 é o único retentor de camada prendendo a camada 1320 ao atuador de extremidade 1200, a liberação do retentor proximal de camada 1325 pode liberar a camada 1320 do atuador de extremidade 1200. Em tais casos, o início do curso de disparo do deslizador 1060 e da barra de disparo 1061 pode liberar a camada 1320 do atuador de extremidade 1200. Nas modalidades que compreendem um retentor distal de camada além do retentor proximal de camada, a extremidade distal 1322 da camada 1320 ainda está retida de maneira liberável no corpo de cartucho 1200, embora a extremidade proximal 1321 da camada 1320 tenha sido liberada. Por exemplo, a extremidade distal 1322 da camada 1320 compreende um retentor distal de camada 1324 que prende de maneira liberável a extremidade distal 1322 à extremidade distal da bigorna 1030.
[00151] O retentor distal de camada 1324 compreende um gancho que se estende para dentro da segunda fenda de came 1009 da bigorna 1030. O retentor de camada 1324 prende a camada 1320 à bigorna 1030 antes do deslizador 1060 e da barra de disparo 1061 serem avançados distalmente durante um curso de disparo. Esta disposição pode ser útil para manter a camada 1320 em posição enquanto a bigorna 1030 está posicionada em relação ao tecido que está para ser grampeado. Após a bigorna 1030 ter sido adequadamente posicionada em relação ao tecido, a bigorna 1030 pode ser movida para uma posição fechada para prender o tecido contra o corpo de cartucho 1205, por exemplo. Nesse ponto, o retentor de camada 1324 pode prender a camada 1320 à bigorna 1030 durante a totalidade do curso de disparo ou, alternativamente, durante uma parte do curso de disparo. Em qualquer caso, a bigorna 1030 pode ser deslizada de maneira proximal na direção oposta da extremidade distal 1322 da camada ao menos parcialmente implantada 1320 de modo que o retentor distal de camada 1324 se desengata da segunda fenda de came 1009 da bigorna 1030.
[00152] Além de ou em lugar de reter de maneira liberável uma camada ao corpo de cartucho por meio de um retentor proximal de camada e/ou um retentor distal de camada, uma camada por incluir um ou mais retentores de camada engatados de maneira liberável com uma fenda longitudinal definida no corpo de cartucho, por exemplo. Com referência principalmente à Figura 8, a camada de cartucho 1220 compreende uma série longitudinal, ou matriz, de abas 1223 alinhadas com e encunhadas de maneira liberável dentro da fenda longitudinal 1114. A série de abas 1223 se estende entre a extremidade proximal 1221 e a extremidade distal 1222 da camada 1220, embora outras configurações sejam contempladas que não se estendem ao longo de todo o comprimento da camada 1220. Cada aba 1223 inclui um membro de cantiléver, por exemplo, que se estende a partir de uma porção de corpo da camada 1220. As abas 1223 podem ser formadas integralmente com a porção de corpo da camada 1220 e/ou montadas à porção de corpo. Em várias instâncias, cada aba 1223 pode compreender ao menos uma dentre uma configuração em formato de T, uma configuração em formato de I, e uma configuração em formato de V, por exemplo. Em certas instâncias, as abas 1223 podem ser formadas por meio de um processo de corte a laser, por exemplo. As abas 1223 são engatadas com as paredes laterais 1114a e 1114b da fenda longitudinal 1114 e são configuradas para evitar, ou ao menos inibir, o movimento relativo entre a camada 1220 e o corpo do cartucho 1110 antes e/ou durante o curso de disparo. Durante o curso de disparo, a faca 1062, por exemplo, as abas podem cortar transversalmente as abas 1223 conforme a barra de descarga 1061 é avançada distalmente. Quando uma aba 1223 é cortada transversalmente, a aba seccionada 1223 já não pode ser capaz de reter a camada 1220 ao corpo de cartucho 1110. Como resultado, a barra de disparo 1061 pode liberar progressivamente as abas 1223 da fenda longitudinal 1114. Em certas modalidades, o deslizador 1060 e/ou a barra de disparo 1061 pode empurrar as abas 1223 fora da fenda longitudinal 1114 conforme eles são avançados distalmente. Em qualquer caso, todas as abas 1223 podem ser liberadas durante um curso completo de disparo, enquanto apenas uma porção das abas 1223 pode ser liberada durante um curso parcial de disparo. No evento de uma ou mais abas 1223 continuarem engatadas no corpo de cartucho 1110 após o curso de disparo ter sido completado, as abas 1223 podem ser configuradas para deslizar fora da fenda 1114 quando uma força suficiente é aplicada às mesmas.
[00153] Além de ou em lugar de reter de maneira liberável uma camada à bigorna por meio de um retentor proximal de camada e/ou um retentor distal de camada, uma camada por incluir um ou mais retentores de camada engatados de maneira liberável com uma fenda longitudinal definida na bigorna, por exemplo. Com referência principalmente às Figura 7 e 8, a camada de bigorna 1320 compreende uma série longitudinal, ou matriz, de indentações 1323 alinhadas com e encunhadas de maneira liberável dentro da fenda de came longitudinal 1009. A série de indentações 1323 se estende entre a extremidade proximal 1321 e a extremidade distal 1322 da camada 1320, embora outras configurações sejam contempladas que não se estendem ao longo de todo o comprimento da camada 1320. Cada indentação 1323 compreende uma protuberância elevada, por exemplo, que se estende de uma porção de corpo da camada 1320. As indentações 1323 podem ser formadas integralmente com a porção de corpo da camada 1320 e/ou montadas à porção de corpo. Em várias instâncias, cada indentação 1323 pode compreender uma configuração cilíndrica, por exemplo. Em certas instâncias, as indentações 1323 podem ser formadas por meio de um processo de termoformação e/ou extensão, por exemplo. As indentações 1323 são engatadas com as paredes laterais da fenda longitudinal 1009 e são configuradas para evitar, ou ao menos inibir, o movimento relativo entre a camada 1320 e a bigorna 1030 antes e/ou durante o curso de disparo. Durante o curso de disparo, a faca 1062, por exemplo, corta transversalmente as indentações 1323 conforme a barra de disparo 1061 é avançada distalmente. Quando uma indentação 1323 é cortada transversalmente, a indentação seccionada 1323 já não pode ser capaz de reter a camada 1320 ao corpo de cartucho 1030. Como resultado, a barra de disparo 1061 pode liberar progressivamente as indentações 1323 da fenda longitudinal 1009. Em certas modalidades, o came 1069 da barra de disparo 1061 pode empurrar as indentações 1323 fora da fenda de came 1009 conforme a barra de disparo 1061 é avançada distalmente. Em qualquer caso, todas as indentações 1323 podem ser liberadas durante um curso completo de disparo, enquanto apenas uma porção das indentações 1323 pode ser liberada durante um curso parcial de disparo. No evento de uma ou mais indentações 1323 continuarem engatadas na bigorna 1030 após o curso de disparo ter sido completado, as indentações 1323 podem ser configuradas para deslizar fora da fenda 1009 quando uma força suficiente é aplicada às mesmas.
[00154] Em várias instâncias, todas as indentações 1323 podem ter a mesma configuração. Em outras instâncias, certas indentações 1323 podem ter diferentes configurações. Por exemplo, a indentação mais proximal 1323p pode ser maior do que as indentações 1323 posicionadas distalmente em relação à indentação 1323p e, como resultado, a indentação 1323p pode fornecer uma força de retenção maior à bigorna 1030 do que as indentações distais 1323. Essa disposição pode permitir que a indentação 1323 com a maior força de retenção seja liberada no início do curso de disparo. Além de ou em lugar do exposto acima, a indentação mais distal 1323d pode ser maior do que as indentações 1323 posicionadas proximalmente em relação à indentação 1323d e, como resultado, a indentação 1323d pode fornecer uma força de retenção maior à bigorna 1030 do que as indentações proximais 1323. Essa disposição pode permitir que a indentação 1323 com a maior força de retenção seja liberada no final do curso de disparo. Além disso, tal disposição pode ser mais eficaz em inibir o movimento da extremidade distal 1322 da camada 1320 que pode experimentar forças de cisalhamento maiores quando o atuador de extremidade 1200 é posicionado em relação ao tecido. Várias modalidades podem incluir a indentação 1323p e a indentação 1323d. Uma indentação maior 1323 pode ser mais alta, mais larga e/ou mais espessa que as outras indentações 1323, por exemplo.
[00155] Em várias instâncias, a camada de bigorna 1320 pode compreender uma porção de corpo que compreende uma espessura de corpo. A espessura de corpo pode ser a espessura da camada 1320 conforme medida de um lado da camada 1320, como um lado voltado para a bigorna 1030, por exemplo, e o outro lado da camada 1320, como o lado voltado para o lado oposto da bigorna 1030, por exemplo. A espessura de cada indentação 1323 pode ser medida de maneira similar, por exemplo. Em várias modalidades, a espessura da indentação pode ser igual à espessura do corpo. Em determinadas modalidades, a espessura da indentação pode ser mais fina que a espessura do corpo. Tal disposição pode resultar de um processo de termoformação, por exemplo. Além disso, tal disposição pode permitir que as indentações mais finas 1323 sejam facilmente cortadas transversalmente do que a porção de corpo. Em certas circunstâncias, adicionalmente ao exposto acima, todas as indentações 1323 podem ter a mesma espessura enquanto, em outros casos, certas indentações 1323 podem ser mais espessas que outras, como a indentação mais proximal 1323 e/ou a indentação mais distal 1323, por exemplo.
[00156] Em várias modalidades alternativas, a camada de cartucho 1200 pode compreender indentações 1323, por exemplo. Também, em várias modalidades alternativas, a camada de bigorna 1300 pode compreender abas 1223, por exemplo.
[00157] Em várias instâncias, uma camada de material pode compreender material de reforço e/ou um compensador de espessura de tecido, por exemplo. A camada de material pode ser compreendida de material Gore SeamGuard, material Synovis Peri-Strips e/ou poliuretano, por exemplo. Toda a revelação do pedido de patente US n° de série 13/763.095, intitulado LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES, depositado em 28 de fevereiro de 2013, agora publicação de pedido de patente US n° 2013/0161374, está aqui incorporada a título de referência. Todas as revelações do pedido de patente US n° de série 13/531.619, intitulado TISSUE STAPLER HAVING A THICKNESS COMPENSATOR COMPRISING INCORPORATING A HEMOSTATIC AGENT, depositado em 25 de junho de 2012, agora publicação de pedido de patente US n° 2012/0318842, pedido de patente US n° de série 13/531.623, intitulado TISSUE STAPLER HAVING A THICKNESS COMPENSATOR INCORPORATING AN OXYGEN GENERATING AGENT, depositado em 25 de junho de 2012, agora publicação de patente US n° 2012/0318843, pedido de patente US n° de série 13/531.627, intitulado TISSUE STAPLER HAVING A THICKNESS COMPENSATOR INCORPORATING AN ANTI-MICROBIAL AGENT, depositado em 25 de junho de 2012, agora publicação de pedido de patente US n° 2012/0312860, e pedido de patente US n° de série 13/531.630, intitulado TISSUE STAPLER HAVING A THICKNESS COMPENSATOR INCORPORATING AN ANTI-INFLAMMATORY AGENT, depositado em 25 de junho de 2012, agora publicação de pedido de patente US n° 2012/0318844, estão aqui incorporadas a título de referência. Uma camada pode ser compreendida de um material bioabsorvível e/ou um material não bioabsorvível. Em alguns casos, uma camada de material pode ser fixada à plataforma. Em ao menos um caso, ao menos um adesivo pode ser utilizado para aderir de modo liberável a camada à plataforma. Em alguns casos, a camada de material pode ser fixada de modo liberável à plataforma que utiliza uma ou mais suturas ou correias, por exemplo. Em certos casos, a camada pode compreender uma peça sólida de material. Em alguns casos, a camada pode incluir aberturas definidas na mesma.
[00158] Adicionalmente ao exposto acima, os grampos sendo distribuídos a partir de um cartucho de grampos podem perfurar a camada antes de entrarem no tecido. Os grampos podem também perfurar novamente a camada conforme eles estão sendo deformados pela bigorna. Em várias instâncias, tiras de polímeros mais grossas ou mais resistentes a perfuração poderiam ser integradas na camada, por exemplo. Por exemplo, tais tiras poderiam ser integradas na superfície de contato com o tecido da camada. Em ao menos uma instância, cada tira pode ter uma espessura de 0,008 cm (0,003”) e ser compreendida de 90/10 PLA/PCL, por exemplo. Em determinadas instâncias, cada tira pode ter uma espessura de 0,015 cm (0,006”) e ser compreendida de 25/75 PLA/PCL, por exemplo. As tiras podem ser soldadas na espuma como parte de um processo de feltragem, por exemplo. A revelação do pedido de patente US n° de série 14/187.383, intitulado IMPLANTABLE LAYERS AND METHODS FOR ALTERING IMPLANTABLE LAYERS FOR USE WITH SURGICAL FASTENING INSTRUMENTS está incorporada à presente invenção em sua totalidade a título de referência. O processo de feltragem pode servir um outro propósito que é o de criar uma espuma de célula fechada e/ou uma superfície contínua de contato com o tecido. Em algumas instâncias, tiras de filme finas separadas podem se soldadas na lateral da espuma que está em contato com o tecido. Os vários métodos revelados no presente documento podem criar um material compósito absorvível com características ou zonas alinhadas com os grampos que têm propriedades que diferem quanto a perfuração, formação e re- perfuração iniciais do grampo.
[00159] Uma camada, como um material de reforço, por exemplo, pode ser produzida a partir de qualquer material biocompatível. O material de reforço pode ser formado a partir de um material natural e/ou de um material sintético. O material de reforço pode ser bioabsorvível e/ou não bioabsorvível. Deve-se compreender que qualquer combinação de materiais naturais, sintéticos, bioabsorvíveis e não bioabsorvíveis pode ser usada para formar o material de reforço. Alguns exemplos não limitadores de materiais a partir dos quais o material de reforço pode ser produzido incluem, mas não se limitam a poli(ácido láctico), poli(ácido glicólico), poli(hidroxibutirato), poli (fosfazina), poliésteres, polietileno glicóis, óxidos de polietileno, poliacrilamidas, poli-hidroxietilmetilacrilato, polivinilpirrolidona,poli(álcoois vinílicos), ácido poliacrílico, poliacetato, policaprolactona, polipropileno, poliésteres alifáticos, gliceróis, poli(aminoácidos), copoli(éter-ésteres), poli(oxalatos de alquileno), poliamidas, poli (iminocarbonatos), poli(oxalatos de alquileno), polioxaésteres, poliortoésteres, polifosfazenos e copolímeros, copolímeros em bloco, homopolímeros, blendas e/ou combinações dos mesmos, por exemplo.
[00160] Os polímeros biológicos naturais podem ser usados na formação do material de reforço. Os polímeros biológicos naturais adequados incluem, mas não se limitam a, colágeno, gelatina, fibrina, fibrinogênio, elastina, queratina, albumina, hidroxietilcelulose, celulose, celulose oxidada, hidroxipropilcelulose, carboxietilcelulose,carboximetilcelulose, quitana, quitosano, e/ou combinações dos mesmos, por exemplo. Os polímeros biológicos naturais podem ser combinados com qualquer um dos outros materiais poliméricos aqui descritos para produzir o material de reforço. O colágeno de origem humana e/ou animal, por exemplo, colágeno tipo I porcino ou bovino, colágeno tipo I humano ou colágeno tipo III humano podem ser usados para formar o material de reforço. O material de reforço pode ser produzido a partir de colágeno desnaturado ou colágeno que perdeu ao menos parcialmente sua estrutura helicoidal através de aquecimento ou qualquer outro método, que consiste em principalmente em cadeias a não-hidratadas com peso molecular próximo a 100 kDa, por exemplo. O termo "colágeno desnaturado" significa o colágeno que perdeu sua estrutura helicoidal. O colágeno usado para a camada porosa descrita aqui pode ser colágeno nativo ou atelocolágeno, especialmente, como obtido através digestão com pepsina e/ou após aquecimento moderado, conforme definido anteriormente, por exemplo. O colágeno pode ter sido anteriormente modificado quimicamente por oxidação, metilação, succinilação, etilação e/ou qualquer outro processo conhecido.
[00161] Quando o material de reforço é fibroso, as fibras podem ser filamentos ou fios adequados para tricotagem ou tecelagem ou podem ser fibras têxteis, como aquelas frequentemente usadas para preparar materiais não tecidos. As fibras podem ser produzidas a partir de qualquer material biocompatível. As fibras podem ser formadas a partir de material natural ou um material sintético. O material a partir do qual as fibras são formadas pode ser bioabsorvível ou não bioabsorvível. Deve-se compreender que qualquer combinação de materiais naturais, sintéticos, bioabsorvíveis e não-bioabsorvíveis pode ser usada para formar as fibras. Alguns exemplos não limitadores de materiais a partir dos quais as fibras podem ser produzidas incluem, mas não se limitam a poli(ácido láctico), poli(ácido glicólico), poli(hidroxibutirato), poli (fosfazina), poliésteres, polietileno glicóis, óxidos de polietileno, poliacrilamidas, poli-hidroxietilmetilacrilato, polivinilpirrolidona,poli(álcoois vinílicos), ácido poliacrílico, poliacetato, policaprolactona, polipropileno, poliésteres alifáticos, gliceróis, poli(aminoácidos), copoli(éter-ésteres), poli(oxalatos de alquileno), poliamidas, poli (iminocarbonatos), poli(oxalatos de alquileno), polioxaésteres, poliortoésteres, polifosfazenos e copolímeros, copolímeros em bloco, homopolímeros, blendas e/ou combinações dos mesmos. Quando o material de reforço é fibroso, o mesmo pode ser formado com o uso de qualquer método adequado para formar estruturas fibrosas incluindo, mas não se limitando a, tricotagem, tecelagem, técnicas de não tecidos e similares, por exemplo. Quando o material de reforço é uma espuma, a camada porosa pode ser formada com o uso de qualquer método adequado para formar uma espuma ou esponja incluindo, mas não se limitando à liofilização ou secagem por congelamento de uma composição, por exemplo.
[00162] O material de reforço pode possuir propriedades hemostáticas. Os exemplos ilustrativos de materiais que podem ser usados para fornecer o material de reforço com a capacidade de ajudar a interromper o sangramento ou hemorragia incluem, mas não se limitam a, poli(ácido láctico), poli(ácido glicólico), poli(hidroxibutirato), poli(caprolactona), poli(dioxanona), poli(óxidos de alquileno), copoli(éter-ésteres), colágeno, gelatina, trombina, fibrina, fibrinogênio, fibronectina, elastina, albumina, hemoglobina, ovalbumina, polissacarídeos, ácido hialurônico, sulfato de condroitina, hidroxietilamido, hidroxietilcelulose, celulose, celulose oxidada, hidroxipropilocelulose, carboxietilocelulose, carboximetilcelulose, quitana, quitosano, agarose, maltose, maltodextrina, alginato, fatores de coagulação, metacrilato, poliuretanos, cianoacrilatos, agonistas de plaquetas, vasoconstritores, alume, cálcio, peptídeos de RGD, proteínas, sulfato de protamina, ácido épsilon amino caproico, sulfato férrico, subsulfatos férricos, cloreto férrico, zinco, cloreto de zinco, cloreto de alumínio, sulfatos de alumínio, acetatos de alumínio, permanganatos, taninos, cera de osso, polietileno glicóis, fucanos e/ou combinações dos mesmos, por exemplo. O uso de polímeros biológicos naturais, e, em particular, proteínas, pode ser útil para a formação de material de reforço com propriedades hemostáticas. Os polímeros biológicos naturais adequados incluem, mas não se limitam a, colágeno, gelatina, fibrina, fibrinogênio, elastina, queratina, albumina e/ou combinações dos mesmos, por exemplo. Os polímeros biológicos naturais podem ser combinados com qualquer outro agente hemostático para produzir a camada porosa do reforço. Toda a revelação da patente US n° 8.496.683, intitulada BUTTRESS AND SURGICAL STAPLING APPARATUS, que foi concedida em 30 de julho de 2013, está aqui incorporado a título de referência.
[00163] Em várias circunstâncias, o conjunto de compensador de espessura de tecido pode compreender uma composição polimérica. A composição polimérica pode compreender um ou mais polímeros sintéticos e/ou um ou mais polímeros não sintéticos. O polímero sintético pode compreender um polímero sintético absorvível e/ou um polímero sintético não absorvível. Em várias circunstâncias, a composição polimérica pode compreender uma espuma biocompatível, por exemplo. A espuma biocompatível pode compreender uma espuma de células abertas porosa e/ou uma espuma de células fechadas porosa, por exemplo. A espuma biocompatível pode ter uma morfologia de poros uniforme ou pode ter uma morfologia de gradiente de poros (isto é, pequenos poros que aumentam gradualmente de tamanho em poros grandes ao longo da espessura da espuma em uma direção). Em várias circunstâncias, a composição polimérica pode compreender uma ou mais dentre uma armação porosa, uma matriz porosa, uma matriz de gel, uma matriz de hidrogel, uma matriz de solução, uma matriz filamentosa, uma matriz tubular, uma matriz de compósito, uma matriz membranosa, um polímero bioestável, e um polímero biodegradável, e combinações dos mesmos. Por exemplo, o conjunto de compensador de espessura de tecido pode compreender uma espuma reforçada por uma matriz filamentosa ou compreender uma espuma dotada de uma camada de hidrogel adicional que se expande na presença de fluidos corporais para adicionalmente prover a compressão sobre o tecido. Em várias circunstâncias, um conjunto de compensador de espessura de tecido pode também compreender um revestimento sobre um material e/ou uma segunda ou terceira camada que se expande na presença de fluidos corporais para adicionalmente prover a compressão sobre o tecido. Tal camada poderia ser um hidrogel, que poderia ser um material sintético e/ou de derivação natural, e poderia ser biodurável e/ou biodegradável, por exemplo. Em determinadas circunstâncias, um conjunto de compensador de espessura de tecido poderia ser reforçado com materiais não tecidos fibrosos ou elementos do tipo malha fibrosa, por exemplo, que podem prover flexibilidade, rigidez e/ou resistência adicionais. Em várias circunstâncias, o conjunto de compensador de espessura de tecido tem uma morfologia porosa que apresenta uma estrutura de gradiente como, por exemplo, pequenos poros sobre uma superfície e poros maiores sobre a outra superfície. Tal morfologia poderia ser melhor para crescimento interno do tecido ou comportamento hemostático. Adicionalmente, o gradiente também poderia ser composicional com um perfil de bioabsorção diferente. Um perfil de absorção de curto prazo pode ser preferencial para lidar com hemóstase, enquanto um perfil de absorção de longo prazo pode lidar melhor com cura de tecido sem vazamentos.
[00164] Exemplos de polímeros não sintéticos incluem, mas não se limitam a, polissacarídeo liofilizado, glicoproteína, elastina, proteoglicano, gelatina, colágeno e celulose regenerada oxidada (ORC). Exemplos de polímeros absorvíveis sintéticos incluem, mas não se limitam a, poli(ácido láctico) (PLA), poli(ácido L-láctico) (PLLA), policaprolactona (PCL), ácido poliglicólico (PGA), poli(carbonato de trimetileno) (TMC), politereftalato de etileno (PET), poli- hidroxialcanoato (PHA), um copolímero de glicolídeo e ε-caprolactona (PGCL), um copolímero de glicolídeo e carbonato de trimetileno, poli(sebacato de glicerol) (PGS), polidioxanona, poli(ortoésteres), polianidridos, polissacarídeos, poli(éster-amidas), poliarilatos à base de tirosina, poli-iminocarbonatos à base de tirosina, policarbonatos à base de tirosina, poli(D,L-lactídeo-uretano), poli(B-hidroxibutirato), poli(E-caprolactona), polietileno glicol (PEG), poli[bis(carboxilatofenoxi) fosfazeno], poli(aminoácidos), pseudopoli(aminoácidos), poliuretanos absorvíveis, e combinações dos mesmos. Em várias circunstâncias, a composição polimérica pode compreender de aproximadamente 50% a aproximadamente 90% em peso da composição polimérica de PLLA e de aproximadamente 50% a aproximadamente 10% em peso da composição polimérica de PCL, por exemplo. Em ao menos uma modalidade, a composição polimérica pode compreender aproximadamente 70%, em peso, de PLLA e aproximadamente 30%, em peso, de PCL, por exemplo. Em várias circunstâncias, a composição polimérica pode compreender de aproximadamente 55% a aproximadamente 85% em peso da composição polimérica de PGA e de 15% a 45% em peso da composição polimérica de PCL, por exemplo. Em ao menos uma modalidade, a composição polimérica pode compreender aproximadamente 65%, em peso, de PGA e aproximadamente 35%, em peso, de PCL, por exemplo. Em várias circunstâncias, a composição polimérica pode compreender de aproximadamente 90% a aproximadamente 95% em peso da composição polimérica de PGA e de aproximadamente 5% a aproximadamente 10% em peso da composição polimérica de PLA, por exemplo.
[00165] Em várias circunstâncias, o polímero absorvível sintético pode compreender um copolímero elastomérico bioabsorvível e biocompatível. Copolímeros elastoméricos bioabsorvíveis e biocompatíveis adequados incluem, mas não se limitam a, copolímeros de ípsilon-caprolactona e glicolídeo (de preferência, tendo uma razão molar entre épsilon-caprolactona e glicolídeo de cerca de 30:70 a cerca de 70:30, de preferência 35:65 a cerca de 65:35, e com mais preferência 45:55 a 35:65); copolímeros elastoméricos de épsilon-caprolactona e lactídeo, incluindo L-lactídeo, blendas de D- lactídeo dos mesmos ou copolímeros de ácido lático (de preferência, tendo uma razão molar entre épsilon-caprolactona e lactídeo de cerca de 35:65 a cerca de 65:35 e com mais preferência 45:55 a 30:70) copolímeros elastoméricos de p-dioxanona (1,4-dioxan-2-ona) e lactídeo incluindo L-lactídeo, D-lactídeo e ácido lático (de preferência, tendo uma razão molar entre p-dioxanona e lactídeo de cerca de 40:60 a cerca de 60:40); copolímeros elastoméricos de épsilon-caprolactona e p-dioxanona (de preferência com uma razão molar entre épsilon- caprolactona e p-dioxanona de cerca de 30:70 a cerca de 70:30); copolímeros elastoméricos de p-dioxanona e trimetileno carbonato (de preferência com uma razão molar entre p-dioxanona e trimetileno carbonato de cerca de 30:70 a cerca de 70:30); copolímeros elastoméricos de trimetileno carbonato e glicolídeo (de preferência com uma razão molar entre trimetileno carbonato e glicolídeo de cerca de 30:70 a cerca de 70:30); copolímero elastomérico de trimetileno carbonato e lactídeo, inclusive L-lactídeo, D-lactídeo, blendas dos mesmos ou copolímeros de ácido lático (de preferência com uma razão molar entre trimetileno carbonato e lactídeo de cerca de 30:70 a cerca de 70:30) e blendas dos mesmos. Em uma modalidade, o copolímero elastomérico é um copolímero de glicolídeo e epsílon- caprolactona. Em outra modalidade, o copolímero elastomérico é um copolímero de lactídeo e epsílon-caprolactona.
[00166] As revelações da patente US n° 5.468.253, intitulada ELASTOMERIC MEDICAL DEVICE, que foi concedida em 21 de novembro de 1995, e da patente US n° 6.325.810, intitulada FOAM BUTTRESS FOR STAPLING APPARATUS, que foi concedida em 4 de dezembro de 2001, estão aqui incorporadas, por referência, em suas respectivas totalidades.
[00167] Em várias circunstâncias, o polímero absorvível sintético pode compreender um ou mais de copolímero de poli(glicolídeo-L- lactídeo) 90/10, comercialmente disponível junto à Ethicon, Inc. sob a designação comercial de VICRYL (poligaláctico 910), poliglicolídeo, comercialmente disponível junto à American Cyanamid Co. sob a designação comercial DEXON, polidioxanona, comercialmente disponível junto à Ethicon, Inc., sob a designação comercial de PDS, copolímero em bloco aleatório poli(glicolídeo-carbonato de trimetileno), comercialmente disponível junto à American Cyanamid Co. sob a designação comercial de MAXON, copolímero de poli(glicolídeo-E- caprolactona-poliglecaprolactona 25) 75/25, comercialmente disponível junto à Ethicon, sob a designação comercial de MONOCRYL, por exemplo.
[00168] Exemplos de polímeros não absorvíveis sintéticos incluem, mas não se limitam a, poliuretano espumado, polipropileno (PP), polietileno (PE), policarbonato, poliamidas, como náilon, cloreto de polivinila (PVC), metacrilato de polimetila (PMMA), poliestireno (PS), poliéster, poliéster éter cetona (PEEK), politetrafluoro etileno (PTFE), politrifluorocloroetileno (PTFCE), fluoreto de polivinila (PVF), etileno- propileno fluorado (FEP), poliacetal, polissulfona, e combinações dos mesmos. Os polímeros não absorvíveis sintéticos podem incluir, mas não se limitar a, elastômeros espumados e elastômeros porosos, por exemplo, silicone, poli-isopreno e borracha. Em várias circunstâncias, os polímeros sintéticos podem compreender politetrafluoroetileno expandido (ePTFE), comercialmente disponível junto à W.L. Gore & Associates, Inc. sob a designação comercial de GORE-TEX Soft Tissue Patch e espuma de co-poliéter éster uretano, disponível comercialmente junto à Polyganics, sob a designação comercial de NASOPORE.
[00169] A composição polimérica de um conjunto de compensador de espessura de tecido pode ser caracterizada por percentual de porosidade, tamanho de poro e/ou dureza, por exemplo. Em várias circunstâncias, a composição polimérica pode ter um percentual de porosidade dentre aproximadamente 30% em volume eaproximadamente 99% em volume, por exemplo. Em determinadas circunstâncias, a composição polimérica pode ter um percentual de porosidade dentre aproximadamente 60% em volume e aproximadamente 98% em volume, por exemplo. Em várias circunstâncias, a composição polimérica pode ter um percentual de porosidade dentre aproximadamente 85% em volume e aproximadamente 97% em volume, por exemplo. Em ao menos uma modalidade, a composição polimérica pode compreender aproximadamente 70%, em peso de PLLA e aproximadamente 30%, em peso, de PCL, por exemplo, e pode compreender aproximadamente 90% de porosidade em volume, por exemplo. Em ao menos uma tal modalidade, como resultado, a composição polimérica compreenderia aproximadamente 10% de copolímero em volume. Em ao menos uma modalidade, a composição polimérica pode compreender aproximadamente 65%, em peso, de PGA e aproximadamente 35%, em peso, de PCL, por exemplo, e pode ter um percentual de porosidade de aproximadamente 93%, em volume, a aproximadamente 95%, em volume, por exemplo. Em várias circunstâncias, a composição polimérica pode compreender uma porosidade em volume maior que 85%. A composição polimérica pode ter um tamanho de poro de aproximadamente 5 micrômetros a aproximadamente 2.000 micrômetros, por exemplo. Em várias circunstâncias, a composição polimérica pode ter um tamanho de poro dentre aproximadamente 10 micrômetros e aproximadamente 100 micrômetros, por exemplo. Em ao menos uma tal modalidade, a composição polimérica pode compreender um copolímero de PGA e PCL, por exemplo. Em determinadas circunstâncias, a composição polimérica pode ter um tamanho de poro dentre aproximadamente 100 micrômetros e aproximadamente 1000 micrômetros, por exemplo. Em ao menos uma tal modalidade, a composição polimérica pode compreender um copolímero de PLLA e PCL, por exemplo. De acordo com determinados aspectos, a dureza de uma composição polimérica pode ser expressada em termos da dureza Shore, que pode ser definida como a resistência à indentação permanente de um material, conforme determinado com um durômetro, como um durômetro Shore. Para avaliar o valor do durômetro para um dado material, uma pressão é aplicada ao material com um pé indentador de durômetro de acordo com o procedimento ASTM D2240-00, intitulado, "Standard Test Method for Rubber Property-Durometer Hardness", que está incorporado aqui em sua totalidade, por referência. O pé indentador de durômetro pode ser aplicado ao material por um período de tempo suficiente, como 15 segundos, por exemplo, em que uma leitura é, então, feita na escala adequada. Dependendo do tipo de escala usada, uma leitura de 0 pode ser obtida quando o pé indentador penetrar completamente no material, e uma leitura de 100 pode ser obtida quando não ocorrer nenhuma penetração no material. Esta leitura é adimensional. Em várias circunstâncias, o durômetro pode ser determinado de acordo com qualquer escala adequada, como escalas Tipo A e/ou Tipo OO, por exemplo, de acordo com ASTM D2240-00. Em várias circunstâncias, a composição polimérica de um conjunto de compensador de espessura de tecido pode ter um valor de dureza Shore A de aproximadamente 4 A a aproximadamente 16 A, por exemplo, que se situa entre aproximadamente 45 OO e aproximadamente 65 OO na faixa Shore OO. Em ao menos uma tal modalidade, a composição polimérica pode compreender um copolímero de PLLA/PCL ou um copolímero de PGA/PCL, por exemplo. Em várias circunstâncias, a composição polimérica de um conjunto de compensador de espessura de tecido pode ter um valor de dureza Shore A menor que 15 A. Em várias circunstâncias, a composição polimérica de um conjunto de compensador de espessura de tecido pode ter um valor de dureza Shore A menor que 10 A. Em várias circunstâncias, a composição polimérica de um conjunto de compensador de espessura de tecido pode ter uma dureza Shore A menor que 5 A. Em determinadas circunstâncias, o material polimérico pode ter um valor Shore OO de composição dentre aproximadamente 35 OO e aproximadamente 75 OO, por exemplo.
[00170] Em várias circunstâncias, a composição polimérica pode ter ao menos duas das propriedades identificadas acima. Em várias circunstâncias, a composição polimérica pode ter ao menos três das propriedades identificadas acima. A composição polimérica pode ter uma porosidade de 85% a 97%, em volume, um tamanho dos poros de 5 micrômetros a 2.000 micrômetros, um valor de dureza Shore A de 4 A até 16 A e um valor de dureza Shore OO de 45 OO a 65 OO, por exemplo. Em ao menos uma modalidade, a composição polimérica pode compreender 70%, em peso, da composição polimérica de PLLA e 30%, em peso, da composição polimérica de PCL tendo uma porosidade de 90%, em volume, um tamanho dos poros de 100 micrômetros a 1.000 micrômetros, e um valor de dureza Shore A de 4 A até 16 A e um valor de dureza Shore OO de 45 OO a 65 OO, por exemplo. Em ao menos uma modalidade, a composição polimérica pode compreender 65%, em peso, da composição polimérica de PGA e 35%, em peso, da composição polimérica de PCL tendo uma porosidade de 93% a 95%, em volume, um tamanho dos poros de 10 micrômetros a 100 micrômetros, e um valor de dureza Shore A de 4 A até 16 A e um valor de dureza Shore OO de 45 OO a 65 OO, por exemplo.
[00171] Em várias circunstâncias, a composição polimérica pode compreender um agente farmaceuticamente ativo. A composição polimérica pode liberar uma quantidade terapeuticamente eficaz do agente farmaceuticamente ativo. Em várias circunstâncias, o agente farmaceuticamente ativo pode ser liberado conforme a composição polimérica é dessorvida e/ou absorvida. Em várias circunstâncias, o agente farmaceuticamente ativo pode ser liberado em fluido, como, por exemplo, sangue, passando pela ou através da composição polimérica. Exemplos de agentes farmaceuticamente ativos podem incluir, mas não se limitam a, agentes hemostáticos e fármacos, por exemplo fibrina, trombina, e celulose regenerada oxidada (ORC); medicamentos anti-inflamatórios, por exemplo diclofenaco, aspirina, naproxeno, sulindaco, e hidrocortisona; fármacos ou agentes antibióticos e antimicrobianos, por exemplo triclosano, prata iônica, ampicilina, gentamicina, polimixina B, cloranfenicol; e agentes anticâncer, por exemplo cisplatina, mitomicina, adriamicina.
[00172] Vários métodos são revelados na presente invenção para fabricar um compensador de espessura de tecido. Esses métodos poderiam ser usados para fabricar qualquer camada adequada para uso com um cartucho de prendedores e/ou um instrumento prendedor cirúrgico, por exemplo. Tal camada pode compreender uma composição com densidade menor que cem por cento, que pode ser criada com o uso de qualquer processo adequado. Por exemplo, tais processos podem incluir, por exemplo, processos de extrusão, moldagem por injeção, tecelagem, liofilização, espumação, e/ou sopro de fundido. Alguns processos podem produzir uma espuma, enquanto outros processos podem não produzir uma espuma; entretanto, em qualquer circunstância, todas essas modalidades são contempladas para uso com todas as modalidades reveladas na presente invenção.
[00173] A totalidade das revelações de:
[00174] Patente US n° 5.403.312, intitulada ELECTROSURGICAL HEMOSTATIC DEVICE, que foi concedida em 4 de abril de 1995;
[00175] Patente US n° 7.000.818, intitulada SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS, que foi concedida em 21 de fevereiro de 2006;
[00176] Patente US n° 7.422.139, intitulada MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITH TACTILE POSITION FEEDBACK, que foi concedida em 9 de setembro de 2008;
[00177] Patente US n° 7.464.849, intitulada ELECTROMECHANICAL SURGICAL INSTRUMENT WITH CLOSURE SYSTEM AND ANVIL ALIGNMENT COMPONENTS, que foi concedida em 16 de dezembro de 2008;
[00178] Patente US n° 7.670.334, intitulada SURGICAL INSTRUMENT HAVING AN ARTICULATING END EFFECTOR, que foi concedida em 2 de março de 2010;
[00179] Patente US n° 7.753.245, intitulada SURGICAL STAPLING INSTRUMENTS, que foi concedida em 13 de julho de 2010;
[00180] Patente US n° 8.393.514, intitulada SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE, que foi concedida em 12 de março de 2013;
[00181] Pedido de patente US n° de série 11/343.803, intitulado MULTI-FUNCTION MOTOR FOR A SURGICAL INSTRUMENT; agora patente US n° 7.845.537;
[00182] Pedido de patente US n° de série 12/031.573, intitulado SURGICAL CUTTING AND FASTENING INSTRUMENT HAVING RF ELECTRODES, depositado em 14 de fevereiro de 2008;
[00183] Pedido de patente US n° de série n° 12/031.873, intitulado END EFFECTORS FOR A SURGICAL CUTTING AND STAPLING INSTRUMENT, depositado em 15 de fevereiro de 2008, agora patente US n° 7.980.443;
[00184] Pedido de patente US n° de série 12/235.782, intitulado MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT, agora patente US 8.210.411;
[00185] Pedido de patente US n° de série 12/249.117, intitulado POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLY RETRACTABLE FIRING SYSTEM, agora patente US n° 8.608.045;
[00186] Pedido de patente US n° de série 12/647.100, intitulado MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT WITH ELECTRIC ACTUATOR DIRECTIONAL CONTROL ASSEMBLY, depositado em 24 de dezembro de 2009; agora patente US n° 8.220.688;
[00187] Pedido de patente US n° de série n° 12/893.461, intitulado STAPLE CARTRIDGE, depositado em 29 de setembro de 2012, agora patente US n° 8.733.613;
[00188] Pedido de patente US n° de série n° 13/036.647, intitulado SURGICAL STAPLING INSTRUMENT, depositado em 28 de fevereiro de 2011, agora patente US n° 8.561.870;
[00189] Pedido de patente US n° de série 13/118.241, intitulado SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS, agora publicação de pedido de patente US n° 2012/0298719;
[00190] Pedido de patente US n° de série 13/524.049, intitulado ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE, depositado em 15 de junho de 2012; agora publicação de pedido de patente US n° 2013/0334278;
[00191] Pedido de patente US n° de série 13/800.025, intitulado STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, depositado em 13 de março de 2013; agora publicação de pedido de patente US n° 2014/0263551;
[00192] Pedido de patente US n° de série 13/800.067, intitulado STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, depositado em 13 de março de 2013; agora publicação de pedido de patente US n° 2014/0263552;
[00193] Publicação de pedido de patente US n° 2007/0175955,intitulada SURGICAL CUTTING AND FASTENING INSTRUMENT WITH CLOSURE TRIGGER LOCKING MECHANISM, depositada em 31 de janeiro de 2006; e publicação de pedido de patente US n° 2010/0264194, intitulada SURGICAL STAPLING INSTRUMENT WITH AN ARTICULATABLE END EFFECTOR, depositada em 22 de abril de 2010, agora patente US n° 8.308.040, estão aqui incorporadas, por referência.
[00194] Embora várias modalidades dos dispositivos tenham sido aqui descritas em conexão com determinadas modalidades reveladas, podem ser implementadas muitas modificações e variações dessas modalidades. Além disso, quando os materiais são revelados ara determinados componentes, outros materiais podem ser usados. Além disso, de acordo com várias modalidades, um único componente pode ser substituído por múltiplos componentes e múltiplos componentes podem ser substituídos por um único componente, para realizar uma ou mais funções determinadas. A descrição mencionada anteriormente e as reivindicações seguintes são destinadas a abranger todas essas modificações e variações.
[00195] Os dispositivos aqui revelados podem ser projetados para que sejam descartados após um único uso, ou podem ser projetados para que sejam usados múltiplas vezes. Em qualquer dos casos, entretanto, o dispositivo pode ser recondicionado para reuso após ao menos um uso. O recondicionamento pode incluir qualquer combinação das etapas de desmontagem do dispositivo, seguida de limpeza ou substituição de peças específicas e subsequente remontagem. Em particular, o dispositivo pode ser desmontado e qualquer número de peças ou partes específicas do dispositivo podem ser seletivamente substituídas ou removidas, em qualquer combinação. Mediante a limpeza e/ou substituição de partes específicas, o dispositivo pode ser remontado para uso subsequente na instalação de recondicionamento ou por uma equipe cirúrgica, imediatamente antes de um procedimento cirúrgico. Os versados na técnica entenderão que o recondicionamento de um dispositivo pode usar uma variedade de técnicas para desmontar, limpar/substituir e remontar. O uso de tais técnicas e o dispositivo recondicionado resultante estão dentro do escopo do presente pedido.
[00196] De preferência, a invenção aqui descrita será processada antes da cirurgia. Primeiramente, um instrumento novo ou usado é obtido e, se necessário, limpo. O instrumento pode ser, então, esterilizado. Em uma técnica de esterilização, o instrumento é disposto em um recipiente fechado e selado, como uma bolsa plástica ou de TYVEK. O recipiente e o instrumento são, então, colocados em um campo de radiação que pode penetrar no recipiente, como radiação gama, raios X ou elétrons de alta energia. A radiação extermina bactérias no instrumento e no recipiente. O instrumento esterilizado pode ser, então, armazenado em um recipiente estéril. O recipiente vedado mantém o instrumento estéril até que o mesmo seja aberto na unidade médica.
[00197] Embora esta invenção tenha sido descrita como tendo designs exemplificadores, a presente invenção pode ser adicionalmente modificada dentro do espírito e do escopo da revelação. Pretende-se, portanto, que este pedido cubra quaisquer variações, usos ou adaptações da invenção com o uso de seus princípios gerais. Adicionalmente, este pedido tem por objetivo abranger esses desvios da presente revelação que possam ocorrer com a prática conhecida ou costumeira na técnica à qual esta invenção está relacionada.
[00198] Qualquer patente, publicação ou outro material de revelação, no todo ou em parte, que seja tido como incorporado a título de referência à presente invenção, é incorporado à presente invenção apenas até o ponto em que os materiais incorporados não entrem em conflito com definições, declarações ou outros materiais de revelação existentes 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.
Claims (12)
1. Aparelho de grampeamento cirúrgico para grampear tecido, que compreende: um corpo de cartucho (1110) que compreende: uma extremidade proximal (1111); uma extremidade distal (1112); uma plataforma (1113) compreendendo uma superfície de suporte de tecido; e uma pluralidade de cavidades de grampo (1015); uma pluralidade de grampos (1040) armazenados de modo removível nas cavidades de grampos (1015); um membro de disparo (1060) móvel entre uma posição proximal em direção a uma posição distal para ejetar os grampos (1040) das cavidades de grampo (1015); uma camada (1220) posicionada acima da plataforma (1113), sendo que a camada (1220) compreende uma porção proximal (1221) e uma porção distal (1222), sendo que os grampos (1040) são configurados para implantar a camada (1220) contra o tecido quando os grampos (1040) são ejetados a partir das cavidades de grampos (1015); e um retentor de camada (1170) configurado para prender de modo liberável a camada (1220) à plataforma (1113), sendo que o membro de disparo (1060) é configurado para engatar o retentor de camada (1170) e levantar o retentor de camada (1170) em relação à plataforma (1113), caracterizado pelo fato de que: a porção proximal (1221) da camada (1220) é encaixada entre o membro de disparo (1060) e o corpo do cartucho (1110) quando o membro de disparo (1060) está na posição proximal, e em que a porção proximal (1221) da camada (1220) é liberada quando o membro de disparo (1060) é movido em direção à posição distal.
2. Aparelho de grampeamento cirúrgico, de acordo com a reivindicação 1, caracterizado pelo fato de que o retentor de camada (1170) compreende um clipe (1173) móvel entre uma posição de retenção e uma posição liberada, sendo que a plataforma (1113) compreende uma fenda de clipe (1123), e sendo que uma porção da camada (1220) é encaixada entre o clipe (1173) e a fenda de clipe (1123) quando o clipe (1173) está na posição de retenção.
3. Aparelho de grampeamento cirúrgico, de acordo com a reivindicação 1, caracterizado pelo fato de que o retentor de camada (1170) é posicionado na extremidade distal (1112) do corpo de cartucho (1110) e está configurado para segurar de forma liberável a porção distal (1222) da camada (1220) contra a plataforma (1113).
4. Aparelho de grampeamento cirúrgico, de acordo com a reivindicação 1, caracterizado pelo fato de que o corpo de cartucho (1110) compreende uma fenda longitudinal (1114) configurada para receber uma porção do membro de disparo (1060) na mesma, sendo que a camada (1220) compreende uma série de abas (1223) alinhadas com e encaixadas de maneira liberável dentro da fenda longitudinal (1114), e sendo que o membro de disparo (1060) é configurado para engatar as abas (1223) para liberar progressivamente as abas (1223) da fenda longitudinal (1114).
5. Aparelho de grampeamento cirúrgico, de acordo com a reivindicação 1, caracterizado pelo fato de que compreende: o corpo de cartucho (1110) que ainda compreende uma fenda longitudinal (1114); uma porção do membro de disparo (1060) é posicionada dentro da fenda longitudinal (1114); e o retentor de camada (1170) compreende uma série longitudinal de retentores de camada (1223), em que os retentores de camada (1223) estão alinhados e encaixados de forma liberável dentro da fenda longitudinal (1114), e em que o membro de disparo (1060) está configurado para engatar os retentores de camada (1223) para liberar progressivamente os retentores de camada (1223) da fenda longitudinal (1114).
6. Aparelho de grampeamento cirúrgico, de acordo com a reivindicação 5, caracterizado pelo fato de que a fenda longitudinal (1114) compreende uma primeira parede lateral longitudinal (1114a) e uma segunda parede lateral longitudinal (1114b), e sendo que cada retentor de camada (1223) compreende uma aba encaixada de maneira liberável entre a primeira parede lateral (1114a) e a segunda parede lateral (1114b).
7. Aparelho de grampeamento cirúrgico, de acordo com a reivindicação 5, caracterizado pelo fato de que a camada (1220) compreende um corpo implantável, e sendo que os retentores de camada (1223) são formados integralmente com o corpo implantável.
8. Instrumento de grampeamento cirúrgico, de acordo com a reivindicação 5, caracterizado pelo fato de que ainda compreende: uma pluralidade de acionadores de grampo (1050) configurados para levantar os grampos (1040) em direção à plataforma (1013), sendo que os acionadores de grampo (1050) compreendem um acionador de grampo proximal e um acionador de grampo distal (1050d); e um retentor distal de camada (1070) configurado para prender de modo liberável a camada (1020) à plataforma (1013), sendo que o dito acionador distal (1050d) é configurado para retrair o retentor distal de camada (1070) em relação à plataforma (1013).
9. Aparelho de grampeamento cirúrgico, de acordo com a reivindicação 8, caracterizado pelo fato de que o retentor distal de camada (1070) compreende um pino (1073) móvel entre uma posição de retenção e uma posição liberada, sendo que a camada (1020) compreende uma abertura de pino (1023), sendo que o pino (1073) é posicionado na abertura de pino (1023) quando o retentor de camada (1070) está na posição de retenção, e sendo que o pino (1073) é desengatado da abertura de pino (1023) quando o retentor de camada (1070) está na posição liberada.
10. Aparelho de grampeamento cirúrgico, de acordo com a reivindicação 5, caracterizado pelo fato de que o retentor de camada ainda compreende um retentor distal de camada (1170) configurado para prender de modo liberável a camada (1120) à plataforma (1113), sendo que o membro de disparo (1060) é configurado para engatar o retentor distal de camada (1170) e levantar o retentor distal de camada (1170) em relação à plataforma (1113).
11. Aparelho de grampeamento cirúrgico, de acordo com a reivindicação 10, caracterizado pelo fato de que o retentor distal de camada (1170) compreende um clipe (1173) móvel entre uma posição de retenção e uma posição liberada, sendo que a plataforma (1113) compreende uma fenda de clipe (1123) e, sendo que uma porção da camada (1120) é encaixada entre o clipe (1173) e a fenda de clipe (1123) quando o clipe (1173) está na posição de retenção.
12. Aparelho de grampeamento cirúrgico, de acordo com a reivindicação 1 ou 10, caracterizado pelo fato de que o retentor de camada (1173) compreende um rebordo de retentor (1174), sendo que a plataforma (1113) compreende um rebordo de plataforma (1124), e sendo que o rebordo de retentor (1174) e o rebordo de plataforma (1124) prendem de maneira liberável a camada (1120) entre os mesmos.
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2015
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EP3192457B1 (en) | 2019-01-09 |
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