BR112018005768B1 - Sistema de cartucho de grampos para uso com um instrumento de grampeamento cirúrgico e sistema de atuador de extremidade cirúrgico - Google Patents
Sistema de cartucho de grampos para uso com um instrumento de grampeamento cirúrgico e sistema de atuador de extremidade cirúrgico Download PDFInfo
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/06—Measuring instruments not otherwise provided for
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07292—Reinforcements for staple line, e.g. pledgets
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
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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
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00004—(bio)absorbable, (bio)resorbable, resorptive
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07228—Arrangement of the staples
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07271—Stapler heads characterised by its cartridge
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0807—Indication means
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Abstract
SISTEMAS DE ADJUNTO IMPLANTÁVEL PARA DETERMINAR A INCLINAÇÃO DO ADJUNTO. É fornecido um auxiliar implantável para uso com um instrumento de grampeamento cirúrgico. O auxiliar implantável compreende meios para permitir que um médico determine o grau de inclinação, se houver, que o auxiliar pode sofrer quando implantado em um indivíduo com um instrumento de grampeamento cirúrgico. O auxiliar implantável compreende um ou mais sistemas de referência configurados para serem comparados com os grampos, as bordas do auxiliar e/ou quaisquer outros elementos auxiliares por um médico uma vez que o auxiliar foi implantado no indivíduo. O um ou mais sistemas de referência compreendem referências que definem uma ou mais zonas do auxiliar. Um médico pode determinar visualmente que zona ou zonas do auxiliar os grampos adquiriram satisfatória e/ou insatisfatoriamente.
Description
[0001] Atualmente, existem vários métodos utilizados para reter um adjunto implantável em um cartucho de grampos e/ou em uma bigorna de um instrumento de grampeamento cirúrgico antes de o instrumento de grampeamento cirúrgico ser disparado. Entretanto, após o instrumento de grampeamento cirúrgico ser disparado e o adjunto implantável ser implantado no tecido por uma pluralidade de grampos, o médico pode ou não ser capaz de determinar se o adjunto implantável ficou desalinhado ou inclinado em relação ao cartucho de grampos durante a manipulação, o posicionamento e/ou o disparo do instrumento. Atualmente, o médico simplesmente olha o adjunto implantado para estimar se o adjunto foi adequadamente capturado pelos grampos ou não. Dessa forma, existe uma necessidade de ser capaz de determinar claramente se o adjunto foi adequadamente capturado pelos grampos. A discussão anteriormente mencionada se destina somente a ilustrar vários aspectos da técnica relacionada no campo da invenção no momento e não deve ser tomada como uma negação do escopo das concretizações.
[0002] A presente invenção refere-se a um adjunto implantável para uso com um instrumento de grampeamento cirúrgico. O adjunto implantável destina-se a ser implantado em um indivíduo com o uso de um instrumento de grampeamento cirúrgico. Uma pluralidade de grampos é configurada para ser disparada a partir do instrumento cirúrgico para prender o tecido e implantar o adjunto. O adjunto compreende um sistema de referência para amplificar visualmente a posição dos grampos em relação ao adjunto implantável quando os grampos tiverem sido disparados. A discussão supracitada tem a intenção apenas de ilustrar certos aspectos da invenção e não deve ser tomada como uma contradição do escopo da concretização.
[0003] Vários recursos das modalidades aqui descritas são demonstrados com particularidade nas concretizações anexas. As várias modalidades, porém, no que se refere tanto à organização como aos métodos de operação, juntamente com vantagens dos mesmos, podem ser compreendidas de acordo com a descrição apresentada a seguir, considerada em conjunto com os desenhos anexos, da seguinte forma:
[0004] A Figura 1 é uma vista em perspectiva de um sistema de atuador de extremidade, de acordo com ao menos uma modalidade, que compreende uma primeira garra, uma segunda garra e um adjunto implantável que compreende um primeiro sistema de referência;
[0005] A Figura 2 é uma vista em perspectiva do adjunto implantável e do primeiro sistema de referência da Figura 1;
[0006] A Figura 3 é uma vista em seção transversal da primeira garra, do adjunto implantável e do primeiro sistema de referência da Figura 1;
[0007] A Figura 4 é uma vista de topo do adjunto implantável e do primeiro sistema de referência da Figura 1, em que o tecido e o adjunto são capturados por uma pluralidade de grampos de acordo com um primeiro cenário;
[0008] A Figura 5 é uma vista de topo do adjunto implantável e do primeiro sistema de referência da Figura 1, em que o tecido e o adjunto são capturados por uma pluralidade de grampos de acordo com um segundo cenário;
[0009] A Figura 6 é uma vista de topo de um adjunto implantável que compreende um segundo sistema de referência de acordo com ao menos uma modalidade;
[00010] A Figura 7 é uma vista em perspectiva de um adjunto implantável que compreende um terceiro sistema de referência de acordo com ao menos uma modalidade;
[00011] A Figura 8 é uma vista lateral em seção transversal do adjunto implantável da Figura 7 posicionado na primeira garra da Figura 1;
[00012] A Figura 9 é uma vista de topo do adjunto implantável da Figura 7, em que o tecido e o adjunto são capturados por uma pluralidade de grampos de acordo com um primeiro cenário;
[00013] A Figura 10 é uma vista de topo do adjunto implantável da Figura 7, em que o tecido e o adjunto são capturados por uma pluralidade de grampos de acordo com um segundo cenário;
[00014] A Figura 11 é uma vista de topo do adjunto implantável da Figura 7 e de um contorno parcial do sistema de atuador de extremidade da Figura 1 antes de o adjunto implantável ser implantado;
[00015] A Figura 11A a 11C são vistas de topo do adjunto implantável da Figura 7 ilustrando vários cenários de implantação;
[00016] A Figura 12 é uma vista de topo de um adjunto implantável, de acordo com ao menos uma modalidade que compreende um primeiro sistema de referência tecido;
[00017] A Figura 13 é uma vista de topo de um adjunto implantável, de acordo com ao menos uma modalidade, que compreende um segundo sistema de referência tecido; e
[00018] A Figura 14 é uma vista de topo de um adjunto implantável, de acordo com ao menos uma modalidade.
[00019] Os caracteres de referência correspondentes indicam as partes correspondentes através das várias vistas. As exemplificações aqui descritas ilustram várias modalidades da invenção, em uma forma, e tais exemplificações não devem ser consideradas como limitadoras do escopo da invenção em qualquer modo.
[00020] O Requerente do presente pedido também detém os Pedidos de Patente US identificados abaixo que são aqui incorporados, cada um, por referência em suas respectivas totalidades:
[00021] Pedido de Patente US N° de série 12/894.311, intitulado "SURGICAL INSTRUMENTS WITH RECONFIGURABLE SHAFT SEGMENTS"; agora Patente US N° 8.763.877;
[00022] Pedido de Patente US N° de série 12/894.340, intitulado SURGICAL STAPLE CARTRIDGES SUPPORTING NON-LINEARLY ARRANGED STAPLES AND SURGICAL STAPLING INSTRUMENTS WITH COMMON STAPLE-FORMING POCKETS; agora Patente US N° 8.899.463;
[00023] Pedido de Patente US N° de série 12/894.327, intitulado JAW CLOSURE ARRANGEMENTS FOR SURGICAL INSTRUMENTS; agora Patente US N° 8.978.956;
[00024] Pedido de Patente US N° de série 12/894.351, intitulado SURGICAL CUTTING AND FASTENING INSTRUMENTS WITH SEPARATE AND DISTINCT FASTENER DEPLOYMENT AND TISSUE CUTTING SYSTEMS; agora Publicação de Pedido de Patente US N° 2012/0080502;
[00025] Pedido de Patente US N° de série 12/894.338, intitulado IMPLANTABLE FASTENER CARTRIDGE HAVING A NON-UNIFORM ARRANGEMENT; agora Patente US N° 8.864.007;
[00026] Pedido de Patente US N° de série 12/894.369, intitulado IMPLANTABLE FASTENER CARTRIDGE COMPRISING A SUPPORT RETAINER; agora Publicação de Pedido de Patente US N° 2012/0080344;
[00027] Pedido de Patente US N° de série 12/894.312, intitulado IMPLANTABLE FASTENER CARTRIDGE COMPRISING MULTIPLE LAYERS; agora Patente US N° 8.925.782;
[00028] Pedido de Patente US N° de série 12/894.377, intitulado SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE; agora Patente US N° 8.393.514;
[00029] Pedido de Patente US N° de série 12/894.339, intitulado SURGICAL STAPLING INSTRUMENT WITH COMPACT ARTICULATION CONTROL ARRANGEMENT; agora Patente US N° 8.840.003;
[00030] Pedido de Patente US N° de série 12/894.360, intitulado SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAPLE FORMING SYSTEM; agora Publicação de Pedido de Patente US N° 2012/0080484;
[00031] Pedido de Patente US N° de série 12/894.322, intitulado SURGICAL STAPLING INSTRUMENT WITH INTERCHANGEABLE STAPLE CARTRIDGE ARRANGEMENTS; agora Patente US N° 8.740.034;
[00032] Pedido de Patente US N° de série 12/894.350, intitulado SURGICAL STAPLE CARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES; agora Publicação de Pedido de Patente US N° 2012/0080478;
[00033] Pedido de Patente US N° de série 12/894.383, intitulado IMPLANTABLE FASTENER CARTRIDGE COMPRISING BIOABSORBABLE LAYERS; agora Patente US N° 8.752.699;
[00034] Pedido de Patente US N° de série 12/894.389, intitulado COMPRESSIBLE FASTENER CARTRIDGE; agora Patente US N° 8.740.037;
[00035] Pedido de Patente US N° de série 12/894.345, intitulado FASTENERS SUPPORTED BY A FASTENER CARTRIDGE SUPPORT; agora Patente US N° 8.783.542;
[00036] Pedido de Patente US N° de série 12/894.306, intitulado COLLAPSIBLE FASTENER CARTRIDGE; agora Patente US N° 9.044.227;
[00037] Pedido de Patente US N° de série 12/894.318, intitulado FASTENER SYSTEM COMPRISING A PLURALITY OF CONNECTED RETENTION MATRIX ELEMENTS; agora Patente US N° 8.814.024;
[00038] Pedido de Patente US N° de série 12/894.330, intitulado FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND AN ALIGNMENT MATRIX; agora Patente US N° 8.757.465;
[00039] Pedido de Patente US N° de série 12/894.361, intitulado FASTENER SYSTEM COMPRISING A RETENTION MATRIX; agora Patente US N° 8.529.600;
[00040] Pedido de Patente US N° de série 12/894.367, intitulado FASTENING INSTRUMENT FOR DEPLOYING A FASTENER SYSTEM COMPRISING A RETENTION MATRIX; agora Patente US N° 9.033.203;
[00041] Pedido de Patente US N° de série 12/894.388, intitulado FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND A COVER; agora Patente US N° 8.474.677;
[00042] Pedido de Patente US N° de série 12/894.376, intitulado FASTENER SYSTEM COMPRISING A PLURALITY OF FASTENER CARTRIDGES; agora Patente US N° 9.044.228;
[00043] Pedido de Patente US N° de série 13/097.865, intitulado SURGICAL STAPLER ANVIL COMPRISING A PLURALITY OF FORMING POCKETS; agora Publicação de Pedido de Patente US N° 2012/0080488;
[00044] Pedido de Patente US N° de série 13/097.936, intitulado TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER; agora Patente US N° 8.657.176;
[00045] Pedido de Patente US N° de série 13/097.954, intitulado STAPLE CARTRIDGE COMPRISING A VARIABLE THICKNESS COMPRESSIBLE PORTION; agora Publicação de Pedido de Patente US N° 2012/0080340;
[00046] Pedido de Patente US N° de série 13/097.856, intitulado STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN A COMPRESSIBLE PORTION THEREOF; agora Publicação de Pedido de Patente US N° 2012/0080336;
[00047] Pedido de Patente US N° de série 13/097.928, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING DETACHABLE PORTIONS; agora Patente US N° 8.746.535;
[00048] Pedido de Patente US N° de série 13/097.891, intitulado TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISING AN ADJUSTABLE ANVIL; agora Patente US N° 8.864.009;
[00049] Pedido de Patente US N° de série 13/097.948, intitulado STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISTAL PORTION; agora Patente US N° 8.978.954;
[00050] Pedido de Patente US N° de série 13/097.907, intitulado COMPRESSIBLE STAPLE CARTRIDGE ASSEMBLY; agora Publicação de Pedido de Patente US N° 2012/0080338;
[00051] Pedido de Patente US N° de série 13/097.861, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING PORTIONS HAVING DIFFERENT PROPERTIES; agora Publicação de Pedido de Patente US N° 2012/0080337;
[00052] Pedido de Patente US N° de série 13/097.869, intitulado STAPLE CARTRIDGE LOADING ASSEMBLY; agora Patente US N° 8.857.694;
[00053] Pedido de Patente US N° de série 13/097.917, intitulado COMPRESSIBLE STAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS; agora Patente US N° 8.777.004;
[00054] Pedido de Patente US N° de série 13/097.873, intitulado STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTION; agora Patente US N° 8.740.038;
[00055] Pedido de Patente US N° de série 13/097.938, intitulado STAPLE CARTRIDGE COMPRISING COMPRESSIBLE DISTORTION RESISTANT COMPONENTS; agora Patente US N° 9.016.542;
[00056] Pedido de Patente US N° de série 13/097.924, intitulado STAPLE CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR; agora Publicação de Pedido de Patente US N° 2012/0083835;
[00057] Pedido de Patente US N° de série 13/242.029, intitulado SURGICAL STAPLER WITH FLOATING ANVIL; agora Patente US N° 8.893.949;
[00058] Pedido de Patente US N° de série 13/242.066, intitulado CURVED END EFFECTOR FOR A STAPLING INSTRUMENT; agora Publicação de Pedido de Patente US N° 2012/0080498;
[00059] Pedido de Patente US N° de série 13/242.086, intitulado STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK; agora Patente US N° 9.055.941;
[00060] Pedido de Patente US N° de série 13/241.912, intitulado STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT; agora Patente US N° 9.050.084;
[00061] Pedido de Patente US N° de série 13/241.922, intitulado SURGICAL STAPLER WITH STATIONARY STAPLE DRIVERS; agora Publicação de Pedido de Patente US N° 2013/0075449;
[00062] Pedido de Patente US N° de série 13/241.637, intitulado SURGICAL INSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING MULTIPLE ACTUATION MOTIONS; agora Patente US N° 8.789.741;
[00063] Pedido de Patente US N° de série 13/241.629, intitulado SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLE END EFFECTOR; agora Publicação de Pedido de Patente US N° 2012/0074200;
[00064] Pedido de Patente US N° de série 13/433.096, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF CAPSULES; agora Publicação de Pedido de Patente US N° 2012/0241496;
[00065] Pedido de Patente US N° de série 13/433.103, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF LAYERS; agora Publicação de Pedido de Patente US N° 2012/0241498;
[00066] Pedido de Patente US N° de série 13/433.098, intitulado EXPANDABLE TISSUE THICKNESS COMPENSATOR; agora Publicação de Pedido de Patente US N° 2012/0241491;
[00067] Pedido de Patente US N° de série 13/433.102, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING A RESERVOIR; agora Publicação de Pedido de Patente US N° 2012/0241497;
[00068] Pedido de Patente US N° de série 13/433.114, intitulado RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR; agora Publicação de Pedido de Patente US N° 2012/0241499;
[00069] Pedido de Patente US N° de série 13/433.136, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING AT LEAST ONE MEDICAMENT; agora Publicação de Pedido de Patente US N° 2012/0241492;
[00070] Pedido da Patente US N° de série 13/433.141, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING CONTROLLED RELEASE AND EXPANSION; agora Publicação de Pedido de Patente US N° 2012/0241493;
[00071] Pedido de Patente US N° de série 13/433.144, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING FIBERS TO PRODUCE A RESILIENT LOAD; agora Publicação de Pedido de Patente US N° 2012/0241500;
[00072] Pedido de Patente US N° de série 13/433.148, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING STRUCTURE TO PRODUCE A RESILIENT LOAD; agora Publicação de Pedido de Patente US N° 2012/0241501;
[00073] Pedido de Patente US N° de série 13/433.155, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING RESILIENT MEMBERS; agora Publicação de Pedido de Patente US N° 2012/0241502;
[00074] Pedido de Patente US N° de série 13/433.163, intitulado METHODS FOR FORMING TISSUE THICKNESS COMPENSATOR ARRANGEMENTS FOR SURGICAL STAPLERS; agora Publicação de Pedido de Patente US N° 2012/0248169;
[00075] Pedido de Patente US N° de série 13/433.167, intitulado TISSUE THICKNESS COMPENSATORS; agora Publicação de Pedido de Patente US N° 2012/0241503;
[00076] Pedido de Patente US N° de série 13/433.175, intitulado LAYERED TISSUE THICKNESS COMPENSATOR; agora Publicação de Pedido de Patente US N° 2012/0253298;
[00077] Pedido de Patente US N° de série 13/433.179, intitulado TISSUE THICKNESS COMPENSATORS FOR CIRCULAR SURGICAL STAPLERS; agora Publicação de Pedido de Patente US N° 2012/0241505;
[00078] Pedido de Patente US N° de série 13/763.028, intitulado ADHESIVE FILM LAMINATE; agora Publicação de Pedido de Patente US N° 2013/0146643;
[00079] Pedido de Patente US N° de série 13/433.115, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING CAPSULES DEFINING A LOW PRESSURE ENVIRONMENT; agora Publicação de Pedido de Patente US N° 2013/0256372;
[00080] Pedido de Patente US N° de série 13/433.118, intitulado TISSUE THICKNESS COMPENSATOR COMPRISED OF A PLURALITY OF MATERIALS; agora Publicação de Pedido de Patente US N° 2013/0256365;
[00081] Pedido de Patente US N° de série 13/433.135, intitulado MOVABLE MEMBER FOR USE WITH A TISSUE THICKNESS COMPENSATOR; agora Publicação de Pedido de Patente US N° 2013/0256382;
[00082] Pedido de Patente US N° de série 13/433.140, intitulado TISSUE THICKNESS COMPENSATOR AND METHOD FOR MAKING THE SAME; agora Publicação de Pedido de Patente US N° 2013/0256368;
[00083] Pedido de Patente US N° de série 13/433.129, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF MEDICAMENTS; agora Publicação de Pedido de Patente US N° 2013/0256367;
[00084] Pedido de Patente US N° de série 11/216.562, intitulado STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS, agora Patente US N° 7.669.746;
[00085] Pedido de Patente US N° de série 11/714.049, intitulado SURGICAL STAPLING DEVICE WITH ANVIL HAVING STAPLE FORMING POCKETS OF VARYING DEPTHS, agora Publicação de Pedido de Patente US N° 2007/0194082;
[00086] Pedido de Patente US N° de série 11/711.979, intitulado SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS, agora Patente US N° 8.317.070;
[00087] Pedido de Patente US N° de série 11/711.975, intitulado SURGICAL STAPLING DEVICE WITH STAPLE DRIVERS OF DIFFERENT HEIGHT, agora Publicação de Pedido de Patente US N° 2007/0194079;
[00088] Pedido de Patente US N° de série 11/711.977, intitulado SURGICAL STAPLING DEVICE WITH STAPLE DRIVER THAT SUPPORTS MULTIPLE WIRE DIAMETER STAPLES, agora Patente US N° 7.673.781;
[00089] Pedido de Patente US N° de série 11/712.315, intitulado SURGICAL STAPLING DEVICE WITH MULTIPLE STACKED ACTUATOR WEDGE CAMS FOR DRIVING STAPLE DRIVERS, agora Patente US N° 7.500.979;
[00090] Pedido de Patente US N° de série 12/038.939, intitulado STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS, agora Patente US N° 7.934.630;
[00091] Pedido de Patente US N° de série 13/020.263, intitulado SURGICAL STAPLING SYSTEMS THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS, agora Patente US N° 8.636.187;
[00092] Pedido de Patente US N° de série 13/118.278, intitulado ROBOTICALLY-CONTROLLED SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS, agora Publicação de Pedido de Patente US N° 2011/0290851;
[00093] Pedido de Patente US N° de série 13/369.629, intitulado ROBOTICALLY-CONTROLLED CABLE-BASED SURGICAL END EFFECTORS, agora Patente US N° 8.800.838;
[00094] Pedido de Patente US N° de série 12/695.359, intitulado SURGICAL STAPLING DEVICES FOR FORMING STAPLES WITH DIFFERENT FORMED HEIGHTS, agora Patente US N° 8.464.923;
[00095] Pedido de Patente US N° de série 13/072.923, intitulado STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS, agora Patente US N° 8.567.656;
[00096] Pedido de Patente US N° de série 13/766.325, intitulado LAYER OF MATERIAL FOR A SURGICAL END EFFECTOR; agora Publicação de Pedido de Patente US N° 2013/0256380;
[00097] Pedido de Patente US N° de série 13/763.078, intitulado ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTOR; agora Publicação de Pedido de Patente US N° 2013/0256383;
[00098] Pedido de Patente US N° de série 13/763.094, intitulado LAYER COMPRISING DEPLOYABLE ATTACHMENT MEMBERS; agora Publicação de Pedido de Patente US N° 2013/0256377;
[00099] Pedido de Patente US N° de série 13/763.106, intitulado END EFFECTOR COMPRISING A DISTAL TISSUE ABUTMENT MEMBER; agora Publicação de Pedido de Patente US N° 2013/0256378;
[000100] Pedido de Patente US N° de série 13/433.147, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS; agora Publicação de Pedido de Patente US N° 2013/0256369;
[000101] Pedido de Patente US N° de série 13/763.112, intitulado SURGICAL STAPLING CARTRIDGE WITH LAYER RETENTION FEATURES; agora Publicação de Pedido de Patente US N° 2013/0256379;
[000102] Pedido de Patente US N° de série 13/763.035, intitulado ACTUATOR FOR RELEASING A TISSUE THICKNESS COMPENSATOR FROM A FASTENER CARTRIDGE; agora Publicação de Pedido de Patente US N° 2013/0214030;
[000103] Pedido de Patente US N° de série 13/763.042, intitulado RELEASABLE TISSUE THICKNESS COMPENSATOR AND FASTENER CARTRIDGE HAVING THE SAME; agora Publicação de Pedido de Patente US N° 2013/0221063;
[000104] Pedido de Patente US N° de série 13/763.048, intitulado FASTENER CARTRIDGE COMPRISING A RELEASABLE TISSUE THICKNESS COMPENSATOR; agora Publicação de Pedido de Patente US N° 2013/0221064;
[000105] Pedido de Patente US N° de série 13/763.054, intitulado FASTENER CARTRIDGE COMPRISING A CUTTING MEMBER FOR RELEASING A TISSUE THICKNESS COMPENSATOR; agora Publicação de Pedido de Patente US N° 2014/0097227;
[000106] Pedido de Patente US N° de série 13/763.065, intitulado FASTENER CARTRIDGE COMPRISING A RELEASABLY ATTACHED TISSUE THICKNESS COMPENSATOR; agora Publicação de Pedido de Patente US N° 2013/0221065;
[000107] Pedido de Patente US N° de série 13/763.021, intitulado STAPLE CARTRIDGE COMPRISING A RELEASABLE COVER; agora Publicação de Pedido de Patente US N° 2014/0224686;
[000108] Pedido de Patente US N° de série 13/763.078, intitulado ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTOR; agora Publicação de Pedido de Patente US N° 2013/0256383;
[000109] Pedido de Patente US N° de série 13/763.095, intitulado LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES; agora Publicação de Pedido de Patente US N° 2013/0161374;
[000110] Pedido de Patente US N° de série 13/763.147, intitulado IMPLANTABLE ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES; agora Publicação de Pedido de Patente US N° 2013/0153636;
[000111] Pedido de Patente US N° de série 13/763.192, intitulado MULTIPLE THICKNESS IMPLANTABLE LAYERS FOR SURGICAL STAPLING DEVICES; agora Publicação de Pedido de Patente US N° 2013/0146642;
[000112] Pedido de Patente US N° de série 13/763.161, intitulado RELEASABLE LAYER OF MATERIAL AND SURGICAL END EFFECTOR HAVING THE SAME; agora Publicação de Pedido de Patente US N° 2013/0153641;
[000113] Pedido de Patente US N° de série 13/763.177, intitulado ACTUATOR FOR RELEASING A LAYER OF MATERIAL FROM A SURGICAL END EFFECTOR; agora Publicação de Pedido de Patente US N° 2013/0146641;
[000114] Pedido de Patente US N° de série 13/763.037, intitulado STAPLE CARTRIDGE COMPRISING A COMPRESSIBLE PORTION; agora Publicação de Pedido de Patente US N° 2014/0224857;
[000115] Pedido de Patente US N° de série 13/433.126, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING TISSUE INGROWTH FEATURES; agora Publicação de Pedido de Patente US N° 2013/0256366;
[000116] Pedido de Patente US N° de série 13/433.132, intitulado DEVICES AND METHODS FOR ATTACHING TISSUE THICKNESS COMPENSATING MATERIALS TO SURGICAL STAPLING INSTRUMENTS; agora Publicação de Pedido de Patente US N° 2013/0256373;
[000117] Pedido de Patente US N° de série 13/851.703, intitulado FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR INCLUDING OPENINGS THEREIN; agora Publicação de Pedido de Patente US N° 2014/0291382;
[000118] Pedido de Patente US N° de série 13/851.676, intitulado TISSUE THICKNESS COMPENSATOR COMPRISING A CUTTING MEMBER PATH; agora Publicação de Pedido de Patente US N° 2014/0291379;
[000119] Pedido de Patente US N° de série 13/851.693, intitulado FASTENER CARTRIDGE ASSEMBLIES; agora Publicação de Pedido de Patente US N° 2014/0291381;
[000120] Pedido de Patente US N° de série 13/851.684, intitulado FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR AND A GAP SETTING ELEMENT; agora Publicação de Pedido de Patente US N° 2014/0291380;
[000121] Pedido de Patente US N° de série 14/187.387, intitulado STAPLE CARTRIDGE INCLUDING A BARBED STAPLE, agora Publicação de Pedido de Patente US N° 2014/0166724;
[000122] Pedido de Patente US N° de série 14/187.395, intitulado STAPLE CARTRIDGE INCLUDING A BARBED STAPLE, agora Publicação de Pedido de Patente US N° 2014/0166725;
[000123] Pedido de Patente US N° de série 14/187.400, intitulado STAPLE CARTRIDGE INCLUDING A BARBED STAPLE, agora Publicação de Pedido de Patente US N° 2014/0166726;
[000124] Pedido de Patente US N° de série 14/187.383, intitulado IMPLANTABLE LAYERS AND METHODS FOR ALTERING IMPLANTABLE LAYERS FOR USE WITH SURGICAL FASTENING INSTRUMENTS, agora Publicação de Pedido de Patente US N° 2015/0238185;
[000125] Pedido de Patente US N° de série 14/187.386, intitulado IMPLANTABLE LAYERS AND METHODS FOR ALTERING ONE OR MORE PROPERTIES OF IMPLANTABLE LAYERS FOR USE WITH FASTENING INSTRUMENTS, agora Publicação de Pedido de Patente US N° 2015/0239180;
[000126] Pedido de Patente US N° de série 14/187.390, intitulado IMPLANTABLE LAYERS AND METHODS FOR MODIFYING THE SHAPE OF THE IMPLANTABLE LAYERS FOR USE WITH A SURGICAL FASTENING INSTRUMENT, agora Publicação de Pedido de Patente US N° 2015/0238188;
[000127] Pedido de Patente US N° de série 14/187.389, intitulado IMPLANTABLE LAYER ASSEMBLIES, agora Publicação de Pedido de Patente US N° 2015/0238187;
[000128] Pedido de Patente US N° de série 14/187.385, intitulado IMPLANTABLE LAYERS COMPRISING A PRESSED REGION, agora Publicação de Pedido de Patente US N° 2015/0238191;
[000129] Pedido de Patente US N° de série 14/187.384, intitulado FASTENING SYSTEM COMPRISING A FIRING MEMBER LOCKOUT, agora Publicação de Pedido de Patente US N° 2015/0238186;
[000130] Pedido de Patente US N° de série 14/827.856, intitulado IMPLANTABLE LAYERS FOR A SURGICAL INSTRUMENT;
[000131] Pedido de Patente US N° de série 14/827.907, intitulado IMPLANTABLE LAYERS FOR A SURGICAL INSTRUMENT; e
[000132] Pedido de Patente US N° de série 14/827.932, intitulado IMPLANTABLE LAYERS FOR A SURGICAL INSTRUMENT.
[000133] Numerosos detalhes específicos são apresentados para fornecer um completo entendimento da estrutura, função, fabricação e uso geral das modalidades conforme descrito no relatório descritivo e ilustrado nos desenhos anexos. Será entendido pelos versados na técnica, entretanto, que as modalidades podem ser praticadas sem esses detalhes específicos. Em outros casos, operações, componentes e elementos bem conhecidos foram descritos em detalhes de modo a não obscurecer as modalidades descritas no relatório descritivo. As pessoas versadas na técnica entenderão que as modalidades descritas e ilustradas na presente invenção são exemplos não limitadores e, portanto, pode-se entender que os detalhes estruturais e funcionais específicos descritos na presente invenção podem ser representativos e ilustrativos. Podem ser feitas variações e alterações a isso, sem se desviar do escopo das concretizações.
[000134] 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.
[000135] Os termos "proximal" e "distal" são usados na presente invenção com referência a um médico que manipula a porção de cabo do instrumento cirúrgico. O termo "proximal" refere-se à porção mais próxima ao médico, e o termo "distal" refere-se à porção situada na direção oposta ao médico. Também será entendido que, por uma questão de conveniência e clareza, termos espaciais como "vertical", "horizontal", "para cima" e "para baixo" podem ser usados na presente invenção com relação aos desenhos. Entretanto, instrumentos cirúrgicos podem ser usados em muitas orientações e posições, e esses termos não se destinam a ser limitadores e/ou absolutos.
[000136] São fornecidos vários dispositivos e métodos exemplificadores para a realização de procedimentos cirúrgicos laparoscópicos e minimamente invasivos. Entretanto, o versado na técnica entenderá prontamente que os vários métodos e dispositivos aqui descritos podem ser usados em inúmeros procedimentos e aplicações cirúrgicos inclusive, por exemplo, aqueles em conjunto com procedimentos cirúrgicos abertos. Com o avanço da presente Descrição Detalhada, aqueles de habilidade comum na técnica entenderão ainda que os vários instrumentos aqui descritos podem ser inseridos em um corpo de qualquer maneira, como através de um orifício natural, através de uma incisão ou perfuração formada em tecido, etc. As porções funcionais ou porções do atuador de extremidade dos instrumentos podem ser inseridas diretamente no corpo de um paciente ou podem ser inseridas por meio de um dispositivo de acesso que tenha uma canaleta de trabalho através da qual o atuador de extremidade e o eixo de acionamento alongado de um instrumento cirúrgico podem ser avançados.
[000137] Muitos dos pedidos de patente mencionados acima revelam várias camadas que são usadas em conexão com um cartucho de grampos. Quando grampos são distribuídos a partir do cartucho de grampos, os grampos podem capturar ao menos uma camada e implantar a camada, ou camadas, contra o tecido. Abaixo é fornecida uma breve descrição de um sistema de grampeamento cirúrgico. Os cartuchos de grampos e as camadas descritas no presente documento podem ser usados com esse sistema de grampeamento cirúrgico e/ou qualquer sistema de grampeamento adequado.
[000138] 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, ainda, 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.
[000139] 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, em 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.
[000140] 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.
[000141] Ainda 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.
[000142] Um adjunto, ou camada, implantável aqui descritos compreendem meios para possibilitar que um médico determine o grau de inclinação, se houver, que o adjunto sofre quando implantado contra o tecido de um paciente por um instrumento de grampeamento cirúrgico. O adjunto implantável compreende um ou mais sistemas de referência configurados para auxiliar um médico na avaliação da posição dos grampos no adjunto quando o adjunto tiver sido implantado no indivíduo pelos grampos. Os sistemas de referência são posicionados sobre e/ou no adjunto para corresponder aos recursos do instrumento de grampeamento. Além disso, o um ou mais sistemas de referência definem, ainda, diferentes zonas do adjunto. Quando o adjunto capturado ou capturado pelos grampos, um médico pode determinar facilmente qual zona, ou quais zonas, do adjunto os grampos capturaram satisfatória e/ou insatisfatoriamente.
[000143] Um adjunto implantável aqui descrito pode compreender zonas diferentes definidas por um ou mais sistemas de referência. O médico é capaz de ver as diferentes zonas para distinguir mais facilmente a posição dos grampos formados em relação às bordas do adjunto, das fileiras de grampos formadas e/ou dos sistemas de referência do adjunto. Em várias modalidades, o um ou mais sistemas e/ou zonas de referência são usados para determinar se o adjunto implantável sofreu inclinação lateral e/ou longitudinal após ser implantado com o instrumento cirúrgico pela comparação da posição dos grampos formados em relação ao um ou mais sistemas de referência e pela determinação de em qual zona, ou quais zonas, do adjunto os grampos formados adquiriram o adjunto. Quando um médico pode ver que zonas do adjunto os grampos capturaram, o médico pode determinar a qualidade da captura dos grampos e decidir, ainda, se e qual ação adicional pode ser necessária.
[000144] Um conjunto de atuador de extremidade, ou sistema, 100 é representado na Figura 1. O conjunto de atuador de extremidade 100 compreende uma primeira garra 101, uma segunda garra 103 e um adjunto implantável 120. A primeira garra 101 compreende um cartucho de grampos 130 e um canal de cartucho 150. O cartucho de grampos 130 compreende uma bandeja de cartucho 140 que é configurada para conter uma pluralidade de acionadores de grampos, que sustentam uma pluralidade de grampos 132 e um deslizador no cartucho de grampos 130. O canal de cartucho 150 é configurado para alojar o cartucho de grampos 130 e é operacionalmente acoplado ao conjunto de atuador de extremidade 100. O cartucho de grampos 130 é prontamente removível da primeira garra 101 e pode ser substituído por um outro cartucho de grampos. São previstas outras modalidades nas quais o cartucho de grampos 130 não é prontamente removível da primeira garra 101. A segunda garra 103 compreende uma bigorna 110 que compreende uma superfície de formação de grampo 113. A superfície de formação de grampo 113 compreende uma pluralidade de bolsos de formação configurados para deformar os grampos 132. A segunda garra 103 é giratória em relação à primeira garra 101 e, dessa forma, a bigorna 110 é giratória em relação ao cartucho de grampo 130; entretanto, são previstas determinadas modalidades nas quais o cartucho de grampos 130 é giratório em relação à bigorna 110.
[000145] O cartucho de grampos 130 compreende um corpo de cartucho 139 que inclui uma plataforma de cartucho 135, uma pluralidade de cavidades de grampo 131 definidas no corpo de cartucho 139 e configuradas para armazenar a pluralidade de grampos 132 e/ou qualquer outro prendedor adequado em seu interior, e uma fenda longitudinal 137 configurada para receber um membro de corte 160. O corpo de cartucho 139 compreende uma porção de extremidade proximal 139P, uma porção de extremidade distal 139D e bordas laterais externas 138. O membro de corte 160 é configurado para atravessar a fenda 137 a partir da porção de extremidade proximal 139P até a porção de extremidade distal 139D a fim de empurrar o deslizador distalmente e acionar os grampos 132 em direção à superfície de formação de grampo 113, ponto em que a superfície de formação de grampo 113 deforma os grampos 132.
[000146] As cavidades de grampo 131 e os grampos 132 armazenados nas cavidades de grampo 131 estão dispostos em uma pluralidade de fileiras longitudinais em cada lado da fenda 137. Em um lado da fenda 137, a pluralidade de fileiras compreende uma fileira interna de cavidades de grampo 131C posicionadas adjacentes e lateralmente para fora em relação à fenda 137, uma fileira externa de cavidades de grampo 131A posicionadas adjacentes e lateralmente para dentro em relação à borda lateral externa 138 do cartucho de grampos 130, e uma fileira intermediária de cavidades de grampo 131B posicionadas entre a fileira externa de cavidades de grampo 131A e a fileira interna de cavidades de grampo 131C. Em outras palavras, as fileiras internas de cavidades de grampo 131C ficam mais próximas à fenda 137, as fileiras externas de cavidades de grampo 131A ficam mais próximas às bordas do cartucho e, em cada lado da fenda 137, as fileiras intermediárias de cavidades de grampo 131B são intermediárias à fileira interna de cavidades de grampo 131C e à fileira externa de cavidades de grampo 131A. As cavidades de grampo 131 também compreendem cavidades de grampo proximais perto da porção de extremidade proximal 139P do corpo de cartucho 139, as quais definem um dado de captura proximal PPD, e cavidades distais de grampo perto da porção de extremidade distal 139D do corpo de cartucho 139, as quais definem um dado de captura distal DPD.
[000147] Com referência agora às Figuras 2 a 5, o adjunto implantável 120 compreende bordas de adjuntos externas 122, uma superfície de contato com o tecido 124 voltada para a superfície de formação de grampo 113 da bigorna 110 quando fixada ao cartucho de grampos 130, uma superfície de contato com a plataforma 121 voltada para a plataforma 137 e um sistema de referência 123. O sistema de referência 123 é visível ao menos sobre a superfície de contato com a plataforma 121 do adjunto implantável 120. Outras modalidades são previstas nas quais o adjunto implantável 120 é fixado à bigorna 110 e/ou à superfície de formação de grampo 113 do instrumento cirúrgico, e, nesse caso, o sistema de referência 123 ficaria visível sobre uma superfície de contato com a bigorna voltada para a superfície de formação de grampo 113. O adjunto 120 pode ser retido de modo liberável à plataforma do cartucho 137 do cartucho de grampos 130 ou à superfície de formação de grampo 113 através de quaisquer meios adequados como correias, adesivo, pinos, uma conexão de encaixe por pressão e/ou VELCRO, por exemplo.
[000148] O sistema de referência 123 compreende referências laterais externas 125 e referências laterais internas 126. A localização das referências 125, 126 corresponde às cavidades de grampo 131, às bordas externas 138 do cartucho de grampo 130 e à fenda 137 do cartucho de grampos 130. As referências laterais externas 125 são posicionadas lateralmente para fora (em direção às bordas externas 138 do cartucho de grampos 130) em relação às fileiras externas das cavidades de grampo 131A, e lateralmente para dentro (em direção à fenda 137) em relação às bordas externas 138 do cartucho de grampos 130. As referências laterais internas 126 são posicionadas lateralmente para fora (em direção às bordas externas 138 do cartucho de grampos 130) em relação à fenda 137, e lateralmente para dentro (em direção à fenda 137) em relação às fileiras internas de cavidades de grampo 131C.
[000149] As referências laterais internas 126 e as referências laterais externas 125 podem agir como um indicador de referência ou alvo para análise do médico após o disparo do instrumento de grampeamento cirúrgico. Para auxiliar o médico na determinação da qualidade da captura de grampos, as referências laterais internas 126 e as referências laterais externas 125 definem uma primeira zona 127A e uma segunda zona 127B. A primeira zona 127A compreende a área e/ou o volume do adjunto 120 entre as referências laterais internas 126 e as referências laterais externas 125. A segunda zona 127B compreende a área e/ou o volume do adjunto 120 entre as referências laterais internas 126 bem como a área e/ou o volume do adjunto 120 disposto lateralmente para fora (em direção às bordas externas 138 do cartucho de grampos 130) das referências laterais externas 125.
[000150] Na Figura 4, um primeiro cenário é ilustrado onde o adjunto implantável 120 e o tecido T foram presos pelos grampos 132. O adjunto 120 e o tecido T foram cortados ao menos substancialmente ao longo da linha de corte intencionada CL. O adjunto 120 e o tecido T são presos por múltiplas fileiras de grampos que compreendem fileiras externas de grampos 132A, fileiras intermediárias de grampos 132B e fileiras internas de grampos 132C, que correspondem às fileiras de cavidades de grampo 131A, 131B, 131C, respectivamente. Esse primeiro cenário compreende uma situação em que todos os grampos 132 capturam o adjunto 120 na primeira zona 127A. Em tal cenário, um médico pode identificar visualmente que todos os grampos 132 capturaram o adjunto 120 na primeira zona 127A. Além disso, o sistema de referência 123 também possibilita que o médico determine facilmente que nenhum dos grampos 132 capturou o adjunto 120 na segunda zona 127B. Com base nessas observações, o médico pode ter certeza de que nenhum dos grampos 132 deixou de capturar o adjunto 120. Além disso, o médico pode ter certeza de que nenhum dos grampos 132 capturou o adjunto 120 em uma área que pode próxima demais da borda 122 do adjunto 120, por exemplo, ou em uma área que pode não fornecer preensão ideal do tecido T.
[000151] Na Figura 5, é ilustrado um segundo cenário no qual o adjunto 120 não foi cortado ao longo da linha de corte intencionada CL do adjunto 120. Ao invés disso, neste segundo cenário, o adjunto 120 foi inclinado lateralmente antes de ser implantado e foi cortado ao longo de uma linha de corte real CL'. Ao contrário do primeiro cenário mostrado na Figura 4, o adjunto 120 foi capturado por apenas alguns dos grampos 132. Neste segundo cenário, alguns dos grampos 132 capturaram o adjunto na primeira zona 127A, alguns dos grampos 132 capturaram o adjunto 120 na segunda zona 127B, alguns dos grampos 132 capturaram o adjunto 120 tanto na primeira zona 127A quanto na segunda zona 127B, e alguns dos grampos 132 não capturaram o adjunto 120. Em tal situação, um médico pode determinar visualmente, com o uso do sistema de referência 123, que alguns dos grampos 132 prenderam, ou capturaram, o adjunto 120 na segunda zona 127B, e que alguns dos grampos 132 deixaram o adjunto 120 escapar. Ser capaz de identificar facilmente o local preciso dos grampos formados 132 em relação às bordas 122 do adjunto 120 possibilita que o médico determine que a qualidade de captura dos grampos 132 na segunda zona 127B pode ser menor que a qualidade de captura dos grampos 132 na primeira zona 127A. Essas informações, facilmente identificáveis usando as zonas 127A, 127B e as referências 125, 126, ajudam o médico a determinar se uma ação adicional é necessária.
[000152] O sistema de referência 123 na Figura 5 amplifica visualmente a posição dos grampos formados 132 em relação às referências 125, 126 do sistema de referência 123. As referências 125, 126 são ao menos substancialmente paralelas às fileiras de grampos formadas 132A, 132B, 132C. Em certos casos, um médico também pode determinar se as zonas 127A, 127B podem estar desalinhadas em relação às fileiras de grampos 132A, 132B, 132C quando as referências 125, 126 não são ao menos substancialmente paralelas às fileiras de grampos 132A, 132B, 132C, uma vez que os grampos são formados em linhas ao menos substancialmente retas neste exemplo.
[000153] Em várias modalidades, a segunda zona 127B discutida acima compreende uma zona externa e uma zona de linha de corte. A zona externa compreende a área da segunda zona 127B posicionada lateralmente para fora em relação às referências laterais externas 125. A zona de linha de corte compreende a área da segunda zona 127B que o membro de corte 160 do instrumento cirúrgico tem por objetivo cortar. Neste exemplo, a zona de linha de corte compreende a área da segunda zona 127B encontrada entre as referências laterais internas 126. Em alguns casos, um médico pode ver que os grampos 132 que capturam o adjunto 120 na zona de linha de corte necessitam de uma inspeção mais de perto que os grampos 132 que capturam o adjunto 120 na zona externa. Isso se deve ao fato de que os grampos 132 próximos à zona de linha de corte estão em estreita proximidade com o tecido recém- cortado. O médico pode ver os grampos 132 na zona de linha de corte como um risco maior em termos de ligação ou união do tecido devido ao tecido recém-cortado nesta área. Além disso, pode ser mais importante ter uma captura de grampo de qualidade superior próxima à linha de corte intencionada CL, ou na zona de linha de corte no geral, do que na zona externa.
[000154] Além disso, a forma dos grampos pode ser afetada se o adjunto 120 ficar inclinado antes de ser grampeado. Por exemplo, uma forma de grampo desejada pode ser uma forma B, uma forma de gravata borboleta ou uma forma de caixa, por exemplo, e, se os grampos agarrarem apenas uma borda do adjunto 120 e/ou perderem o adjunto 120 totalmente, os grampos podem não se formar da maneira desejada. O cirurgião pode usar o sistema de referência para procurar grampos que podem ter assumido uma forma de grampo diferente daquela pretendida.
[000155] Em várias modalidades, os sistemas de referência aqui descritos podem compreender cores diferentes, por exemplo. Zonas de cores diferentes ajudam o médico a determinar mais facilmente onde o membro de corte 160 ou a faca do instrumento cirúrgico cortou o adjunto implantável 120 em um local desejado. Por exemplo, a zona de linha de corte da segunda zona 127B discutida acima pode compreender uma primeira cor, como amarela, e a primeira zona 127A pode compreender uma segunda cor, como azul. As cores podem ser quaisquer cores adequadas. No caso de o membro de corte 160 cortar a primeira zona 127A do adjunto 120, por exemplo, o membro de corte 160 corta através, ao menos parcialmente, das zonas amarelas e azuis, e um médico seria capaz de distinguir visualmente, com o uso do contraste de cores, onde o membro de corte 160 cortou o adjunto 120. Além disso, esse sistema de referência, juntamente com os outros sistemas de referência aqui descritos, pode mostrar se o adjunto sobre o cartucho de grampos foi inclinado com relação às linhas de grampos do cartucho de grampos quando o cartucho de grampos foi inserido e/ou manipulado dentro do sítio cirúrgico. Muitos desses sistemas de referência só serão visíveis após os grampos terem sido disparados e o atuador de extremidade ter sido liberado do tecido. Nesse ponto, um cirurgião pode usar os sistemas de referência para ver se as zonas adequadas no adjunto estão ou não alinhadas com as linhas de grampo e determinar o impacto, se houver, quando o adjunto tiver sido deslocado em relação às linhas de grampo e se quaisquer outras ações corretivas adicionais são necessárias.
[000156] A Figura 6 representa um outro sistema de referência 223 empregado com um adjunto implantável 220. O sistema de referência 223 é similar ao sistema de referência 123 em muitos aspectos, entretanto, o sistema de referência 223, visível ao menos em uma superfície de contato com a plataforma 221, compreende apenas uma referência lateral interna 226. A referência lateral interna 226 está alinhada, ou está ao menos substancialmente alinhada, com a linha de corte intencionada CL. O sistema de referência 223 compreende ainda referências laterais externas 225 dispostas de modo similar ao das referências laterais externas 125 discutidas acima. O sistema de referência 223 define uma primeira zona 227A e uma segunda zona 227B. A primeira zona 227A compreende a área e/ou o volume do adjunto 220 situados entre as referências laterais externas 225, e é projetada para ser dividida, separada e/ou bifurcada ao longo da linha de corte intencionada CL pelo membro de corte 160, por exemplo. A segunda zona 227B compreende a área e/ou o volume restantes do adjunto 220 situado lateralmente para fora (em direção às bordas 122) das referências laterais externas 225. A referência lateral interna 226 é configurada para ser cortada e, se o adjunto 220 não se deslocar em relação ao cartucho 130 durante o procedimento de grampeamento, a referência lateral interna 226 será cortada completamente. Em alguns casos, um médico pode não ser capaz de ver a referência lateral interna 226 se nenhuma inclinação lateral tiver ocorrido devido ao fato de a referência lateral interna 226 ter sido totalmente cortada. Modalidades são previstas nas quais a primeira zona 227A compreende cores diferentes; uma cor em um lado da fenda 137 e uma cor no outro lado da fenda 137. Em ao menos uma modalidade, a referência 226 divide as duas cores. Isso possibilita que o médico determine com maior precisão onde o membro de corte 160 atravessou o adjunto implantável 220. Por exemplo, se o membro de corte 160 cortar o adjunto implantável 220 em um local diferente da linha de corte intencionada CL, o médico será capaz de ver a primeira cor e a segunda cor em um lado da linha de corte real CL'. O médico determinará, então, que o membro de corte 160 não cortou o adjunto 220 ao longo da linha de corte intencionada CL.
[000157] Uma outra modalidade alternativa inclui um sistema de referência que compreende referências laterais, similares àquelas discutidas acima, que são posicionadas entre e ao menos substancialmente paralelas a cada fileira de grampos. Por exemplo, uma primeira referência lateral é posicionada de modo que a primeira referência lateral corresponde a uma posição entre a fileira externa de grampos e a fileira intermediária de grampos, enquanto uma segunda referência lateral é posicionada de modo que a segunda referência lateral corresponde a uma posição entre a fileira intermediária de grampos e a fileira interna de grampos. Se os grampos adquirem o adjunto 220 de modo que um ou mais grampos formados cruzam, atravessam e/ou capturam a primeira referência lateral e/ou a segunda referência lateral, o médico pode determinar facilmente que o adjunto 220 se inclinou lateralmente antes de ser implantado.
[000158] Com relação agora às Figuras 7 a 11C, um adjunto 320 compreende uma borda proximal 328P, uma borda distal 328D, uma superfície de contato com a plataforma 321 e um sistema de referência 323. O sistema de referência 323 é configurado para possibilitar que um médico determine a inclinação longitudinal do adjunto 320 em relação ao cartucho de grampos 130 e/ou aos grampos 132, por exemplo. Esse sistema de referência 323 pode ser empregado com outros sistemas de referência apresentados na presente invenção; entretanto, para maior clareza, o sistema de referência 323 é mostrado independentemente.
[000159] O sistema de referência 323 é visível ao menos sobre a superfície de contato com a plataforma 321 do adjunto 120. O sistema de referência 323 é configurado para exibir ou amplificar visualmente qualquer deslocamento longitudinal do adjunto 320 quando ele é implantado em um indivíduo. Um médico pode usar o sistema de referência 323 de maneira similar àquela dos outros sistemas de referência apresentados na presente invenção. O sistema de referência 323 compreende uma referência proximal 325 e uma referência distal 326. As referências 325, 326 são perpendiculares, ou ao menos substancialmente perpendiculares, à linha de corte intencionada CL. A referência proximal 325 é disposta próxima à borda proximal 328P do adjunto 320, e a referência distal 326 é disposta próximo à borda distal 328D do adjunto 320. Modalidades são previstas nas quais o sistema de referência 323 compreende uma ou mais referências longitudinais intermediárias posicionadas entre a referência proximal 325 e a referência distal 326. Outras modalidades são previstas nas quais o sistema de referência 323 compreende apenas uma entre a referência proximal 325 e a referência distal 326.
[000160] A referência proximal 325 e a referência distal 326 podem agir como um indicador de referência ou alvo para o médico após o disparo do instrumento de grampeamento cirúrgico. A referência proximal 325 está situada de maneira proximal ao dado de captura proximal PPD (discutido acima). A referência distal 326 está situada distal ao dado de captura distal DPD (discutido acima). As referências 325, 326 definem uma zona proximal 327A, uma zona intermediária 327B e uma zona distal 327C. A zona proximal 327A compreende a área e/ou volume do adjunto 320 disposto proximal à referência proximal 325. A zona intermediária 327B compreende a área e/ou o volume do adjunto 320 disposto entre a referência proximal 325 e a referência distal 326. A zona distal 327C compreende a área e/ou o volume do adjunto 320 disposto distal à referência distal 326. A zona proximal 327A compreende a borda mais proximal 128P do adjunto 320. A zona distal 327C compreende a borda mais distal 128D do adjunto 320. O dado de captura proximal PPD e o dado de captura distal DPD estão localizados ao menos substancialmente na zona intermediária 327B. Em outras palavras, o dado de captura proximal PPD está localizado proximal à referência distal 326, e o dado de captura distal DPD está localizado distal à referência proximal 325. Outras modalidades são previstas nas quais o dado de captura proximal PPD está alinhado com a referência proximal 325 e o dado de captura distal DPD está alinhado com a referência distal 326.
[000161] No cenário ilustrado na Figura 9, os grampos 132 capturaram o adjunto implantável 320 da maneira mostrada. O adjunto 320 foi cortado ao menos substancialmente ao longo da linha de corte intencionada CL. Este cenário compreende uma situação em que todos os grampos 132 capturam o adjunto 320 na zona intermediária 327B. Quando nenhum dos grampos 132 capturou o adjunto 320 e o tecido T na zona proximal 327A ou na zona distal 327C, o médico pode verificar que o dado PPD, DPD permaneceu entre as referências 325, 326. O médico pode, então, decidir recarregar o instrumento cirúrgico e prosseguir com a próxima parte do procedimento.
[000162] Em um outro cenário ilustrado na Figura 10, os grampos 132 capturaram o adjunto 320 da maneira mostrada. O adjunto 320 foi cortado ao menos substancialmente ao longo da linha de corte intencionada CL. Nesse cenário, alguns dos grampos 132 adquiriram o adjunto 320 na zona intermediária 327B, e alguns dos grampos 132 adquiriram o adjunto 320 tanto na zona intermediária 327B quanto na zona distal 327C. Nesse caso, um médico pode identificar visualmente que alguns dos grampos 132 adquiriram ou capturaram o adjunto na zona distal 327C e que o dado de captura distal DPD dos grampos terminou distal à referência distal 326, o que pode instruir o médico a analisar os grampos 132, especialmente os grampos 132 na zona distal 327C. Essas informações, facilmente identificáveis com o uso do sistema de referência 323, podem ajudar o médico a determinar se uma ação adicional é necessária.
[000163] Quando alguns dos grampos 132 adquirem o adjunto 320 na zona distal 327C, um médico pode querer levar isso em consideração durante o alinhamento do instrumento de grampeamento cirúrgico para executar uma próxima etapa da operação de grampeamento. A referência distal 326 pode agir como uma zona de extremidade que é configurada para ajudar o médico a identificar a extremidade de corte EOC em relação à posição do adjunto implantado 320 e/ou dos grampos 132. A extremidade de corte EOC pode ser definida pelo o ponto mais distante em que o membro de corte 160 cortou o tecido T e o adjunto 320. Com referência às Figuras 11 a 11C, cenários diferentes são representados nos quais o adjunto implantável 320 que emprega o sistema de referência 323 se inclina distalmente (Figura 11A), se inclina proximalmente (Figura 11B) e não se inclina (Figura 11C). Mostrada na Figura 11, a referência distal 326 está em alinhamento com e corresponde à extremidade de corte EOC. A Figura 11A ilustra um cenário em que a referência distal 326 não foi atravessada pelo membro de corte 160. Nesse caso, o médico pode deduzir que o adjunto implantado 320 se inclinou e/ou se estendeu distalmente. A Figura 11B ilustra outro cenário no qual a referência distal 326 foi atravessada pelo membro de corte 160. Nesse caso, o médico pode deduzir que o adjunto implantado 320 se inclinou e/ou encolheu proximalmente. A Figura 11C ilustra um terceiro cenário no qual a referência distal 326 está alinhada, ou está substancialmente alinhada, com a extremidade de corte. Nesse caso, o médico pode deduzir que o adjunto 320 não se inclinou longitudinalmente e que o adjunto 320 foi implantado no alvo.
[000164] A Figura 12 representa um adjunto implantável 400 que compreende um material tecido 421, um sistema de referência 423 integralmente tecido no adjunto 400 e uma superfície de contato com a plataforma 424. O sistema de referência 423, visível ao menos sobre a superfície de contato com a plataforma 424, compreende referências laterais internas 426 e referências laterais externas 425. As referências 425, 426 são costuradas no material tecido 421. Outras modalidades são previstas nas quais as referências 425, 426 são costuradas em um material não tecido. Cada referência 425, 426 pode compreender um fio que tem uma cor que é diferente do material subjacente 421 para ajudar o médico a identificar prontamente as referências 425, 426. As referências laterais internas 426 podem compreender uma primeira cor e as referências laterais externas 425 podem compreender uma segunda cor, em que a primeira cor é diferente da segunda cor. Os fios usados para as referências 425, 426 podem ser tingidos com uma cor ou com cores específicas antes de serem costurados no adjunto 400, por exemplo. Os fios que compreendem as referências 425, 426 podem ser costurados no material 421 e podem ser visíveis em ambos os lados do adjunto 420. Em tal modalidade, o médico poderia usar as referências 425, 426 antes e depois do grampeamento do tecido.
[000165] A Figura 13 representa um adjunto implantável 500 que compreende um sistema de referência tecido 523 e uma superfície de contato com a plataforma 524. O sistema de referência tecido 523 compreende referências laterais externas 525A, 525B e uma referência lateral interna 526. A referência lateral interna 526 é similar àquela da referência lateral interna 226 discutida acima. No cenário representado na Figura 13, o adjunto 500 se moveu lateralmente durante o procedimento de grampeamento cirúrgico. Uma vez que a referência lateral interna 526 corresponde à linha de corte intencionada CL, o médico pode determinar facilmente a inclinação lateral quando vê alguma referência lateral interna 526 em um lado da linha de corte real CL' e alguma referência lateral interna 526 do outro lado da linha de corte real CL'.
[000166] Similar às zonas discutidas acima, o adjunto implantável 500 compreende cores diferentes para amplificar visualmente as zonas do adjunto. Por exemplo, o adjunto 500 compreende cores 530, 540, 550. A cor 530 cobre, ao menos substancialmente, a área da superfície de contato com a plataforma 524 encontrada lateralmente para fora em relação às referências externas 525A, 525B. A cor 540 cobre, ao menos substancialmente, a área da superfície de contato com o tecido 524 encontrada entre a referência lateral externa 525A e a referência lateral interna 526. A cor 550 cobre, ao menos substancialmente, a área da superfície de contato com o tecido encontrada entre a referência lateral externa 525B e a referência lateral interna 526. Tais cores possibilitam que o médico determine com maior precisão onde os grampos 132 capturaram o adjunto 520 e/ou onde o membro de corte 160 atravessou o adjunto implantável 520. Por exemplo, após o disparo do instrumento de grampeamento cirúrgico e a remoção do instrumento do local para ver o adjunto 500, o médico pode ver a cor 540 em um lado da linha de corte real e a cor 550 do outro lado da linha de corte real. Nesse caso, o médico pode determinar que o membro de corte 160 cortou ao menos substancialmente o adjunto através da linha de corte intencionada CL. Se o médico vir ambas as cores 540, 550 em um lado da linha de corte real CL', conforme ilustrado na Figura 13, o médico pode determinar que o adjunto inclinou lateralmente em relação ao cartucho de grampos 130.
[000167] Um adjunto implantável 620 implantado no tecido T é representado na Figura 14. O adjunto implantável 620 compreende um sistema de referência 623, bordas externas 622 e uma linha de corte intencionada CL. O sistema de referência 623 compreende as referências de fileira de grampos 625 que estão alinhadas ou ao menos substancialmente alinhadas com as fileiras de cavidades de grampo 131A, 131B, 131C. As referências de fileira de grampos 625 correspondem às fileiras de cavidades de grampo 131A, 131B, 131C, de modo que uma implantação satisfatória do adjunto 620 compreende uma situação em que os grampos 132 capturam o adjunto 620 ao longo das referências de fileira de grampos 625. Uma implantação potencialmente insatisfatória do adjunto 620, ilustrada na Figura 14, pode compreender uma situação em que as referências de fileira 625 ficam desalinhadas em relação aos grampos 132. O sistema de referência 623 possibilita que um médico identifique o desalinhamento das fileiras de grampos formadas 132A, 132B, 132C em relação às referências de fileira de grampos 625 e determine se uma ação adicional é necessária. Em ao menos uma modalidade, por exemplo, o sistema de referência 623 compreende seis referências de fileira longitudinal 625 que estão alinhadas, ou são alinháveis, com seis fileiras longitudinais de cavidades de grampos e com os grampos armazenados nas mesmas. As referências longitudinais 625 são retas para corresponder às fileiras longitudinais subjacentes retas das cavidades de grampos/grampos; entretanto, modalidades são previstas nas quais as referências longitudinais são curvas para corresponder às fileiras longitudinais curvas subjacentes das cavidades de grampos/grampos.
[000168] Em várias modalidades, os sistemas de referência são tingidos diretamente dentro e/ou sobre o adjunto implantável. Para adjuntos tecidos, as referências podem ser tecidas diretamente no adjunto. Essas referências podem compreender um filamento tingido, por exemplo, que compreende um material igual ou diferente ao do próprio adjunto. Fios de VICRYL podem ser incorporados a um adjunto durante um processo de moldagem por compressão. Os filamentos de VICRYL podem ser especificamente posicionados no molde para corresponder às referências discutidas acima. Para adjuntos fabricados com o uso de um processo de extrusão, o corante pode ser adicionado ao processo de extrusão para tingir diretamente as referências sobre o adjunto. As bordas externas de um adjunto também podem ser tingidas para fornecer referência adicional a um médico caso o adjunto não seja facilmente distinguível do tecido. Por exemplo, um adjunto translúcido pode obstruir a visibilidade através do adjunto quando implantado em um indivíduo. Corante e/ou tinta, por exemplo, podem ser aplicados a um ou a ambos os lados do adjunto para fornecer as referências aqui descritas.
[000169] Em várias modalidades, um sistema de referência pode compreender esquemas de padrão para ajudar um médico a identificar ainda mais a atividade do adjunto. Um exemplo de um esquema de padrão pode compreender círculos de referência, por exemplo. Os círculos podem ser usados para identificar visualmente o estiramento do adjunto. Os círculos se estenderiam para se tornarem ovais, ou encolheriam para se tornarem ovais, o que seria facilmente visível ou discernível para um médico. Outros exemplos de esquemas de padrão incluem um padrão em ziguezague, que se entrelaça ao redor dos grampos, ou formatos que correspondem à posição de cada grampo. Outra atividade do adjunto pode compreender, por exemplo, ruptura, deslizamento, aglomeramento, levantamento, enrugamento, dobra, expansão e/ou contração.
[000170] Métodos para distinguir os grampos do adjunto implantável podem envolver corante para mudança de cor e/ou ativado pelo material. O adjunto pode ser fabricado para incluir corante de mudança de cor que pode ser ativado pelos grampos, fluidos no indivíduo e/ou por recursos do instrumento cirúrgico, como a plataforma do cartucho, por exemplo. Por exemplo, um adjunto pode compreender uma primeira cor configurada para mudar para uma segunda cor após o contato com o material dos grampos. Este método pode realçar ou enfatizar, por exemplo, a presença dos grampos ao mesmo tempo e/ou depois que os grampos adquirem o adjunto.
[000171] A fim de amplificar a visibilidade dos grampos em uma modalidade que compreende um adjunto transparente, o adjunto pode compreender uma bexiga interna e um corpo externo que circunda a bexiga interna. A bexiga interna pode compreender um primeiro corante de cor configurado para ser liberado mediante a perfuração da bexiga interna pelos grampos. Em ao menos um caso, o corante é configurado para emergir do adjunto e/ou sobre as pernas dos grampos para amplificar a localização dos grampos em relação ao adjunto.
[000172] Outras modalidades são previstas nas quais a bigorna do instrumento cirúrgico compreende recursos configurados para estampar as referências sobre a superfície de contato com o tecido do adjunto.
[000173] Exemplo 1 — Um sistema de cartucho de grampos para uso com um instrumento de grampeamento cirúrgico, em que o sistema de cartucho de grampos compreende um corpo de cartucho que inclui uma fenda longitudinal configurada para receber um membro de corte, uma plataforma e uma pluralidade de cavidades de grampo compreendendo uma fileira externa de cavidades de grampo e uma fileira interna de cavidades de grampo posicionadas de modo adjacente à fenda longitudinal. O sistema de cartucho de grampos compreende, ainda, uma pluralidade de grampos armazenados de modo removível dentro das cavidades de grampo, em que os grampos são configurados para serem ejetados a partir das cavidades de grampos de uma posição não disparada para uma posição disparada, e um adjunto implantável posicionado adjacente à plataforma, em que o adjunto implantável é configurado para ser implantado em um indivíduo quando os grampos são ejetados das cavidades de grampos para a posição disparada, em que o adjunto implantável compreende um sistema de referência que define uma primeira zona e uma segunda zona, e em que o sistema de referência é configurado para auxiliar um médico na determinação da posição dos grampos em relação à primeira zona e à segunda zona quando os grampos estão na posição disparada.
[000174] Exemplo 2 — O sistema de cartucho de grampos do Exemplo 1, em que o sistema de referência compreende uma referência longitudinal posicionada de modo que o médico possa determinar a quantidade de inclinação longitudinal do adjunto implantável através da comparação dos grampos com a referência longitudinal quando os grampos estão na posição disparada.
[000175] Exemplo 3 - O sistema de cartucho de grampos dos Exemplos 1 ou 2, em que a pluralidade de cavidades de grampo compreende ao menos uma cavidade mais distal e ao menos uma cavidade mais proximal, em que a ao menos uma cavidade mais distal define um dado de captura distal, e a ao menos uma cavidade mais proximal define um dado de captura proximal, e em que o dado de captura distal e o dado de captura proximal estão posicionados na primeira zona quando os grampos estão na posição não disparada.
[000176] Exemplo 4 — O sistema de cartucho de grampos dos Exemplos 1, 2 ou 3, em que o sistema de referência compreende uma referência lateral posicionada de modo que um médico possa determinar a quantidade de inclinação lateral do adjunto implantável através da comparação dos grampos com a referência quando os grampos estão na posição disparada.
[000177] Exemplo 5 — O sistema de cartucho de grampos do Exemplo 4, em que o corpo de cartucho compreende uma borda externa, em que a fileira externa de cavidades de grampo é posicionada adjacente à borda externa, e em que a referência lateral compreende uma primeira referência posicionada entre a borda externa e a fileira externa de cavidades de grampo.
[000178] Exemplo 6 — O sistema de cartucho de grampos do Exemplo 5, em que o sistema de referência compreende ainda uma segunda referência posicionada entre a fileira interna de cavidades de grampo e a fenda.
[000179] Exemplo 7 — O sistema de cartucho de grampos dos Exemplos 1, 2, 3, 4, 5 ou 6, em que o sistema de referência compreende um corante aplicado ao adjunto implantável.
[000180] Exemplo 8 — O sistema de cartucho de grampos dos Exemplos 1, 2, 3, 4, 5, 6 ou 7, em que o adjunto implantável compreende um material tecido.
[000181] Exemplo 9 — O sistema de cartucho de grampos do Exemplo 8, em que a referência compreende um filamento colorido tecido no material tecido.
[000182] Exemplo 10 — O sistema de cartucho de grampos dos Exemplos 1, 2, 3, 4, 5, 6, 7, 8 ou 9, em que o adjunto implantável compreende um material não tecido.
[000183] Exemplo 11 — O sistema de cartucho de grampos dos Exemplos 1, 2, 3, 4, 5, 6, 7, 8, 9, ou 10, em que a primeira zona compreende uma primeira cor e uma segunda cor, em que a primeira cor e a segunda cor são divididas por uma linha de corte intencionada, e em que o membro de corte é configurado para cortar o adjunto implantável ao longo da linha de corte intencionada.
[000184] Exemplo 12 — O sistema de cartucho de grampos dos Exemplos 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, ou 11, em que o sistema de referência compreende duas referências laterais internas, em que a área entre as duas referências laterais internas define a segunda zona, e em que o membro de corte é configurado para cortar o adjunto implantável na segunda zona.
[000185] Exemplo 13 — Um sistema de cartucho de grampos para uso com um instrumento de grampeamento cirúrgico, o sistema de cartucho de grampos compreendendo um corpo de cartucho que inclui uma fenda longitudinal configurada para receber um membro de corte, uma plataforma e uma pluralidade de cavidades de grampo disposta em uma pluralidade de fileiras longitudinais. O sistema de cartucho de grampos compreende, ainda, uma pluralidade de grampos armazenados de modo removível dentro das cavidades de grampo, em que os grampos são configurados para serem ejetados a partir das cavidades de grampos para uma posição disparada, e um adjunto implantável posicionado acima da plataforma, em que o adjunto implantável é configurado para ser implantado em um indivíduo quando os grampos são ejetados a partir das cavidades de grampos para a posição disparada, e em que o adjunto implantável compreende uma referência para determinar o alinhamento da pluralidade de grampos em relação ao adjunto implantável quando os grampos estão na posição disparada.
[000186] Exemplo 14 — O sistema de cartucho de grampos do Exemplo 13, em que a pluralidade de cavidades de grampo compreende uma fileira externa de cavidades de grampo e uma fileira interna de cavidades de grampo, em que a fileira interna de cavidades de grampo é adjacente à fenda longitudinal, e em que o sistema de referência compreende uma primeira referência que corresponde à fileira interna de cavidades de grampo e uma segunda referência que corresponde à fileira externa de cavidades de grampo.
[000187] Exemplo 15 — O sistema de cartucho de grampos dos Exemplos 13 ou 14, em que o adjunto implantável compreende um material tecido.
[000188] Exemplo 16 — O sistema de cartucho de grampos dos Exemplos 13, 14 ou 15, em que o adjunto implantável compreende um material não tecido.
[000189] Exemplo 17 — Um sistema de atuador de extremidade cirúrgico que compreende um membro de corte, uma primeira garra, uma segunda garra, em que a primeira garra é móvel em relação à segunda garra, uma bigorna e um cartucho de grampos incluindo uma porção de borda externa, uma pluralidade de cavidades de grampo disposta em uma pluralidade de fileiras, uma pluralidade de grampos configurados para serem ejetados a partir das cavidades de grampos, em que os grampos são dispostos em uma fileira interna de grampos e em uma fileira externa de grampos, e uma fenda, em que a fileira interna de grampos é posicionada lateralmente para fora em relação à fenda, e em que a fileira externa de grampos é posicionada lateralmente para fora em relação à fileira interna de grampos e lateralmente para dentro em relação à borda externa. O atuador de extremidade compreende um adjunto implantável que compreende um sistema de referência que define uma primeira zona e uma segunda zona, em que a primeira zona corresponde à fileira interna de grampos e à fileira externa de grampos, de modo que antes de os grampos serem ejetados das cavidades de grampo, a primeira zona está acima da fileira interna dos grampos e da fileira externa dos grampos, e em que a segunda zona corresponde à fenda e à porção de borda externa, de modo que antes de os grampos serem ejetados das cavidades de grampo, a segunda zona está acima da porção de borda externa e da fenda.
[000190] Exemplo 18 — O sistema de atuador de extremidade cirúrgico do Exemplo 17, em que a primeira zona compreende uma primeira cor e a segunda zona compreende uma segunda cor que é diferente da primeira cor.
[000191] Exemplo 19 - O sistema de atuador de extremidade cirúrgico dos Exemplos 17 ou 18, em que a camada implantável compreende um material não tecido.
[000192] Exemplo 20 - O sistema de atuador de extremidade cirúrgico dos Exemplos 17, 18 ou 19, em que a camada implantável compreende um material tecido.
[000193] Várias modalidades são descritas que incluem adjuntos fixados e/ou posicionados em um cartucho de grampos. Deve-se compreender que tais ensinamentos são aplicáveis a modalidades nas quais um adjunto fixado a e/ou posicionado em uma bigorna de um instrumento cirúrgico. De fato, são contempladas modalidades nas quais um primeiro adjunto fixado a e/ou posicionado em um cartucho, e um segundo adjunto fixado a e/ou posicionado em uma bigorna.
[000194] A totalidade das descrições de:
[000195] Patente US N° 5.403.312, intitulada ELECTROSURGICAL HEMOSTATIC DEVICE, que foi concedida em 4 de abril de 1995;
[000196] 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;
[000197] 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;
[000198] 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;
[000199] Patente US N° 7.670.334, intitulada SURGICAL INSTRUMENT HAVING AN ARTICULATING END EFFECTOR, que foi concedida em 2 de março de 2010;
[000200] Patente US N° 7.753.245, intitulada SURGICAL STAPLING INSTRUMENTS, que foi concedida em 13 de julho de 2010;
[000201] Patente US N° 8.393.514, intitulada SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE, que foi concedida em 12 de março de 2013;
[000202] Pedido de Patente US N° de série 11/343.803, intitulado SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES; agora Patente US N° 7.845.537;
[000203] 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;
[000204] 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;
[000205] Pedido de Patente US N° de série 12/235.782, intitulado MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT, atualmente Patente US 8.210.411;
[000206] 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;
[000207] 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;
[000208] 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;
[000209] 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;
[000210] Pedido de Patente US N° de série 13/118.241, intitulado SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS, agora Patente US N° 9.072.535;
[000211] 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 Patente US N° 9.101.358;
[000212] Pedido de Patente US N° de série 13/800.025, intitulado STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, depositado em 13 de março de 2013, agora Publicação de Pedido de Patente US N° 2014/0263551;
[000213] Pedido de Patente US N° de série 13/800.067, intitulado STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, depositado em 13 de março de 2013, agora Publicação de Pedido de Patente US N° 2014/0263552;
[000214] Publicação de Pedido de Patente US N° de série 2007/0175955, intitulada SURGICAL CUTTING AND FASTENING INSTRUMENT WITH CLOSURE TRIGGER LOCKING MECHANISM, depositada em 31 de janeiro de 2006; e
[000215] 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.
[000216] Embora várias modalidades dos dispositivos tenham sido aqui descritas em conexão com determinadas modalidades descritas, podem ser implementadas muitas modificações e variações dessas modalidades. Além disso, onde forem descritos 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 seguintes são destinadas a abranger todas essas modificações e variações.
[000217] Os dispositivos aqui descritos podem ser projetados para que sejam descartados após um único uso, ou podem ser projetados para que sejam usados múltiplas vezes. Em qualquer dos casos, entretanto, o dispositivo pode ser recondicionado para reuso após 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.
\[000218] Somente a título de exemplo, os aspectos aqui descritos podem ser processados antes da cirurgia. Primeiro, um instrumento novo ou usado pode ser 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 podem, então, ser colocados em um campo de radiação que possa penetrar no recipiente, como radiação gama, raios X ou elétrons de alta energia. A radiação pode exterminar as bactérias no instrumento e no recipiente. O instrumento esterilizado pode, então, ser armazenado em um recipiente estéril. O recipiente vedado pode manter o instrumento estéril até que seja aberto na instalação médica. O dispositivo pode também ser esterilizado com o uso de qualquer outra técnica conhecida, incluindo, mas sem limitação, radiação beta ou gama, óxido de etileno, peróxido de plasma ou vapor d'água.
[000219] Embora esta invenção tenha sido descrita como tendo designs exemplificadores, a presente invenção pode ser ainda modificada dentro do espírito e do escopo da descrição. Pretende-se, portanto, que este pedido cubra quaisquer variações, usos ou adaptações da invenção com o uso de seus princípios gerais.
[000220] 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.
Claims (10)
1. Sistema de cartucho de grampos (130) para uso com um instrumento de grampeamento cirúrgico (100), o sistema de cartucho de grampos compreendendo: um corpo de cartucho (139) compreendendo: uma fenda longitudinal (137) configurada para receber um membro de corte; uma plataforma (135); e uma pluralidade de cavidades de grampo (131) dispostas em uma pluralidade de filas longitudinais; uma pluralidade de grampos (132) armazenados de forma removível dentro das cavidades de grampos, em que os grampos são configurados para serem ejetados a partir das cavidades de grampos para uma posição disparada; e um adjunto implantável (120) posicionável acima da plataforma, em que o adjunto implantável é configurado para ser implantado em um indivíduo quando os grampos são ejetados das cavidades de grampo para a posição de disparo, caracterizado pelo fato de que o adjunto implantável compreende uma referência (123) para determinar o alinhamento da pluralidade de grampos em relação ao adjunto implantável uma vez que os grampos estão na posição de disparo, em que, quando o adjunto implantável está posicionado na plataforma, a referência é paralela à pluralidade de filas longitudinais de cavidades de grampos, em que a referência compreende corante aplicado no adjunto implantável, ou o adjunto implantável compreende um material tecido e a referência compreende um fio colorido tecido no material tecido.
2. Sistema de cartucho de grampos, de acordo com a reivindicação 1, caracterizado pelo fato de que a pluralidade de cavidades de grampos compreende uma fileira externa de cavidades de grampos (131A) e uma fileira interna de cavidades de grampos (131C), em que a fileira interna de cavidades de grampos é adjacente à fenda longitudinal, e em que a referência (123) compreende uma primeira referência (126) correspondendo à linha interna de cavidades de grampos e uma segunda referência (125) correspondendo à linha externa de cavidades de grampos.
3. Sistema de cartucho de grampos, de acordo com a reivindicação 1, caracterizado pelo fato de que: a pluralidade de fileiras de cavidades de grampos compreende: uma fileira externa de cavidades básicas; e uma fileira interna de cavidades de grampo posicionadas adjacentes à fenda longitudinal; e a referência (123) compreende um sistema de referência que define uma primeira zona (127A) e uma segunda zona (127B), e em que o sistema de referência é configurado para auxiliar um médico a determinar a posição dos grampos em relação à primeira zona e a segunda zona quando os grampos estão na posição de disparo.
4. Sistema de cartucho de grampos, de acordo com a reivindicação 3, caracterizado pelo fato de que o sistema de referência compreende uma referência lateral posicionada de modo que um médico possa determinar a quantidade de inclinação lateral do adjunto implantável (120) comparando os grampos (132) com a referência quando os grampos estão na posição de disparo.
5. Sistema de cartucho de grampos, de acordo com a reivindicação 4, caracterizado pelo fato de que o corpo de cartucho (139) compreende uma borda externa (138), em que a fileira externa de cavidades de grampos (131A) está posicionada adjacente à borda externa e em que a referência lateral compreende uma primeira referência (125) posicionada entre a borda externa e a linha externa de cavidades de grampos.
6. Sistema de cartucho de grampos, de acordo com a reivindicação 5, caracterizado pelo fato de que o sistema de referência ainda compreende uma segunda referência (126) posicionada entre a fileira interna de cavidades de grampos (131C) e a fenda (137).
7. Sistema de cartucho de grampos, de acordo com qualquer uma das reivindicações 1 a 6, caracterizado pelo fato de que o adjunto implantável (120) compreende um material não tecido.
8. Sistema de cartucho de grampos, de acordo com qualquer uma das reivindicações 5 a 7, caracterizado pelo fato de que a primeira zona (127A) compreende uma primeira cor e uma segunda cor, em que a primeira cor e a segunda cor são divididas por uma linha de corte intencionada e em que o membro de corte (160) é configurado para cortar o adjunto implantável ao longo da linha de corte intencionada.
9. Sistema de cartucho de grampos, de acordo com a reivindicação 3, caracterizado pelo fato de que o sistema de referência compreende duas referências laterais internas (126), em que a área entre as duas referências laterais internas define a segunda zona (127B) e em que o membro de corte (160) está configurado para cortar o adjunto implantável na segunda zona.
10. Sistema de atuador de extremidade cirúrgico compreendendo: um membro de corte (160); uma primeira garra (101); uma segunda garra (103), em que a primeira garra é móvel em relação à segunda garra; uma bigorna (110); sistema de cartucho de grampos, conforme definido na reivindicação 1, caracterizado pelo fato de que ainda compreende uma porção de borda externa (138), em que: os grampos estão dispostos numa fileira interior (131C) de grampos e numa fila exterior (131A) de grampos; a linha interna de grampos está posicionada lateralmente para fora em relação à fenda (137), e em que a linha externa de grampos está posicionada lateralmente para fora em relação à linha interna de grampos e lateralmente para dentro em relação à borda externa; e a referência compreende um sistema de referência que define uma primeira zona (127A) e uma segunda zona (127B), em que a primeira zona corresponde à linha interna de grampos e a linha externa de grampos de modo que antes dos grampos serem ejetados das cavidades de grampos (131), a primeira zona está acima da linha interna dos grampos e a linha externa dos grampos; e em que a segunda zona corresponde à fenda e à porção de borda externa de modo que, antes dos grampos serem ejetados das cavidades de grampos, a segunda zona está acima da porção de borda externa e da fenda.
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-
2015
- 2015-09-25 US US14/865,306 patent/US10299878B2/en active Active
-
2016
- 2016-09-16 CN CN201680056030.1A patent/CN108135600B/zh active Active
- 2016-09-16 WO PCT/US2016/052125 patent/WO2017053193A1/en active Application Filing
- 2016-09-16 JP JP2018515446A patent/JP6790079B2/ja active Active
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EP3146911A1 (en) | 2017-03-29 |
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US20200030050A1 (en) | 2020-01-30 |
JP6790079B2 (ja) | 2020-11-25 |
BR112018005768A2 (pt) | 2018-10-09 |
WO2017053193A1 (en) | 2017-03-30 |
CN108135600B (zh) | 2021-02-26 |
JP2018531677A (ja) | 2018-11-01 |
MA41093A (fr) | 2017-03-29 |
US20230355345A1 (en) | 2023-11-09 |
US10299878B2 (en) | 2019-05-28 |
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