BR112017012996B1 - Instrumento cirúrgico com uma bigorna que é seletivamente móvel sobre um eixo geométrico imóvel distinto em relação a um cartucho de grampos - Google Patents
Instrumento cirúrgico com uma bigorna que é seletivamente móvel sobre um eixo geométrico imóvel distinto em relação a um cartucho de grampos Download PDFInfo
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
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- A—HUMAN NECESSITIES
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- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B17/0644—Surgical staples, i.e. penetrating the tissue penetrating the tissue, deformable to closed position
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- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
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- A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
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Abstract
INSTRUMENTO CIRÚRGICO COM UMA BIGORNA QUE É SELETIVAMENTE MÓVEL SOBRE UM EIXO GEOMÉTRICO IMÓVEL DISTINTO EM RELAÇÃO A UM CARTUCHO DE GRAMPOS. A presente invenção refere-se a um instrumento cirúrgico que inclui um canal alongado que é configurado para suportar operacionalmente um cartucho de grampos cirúrgicos no mesmo. Em pelo menos uma forma, uma bigorna é acoplada de modo pivotante a uma extremidade proximal do canal alongado, de modo que a bigorna seja pivotante em torno de um eixo geométrico imóvel e distinto definido pelo canal alongado. Um membro de disparo é configurado para deslocar-se axialmente no interior do canal alongado axial em resposta a uma aplicação de movimentos de disparo ao mesmo. O membro de disparo é configurado para se engatar de forma móvel à bigorna e ao canal alongado para espaçar a bigorna em relação ao canal alongado a uma distância desejada à medida que o membro de disparo é acionado axialmente através do canal alongado. Um membro de fechamento é configurado para mover a bigorna de uma posição aberta para posições fechadas em relação ao canal alongado mediante a aplicação de movimentos de fechamento ao membro de fechamento.
Description
[001] A presente invenção refere-se a instrumentos cirúrgicos e, em várias modalidades, a instrumentos cirúrgicos de grampeamento e/ou de corte e a cartuchos de grampos para uso com os mesmos.
[002] 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 ao membro 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 deslizador 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 descrição 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 concretizações.
[004] Vários recursos das modalidades descritas aqui, juntamente com as vantagens das mesmas, podem ser entendidos em conformidade com a descrição a seguir, considerada juntamente com os desenhos anexos da seguinte forma:
[005] A Figura 1 é uma vista em perspectiva de uma modalidade de um instrumento cirúrgico equipado com motor que compreende um cabo, um eixo de acionamento e um atuador de extremidade articulável;
[006] A Figura 2 é uma vista em perspectiva de uma modalidade de um instrumento cirúrgico acionado manualmente que compreende um cabo, um eixo de acionamento e um atuador de extremidade articulável;
[007] A Figura 3 é uma vista em perspectiva de uma modalidade de instrumento cirúrgico que compreende um alojamento, um eixo de acionamento e um atuador de extremidade articulável que é configurado para uso com um sistema controlado roboticamente;
[008] A Figura 4 é uma vista em perspectiva de uma modalidade de sistema cirúrgico controlado roboticamente;
[009] A Figura 5 é uma vista em perspectiva de uma modalidade de um atuador de extremidade cirúrgico articulável;
[0010] A Figura 6 é uma vista em perspectiva explodida do atuador de extremidade cirúrgico articulável da Figura 5;
[0011] A Figura 7 é uma vista em perspectiva de um canal alongado do atuador de extremidade cirúrgico das Figuras 5 e 6;
[0012] A Figura 8 é uma vista de topo do canal alongado da Figura 7;
[0013] A Figura 9 é uma vista em elevação lateral do canal alongado das Figuras 7 e 8;
[0014] A Figura 10 é uma vista de topo de uma bigorna do atuador de extremidade cirúrgico das Figuras 5 e 6;
[0015] A Figura 11 é uma vista em elevação lateral da bigorna da Figura 10;
[0016] A Figura 12 é uma vista em seção transversal do atuador de extremidade cirúrgico das Figuras 5 e 6 com a bigorna em uma posição aberta;
[0017] A Figura 13 é uma vista em seção transversal do atuador de extremidade cirúrgico da Figura 12 com a bigorna em uma posição fechada e o membro de disparo em uma posição inicial não disparada;
[0018] A Figura 14 é uma vista em perspectiva de uma modalidade do conjunto de orientação de feixe de disparo;
[0019] A Figura 15 é uma vista em perspectiva em seção transversal do conjunto de orientação de feixe de disparo da Figura 14;
[0020] A Figura 16 é uma vista em perspectiva do atuador de extremidade das Figuras 11 e 12;
[0021] A Figura 17 é uma vista de topo do atuador de extremidade cirúrgico da Figura 16;
[0022] A Figura 18 é uma vista em perspectiva do atuador de extremidade cirúrgico das Figuras 16 e 17 articulados em uma primeira direção "FD";
[0023] A Figura 19 é uma vista de topo do atuador de extremidade cirúrgico da Figura 18;
[0024] A Figura 20 é uma vista em perspectiva do atuador de extremidade cirúrgico das Figuras 16 e 17 articulados em uma segunda direção "SD";
[0025] A Figura 21 é uma vista de topo do atuador de extremidade cirúrgico da Figura 20;
[0026] A Figura 22 é uma comparação diagramática ilustrando as faixas de movimento de dois atuadores de extremidade cirúrgicos em uma área da pelve humana;
[0027] A Figura 23 é uma vista em elevação lateral que compara as zonas mortas proximais ("PDZ's") de dois atuadores de extremidade cirúrgicos;
[0028] A Figura 24 é uma vista em perspectiva de outra modalidade de atuador de extremidade cirúrgico;
[0029] A Figura 25 é uma vista em perspectiva explodida do atuador de extremidade da Figura 24;
[0030] A Figura 26 é uma vista em perspectiva do atuador de extremidade das Figuras 24 e 25;
[0031] A Figura 27 é outra vista em perspectiva parcial do atuador de extremidade cirúrgico das Figuras 24 a 26 articulado em uma primeira direção ("FD");
[0032] A Figura 28 é outra vista em perspectiva do atuador de extremidade cirúrgico da Figura 27 articulado em uma segunda direção ("SD");
[0033] A Figura 29 é uma vista de topo do atuador de extremidade das Figuras 24 e 25;
[0034] A Figura 30 é outra vista de topo do atuador de extremidade da Figura 29 articulado em uma primeira direção ("FD");
[0035] A Figura 31 é outra vista de topo do atuador de extremidade cirúrgico da Figura 29 articulado em uma segunda direção ("SD");
[0036] A Figura 32 é outra vista de topo de uma porção do atuador de extremidade cirúrgico da Figura 29;
[0037] A Figura 33 é uma vista de topo ampliada de uma porção do atuador de extremidade cirúrgico da Figura 32;
[0038] A Figura 34 é uma vista de topo ampliada de uma porção de outra modalidade de atuador de extremidade cirúrgico;
[0039] A Figura 35 é uma vista em perspectiva de uma porção de outra modalidade do instrumento cirúrgico;
[0040] A Figura 36 é uma vista de topo do instrumento cirúrgico da Figura 35;
[0041] A Figura 37 é outra vista de topo do instrumento cirúrgico das figuras 35 e 36 com o atuador de extremidade do mesmo em uma orientação articulada;
[0042] A Figura 38 é uma vista em perspectiva de uma porção de outra modalidade do instrumento cirúrgico;
[0043] A Figura 39 é uma vista de topo do instrumento cirúrgico da Figura 38.
[0044] A Figura 40 é outra vista de topo do instrumento cirúrgico das figuras 38 e 39 com o atuador de extremidade do mesmo em uma orientação articulada;
[0045] A Figura 41 é uma vista em perspectiva de uma porção de outra modalidade do instrumento cirúrgico;
[0046] A Figura 42 é uma vista montada de uma porção do instrumento cirúrgico da Figura 41;
[0047] A Figura 43 é outra vista montada explodida de uma porção do instrumento cirúrgico das Figuras 41 e 42;
[0048] A Figura 44 é uma vista de topo de uma porção do instrumento cirúrgico das Figuras 41 a 43;
[0049] A Figura 45 é outra vista de topo do instrumento cirúrgico das Figuras 41 a 44 com o atuador de extremidade do mesmo em uma orientação articulada;
[0050] A Figura 46 é uma vista em perspectiva de uma porção de outra modalidade do instrumento cirúrgico;
[0051] A Figura 47 é uma vista de topo do instrumento cirúrgico da Figura 46.
[0052] A Figura 48 é outra vista de topo do instrumento cirúrgico das figuras 46 e 47 com o atuador de extremidade do mesmo em uma orientação articulada;
[0053] A Figura 49 é uma vista em perspectiva de uma porção de outra modalidade do instrumento cirúrgico;
[0054] A Figura 50 é uma vista de topo do instrumento cirúrgico da Figura 49.
[0055] A Figura 51 é outra vista de topo do instrumento cirúrgico das figuras 49 e 50 com o atuador de extremidade do mesmo em uma orientação articulada;
[0056] A Figura 52 é uma vista em perspectiva parcial de uma modalidade de conjunto de suporte de feixe de disparo;
[0057] A Figura 53 é uma vista em perspectiva de uma porção de uma modalidade do instrumento cirúrgico;
[0058] A Figura 54 é uma vista montada de uma porção do instrumento cirúrgico da Figura 53;
[0059] A Figura 55 é uma vista em perspectiva de uma porção de conector de extremidade proximal de um canal alongado de uma modalidade do atuador de extremidade;
[0060] A Figura 56 é uma vista de topo de uma porção do instrumento cirúrgico das Figuras 53 a 55;
[0061] A Figura 57 é outra vista de topo do instrumento cirúrgico das Figuras 53 a 56 com o atuador de extremidade do mesmo em uma orientação articulada;
[0062] A Figura 58 é uma vista em perspectiva do instrumento cirúrgico articulado da Figura 57;
[0063] A Figura 59 é uma vista em perspectiva de uma porção de outra modalidade do instrumento cirúrgico;
[0064] A Figura 60 é uma vista montada de uma porção do instrumento cirúrgico da Figura 59;
[0065] A Figura 61 é uma vista de topo de uma porção do instrumento cirúrgico das Figuras 59 e 60;
[0066] A Figura 62 é uma vista de topo do instrumento cirúrgico das Figuras 59 a 61 com o atuador de extremidade do mesmo em uma orientação articulada;
[0067] A Figura 63 é uma vista em perspectiva do instrumento cirúrgico da Figura 62;
[0068] A Figura 64 é uma vista em perspectiva de uma modalidade do conjunto de orientação de feixe de disparo;
[0069] A Figura 65 é uma vista em perspectiva de outra modalidade de conjunto de orientação de feixe de disparo;
[0070] A Figura 66 é uma vista em perspectiva de fundo do conjunto de orientação de feixe de disparo da Figura 65;
[0071] A Figura 67 é uma vista em perspectiva em seção transversal do conjunto de orientação de feixe de disparo das Figuras 65 e 66;
[0072] A Figura 68 é uma vista em perspectiva de outra modalidade de conjunto de orientação de feixe de disparo;
[0073] A Figura 69 é uma vista montada explodida do conjunto de orientação de feixe de disparo da Figura 68;
[0074] A Figura 70 é uma vista em perspectiva de outra modalidade de conjunto de orientação de feixe de disparo;
[0075] A Figura 71 é uma vista em perspectiva de outra modalidade de conjunto de orientação de feixe de disparo;
[0076] A Figura 72 é uma vista em perspectiva de outra modalidade do instrumento cirúrgico;
[0077] A Figura 73 é uma vista perspectiva em seção transversal de uma porção do conjunto de eixo de acionamento intercambiável do instrumento cirúrgico da Figura 72;
[0078] A Figura 74 é uma vista em perspectiva parcial de uma porção do eixo de acionamento intercambiável da Figura 72;
[0079] A Figura 75 é uma vista montada explodida de uma porção do conjunto de eixo de acionamento intercambiável das Figuras 72 a 74;
[0080] A Figura 76 é uma vista em seção transversal parcial do conjunto de eixo de acionamento intercambiável das Figuras 72 a 75;
[0081] A Figura 77 é outra vista em seção transversal parcial do conjunto de eixo de acionamento intercambiável das Figuras 72 a 76;
[0082] A Figura 78 mostra uma vista em elevação lateral do atuador de extremidade do instrumento cirúrgico da Figura 72 com a bigorna em uma posição aberta e uma posição fechada;
[0083] A Figura 79 é uma vista de topo de uma porção do instrumento cirúrgico da Figura 72; e
[0084] A Figura 80 é outra vista de topo do instrumento cirúrgico da Figura 79 com o atuador de extremidade do mesmo em uma posição articulada.
[0085] Os caracteres de referência correspondentes indicam as partes correspondentes através das várias vistas. As exemplificações apresentadas na presente invenção ilustram certas modalidades da invenção, em uma forma, e tais exemplificações não devem ser entendidas como limitadoras do escopo da invenção de nenhuma maneira.
[0086] A requerente do presente pedido é a autora dos seguintes pedidos de patente que foram depositados em 01 de março de 2013 e que estão, todos, aqui incorporados por referência, em sua totalidade:
[0087] - Pedido de Patente US n° de série 13/782.295, intitulado ARTICULATABLE SURGICAL INSTRUMENTS WITH CONDUCTIVE PATHWAYS FOR SIGNAL COMMUNICATION, agora Publicação de Patente US n° 2014/0246471;
[0088] - Pedido de Patente US n° de série 13/782.323, intitulado JAW ROTARY POWERED ARTICULATION JOINTS FOR SURGICAL INSTRUMENTS, agora Publicação de Patente US n° 2014/0246472;
[0089] - Pedido de Patente US n° de série 13/782.338, intitulado JAW THUMBWHEEL SWITCH ARRANGEMENTS FOR SURGICAL INSTRUMENTS, agora Publicação de Patente US n° 2014/0249557;
[0090] - Pedido de Patente US n° de série 13/782.499, intitulado ELECTROMECHANICAL SURGICAL DEVICE WITH SIGNAL RELAY ARRANGEMENT, agora publicação de pedido de patente US n° 2014/0246474;
[0091] - Pedido de Patente US n° de série 13/782.460, intitulado MULTIPLE PROCESSOR MOTOR CONTROL FOR MODULAR SURGICAL INSTRUMENTS, agora Publicação de Patente US n° 2014/0246478;
[0092] - Pedido de Patente US n° de série 13/782.358, intitulado JOYSTICK SWITCH ASSEMBLIES FOR SURGICAL INSTRUMENTS, agora Publicação de Patente US n° 2014/0246477;
[0093] - Pedido de Patente US n° de série 13/782.481, intitulado SENSOR STRAIGHTENED END EFFECTOR DURING REMOVAL THROUGH TROCAR, agora Publicação de Patente US n° 2014/0246479;
[0094] - Pedido de Patente US n° de série 13/782.518, intitulado CONTROL METHODS FOR SURGICAL INSTRUMENTS WITH REMOVABLE IMPLEMENT PORTIONS, agora Publicação de Patente US n° 2014/0246475;
[0095] - Pedido de patente US n° de série 13/782.375, intitulado ROTARY POWERED SURGICAL INSTRUMENTS WITH MULTIPLE DEGREES OF FREEDOM, agora publicação de pedido de patente US n° 2014/0246473; e
[0096] - Pedido de patente US n° de série 13/782.536, intitulado SURGICAL INSTRUMENT SOFT STOP, agora publicação de pedido de patente US n° 2014/0246476.
[0097] O requerente do presente pedido também detém os seguintes pedidos de patente que foram depositados em quinta-feira, 14 de março de 2013 e que estão, cada um, aqui incorporados por referência em suas respectivas totalidades:
[0098] - Pedido de Patente US n° de série 13/803.097, intitulado ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE, agora publicação de pedido de patente US n° 2014/0263542;
[0099] - Pedido de Patente US n° de série 13/803.193, intitulado CONTROL ARRANGEMENTS FOR A DRIVE MEMBER OF A SURGICAL INSTRUMENT, agora Publicação de Patente US n° 2014/0263537;
[00100] - Pedido de Patente US n° de série 13/803.053, intitulado INTERCHANGEABLE SHAFT ASSEMBLIES FOR USE WITH A SURGICAL INSTRUMENT, agora Publicação de Patente US n° 2014/0263564;
[00101] - Pedido de Patente US n° de série 13/803.086, intitulado ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK, agora publicação de pedido de patente US n° 2014/0263541;
[00102] - Pedido de Patente US n° de série 13/803.210, intitulado SENSOR ARRANGEMENTS FOR ABSOLUTE POSITIONING SYSTEM FOR SURGICAL INSTRUMENTS, agora publicação de pedido de patente US n° 2014/0263538;
[00103] - Pedido de Patente US n° de série 13/803.148, intitulado MULTI-FUNCTION MOTOR FOR A SURGICAL INSTRUMENT, agora Publicação de Patente US n° 2014/0263554;
[00104] - Pedido de Patente US n° de série 13/803.066, intitulado DRIVE SYSTEM LOCKOUT ARRANGEMENTS FOR MODULAR SURGICAL INSTRUMENTS, agora publicação de pedido de patente US n° 2014/0263565;
[00105] - Pedido de patente US n° de série 13/803.117, intitulado ARTICULATION CONTROL SYSTEM FOR ARTICULATABLE SURGICAL INSTRUMENTS, agora publicação de pedido de patente US n° 2014/0263553;
[00106] - Pedido de patente US n° de série 13/803.130, intitulado DRIVE TRAIN CONTROL ARRANGEMENTS FOR MODULAR SURGICAL INSTRUMENTS, agora publicação de pedido de patente US n° 2014/0263543; e
[00107] - Pedido de Patente US n° de série 13/803.159, intitulado METHOD AND SYSTEM FOR OPERATING A SURGICAL INSTRUMENT, agora Publicação de Patente US n° 2014/0277017;
[00108] O requerente do presente pedido também detém os seguintes pedidos de patente que foram depositados em 7 de março de 2014 e que estão, cada um, aqui incorporados, por referência, em suas respectivas totalidades:
[00109] - Pedido de Patente US n° de série 14/200.111, intitulado CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS, agora Publicação de Patente US n° 2014/0263539;
[00110] O requerente do presente pedido também detém os seguintes pedidos de patente que foram depositados 26 de março de 2014 e que estão, cada um, aqui incorporados, por referência, em suas respectivas totalidades:
[00111] Pedido de Patente US n° de série 14/226.106, intitulado POWER MANAGEMENT CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS;
[00112] Pedido de Patente US n° de série 14/226.099, intitulado STERILIZATION VERIFICATION CIRCUIT;
[00113] Pedido de Patente US n° de série 14/226.094, intitulado VERIFICATION OF NUMBER OF BATTERY EXCHANGES/PROCEDURE COUNT;
[00114] Pedido de patente US n° de série 14/226.117, intitulado POWER MANAGEMENT THROUGH SLEEP OPTIONS OF SEGMENTED CIRCUIT AND WAKE UP CONTROL;
[00115] Pedido de patente US n° de série 14/226.075, intitulado MODULAR POWERED SURGICAL INSTRUMENT WITH DETACHABLE SHAFT ASSEMBLIES;
[00116] Pedido de Patente US n° de série 14/226.093, intitulado FEEDBACK ALGORITHMS FOR MANUAL BAILOUT SYSTEMS FOR SURGICAL INSTRUMENTS;
[00117] Pedido de Patente US n° de série 14/226.116, intitulado SURGICAL INSTRUMENT UTILIZING SENSOR ADAPTATION;
[00118] Pedido de Patente US n° de série 14/226.071, intitulado SURGICAL INSTRUMENT CONTROL CIRCUIT HAVING A SAFETY PROCESSOR;
[00119] Pedido de Patente US n° de série 14/226.097, intitulado SURGICAL INSTRUMENT COMPRISING INTERACTIVE SYSTEMS;
[00120] Pedido de Patente US n° de série 14/226.126, intitulado INTERFACE SYSTEMS FOR USE WITH SURGICAL INSTRUMENTS;
[00121] Pedido de Patente US n° de série 14/226.133, intitulado MODULAR SURGICAL INSTRUMENT SYSTEM;
[00122] Pedido de Patente US n° de série 14/226.081, intitulado SYSTEMS AND METHODS FOR CONTROLLING A SEGMENTED CIRCUIT;
[00123] Pedido de Patente US n° de série 14/226.076, intitulado POWER MANAGEMENT THROUGH SEGMENTED CIRCUIT AND VARIABLE VOLTAGE PROTECTION;
[00124] Pedido de Patente n° de série U.S. 14/226.111, intitulado SURGICAL STAPLING INSTRUMENT SYSTEM; e
[00125] Pedido de Patente US n° de série 14/226.125, intitulado SURGICAL INSTRUMENT COMPRISING A ROTATABLE SHAFT.
[00126] O requerente do presente pedido também detém os seguintes pedidos de patente que foram depositados em 5 de setembro de 2014 e que estão, cada um, aqui incorporados por referência em suas respectivas totalidades:
[00127] - Pedido de Patente US n° de série 14/479.103, intitulado CIRCUITRY AND SENSORS FOR POWERED MEDICAL DEVICE;
[00128] - Pedido de Patente U.S. n° 14/479.119, intitulado ADJUNCT WITH INTEGRATED SENSORS TO QUANTIFY TISSUE COMPRESSION;
[00129] - Pedido de Patente U.S. n° 14/478.908, intitulado MONITORING DEVICE DEGRADATION BASED ON COMPONENT EVALUATION;
[00130] - Pedido de Patente U.S. n° 14/478.895, intitulado MULTIPLE SENSORS WITH ONE SENSOR AFFECTING A SECOND SENSOR'S OUTPUT OR INTERPRETATION;
[00131] - Pedido de Patente U.S. n° 14/479.110, intitulada USE OF POLARITY OF HALL MAGNET DETECTION TO DETECT MISLOADED CARTRIDGE;
[00132] - Pedido de Patente US n° de série 14/479.098, intitulado SMART CARTRIDGE WAKE UP OPERATION AND DATA RETENTION;
[00133] - Pedido de Patente US n° de série 14/479.115, intitulado MULTIPLE MOTOR CONTROL FOR POWERED MEDICAL DEVICE; e
[00134] - Pedido de Patente US n° de série 14/479.108, intitulado LOCAL DISPLAY OF TISSUE PARAMETER STABILIZATION.
[00135] O requerente do presente pedido também detém os seguintes pedidos de patente que foram depositados em 9 de abril de 2014 e que estão, cada um, aqui incorporados por referência em suas respectivas totalidades:
[00136] - Pedido de patente US n° de série 14/248.590, intitulado MOTOR DRIVEN SURGICAL INSTRUMENTS WITH LOCKABLE DUAL DRIVE SHAFTS, agora publicação de pedido de patente US n° 2014/0305987;
[00137] - Pedido de patente US n° de série 14/248.581, intitulado SURGICAL INSTRUMENT COMPRISING A CLOSING DRIVE AND A FIRING DRIVE OPERATED FROM THE SAME ROTATABLE OUTPUT, agora publicação de pedido de patente US no 2014/0305989;
[00138] - Pedido de patente US n° de série 14/248.595, intitulado SURGICAL INSTRUMENT SHAFT INCLUDING SWITCHES FOR CONTROLLING THE OPERATION OF THE SURGICAL INSTRUMENT, agora publicação de pedido de patente US no 2014/0305988;
[00139] - Pedido de patente US n° de série 14/248.588, intitulado POWERED LINEAR SURGICAL STAPLER, agora publicação de pedido de patente US n° 2014/0309666;
[00140] - Pedido de patente US n° de série 14/248.591, intitulado TRANSMISSION ARRANGEMENT FOR A SURGICAL INSTRUMENT, agora publicação de pedido de patente US n° 2014/0305991;
[00141] - Pedido de patente US n° de série 14/248.584, intitulado MODULAR MOTOR DRIVEN SURGICAL INSTRUMENTS WITH ALIGNMENT FEATURES FOR ALIGNING ROTARY DRIVE SHAFTS WITH SURGICAL END EFFECTOR SHAFTS, agora publicação de pedido de patente US no 2014/0305994;
[00142] - Pedido de Patente US n° de série 14/248.587, intitulado POWERED SURGICAL STAPLER, agora Publicação de Patente US n° 2014/0309665;
[00143] - Pedido de Patente US n° de série 14/248.586, intitulado DRIVE SYSTEM DECOUPLING ARRANGEMENT FOR A SURGICAL INSTRUMENT, agora Publicação de Patente US n° 2014/0305990; e
[00144] - Pedido de patente US n° de série 14/248.607, intitulado MODULAR MOTOR DRIVEN SURGICAL INSTRUMENTS WITH STATUS INDICATION ARRANGEMENTS, agora publicação de pedido de patente US n° 2014/0305992.
[00145] O requerente do presente pedido também detém os seguintes pedidos de patente que foram depositados em 16 de abril de 2013 e que estão, cada um, aqui incorporados por referência em suas respectivas totalidades:
[00146] - Pedido de patente US n° de série 61/812.365, intitulado SURGICAL INSTRUMENT WITH MULTIPLE FUNCTIONS PERFORMED BY A SINGLE MOTOR;
[00147] - Pedido de patente US n° de série 61/812.376, intitulado LINEAR CUTTER WITH POWER;
[00148] - Pedido de patente US n° de série 61/812.382, intitulado LINEAR CUTTER WITH MOTOR AND PISTOL GRIP;
[00149] - Pedido de patente provisório U.S. n° de série 61/812.385, intitulado SURGICAL INSTRUMENT HANDLE WITH MULTIPLE ACTUATION MOTORS AND MOTOR CONTROL; e
[00150] - Pedido de patente US n° de série 61/812.372, intitulado SURGICAL INSTRUMENT WITH MULTIPLE FUNCTIONS PERFORMED BY A SINGLE MOTOR.
[00151] O requerente do presente pedido detém os seguintes pedidos de patente que foram depositados na mesma data do presente pedido e que estão, cada um, aqui incorporados por referência em suas respectivas totalidades:
[00152] - Pedido de patente U.S. n° _______, intitulada SURGICAL INSTRUMENT SYSTEMS COMPRISING AN ARTICULATABLE END EFFECTOR AND MEANS FOR ADJUSTING THE FIRING STROKE OF A FIRING MEMBER, n° do documento do procurador END7415USNP/140289;
[00153] - Pedido de patente US n° de série _______, intitulado SURGICAL INSTRUMENT COMPRISING INTERACTIVE SYSTEMS, n° do Documento do Procurador END7416USNP/140291;
[00154] - Pedido de patente U.S. n° de série _______, intitulado DRIVE ARRANGEMENTS FOR ARTICULATABLE SURGICAL INSTRUMENTS, n° do documento do procurador END7418USNP/140292;
[00155] - Pedido de patente U.S. n° - _______, intitulado LOCKING ARRANGEMENTS FOR DETACHABLE SHAFT ASSEMBLIES WITH ARTICULATABLE SURGICAL END EFFECTORS, n° do documento do procurador END7417USNP/140293;
[00156] - Pedido de patente US n° de série _______, intitulado SURGICAL INSTRUMENTS WITH IMPROVED CLOSURE ARRANGEMENTS, n° do documento do procurador END7486/140296;
[00157] - Pedido de patente US n° de série_______, intitulado SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTORS AND MOVABLE FIRING BEAM SUPPORT ARRANGEMENTS, n° do documento do procurador END7489USNP/140299;
[00158] - Pedido de patente US n° de série _______, intitulado SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTORS AND IMPROVED FIRING BEAM SUPPORT ARRANGEMENTS, n° do documento do procurador END7491USNP/140301;
[00159] - Pedido de patente US n° de série. _______, intitulado SURGICAL INSTRUMENT ASSEMBLY COMPRISING A FLEXIBLE ARTICULATION SYSTEM, n° do documento do procurador END7492USNP/140302; e
[00160] - Pedido de patente US n° de série. _______, intitulado SURGICAL INSTRUMENT ASSEMBLY COMPRISING A LOCKABLE ARTICULATION SYSTEM, n° do documento do procurador END7494USNP/140304.
[00161] 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. Operações, componentes e elementos bem conhecidos não foram descritos em detalhes de modo a não obscurecer as modalidades descritas no relatório descritivo. O leitor entenderá 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 concretizações.
[00162] 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.
[00163] Os termos "proximal" e "distal" são usados na presente invenção com referência a um médico que manipula a porção de punho 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.
[00164] São fornecidos vários dispositivos e métodos exemplificadores para a realização de procedimentos cirúrgicos laparoscópicos e minimamente invasivos. Entretanto, o leitor entenderá prontamente que os vários métodos e dispositivos revelados na presente invenção podem ser usados em inúmeros procedimentos e aplicações cirúrgicas, inclusive, por exemplo, juntamente com procedimentos cirúrgicos abertos. Com o avanço da presente Descrição Detalhada, o leitor entenderá 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 um canal de trabalho através do qual o atuador de extremidade e o eixo de acionamento alongado de um instrumento cirúrgico podem ser avançados.
[00165] 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 prontamente 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.
[00166] 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.
[00167] Os grampos são sustentados por acionadores de grampos no corpo de cartucho. Os acionadores são móveis entre uma primeira posição, ou posição não disparada, e uma segunda posição, ou 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.
[00168] 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, ainda, 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.
[00169] A Figura 1 ilustra um instrumento cirúrgico 10 acionado (ou "alimentado") por motor que inclui um alojamento 20, um conjunto de eixo de acionamento alongado 100 e um atuador de extremidade 200 que está operacionalmente conectado ao conjunto de eixo de acionamento alongado 100. O atuador de extremidade 200, conforme mostrado, é configurado para atuar como um endocortador para prender, cortar e grampear o tecido. Entretanto, será reconhecido que várias modalidades podem incluir atuadores de extremidade configurados de modo a agir como outros dispositivos cirúrgicos incluindo, por exemplo, garras, cortadores, grampeadores, aplicadores de clipe, dispositivos de acesso, dispositivos aplicação de fármaco/terapia gênica, ultrassom, RF, e/ou dispositivos de energia a laser etc. Conforme indicado acima e conforme será descrito abaixo, várias porções do instrumento cirúrgico 10 são acionadas por motor. Detalhes adicionais relacionados aos muitos aspectos dos componentes acionados por motor do instrumento cirúrgico 10 podem ser encontrados, por exemplo, no pedido de patente U.S. n° 13/803.086, intitulado ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK, publicação de pedido de patente US n° 2014/0263541, que foi aqui incorporado por referência em sua totalidade. Entretanto, deve-se compreender que as diversas disposições do atuador de extremidade reveladas no presente documento também podem ser eficazmente empregadas juntamente com alojamentos portáteis (cabos) que contêm sistemas de disparo e fechamento "manualmente operáveis" (isto é, não alimentados por motor (ou motores)), como aqueles revelados na publicação de pedido de patente U.S. n° 2014/0263541. Por exemplo, a Figura 2 ilustra o atuador de extremidade 200 fixado a um conjunto de eixo de acionamento alongado 100' que é operacionalmente fixado a um alojamento 20' de um instrumento cirúrgico 10' que suporta operacionalmente os sistemas de disparo e fechamento manualmente operáveis.
[00170] Também será entendido que várias disposições reveladas na presente invenção podem ser eficazmente empregadas juntamente com sistemas cirúrgicos controlados roboticamente. Por exemplo, várias disposições reveladas na presente invenção podem ser empregadas com sistemas, instrumentos, componentes e métodos robóticos revelados no 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, aqui incorporada em sua totalidade, a título de referência. Por exemplo, a Figura 3 apresenta um instrumento cirúrgico 10" que é bem adaptado para uso com um sistema robótico como o sistema robótico 13 representado na Figura 4. O instrumento cirúrgico 10" inclui um atuador de extremidade 200 que é operacionalmente fixado a um conjunto de eixo de acionamento alongado 100" que é acoplado a um alojamento 20" na forma de um conjunto de acionamento de ferramenta. A Figura 4 ilustra um transportador de braço robótico 15 que é configurado para atuar uma pluralidade de ferramentas cirúrgicas como as ferramentas cirúrgicas 10". O transportador de braço robótico 15 e as ferramentas cirúrgicas 10" podem ser controlados por um controlador mestre 17 que é operacionalmente acoplado (diretamente ou sem fio) aos mesmos. Vários detalhes concernentes à operação de componentes de sistema robótico e a vários conjuntos de acionamento de ferramenta podem ser encontrados na publicação de pedido de patente US n° 2012/0298719, supracitada e incorporada, bem como na patente U.S. n° 6.132.368, intitulado MULTI-COMPONENT TELEPRESENCE SYSTEM AND METHOD, patente US n° 5.878.193, intitulada AUTOMATED ENDOSCOPE SYSTEM FOR OPTIMAL POSITIONING, patente U.S. n° 5.792.135, intitulada ARTICULATED SURGICAL INSTRUMENT FOR PERFORMING MINIMALLY INVASIVE SURGERY WITH ENHANCED DEXTERITY AND SENSITIVITY, patente U.S. n° 6.231.565, intitulado ROBOTIC ARM DLUS FOR PERFORMING SURGICAL TASKS, patente U.S. n° 6.783.524, intitulada ROBOTIC SURGICAL TOOL WITH ULTRASOUND CAUTERIZING AND CUTTING INSTRUMENT, na patente US n° 6.364.888, intitulada ALIGNMENT OF MASTER AND SLAVE IN A MINIMALLY INVASIVE SURGICAL APPARATUS, a patente U.S. n° 7.524.320, intitulada MECHANICAL ACTUATOR INTERFACE SYSTEM FOR ROBOTIC SURGICAL TOOLS, a patente U.S. n° 7.691.098, intitulada PLATFORM LINK WRIST MECHANISM, patente U.S. n° 7.806.891, intitulada REPOSITIONING AND REORIENTATION OF MASTER/SLAVE RELATIONSHIP IN MINIMALLY INVASIVE TELESURGERY e na patente US n° 7.824.401, intitulada SURGICAL TOOL WITH WRITED MONOPOLAR ELECTROSURGICAL END EFFECTORS, as descrições completas de cada uma das quais está aqui incorporada a título de referência na presente invenção.
[00171] Dessa forma, conforme usado no presente documento, o termo "alojamento" também pode abranger um alojamento ou porção similar de um sistema robótico que aloja ou sustenta, de outra forma, ao menos um sistema de acionamento configurado para gerar e aplicar ao menos um movimento de controle que possa ser usado para atuar os conjuntos de eixos de acionamento intercambiáveis descritos na presente invenção e seus respectivos equivalentes. O termo "armação" pode se referir a uma porção de um instrumento cirúrgico de mão, por exemplo, um "cabo". O termo "armação" também pode representar uma porção de um instrumento cirúrgico controlado roboticamente e/ou uma porção do sistema robótico que pode ser usada para controlar operacionalmente um instrumento cirúrgico.
[00172] Deve-se observar que termos espaciais como vertical, horizontal, direita, esquerda, etc, são fornecidos na presente invenção com referências às Figuras, assumindo-se que o eixo geométrico longitudinal ou de "acionamento" do instrumento cirúrgico 10 (ou dos outros exemplos de instrumentos cirúrgicos revelados no presente documento) é coaxial em relação ao eixo geométrico central do eixo de acionamento 100. Na prática efetiva, contudo, qualquer um dos instrumentos cirúrgicos revelados na presente invenção pode ser orientado em vários ângulos e, dessa forma, esses termos espaciais são usados em relação ao próprio instrumento cirúrgico. Adicionalmente, para um alojamento portátil, "proximal" é usado para denotar uma perspectiva de um médico que está atrás do cabo e que posiciona o atuador de extremidade distalmente ou distante de si. Como usado aqui, a frase "substancialmente transversal ao eixo geométrico longitudinal", em que o "eixo geométrico longitudinal" é o eixo geométrico do eixo de acionamento, se refere a uma direção que é quase perpendicular ao eixo geométrico longitudinal. Será entendido, entretanto, que as direções que desviam um pouco da perpendicular ao eixo geométrico longitudinal, também são substancialmente transversais ao eixo geométrico longitudinal.
[00173] Como pode ser visto na Figura 1, o atuador de extremidade 200 é conectado de forma pivotante ao eixo de acionamento 100 em junta de articulação 109. Uma variedade de juntas de articulação e de sistemas de controle é revelada em várias patentes e pedidos de patente que foram incorporados ao presente documento a título de referência. Outros sistemas de articulação e juntas de articulação são revelados na patente U.S. n° 7.753.245, intitulada SURGICAL STAPLING INSTRUMENTS e na patente US n° 7.670.334, intitulada SURGICAL INSTRUMENT HAVING AN ARTICULATING END EFFECTOR, as descrições completas das quais estão aqui incorporadas, por referência na presente invenção. Vários outros meios para articular o atuador de extremidade 200 são discutidos em mais detalhes abaixo.
[00174] Com relação às Figuras 5 e 6, o atuador de extremidade 200 inclui, entre outras coisas, um canal alongado 210 que é configurado para suportar operacionalmente um cartucho de grampos 230 no mesmo. O cartucho de grampos 230 inclui um corpo de cartucho 232 que tem uma fenda de cartucho alongada 234 disposta de forma centralizada no mesmo (Figura 6). Na disposição ilustrada, o cartucho de grampos 230 tem três fileiras 238 bolsos de grampo 236 em cada lado da fenda de cartucho alongada 234. Um ou mais grampos cirúrgicos 242 são suportados nos acionadores de grampo correspondentes 240 que são suportados de forma móvel nos bolsos de grampo 236. Uma bandeja de cartucho 215 é fixada à parte inferior do corpo do cartucho 232. A bandeja de cartucho 215 inclui uma fenda de bandeja 217 que está alinhada com a fenda do cartucho 234 e com uma fenda de canal 212 no canal alongado 210. Vide Figura 6.
[00175] O instrumento cirúrgico 10 inclui, ainda, um membro de disparo 300 que é fixado a um feixe de disparo 310 que realiza interface com um sistema de disparo que é suportado no alojamento 20, 20' ou 20''. O sistema de disparo pode ser acionado por um motor suportado no cabo 20 disposição (Figura 1) ou pode ser manualmente operado pela atuação de um gatilho de disparo 26' (Figura 2) ou pode ser acionado pelo sistema de disparo 13 (Figura 4). Em qualquer disposição aplicada, mediante a atuação, o sistema de disparo aplica um movimento de disparo axial ao feixe de disparo 310 para acionar o membro de disparo 300 na direção distal "DD". Como pode ser visto na Figura 6, o membro de disparo 300 inclui um corpo de membro de disparo que se estende verticalmente 302 que tem uma superfície ou lâmina de corte de tecido 304 no mesmo. Uma primeira aba do membro de disparo 306 se projeta de um primeiro lado lateral 305 do corpo de membro de disparo 302 e uma segunda aba de membro de disparo 308 se projeta de um segundo lado lateral 307 do corpo de membro de disparo 302. Além disso, uma primeira aba intermediária (não mostrado) se projeta do primeiro lado lateral 305 do corpo de membro de disparo 302 e uma segunda aba intermediária 309 se projeta do segundo lado lateral 307 do corpo do membro de disparo 302. O membro de disparo 300 inclui, adicionalmente, um pé ou uma aba 312 que se projeta lateralmente do fundo do corpo do membro de disparo 302. O propósito das abas 306, 308, 309 e do pé 312 será discutido em mais detalhes abaixo. Além disso, um deslizador de cunha 320 pode ser montado no interior do corpo do cartucho 232 para entrar em contato de acionamento com o membro de disparo 300. Conforme o membro de disparo 300 é acionado distalmente através do corpo de cartucho 232, as superfícies de cunha 322 entram em contato com os acionadores de grampo 240 e com os grampos cirúrgicos 242 suportados no mesmo para cima no corpo de cartucho 232.
[00176] O atuador de extremidade 200 inclui, adicionalmente, uma bigorna 250 que inclui um corpo de bigorna 252 que tem uma superfície inferior de formação de grampo 254 na mesma. A bigorna 250 inclui também uma porção de montagem de bigorna 260 para acoplar de forma pivotante a bigorna 250 à porção de extremidade proximal 211 do canal alongado 210 para deslocamento pivotante em relação à mesma ao redor de um eixo geométrico de bigorna imóvel A- A. Particularmente, conforme pode ser mais bem observado nas Figuras 6 e 10, a porção de montagem de bigorna 260 na disposição ilustrada compreende um primeiro braço de bigorna que se projeta proximalmente 262 que inclui um primeiro munhão de bigorna 264 que se estende para dentro. A porção de montagem de bigorna ilustrada 260 compreende, adicionalmente, um segundo braço de bigorna que se projeta proximalmente 266 que é espaçado em relação ao primeiro braço de bigorna 262. Um segundo munhão de bigorna 268 se projeta para dentro a partir do segundo braço de bigorna 266. O primeiro munhão de bigorna 264 é suportado de forma giratória em um primeiro orifício de munhão 214 que é fornecido na porção de extremidade proximal 211 do canal alongado 210 (Figura 8) e o segundo munhão de bigorna 268 é recebido de forma giratória em um segundo orifício de munhão 216 (Figuras 3, 7, 8 e 9) na porção de extremidade proximal 211 do canal alongado 210. O primeiro e o segundo orifícios de munhão 214, 216 servem para definir o eixo geométrico de bigorna imóvel A-A que é transversal ao eixo geométrico de eixo de acionamento longitudinal SA-SA. Quando o primeiro munhão de bigorna 264 é recebida de forma giratória no primeiro orifício de munhão 214 e o segundo munhão de bigorna 268 é recebido no segundo orifício de munhão de bigorna 216, a bigorna 250 é móvel em relação ao canal alongado 210 de modo que a extremidade distal 253 da bigorna 250 possa ser movida seletivamente em direção e para longe do canal alongado 210.
[00177] Com referência às Figuras 3, 10 e 11, a porção de montagem da bigorna 260 inclui uma porção de rampa de fechamento 270. A porção de rampa de fechamento 270 inclui um primeiro segmento de rampa 272 e um segundo segmento de rampa 274 que é espaçado em relação ao primeiro segmento de rampa 272 para formar uma abertura intermediária de membro de disparo 280 entre os mesmos. Vide Figuras 10, 12 e 13. Como pode ser visto na Figura 12, a porção de topo do membro de disparo 300 pode se estender para dentro da abertura intermediária 280 quando a bigorna 250 estiver em uma posição aberta e o membro de disparo 300 estiver em uma posição inicial não disparada. Quando a bigorna 250 estiver fechada, conforme mostrado na Figura 13, o topo do membro de disparo 300 se estende através da abertura intermediária 280. Com referência à Figura 10, uma fenda de bigorna alongada 290 é fornecida na superfície inferior de formação de grampo 254 da bigorna 250. Além disso, uma primeira saliência de fechamento 292 e uma segunda saliência de fechamento 294 são formadas nos lados laterais da fenda de bigorna 290. Uma primeira rampa de saliência de fechamento 273 é fornecida na porção de rampa de fechamento 270 e conduz para a primeira saliência de fechamento 292, e uma segunda rampa de saliência de fechamento 275 é fornecida na porção de rampa de fechamento 270 e conduz para a segunda saliência de fechamento 294.
[00178] A bigorna 250 é movida para uma posição aberta (Figura 12) por uma mola (não mostrada) que inclina a porção de montagem de bigorna 260 para cima em relação à extremidade proximal 211 do canal alongado 210, de modo que a superfície inferior de formação de grampo 254 da bigorna 250 seja espaçada em relação ao cartucho de grampos cirúrgicos 230. A extremidade distal 253 da bigorna 250 é movida em direção ao cartucho de grampos cirúrgicos 230 para posições fechadas em relação aos mesmos mediante a atuação de um sistema de fechamento que avança axial e distalmente um membro de fechamento 110 em contato com a porção de rampa de fechamento 270. Na modalidade ilustrada, por exemplo, o membro de fechamento 110 compreende um conjunto de tubo de fechamento 120 que é móvel axialmente em resposta a movimentos de fechamento gerados pelo sistema de fechamento suportado no alojamento. O sistema de fechamento pode ser acionado por uma disposição de motor suportada no cabo 20 ou pode ser operado manualmente através da atuação de um acionador de fechamento 28 (Figura 1) ou 28' (Figura 2) ou pode ser acionado pelo sistema robótico 13 (Figura 4). Em qualquer disposição empregada, a atuação do sistema de fechamento faz com que um movimento de fechamento axial seja aplicado ao conjunto de tubo de fechamento 120 do conjunto de eixo de acionamento 100. A Figura 12 ilustra a posição do conjunto de tubo de fechamento 120 antes da atuação do sistema de fechamento. À medida que o conjunto de tubo de fechamento 120 é acionado na direção distal, "DD", a extremidade distal 122 do conjunto de tubo de fechamento 120 entra em contato com a porção de rampa de fechamento 270 porção de montagem de bigorna 260 e gira a bigorna 250 de modo que a extremidade distal 253 da mesma se mova em direção ao cartucho de grampos cirúrgicos 230. A Figura 13 ilustra a posição do conjunto de tubo de fechamento 120 em uma posição "completamente fechada". Uma vez que a bigorna 250 é movida para a posição completamente fechada, o sistema de disparo pode ser atuado para acionar axialmente o membro de disparo 300 da posição inicial ou não acionada, mostrada nas Figuras 12 e 13, distalmente através do cartucho de grampos 230 para cortar o tecido preso entre a superfície inferior de formação de grampo 254 da bigorna 250 e o cartucho de grampos 230. Conforme o membro de disparo 300 se move distalmente, a primeira aba 306 se move a primeira rampa de fechamento 273 sobre a primeira saliência de fechamento 292 e a segunda aba 308 move a segunda rampa de fechamento 275 sobre a segunda saliência de fechamento 294 na bigorna 250. As abas intermediárias 309 deslizam sobre a superfície superior do canal alongado 210 e o pé 312 se desloca sobre a superfície de fundo 223 do canal alongado 210. A primeira e a segunda abas 306, 308, na primeira e na segunda saliências de fechamento 292, 294, bem como as abas intermediárias 309 e o pé 312 servem para espaçar superfície inferior de formação de grampo 254 da bigorna 250 em uma distância "S" desejada em relação à superfície superior da plataforma de cartucho do cartucho de grampos cirúrgicos. Vide Figura 13.
[00179] Como pode ser visto na Figura 5, no exemplo ilustrado, o atuador de extremidade 200 é seletivamente articulável sobre um eixo geométrico de articulação B-B, que é transversal ao eixo geométrico de eixo de acionamento SA-SA que é definido pelo conjunto de eixo de acionamento alongado 100. Na disposição ilustrada, o conjunto de tubo de fechamento 120 inclui um segmento de eixo de acionamento de tubo de fechamento 123 que se estende para o alojamento 20, 20', 20'' e realiza interface operacionalmente com o sistema de fechamento suportado no mesmo. O segmento de tubo de fechamento proximal 123 é acoplado de modo pivotante a um segmento de tubo de fechamento distal 130. Como pode ser visto na Figura 6, por exemplo, o segmento de tubo de fechamento proximal 123 inclui abas inferior e superior que se projetam distalmente 124, 126. O segmento de tubo de fechamento distal 130 inclui abas superior e inferior que se projetam proximalmente 132, 134. Uma conexão superior articulada dupla 140 inclui pinos pivotantes distal e proximal que se projetam para cima 142, 144, que se engatam, respectivamente, a um furo de pino superior distal 133 na aba superior de projeção proximal 132 e a um furo de pino superior proximal 125 na aba superior de projeção distal 124. Um enlace pivotante duplo inferior 150 inclui pinos pivotantes distais e proximais que se projetam para baixo 152, 154, que se engatam, respectivamente, a um orifício de pino distal inferior (não mostrado) na aba que se projeta proximalmente 134 e ao orifício de pino 127 na aba que se projeta distalmente 126.
[00180] Na disposição ilustrada, bem como nas disposições alternativas, o conjunto de eixo de acionamento alongado 100 ainda inclui um conjunto de armação ou conjunto dorsal ou conjunto de restrição em geral designado como 159. Em uma disposição, por exemplo, o conjunto de armação 159 inclui uma porção de armação proximal 160 e uma porção de armação distal 170. A porção de armação proximal 160 é configurada para suportar o feixe de disparo 310 de modo móvel no mesmo e se estende de volta ao alojamento 20, 20 ', 20" em qualquer caso. A extremidade proximal (não mostrada) da porção de armação proximal 160 pode fazer interface operacionalmente com um sistema de controle correspondente que pode facilitar a rotação do conjunto de armação 159 (e do atuador de extremidade 200 acoplado ao mesmo) em torno do eixo geométrico do eixo de acionamento SA-SA. Outros detalhes referentes à construção e operação de tais sistemas de controle podem ser encontrados em várias referências que foram incorporadas ao presente documento a título de referência. Como pode ser visto na Figura 6, a porção de armação distal 170 inclui um pino pivotante 172 que é recebido de forma giratória dentro de uma abertura pivotante 220 definida na extremidade proximal 211 do canal alongado 210. A abertura pivotante 220 define o eixo geométrico de articulação B-B em torno do qual o pino pivotante 172 pode girar. Em outras palavras, o canal alongado pode 210 pode girar em torno do pino pivotante 172 e em torno do eixo geométrico de articulação B-B quando um movimento de articulação for aplicado ao canal alongado 210. Ainda com referência à Figura 6, a extremidade proximal 211 do canal alongado 210 inclui um pino de acionamento 222 que é configurado para ser engatado de maneira funcional a um acionador de articulação. O pino de acionamento 222 é configurado para receber uma força aplicada ao mesmo pelo sistema de acionamento de articulação 500 e, dependendo da direção em que a força é aplicada no pino de acionamento 222, faz com que o atuador de extremidade 200 se articule em uma primeira direção "FD" ou em uma segunda direção oposta "SD".
[00181] O sistema de acionador de articulação ilustrado 500 pode ser similar ao sistema de acionador de articulação revelado na publicação de pedido de patente U.S. n° 2014/0263541 que foi aqui incorporado em sua totalidade a título de referência. Em uma forma, por exemplo, o sistema de acionador de acionador de articulação 500 inclui um acionador de articulação proximal 510 e um acionador de articulação distal 520. Vide Figura 6. Conforme discutido na referência incorporada acima, o acionador de articulação proximal 510 é suportado para deslocamento axial seletivo nas direções distal e proximal em resposta a movimentos de controle de articulação aplicados ao mesmo por um sistema de controle de articulação. O controle de articulação pode, por exemplo, ser operacionalmente suportado no alojamento 20, 20 ', 20" em qualquer caso. Quando um movimento de acionamento ou articulação é transmitido ao acionador de articulação proximal 510, seja na direção proximal ou na direção distal, a força de acionamento pode ser transmitida para o acionador de articulação distal 520 através de uma trava de articulação 550, conforme descrito em detalhes na referência incorporada acima. Detalhes adicionais em relação à operação da trava de articulação distal 550 podem ser obtidos a partir da revisão dessa referência e, por uma questão de brevidade, não serão repetidos neste documento.
[00182] Conforme discutido em mais detalhes na referência incorporada anteriormente mencionada, o movimento do acionador de articulação proximal 510, seja proximal ou distal, pode destravar a trava de articulação 550 que é suportada operacionalmente no acionador de articulação distal e na porção de armação distal 170. Na disposição representada na Figura 6, por exemplo, o acionador de articulação distal 520 inclui uma porção que se estende distalmente 522 que está acoplada de modo pivotante a um enlace intermediário 524 para deslocamento pivotante relativo em torno de um eixo geométrico intermediário IA-IA. Vide Figura 6. Embora não mostrado especificamente na Figura 6, a porção que se projeta distalmente 522 inclui um pino proximal que se estende para baixo que é recebido de forma pivotante em um orifício de pivô proximal no enlace intermediário 524. A extremidade distal do enlace intermediário 524 inclui um orifício de pivô distal 526 para o recebimento do pino de acionamento 222 no mesmo. A atuação do acionador de articulação proximal 510 irá eventualmente resultar na articulação do canal alongado 210 através do acionador de articulação distal e da trava de articulação 550. Por exemplo, um movimento proximal inicial do acionador de articulação proximal 510 pode destravar o movimento proximal do acionador de articulação distal 520 e da trava de articulação 550, ao passo que um movimento proximal adicional do acionador de articulação proximal 510 pode acionar o acionador de articulação distal 520 e a trava de articulação 550 proximalmente. De modo semelhante, um movimento distal inicial do acionador de articulação proximal 510 pode destravar o movimento distal do acionador de articulação distal 520 e a trava de articulação 550, ao passo que um movimento distal adicional do acionador de articulação proximal 510 pode acionar o acionador de articulação distal 520 e a trava de articulação 550 em sentido distal.
[00183] Ainda com referência à Figura 6, por exemplo, o feixe de disparo 310 pode compreender uma estrutura laminada. Essa disposição permite que o feixe de disparo 310 se flexione suficientemente quando o atuador de extremidade 200 for articulado em torno do eixo geométrico de articulação B-B. O feixe de disparo 310 é suportado de modo deslizante em uma fenda de barra de disparo 162 na porção de armação proximal 160. A porção de extremidade distal 164 da porção de armação proximal 160 é formada por duas superfícies opostas arredondadas 166, 168 para fornecer suporte lateral adicional ao feixe de disparo 310 durante a articulação.
[00184] Os atuadores de extremidade que empregam feixes de disparo ou membros de disparo que têm a capacidade de se articular ao longo de uma faixa de, por exemplo, quarenta e cinco degraus têm numerosos desafios a serem superados. Para facilitar a articulação operacional desses atuadores de extremidade, o membro de disparo ou o feixe de disparo precisam ser suficientemente flexíveis para acomodar essa faixa de articulação. Entretanto, o feixe de disparo ou o membro de disparo também precisam evitar a deformação quando encontram as cargas compressivas de disparo. Para fornecer suporte adicional ao feixe de disparo ou ao membro de disparo, várias disposições de placa de "suporte" ou "erupção" foram desenvolvidas. Várias dessas disposições são apresentados nas patentes U.S. n° 6.964.363, intitulada SURGICAL STAPLING INSTRUMENT HAVING ARTICULATION JOINT SUPPORT PLATES FOR SUPPORTING A FIRING BAR e na patente US n° 7.213.736, intitulada instrumento de SURGICAL STAPLING INSTRUMENT INCORPORATING AN ELECTROACTIVE POLYMER ACTUATED FIRING BAR TRACK THROUGH AN ARTICULATION JOINT, das quais a totalidade das descrições está aqui incorporada a título de referência. As placas de erupção que forneçam resistência substancial à deformação são difíceis de serem flexionados em geral, o que é adicionado às forças que o sistema de junta de articulação precisa acomodar.
[00185] As Figuras 14 e 15 ilustram um conjunto de suporte de feixe de disparo de 600 sob a forma de um conjunto de orientação de feixe de disparo 601 que é empregado no instrumento cirúrgico ilustrado 10. Conforme pode ser visto nessas Figuras, assim como na Figura 6, o conjunto de orientação de feixe de disparo 601 inclui uma extremidade proximal 602 e uma extremidade distal 604 que são interconectadas pelos membros de suporte de feixe de disparo 606, 608 que são separados por uma fenda de feixe de disparo 610 que se estende através das extremidades proximal e distal 602, 604. Em uma vista plana, o conjunto de orientação de feixe de disparo 601 se assemelha a uma disposição de "feixe i" com uma fenda que se estende através da manta central do feixe. Como pode ser visto na Figura 15, por exemplo, o membro de suporte de feixe de disparo 606 é "semelhante a placa" ou compreende uma placa que inclui um lábio superior que se estende para dentro 607 e o membro de suporte de feixe de disparo 608 é "semelhante a placa" ou compreende uma placa que inclui um lábio superior que se estende para dentro 609. Os lábios superiores 607, 609 fornecem alguma resistência à flexão aos membros de suporte de feixe de disparo 606, 608 e podem servir para impedir que o membro de disparo 310 saia do topo do conjunto de orientação de feixe de disparo 601 durante a flexão do feixe de disparo 310. O conjunto de orientação de feixe de disparo 601 pode ser fabricado, por exemplo, a partir de fibra de vidro ISOPLAST®, nylon, vidro preenchido com VECTRA®, e pode ser de construção integral. Em outras disposições, os membros de suporte de feixe de disparo 606, 608 podem compreender componentes que são diferentes das extremidades proximal e distal e são fixados às mesmas por meio de técnicas de fixação apropriadas como sobreposição por soldagem, etc.
[00186] Como pode ser visto na Figura 6, a extremidade proximal 602 do conjunto de orientação de feixe de disparo 601 é recebido em uma cavidade de feixe proximal 169 formada porção de extremidade distal 164 da porção de armação proximal 160. A extremidade distal 604 do conjunto de orientação de feixe de disparo 601 é recebida em uma cavidade de barra distal 224 formada em um pino de suporte vertical 1700 formado na extremidade proximal 211 do canal alongado 210. Para facilitar um movimento axial do conjunto de orientação de feixe de disparo 601 durante a articulação do atuador de extremidade 200, a cavidade de feixe proximal 169 é dimensionada em relação à porção de extremidade proximal 602 do conjunto de suporte de feixe de disparo 600 para permitir algum movimento axial da porção de extremidade proximal 602 na mesma. Similarmente, a cavidade de feixe distal 224 pode ser dimensionada em relação à porção de extremidade distal 604 do conjunto de orientação de feixe de disparo 601 para facilitar o movimento axial do conjunto de orientação de feixe de disparo 601 em relação ao canal alongado 210 durante a articulação dos mesmos. A Figura 17 ilustra o atuador de extremidade 200 em uma posição não articulada, em que o atuador de extremidade 200 é essencialmente coaxial com o conjunto de eixo de acionamento 100. Essa posição do atuador de extremidade permite que o atuador de extremidade 200 e uma porção do conjunto de eixo de acionamento alongado 100 sejam inseridos no paciente através de um trocarte, por exemplo. As Figuras 18 e 19 ilustram o atuador de extremidade 200 articulado em uma primeira direção "FD" e as Figuras 20 e 21 ilustram o atuador de extremidade 200 em uma segunda direção oposta "SD".
[00187] Os atuadores de extremidade tais como aqueles revelados no presente documento, assim como aqueles atuadores de extremidade revelados na publicação de pedido de patente U.S. n°. 2014/0263541 incorporada anteriormente são frequentemente empregados durante a realização de uma ressecção anterior inferior do cólon ("LAR"). LAR é uma cirurgia comum para câncer retal e é ocasionalmente realizada para remover uma porção doente ou rompida do intestino em casos de diverticulite. A capacidade de acessar a porção-alvo (ou porções-alvo) do cólon com esses atuadores de extremidade durante uma LAR pode ser efetuada pelos seguintes fatores: (i) o ângulo de articulação do eixo de acionamento, (ii) a distância do pivô ou do eixo geométrico de articulação e os grampos mais proximais (às vezes denominada de "zona morta proximal"), (iii) a distância entre os grampos mais distais e a extremidade distal do atuador de extremidade (às vezes denominada de "zona morta distal"), e (iv) o diâmetro do eixo de acionamento. A Figura 22 compara a faixa de movimento dentro de um contorno da pelve de um atuador de extremidade 200, conforme revelado na presente invenção, à faixa de movimento de um atuador de extremidade 200' do tipo que inclui uma bigorna que é acoplada de forma pivotante ao canal alongado por uma disposição de fenda em formato de rim, conforme revelado na publicação de pedido de patente U.S. n° 2014/0263541 incorporada acima. Em uma disposição de atuador de extremidade 200', por exemplo, a zona morta proximal PDZ" tem aproximadamente 3,91 centímetros (1,54 polegadas) de comprimento. Por outro lado, a zona morta proximal PDZ que pode ser obtida juntamente com pelo menos uma implantação do atuador de extremidade 200, conforme descrito na presente invenção, pode ser reduzida em, por exemplo, 0,813 centímetros (0,320 polegadas). Vide Figura 23. Portanto, PDZ < PDZ '. Conforme pode ser visto naquela Figura, a distância da extremidade distal 201 do atuador de extremidade em relação ao eixo geométrico de articulação A-A ou ponto de pivô é menor que a distância da extremidade distal 201' do atuador de extremidade 200' em relação ao eixo geométrico de articulação B-B ou ponto de pivô por uma quantidade de aproximadamente 2,3 centímetros (0,9 polegadas) (comprimento "L" na Figura 23) em pelo menos uma implantação, por exemplo. Dessa forma, a manipulabilidade do atuador de extremidade 200 apresenta um vasto aprimoramento da manipulabilidade de disposições de atuadores de extremidade anteriores. Além disso, o atuador de extremidade 200 experimenta um aumento sensível de vantagem mecânica (por exemplo, um aumento de até 300% em alguns casos) movendo-se o eixo geométrico de pivô ou de articulação de maneira mais proximal e o membro de fechamento ou fulcro de forma mais distal. Tal aprimoramento de acesso permite, por exemplo, que um endocortador de 60 mm chegue ao cólon em quase 90 graus, criando uma transeção perpendicular significativamente melhor, que pode minimizar os efeitos do disparo de grampeador circular subsequente e, assim, reduzir a probabilidade de vazamentos. A redução da distância da junta de articulação em relação ao primeiro grampo ou ao grampo mais proximal permite que o endocortador seja girado mais em relação à cintura pélvica, aumentando sua eficácia de ângulo de acesso em relação ao cólon para LARs "profundas". O movimento adicional da arquitetura de canal de came para tubo de came aprimora a vantagem mecânica do sistema e, assim, reduz as cargas retransmitidas ao cabo ou ao alojamento e aumenta a robustez do instrumento.
[00188] As Figuras 24 a 31 ilustram outro instrumento cirúrgico 1010 que inclui um atuador de extremidade 1200 que está fixado operacionalmente a um conjunto de eixo de acionamento alongado 1100. O conjunto de eixo de acionamento alongado 1100 pode ser acoplado operacionalmente a qualquer um dos alojamentos 20, 20 ', 20", conforme discutido acima. O atuador de extremidade 1200 é conectado de maneira pivotante ao eixo de acionamento alongado 1100 na junta de articulação 1109. O atuador de extremidade 1200, inclui, entre outras coisas, um canal alongado 1210 que é configurado para suportar operacionalmente um cartucho de grampos 1230 no mesmo. Vide Figura 25. O cartucho de grampos 1230 inclui um corpo de cartucho 1232 que tem uma fenda de cartucho alongada 1234 disposta de maneira centralizada no mesmo. Na disposição ilustrada, o cartucho de grampos 1230 tem três fileiras 1238 de bolsos de grampos 1236 em cada lado da fenda alongada 1234. Um ou mais grampos 1242 são suportados em acionadores de grampo correspondentes 1240 que são suportados de modo móvel nos bolsos de grampo 1236. Uma bandeja de cartucho 1215 é fixada à parte inferior do corpo do cartucho 1232. A bandeja de cartucho 1215 inclui uma fenda de bandeja 1217 que está alinhada com a fenda do cartucho 1234 e com uma fenda de canal 1212 no canal alongado 1210.
[00189] O instrumento cirúrgico 1010 ainda inclui um membro de disparo 1300 que é fixado a um feixe de disparo 1310 que realiza interface com um sistema de disparo suportado no alojamento 20, 20 ' ou 20". O sistema de disparo pode ser acionado por uma disposição de motor suportada no cabo 20 (Figura 1) ou pode ser manualmente operado pela atuação de um gatilho de disparo 26' (Figura 2) ou pode ser acionado pelo sistema robótico 13 (Figura 4). Em qualquer disposição aplicada, mediante a atuação, o sistema de disparo aplica um movimento de disparo axial ao feixe de disparo 1310 para acionar o membro de disparo 1300 na direção distal "DD". Como pode ser visto na Figura 25, o membro de disparo 1300 inclui um corpo de membro de disparo que se estende verticalmente 1302 que tem uma superfície ou lâmina de corte de tecido 1304 no mesmo. Uma primeira aba do membro de disparo 1306 se projeta de um primeiro lado lateral 1305 do corpo de membro de disparo 1302 e uma segunda aba de membro de disparo 1308 se projeta de um segundo lado lateral 1307 do corpo de membro de disparo 1302. Além disso, uma primeira aba intermediária (não mostrado) se projeta do primeiro lado lateral 1305 do corpo de membro de disparo 1302 e uma segunda aba intermediária 1309 se projeta do segundo lado lateral 1307 do corpo de membro de disparo 1302. O membro de disparo 1300 inclui, adicionalmente, um pé ou uma aba 1312 que se projeta lateralmente do fundo do corpo do membro de disparo 1302. O propósito das abas 1306, 1308, 1309 e do pé 1312 será discutido em mais detalhes abaixo. Além disso, um deslizador de cunha 1320 pode ser montado no interior do corpo do cartucho 1232 para entrar em contato de acionamento com o membro de disparo 1300. Conforme o membro de disparo 1300 é acionado distalmente através do corpo de cartucho 1232, as superfícies de cunha 1322 entram em contato com os acionadores de grampo 1240 para acionar os acionadores 1240 e os grampos cirúrgicos 1242 suportados no mesmo para cima no corpo do cartucho 1232, como é conhecido.
[00190] O atuador de extremidade 1200 inclui, adicionalmente, uma bigorna 1250 que inclui um corpo de bigorna 1252 que tem uma superfície inferior de formação de grampo 1254 na mesma. A bigorna 1250 também inclui uma porção de montagem de bigorna 1260 para acoplar de modo pivotante a bigorna 1250 à porção de extremidade proximal 1211 do canal alongado 1210 para deslocamento pivotante em relação ao mesmo. A porção de montagem de bigorna 1260 inclui dois (somente um pode ser visto nas Figuras 25 a 28) munhões de bigorna que se estendem lateralmente 1264. Os munhões de bigorna 1264 são recebidos de modo móvel nas fendas em formato de rim 1214 correspondentes que são fornecidas na porção de extremidade proximal 1211 do canal alongado 1210. Essa disposição permite que a bigorna 1250 gire em relação ao canal alongado 1210 mediante a aplicação de movimentos de abertura e fechamento à porção de montagem de bigorna 1260. A porção de montagem de bigorna 1260 inclui uma aba de bigorna vertical 1263 que interage operacionalmente com uma abertura em formato de ferradura 1131 fornecida em um membro de fechamento 1110.
[00191] No exemplo ilustrado, o membro de fechamento 1110 compreende um conjunto de tubo de fechamento 1120 que inclui um segmento de tubo de fechamento distal 1130 no qual a abertura 1131 é fornecida. O conjunto de tubo de fechamento 1120 inclui um segmento de eixo de acionamento de tubo de fechamento 1122 que se estende para o alojamento 20, 20 ', 20" e realiza interface operacionalmente com o sistema de fechamento suportado no mesmo. O segmento de tubo de fechamento proximal 1123 é acoplado de modo pivotante ao segmento de tubo fechamento distal 1130. Como pode ser visto na Figura 25, por exemplo, o segmento de tubo de fechamento proximal 1123 inclui abas inferiores e superiores que se projetam distalmente 1124, 1126. O segmento de tubo de fechamento distal 1130 inclui abas superiores e inferiores que se projetam proximalmente 1132, 1134. Uma conexão superior articulada dupla 1140 inclui pinos pivotantes distal e proximal que se projetam para cima 1142, 1144, que se engatam, respectivamente, a um furo de pino superior distal 1133 na aba superior de projeção proximal 1132 e a um furo de pino superior proximal 1125 na aba superior de projeção distal 1124. Um enlace pivotante duplo inferior 1150 inclui pinos pivotantes distais e proximais que se projetam para baixo 1152, 1154, que se engatam, respectivamente, a um orifício de pino distal inferior (não mostrado) na aba que se projeta proximalmente 1134 e ao orifício de pino 1127 na aba que se projeta distalmente 1126. O movimento do tubo de fechamento distal 1130 na direção distal "DD" fará com que a bigorna 1250 gire para uma posição fechada em relação ao cartucho de grampos cirúrgicos 1230 em virtude da interação entre a abertura 1131 no tubo de fechamento distal 1130 e a aba de bigorna 1263, e o movimento do tubo de fechamento distal 1130 na direção proximal "PD" gira a bigorna 1250 para uma posição aberta em virtude da aba central 1137 no segmento do tubo de fechamento distal 1130. O movimento do segmento de tubo de fechamento distal 1130 é controlado por um sistema de fechamento que pode ser acionado por uma disposição de motor suportada no cabo 20 ou pode ser operado manualmente mediante a atuação de um gatilho de fechamento 28' (Figura 2) ou pode ser acionado pelo sistema robótico 13 (Figura 4).
[00192] A bigorna 1250 pode ter ainda uma fenda de bigorna e saliências de fechamento, conforme discutido acima em relação à bigorna 250, para interação com as abas 1306, 1308, conforme também foi descrito acima em detalhes. Uma vez que a bigorna 1250 é movida para a posição completamente fechada, o sistema de disparo pode ser atuado para acionar axialmente o membro de disparo 1300 da posição não atuada ou posição inicial distalmente através do cartucho de grampos 1230 para cortar o tecido preso entre a superfície inferior de formação de grampo 1254 da bigorna 1250 e o cartucho de grampos 1230. À medida que o membro de disparo 1300 é movido distalmente, a primeira aba 1306 se engata de modo móvel à primeira saliência de fechamento, e a segunda aba 1308 se engata de modo móvel à segunda saliência de fechamento na bigorna 1250. As abas intermediárias 1309 deslizam sobre a superfície superior do canal alongado 1210 e o pé 1312 se desloca sobre a superfície de fundo 1223 do canal alongado 1210. A primeira e a segunda abas 1306, 1308, na primeira e na segunda saliências de fechamento, assim como as abas intermediárias 1309 e o pé 1312, servem para espaçar a superfície inferior de formação de grampo 1254 da bigorna 1250 em uma distância desejada em relação à superfície superior ou plataforma de cartucho do cartucho de grampos cirúrgicos 1230.
[00193] Como pode ser visto nas Figuras 24 a 26, no exemplo ilustrado, o atuador de extremidade 1200 é seletivamente articulável sobre um eixo geométrico de articulação B-B, que é transversal ao eixo geométrico de eixo de acionamento SA-SA que é definido pelo conjunto de eixo de acionamento alongado 1100. Na disposição ilustrada, o conjunto de eixo de acionamento alongado 1100 inclui adicionalmente um conjunto de armação ou conjunto dorsal ou conjunto de retenção em geral designado por 1159. Em uma disposição, por exemplo, o conjunto de armação 1159 inclui uma porção de armação proximal 1160 e uma porção de armação distal 1170. A porção de armação proximal 1160 é configurada para suportar o feixe de disparo 1310 de modo móvel no mesmo e se estende de volta ao alojamento 20, 20 ', 20" em qualquer caso. A extremidade proximal (não mostrada) da porção de armação proximal 1160 pode fazer interface operacionalmente com um sistema de controle correspondente que pode facilitar a rotação do conjunto de armação 1159 (e do atuador de extremidade 1200 acoplado ao mesmo) em torno do eixo geométrico do eixo de acionamento SA-SA. Outros detalhes referentes à construção e operação de tais sistemas de controle podem ser encontrados em várias referências que foram incorporadas ao presente documento a título de referência.
[00194] Como pode ser visto na Figura 25, a porção de armação distal 1170 inclui um pino pivotante 1172 que é recebido de forma giratória dentro de uma abertura pivotante 1220 definida na extremidade proximal 211 do canal alongado 1210. A abertura pivotante 1120 define o eixo geométrico de articulação B-B em torno do qual o pino pivotante 1172 pode girar. Em outras palavras, o canal alongado pode 1210 pode girar em torno do pino pivotante 1172 e em torno do eixo geométrico de articulação B-B quando um movimento de articulação for aplicado ao canal alongado 210. Ainda com referência à Figura 25, a extremidade proximal 1211 do canal alongado 1210 inclui um pino de acionamento 1222 que é configurado para ser engatado de maneira funcional a um acionador de articulação. O pino de acionamento 1222 é configurado para receber uma força aplicada ao mesmo por um sistema de acionador de articulação 1500 e, dependendo da direção em que a força é aplicada ao pino de acionamento 1222, faz com que o atuador de extremidade 1200 se articule em uma primeira direção ou em uma segunda direção oposta em torno de um eixo geométrico de articulação B-B.
[00195] O sistema de acionador de articulação 1500 ilustrado pode ser similar ao sistema de acionador de articulação revelado na publicação de pedido de patente U.S. n° 2014/0263541, que foi aqui incorporada, a título de referência, em sua totalidade. Em uma forma, por exemplo, o sistema de acionador de acionador de articulação 1500 inclui um acionador de articulação proximal 1510 e um acionador de articulação distal 1520. Conforme discutido na referência incorporada acima, o acionador de articulação proximal 1510 é suportado para deslocamento axial seletivo nas direções distal e proximal em resposta a movimentos de controle de articulação aplicados ao mesmo por um sistema de controle de articulação. O controle de articulação pode, por exemplo, ser operacionalmente suportado no alojamento 20, 20', 20" em qualquer caso. Quando um movimento de acionamento ou articulação é transmitido ao acionador de articulação proximal 1510, seja na direção proximal ou na direção distal, a força de acionamento pode ser transmitida para o acionador de articulação distal 1520 através de uma trava de articulação 1550, conforme descrito em detalhes na referência incorporada acima. Detalhes adicionais em relação à operação da trava de articulação distal 1550 podem ser obtidos a partir da revisão dessa referência e, por uma questão de brevidade, não serão repetidos neste documento.
[00196] Conforme discutido em mais detalhes na referência incorporada anteriormente mencionada, o movimento do acionador de articulação proximal 1510, seja proximal ou distal, pode destravar a trava de articulação 1550 que é suportada operacionalmente no acionador de articulação distal e na porção de armação distal 1170. Na disposição representada na Figura 25, por exemplo, um enlace intermediário 1524 está acoplado de modo pivotante ao acionador de articulação distal 1520 para deslocamento pivotante relativo em torno de um eixo geométrico intermediário IA-IA. Como pode ser visto na Figura 25, um pino de pivô 1523 é formado no acionador de articulação distal 1520 e se estende em um orifício de pivô proximal 1525 no enlace intermediário 1524. A extremidade distal do enlace intermediário 1524 inclui um orifício de pivô distal 1526 para o recebimento do pino de acionamento 1222 no mesmo. A atuação do acionador de articulação proximal 1510 irá eventualmente resultar na articulação do canal alongado 1210 através do acionador de articulação distal e da trava de articulação 1550. Por exemplo, um movimento proximal inicial do acionador de articulação proximal 1510 pode destravar o movimento proximal do acionador de articulação distal 1520 e da trava de articulação 1550, ao passo que um movimento proximal adicional do acionador de articulação proximal 1510 pode acionar o acionador de articulação distal 1520 e a trava de articulação 1550 proximalmente. De modo semelhante, um movimento distal inicial do acionador de articulação proximal 1510 pode destravar o movimento distal do acionador de articulação distal 1520 e a trava de articulação 1550, ao passo que um movimento distal adicional do acionador de articulação proximal 1510 pode acionar o acionador de articulação distal 1520 e a trava de articulação 1550 em sentido distal.
[00197] Em modalidades que empregam placas de erupção convencionais para fornecer suporte de deformação ao feixe de disparo, dependendo da trajetória de curvatura (devido à direção de articulação), apenas uma das placas de erupção pode fazer eficazmente qualquer trabalho. Dessa forma, pode ser vantajoso, em pelo menos algumas aplicações, amarrar ou acoplar as placas de erupção interna e externa (ou membros de suporte de feixe de disparo) uma à outra, o que pode permitir que as mesmas atuem como um par ao invés de independentemente entre si. Essa disposição pode, por exemplo, fornecer mais que o dobro do momento de inércia da placa externa sozinha, enquanto ainda minimiza a força total para flexão. Em algumas disposições, como será descrito em maiores detalhes abaixo, as placas de erupção (ou membros de suporte de feixe de disparo) são configuradas de modo que se movam longitudinalmente um em relação ao outro. Visto que nenhum dos membros está na linha central de flexão, por exemplo, um dos membros tem uma trajetória mais longa e o outro membro tem uma trajetória mais curta.
[00198] No exemplo ilustrado, o instrumento cirúrgico 1010 inclui adicionalmente um primeiro membro de suporte de feixe de disparo 1610 e um segundo membro de suporte de feixe de disparo 1620. O primeiro e o segundo membros de suporte de feixe de disparo 1610, 1620 podem compreender, cada um, uma placa que é fabricada a partir de, por exemplo, aço inoxidável, aço de mola, titânio, NITINOL™, etc. Conforme pode ser visto na Figura 25, o primeiro membro de suporte de feixe de disparo 1610 inclui aba proximal que se estende para baixo 1612 em uma aba distal que se estende para baixo 614. O segundo membro de suporte de feixe de disparo 1620 inclui abas proximal e distal que se estendem para baixo (não visíveis na Figura 25). Como pode ser visto na Figura 26, o feixe de disparo 1310 se estende de maneira deslizante entre o primeiro e o segundo membros de suporte de feixe de disparo 1610, 1620. As extremidades distais do primeiro e do segundo membros de suporte de feixe de disparo 1610, 1620 são recebidas de maneira deslizante dentro de uma fenda 1702 formada no pino de suporte vertical 1700 formado na extremidade proximal 1211 do canal alongado 1210. Figuras 27 e 30 ilustram a articulação do atuador de extremidade 1200 na primeira direção "FD". Como pode ser visto naquelas Figuras, o primeiro membro de suporte de feixe de disparo 1610 se move em posição levemente distal em relação ao segundo membro de suporte de feixe de disparo 1620 de modo a proporcionar suporte de flexão ao feixe de disparo durante a articulação 1310. As abas de montagem podem servir para limitar o grau de movimento axial dos membros de suporte, de feixe de disparo. As Figuras 28 e 31 ilustram a articulação do atuador de extremidade 1200 em uma segunda direção "SD". Conforme pode ser visto nessas Figuras, o segundo membro de suporte de feixe de disparo 1620 se move em posição levemente distal em relação ao primeiro membro de suporte de feixe de disparo 1610 para fornecer suporte de flexão ou deformação ao feixe de disparo durante a articulação 1310. Conforme ilustrado nas Figuras 30 e 31, essa disposição permite a articulação do atuador de extremidade 1200 através de faixas de aproximadamente setenta e cinco graus (75°) em ambos os lados do eixo geométrico de eixo de acionamento SA-SA. Em ao menos uma disposição, a fenda 1702 é dimensionada de modo a fornecer uma folga entre o membro de suporte de feixe de disparo 1610, 1620 e o feixe de disparo 1310 de aproximadamente 0,13 cm a 0,038 cm (0,05" a 0,015"), por exemplo, para facilitar o deslocamento deslizante dos membros de suporte de feixe de disparo 1610, 1620 dentro da fenda 1702 e o deslocamento deslizante do feixe de disparo 1310 durante o disparo do instrumento (isto é, avanço axial na direção distal do feixe de disparo 1310). Em uma disposição, por exemplo, a ranhura 1702 pode ter 0,13 cm a 0,165 cm (0,05" a 0,065") de largura ("W"), os membros de suporte de feixe de disparo 1610, 1620 podem, cada um, ter uma espessura de aproximadamente 0,020 cm a 0,038 cm (0,008" a 0,015") ("FBT") e o feixe de disparo 1310 pode ter uma espessura de aproximadamente 0,114 cm (0,045") ("BT"). Vide Figura 32. Como pode ser visto na Figura 33, a extremidade proximal 1704 da fenda 1702 se expande para fora a fim de facilitar a curvatura ou a flexão dos membros de suporte de feixe de disparo 1610, 1620 durante a articulação do atuador de extremidade 1200. A extremidade proximal 1704 da fenda 1702 tem uma largura de fenda proximal "PW" de aproximadamente 0,18 cm a 0,20 cm (0,07" a 0,08"), por exemplo. Outras larguras de fenda podem também ser empregadas. Desse modo, no exemplo ilustrado PT > PW. Será compreendido que os membros de suporte de feixe de disparo 1610 auxiliam a suportar o feixe de disparo 1310 durante a articulação do atuador de extremidade e servem para impedir que o feixe de disparo 1310 se deforme sob as cargas de disparo compressivas.
[00199] A Figura 34 ilustra uma porção de outro canal alongado 1210' que inclui um pino de suporte vertical 1700' com uma fenda 1702' no mesmo para receber de maneira deslizante o os membros de suporte de feixe de disparo 1610,1620 (não mostrado na Figura 34) da maneira acima descrita. Nessa disposição, entretanto, um par de protuberâncias ou detentores opostos 1706' é formado no pino de suporte 1700' de modo que a largura da extremidade proximal da fenda 1702 ("PW") seja menor que a largura da fenda 1702 ("W"), conforme mostrado. A saída distal de 1620 a partir de 1160 é, de preferência, mais apertada do que a fenda de retenção que detém a porção "L" do feixe. Esta "compressão" serve para fazer com que as placas de suporte se comportem como feixes em cantiléver em vez de juntas de pivô flutuantes e podem aumentar significativamente o suporte de feixe de disparo que a placa fornece ao eixo de disparo. Por exemplo, comparando a disposição em cantiléver a uma disposição de "pivotante" (encaixe frouxo), espera-se que a disposição em cantiléver forneça uma resistência 4x - 16x melhor, o que resulta em uma deflexão muito menor da placa de suporte logo no início.
[00200] Com referência agora às Figuras 35 a 37, o instrumento cirúrgico 1010’ ali mostrado é substancialmente idêntico ao instrumento cirúrgico 1010 descrito em detalhe acima e emprega os membros de suporte de feixe de disparo 1610' e 1620' para fornecer suporte ao feixe de disparo 1310 durante a articulação do atuador de extremidade 1200. As figuras 35 e 36 ilustram as posições dos membros de suporte de feixe de disparo 1610', 1620' quando o atuador de extremidade está em uma posição não articulada. A Figura 37 ilustra o atuador de extremidade 1200 em uma posição não articulada. Conforme pode ser visto naquela Figura, os membros de suporte de feixe de disparo 1610', 1620' se movem longitudinalmente entre si durante a articulação. Mais especificamente, conforme mostrado na Figura, por exemplo, o membro de suporte de feixe de disparo 1610' no lado de curva curto.
[00201] As Figuras 38 a 40 ilustram outro instrumento cirúrgico 2010 que pode ser, por exemplo, idêntico ao instrumento cirúrgico 1010, exceto para pelo menos algumas das diferenças discutidas abaixo. Por exemplo, instrumento cirúrgico 2010 emprega um conjunto de suporte de feixe de disparo, genericamente designado por 2600, que compreende um primeiro membro de suporte de feixe de disparo 2610 e um segundo membro de suporte de feixe de disparo 2620. Os membros de suporte de feixe de disparo 2610, 2620, compreendem, cada um, uma disposição de faixa de compressão que suporta lateralmente o feixe de disparo 1310 durante a articulação, enquanto facilita o movimento axial do feixe de disparo 1310 entre os mesmos durante os cursos de disparo e de retração dos mesmos. Mais particularmente, em uma disposição, o primeiro membro de suporte de feixe de disparo 2610 compreende uma primeira faixa de compressão 2612 que pode compreender, por exemplo, um membro semelhante a faixa fabricado a partir de alumínio de mola ou material similar. Como pode ser visto nas Figuras 38 a 40, a primeira faixa de compressão 2612 inclui um primeiro membro de montagem proximal 2614 soba forma de uma primeira aba de montagem proximal 2615 que é configurado para ser recebido em uma fenda de montagem 1162 na porção de armação proximal 1160. Além disso, a primeira faixa de compressão proximal 2612 inclui, ainda, um primeiro membro de montagem distal 2616 sob a forma de uma primeira aba de montagem distal 2617 que é configurado para ser recebido em uma fenda de montagem distal 1710 no pino de suporte vertical 1700 formado na extremidade proximal 1211 do canal alongado 1210. Como pode ser mais particularmente visto na Figura 39, a primeira fenda de montagem distal 1710 tem uma primeira largura de fenda "FSW" que é maior que a espessura da primeira aba de montagem distal 2617 para facilitar o movimento axial da primeira aba de montagem distal 2617 na primeira fenda de montagem distal 1710. Além disso, a primeira faixa de compressão 2612 inclui uma primeira porção ou dobra de mola 2618 que é recebida de forma passível de montagem em uma cavidade alongada 1166 na porção de armação proximal 1160.
[00202] Conforme pode ser adicionalmente visto na Figura 39, o segundo membro de suporte de feixe de disparo 2620 compreende uma segunda faixa de compressão 2622 que pode compreender, por exemplo, um membro semelhante a faixa fabricado a partir de aço de mola ou material similar. A segunda faixa e compressão 2622 inclui um segundo membro de montagem proximal 2624 sob a forma de uma segunda aba de montagem proximal 2625 que é configurado para ser recebido em uma fenda de montagem 1164 na porção de armação proximal 1160. Além disso, a segunda faixa de compressão proximal 2622 inclui, ainda, um segundo membro de montagem distal 2626 sob a forma de uma segunda aba de montagem distal 2627 que é configurado para ser recebido em uma fenda de montagem distal 1712 no outro pino de suporte vertical 1700 formado na extremidade distal 1211 do canal alongado 1210. Como pode ser mais particularmente visto na Figura 39, a segunda fenda de montagem distal 1712 tem uma segunda largura de fenda "SSW" que é maior que a espessura da segunda aba de montagem distal 2627 para facilitar o movimento axial da segunda aba de montagem distal 2627 na segunda fenda de montagem distal 1712. Além disso, a segunda faixa de compressão 2622 inclui uma segunda porção ou dobra de mola 2628 que é recebida de forma passível de montagem em uma segunda cavidade alongada 1168 na porção de armação proximal 1160. Conforme pode ser visto nas Figuras 38 a 40, na modalidade ilustrada, a extremidade distal 1161 da porção de armação proximal 1160 tem superfícies opostas arredondadas 1163, 1165 que são configuradas para suportar lateralmente os membros de suporte de feixe de disparo 2610, 2620 durante a articulação do atuador de extremidade 1200.
[00203] A Figura 39 ilustra as posições da primeira e da segunda faixas de compressão 2610, 2620 quando o atuador de extremidade está em uma posição não articulada 1200. Quando naquela posição, a primeira e a segunda faixas de compressão 2610, 2620 aplicam forças de compressão opostas "CF" aos lados laterais opostos do feixe de disparo flexível 1310 enquanto permitem o deslocamento axial do feixe de disparo 1310 durante os cursos de disparo e retração. Quando na posição não articulada, cada uma dentre a primeira e a segunda faixas de compressão 2610, 2620 tem um primeiro comprimento não articulado "CL1", "CL2", respectivamente. A Figura 40 ilustra as posições da primeira e da segunda faixas de compressão 2610, 2620 quando o atuador de extremidade 1200 é articulado em uma direção de articulação. Conforme pode ser visto naquela Figura, a primeira faixa de compressão 2610 foi alongada (CL3>CL1) e a segunda faixa de compressão 2620 foi comprimida (CL4<CL2). As porções de mola 2618 e 2628 facilitam o alongamento e a compressão das faixas de compressão 6210, 2620 durante a articulação, enquanto também mantêm as forças de compressão lateral sobre o feixe de disparo 1310 para, assim, impedir a deformação do feixe de disparo 1310 à medida que o mesmo é movido axialmente entre os mesmos.
[00204] As Figuras 41 a 45 ilustram outro instrumento cirúrgico 2010 que pode ser, por exemplo, idêntico ao instrumento cirúrgico 1010, exceto para pelo menos algumas das diferenças discutidas abaixo. Por exemplo, instrumento cirúrgico 2010 emprega um conjunto de suporte de feixe de disparo, genericamente designado por 2700, que compreende um primeiro membro de suporte de feixe de disparo 2710 e um segundo membro de suporte de feixe de disparo 2720. Os membros de suporte de feixe de disparo 2710, 2720, compreendem, cada um, uma disposição de faixa de compressão que suporta lateralmente o feixe de disparo 1310 durante a articulação, enquanto facilita o movimento axial do feixe de disparo 1310 entre os mesmos durante os cursos de disparo e de retração dos mesmos. Mais particularmente, em uma disposição, o primeiro membro de suporte de feixe de disparo 2710 compreende uma primeira faixa de compressão 2712 que pode compreender, por exemplo, um membro semelhante a faixa fabricado a partir de aço de mola ou material similar. Como pode ser visto na Figura 42, a primeira faixa de compressão 2712 inclui um primeiro membro de montagem proximal 2714 soba forma de uma primeira aba de montagem proximal 2715 que é configurado para ser recebido em uma primeira fenda de montagem 1162 na porção de armação proximal 1160. Além disso, a primeira faixa de compressão proximal 2712 inclui, ainda, um primeiro membro de montagem 2716 sob a forma de uma primeira abade montagem distal 2717 que é configurado para ser recebido em uma primeira fenda de montagem distal 1710 no pino de suporte vertical 1700 formado na porção de extremidade proximal 1211 do canal alongado 1210. Como pode ser mais particularmente visto na Figura 44, a fenda de montagem 1162 na porção de armação proximal 1160 tem uma primeira largura de fenda "FSW" que é maior do que a espessura da primeira aba de montagem proximal 2715 para facilitar o movimento axial da primeira aba de montagem distal 2715 dentro da primeira fenda de montagem proximal 1162.
[00205] Conforme pode ser adicionalmente visto na Figura 44, o segundo membro de suporte de feixe de disparo 2720 compreende uma segunda faixa de compressão 2722 que pode compreender, por exemplo, um membro semelhante a faixa fabricado a partir de aço de mola ou material similar. A segunda faixa e compressão 2722 inclui um segundo membro de montagem proximal 2724 sob a forma de uma segunda aba de montagem proximal 2725 que é configurado para ser recebido em uma fenda de montagem 1164 na porção de armação proximal 1160. Além disso, a segunda faixa de compressão proximal 2722 inclui, ainda, um segundo membro de montagem distal 2726 sob a forma de uma segunda aba de montagem distal 2727 que é configurado para ser recebido em uma segunda fenda de montagem distal 1712 no outro pino de suporte vertical 1700 formado na porção de extremidade proximal 1211 do canal alongado 1210. Como pode ser mais particularmente visto na Figura 44, a segunda fenda de montagem proximal 1164 tem uma segunda largura de fenda "SSW" que é maior do que a espessura da segunda aba de montagem proximal 2725 para facilitar o movimento axial da segunda aba de montagem proximal 2725 na segunda fenda de montagem proximal 1164. Como pode ser também visto nas Figuras 41, 42 e 44, na modalidade ilustrada, a extremidade distal 1161 da porção de armação proximal 1160 tem superfícies arredondadas opostas 1163, 1165 que são configuradas para suportar lateralmente os membros de suporte de feixe de disparo 2710, 2720 durante a articulação do atuador de extremidade 1200.
[00206] Ainda com referência às Figuras 41 a 45, o instrumento cirúrgico 2010 compreende adicionalmente um conjunto de suporte de feixe de disparo móvel 2800 que é configurado para fornecer suporte às faixas de compressão 2712, 2722 durante a articulação do atuador de extremidade 1200. Na disposição ilustrada, o conjunto de suporte de feixe de disparo móvel 2800 compreende um conjunto de saliência de suporte 2810 que é móvel de modo giratório e lateral em relação ao eixo geométrico de saliência ou eixo geométrico de suporte BA disposto de forma centralizada que é transversal ao eixo geométrico de eixo de acionamento SA-SA e paralelo ao eixo geométrico de articulação B-B. Com referência agora à Figura 42, um pino de saliência de suporte 1224 se projeta para cima a partir da porção de extremidade distal 1211 do canal alongado 1210. Na disposição ilustrada, o pino de saliência de suporte 1224 é localizado concentricamente em relação ao pino de pivô 1172, de modo que o eixo geométrico de saliência BA seja coaxial com o eixo geométrico de articulação B-B. Em uma disposição, por exemplo, o pino de saliência de suporte 1224 é integralmente formado com o pino de pivô 1172.
[00207] Conforme pode ser adicionalmente visto na Figura 42, na disposição ilustrada, o conjunto de saliência de suporte 2810 inclui uma porção de corpo 2812 que inclui uma primeira saliência de suporte 2820, a qual está espaçada de uma segunda saliência de suporte 2830. A primeira saliência de suporte 2820 inclui uma primeira superfície de suporte arqueada 2822 e a segunda saliência de suporte 2830 inclui uma segunda superfície de suporte arqueada 2832. A primeira superfície de suporte arqueada 2822 é espaçada da segunda superfície de suporte arqueada 2832 por uma fenda 2834 que é larga o bastante para receber o primeiro membro de suporte de feixe de disparo 2710 e o segundo membor de suporte de feixe de disparo 2720 e para o feixe de disparo 1310 passar entre eles enquanto a primeira superfície de suporte arqueada permanece em contato móvel tangencial com o primeiro membro de suporte de feixe de disparo 2710 e a segunda superfície de suporte arqueada 2832 permanece em contato móvel tangencial com o segundo membro de suporte de feixe de disparo 2720 durante a articulação do atuador de extremidade 1200. Além disso, para facilitar esse contato entre a primeira superfície de suporte arqueada 2822 e o primeiro membro de suporte de feixe de disparo 2710 e a segunda superfície de suporte arqueada 2832 e o segundo membro de suporte de feixe de disparo 2720 durante a articulação do atuador de extremidade 1200, o conjunto de saliência de suporte 2810 é configurado não apenas para girar em torno do eixo geométrico de saliência BA-BA, mas também para se mover lateralmente em relação ao eixo geométrico de saliência BA-BA. Por exemplo, na disposição ilustrada, uma cavidade de montagem 2814 é formada na porção de corpo 2812 para receber de modo móvel o pino de saliência de suporte 1224 na mesma. Vide Figura 43. Tal movimento lateral do conjunto de saliência de suporte 2810 durante a articulação é ilustrado, por exemplo, na Figura 45, em que a posição do pino de saliência de suporte 1224 é mostrada em linhas imaginárias na cavidade de montagem 2814 (também mostrada em linhas imaginárias). Essa disposição permite que o conjunto de saliência de suporte 2810 se mova em direções laterais, por exemplo, que são transversais ao eixo geométrico do eixo de acionamento SA-SA. A Figura 45 ilustra a articulação do atuador de extremidade 1200 em torno do eixo geométrico de articulação (não mostrado) em uma primeira direção "FD". Conforme pode ser visto naquela Figura, além do movimento lateral e da rotação do conjunto de saliência de suporte 2800, a fim de fornecer suporte lateral (antideformação) aos membros de suporte de feixe de disparo 2710, 2720, assim como ao feixe de disparo 1310, pode-se observar que a primeira aba de montagem proximal 2715 se moveu axialmente em relação à segunda aba de montagem proximal 2725 em suas respectivas fendas de montagem 1164, 1162. Essa disposição, portanto, fornece suporte antideformação eficaz ao feixe de disparo 1310 durante a articulação do atuador de extremidade 1200 enquanto permite que o feixe de disparo 1310 se mova axialmente durante os cursos de disparo e de retração. Embora o conjunto de suporte de feixe de disparo 2800 seja bem adequado para uso juntamente com os membros de suporte de feixe de disparo e/ou com os vários tipos de disposições de placa de compressão revelados aqui, também se pode observar que o conjunto de suporte de feixe de disparo 2800 pode ser eficazmente empregado com instrumentos cirúrgicos que não incluem essas estruturas. Nestas disposições alternativas, por exemplo, o conjunto de suporte de feixe de disparo é configurado para fornecer suporte diretamente ao próprio feixe de disparo à medida que o mesmo é articulado sobre a junta de articulação.
[00208] As Figuras 46 a 48 ilustram outro instrumento cirúrgico 2010 que pode ser, por exemplo, idêntico ao instrumento cirúrgico 1010, exceto para pelo menos algumas das diferenças discutidas abaixo. Por exemplo, o instrumento cirúrgico 2010 emprega um conjunto de suporte de feixe de disparo, em geral designado por 2900, que compreende uma pluralidade de membros de suporte de feixe de disparo 2910 feixe de disparo que são assentados de modo móvel em uma porção do feixe de disparo 1310. Para fins de ilustração, o membro de suporte de feixe de disparo móvel mais proximal foi designado por 2910P e o membro de suporte de feixe de disparo mais distal foi designado por 2910P e o membro de suporte de feixe de disparo mais distal foi designado por 2910D. Na disposição ilustrada, cada um dos membros de suporte de feixe de disparo 2910 tem o mesmo formato e configuração. Como pode ser mais particularmente visto na Figura 47, por exemplo, cada membro de suporte de feixe de disparo 2910 inclui uma primeira saliência de suporte 2912 que é espaçada de uma segunda saliência de suporte 2914. A primeira saliência de suporte 2912 inclui uma primeira superfície de suporte arqueada 2916 e a segunda saliência de suporte 2914 inclui uma segunda superfície de suporte arqueada 2918. Na modalidade ilustrada, por exemplo, cada uma dentre a primeira e a segunda saliências de suporte 2912, 2914 em um formato em seção transversal circular. A primeira superfície de suporte arqueada 2916 está espaçada da segunda superfície de suporte arqueada 2918 por uma fenda 2919 que é larga o bastante para receber o feixe de disparo 1310 entre as mesmas, enquanto a primeira superfície de suporte arqueada 2916 permanece em contato móvel tangencial com a porção de lado lateral do feixe de disparo 1310 e a segunda superfície de suporte arqueada 2918 permanece em contato móvel tangencial com a outra porção de lado lateral do membro de suporte de feixe de disparo 1310 durante a articulação do atuador de extremidade 1200. Deve-se compreender que a primeira e a segunda saliências de suporte 2912, 2914 evitam a deformação do feixe de disparo 1310 durante a articulação e a atuação do feixe de disparo 1310.
[00209] Como também pode ser visto nas Figuras 46 a 48, cada um dos membros de suporte de feixe de disparo móveis 2910 tem superfícies de oscilação arqueadas opostas 2920 que definem uma área de contato central ou ponto de oscilação 2922. A Figura 48 ilustra as posições dos membros de suporte de feixe de disparo 2910 durante a articulação do atuador de extremidade 1200. Conforme pode ser visto naquela Figura, os membros de suporte de feixe de disparo 2910 giram entre si enquanto permanecem em contato entre si para suportar o feixe de disparo 1310 e impedir a deformação do mesmo durante a articulação e operação do mesmo. Conforme mostrado na Figura 48, a extremidade distal 1161 da porção de armação proximal 1160 tem superfícies opostas arredondadas 1163, 1165 que servem para suportar porções do membro de suporte de feixe de disparo mais proximal 2910P durante a articulação. De modo semelhante, cada um dos pinos de suporte verticais 1700 inclui uma superfície arqueada 1701 para receber uma porção do membro de suporte de feixe de disparo móvel mais distal 2910D no mesmo durante a articulação.
[00210] As Figuras 49 a 51 ilustram o uso de membros de tensão 2930 para fornecer suporte aos membros de suporte de feixe de disparo 2910 e para manter as superfícies de oscilação 2920 de membros de suporte de feixe de disparo móveis adjacentes 2910 em contato pivotante entre si. Em um exemplo, dois membros de tensão 2930 são empregados e podem compreender, cada um, membro de cabo ou de fio que tem uma extremidade distal 2932 que é ancorada no pino de suporte vertical 1700. A extremidade proximal (não mostrada) de cada membro de tensão 2930 pode ser localizada no interior do cabo ou do alojamento e pode ser suportada de modo móvel no mesmo. A Figura 51 ilustra a articulação do atuador de extremidade 1200, sendo que os membros de tensão 2930 retêm os membros de suporte de feixe de disparo 2910 em contato entre si para, assim, fornecer uma estrutura de suporte arqueada para impedir a deformação do feixe de disparo 1310 durante a atuação do mesmo. A Figura 52 ilustra um conjunto de suporte de feixe de disparo 2900 que pode ser usado juntamente com um atuador de extremidade que é fixado ao eixo de acionamento alongado por uma disposição de junta flexível do tipo revelado, por exemplo, na patente U.S. n° 7.213.736 intitulada SURGICAL STAPLING INSTRUMENT INCORPORATING AN ELECTROACTIVE POLYMER ACTUATED FIRING BAR TRACK THROUGH AN ARTICULATION JOINT, a qual foi aqui incorporada, a título de referência, em sua totalidade. Nessa disposição, por exemplo, o atuador de extremidade 1200 pode ser articulado aplicando-se um movimento de articulação a um dos membros de tensão 2930, dependendo da direção desejada da articulação. Mais especificamente, com referência à Figura 52, para fazer com que o atuador de extremidade seja articulado em uma primeira direção "FD", um movimento de articulação na forma de uma primeira força de tensão "FTF" é aplicado ao primeiro membro de tensão. A primeira força de tensão "FTF" pode ser aplicada ao primeiro membro de tensão 2931 por uma disposição de atuador (não mostrado) no cabo ou no alojamento configurada para puxar o primeiro membro de tensão 2931 na direção proximal "PD". De modo similar, para fazer com que o atuador de extremidade seja articulado em uma segunda direção "SD", um movimento de articulação na forma de uma segunda força de tensão "STF" é aplicado a ao segundo membro de tensão 2933. A segunda força de tensão "STF" pode ser aplicada ao segundo membro de tensão 2933 por uma disposição de atuador (não mostrado) no cabo ou no alojamento que é configurada para puxar o segundo membro de tensão 2933 na direção proximal "PD".
[00211] Quando o atuador de extremidade é articulado, uma certa quantidade de esforço é introduzida no mecanismo de acionamento de articulação, o que pode tornar os feixes de disparo significativamente mais fáceis de deformar e, assim, reduz potencialmente as cargas que podem ser transmitidas por meio disso. Vários conjuntos de suporte de feixe de disparo revelados na presente invenção resolvem esses problemas. As Figuras 53 a 58 ilustram outro instrumento cirúrgico 3010 que pode ser, por exemplo, idêntico ao instrumento cirúrgico 10, exceto para pelo menos algumas das diferenças discutidas abaixo. Por exemplo, um instrumento cirúrgico 3010 emprega um conjunto de suporte de feixe de disparo, em geral designado por 3100, que é usado juntamente com o conjunto de suporte de feixe de disparo 600, conforme detalhado acima. Conforme descrito acima, o conjunto de orientação de feixe de disparo 601 inclui uma extremidade proximal 602 e uma extremidade distal 604 que são interconectados pelos membros de suporte de feixe de disparo 606, 608 que são separados por uma fenda de feixe de disparo 610 que se estende através das extremidades distais e proximais 602, 604. A extremidade proximal 602 do conjunto de orientação de feixe de disparo 601 é recebida em uma cavidade de feixe de disparo proximal 169 formada na porção de extremidade distal 164 da porção de armação proximal 160. A extremidade distal 604 do conjunto de suporte de feixe de disparo 601 é recebida em uma cavidade de barra feixe de disparo 224 formada em um pino de suporte vertical 1700 formado porção de extremidade proximal 211 do canal alongado 210. Para facilitar um movimento axial do conjunto de orientação de feixe de disparo 601 durante a articulação do atuador de extremidade 200, a cavidade de feixe proximal 169 é dimensionada em relação à porção de extremidade proximal 602 do conjunto de orientação de feixe de disparo 601 para permitir algum movimento axial da porção de extremidade proximal 602 ali. Similarmente, a cavidade de feixe distal 224 pode ser dimensionada em relação à porção de extremidade distal 604 do conjunto de orientação de feixe de disparo 601 para facilitar o movimento axial do conjunto de orientação de feixe de disparo 601 em relação ao canal alongado 210 durante a articulação dos mesmos.
[00212] Agora com referência à Figura 54, no exemplo ilustrado, o conjunto de suporte de feixe de disparo dinâmico ou "móvel" 3100 compreende uma base de suporte 3102 que está assentada de modo móvel em um pino de pivô vertical 174 formado no conjunto de armação 159. Mais especificamente, o pino de pivô 174 é recebido de forma giratória dentro de um orifício de pivô 3104 na base de suporte 3102, de modo que o pino de pivô 174 se estenda para cima entre os mesmos. A base de suporte 3102 é móvel em torno de um eixo geométrico de base A1-A1 definido pelo pino de pivô 174. Além disso, a base de suporte 3102 inclui uma fenda alongada 3106 que é dimensionada para receber de modo móvel pino de orientação de base de erupção 1708 que é formado na porção de extremidade proximal ou membro de montagem 211 do canal alongado 210. Vide Figura 55. Além disso, o conjunto de suporte de feixe dinâmico 3100 inclui um primeiro suporte móvel ou pino de orientação 3110 e um segundo suporte móvel ou pino de orientação 3120. O primeiro e o segundo pinos de orientação móveis 3110, 3120 podem se mover independentemente entre si e em relação à base de suporte 3102 em torno de um eixo geométrico de orientação GA-GA definido por um orifício de pivô 3108 na base de suporte 3102. Como pode ser visto na Figura 54, por exemplo, o primeiro pino de orientação móvel 3110 compreende uma primeira base de pino de orientação 3112 que tem um primeiro membro de suporte vertical 3114 e um segundo membro ou pino ou de suporte 3116 que se projeta da mesma. Similarmente, o segundo pino de orientação móvel 3120 compreende um segundo pino de orientação 3122 que tem um membro ou pino de suporte vertical primário 3124 e um membro ou pino de suporte vertical secundário 3126. A segunda base de pino de orientação 3122 inclui um pino de montagem 3125 que se estende através de um orifício de montagem 3113 na primeira base de pino de orientação 3112 e é recebido em um orifício de montagem de base 3108 na base de suporte 3102.
[00213] No exemplo ilustrado, o primeiro membro ou pino de suporte 3114 e o membro ou pino de suporte primário 3124 são configurados para entrarem em contato de modo móvel com a primeira placa lateral 606 do conjunto de orientação de feixe de disparo 601 dependendo da direção na qual o atuador de extremidade é articulado. De modo similar, o segundo membro ou pino de suporte 3116 e o membro ou pino de suporte secundário 3126 são configurados para entrarem em contato de modo móvel com a segunda placa lateral 608 dependendo da direção da articulação. O primeiro pino e o pino primário 3114, 124 podem entrar em contato de modo deslizante com a primeira placa lateral 606 e o segundo pino e o pino secundário 3116, 3126 podem entrar em contato de modo deslizante com a segunda placa lateral 608 quando o atuador de extremidade não estiver articulado (axialmente alinhado com o eixo geométrico de eixo de acionamento SA-SA). Essa disposição serve para suportar o feixe de disparo antes e durante a articulação. Em exemplos alternativos, o conjunto de suporte de feixe de disparo móvel 3100 pode ser usado sem o conjunto de orientação de feixe de disparo 601 ou as placas de suporte de feixe de disparo 601, etc. Nessas disposições, por exemplo, o primeiro pino e o pino primário 3114, 3124 podem entrar em contato diretamente com uma primeira porção de lado lateral do feixe de disparo e o segundo pio e o pino secundário 3116, 3126 podem entrar em contato diretamente com uma segunda porção de lado lateral do feixe de disparo para fornecer suporte antideformação ao feixe de disparo.
[00214] As Figuras 59 a 63 ilustram outro instrumento cirúrgico 3010’ que pode ser idêntico, por exemplo, ao instrumento cirúrgico 3010, exceto por pelo menos algumas das diferenças discutidas abaixo. Por exemplo, o conjunto de suporte de feixe de disparo dinâmico ou "móvel" 3100 inclui apenas dois pinos de suporte verticais 3114' e 3116'. A base de suporte 3102' é substancialmente similar à base 3102 exceto pelo fato de que os pinos verticais 3114' e 3116 'são fixados diretamente à base 3102' e se movem com a mesma.
[00215] O conjunto de suporte de feixe de disparo dinâmico ou móvel 3100 e 3100' oferece diversas vantagens sobre disposições anteriores. Por exemplo, essa estrutura relaciona o ângulo de articulação à quantidade de suporte lateral que é fornecida ao feixe de disparo. Essa versão dinâmica do suporte ativo não apenas gira com a articulação do retentor de canal distal e proximal, mas também gira os próprios elementos de suporte (pinos móveis) em relação às placas de suporte que variam os comprimentos não suportados em relação ao ângulo de articulação. As mudanças de resiliência de placa de suporte podem ser ajustadas com uma análise dinâmica para fornecer mais suporte quando estiver completamente articulada ou mais suporte quando estiver reta ou em outra forma desejada. Os designs de placa de suporte e de placa de erupção tradicionais não podem se ajustar e fornecer o mesmo suporte em qualquer ponto da extensão da articulação. Esta estrutura de suporte que se altera dinamicamente pode ser configurada para suportar o sistema quando estiver em seu momento mais fraco, embora também não realize sobrecompensação quando estiver em seu momento mais forte. As estruturas pivotantes de autotravamento giram apenas até que sejam carregadas, ponto em que as mesmas se unem e fornecem suporte. Tais disposições são relativamente fáceis de se fabricar e montar. "Dinamicamente mutável" significa que seção não suportada pode vaiar em relação ao risco de deformação. A disposição dinâmica pode ser eficazmente empregada juntamente com várias configurações de membro de suporte reveladas aqui.
[00216] A ideia atrás do suporte ativo é permitir que o ângulo de articulação se relacione com a quantidade de suporte que é fornecida ao feixe de disparo e ao membro de suporte de feixe de disparo. Isto pode ser feito criando-se um par que fornece uma zona não suportada mais curta quanto maior for a probabilidade de os feixes sofrerem deformação (isto é, seu maior ângulo de articulação). As configurações móveis das disposições dinâmicas reveladas aqui fornecem suporte aos retentores de canal distal e proximal e permitem que o conjunto de suporte gire e deslize em relação a eles. Essa disposição fornece suporte à placa de suporte de articulação externa quando a mesma mais precisa da zona não suportada mais curta. Outro recurso é aquele em que as placas de suporte esquerda e direita também se unem entre si pela própria ligação, aumentando adicionalmente a resistência à deformação, visto que ambas as placas de suporte esquerda e direita têm que se deformar para que o sistema falhe.
[00217] As Figuras 64 a 71 ilustram vários conjuntos de suporte de feixe de disparo que podem ser usados com vários exemplos de instrumentos cirúrgicos revelados aqui. A Figura 64 é uma vista em perspectiva de um conjunto de suporte de feixe de disparo 600 descrito em detalhes acima. As Figuras 65 e 66 ilustram um conjunto de suporte de feixe de disparo 2700' que é similar ao conjunto de suporte de feixe de disparo 2700 descrito acima, exceto por pelo menos algumas das diferenças discutidas abaixo. Por exemplo, a primeira e a segunda faixas de compressão 2712' 2722' são frouxamente acopladas entre si por acopladores proximais e distais 2730, 2740 que facilitam o movimento axial das faixas de compressão 2712', 2722' entre si enquanto mantêm as faixas de compressão 2712', 2722' em contato compressivo com o feixe de disparo 1310 nas maneiras descritas em detalhes aqui. Os acopladores proximais e distais 2730, 2740 podem se estender completamente em torno das faixas de compressão 2712', 2722'. Para facilitar o movimento axial relativo das faixas 2712', 2722', o acoplador proximal 2730 é recebido em entalhes de topo e de fundo proximais 2732, 2734 em cada uma das faixas de compressão 2712', 2722' e o acoplador distal 2740 é recebido em fendas de topo e de fundo distais em cada uma das faixas de compressão 2712', 2722', conforme mostrado. A Figura 68 ilustra outro conjunto de suporte de feixe de disparo 2700" que é idêntico ao conjunto de suporte de feixe de disparo 2700' exceto pelo fato de que os acopladores 2730' e 2740' não se estendem completamente em torno de ambas as faixas de compressão 2712', 2722'. Em ambas as disposições, os acopladores distal e proximal permitem que as placas de compressão de movam axialmente entre si, enquanto impedem, ou pelo menos limitam, o movimento lateral em sentidos opostos entre si em direções que são transversais ao eixo geométrico de eixo de acionamento. Dessa forma, tal disposição mantém as placas de compressão em contato com o feixe de disparo durante a articulação do atuador de extremidade. Entende-se, também, que o comprimento axial dos entalhes define essencialmente a quantidade de deslocamento axial relativo em que as placas de compressão podem se mover entre si.
[00218] As Figuras 68 e 69 ilustram outro conjunto de suporte de feixe de disparo 3200 que pode ser usado juntamente com vários exemplos de instrumentos cirúrgicos revelados aqui. Conforme pode ser visto nessas Figuras, o conjunto de suporte de feixe de disparo 3200 pode incluir um retentor de suporte 3210 que tem formato semelhante a caixa. No exemplo ilustrado, o retentor 3200 inclui porções de topo e de fundo sólidas 3212, 3214 que são interconectadas por membros laterais espaçados 3216, 3218 que têm, cada um, uma série de janelas 3220 nos mesmos para fornecer ao retentor alguma flexão (representada pela seta "B") nas direções Z, mas nenhuma flexão significativa nas direções "Y". A extremidade proximal 3211 do retentor de suporte 3210 inclui um flange proximal 3213 para montagem móvel no interior de uma abertura no conjunto dorsal ou de armação do instrumento cirúrgico, como foi aqui descrito. De modo similar, a extremidade distal 3215 do retentor de suporte 3210 tem um flange distal 3217 para montagem móvel dentro de uma abertura na porção de extremidade proximal do canal alongado, conforme também descrito na presente invenção. Um par de pinos superiores que se estendem para baixo 3230 se projeta a partir da porção superior 3212 e um par de pinos inferiores que se projeta para cima 3232 se projetam a partir da porção inferior 3214, conforme mostrado. Os pinos superiores e inferiores 3230 e 3232 definem um canal de feixe de disparo 3240 através do qual o feixe de disparo (não mostrado) pode se estender axialmente. Em uma disposição, as camadas laminadas externas do feixe de disparo podem ser recebidas entre os pinos 3230 e 3232. No exemplo ilustrado, entretanto, o primeiro e o segundo espaçadores de atrito 3250, 3252 se estendem entre os pinos 3230, 3232. Além disso, o exemplo ilustrado inclui placas de compressão 3260, 3262 do tipo e construção descritos na presente invenção para fornecer suporte compressivo ao feixe de disparo à medida que o mesmo atravessa o retentor para impedir a deformação do feixe de disparo durante a articulação do instrumento cirúrgico.
[00219] A Figura 70 ilustra outro conjunto de suporte de feixe de disparo 3300 que pode ser usado juntamente com vários exemplos de instrumentos cirúrgicos revelados na presente invenção. Conforme pode ser visto nessas Figuras, o conjunto de suporte de feixe de disparo 3300 inclui um corpo tubular 3302 que é fabricado a partir de, por exemplo, náilon, policarbonato, Isoplast®, etc. O corpo 3302 inclui uma passagem de feixe de disparo 3304 para receber de modo móvel um feixe de disparo (não mostrado) através da mesma e é configurado para oferecer alguma flexão nas direções Z. A extremidade proximal 3311 do conjunto de suporte de feixe de disparo 3300 inclui um flange proximal 3313 para montagem móvel em uma abertura no conjunto dorsal ou de armação do instrumento cirúrgico, conforme descrito aqui. De modo similar, a extremidade distal 32315 conjunto de suporte de feixe de disparo 3300 tem um flange distal 3317 para montagem móvel em uma abertura na porção de extremidade proximal do canal alongado, conforme descrito aqui. A Figura 71 ilustra outro conjunto de suporte de feixe de disparo 3300' que é idêntico ao conjunto de suporte de feixe de disparo 3300, mas inclui janelas 3310 nas paredes laterais do mesmo para aumentar flexibilidade do corpo 3302 nas direções Z.
[00220] A Figura 72 ilustra um instrumento cirúrgico acionado (ou "alimentado") por motor 4010 exemplificativo que inclui um alojamento ou um cabo 4020, um conjunto de eixo de acionamento alongado 4100 e um atuador de extremidade 4200 que é conectado operacionalmente ao conjunto de eixo de acionamento alongado 4100. O atuador de extremidade 4200 é similar ao atuador de extremidade 200, conforme discutido em detalhes acima. Conforme indicado acima e como será adicionalmente descrito abaixo, várias porções do instrumento cirúrgico 4010 são acionadas por motor. Além disso, o conjunto de eixo de acionamento alongado 4010 está configurado para se separar do cabo 4020. Várias características e detalhes sobre estes componentes podem ser encontrados no pedido de patente U.S. n° 13/803.053, intitulado NTERCHANGEABLE SHAFT ASSEMBLIES FOR USE WITH A SURGICAL INSTRUMENT, e na publicação de pedido de patente US n° 2014/0263564, cuja descrição inteira é aqui incorporada por referência.
[00221] O atuador de extremidade 4200, inclui, entre outras coisas, um canal alongado 210 que é configurado para suportar operacionalmente um cartucho de grampos 230 no mesmo. O atuador de extremidade 200 inclui, adicionalmente, uma bigorna 250 que inclui um corpo de bigorna 252 que tem uma superfície inferior de formação de grampo 254 na mesma. A bigorna 250 se move entre as posições aberta e fechada por um conjunto de tubo de fechamento 4120 que avança axialmente nas direções distal e proximal atuando-se o gatilho de fechamento 4028. O conjunto de tubo de fechamento 4120 inclui um segmento de eixo de acionamento de tubo de fechamento proximal 4123 que é acoplado de modo pivotante a um segmento de tubo de fechamento distal 4130 nas maneiras descritas aqui para facilitar a articulação em torno de um eixo geométrico de articulação B-B. O segmento de eixo de acionamento de tubo de fechamento 4123 inclui uma porção de extremidade proximal 4200 que faz interface de modo operacional com um conjunto de bocal 4202, uma disposição de tambor de chave 4204 e um conjunto de anel de deslizamento 4206. Detalhes adicionais com relação ao conjunto de bocal, à disposição de tambor de chave e ao conjunto de anel de deslizamento podem ser encontrados na publicação de pedido de patente U.S. n° 2014/0263564, que foi aqui incorporada por referência em sua totalidade, bem como no pedido de patente U.S. n° 14/226.075, depositado 26 de março de 2014, intitulado MODULAR POWERED SURGICAL INSTRUMENT WITH DETACHABLE SHAFT ASSEMBLIES, cuja descrição inteira é aqui incorporada por referência.
[00222] As disposições de tubo de fechamento reveladas nas referências acima têm, em geral, uma faixa fixa de curso de fechamento. Ou seja, a atuação do gatilho de fechamento, ou de outra disposição de atuador de fechamento, resulta no avanço axial do tubo de fechamento. A magnitude desse avanço axial é limitada à quantidade de espaço disponível no cabo ou no alojamento para acomodar todos os diversos componentes do sistema de fechamento. Por exemplo, as modalidades portáteis empregam um cabo que pode ser facilmente suportado e manipulado com uma mão. Tais disposições de cabo, contudo, têm espaço limitado para acomodar os sistemas de fechamento e disparo. Como discutido em detalhes naquelas referências, em algumas disposições, o gatilho de disparo está conectado de maneira móvel a uma peça móvel que é fixada ao conjunto de tubo de fechamento. A atuação do gatilho de fechamento faz com que a disposição de acoplamento avance axialmente a peça móvel de fechamento e o conjunto de tubo de fechamento. Várias vantagens podem ser obtidas pelo aumento da quantidade ou da magnitude de tal curso de fechamento.
[00223] O conjunto de eixo de acionamento 4100 inclui um chassi 4300 que é configurado para ser acoplado de modo removível ao cabo 4020 das várias maneiras descritas em detalhes adicionais nas referências citadas acima. Como pode ser visto nas Figuras 76 e 77, o conjunto de eixo de acionamento 4100 inclui a armação proximal ou a porção dorsal proximal 4160 que inclui uma extremidade proximal 4161 que é suportada de forma giratória em um chassi 4300. No exemplo ilustrado, a extremidade proximal 4141 da porção de armação proximal 4160 tem uma rosca 4163 formada na mesma para fixação rosqueada a um rolamento dorsal 4180 configurado para ser suportado no chassi 4300. Essa disposição facilita a fixação giratória da porção de armação proximal 4160 ao chassi 4300, de modo que o conjunto dorsal 4159 possa girar seletivamente em torno do eixo geométrico de eixo de acionamento SA-SA em relação ao chassi 4300.
[00224] Referindo-se principalmente às Figura 75 a 77, o conjunto de eixo de acionamento intercambiável 4100 inclui um elemento de transporte de fechamento 4350 que é suportado de modo deslizante no chassi 4300, de modo que possa se mover axialmente em relação ao mesmo. O segmento de tubo de fechamento proximal 4123 é acoplado à peça móvel de fechamento 4350 para giro relativo em relação ao mesmo. Por exemplo, um conector em forma de U 263 é inserido em uma fenda anular 4129 no segmento de tubo de fechamento proximal 4123 e é retido nas fendas verticais na poça móvel de fechamento 4350. Essa disposição serve para fixar o segmento de tubo de fechamento proximal 4123 à peça móvel de fechamento 4350 para deslocamento axial com a mesma, ao mesmo tempo em que possibilita que o segmento de tubo de fechamento proximal 4123 gire em relação à peça móvel de fechamento 4350 ao redor do eixo geométrico de eixo de acionamento SA-SA. Uma mola de fechamento 4353 é assentada sobre o segmento de tubo de fechamento proximal 4123 e serve para inclinar o segmento de tubo de fechamento proximal 4123 na direção proximal "PD", o que pode servir para girar o gatilho de fechamento 4028 para a posição não atuada quando o conjunto de eixo de acionamento 4100 é operacionalmente acoplado ao cabo 4020.
[00225] O conjunto de eixo de acionamento 4100 inclui adicionalmente um conjunto de transmissão de fechamento 4500 para ampliar a quantidade de movimento de fechamento que é aplicado à peça móvel de fechamento 4350 e, por fim, à bigorna através do conjunto de tubo de fechamento. Essa disposição oferece várias vantagens como a capacidade para aumentar o curso de fechamento, o que pode levar a uma maior capacidade de abertura da garra. Em outras palavras, essa capacidade de curso extra em ambas as extremidades proximal e distal permite que o segmento de tubo de fechamento também se retraia adicionalmente na direção proximal para dotar a bigorna da capacidade de se abrir ainda mais. Como pode ser visto nas Figuras 75 e 76, a transmissão de fechamento 4500 liga a peça móvel de fechamento 4350 a um conjunto de gancho de fechamento proximal 4360. O conjunto de gancho de fechamento proximal 4360 inclui ganchos 4362 que são adaptados para se engatarem de forma enganchada ao pino de fixação 4033 que é fixado a um segundo enlace de fechamento 4031 que é acoplado operacionalmente ao gatilho de fechamento 4028, conforme descrito em detalhes no pedido de patente U.S. n° 14/226.075. Conforme descrito nessa referência, a atuação do gatilho de fechamento 4028 avança distalmente o enlace de fechamento 4031 e aplica um movimento de fechamento distal ao conjunto de gancho de fechamento proximal 4360.
[00226] No exemplo ilustrado, o conjunto de transmissão de fechamento 4500 inclui uma cremalheira de gancho de fechamento proximal 4504 que é fixada ao conjunto de gancho de fechamento proximal 4360. Além disso, o conjunto de transmissão de fechamento 4500 inclui adicionalmente uma cremalheira de transferência 4506 que é suportada de modo móvel no alojamento de transmissão 4502. O conjunto de transmissão de fechamento 4500 inclui adicionalmente uma cremalheira de fechamento distal 4508 que é fixada à peça móvel de fechamento 4350. Um pinhão de fechamento 4510 está em engate engrenado com a cremalheira de gancho de fechamento 4504 e a cremalheira de transferência 4506. Uma engrenagem de pinhão de transferência 4512 está fixada a uma engrenagem de pinhão multiplicador 4514 e está em engate engrenado com a cremalheira de transferência 4506. O pinhão multiplicador está em engate engrenado com a cremalheira de fechamento distal 4508. Dessa forma, a atuação do gatilho de fechamento 4028 resulta no avanço distal da cremalheira de gancho de fechamento 4504, o que, por fim, resulta no avanço distal da cremalheira de gancho de fechamento distal 4508 e da peça móvel de fechamento 4350. O movimento distal da peça móvel de fechamento 4350 resulta no movimento do conjunto de tubo de fechamento.
[00227] Dessa forma, o conjunto de transmissão de fechamento compreende meios para aprimorar um curso de fechamento do conjunto de tubo de fechamento. Por exemplo, uma disposição de fechamento convencional pode compreender um atuador de fechamento que, mediante atuação, aplica um movimento de fechamento ao conjunto de tubo de fechamento. A aplicação de tal movimento de fechamento resulta no movimento axial do conjunto de tubo de fechamento através de um curso de fechamento que tem um alcance máximo de deslocamento de fechamento axial "MCT". Um instrumento cirúrgico que emprega vários tipos e construções de um conjunto de transmissão de fechamento de vários revelados aqui também tem um curso de fechamento que tem um alcance máximo de deslocamento de fechamento axial "MCT1". Caso todos os outros aspectos desses dispositivos sejam, de outro modo, iguais MCT1>MCT.
[00228] Agora com referência às Figuras 78 a 80, o atuador de extremidade 200 é acoplado ao conjunto de eixo de acionamento alongado 4100 por uma junta de articulação 109 do tipo e construção descritos acima. Entretanto, outras disposições de junta de articulação podem também ser empregadas. No exemplo ilustrado, o conjunto de eixo de acionamento 4100 inclui um conjunto de tubo de fechamento 4120 que inclui o segmento de tubo de fechamento proximal 4123. O exemplo ilustrado inclui ainda um segmento de tubo de fechamento flexível 4600 que é acoplado à extremidade distal do segmento de tubo de fechamento distal 4123 para mover-se com o mesmo. O segmento do tubo de fechamento flexível 4600 é dimensionado para se estender sobre a junta de articulação 109 e inclui uma extremidade distal 4602 e uma extremidade proximal 4604. A extremidade proximal 4604 é fixada à extremidade distal do segmento de tubo de fechamento distal 4123. Um segmento tubular flexível 4610 se estende entre a extremidade proximal 4604 e a extremidade distal 4602 e, no exemplo ilustrado, inclui dois membros dorsais superiores e inferiores espaçados e que se estendem axialmente 4612, 4614. Estendendo-se a partir de cada lado lateral encontra-se uma pluralidade de membros de nervura espaçados 4616 que servem para uma trajetória tubular através da qual se estende a junta de articulação. Quando o conjunto de tubo de fechamento 4120 avança axialmente na direção distal "DD", a extremidade distal 4602 do segmento de tubo de fechamento flexível 4600 interage com a bigorna 250 nas várias maneiras descritas aqui para mover a bigorna 250 para posições fechadas. O segmento do tubo de fechamento flexível 4600 também acomoda a articulação do atuador de extremidade 200, conforme ilustrado na Figura 80.
[00229] Exemplo 1 - Um instrumento cirúrgico compreende um canal alongado que é configurado para suportar operacionalmente um cartucho de grampos cirúrgicos no mesmo. Uma bigorna é acoplada de modo pivotante a uma extremidade proximal do canal alongado, de modo que a mesma seja pivotante em torno de um eixo geométrico de bigorna distinto e imóvel definido pelo canal alongado. Um membro de disparo é configurado para deslocar-se axialmente no interior do canal alongado em resposta a uma aplicação de um movimento de disparo ao mesmo. O membro de disparo é configurado para se engatar de modo móvel à bigorna e ao canal alongado para espaçar a bigorna em relação ao canal alongado em uma distância desejada, é medida que o membro de disparo é acionado axialmente através do canal alongado. Um membro de fechamento é configurado para mover a bigorna uma posição aberta e posições fechadas em relação ao canal alongado, mediante a aplicação de movimentos de fechamento ao membro de fechamento.
[00230] Exemplo 2 - O instrumento cirúrgico, de acordo com o Exemplo 1, sendo que o canal alongado é acoplado a um conjunto de eixo de acionamento alongado. O conjunto de eixo de acionamento alongado define um eixo geométrico de eixo de acionamento e o membro de fechamento é móvel axialmente entre uma posição não atuada e uma posição atuada ao longo do eixo geométrico de eixo de acionamento.
[00231] Exemplo 3 - O instrumento cirúrgico, de acordo com o Exemplo 2, sendo que o conjunto de eixo de acionamento alongado compreende um conjunto de armação que é acoplado ao canal alongado e o membro de fechamento é móvel axialmente em relação ao conjunto de armação.
[00232] Exemplo 4 - O instrumento cirúrgico, de acordo com os Exemplos 1, 2, ou 3, sendo que a bigorna compreende um corpo de bigorna que inclui uma superfície inferior de formação de grampo e uma porção de montagem de bigorna. A porção de montagem de bigorna compreende um primeiro braço de bigorna que se projeta proximalmente que inclui um primeiro munhão de bigorna que se estende para dentro e um segundo braço de bigorna que se projeta proximalmente é espaçado em relação ao primeiro braço de bigorna. A porção de montagem de bigorna compreende, adicionalmente, um segundo munhão de bigorna que se estende para dentro que é espaçado em relação ao primeiro munhão de bigorna. O primeiro munhão de bigorna é suportado de maneira pivotante em um primeiro orifício de munhão de bigorna em uma primeira porção de extremidade proximal do canal alongado e o segundo munhão de bigorna é suportado de modo pivotante em um segundo orifício de munhão de bigorna em uma segunda porção de extremidade proximal do canal alongado. O primeiro e o segundo orifícios de munhão são alinhados coaxialmente entre si no eixo geométrico de bigorna.
[00233] Exemplo 5 - O instrumento cirúrgico, de acordo com os Exemplos 1, 2, 3 ou 4, sendo que a bigorna compreende uma rampa de bigorna que é configurada para entrar em contato com uma extremidade distal do membro de fechamento.
[00234] Exemplo 6 - O instrumento cirúrgico, de acordo com os Exemplos 1, 2, 3, 4 ou 5, sendo que a bigorna compreende adicionalmente uma superfície inferior de formação de grampo. Uma fenda de membro de disparo é formada na superfície inferior de formação de grampo. Uma primeira saliência de fechamento é localizada na bigorna, de modo que a mesma seja adjacente a um primeiro lado da fenda de membro de disparo. Uma segunda saliência de fechamento é localizada na bigorna, de modo que a mesma seja adjacente a um segundo lado da fenda de membro de disparo. Uma fenda de canal se estende através do fundo do canal alongado. O membro de disparo compreende um corpo de membro de disparo que se estende verticalmente e uma primeira aba de membro de disparo que se projeta de um primeiro lado lateral do corpo de membro de disparo que se estende verticalmente para ser recebida de modo deslizante na primeira saliência de fechamento na bigorna. Uma segunda aba de membro de disparo se projeta de um segundo lado lateral do corpo do membro de disparo que se estende verticalmente para ser recebida de modo deslizante na primeira saliência de fechamento na bigorna. Uma porção de pé inferior é localizada em uma extremidade inferior do corpo de membro de disparo que se estende verticalmente e se estende lateralmente do primeiro e do segundo lados laterais do corpo de membro de disparo que se estende verticalmente.
[00235] Exemplo 7 - O instrumento cirúrgico, de acordo com o Exemplo 6, sendo que uma primeira rampa de saliência de fechamento se comunica com a primeira saliência de fechamento em uma extremidade proximal da mesma. A primeira rampa de saliência de fechamento é configurada para orientar a primeira aba de membro de disparo sobre a primeira saliência de fechamento mediante a aplicação de movimento de disparo ao membro de disparo. Uma segunda rampa de saliência de fechamento se comunica com a segunda saliência de fechamento em uma extremidade proximal da mesma. A segunda rampa de saliência de fechamento é configurada para orientar a segunda aba de membro de disparo sobre a segunda saliência de fechamento mediante a aplicação de movimentos de disparo ao membro de disparo.
[00236] Exemplo 8 - O instrumento cirúrgico, de acordo com os Exemplo 1, 2, 3, 4, 5, 6 ou 7, sendo que o membro de disparo compreende uma superfície de corte de tecido.
[00237] Exemplo 9 - O instrumento cirúrgico, de acordo com os Exemplos 1, 2, 3, 4, 5, 6, 7 ou 8, sendo que o conjunto de eixo de acionamento alongado está operacionalmente acoplado ao canal alongado. Um alojamento é operacionalmente acoplado ao conjunto de eixo de acionamento alongado e suporta operacionalmente um sistema de disparo que é configurado para gerar os movimentos de disparo. O alojamento também suporta operacionalmente um sistema de fechamento que é configurado para gerar os movimentos de fechamento.
[00238] Exemplo 10 - O instrumento cirúrgico, de acordo com o Exemplo 9, sendo que o alojamento compreende um cabo.
[00239] Exemplo 11 - O instrumento cirúrgico, de acordo com os Exemplos 9 ou 10, sendo que pelo menos um dentre o sistema de disparo e o sistema de fechamento é operável manualmente.
[00240] Exemplo 12 - O instrumento cirúrgico, de acordo com os Exemplos 9, 10 ou 11, sendo que pelo menos um dentre o sistema de disparo e o segundo sistema de fechamento é acionado por motor.
[00241] Exemplo 13 - O instrumento cirúrgico, de acordo com os Exemplos 9, 10, 11 ou 12, sendo que o alojamento compreende uma porção de um sistema robótico.
[00242] Exemplo 14 - O instrumento cirúrgico, de acordo com os Exemplos 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 ou 13, sendo que o canal alongado é acoplado de forma pivotante ao conjunto de eixo de acionamento alongado, de modo que o canal alongado possa ser articulado seletivamente em torno de um eixo geométrico de articulação que é transversal ao eixo geométrico de eixo de acionamento que é definido pelo conjunto de eixo de acionamento alongado.
[00243] Exemplo 15 - O instrumento cirúrgico, de acordo com o Exemplo 14, sendo que um conjunto de articulação é operacionalmente acoplado ao canal alongado. O conjunto de articulação responde aos movimentos de articulação gerados por um sistema de articulação.
[00244] Exemplo 16 - Um instrumento cirúrgico que compreende um canal alongado que inclui um cartucho de grampos cirúrgicos operacionalmente suportado no mesmo. O cartucho de grampos cirúrgicos suporta operacionalmente uma pluralidade de grampos cirúrgicos no mesmo. Um membro de disparo é operacionalmente suportado para deslocamento axial através do cartucho de grampos cirúrgicos para ejetar os grampos cirúrgico do cartucho de grampos cirúrgicos. O membro de disparo é configurado para se engatar de modo móvel à bigorna e ao canal alongado para espaçar a bigorna em relação ao canal alongado em uma distância desejada, é medida que o membro de disparo é acionado axialmente através do canal alongado. O instrumento cirúrgico compreende, adicionalmente, meios de disparo para mover o membro de disparo através do cartucho de grampos cirúrgicos. Uma bigorna que inclui superfície de formação de bigorna é configurada para formar os grampos cirúrgicos que são ejetados do cartucho de grampos cirúrgicos. O instrumento cirúrgico compreende adicionalmente meios para montar a bigorna ao canal alongado, de modo que a bigorna seja seletivamente pivotante em relação ao canal alongado sem movimento nas direções axiais em relação ao canal alongado. O instrumento cirúrgico compreende adicionalmente meios pivotantes para girar uma extremidade distal da bigorna em direção ao canal alongado. Os meios pivotantes são operáveis independentemente dos meios de disparo.
[00245] Exemplo 17 - O instrumento cirúrgico, de acordo com o Exemplo 16, sendo que os meios de disparo permanecem sem atuação até que os meio pivotantes tenham girado a extremidade distal da bigorna para uma posição fechada.
[00246] A totalidade das revelações de:
[00247] Patente US n° 5.403.312, intitulada ELECTROSURGICAL HEMOSTATIC DEVICE, que foi concedida em 4 de abril de 1995;
[00248] 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;
[00249] 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;
[00250] 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;
[00251] Patente US n° 7.670.334, intitulada SURGICAL INSTRUMENT HAVING AN ARTICULATING END EFFECTOR, que foi concedida em 2 de março de 2010;
[00252] Patente US n° 7.753.245, intitulada SURGICAL STAPLING INSTRUMENTS, que foi concedida em 13 de julho de 2010;
[00253] Patente US n° 8.393.514, intitulada SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE, que foi concedida em 12 de março de 2013;
[00254] Pedido de patente US n° de série 11/343.803, intitulado SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES, atualmente patente US 7.845.537;
[00255] 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;
[00256] Pedido de patente US n° de série 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;
[00257] Pedido de patente US n° de série 12/235.782, intitulado MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT, atualmente patente US 8.210.411;
[00258] 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;
[00259] 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;
[00260] Pedido de patente US n° de série 12/893.461, intitulado STAPLE CARTRIDGE, depositado em 29 de setembro de 2012, agora patente US n° 8.733.613;
[00261] Pedido de patente US n° de série 13/036.647, intitulado SURGICAL STAPLING INSTRUMENT, depositado em 28 de fevereiro de 2011, agora patente US n° 8.561.870;
[00262] 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;
[00263] 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;
[00264] Pedido de patente US n° de série 13/800,025, intitulado STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, depositado em 13 de março de 2013;
[00265] Pedido de patente US n° de série 13/800,067, intitulado STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, depositado em 13 de março de 2013;
[00266] 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
[00267] 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.
[00268] 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, onde forem revelados materiais para certos 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 executar uma ou mais funções determinadas. A descrição mencionada anteriormente e as concretizações são destinadas a abranger todas essas modificações e variações.
[00269] Com respeito ao uso de substancialmente quaisquer termos plurais e/ou singulares na presente invenção, os versados na técnica podem mudar do plural para o singular e/ou do singular para o plural conforme seja adequado ao contexto e/ou aplicação. As várias permutações singular/plural não estão expressamente apresentadas na presente invenção por motivos de clareza.
[00270] O assunto descrito na presente invenção ilustra por vezes componentes distintos contidos em outros componentes distintos, ou a eles relacionados. É necessário compreender que essas arquiteturas representadas são meramente exemplificadoras, e que, de fato, podem ser implementadas muitas outras arquiteturas que alcancem a mesma funcionalidade. No sentido conceitual, qualquer disposição de componentes para alcançar a mesma funcionalidade está efetivamente "associada" se a funcionalidade desejada for alcançada. Assim, quaisquer dois componentes mencionados na presente invenção que sejam combinados para alcançar uma funcionalidade específica podem ser vistos como "associados" um ao outro se a funcionalidade desejada é alcançada, independentemente das arquiteturas ou dos componentes intermediários. De modo semelhante, quaisquer desses dois componentes assim associados também podem ser vistos como estando "conectados de modo operável" ou "acoplados de modo operável" um ao outro para alcançar a funcionalidade desejada, e quaisquer desses dois componentes capazes de serem associados dessa forma podem ser vistos como sendo "acopláveis de modo operável" um ao outro para alcançar a funcionalidade desejada. Exemplos específicos de componentes operacionalmente acopláveis incluem, mas não se limitam a, componentes fisicamente encaixáveis e/ou em interação física, e/ou os que podem interagir por conexão sem fio, e/ou que interajam por lógica, e/ou podem interagir por lógica.
[00271] Embora várias modalidades tenham sido descritas na presente invenção, muitas modificações, variações, substituições, alterações e equivalentes a essas modalidades podem ser implementadas e irão ocorrer aos versados na técnica. Além disso, onde forem revelados materiais para certos componentes, outros materiais podem ser usados. Deve-se compreender, portanto, que a descrição precedente e as concretizações pretendem cobrir todas essas modificações e variações abrangidas pelo escopo das modalidades apresentadas. As concretizações pretendem englobar todas essas modificações e variações.
[00272] 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.
[00273] 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 vedado, 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.
[00274] Qualquer patente, publicação ou outro material de descrição, 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 descrição existentes apresentados nesta descrição. Desse modo, e na medida em que for necessário, a descrição 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 descrição existentes aqui apresentados estará aqui incorporado apenas na medida em que não haja conflito entre o material incorporado e o material de descrição existente.
[00275] Em resumo, foram descritos inúmeros benefícios que resultam do emprego dos conceitos descritos no presente documento. A descrição anteriormente mencionada de uma ou mais modalidades foi apresentada para propósitos de ilustração e descrição. Essa descrição não pretende ser exaustiva ou limitar a invenção à forma precisa apresentada. Modificações e variações são possíveis à luz dos ensinamentos acima. Uma ou mais modalidades foram escolhidas e descritas com a finalidade de ilustrar os princípios e a aplicação prática para, assim, permitir que o versado na técnica use as diversas modalidades e com inúmeras modificações, conforme sejam convenientes ao uso específico contemplado. Pretende-se que as concretizações definam o escopo global.
Claims (17)
1. Instrumento cirúrgico (10, 1010) caracterizado pelo fato de que compreende: um canal alongado (210, 1210) configurado para suportar de modo operável um cartucho de grampos cirúrgico (230, 1230) no mesmo; uma bigorna (250, 1250) acoplada de forma pivotante a uma extremidade proximal (211, 1211) do canal alongado (210, 1210), a bigorna (250, 1250) sendo pivotante em torno de um eixo geométrico de bigorna (A-A) imóvel e distinto definido pelo canal alongado (210, 1210); um membro de disparo (300, 1300) configurado para deslocar-se axialmente no interior do canal alongado (210, 1210) em resposta a uma aplicação de movimentos de disparo ao mesmo, o membro de disparo (300, 1300) sendo configurado para se engatar de forma móvel ao canal alongado (210, 1210) para espaçar a bigorna (250, 1250) em relação ao canal alongado (210, 1210) a uma distância desejada à medida que o membro de disparo (300, 1300) é acionado axialmente através do canal alongado (210, 1210); e um membro de fechamento (110, 1110) configurado para mover a bigorna (250, 1250) entre uma posição aberta e posições fechadas em relação ao canal alongado (210, 1210) mediante a aplicação de movimentos de fechamento ao membro de fechamento (110, 1110).
2. Instrumento cirúrgico (10, 1010), de acordo com a reivindicação 1, caracterizado pelo fato de que o canal alongado (210, 1210) é acoplado a um conjunto de eixo de acionamento alongado (100, 1100), o conjunto de eixo de acionamento alongado (100, 1100) define um eixo geométrico de eixo de acionamento (SA- SA) e em que o membro de fechamento (110, 1110) é móvel axialmente entre uma posição não atuada e uma posição atuada ao longo do eixo geométrico de eixo de acionamento (SA-SA).
3. Instrumento cirúrgico (10, 1010), de acordo com a reivindicação 2, caracterizado pelo fato de que o eixo de acionamento alongado (100, 1100) compreende um conjunto de armação (159, 1159) acoplado ao canal alongado (210, 1210) e no qual o membro de fechamento (110, 1110) é móvel axialmente em relação ao conjunto de armação (159, 1159).
4. Instrumento cirúrgico (10), de acordo com a reivindicação 1, caracterizado pelo fato de que a bigorna (250) compreende: um corpo de bigorna (252) incluindo uma superfície inferior de formação de grampo (254); e uma porção de montagem de bigorna (260) compreendendo: um primeiro braço de bigorna (262) que se projeta proximalmente e que inclui um primeiro munhão de bigorna que se estende para dentro (264); e um segundo braço de bigorna se projetando proximalmente (266) espaçado a partir do primeiro braço de bigorna (262) e incluindo um segundo munhão de bigorna se estendendo para dentro (268) espaçado a partir do primeiro munhão de bigorna (264), o primeiro munhão de bigorna (264) suportado de modo pivotante em um primeiro orifício de munhão (214) em uma primeira porção de extremidade proximal (211) do canal alongado (210, 1210) e o segundo munhão de bigorna (268) é suportado de modo pivotante em um segundo orifício de munhão (216) em uma segunda porção de extremidade proximal (211) do canal alongado (210, 1210), o primeiro e o segundo orifícios de munhão (214, 216) coaxialmente alinhados entre si no eixo geométrico de bigorna (A-A).
5. Instrumento cirúrgico (10), de acordo com a reivindicação 4, caracterizado pelo fato de que a bigorna (250) ainda compreende uma rampa de bigorna configurada para entrar em contato com uma extremidade distal do membro de fechamento (110).
6. Instrumento cirúrgico (10), de acordo com a reivindicação 1, caracterizado pelo fato de que a bigorna (250) ainda compreende: uma superfície inferior de formação de grampo (254); uma fenda de membro de disparo na superfície inferior de formação de grampo (254); uma primeira saliência de fechamento (292) na bigorna (250) adjacente a um primeiro lado da fenda de membro de disparo; uma segunda saliência de fechamento (294) na bigorna (250) adjacente a um segundo lado da fenda de membro de disparo; uma fenda de canal (212) se estendendo através de um fundo do canal alongado (210) e em que o membro de disparo (300) compreende: um corpo de membro de disparo se estendendo verticalmente (302); uma primeira aba de membro de disparo (306) se projetando a partir de um primeiro lado lateral (305) do membro de disparo se estendendo verticalmente (302) para ser recebida de maneira deslizante na primeira saliência de fechamento (292) na bigorna (250); uma segunda aba de membro de disparo (308) se projetando de um segundo lado lateral (307) do corpo de membro de disparo se estendendo verticalmente (302) para ser recebida de modo deslizante na primeira saliência de fechamento (292) na bigorna (250); e uma porção de pé de fundo em uma extremidade inferior do corpo de membro de disparo se estendendo verticalmente (302) e se estendendo lateralmente dos primeiro e segundo lados laterais (305, 307) do corpo de membro de disparo se estendendo verticalmente (302).
7. Instrumento cirúrgico (10), de acordo com a reivindicação 6, caracterizado pelo fato de que ainda compreende: uma primeira rampa de saliência de fechamento (273) em comunicação com a primeira saliência de fechamento (292) em uma extremidade proximal da mesma, a primeira rampa de saliência de fechamento (273) configurada para guiar a primeira aba de membro de disparo (306) para a primeira saliência de fechamento (292) mediante a aplicação de movimentos de disparo ao membro de disparo (300); e uma segunda rampa de saliência de fechamento (275) em comunicação com a segunda saliência de fechamento (294) em uma extremidade proximal da mesma, a segunda rampa de saliência de fechamento (275) configurada para guiar a segunda aba de membro de disparo (308) para a segunda saliência de fechamento (294) mediante a aplicação de movimentos de disparo ao membro de disparo (300).
8. Instrumento cirúrgico (10), de acordo com a reivindicação 6, caracterizado pelo fato de que o corpo de membro de disparo (302) compreende uma superfície para corte de tecido (304).
9. Instrumento cirúrgico (10), de acordo com a reivindicação 1, caracterizado pelo fato de que ainda compreende: um conjunto de eixo de acionamento alongado (100) acoplado operacionalmente ao canal alongado (210); e um alojamento (20, 20’, 20”) operacionalmente acoplado ao conjunto de eixo de acionamento alongado (100) e operacionalmente configurado para suportar um sistema de disparo configurado para gerar o movimento de disparo e um sistema de fechamento configurado para gerar os movimentos de fechamento.
10. Instrumento cirúrgico (10), de acordo com a reivindicação 9, caracterizado pelo fato de que o alojamento compreende um cabo (20).
11. Instrumento cirúrgico (10), de acordo com a reivindicação 10, caracterizado pelo fato de que pelo menos um dentre o sistema de disparo e o sistema de fechamento é operável manualmente.
12. Instrumento cirúrgico (10), de acordo com a reivindicação 10, caracterizado pelo fato de que pelo menos um dentre o sistema de disparo e o segundo sistema de fechamento é acionado por motor.
13. Instrumento cirúrgico (10), de acordo com a reivindicação 9, caracterizado pelo fato de que o alojamento (20, 20’, 20”) compreende uma porção de um sistema robótico (13).
14. Instrumento cirúrgico (10), de acordo com a reivindicação 9, caracterizado pelo fato de que o canal alongado (210) é acoplado de forma pivotante ao conjunto de eixo de acionamento alongado (100), de modo que o canal alongado (210) possa ser articulado seletivamente em torno de um eixo geométrico de articulação (B-B) que é transversal a um eixo geométrico de eixo de acionamento (SA-SA) definido pelo conjunto de eixo de acionamento alongado (100).
15. Instrumento cirúrgico (10), de acordo com a reivindicação 14, caracterizado pelo fato de que ainda compreende um conjunto de articulação acoplado operacionalmente ao canal alongado (210), o conjunto de articulação sendo responsivo a movimentos de articulação gerados por um sistema de articulação.
16. Instrumento cirúrgico (10, 1010) caracterizado pelo fato de que compreende: um canal alongado (210, 1210); um cartucho de grampos cirúrgicos (230, 1230) suportado operacionalmente no canal alongado (210, 1210), o cartucho de grampos cirúrgicos (230, 1230) suportando operacionalmente uma pluralidade de grampos cirúrgicos (242, 1242) no mesmo; um membro de disparo (300, 1300) operacionalmente suportado para movimento axial através do cartucho de grampos cirúrgicos (230, 1230) para ejetar os grampos cirúrgicos (242, 1242) a partir do cartucho de grampos cirúrgicos (230, 1230), uma bigorna (250, 1250) incluindo uma superfície de formação de bigorna configurada para formar os grampos cirúrgicos (242, 1242) ejetados do cartucho de grampos cirúrgicos (230, 1230), o membro de disparo (300, 1300) configurado para se engatar de forma móvel à bigorna (250, 1250) e o canal alongado (210, 1210) para espaçar a bigorna (250, 1250) em relação ao canal alongado (210, 1210) a uma distância desejada à medida que o membro de disparo (300, 1300) é acionado axialmente através do canal alongado (210, 1210); meios para mover o membro de disparo (300, 1300) através do cartucho de grampos cirúrgicos (230, 1230); meios para a montagem de uma extremidade proximal da bigorna (250, 1250) ao canal alongado (210, 1210) de modo que a bigorna (250, 1250) seja seletivamente pivotante em relação ao canal alongado (210, 1210) sem a extremidade proximal da bigorna (250, 1250) se mover em relação ao canal alongado (210, 1210); e meios para girar uma extremidade distal da bigorna (250, 1250) em direção ao canal alongado (210, 1210), os meios de rotação sendo independentemente operáveis dos meios para mover o membro de disparo (300, 1300).
17. Instrumento cirúrgico (10, 1010), de acordo com a reivindicação 16, caracterizado pelo fato de que os meios para movimento não são passíveis de atuação até que os meios para rotação tenham girado a extremidade distal da bigorna (250, 1250) para uma posição fechada.
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PCT/US2015/063970 WO2016099959A2 (en) | 2014-12-18 | 2015-12-04 | Surgical instrument with an anvil that is selectively movable about a discrete non-movable axis relative to a staple cartridge |
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2015
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MX2017008108A (es) | 2018-03-06 |
RU2017125356A3 (pt) | 2019-06-07 |
RU2703684C2 (ru) | 2019-10-21 |
RU2017125356A (ru) | 2019-01-23 |
US11678877B2 (en) | 2023-06-20 |
US20220225980A1 (en) | 2022-07-21 |
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