BR112020011885A2 - atuadores de extremidade cirúrgicos com disposições enrijecedoras de garra configurados para permitir monitoramento de membro de disparo - Google Patents
atuadores de extremidade cirúrgicos com disposições enrijecedoras de garra configurados para permitir monitoramento de membro de disparo Download PDFInfo
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Abstract
A presente invenção refere-se a um atuador de extremidade para uso com um instrumento cirúrgico. O atuador de extremidade inclui primeira e segunda garras que são interconectadas de modo pivotante e movidas entre as posições aberta e fechada por um membro de disparo. Uma ou ambas as garras são configuradas com recursos enrijecedores de garra que são adaptados para permitir que um usuário monitore o movimento do membro de disparo durante o uso.
Description
Relatório Descritivo da Patente de Invenção para "ATUADORES DE EXTREMIDADE CIRÚRGICOS COM
[001] A presente invenção refere-se a instrumentos cirúrgicos e, em várias disposições, a instrumentos cirúrgicos para grampeamento e corte, e a cartuchos de grampos para uso com eles, que são projetados para grampear e cortar tecido.
[002] Várias características das modalidades aqui descritas, juntamente com suas vantagens, podem ser entendidas de acordo com a descrição apresentada a seguir, considerada em conjunto com os desenhos em anexo, conforme exposto a seguir:
[003] A Figura 1 é uma vista em perspectiva de um instrumento cirúrgico eletromecânico;
[004] A Figura 2 é uma vista em perspectiva de uma extremidade distal de uma porção do instrumento cirúrgico eletromecânico do sistema cirúrgico da Figura 1;
[005] A Figura 3 é uma vista explodida do conjunto de um recurso do envoltório externo e do instrumento cirúrgico eletromecânico da Figura 2;
[006] A Figura 4 é uma vista em perspectiva traseira de uma porção do instrumento cirúrgico eletromecânico da Figura 2;
[007] A Figura 5 é uma vista parcial explodida do conjunto de uma porção de um adaptador e do instrumento cirúrgico eletromecânico do sistema cirúrgico da Figura 1;
[008] A Figura 6 é uma vista explodida do conjunto de uma porção do adaptador da Figura 5;
[009] A Figura 7 é uma vista em perspectiva em seção transversal de uma porção do conjunto de articulação de um adaptador;
[0010] A Figura 8 é uma vista em perspectiva do conjunto de articulação da Figura 7;
[0011] A Figura 9 é uma outra vista em perspectiva do conjunto de articulação da Figura 8;
[0012] A Figura 10 é uma vista explodida do conjunto de uma unidade de carga empregada no sistema do instrumento cirúrgico eletromecânico da Figura 1;
[0013] A Figura 11 é uma vista em perspectiva de uma modalidade alternativa do adaptador;
[0014] A Figura 12 é uma vista em elevação lateral de uma porção de uma unidade de carga do adaptador da Figura 11 com as suas garras em uma posição aberta;
[0015] A Figura 13 é uma outra vista em elevação lateral de uma porção da unidade de carga da Figura 11 com as suas porções mostradas em seção transversal e as suas garras em uma posição fechada;
[0016] A Figura 14 é uma vista de fundo de uma porção da unidade de carga da Figura 13 com as suas porções mostradas em seção transversal;
[0017] A Figura 15 é uma vista em perspectiva de uma porção da unidade de carga da Figura 14 com uma porção do tubo externo mostrada em linhas imaginárias;
[0018] A Figura 16 é uma vista em perspectiva de topo de outra unidade de carregamento de um adaptador com as garras dele em uma posição fechada e um conjunto de preensão dinâmico posicionado em uma posição de disparo;
[0019] A Figura 17 é uma vista em perspectiva de fundo da unidade de carregamento da Figura 16;
[0020] A Figura 18 é uma vista em elevação lateral da unidade de carregamento da Figura 16 com as garras na posição fechada;
[0021] A Figura 19 é outra vista em elevação lateral da unidade de carregamento da Figura 18 com o conjunto de preensão dinâmico posicionado em uma posição de disparo;
[0022] A Figura 20 é outra vista em elevação lateral da unidade de carregamento da Figura 19 com o conjunto de preensão dinâmico em uma posição parcialmente disparada;
[0023] A Figura 21 é outra vista em elevação lateral da unidade de carregamento da Figura 20 com o conjunto de preensão dinâmico posicionado na posição final;
[0024] A Figura 22 é uma vista em elevação lateral parcial de outra unidade de carregamento que ilustra um conjunto de preensão dinâmico dela em uma configuração parcialmente disparada;
[0025] A Figura 23 é uma vista de extremidade em seção transversal de uma porção de um conjunto de bigorna de uma unidade de carregamento; e
[0026] A Figura 24 é uma vista de extremidade em seção transversal de uma porção de outro conjunto de bigorna de uma unidade de carregamento.
[0027] Caracteres de referência correspondentes indicam 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.
[0028] O requerente do presente pedido detém os seguintes pedidos de patente U.S. que foram depositados em 15 de dezembro de 2017, e que estão, cada um, aqui incorporados a título de referência em suas respectivas totalidades:
[0029] - pedido de patente nº de série US 15/843.485, intitulado
[0030] - pedido de patente nº de série US 15/843.518, intitulado END
[0031] - pedido de patente US nº de série 15/843.535, intitulado
[0032] - pedido de patente nos No. de série 15/843.558, intitulado
[0033] - pedido de patente US nº de série 15/843.567, intitulado
[0034] - pedido de patente US nº de série 15/843.556, intitulado DYNAMIC. CLAMPING ASSEMBLIES WITH IMPROVED WEAR
[0035] - pedido de patente US nº de série15/843.514, intitulado
[0036] - pedido de patente US nº de série 15/843.501, intitulado
[0037] - pedido de patente US nº de série 15/843.508, intitulado
[0038] - pedido de patente US nº de série 15/843.683, intitulado
[0039] - pedido de patente US nº de série 15/843.689, intitulado
SYSTEMS AND METHODS OF CONTROLLING A CLAMPING MEMBER; e
[0040] - pedido de patente US nº de série 15/843.704, intitulado METHODS OF OPERATING SURGICAL END EFFECTORS.
[0041] Numerosos detalhes específicos são apresentados para fornecer um completo entendimento da estrutura, da função, da fabricação e do uso geral das modalidades descritas no relatório descritivo e ilustradas nos desenhos em anexo. Operações, componentes e elementos bem conhecidos não foram descritos com detalhes, de modo a não obscurecer as modalidades descritas no relatório descritivo. O leitor entenderá que as modalidades descritas e ilustradas na presente invenção são exemplos não limitadores e, portanto, pode-se entender que os detalhes estruturais e funcionais específicos revelados na presente invenção podem ser representativos e ilustrativos. Podem ser feitas variações e alterações a isso, sem se desviar do escopo das reivindicações.
[0042] 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 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.
[0043] Os termos "proximal" e "distal" são usados na presente invenção com referência a um médico que manipula a porção de empunhadura de um instrumento cirúrgico. O termo "proximal" se refere à porção mais próxima ao médico, e o termo "distal" se refere 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.
[0044] São fornecidos vários dispositivos e métodos exemplificadores para a realização de procedimentos cirúrgicos laparoscópicos e minimamente invasivos. Entretanto, o leitor entenderá prontamente que os vários métodos e dispositivos revelados na presente invenção podem ser usados em inúmeros procedimentos e aplicações cirúrgicas, inclusive, por exemplo, em relação a procedimentos cirúrgicos abertos. Com o avanço da presente Descrição Detalhada, o leitor entenderá ainda que os vários instrumentos aqui revelados podem ser inseridos em um corpo de qualquer maneira, como através de um orifício natural, através de uma incisão ou perfuração formada em tecido, etc. As porções funcionais ou porções do atuador de extremidade dos instrumentos podem ser inseridas diretamente no corpo de um paciente ou podem ser inseridas por meio de um dispositivo de acesso que tenha um canal de trabalho através da qual o atuador de extremidade e o eixo de acionamento alongado de um instrumento cirúrgico podem ser avançados.
[0045] Um sistema de grampeamento cirúrgico pode compreender um eixo de acionamento e um atuador de extremidade que se estende a partir 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 os 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, são previstas outras modalidades nas quais a primeira garra é pivotante em relação à segunda garra. O sistema de grampeamento cirúrgico compreende, adicionalmente, uma junta de articulação configurada para permitir que o atuador de extremidade seja girado ou articulado em relação ao eixo de acionamento. O atuador de extremidade é giratório em torno de um eixo geométrico de articulação que se estende através da junta de articulação. Outras modalidades são previstas que não incluem uma junta de articulação.
[0046] O cartucho de grampos compreende um corpo do cartucho. O corpo do 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 do cartucho podem ser implantados no tecido. O corpo do cartucho inclui cavidades de grampo definidas nele, sendo que os grampos são armazenados de modo removível nas cavidades de grampo. As cavidades de grampo são dispostas em seis fileiras longitudinais. Três fileiras de cavidades de grampo são posicionadas em um primeiro lado de uma fenda longitudinal e três fileiras de cavidades de grampos são posicionadas em um segundo lado da fenda longitudinal. Outras disposições de cavidades de grampo e grampos podem ser possíveis.
[0047] Os grampos são sustentados por acionadores de grampos no corpo do cartucho. Os acionadores são móveis entre uma primeira posição, ou posição não disparada, e uma segunda posição, ou posição disparada, para ejetar os grampos das cavidades de grampo. Os acionadores são retidos no corpo do cartucho por um retentor que se estende em torno do fundo do corpo do cartucho e inclui membros resilientes configurados para prender o corpo do cartucho e reter o retentor no corpo do 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 neles, em direção à bigorna.
[0048] Adicionalmente ao exposto acima, o deslizador é movido distalmente por um membro de disparo. O membro de disparo é configurado para entrar em contato com o deslizador e empurrar o deslizador em direção à extremidade distal. A fenda longitudinal definida no corpo do 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.
[0049] A Figura 1 mostra um sistema cirúrgico acionado por motor (eletromecânico) 1 que pode ser usado para realizar uma variedade de procedimentos cirúrgicos diferentes. Como pode ser visto naquela Figura, um exemplo do sistema cirúrgico 1 inclui um instrumento cirúrgico eletromecânico de mão equipado com motor 100 que é configurado para fixação seletiva a ele de uma pluralidade de diferentes implementos de instrumento cirúrgico (aqui chamados de "adaptadores") que são, cada um, configurados para atuação e manipulação pelo instrumento cirúrgico eletromecânico de mão equipado com motor. Conforme ilustrado na Figura 1, o instrumento cirúrgico de mão 100 é configurado para conexão seletiva com um adaptador 200 e, por sua vez, o adaptador 200 é configurado para conexão seletiva com atuadores de extremidade que compreendem uma unidade de carga de uso único (do inglês "single use loading unit” ("SULU")) ou uma unidade de carga descartável (do inglês "disposable loading unit" ("DLU") ou uma unidade de carga de uso múltiplo (do inglês "multiple use loading unit” "MULU"). Em uma outra modalidade do sistema cirúrgico, várias formas do adaptador 200 podem ser também eficazmente empregadas com um conjunto de acionamento de ferramenta de um sistema cirúrgico controlado roboticamente ou automatizado. Por exemplo, os conjuntos do instrumento cirúrgico aqui revelados podem ser empregados com vários sistemas robóticos, instrumentos, componentes e métodos como os revelados na patente US nº 9.072.535, mas não se limitando a eles, intitulada "SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS", a qual está aqui incorporada por referência, em sua totalidade.
[0050] Conforme ilustrado nas Figuras 1 e 2, o instrumento cirúrgico 100 inclui uma bateria 101 e um gabinete externo do envoltório 10 que é configurado para receber seletivamente e encerrar substancialmente a bateria 101. A bateria 101 pode também ser chamada aqui de conjunto de empunhadura 101. Uma forma de instrumento cirúrgico 100, por exemplo, é revelada na publicação internacional nº WO 2016/057225 A1, pedido internacional nº — PCT/US2015/051837, intitulado — HANDHELD ELECTROMECHANICAL SURGICAL SYSTEM, cuja revelação é aqui incorporada a título de referência. Vários recursos do instrumento cirúrgico 100 não serão divulgados aqui além do que é necessário para entender as várias características das invenções divulgadas na presente invenção, sendo entendido que detalhes adicionais podem ser obtidos por referência ao documento WO 2016/057225 A1 e de outras referências incorporadas aqui a título de referência.
[0051] Conforme ilustrado na Figura 3, um gabinete do envoltório externo 10 inclui uma meia seção distal 10a e uma meia seção proximal 10b que é conectada de modo pivotante à meia seção distal 10a por uma dobradiça 16 situada ao longo da borda superior da meia seção distal 10a e da meia seção proximal 10b. Quando unidas, as meias seções distal e proximal 10a, 10b definem uma cavidade de envoltório 10c em seu interior na qual a bateria 101 está seletivamente situada. Cada uma das meias seções distal e proximal 10a, 10b inclui uma respectiva porção de envoltório superior 12a, 12b e uma respectiva porção de envoltório inferior 14a, 14b. As porções de envoltório inferiores 14a, 14b definem um recurso de fechamento de encaixe por pressão 18 para prender seletivamente as porções de envoltório inferiores 14a, 14b uma à outra e para manter o gabinete do envoltório 10 em uma condição fechada. À meia seção distal 10a do gabinete do envoltório 10 define uma porção de detecção 20 que é configurada para receber um conjunto de acoplamento de acionamento 210 correspondente do adaptador 200 (vide Figura 5). Especificamente, a meia seção distal 10a do gabinete do envoltório 10 tem uma reentrância que recebe uma porção do conjunto de acoplamento de acionamento 210 do adaptador 200 quando o adaptador 200 é acoplado ao instrumento cirúrgico 100.
[0052] A porção de conexão 20 da meia seção distal 10a define um par de trilhos de guia que se estendem axialmente 21a, 21b e que se projetam radialmente para dentro a partir de superfícies laterais internas deles, conforme mostrado na Figura 5. Os trilhos de guia 21a, 21b auxiliam na orientação giratória do adaptador 200 em relação ao instrumento cirúrgico 100 quando o adaptador 200 é acoplado ao instrumento cirúrgico 100. A porção de conexão 20 da meia seção distal 10a define três aberturas 22a, 22b, 22c que são formadas em uma superfície dela voltada para a posição distal e que são dispostas em um plano ou linha comum uma em relação à outra. A porção de conexão 20 da meia seção distal 10a também define uma fenda alongada 24 também formada na superfície dela voltada para a posição distal. À porção de conexão 20 da meia seção distal 10a define adicionalmente um recurso de conexão fêmea 26 (vide Figura 2) formado em uma superfície dela. O recurso de conexão fêmea 26 se engata seletivamente a um recurso de conexão macho do adaptador 200.
[0053] A meia seção distal 10a do gabinete do envoltório 10 suporta um botão de controle de alternância voltado para o lado distal 30. O botão de controle de alternância 30 é capaz de ser acionado em uma direção à esquerda, à direita, para cima e para baixo mediante a aplicação de uma força correspondente ou de uma força depressiva a ele. A meia seção distal 10a do gabinete do envoltório 10 suporta um par lateral direito de botões de controle 32a, 32b (vide Figura 3); e um par lateral direito de botões de controle 34a, 34b (vide Figura 2). Os botões de controle do lado direito 32a, 32b e os botões de controle do lado esquerdo 34a, 34b são capazes de ser acionados mediante a aplicação de uma força correspondente ou de uma força depressiva a eles. A meia seção proximal 10b do gabinete do envoltório 10 suporta um botão de controle do lado direito 36a (veja a Figura 3) e um botão de controle do lado esquerdo 36b (veja a Figura 2). O botão de controle do lado direito 36a e o botão de controle do lado esquerdo 36b são capazes de ser acionados mediante a aplicação de uma força correspondente ou de uma força depressiva a eles.
[0054] O gabinete do envoltório 10 inclui um conjunto de placa de barreira estéril 60 seletivamente suportada na meia seção distal 10a. Especificamente, o conjunto de placa de barreira estéril 60 está disposto atrás da porção de conexão 20 da meia seção distal 10a e dentro da cavidade do envoltório 10c do gabinete do envoltório 10. O conjunto de placa 60 inclui uma placa 62 que giratoriamente apoia três eixos de acionamento de acoplamento 64a, 64b, 64c (vide Figuras 3 e 5). Cada eixo de acionamento de acoplamento 64a, 64b, 64c se estende a partir de lados opostos da placa 62 e tem um perfil em seção transversal trilobado. Cada eixo de acionamento de acoplamento 64a, 64b, 64c se estende através das respectivas aberturas 22a, 22b, 22c da porção de conexão 20 da meia seção distal 10a quando o conjunto de placa de barreira estéril 60 está disposto dentro da cavidade do envoltório 10c do gabinete do envoltório
10. O conjunto de placa 60 inclui adicionalmente um conector de passagem elétrico 66 apoiado na placa 62. O conector de passagem 66 se estende a partir dos lados opostos da placa 62. O conector de passagem 66 define uma pluralidade de trajetórias de contato, sendo que cada uma inclui um conduto elétrico para estender uma conexão elétrica através da placa 62. Quando o conjunto de placa 60 está disposto dentro da cavidade do envoltório 10c do gabinete do envoltório 10, as extremidades distais do eixo de acionamento de acoplamento 64a, 64b, 64c e uma extremidade distal do conector de passagem 66 estão dispostos ou situados dentro da porção de conexão 20 da meia seção distal 10a do gabinete do envoltório 10, e são configurados para se engatar elétrica e/ou mecanicamente aos respectivos recursos correspondentes do adaptador 200.
[0055] Com referência às Figuras 3 e 4, a bateria ou o conjunto de empunhadura 101 inclui um gabinete interno de empunhadura 110 que tem uma porção de gabinete inferior 104 e uma porção de gabinete superior 108 que se estende a partir de e/ou que é apoiada sobre a porção de gabinete inferior 104. A porção de gabinete inferior 104 e a porção de gabinete superior 108 são separadas em uma meia seção distal 110a e uma meia seção proximal 110b conectável à meia seção distal 110a por uma pluralidade de prendedores. Quando unidas, as meias seções distal e proximal 110a, 110b definem o gabinete interno da empunhadura 110 que tem uma cavidade de gabinete interno 110c em seu interior na qual um conjunto de núcleo de bateria 106 está situado. O conjunto de núcleo de bateria 106 é configurado para controlar as várias operações do instrumento cirúrgico 100.
[0056] A meia seção distal 110a do gabinete interno de empunhadura 110 apoia uma interface de controle de alternância distal 130 que está em alinhamento operacional com o botão de controle de alternância distal 30 do gabinete do envoltório 10. Em uso, quando a bateria 101 está disposta dentro do gabinete do envoltório 10, a atuação do botão de controle de alternância 30 exerce uma força sobre a interface de controle de alternância 130. A meia seção distal 110a do gabinete interno de empunhadura 110 também apoia um par lateral direito de interfaces de controle (não mostrado) e um par lateral esquerdo de interfaces de controle 132a, 132b. Em uso, quando a bateria 101 está disposta dentro do gabinete do envoltório 10, a atuação de um dentre o par lateral direito de botões de controle ou o par lateral esquerdo do botão de controle da meia seção distal 10a do gabinete do envoltório 10 exerce uma força sobre um respectivo par dentre o par lateral direito de interfaces de controle 132a, 132b ou o par lateral esquerdo de interfaces de controle 132a, 132b da meia seção distal 110a do gabinete interno de empunhadura 110.
[0057] Com referência às Figuras 1 a 5, o gabinete interno de empunhadura 110 fornece um gabinete no qual está situado um conjunto de núcleo de bateria 106. O conjunto de núcleo de bateria 106 inclui um circuito de bateria 140, uma placa de circuito do controlador 142 e uma bateria recarregável 144 configurada para fornecer energia a quaisquer dos componentes elétricos do instrumento cirúrgico 100. À placa de circuito do controlador 142 inclui uma placa de circuito de controlador de motor 142a, uma placa de circuito de controlador principal 142b e um primeiro cabo de fita 142c interconectando a placa de circuito de controlador de motor 142a e a placa de circuito do controlador principal 142b. O conjunto de núcleo de bateria 106 inclui adicionalmente uma tela de exibição 146 apoiada sobre a placa de circuito de controlador principal 142b. A tela de exibição 146 é visível através de uma janela límpida ou transparente 110d (vide Figura 3) fornecida na meia seção proximal 110b do gabinete interno de empunhadura 110. É previsto que ao menos uma porção do gabinete interno de empunhadura 110 possa ser fabricada a partir de um plástico rígido transparente ou similares. É adicionalmente previsto que o gabinete do envoltório 10 possa incluir uma janela nele formada (em alinhamento visual com a tela de exibição 146 e com a janela 110d da meia seção proximal 110b do gabinete interno da empunhadura 110 e/ou o gabinete do envoltório 10 pode ser fabricado a partir de um plástico rígido transparente ou similares.
[0058] O conjunto de núcleo de bateria 106 inclui adicionalmente um primeiro motor 152, um segundo motor 154 e um terceiro motor 156 que são sustentados por um suporte de motor 148 e são, cada um, eletricamente conectados à placa de circuito de controlador 142 e à bateria 144. Os motores 152, 154, 156 estão dispostos entre a placa de circuito de controlador de motor 142a e a placa de circuito de controlador principal 142b. Cada motor 152, 154, 156 inclui um respectivo eixo de acionamento de motor 152a, 154a, 156a que se estende a partir dele. Cada eixo de acionamento de motor 152a, 154a, 156a tem um perfil em seção transversal trilobado para transmitir forças rotativas ou torque. Cada motor 152, 154, 156 é controlado por um respectivo controlador de motor. A rotação dos eixos de acionamento de motor 152a, 154a, 156a pelos respectivos motores 152, 154, 156 funciona para acionar os eixos de acionamento e/ou os componentes de engrenagem do adaptador 200 para executar as várias operações do instrumento cirúrgico 100. Em particular, os motores 152, 154, 156 do conjunto de núcleo da bateria 106 são configurados para acionar os eixos de acionamento e/ou os componentes de engrenagem do adaptador 200.
[0059] Conforme ilustrado nas Figuras | e 5, o instrumento cirúrgico 100 é configurado para realizar conexão seletiva com o adaptador 200 e, por sua vez, o adaptador 200 é configurado para realizar conexão seletiva com um atuador de extremidade 500. O adaptador 200 inclui um gabinete externo do botão 202 e um tubo externo 206 que se estende a partir de uma extremidade distal do gabinete do botão 202. O gabinete do botão 202 e o tubo externo 206 são configurados e dimensionados para alojar os componentes do conjunto do adaptador 200. O tubo externo 206 é dimensionado para a inserção endoscópica, em particular, para que o tubo externo possa passar por uma porta de trocarte típica, cânula ou similares. O gabinete do botão 202 é dimensionado para não entrar na porta do trocarte, na cânula ou similares. O gabinete do botão 202 é configurado e adaptado para se conectar à porção de conexão 20 do gabinete do envoltório externo 10 do instrumento cirúrgico 100.
[0060] O adaptador 200 é configurado para converter uma rotação do primeiro ou do segundo eixos de acionamento de acoplamento 64a, 64b do instrumento cirúrgico 100 em translação axial útil para operar um conjunto de acionamento 540 e um elo de articulação 560 do atuador de extremidade 500, conforme ilustrado na Figura 10, e conforme será descrito com mais detalhes abaixo. Conforme ilustrado na Figura 6, o adaptador 200 inclui o conjunto de gabinete interno proximal 204 que apoia giratoriamente um primeiro eixo de acionamento proximal giratório 212, um segundo eixo de acionamento proximal giratório 214 e um terceiro eixo de acionamento proximal giratório 216 em seu interior. Cada eixo de acionamento proximal 212, 214, 216 funciona como um membro de recepção de rotação para receber forças rotacionais dos respectivos eixos de acionamento de acoplamento 64a, 64b e 64c do instrumento cirúrgico
100. Além disso, o conjunto de acoplamento de acionamento 210 do adaptador 200 também é configurado para giratoriamente apoiar a primeira, a segunda e a terceira luvas do conector 218, 220 e 222, respectivamente, dispostas em um plano ou linha comum uma em relação à outra. Cada luva de conector 218, 220, 222 é configurada para se emparceirar com os respectivos primeiro, segundo e terceiro eixos de acionamento de acoplamento 64a, 64b, 64c do instrumento cirúrgico 100, conforme descrito acima. Cada luva do conector 218, 222, 220 é adicionalmente configurada para se emparceirar com uma extremidade proximal dos respectivos primeiro, segundo e terceiro eixos de acionamento proximal 212, 214, 216 do adaptador 200.
[0061] O conjunto de acoplamento de acionamento 210 do adaptador 200 inclui também um primeiro, um segundo e um terceiro membros de propensão 224, 226, 228 dispostos distalmente das respectivas primeira, segunda e terceira luvas do conector 218, 220 e
222. Cada membro de propensão 224, 226 e 228 está disposto ao redor dos respectivos primeiro, segundo e terceiro eixos de acionamento proximais giratórios 212, 214 e 216. Os membros de propensão 224, 226 e 228 atuam sobre as respectivas luvas do conector 218, 222 e 220 para ajudar a manter as luvas do conector 218, 222 e 220 engatadas à extremidade distal dos respectivos eixos de acionamento de acoplamento 64a, 64b e 64c do instrumento cirúrgico 100 quando o adaptador 200 estiver conectado ao instrumento cirúrgico 100.
[0062] Também na disposição ilustrada, o adaptador 200 inclui o primeiro, o segundo e o terceiro conjuntos de conversão de acionamento 240, 250, 260, respectivamente, que estão, cada um, dispostos no conjunto de gabinete interno 204 e tubo externo 206. Cada conjunto de conversão de acionamento 240, 250, 260 é configurado e adaptado para transmitir ou converter uma rotação de um primeiro, segundo e terceiro eixos de acionamento de acoplamento 64a, 64b e 64c do instrumento cirúrgico 100 em translação axial de um acionador ou barra de articulação 258 do adaptador 200, para efetuar a articulação do atuador de extremidade 500; uma rotação de uma engrenagem anular 266 do adaptador 200 para efetuar a rotação do adaptador 200; ou a translação axial de um membro de acionamento distal 248 do adaptador 200 para efetuar o fechamento, abertura e disparo do atuador de extremidade 500.
[0063] Ainda com referência à Figura 6, o primeiro conjunto de transmissão/conversão de força/rotação 240 inclui o primeiro eixo de acionamento proximal giratório 212 que, conforme descrito acima, é giratoriamente apoiado dentro do conjunto de gabinete interno 204. O primeiro eixo de acionamento proximal giratório 212 inclui uma porção de extremidade não circular ou formatada configurada para realizar conexão com a primeira luva do conector 218 que está conectada ao respectivo primeiro eixo de acionamento de acoplamento 64a do instrumento cirúrgico 100. O primeiro eixo de acionamento proximal giratório 212 inclui uma porção de extremidade distal rosqueada 212b. O primeiro conjunto de transmissão/conversão de força/rotação 240 inclui adicionalmente uma porca de acoplamento de acionamento 244 que se engata de maneira rosqueável à porção de extremidade distal rosqueada 212b do primeiro eixo de acionamento proximal giratório 212 e que é disposta de maneira deslizante dentro do tubo externo 206. A porca de acoplamento de acionamento 244 é chavetada de maneira deslizável dentro da porção de tubo de núcleo proximal do tubo externo 206 de modo a ser impedida de girar conforme o primeiro eixo de acionamento proximal giratório 212 é girado. Desse modo, conforme o primeiro eixo de acionamento proximal giratório 212 é girado, a porca de acoplamento de acionamento 244 é transladada ao longo da porção de extremidade distal rosqueada 212b do primeiro eixo de acionamento proximal giratório 212 e, por sua vez, através e/ou ao longo do tubo externo 206.
[0064] O primeiro conjunto de transmissão/conversão de força/rotação 240 inclui adicionalmente um membro de acionamento distal 248 que é engatado mecanicamente com a porca de acoplamento de acionamento 244, de modo que o movimento axial da porca de acoplamento de acionamento 244 resulte em uma quantidade correspondente de movimento axial do membro de acionamento distal
248. A porção de extremidade distal do membro de acionamento distal 248 apoia um membro de conexão 247 configurado e dimensionado para engate seletivo com um membro de engate 546 de um conjunto de acionamento 540 do atuador de extremidade 500 (Figura 10). À porca de acoplamento 244 e/ou o membro de acionamento distal 248 funciona como um membro de transmissão de força para os componentes do atuador de extremidade 500. Em operação, conforme o primeiro eixo de acionamento proximal giratório 212 é girado, como resultado da rotação do primeiro eixo de acionamento de acoplamento
64a do instrumento cirúrgico 100, a porca de acoplamento de acionamento 244 é transladada axialmente ao longo do primeiro eixo de acionamento proximal giratório 212. À medida que a porca de acoplamento de acionamento 244 é transladada axialmente ao longo do primeiro eixo de acionamento proximal giratório 212, o membro de acionamento distal 248 é transladado axialmente em relação ao tubo externo 206. À medida que o membro de acionamento distal 248 é transladado axialmente, com o membro de conexão 247 conectado a ele e engatado com um membro de acionamento oco 548 fixado ao conjunto de acionamento 540 do atuador de extremidade 500 (Figura 10), o membro de acionamento distal 248 causa a translação axial concomitante do conjunto de acionamento 540 do atuador de extremidade 500 para efetuar um fechamento de uma porção de conjunto de ferramentas 600 do atuador de extremidade 500 e um disparo de vários componentes dentro do conjunto de ferramentas.
[0065] Ainda com referência à Figura 6, o segundo conjunto de conversão de acionamento 250 do adaptador 200 inclui um segundo eixo de acionamento proximal 214 que é giratoriamente apoiado dentro do conjunto de gabinete interno 204. O segundo eixo de acionamento proximal giratório 214 inclui uma porção de extremidade não circular ou formatada configurada para realizar conexão com o segundo eixo de acionamento de acoplamento 64c do instrumento cirúrgico 100. O segundo eixo de acionamento proximal giratório 214 inclui adicionalmente uma porção de extremidade distal rosqueada 214a configurada para engatar de maneira rosqueável um gabinete de mancal de articulação 253 de um conjunto de mancal de articulação
252. Com referência às Figuras 6 a 9, o gabinete do mancal de articulação 253 apoia um rolamento de articulação 255 dotado de uma pista interna 257 que é independentemente giratória em relação a uma pista externa 259. O gabinete do mancal de articulação 253 tem um perfil externo não circular, por exemplo, em formato de lágrima, que é disposto de maneira deslizante e não giratória dentro de um orifício complementar (não mostrado) do controlador central do gabinete interno 204a. O segundo conjunto de conversão de acionamento 250 do adaptador 200 inclui adicionalmente uma barra de articulação 258 dotada de uma porção proximal que é presa à pista interna 257 do mancal de articulação 255. Uma porção distal da barra de articulação 258 tem nela incluída uma fenda 258a, que é configurada para receber um gancho 562 do elo de articulação 560 (Figura 10) do atuador de extremidade 500. A barra de articulação 258 funciona como um membro transmissor de força para os componentes do atuador de extremidade
500. Na disposição ilustrada e conforme discutido adicionalmente no documento WO 2016/057225 A1, o conjunto de mancal de articulação 252 é tanto giratório como longitudinalmente transladável e é configurado para possibilitar o movimento giratório livre e desimpedido do atuador de extremidade 500 quando seus primeiro e segundo membros de garra 610, 700 estão em uma posição aproximada e/ou quando os membros de garra 610, 700 são articulados.
[0066] Em operação, conforme o segundo eixo de acionamento proximal 214 é girado, o conjunto de mancal de articulação 252 é axialmente transladado ao longo da porção de extremidade distal rosqueada 214a do segundo eixo de acionamento proximal 214, que por sua vez, faz com que a barra de articulação 258 seja axialmente transladada em relação ao tubo externo 206. Conforme a barra de articulação 258 é transladada axialmente, a barra de articulação 258 sendo acoplada ao elo de articulação 560 do atuador de extremidade 500, faz com que a translação axial concomitante do elo de articulação 560 do atuador de extremidade 500 efetue uma articulação do conjunto de ferramentas 600. A barra de articulação 258 é presa à pista interna 257 do mancal de articulação 253 sendo, dessa forma, livre para girar ao redor do eixo geométrico longitudinal em relação à pista externa 259 do mancal de articulação 253.
[0067] Conforme ilustrado na Figura 6, o adaptador 200 inclui um terceiro conjunto de conversão de acionamento 260 que é suportado no conjunto de gabinete interno 204. O terceiro conjunto de conversão de acionamento 260 inclui uma engrenagem anular de rotação 266 que é apoiada de modo fixo no gabinete externo do botão 202 e a ela conectada. A engrenagem anular 266 define um conjunto interno de dentes de engrenagem 266a e inclui um par de protuberâncias diametralmente opostas que se estendem radialmente 266b. As projeções 266b são configuradas para ser dispostas dentro das reentrâncias definidas no gabinete externo do botão 202, de modo que a rotação da engrenagem anular 266 resulte na rotação do gabinete externo do botão 202, e vice-versa. O terceiro conjunto de conversão de acionamento 260 inclui adicionalmente um terceiro eixo de acionamento proximal giratório 216 que, conforme descrito acima, é giratoriamente apoiado dentro do conjunto de gabinete interno 204. O terceiro eixo de acionamento proximal giratório 216 inclui uma porção de extremidade não circular ou formatada que é configurada para conexão com o terceiro conector 220. O terceiro eixo de acionamento proximal giratório 216 inclui uma roda dentada 216 chavetada a uma extremidade distal dela. Uma roda dentada de reversão 264 interengata a roda dentada 216a do terceiro eixo de acionamento proximal giratório 216 aos dentes de engrenagem 266a da engrenagem anular 266. Em funcionamento, conforme o terceiro eixo de acionamento proximal giratório 216 é girado, devido a uma rotação do terceiro eixo de acionamento de acoplamento 64b do instrumento cirúrgico 100, a roda dentada 216a do terceiro eixo de acionamento proximal giratório 216 engata a engrenagem de reversão 264 fazendo com que a engrenagem de reversão 264 gire. Conforme a engrenagem de reversão 264 gira, a engrenagem anular
266 também gira, fazendo assim com que o gabinete externo do botão 202 gire. A rotação do gabinete externo do botão 202 faz com que o tubo externo 206 gire ao redor do eixo geométrico longitudinal do adaptador 200. Conforme o tubo externo 206 é girado, o atuador de extremidade 500 que está conectado a uma porção de extremidade distal do adaptador 200, também é girado em torno de um eixo geométrico longitudinal do adaptador 200.
[0068] O adaptador 200 inclui adicionalmente um botão de fixação/separação 272 (Figura 5) que está apoiado sobre uma haste 273 (Figura 6) que se projeta a partir do conjunto de acoplamento de acionamento 210 do adaptador 200. O botão de fixação/separação 272 é propendido por um membro de propensão (não mostrado), que está disposto dentro ou em torno da haste 273, para uma condição não atuada. O botão 272 inclui um rebordo ou saliência que é configurado para se encaixar por pressão atrás de um rebordo ou saliência correspondente 20 do instrumento cirúrgico 100. Conforme também discutido no documento WO 2016/057225 A1, o adaptador 200 pode incluir adicionalmente um mecanismo de trava 280 para fixar a posição axial do membro de acionamento distal 248. Como pode ser visto na Figura 21, por exemplo, o mecanismo de trava 280 inclui um botão 282 que está apoiado de maneira deslizante sobre o gabinete externo do botão 202. O botão de trava 282 está conectado a uma barra de atuação (não mostrada) que se estende longitudinalmente através do tubo externo 206. A barra de atuação se move mediante um movimento do botão de trava 282. Em funcionamento, para travar a posição e/ou orientação do membro de acionamento distal 248, um usuário move o botão de trava 282 de uma posição distal para uma posição proximal, fazendo assim com que a trava (não mostrada) se mova para a posição proximal, de modo que uma face distal da trava saia do contato com o membro de atuação do came 288, o que faz com que o membro de atuação do came 288 gire para dentro da reentrância 249 do membro de acionamento distal 248. Dessa maneira, o membro de acionamento distal 248 é impedido de realizar movimento distal e/ou proximal. Quando o botão de trava 282 é movido da posição proximal para a posição distal, a extremidade distal da barra de atuação se move distalmente para dentro da trava (não mostrada), contra a propensão de um membro de propensão (não mostrado), para forçar o membro de atuação do came 288 para fora da reentrância 249, possibilitando assim uma translação axial e um movimento radial desimpedidos do membro de acionamento distal 248.
[0069] Novamente com referência à Figura 6, o adaptador 200 inclui um conjunto elétrico 290 apoiado sobre e no gabinete externo do botão 202 e no conjunto de gabinete interno 204. O conjunto elétrico 290 inclui uma pluralidade de lâminas de contato elétrico 292, apoiadas sobre uma placa de circuito 294, para conexão elétrica com o conector de passagem do conjunto de placa do gabinete do envoltório 10 do instrumento cirúrgico 100. O conjunto elétrico 290 possibilita que as informações calibração e a comunicação (ou seja, informações sobre o ciclo de vida, informações do sistema, informações de força) sejam transmitidas para a placa de circuito do instrumento cirúrgico 100 através de uma porção de receptáculo elétrico do conjunto de núcleo de bateria 106 do instrumento cirúrgico 100. O conjunto elétrico 290 inclui adicionalmente um medidor de esforço 296 que está conectado eletricamente à placa de circuito 294. O medidor de esforço 296 é montado no interior do conjunto de gabinete interno 204 para restringir a rotação do medidor de esforço 296 em relação a ele. O eixo de acionamento proximal giratório 212 se estende através do medidor de esforço 296 para possibilitar que o medidor de esforço 296 forneça uma retroinformação em circuito fechado para uma carga de disparo/preensão mostrada pelo primeiro eixo de acionamento proximal giratório 212. O conjunto elétrico 290 inclui também um anel deslizante
298 que é disposto de maneira deslizante e não giratória ao longo da porca de acoplamento de acionamento 244 do tubo externo 206. O anel deslizante 298 está em conexão elétrica com a placa de circuito 294 e serve para possibilitar a rotação do primeiro eixo de acionamento proximal giratório 212 e a translação axial da porca de acoplamento de acionamento 244, mantendo ainda ao mesmo tempo o contato elétrico do anel deslizante 298 com ao menos um outro componente elétrico dentro do adaptador 200, possibilitando ao mesmo tempo que os outros componentes elétricos girem ao redor do primeiro eixo de acionamento proximal giratório 212 e da porca de acoplamento de acionamento 244.
[0070] Ainda com referência à Figura 6, o conjunto de gabinete interno 204 inclui um controlador central 205 que tem uma parede anular orientada distalmente 207 que define um perfil externo substancialmente. O controlador central 205 inclui uma reentrância ou orifício substancialmente em forma de lágrima que é conformado e formatado para receber de maneira deslizante o conjunto de mancal de articulação 252 em seu interior. O conjunto de gabinete interno 204 inclui adicionalmente uma placa anular 254 que é presa a uma face distal da parede anular distalmente orientada 207 do controlador central 204a. A placa anular 254 define uma abertura 254a ao longo dela que é ali dimensionada e formada de modo a ser alinhada com o segundo eixo de acionamento proximal 214 e para receber de forma giratória uma ponta distal dele. Dessa maneira, a ponta distal do segundo eixo de acionamento proximal 214 é apoiada e impedida de se mover radialmente para longe de um eixo geométrico giratório longitudinal do segundo eixo de acionamento proximal 214 conforme o segundo eixo de acionamento proximal 214 é girado para transladar axialmente o conjunto de mancal de articulação 252.
[0071] Voltando à Figura 10, em um exemplo, o atuador de extremidade 500 pode ser configurado para um uso único ("unidade de carga descartável - DLU" "disposable loading unit") e para ser similar àquelas DLUs reveladas na publicação de pedido de patente US nº 2010/0301097, intitulada LOADING UNIT HAVING DRIVE ASSEMBLY LOCKING MECHANISM, atualmente patente US nº 9.795.384, publicação do pedido de patente US nº 2012/0217284, intitulada LOCKING MECHANISM FOR USE WITH LOADING UNITS, atualmente patente US nº 8.292.158 e publicação de pedido de patente US nº 2015/0374371, intitulada ADAPTER ASSEMBLIES FOR
INTERCONNECTING SURGICAL LOADING UNITS AND HANDLE ASSEMBLIES, cujas revelações de cada uma de tais referências, em sua totalidade, são incorporadas aqui a título de referência. Também é previsto que o atuador de extremidade 500 pode ser configurado para múltiplos usos (MULU) como aqueles atuadores de extremidade revelados na publicação de pedido de patente US nº 2017/0095250, intitulada MULTI-USE LOADING UNIT, cujas revelações de cada uma de tais referências, em sua totalidade, são incorporadas aqui a título de referência.
[0072] O instrumento cirúrgico 100 mostrado dispara grampos, mas pode ser adaptado para disparar qualquer outro prendedor como clipes e prendedores de duas partes. Na disposição ilustrada, o atuador de extremidade 500 compreende uma unidade de carga 510. A unidade de carga 510 compreende uma parte estrutural proximal 520 e um conjunto de ferramentas 600. O conjunto de ferramentas 600 inclui um par de membros de garra incluindo um primeiro membro de garra 610 que compreende um conjunto de bigorna 612 e um segundo membro de garra 700 que compreende um conjunto de cartucho 701. Um membro de garra é pivotante em relação ao outro para possibilitar a preensão do tecido entre os membros de garra. O conjunto de cartucho 701 é móvel em relação ao conjunto de bigorna 612 e é móvel entre uma posição aberta ou não presa e uma posição fechada ou aproximada. Entretanto, o conjunto de bigorna
612, ou tanto o conjunto de cartucho 701 como o conjunto de bigorna 612, podem ser móveis.
[0073] O conjunto de cartucho 701 tem um corpo de cartucho 702 e, em alguns casos, uma placa de apoio 710 que são fixados a um canal 720 por uma conexão de encaixe por pressão, um detentor, uma trava, ou por um outro tipo de conexão. O conjunto de cartucho 701 inclui prendedores ou grampos 704 que são suportados de modo móvel em uma pluralidade de fendas de retenção de grampos lateralmente espaçadas 706, que são configuradas como aberturas em uma superfície de contato com o tecido 708. Cada fenda 706 é configurada para receber um prendedor ou grampo em seu interior. O corpo de cartucho 702 também define uma pluralidade de fendas de cunha de came que acomodam empurradores de grampos 709 e que são abertas no fundo (isto é, na direção oposta à superfície de contato com o tecido) para possibilitar que um deslizador de atuação 712 passe longitudinalmente através delas. O conjunto de cartucho 701 é removível do canal 720 após os grampos terem sido disparados do corpo de cartucho 702. Um outro conjunto de cartucho removível é capaz de ser carregado no canal 720, de modo que o instrumento cirúrgico 100 possa ser atuado mais uma vez para disparar prendedores ou grampos adicionais. Mais detalhes sobre o conjunto de cartucho podem ser encontrados, por exemplo na publicação de pedido de patente US nº 2017/0095250, bem como em várias outras referências que foram incorporadas na presente invenção a título de referência.
[0074] O conjunto de cartucho 701 é pivotante em relação ao conjunto de bigorna 612 e é móvel entre uma posição aberta ou não presa e uma posição fechada ou presa para inserção através da cânula de um trocarte. A parte estrutural proximal 520 inclui ao menos um conjunto de acionamento 540 e um elo de articulação 560. Em uma disposição, o conjunto de acionamento 540 inclui uma barra de acionamento flexível 542 que tem uma extremidade distal 544 e uma seção de engate proximal 546. Uma extremidade proximal da seção de engate 546 inclui dedos diametralmente opostos que se estendem para dentro 547 que engatam um membro de acionamento oco 548 para prender de modo fixo o membro de acionamento 548 à extremidade proximal da barra 542. O membro de acionamento 548 define um orifício proximal que recebe um membro de conexão 247 do tubo de acionamento 246 do primeiro conjunto de conversão de acionamento 240 do adaptador 200 quando o atuador de extremidade 500 é fixado à extremidade distal do adaptador 200.
[0075] O atuador de extremidade 500 inclui adicionalmente um conjunto de gabinete 530 que compreende um gabinete externo 532 e um gabinete interno 534 que está disposto dentro do gabinete externo
532. A primeira e a segunda patilhas 536 estão, cada uma, dispostas sobre uma superfície externa de uma extremidade proximal 533 do gabinete externo 532 e são configurados para engatar operacionalmente a extremidade distal do adaptador 200, conforme discutido em maiores detalhes em WO 2016/057225 A1.
[0076] Com referência à Figura 10, por exemplo, o conjunto de bigorna 612 inclui uma tampa de bigorna 630 e uma placa de bigorna 620, que inclui uma pluralidade de depressões formadoras de grampos. A placa de bigorna 620 é presa a um lado de baixo da tampa de bigorna 630. Quando o conjunto de ferramentas 600 está na posição aproximada, as depressões formadoras de grampos são posicionadas em alinhamento justaposto com as fendas receptoras de grampos do conjunto de cartucho 701.
[0077] O conjunto de ferramentas 600 inclui um conjunto de montagem 800 que compreende uma porção de montagem superior 810 e uma porção de montagem inferior 812. Uma cauda de montagem 632 se projeta proximalmente a partir de uma extremidade proximal 631 da tampa de bigorna 630. Um membro de pivô situado distalmente 814 se estende a partir de cada porção de montagem superior e inferior 810 e 812 através das aberturas 822 que são formadas nos membros de acoplamento 820. Em ao menos uma disposição, o membro de pivô 814 da porção de montagem superior 810 também se estende através de uma abertura 634 na cauda de montagem 632. Os membros de acoplamento 820 incluem, cada um, uma porção proximal de intertravamento 824 que é configurada para ser recebida em sulcos correspondentes formados em extremidades distais do gabinete externo 532 e do gabinete interno 534. A parte estrutural proximal 520 do atuador de extremidade 500 inclui um elo de articulação 560 que tem uma extremidade proximal em forma de gancho 562. O elo de articulação 560 é dimensionado para ser posicionado de maneira deslizante dentro de uma fenda no gabinete interno. Um par de conjuntos de blocos em H 830 está em posição adjacente à extremidade distal do gabinete externo 532 e adjacente à extremidade distal 544 do conjunto de acionamento axial 540 para evitar o empenamento e a dilatação para fora da barra de acionamento flexível 542 durante a articulação e disparo do aparelho de grampeamento cirúrgico 10. Cada conjunto de bloco em H 830 inclui um corpo flexível 832 que inclui uma extremidade proximal presa de modo fixo à extremidade distal do gabinete externo 532 e uma extremidade distal que é presa de modo fixo ao conjunto de montagem 800. Em uma disposição, uma extremidade distal 564 do elo de articulação é fixada de modo pivotante ao conjunto de blocos em H direito 830. O movimento axial do elo de articulação 560 fará com que o conjunto de ferramentas se articule em relação à parte estrutural 520.
[0078] As Figuras 11 a 15 ilustam um adaptador 200 ' que é substancialmente idêntica ao adaptador 200 descrito acima, exceto pelas diferenças mostradas abaixo. Como pode ser visto na Figura 11, o adaptador 200' inclui um tubo externo 206 que tem uma porção de extremidade proximal 910 que tem um primeiro diâmetro "FD" e que é montada dentro do gabinete externo do botão 202. A porção de extremidade proximal 910 pode ser acoplada ao conjunto de gabinete interno 204 ou de outra forma apoiada nele nas formas discutidas em mais detalhes em WO 2016/057225 A1, por exemplo.
A porção de extremidade proximal 910 se estende proximalmente a partir de uma porção de tubo central 912 que tem um segundo diâmetro "SD". Na modalidade ilustrada, um atuador de extremidade 500 é acoplado a uma extremidade distal 914 de um conjunto de eixo de acionamento 203 ou tubo externo 206. O tubo externo 206 define um eixo geométrico longitudinal LA que se estende entre a porção de extremidade proximal 910 e a extremidade distal 914, como pode ser visto na Figura 11. Como pode ser visto nas Figuras 10 e 11, uma luva externa 570 da parte estrutural proximal 520 do atuador de extremidade 500 tem uma porção de extremidade distal 572 e uma porção de extremidade proximal 574. A porção de extremidade proximal 574 tem um diâmetro SD' que é aproximadamente igual ao segundo diâmetro SD da porção de tubo central 912. A porção de extremidade distal 572 tem um terceiro diâmetro "TD". Em uma disposição, FD e TD são aproximadamente iguais e maiores que SD.
Outras disposições são contempladas em que FD e TD não são iguais, mas cada um é maior que SD.
Entretanto, é preferencial que para a maioria dos casos FD e TD sejam dimensionados para inserção endoscópica através de uma porta de trocarte típica, cânula ou similares.
Em ao menos uma disposição (Figura 11), a luva externa 570 é formada com um lado plano ou com recorte lateral 576 para facilitar o acesso aprimorado dentro do paciente, ao mesmo tempo em que acomoda eficazmente os vários componentes de acionamento e articulação do adaptador 200. Além disso, o fornecimento de um diâmetro reduzido à porção de tubo central 912 pode conferir ao adaptador 200' um melhor acesso torácico entre as costelas.
[0079] Em ao menos uma disposição, o canal 720, que pode ser usinado ou feito de folha metálica, inclui um par de orifícios proximais 722 (Figura 10) que são configurados para alinhamento com um par de orifícios correspondentes 636 na tampa da bigorna 630 para receber pinos ou protuberâncias correspondentes 638 (Figura 12) para facilitar uma relação pivotante entre o conjunto de bigorna 612 e o conjunto de cartucho 701. No exemplo ilustrado, um conjunto de preensão dinâmico 550 é fixado a ou formado na extremidade distal 544 da barra de acionamento flexível 542. O conjunto de preensão dinâmico 550 inclui uma parte estrutural vertical 552 que tem uma superfície de corte de tecido 554 formada sobre ela ou fixada a ela. Veja a Figura 10, por exemplo. Um recurso de engate de bigorna 556 é formado sobre uma extremidade da parte estrutural 552 e compreende uma aba de engate de bigorna 557 que se projeta a partir de cada lado lateral da parte estrutural 552. De modo similar, um recurso de engate de canal 558 é formado sobre a outra extremidade da parte estrutural 552 e compreende uma aba de engate de canal 559 que se projeta a partir de cada lado lateral da parte estrutural 552. Consulte a Figura 15.
[0080] Conforme indicado acima, o conjunto de bigorna 612 inclui uma placa de bigorna 620. A placa da bigorna 620 inclui uma fenda alongada 622 que é configurada para acomodar a parte estrutural 552 do conjunto de preensão dinâmico 550 conforme o conjunto de preensão dinâmico 550 é axialmente avançado durante o processo de disparo. A fenda alongada 622 é definida entre duas saliências da placa de bigorna 624 que se estendem ao longo de cada lado lateral da fenda alongada 622. Consulte a Figura 10. À medida que o conjunto de preensão dinâmico 550 é avançado distalmente, as abas de engate de bigorna 557 se engatam de maneira deslizante às saliências da placa de bigorna 624 para manter o conjunto de bigorna 612 preso sobre o tecido alvo. De modo similar, durante a operação de disparo, a parte estrutural 552 do conjunto de preensão dinâmico 550 se estende através de uma fenda central no canal 720 e as abas de engate de canal 559 se engatam de maneira deslizante às saliências do canal 725 estendendo-se ao longo de cada lado da fenda de canal central para manter o conjunto de cartucho 701 preso sobre o tecido alvo.
[0081] Voltando às Figuras 13 e 15, o canal 720 define uma área de acoplamento genericamente designada como 730 que é configurada para acomodar o conjunto de preensão dinâmico 550 quando ele está em sua posição mais proximal, chamada aqui de uma posição não disparada ou inicial. Em particular, a área de acoplamento 730 é parcialmente definida por superfícies de acoplamento planas 732 que fornecem uma folga entre as abas de engate de canal 559 no conjunto de preensão dinâmico 550 para possibilitar que o conjunto de cartucho 701 gire para uma posição completamente aberta. Uma superfície inclinada ou de atuação do came 726 se estende a partir de uma extremidade distal de cada uma das superfícies de acoplamento
732. A superfície inclinada 726 é engatada pelo conjunto de preensão dinâmico 550 para mover o conjunto de bigorna 612 e o conjunto de cartucho 701 um em relação ao outro. Uma superfície de atuação do came similar poderia ser fornecida no conjunto de bigorna 612 em outras modalidades. É previsto que as superfícies inclinadas 726 possam também facilitar o alinhamento e/ou o engate entre o canal 720 e a placa de apoio 620 e/ou o corpo do cartucho 702. À medida que o conjunto de acionamento 540 é avançado distalmente (disparado), as abas de engate de canal 559 no conjunto de preensão dinâmico 550 se engatam às superfícies inclinadas correspondentes 726 para aplicar um movimento de fechamento ao conjunto de cartucho 701 fechando assim o conjunto de cartucho 701 e o conjunto de bigorna 612. A translação distal adicional do conjunto de preensão dinâmico 550 faz com que o deslizador de atuação 712 se mova distalmente através do corpo de cartucho 702, o que faz com que as cunhas de came 713 do deslizador de atuação 712 se engatem sequencialmente aos empurradores de grampos 709 para mover os empurradores de grampos 709 verticalmente dentro das fendas de retenção de grampos 706 e ejetem os grampos 704 nas depressões formadoras de grampo da placa de bigorna 620. Subsequente à ejeção dos grampos 704 das fendas de retenção 706 (e no tecido), o gume cortante 554 do conjunto de preensão dinâmico 550 corta o tecido grampeado conforme o gume cortante de tecido 554 na parte estrutural vertical 552 do conjunto de preensão dinâmico 550 se desloca distalmente através de uma fenda central 703 do corpo de cartucho
702. Após os grampos 704 terem sido ejetados do corpo do cartucho 702 e um usuário desejar usar o mesmo instrumento 10 para disparar grampos adicionais 704 (ou um outro tipo de prendedor ou faca), o usuário pode remover a unidade de carga 510 do adaptador 200' e substitui-la por uma outra unidade de carga nova ou não gasta. Em uma disposição alternativa, o usuário pode simplesmente remover o corpo de cartucho gasto 702 e substitui-lo por um novo corpo de cartucho não disparado ou não gasto 702.
[0082] Durante um procedimento cirúrgico, pode ser desejável que um médico consiga monitorar o andamento ou o local de um membro de preensão dinâmico do adaptador que é empregado. As Figuras 16 a 21 ilustram outro atuador de extremidade 2500 que inclui meios para avaliar uma posição de um conjunto de preensão dinâmico 550 do atuador de extremidade 2500 tanto para disparar em série quanto para fechar os grampos de um cartucho de grampos enquanto continua a fechar mais as garras do atuador de extremidade 2500. Em uma forma, o atuador de extremidade 2500 inclui um conjunto de ferramentas 2600 que pode ser idêntico ao conjunto de ferramentas 600 descrito acima, exceto pelas diferenças abordadas na presente invenção. O conjunto de ferramentas 2600 inclui uma primeira garra 2610 que compreende um conjunto de bigorna 2612 e uma segunda garra 2700 que compreende um conjunto de cartucho 2701. Em uma forma, o conjunto de bigorna 2612 compreende uma placa de bigorna 2620 que inclui uma superfície inferior de formação de grampo 2626 que é configurada em posição face a face com o conjunto de cartucho 2701. Uma tampa de bigorna 2630 é fixada na placa de bigorna 2620.
[0083] No exemplo ilustrado, a tampa de bigorna 2630 compreende uma parte estrutural 2632 que se estende de uma extremidade proximal 2642 até uma extremidade distal 2644. Conforme mostrado, a tampa de bigorna 2630 pode também incluir um par de batentes de tecido que se estendem para baixo 2646 que servem para evitar que o tecido-alvo se estenda proximalmente além dos grampos mais proximais que estão armazenados no conjunto de cartucho 2701. As Figuras 17 e 18 ilustram o conjunto de ferramentas 2600, em que o conjunto de preensão dinâmico 550 está em uma posição de partida. De outra maneira, nas Figuras 17 e 18, o conjunto de preensão dinâmico 550 está em sua posição mais proximal. Conforme pode ser mais particularmente visto na Figura 16, por exemplo, a parte estrutural de tampa de bigorna 2632 compreende uma primeira porção de lado lateral 2634 e uma segunda porção de lado lateral 2636 que é lateralmente espaçada da primeira porção de lado lateral 2634. Uma pluralidade de primeiros recursos enrijecedores de garra 2650, 2652 se estendem entre a primeira e a segunda porções de lado lateral 2634 e
2636. Os recursos enrijecedores 2650 e 2652 são longitudinalmente deslocados uns dos outros para definir uma primeira abertura de garra 2654 entre eles. Adicionalmente, o primeiro recurso enrijecedor de garra 2650 é longitudinalmente separado da porção de extremidade proximal 2642 por uma primeira abertura de garra proximal 2656 e o segundo recurso enrijecedor de garra 2652 é longitudinalmente separado da porção de extremidade distal 2644 por uma primeira abertura de garra distal 2658,
conforme mostrado.
[0084] Com relação à Figura 17, a segunda garra 2700 compreende um canal 2720 que é configurado para sustentar operacionalmente o conjunto de cartucho 2701 nele. O canal 2720 compreende uma parte estrutural de canal 2721 que inclui uma porção de extremidade proximal 2723 e uma porção de extremidade distal 2726. O canal 2720 compreende adicionalmente uma porção de lado lateral primária 2727 e uma porção de lado lateral secundária 2728 que é lateralmente espaçada da porção de lado lateral primária 2727. Uma pluralidade de segundos recursos enrijecedores de garra 2734, 2735 se estendem entre as porções de lado lateral primária e secundária 2727 e 2728. Os segundos recursos enrijecedores de garra 2734 e 2735 são longitudinalmente deslocados um do outro para definir uma segunda abertura de garra 2736 entre si. Adicionalmente, o segundo recurso enrijecedor de garra 2734 é longitudinalmente separado de uma porção de extremidade proximal 2725 por uma segunda abertura de garra proximal 2737 e o segundo recurso enrijecedor de garra 2735 é longitudinalmente separado da porção de extremidade distal 2726 por uma segunda abertura de garra distal 2738, conforme mostrado.
[0085] Os primeiros enrijecedores de garra 2650, 2652 e os segundos enrijecedores de garra 2734, 2735 servem para enrijecer a primeira e a segunda garras 2610, 2700, respectivamente, enquanto grampeiam o tecido-alvo entre si. Adicionalmente, as aberturas longitudinalmente deslocadas 2654, 2656, 2658, 2736, 2737, 2738 possibilitam que o médico visualize o andamento e o local do conjunto de preensão dinâmico durante o disparo (por exemplo, a porção do avanço distal do conjunto de preensão dinâmico 550, em que os grampos são disparados do conjunto de cartucho 701). Por exemplo, conforme mostrado na Figura 19, o eixo geométrico de referência A, corresponde aos locais dos grampos mais proximais ou prendedores no conjunto de cartucho 2701. O eixo geométrico de referência Ar corresponde aos locais dos grampos mais distais ou prendedores no conjunto de cartucho 2701. No exemplo ilustrado, a segunda abertura de garra proximal 2737 se estende distalmente dos locais de prendedor mais proximais (representados pelo eixo geométrico de referência A) até o segundo recurso enrijecedor de garra 2734 e a primeira abertura de garra distal 2658 se estende proximalmente dos locais de prendedor mais distal (representados pelo eixo geométrico Az) até o primeiro recurso enrijecedor de garra 2652.
[0086] Ainda com referência à Figura 19, a porção de extremidade proximal 2642 da primeira garra 2610 está alinhada verticalmente (por exemplo, diretamente acima) com a segunda abertura de garra proximal 2737 na segunda garra 2700 quando as garras 2610, 2700 estão em suas posições completamente fechadas, conforme mostrado. Em pelo menos um exemplo, o comprimento longitudinal LL, da porção de extremidade proximal 2642 e o comprimento longitudinal LLC da segunda abertura de garra proximal 2737 são aproximadamente iguais. Da mesma forma, a primeira abertura de garra proximal 2656 está alinhada verticalmente com o segundo recurso enrijecedor de garra 2734 quando as garras estão nas posições completamente fechadas. O comprimento longitudinal LL2 da primeira abertura de garra proximal 2656 é aproximadamente igual ao comprimento longitudinal LLg do segundo recurso enrijecedor de garra
2734. O primeiro recurso enrijecedor de garra 2650 está alinhado verticalmente com a segunda abertura de garra 2736. O comprimento longitudinal LL3 do primeiro recurso enrijecedor de garra 2650 é aproximadamente igual ao comprimento longitudinal LLc da segunda abertura de garra 2736. O segundo recurso enrijecedor de garra 2735 está alinhado verticalmente com a primeira abertura de garra 2654. O comprimento longitudinal LLpy do segundo recurso enrijecedor de garra 2735 é aproximadamente igual ao comprimento longitudinal LL, da primeira abertura de garra 2654. O primeiro recurso enrijecedor de garra
2652 está alinhado verticalmente com a segunda abertura de garra 2738. O comprimento longitudinal LLs do primeiro recurso enrijecedor de garra 2652 é aproximadamente igual ao comprimento longitudinal LLe da segunda abertura de garra 2738. A primeira abertura de garra mais distal 2658 está alinhada verticalmente com a porção de extremidade distal 2726 da segunda garra 2700 que se estende da localização de prendedor mais distal Ar até a segunda abertura de garra 2738. O comprimento longitudinal da primeira abertura de garra distal LLs é aproximadamente igual ao comprimento longitudinal LLF da porção de extremidade distal
2726.
[0087] No exemplo ilustrado, os primeiros recursos enrijecedores de garra 2650, 2652, assim como a porção de extremidade proximal 2642? e a porção de extremidade distal 2644 da primeira garra 2610, se estendem transversalmente até o eixo geométrico longitudinal entre a primeira e a segunda porções de lado lateral 2634 e 2636 e têm um formato em seção transversal arqueado. Os primeiros recursos enrijecedores de garra 2650, 2652, assim como a porção de extremidade proximal 2642 e a porção de extremidade distal 2644 da primeira garra 2610, podem também ser chamados de "pontes enrijecedoras". De modo semelhante, os segundos recursos enrijecedores de garra 2734, 2/35 assim como a porção de extremidade proximal 2725 e a porção de extremidade distal 2726 da segunda garra 2700 se estendem transversalmente até o eixo geométrico longitudinal LA entre as porções de lado lateral primária e secundária 2727 e 2728 e têm um formato em seção transversal arqueado. Os segundos recursos enrijecedores de garra 2734, 2735, assim como a porção de extremidade proximal 2725 e a porção de extremidade distal 2726 da segunda garra 2700, podem também ser chamados de "pontes enrijecedoras".
[0088] A Figura 19 ilustra uma posição do conjunto de preensão dinâmico 550 em uma posição de disparo ou pronta para disparar.
Como pode ser visto nessa Figura, uma porção do conjunto de preensão dinâmico 550 pode ser vista pelo médico através da segunda abertura de garra proximal 2737. Na Figura 20, o conjunto de preensão dinâmico 550 foi distalmente avançado e, quando nessa posição, o médico pode visualizar a posição do conjunto de preensão dinâmico 550 através da primeira abertura de garra 2654, assim como através da segunda abertura de garra 2736. A Figura 21 ilustra a posição do conjunto de preensão dinâmico 550 em sua posição final ou última em que os grampos mais distais foram disparados.
Como pode ser visto nessa Figura, a posição do conjunto de preensão dinâmico 550 é visível através da primeira abertura de garra 2658. Assim, desalinhando-se longitudinalmente as posições do primeiro e do segundo recursos enrijecedores de garra, assim como da primeira e da segunda aberturas de garra da maneira descrita acima, tal disposição serve para manter um enrijecimento do atuador de extremidade 2500 e mais particularmente do conjunto de ferramentas 2600 do atuador de extremidade 2500 e ainda mais particularmente da primeira e da segunda garras 2610, 2700 quando a primeira e a segunda garras estão em suas posições completamente fechadas ou presas e o conjunto de preensão dinâmico 550 é avançado distalmente para cortar o tecido preso e disparar os grampos sustentados no conjunto de cartucho.
Adicionalmente, tal disposição possibilita que o médico observe uma posição do conjunto de preensão dinâmico 550 em qualquer posição durante um curso de disparo do conjunto de preensão dinâmico 550. Conforme usado nesse contexto, o termo "curso de disparo" significa a faixa de movimento do conjunto de preensão dinâmico 550 a partir de uma posição de disparo FP ou posição pronta para disparo antes de disparar qualquer grampo em uma posição de disparo final, em que todos os grampos foram, assim, disparados.
Disposições alternativas são contempladas, em que recursos enrijecedores adicionais e aberturas de garra são empregados da maneira descrita acima na primeira e na segunda garras. Ainda outras disposições são contempladas, em que apenas uma dentre a primeira e a segunda garras inclui os recursos enrijecedores espaçados que permitem ao usuário monitorar o movimento do conjunto de preensão dinâmico (membro de disparo).
[0089] A Figura 22 ilustra um conjunto de preensão dinâmico convencional 550 que aplica forças de preensão em um conjunto de bigorna 612 que pode levar à deflexão indesejada das saliências 624 na placa de bigorna 620 através dos recursos de engate de bigorna 557, assim como a deflexão de saliências de canal formadas no canal 720 através dos recursos de engate de canal 559. Diferente dos atuadores de extremidade que empregam um sistema de fechamento de garra secundário, tal disposição emprega o conjunto de preensão dinâmico para aplicar todas as forças de fechamento na primeira e na segunda garras. Tal design depende, por exemplo, de forças de rolamento locais muito altas para provocar compressão de tecido e estabelecer um vão de tecido apropriado entre as garras. Sistemas de fechamento e disparo separados e independentes, ao contrário, dependem da projeção de força mais distal possível.
[0090] A Figura 23 ilustra uma porção de um conjunto de bigorna 2800 que compreende uma placa de bigorna 2810 que inclui uma superfície inferior de formação de grampo 2812 nela. A placa da bigorna 2810 inclui uma fenda alongada 2814 que é configurada para acomodar a parte estrutural de um conjunto de preensão dinâmico 550 conforme o conjunto de preensão dinâmico é axialmente avançado durante o processo de disparo. A fenda alongada 2814 é definida entre duas saliências da placa de bigorna 2816 que se estendem ao longo de cada lado lateral da fenda
2814. Como um membro de preensão dinâmico é avançado distalmente, abas ou pinos de engate de bigorna no conjunto de preensão dinâmico 550 se engatam de maneira deslizante às saliências da placa de bigorna
2816 para reter o conjunto de bigorna 2800 preso no tecido-alvo. Uma placa de tampa de bigorna ou um tampão de bigorna 2820 é recebido nas saliências do tampão 2818 na placa de bigorna 2810 e pode ser soldado ou fixado de outra forma nela. Cada uma das saliências de placa de bigorna 2816 se estende para dentro em uma configuração de cantiléver e tem uma largura de saliência LW. Conforme o conjunto de preensão dinâmico 550 se engata através de preensão ao conjunto de bigorna 2800, os recursos de engate de bigorna ou abas 556 do conjunto de preensão dinâmico 550 se engatam às saliências 2816 para aplicar os movimentos de fechamento nelas. Nessa disposição, no entanto, as saliências 2816 são mais robustas e têm uma espessura de saliência LT que é maior que a espessura de saliência das saliências em uma placa de bigorna 620, por exemplo.
[0091] A Figura 24 ilustra outro conjunto de bigorna 2900 que compreende uma placa de bigorna 2910 que inclui uma superfície inferior de formação de grampo 2912 nela. A placa da bigorna 2910 inclui uma fenda alongada 2914 que é configurada para acomodar a parte estrutural de um conjunto de preensão dinâmico 550 conforme o conjunto de preensão dinâmico é axialmente avançado durante o processo de disparo. A fenda alongada 2914 é definida entre duas saliências da placa de bigorna 2916 que se estendem ao longo de cada lado lateral da fenda
2914. Uma placa de tampa de bigorna ou um tampão de bigorna 2920 é recebido nas saliências 2918 na placa de bigorna 2910 e pode ser soldado ou fixado de outra forma nela. Cada uma das saliências de placa de bigorna 2916 se estende para dentro em uma configuração de cantiléver. Embora cada saliência 2916 tenha uma espessura de saliência LT' que é menor que a espessura de saliência LT (Figura 23), cada saliência 2916 tem uma largura de saliência LW' que é menor do que a largura de saliência LW das saliências 2816. Tais saliências mais curtas 2916 vão experimentar menos deflexão do que as saliências na placa de bigorna 620, por exemplo. Tal disposição representa um melhoramento em relação às últimas disposições de placa de bigorna devido às saliências 2916 serem mais curtas, o que pode limitar a quantidade de deflexão experimentada durante o avanço de carga alta do conjunto de preensão dinâmico.
Exemplos
[0092] Exemplo 1 - Um atuador de extremidade para uso com um instrumento cirúrgico. Em um exemplo, o atuador de extremidade compreende uma primeira garra que define um primeiro eixo geométrico longitudinal de garra que se estende entre uma primeira extremidade proximal de garra e uma primeira extremidade distal de garra. A primeira garra compreende adicionalmente uma pluralidade de primeiros recursos enrijecedores de garra que são longitudinalmente deslocados uns dos outros para definir uma primeira abertura de garra entre si. Uma segunda garra é acoplada de maneira móvel à primeira garra de modo que a primeira garra e a segunda garra sejam móveis uma em relação à outra entre uma posição completamente aberta e uma posição completamente fechada. A segunda garra compreende uma pluralidade de segundos recursos enrijecedores de garra que são longitudinalmente deslocados uns dos outros para definir uma segunda abertura de garra entre si, de modo que, quando a primeira e a segunda garras estão na posição completamente fechada, cada primeiro recurso enrijecedor de garra está alinhado verticalmente com aquela correspondente dentre as segundas aberturas de garra e cada segundo recurso enrijecedor de garra está alinhado verticalmente com aquela correspondente dentre as primeiras aberturas de garra. O atuador de extremidade compreende adicionalmente meios para mover seletivamente a primeira e a segunda garras entre a posição completamente aberta e a posição completamente fechada.
[0093] Exemplo 2 - O atuador de extremidade do Exemplo 1, em que a pluralidade de primeiros recursos enrijecedores de garra compreendem um primeiro enrijecedor de garra proximal que é espaçado de uma extremidade proximal da primeira garra para definir uma primeira abertura de garra proximal entre si. Um primeiro enrijecedor de garra central é distalmente espaçado do primeiro enrijecedor de garra proximal para definir uma primeira abertura de garra central entre si. Um primeiro enrijecedor de garra distal é espaçado distalmente do primeiro enrijecedor de garra central para definir uma primeira abertura de garra distal entre si. Em pelo menos um exemplo, a pluralidade de segundos recursos enrijecedores de garra compreendem um segundo enrijecedor de garra proximal que está alinhado verticalmente com a primeira abertura de garra proximal quando a primeira e a segunda garras estão na posição completamente fechada. Um segundo enrijecedor de garra central espaçado distalmente do segundo enrijecedor de garra proximal para definir uma segunda abertura de garra proximal entre si que está alinhada verticalmente com o primeiro enrijecedor de garra proximal quando a primeira e a segunda garras estão na posição completamente fechada. Um segundo enrijecedor de garra distal espaçado distalmente do segundo enrijecedor de garra central para definir uma segunda abertura de garra central entre si que está alinhada verticalmente com o primeiro enrijecedor de garra central quando a primeira e a segunda garras estão na posição completamente fechada. O segundo enrijecedor de garra distal é espaçado proximalmente de uma extremidade distal da segunda garra para definir uma segunda abertura de garra distal entre si que está alinhada verticalmente com o primeiro enrijecedor de garra distal quando a primeira e a segunda garras estão na posição completamente fechada.
[0094] Exemplo 3 - O atuador de extremidade dos Exemplos 1 ou 2, em que a primeira garra compreende um primeiro corpo de garra que tem um primeiro lado lateral e um segundo lado lateral que é lateralmente espaçado do primeiro lado lateral. Cada primeiro recurso enrijecedor de garra se estende entre o primeiro lado lateral e o segundo lado lateral. A segunda garra compreende um segundo corpo de garra que define um segundo eixo geométrico longitudinal de garra que se estende entre uma segunda extremidade distal de garra e uma segunda extremidade proximal de garra. A segunda garra compreende adicionalmente um lado lateral primário e um lado lateral secundário que é espaçado do lado lateral primário. Cada segundo recurso enrijecedor de garra se estende entre o lado lateral primário e o lado lateral secundário.
[0095] Exemplo 4 - O atuador de extremidade do Exemplo 3, em que o primeiro recurso enrijecedor de garra é transversal ao primeiro eixo geométrico longitudinal de garra e em que cada segundo recurso enrijecedor de garra é transversal ao segundo eixo geométrico longitudinal de garra.
[0096] Exemplo 5 - O atuador de extremidade dos Exemplos 1,2,3 ou 4, em que os meios para mover seletivamente compreendem um conjunto de preensão dinâmico axialmente móvel que é seletivamente móvel entre uma posição de partida que corresponde à posição completamente aberta da primeira e da segunda garras e uma posição final. Em pelo menos um exemplo, o conjunto de preensão dinâmico axialmente móvel compreende uma parte estrutural que se estende verticalmente que inclui pelo menos um primeiro recurso de engate de garra que é configurado para engatar de maneira deslizante a primeira garra e pelo menos um segundo recurso de engate de garra que é configurado para engatar de maneira deslizante a segunda garra.
[0097] Exemplo 6 - O atuador de extremidade do Exemplo 5, em que pelo menos um primeiro recurso de engate de garra é visível através de pelo menos uma das primeiras aberturas de garra na primeira garra ou o pelo menos um segundo recurso de engate de garra é visível através de pelo menos uma das segundas aberturas de garra na segunda garra, conforme o conjunto de preensão dinâmico é axialmente movido dentro do atuador de extremidade.
[0098] Exemplo 7 - O atuador de extremidade do Exemplo 3, em que pelo menos um primeiro recurso de engate de garra é visível através de pelo menos uma das primeiras aberturas de garra na primeira garra a partir de uma dentre o primeiro e o segundo lados laterais da primeira garra ou o pelo menos um segundo recurso de garra é visível através de pelo menos uma das segundas aberturas de garra na segunda garra a partir de um dos lados laterais primário e secundário da segunda garra, conforme o conjunto de preensão dinâmico é axialmente movido dentro do atuador de extremidade.
[0099] Exemplo 8 - O atuador de extremidade dos Exemplos 1, 2, 3, 4, 5, 6 ou 7, em que a primeira garra compreende um canal que é configurado para sustentar um cartucho de grampos cirúrgicos nele e em que a segunda garra compreende uma bigorna.
[00100] Exemplo 9 -O0O atuador de extremidade do Exemplo 5, em que a parte estrutural que se estende verticalmente compreende uma superfície de corte de tecido.
[00101] Exemplo 10-Um atuador de extremidade para uso com um instrumento cirúrgico. Em pelo menos um exemplo, o atuador de extremidade compreende uma primeira garra e uma segunda garra que é acoplada de maneira móvel à primeira garra, de modo que a primeira e a segunda garras sejam móveis uma em relação à outra entre uma posição completamente aberta e uma posição completamente fechada. Um conjunto de preensão dinâmico é configurado para engatar a primeira e a segunda garras, conforme o conjunto de preensão dinâmico é movido axialmente de uma posição de partida até uma posição final para aplicar movimentos de fechamento na primeira e na segunda garras. Pelo menos uma dentre a primeira e a segunda garras compreende recursos enrijecedores que são longitudinalmente espaçados uns dos outros por aberturas que são configuradas para permitir a visualização do conjunto de preensão dinâmico através delas, conforme o conjunto de preensão dinâmico se move entre a posição de partida e a posição final.
[00102] Exemplo 11-O atuador de extremidade do Exemplo 10, em que o conjunto de preensão dinâmico compreende uma parte estrutural que se estende verticalmente que inclui pelo menos um primeiro recurso de engate de garra que é configurado para engatar de maneira deslizante a primeira garra e pelo menos um segundo recurso de engate de garra que é configurado para engatar de maneira deslizante a segunda garra.
[00103] Exemplo 12-O atuador de extremidade dos Exemplos 10 ou 11, em que a primeira garra compreende um canal que tem um corpo de canal que inclui um primeiro lado de canal lateral e um segundo lado de canal lateral que é lateralmente espaçado do primeiro lado de canal lateral. Uma pluralidade de pontes enrijecedoras de canal são axialmente espaçadas umas das outras por aberturas de canal e se entendem entre o primeiro lado de canal lateral e o segundo lado de canal lateral.
[00104] Exemplo 13-O atuador de extremidade do Exemplo 12, em que a segunda garra compreende uma bigorna que inclui uma placa de bigorna que é sustentada em posição face a face com um cartucho que é sustentado no canal. Uma tampa de bigorna é acoplada à placa de bigorna e compreende um primeiro lado de bigorna lateral e um segundo lado de bigorna lateral que é espaçado do primeiro lado de bigorna lateral e é conectado a ele por uma pluralidade de pontes enrijecedoras de bigorna que são axialmente espaçadas umas das outras por aberturas de bigorna, sendo que as pontes enrijecedoras de bigorna se estendem entre o primeiro lado de bigorna lateral e o segundo lado de bigorna lateral.
[00105] Exemplo 14-0O atuador de extremidade do Exemplo 13, em que cada ponte enrijecedora de canal é transversal ao primeiro eixo geométrico longitudinal e em que a bigorna define um segundo eixo geométrico longitudinal que se estende entre uma extremidade de bigorna proximal e uma extremidade de bigorna distal e em que cada ponte enrijecedora de bigorna é transversal ao segundo eixo geométrico longitudinal.
[00106] Exemplo 15-O0O atuador de extremidade do Exemplo 11, em que a parte estrutural que se estende verticalmente compreende uma superfície de corte de tecido.
[00107] Exemplo 16-0O atuador de extremidade do Exemplo 13, em que uma porção do conjunto de preensão dinâmico é visível através de pelo menos uma das aberturas de canal no canal a partir de um dentre o primeiro lado de canal lateral e o segundo lado de canal lateral ou pelo menos outra porção do membro de preensão dinâmico é visível através de pelo menos uma das aberturas de bigorna a partir de um dentre o primeiro lado lateral de bigorna e o segundo lado lateral de bigorna, conforme o conjunto de preensão dinâmico é axialmente movido dentro do atuador de extremidade.
[00108] Exemplo 17 - Uma unidade de carregamento cirúrgica para uso com um instrumento cirúrgico acionado por motor. Em pelo menos um exemplo, a unidade de carregamento compreende um gabinete que é configurado para fazer interface operacionalmente com uma porção do instrumento cirúrgico acionado por motor. Um conjunto de ferramentas é acoplado operacionalmente ao gabinete e compreende um canal que sustenta um corpo de cartucho de grampos nele. O canal define um primeiro eixo geométrico longitudinal que se estende entre uma extremidade proximal e uma extremidade distal dele. O canal inclui adicionalmente uma porção de fundo segmentada que define uma pluralidade de pontes enrijecedoras de canal que são separadas por aberturas de canal localizadas entre elas. Uma bigorna é acoplada de modo pivotante ao canal, de modo que o canal e a bigorna sejam móveis entre si entre uma posição completamente aberta e uma posição completamente fechada. A bigorna inclui uma porção de topo segmentada que define uma pluralidade de pontes enrijecedoras de bigorna que são separadas por aberturas de bigorna localizadas entre elas. Um conjunto de preensão dinâmico é configurado para engatar o canal e a bigorna, conforme o conjunto de preensão dinâmico é axialmente movido de uma posição de partida até uma posição final para aplicar movimentos de fechamento no canal e na bigorna. O conjunto de preensão dinâmico é visível através das aberturas de canal ou das aberturas de bigorna, conforme o conjunto de preensão dinâmico se move entre a posição de partida e a posição final.
[00109] Exemplo 18 - A unidade de carregamento cirúrgica do Exemplo 17, em que o conjunto de ferramentas é acoplado de modo pivotante ao conjunto de gabinete para deslocamento pivotante seletivo em relação a ele.
[00110] Exemplo 19-A unidade de carregamento dos Exemplos 17 ou 18, em que o gabinete é configurado para ser acoplado de modo removível a um adaptador que é configurado para ser acoplado de modo removível ao instrumento cirúrgico acionado por motor.
[00111] Exemplo 20 - A unidade de carregamento cirúrgica dos Exemplos 17, 18 ou 19, em que a pluralidade de pontes enrijecedoras de canal compreendem uma ponte enrijecedora de canal proximal que é espaçada de uma extremidade proximal do canal para definir uma abertura de canal proximal entre si e uma ponte enrijecedora de canal central que é distalmente espaçada da ponte enrijecedora de canal proximal para definir uma abertura de canal central entre si e uma ponte enrijecedora de canal distal que é espaçada distalmente da ponte enrijecedora de canal central para definir uma abertura de canal distal entre sií A pluralidade de pontes enrijecedoras de bigorna compreendem uma ponte enrijecedora de bigorna proximal que está alinhada verticalmente com a abertura de canal proximal quando o canal e a bigorna estão na posição completamente fechada. Uma ponte enrijecedora de bigorna central é espaçada distalmente da ponte enrijecedora de bigorna proximal para definir uma abertura de bigorna proximal entre si que está alinhada verticalmente com a ponte enrijecedora de canal proximal quando o canal e a bigorna estão na posição completamente fechada. Uma ponte enrijecedora de bigorna distal é espaçada distalmente da ponte enrijecedora de bigorna central para definir uma abertura de bigorna central entre si que está alinhada verticalmente com a ponte enrijecedora de canal central quando o canal e a bigorna estão na posição completamente fechada. A ponte enrijecedora de bigorna distal é espaçada proximalmente de uma extremidade distal da bigorna para definir uma abertura de bigorna distal entre si que está alinhada verticalmente com a ponte enrijecedora de canal distal quando a bigorna e o canal estão na posição completamente fechada.
[00112] Muitos dos sistemas de instrumento cirúrgico aqui descritos são acionados por um motor elétrico; entretanto, os sistemas de instrumento cirúrgico aqui descritos podem ser induzidos de qualquer maneira adequada. Em vários exemplos, os sistemas de instrumento cirúrgico aqui descritos podem ser induzidos, por exemplo, por um gatilho manualmente operado. Em certos casos, os motores revelados no presente documento podem compreender uma porção ou porções de um sistema roboticamente controlado. Além disso, qualquer um dos atuadores de extremidade e/ou conjuntos de ferramenta apresentados na presente invenção pode ser utilizado com um sistema de instrumento cirúrgico robótico. O pedido de patente US nº de série 13/118.241, intitulado SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE
STAPLE DEPLOYMENT ARRANGEMENTS, agora patente US nº
9.072.535, por exemplo, revela vários exemplos de um sistema de instrumento cirúrgico robótico com mais detalhes.
[00113] Os sistemas de instrumento cirúrgico aqui descritos foram descritos em conexão com a implantação e a deformação dos grampos; entretanto, as modalidades descritas na presente invenção não são limitadas dessa forma. Várias modalidades são previstas, as quais implantam prendedores além de grampos, como garras ou tachas, por exemplo. Além disso, várias modalidades são contempladas, as quais utilizam quaisquer meios adequados para selar o tecido. Por exemplo, um atuador de extremidade, de acordo com várias modalidades, pode compreender eletrodos configurados para aquecer e vedar o tecido. Da mesma forma, por exemplo, um atuador de extremidade de acordo com certas modalidades, pode aplicar energia vibracional para selar o tecido.
[00114] Embora vários dispositivos tenham sido aqui descritos em conexão com determinadas modalidades, modificações e variações dessas modalidades podem ser implementadas. Os recursos, estruturas ou características específicos podem ser combinados de qualquer maneira adequada em uma ou mais modalidades. Portanto, os recursos, as estruturas ou as características específicos ilustrados ou descritos em conexão com uma modalidade podem ser combinados, no todo ou em parte, com os recursos, estruturas ou características de uma ou mais outras modalidades, sem limitação. Além disso, onde forem revelados materiais para determinados componentes, outros materiais podem ser usados. Além disso, de acordo com várias modalidades, um único componente pode ser substituído por múltiplos componentes e múltiplos componentes podem ser substituídos por um único componente, para executar uma ou mais funções determinadas. A descrição mencionada anteriormente e as reivindicações seguintes são destinadas a abranger todas essas modificações e variações.
[00115] Os dispositivos aqui revelados podem ser projetados para serem descartados após um único uso, ou podem ser projetados para serem usados múltiplas vezes. Em qualquer um dos casos, entretanto, um dispositivo pode ser recondicionado para reuso após ao menos um uso. O recondicionamento pode incluir qualquer combinação das etapas incluindo, mas não se limitando a, a desmontagem do dispositivo seguida de limpeza ou substituição de peças específicas do dispositivo e remontagem subsequente do dispositivo. Em particular, uma instalação de recondicionamento e/ou equipe cirúrgica pode desmontar um dispositivo e, após a limpeza e/ou substituição de partes particulares do dispositivo, o dispositivo pode ser remontado para uso subsequente. 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 dessas técnicas, bem como o dispositivo recondicionado resultante, estão todos no escopo do presente pedido.
[00116] Osdispositivos revelados aqui 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 e/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. Um dispositivo pode também ser esterilizado com o uso de qualquer outra técnica conhecida, incluindo, mas não se limitando a, radiação beta,
radiação gama, óxido de etileno, peróxido de plasma e/ou vapor dágua.
[00117] Embora esta invenção tenha sido descrita como tendo designs exemplificadores, a presente invenção pode ser adicionalmente modificada dentro do espírito e do escopo da revelação. Pretende-se, portanto, que este pedido cubra quaisquer variações, usos Ou adaptações da invenção com o uso de seus princípios gerais.
Claims (20)
1. Atuador de extremidade para uso com um instrumento cirúrgico, caracterizado por compreender: uma primeira garra que define um primeiro eixo geométrico longitudinal de garra entre uma primeira extremidade proximal de garra e uma primeira extremidade distal de garra dela, e que compreende uma pluralidade de primeiros recursos enrijecedores de garra longitudinalmente deslocados uns dos outros para definir uma primeira abertura de garra entre si; uma segunda garra acoplada de maneira móvel à dita primeira garra de modo que a dita primeira garra e a dita segunda garra sejam móveis em relação uma à outra entre uma posição completamente aberta e completamente fechada, sendo que a dita segunda garra compreende uma pluralidade de segundos recursos enrijecedores de garra longitudinalmente deslocados uns dos outros para definir uma segunda abertura de garra entre si e em que, quando as ditas primeira e segunda garras estão na dita posição completamente fechada, cada dito primeiro recurso enrijecedor de garra está alinhado verticamente com aquela correspondente dentre as ditas segundas aberturas de garra e cada dito segundo recurso enrijecedor de garra está alinhado verticalmente com aquela correspondente dentre as ditas primeiras aberturas de garra; e meios para mover seletivamente as ditas primeira e segunda garras entre as ditas posições completamente abertas e as ditas posições completamente fechadas.
2. Atuador de extremidade, de acordo com a reivindicação 1, caracterizado por a dita pluralidade dos ditos primeiros recursos enrijecedores de garra compreenderem: um primeiro enrijecedor de garra proximal que é espaçado de uma extremidade proximal da dita primeira garra para definir uma primeira abertura de garra proximal entre si;
um primeiro enrijecedor de garra central que é distalmente espaçado do dito primeiro enrijecedor de garra proximal para definir uma primeira abertura de garra central entre si; e um primeiro enrijecedor de garra distal espaçado distalmente do dito primeiro enrijecedor de garra central para definir uma primeira abertura de garra distal entre si e em que a dita pluralidade de segundos recursos enrijecedores de garra compreendem: um segundo enrijecedor de garra proximal alinhado verticalmente com a dita primeira abertura de garra proximal quando as ditas primeira e segunda garras estão na dita posição completamente fechada; um segundo enrijecedor de garra central espaçado distalmente do dito segundo enrijecedor de garra proximal para definir uma segunda abertura de garra proximal entre si que está alinhada verticalmente com o dito primeiro enrijecedor de garra proximal quando as ditas primeira e segunda garras estão na dita posição completamente fechada; e um segundo enrijecedor de garra distal espaçado distalmente do dito segundo enrijecedor de garra central para definir uma segunda abertura de garra central entre si que está alinhada verticalmente com o dito primeiro enrijecedor de garra central quando as ditas primeira e segunda garras estão na dita posição completamente fechada, sendo que o dito segundo enrijecedor de garra distal está espaçado proximalmente de uma extremidade distal da dita segunda garra para definir uma segunda abertura de garra distal entre si que está alinhada verticalmente com o dito primeiro enrijecedor de garra distal quando as ditas primeira e segunda garras estão na dita posição completamente fechada.
3. Atuador de extremidade, de acordo com a reivindicação 1,
caracterizado por a dita primeira garra compreender um primeiro corpo de garra que compreende um primeiro lado lateral e um segundo lado lateral que é lateralmente espaçado do dito primeiro lado lateral, e em que cada um dentre a dita pluralidade dos ditos primeiros recursos enrijecedores de garra se estende entre o dito primeiro lado lateral e o dito segundo lado lateral, e em que a dita segunda garra compreende um segundo corpo de garra que define um segundo eixo geométrico longitudinal de garra entre uma segunda extremidade distal de garra e uma segunda extremidade proximal de garra, e em que a dita segunda garra compreende adicionalmente um lado lateral primário e um lado lateral secundário que é espaçado do dito lado lateral primário, e em que cada um dentre a dita pluralidade de segundos recursos enrijecedores de garra se estende entre o dito lado lateral primário e o dito lado lateral secundário.
4. Atuador de extremidade, de acordo com a reivindicação 3, caracterizado por cada dito primeiro recurso enrijecedor de garra ser transversal ao dito primeiro eixo geométrico longitudinal de garra e em que cada dito segundo recurso enrijecedor de garra é transversal ao dito segundo eixo geométrico longitudinal de garra.
5. Atuador de extremidade, de acordo com a reivindicação 1, caracterizado por os meios para mover seletivamente compreenderem um conjunto de preensão dinâmico axialmente móvel que é seletivamente móvel entre uma posição de partida que corresponde à dita posição completamente aberta das ditas primeira e segunda garras e uma posição final, em que o dito conjunto de preensão dinâmico axialmente móvel compreende: uma parte estrutural que se estende verticalmente; pelo menos um primeiro recurso de engate de garra configurado para engatar de maneira deslizante a dita primeira garra; e pelo menos um segundo recurso de engate de garra configurado para engatar de maneira deslizante a dita segunda garra.
6. Atuador de extremidade, de acordo com a reivindicação 5, caracterizado por o dito pelo menos um primeiro recurso de engate de garra ser visível através de pelo menos uma das ditas primeiras aberturas de garra na dita primeira garra ou o dito pelo menos um segundo recurso de engate de garra ser visível através de pelo menos uma das ditas segundas aberturas de garra na dita segunda garra, conforme o dito conjunto de preensão dinâmico é axialmente movido dentro do dito atuador de extremidade.
7. Atuador de extremidade, de acordo com a reivindicação 3, caracterizado por o dito pelo menos um primeiro recurso de engate de garra ser visível através de pelo menos uma das ditas primeiras aberturas de garra na dita primeira garra a partir de um dos ditos primeiro e segundo lados laterais da dita primeira garra ou o dito pelo menos um segundo recurso de garra ser visível através de pelo menos uma das ditas segundas aberturas de garra na dita segunda garra a partir de um dos ditos lados laterais primário e secundário da dita segunda garra, conforme o dito conjunto de preensão dinâmico é axialmente movido dentro do dito atuador de extremidade.
8. Atuador de extremidade, de acordo com a reivindicação 5, caracterizado por a dita primeira garra compreender um canal configurado para sustentar um cartucho de grampo cirúrgico nele e em que a dita segunda garra compreende uma bigorna.
9. Atuador de extremidade, de acordo com a reivindicação 8, caracterizado por a dita parte estrutural que se estende verticalmente compreender uma superfície de corte de tecido.
10. Atuador de extremidade para uso com um instrumento cirúrgico, caracterizado por compreender: uma primeira garra;
uma segunda garra acoplada de modo pivotante à dita primeira garra, de modo que as ditas primeira e segunda garras sejam móveis entre si entre uma posição completamente aberta e uma posição completamente fechada; e um conjunto de preensão dinâmico configurado para engatar as ditas primeira e segunda garras, conforme o dito conjunto de preensão dinâmico é axialmente movido de uma posição de partida para uma posição final para aplicar movimentos de fechamento nas ditas primeira e segunda garras e em que pelo menos uma dentre as ditas primeira e segunda garras compreende recursos enrijecedores que são longitudinalmente espaçados uns dos outros por aberturas configuradas para permitir visualização do conjunto de preensão dinâmico através delas, conforme o dito conjunto de preensão dinâmico se move entre a dita posição de partida e a dita posição final.
11. Atuador de extremidade, de acordo com a reivindicação 10, caracterizado por o dito conjunto de preensão dinâmico compreender: uma parte estrutural que se estende verticalmente; pelo menos um primeiro recurso de engate de garra configurado para engatar de maneira deslizante a dita primeira garra; e pelo menos um segundo recurso de engate de garra configurado para engatar de maneira deslizante a dita segunda garra.
12. Atuador de extremidade, de acordo com a reivindicação 10, caracterizado por a dita primeira garra compreender um canal que compreende: um corpo de canal que compreende um primeiro lado de canal lateral e um segundo lado de canal lateral que é lateralmente espaçado do dito primeiro lado de canal lateral; e uma pluralidade de pontes enrijecedoras de canal axialmente espaçadas entre si pelas aberturas de canal e que se estendem entre o dito primeiro lado de canal lateral e o dito segundo lado de canal lateral.
13. Atuador de extremidade, de acordo com a reivindicação 12, caracterizado por a dita segunda garra compreender uma bigorna que compreende: uma placa de bigorna sustentada em posição face a face com um cartucho sustentado no dito canal; e uma tampa de bigorna acoplada à dita placa de bigorna e que compreende: um primeiro lado de bigorna lateral; e um segundo lado de bigorna lateral espaçado do dito primeiro lado de bigorna lateral e conectado a ele pela dita pluralidade de pontes enrijecedoras de bigorna axialmente espaçadas uma das outras por aberturas de bigorna e que se estendem entre o dito primeiro lado de bigorna lateral e o dito segundo lado de bigorna lateral.
14. Atuador de extremidade, de acordo com a reivindicação 13, caracterizado por cada dita ponte enrijecedora de canal ser transversal ao dito primeiro eixo geométrico longitudinal e em que a dita bigorna define um segundo eixo geométrico longitudinal entre uma extremidade de bigorna proximal e uma extremidade de bigorna distal, e em que cada dita ponte enrijecedora de bigorna é transversal ao dito segundo eixo geométrico longitudinal.
15. Atuador de extremidade, de acordo com a reivindicação 11, caracterizado por a dita parte estrutural que se estende verticalmente compreender uma superfície de corte de tecido.
16. Atuador de extremidade, de acordo com a reivindicação 12, caracterizado por uma porção do dito conjunto de preensão dinâmico ser visível através de pelo menos uma das ditas aberturas de canal no dito canal a partir de um dentre o dito primeiro lado de canal lateral e o dito segundo lado de canal lateral ou pelo menos outra porção do dito conjunto de preensão dinâmico ser visível através de pelo menos uma das ditas aberturas de bigorna a partir de uma dentre o dito primeiro lado lateral de bigorna e o dito segundo lado lateral de bigorna, conforme o dito conjunto de preensão dinâmico é axialmente movido dentro do dito atuador de extremidade.
17. Unidade de carregamento cirúrgica para uso com um instrumento cirúrgico acionado por motor, caracterizada por compreender: um gabinete configurado para fazer interface operacionalmente com uma porção do instrumento cirúrgico acionado por motor; um conjunto de ferramentas acoplado operacionalmente ao dito gabinete e que compreende: um canal que sustenta um corpo de cartucho de grampo nele, sendo que o dito canal define um primeiro eixo geométrico longitudinal entre uma extremidade proximal e uma extremidade distal dele, sendo que o dito canal compreende uma porção de fundo segmentada que define uma pluralidade de pontes enrijecedoras de canal e aberturas de canal entre si; uma bigorna acoplada de modo pivotante ao dito canal, de modo que o dito canal e a dita bigorna sejam móveis entre si entre uma posição completamente aberta e uma posição completamente fechada, sendo que a dita bigorna compreende uma porção de topo segmentada que define uma pluralidade de pontes enrijecedoras de bigorna e aberturas de bigorna entre si; e um conjunto de preensão dinâmico configurado para engatar o dito canal e a dita bigorna conforme o dito conjunto de preensão dinâmico é axialmente movido de uma posição de partida para uma posição final para aplicar movimentos de fechamento no dito canal e na dita bigorna, e é visível através das ditas aberturas de canal ou ditas aberturas de bigorna, conforme o dito conjunto de preensão dinâmico se move entre a dita posição de partida e a dita posição final.
18. Unidade de carregamento cirúrgica, de acordo com a reivindicação 17, caracterizada por o dito conjunto de ferramentas ser acoplado de modo pivotante ao dito conjunto de gabinete para movimento pivotante seletivo com relação a ele.
19. Unidade de carregamento cirúrgica, de acordo com a reivindicação 18, caracterizada por o dito gabinete ser configurado para ser acoplado de modo removível a um adaptador configurado para ser acoplado de modo removível ao instrumento cirúrgico acionado por motor.
20. Unidade de carregamento cirúrgica, de acordo com a reivindicação 17, caracterizada por a dita pluralidade das ditas pontes enrijecedoras de canal compreenderem: uma ponte enrijecedora de canal proximal espaçada de uma extremidade proximal do dito canal para definir uma abertura de canal proximal entre si; uma ponte enrijecedora de canal central distalmente espaçada da dita ponte enrijecedora de canal proximal para definir uma abertura de canal central entre si; e uma ponte enrijecedora de canal distal espaçada distalmente da dita ponte enrijecedora de canal central para definir uma abertura de canal distal entre si e em que a dita pluralidade de pontes enrijecedoras de bigorna compreendem: uma ponte enrijecedora de bigorna proximal alinhada verticalmente com a dita abertura de canal proximal quando o dito canal e a bigorna estão na dita posição completamente fechada; uma ponte enrijecedora de bigorna central espaçada distalmente da dita ponte enrijecedora de bigorna proximal para definir uma abertura de bigorna proximal entre si que está alinhada verticalmente com a dita ponte enrijecedora de canal proximal quando o dito canal e bigorna estão na dita posição completamente fechada; e uma ponte enrijecedora de bigorna distal espaçada distalmente da dita ponte enrijecedora de bigorna central para definir uma abertura de bigorna central entre si que está alinhada verticalmente com a dita ponte enrijecedora de canal central quando o dito canal e a dita bigorna estão na dita posição completamente fechada, sendo a dita ponte enrijecedora de bigorna distal espaçada proximalmente de uma extremidade distal da dita bigorna para definir uma abertura de bigorna distal entre si que está alinhada verticalmente com a dita ponte enrijecedora de canal distal quando a dita bigorna e o dito canal estão na dita posição completamente fechada.
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US10743875B2 (en) | 2020-08-18 |
WO2019116275A1 (en) | 2019-06-20 |
CN111479516A (zh) | 2020-07-31 |
CN111479516B (zh) | 2024-03-15 |
EP3498182A1 (en) | 2019-06-19 |
BR112020011885B1 (pt) | 2023-10-03 |
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