BR112021002935A2 - dispositivos de grampeamento cirúrgico com membros de fechamento aprimorados - Google Patents
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/30—Surgical robots
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
- A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00681—Aspects not otherwise provided for
- A61B2017/00734—Aspects not otherwise provided for battery operated
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07228—Arrangement of the staples
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07257—Stapler heads characterised by its anvil
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07271—Stapler heads characterised by its cartridge
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07285—Stapler heads characterised by its cutter
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
- A61B2017/2933—Transmission of forces to jaw members camming or guiding means
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
- A61B2017/2933—Transmission of forces to jaw members camming or guiding means
- A61B2017/2934—Transmission of forces to jaw members camming or guiding means arcuate shaped guiding means
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Abstract
DISPOSITIVOS DE GRAMPEAMENTO CIRÚR-GICO COM MEMBROS DE FECHAMENTO APRIMORADOS. A presente invenção refere-se a sistemas e membros de fechamento para atuar as garras de um atuador de extremidade cirúrgico. Os sistemas de fechamento incluem um membro de fechamento que é configurado para interagir com porções correspondentes das garras para estabelecer cargas de fechamento e preensão aprimoradas.
Description
Relatório Descritivo da Patente de Invenção para "DISPOSITI- VOS DE GRAMPEAMENTO CIRÚRGICO COM MEMBROS DE FECHA- MENTO APRIMORADOS".
[0001] 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 os mesmos, que são projetados para grampear e cortar tecido.
[0002] Várias características das modalidades no presente docu- mento descritas, juntamente com suas vantagens, podem ser entendi- das de acordo com a descrição apresentada a seguir, considerada em conjunto com os desenhos em anexo, conforme exposto a seguir:
[0003] A Figura 1 é uma vista em perspectiva de um sistema de grampeamento cirúrgico energizado;
[0004] A Figura 2 é uma vista em perspectiva de um conjunto de eixo de acionamento cirúrgico intercambiável do sistema de grampeamento ci- rúrgico energizado da Figura 1;
[0005] A Figura 3 é uma vista do conjunto explodida de porções de um conjunto de empunhadura do sistema de grampeamento cirúrgico energizado Figura 1;
[0006] A Figura 4 é uma vista explodida de conjunto do conjunto de eixo de acionamento intercambiável da Figura 2;
[0007] A Figura 5 é uma outra vista explodida parcial do conjunto de uma porção do conjunto cirúrgica intercambiável da Figura 4;
[0008] A Figura 6 é uma outra vista em perspectiva parcial de uma porção do conjunto de eixo de acionamento cirúrgico intercambiável da Figura 2 com garras do mesmo em uma posição aberta;
[0009] A Figura 7 é uma outra vista em perspectiva de uma porção do atuador de extremidade e do conjunto de eixo de acionamento intercam- biável da Figura 6;
[0010] A Figura 8 é uma vista em perspectiva de uma modalidade de membro de fechamento distal;
[0011] A Figura 9 é uma vista de extremidade da modalidade do mem- bro de fechamento distal da Figura 8;
[0012] A Figura 10 é uma vista em elevação lateral do atuador de extremidade e da porção do conjunto de eixo de acionamento cirúrgico intercambiável da Figura 7, com uma bigorna e um membro de fecha- mento da mesma em uma posição completamente aberta;
[0013] A Figura 11 é uma vista em seção transversal do atuador de extremidade e do membro de fechamento da Figura 10 tomada ao longo da linha 11-11 da Figura 10;
[0014] A Figura 12 é uma vista em elevação lateral do atuador de extremidade e da porção do conjunto de eixo de acionamento cirúrgico intercambiável da Figura 11, com a bigorna e um membro de fecha- mento em uma posição fechada;
[0015] A Figura 13 é uma vista em seção transversal da bigorna e do membro de fechamento da Figura 12 tomada ao longo da linha 13-13 na Figura 12;
[0016] A Figura 14 é uma vista em elevação lateral do atuador de extremidade e da porção do conjunto de ferramenta cirúrgica intercam- biável da Figura 13 com a bigorna e o membro de fechamento da mesma em uma posição "mais fechada";
[0017] A Figura 15 é uma vista em seção transversal do atuador de extremidade e do membro de fechamento da Figura 14 tomada ao longo da linha 15-15 da Figura 14;
[0018] A Figura 16 é uma vista em perspectiva de uma porção de um outro atuador de extremidade cirúrgico do conjunto de eixo de aciona-
mento cirúrgico intercambiável, com uma bigorna do mesmo em uma con- figuração aberta;
[0019] A Figura 17 é uma vista em elevação lateral do atuador de extremidade e da porção do conjunto de eixo de acionamento cirúrgico intercambiável da Figura 16 com a bigorna e o membro de fechamento da mesma em uma posição completamente aberta;
[0020] A Figura 18 é uma vista em seção transversal do atuador de extremidade e do membro de fechamento da Figura 17 tomada ao longo da linha 18-18 da Figura 17;
[0021] A Figura 19 é uma vista em elevação lateral do atuador de ex- tremidade e da porção do conjunto de eixo de acionamento cirúrgico inter- cambiável da Figura 17 com a bigorna e o membro de fechamento da mesma em uma posição fechada;
[0022] A Figura 20 é uma vista em seção transversal do atuador de extremidade e do membro de fechamento da Figura 19 tomada ao longo da linha 20-20 da Figura 19;
[0023] A Figura 21 é uma vista em elevação lateral do atuador de extremidade e da porção do conjunto de eixo de acionamento cirúrgico intercambiável da Figura 19 com a bigorna e o membro de fechamento da mesma em uma posição mais fechada;
[0024] A Figura 22 é uma vista em seção transversal do atuador de extremidade e do membro de fechamento da Figura 21 tomada ao longo da linha 22-22 da Figura 21;
[0025] A Figura 23 é uma vista de extremidade de uma modalidade de um outro membro de fechamento distal;
[0026] A Figura 24 é uma vista em elevação lateral de um outro atu- ador de extremidade e porção de um outro conjunto de eixo de aciona- mento cirúrgico intercambiável, com uma bigorna e um membro de fe- chamento da mesma em uma posição aberta;
[0027] A Figura 25 é uma vista em seção transversal do atuador de extremidade e do membro de fechamento da Figura 24 tomada ao longo da linha 25-25 da Figura 24;
[0028] A Figura 26 é uma vista em elevação lateral do atuador de extremidade e do conjunto de eixo de acionamento cirúrgico intercam- biável da Figura 24, com a bigorna e o membro de fechamento da mesma em uma posição fechada;
[0029] A Figura 27 é uma vista em seção transversal do atuador de extremidade e do membro de fechamento da Figura 26 tomada ao longo da linha 27-27 da Figura 26;
[0030] A Figura 28 é uma outra vista em elevação lateral do atua- dor de extremidade e do conjunto de eixo de acionamento cirúrgico intercambiável da Figura 24 com a bigorna e o membro de fechamento da mesma em uma posição mais fechada;
[0031] A Figura 29 é uma vista em seção transversal do atuador de extremidade e do membro de fechamento da Figura 28 tomada ao longo da linha 29-29 da Figura 28;
[0032] A Figura 30 é uma vista de extremidade de uma modalidade de um outro membro de fechamento;
[0033] A Figura 31 é uma vista em elevação lateral de um outro atu- ador de extremidade e porção de um outro conjunto de eixo de aciona- mento cirúrgico intercambiável, com uma bigorna e um membro de fe- chamento da mesma em uma posição fechada;
[0034] A Figura 32 é uma outra vista em elevação lateral do atuador de extremidade do conjunto de eixo de acionamento cirúrgico intercam- biável da Figura 31 com a bigorna e o membro de fechamento da mesma em uma posição "mais fechada";
[0035] A Figura 33 é vista em elevação lateral ampliada de uma porção do atuador de extremidade e do membro de fechamento da Fi- gura 31 com a bigorna na posição fechada;
[0036] A Figura 34 é uma outra vista em elevação lateral ampliada de uma porção do atuador de extremidade e do membro de fecha- mento da Figura 32 com a bigorna na posição mais fechada;
[0037] A Figura 35 é uma vista em elevação lateral de um outro atu- ador de extremidade e porção de um outro conjunto de eixo de aciona- mento cirúrgico intercambiável, com uma bigorna e um membro de fe- chamento da mesma em uma posição fechada;
[0038] A Figura 36 é vista em elevação lateral ampliada de uma porção do atuador de extremidade e do membro de fechamento da Fi- gura 35 com a bigorna na posição fechada;
[0039] A Figura 37 é uma outra vista em elevação lateral do atuador de extremidade do conjunto de eixo de acionamento cirúrgico intercam- biável da Figura 35 com a bigorna e o membro de fechamento da mesma em uma posição mais fechada;
[0040] A Figura 38 é uma outra vista em elevação lateral ampliada de uma porção do atuador de extremidade e do membro de fecha- mento da Figura 37 com a bigorna na posição mais fechada;
[0041] A Figura 39 é uma vista em perspectiva de um cartucho de grampos cirúrgicos precedente configurado para formar linhas flexíveis de grampos cirúrgicos;
[0042] A Figura 40 é uma vista de topo de linhas de grampos cirúr- gicos formados no tecido pelo cartucho de grampos cirúrgicos da Fi- gura 39;
[0043] A Figura 41 é uma vista em elevação lateral de uma modali- dade do grampo cirúrgico precedente; e
[0044] A Figura 42 é uma vista em elevação lateral de uma outra modalidade do grampo cirúrgico precedente.
[0045] Caracteres de referência correspondentes indicam partes cor- respondentes através das várias vistas. Os exemplos no presente docu- mento descritos ilustram várias modalidades da invenção, em uma forma,
e tais exemplos não devem ser considerados de forma alguma como limi- tadores do escopo da invenção.
[0046] O requerente do presente pedido detém os seguintes pedidos de patente US, que foram depositados na mesma data do presente pedido e que estão, cada um, no presente documento incorporados a título de referência em suas respectivas totalidades: - pedido de patente US n° de série __________, intitulado METHOD FOR FABRICATING SURGICAL STAPLER ANVILS, n° do documento do procurador END8577USNP/180088m; - pedido de patente US n° de série __________, intitulado
REINFORCED DEFORMABLE ANVIL TIP FOR SURGICAL STAPLER ANVIL, n° do documento do procurador END8578USNP/180393; - pedido de patente US n° de série _____________, intitulado SURGICAL STAPLER ANVILS WITH STAPLE DIRECTING PROTRUSI- ONS AND TISSUE STABILITY FEATURES, n° do documento do procura- dor END8579USNP/180089; - pedido de patente US n° de série __________, intitulado FABRICATING TECHNIQUES FOR SURGICAL STAPLER ANVILS, n° do documento do procurador END8580USNP/180090; - pedido de patente US n° de série __________, intitulado SURGICAL STAPLER ANVILS WITH TISSUE STOP FEATURES CON- FIGURED TO AVOID TISSUE PINCH, n° do documento do procurador END8582USNP/180092; - pedido de patente US n° de série __________, intitulado METHOD FOR OPERATING A POWERED ARTICULATABLE SURGI- CAL INSTRUMENT, n° do documento do procurador END8583USNP/180093M; - pedido de patente US n° de série __________, intitulado
ARRANGEMENTS, n° do documento do procurador END8584USNP/180094; - pedido de patente US n° de série __________, intitulado POWERED SURGICAL INSTRUMENTS WITH CLUTCHING ARRAN-
GEMENTS TO CONVERT LINEAR DRIVE MOTIONS TO ROTARY DRIVE MOTIONS, n° do documento do procurador END8585USNP/180095; - pedido de patente US n° de série ____________ intitulado POWERED ARTICULATABLE SURGICAL INSTRUMENTS WITH CLUT- CHING AND LOCKING ARRANGEMENTS FOR LINKING AN ARTICU- LATION DRIVE SYSTEM TO A FIRING DRIVE SYSTEM n° do documento do procurador END8586USNP/180096; - pedido de patente US n° de série __________, intitulado AR-
TICULATABLE MOTOR POWERED SURGICAL INSTRUMENTS WITH DEDICATED ARTICULATION MOTOR ARRANGEMENTS, n° do docu- mento do procurador END8587USNP/180097; - pedido de patente US n° de série __________, intitulado SWITCHING ARRANGEMENTS FOR MOTOR POWERED ARTICULA- TABLE SURGICAL INSTRUMENTS, n° do documento do procurador END8588USNP/180098; e - pedido de patente de desenho industrial US n° de série, inti- tulado SURGICAL STAPLER ANVILS, n° do documento do procurador END8581USDP/180099D.
[0047] O requerente do presente pedido detém os seguintes pedi- dos de patente US e patentes US que estão, cada um, incorporados no presente documento a título de referência em suas respectivas to- talidades: - pedido de patente US n° de série 15/386.185, intitulado
SURGICAL STAPLING INSTRUMENTS AND REPLACEABLE TOOL ASSEMBLIES THEREOF, publicação do pedido de patente US n°
2018-0168642; - pedido de patente US n° de série 15/386.230, intitulado ARTICULATABLE SURGICAL STAPLING INSTRUMENTS, publica- ção do pedido de patente US n° 2018-0168649; - pedido de patente US n° de série 15/386.221, intitulado LOCKOUT ARRANGEMENTS FOR SURGICAL END EFFECTORS, publicação do pedido de patente US n° 2018-01686; - pedido de patente US n° de série 15/386.209, intitulado SURGICAL END EFFECTORS AND FIRING MEMBERS THEREOF, publicação do pedido de patente US n° 2018-0168645; - pedido de patente US n° de série 15/386.198, intitulado
LOCKOUT ARRANGEMENTS FOR SURGICAL END EFFECTORS AND REPLACEABLE TOOL ASSEMBLIES, publicação do pedido de patente US n° 2018-0168644; - pedido de patente US n° de série 15/386.240, intitulado
SURGICAL END EFFECTORS AND ADAPTABLE FIRING MEMBERS THEREFOR, publicação do pedido de patente US n° 2018-0168651; - pedido de patente US n° de série 15/385.939, intitulado STA-
PLE CARTRIDGES AND ARRANGEMENTS OF STAPLES AND STAPLE CAVITIES THEREIN, publicação do pedido de patente US n° 2018- 0168629; - pedido de patente US n° de série 15/385.941, intitulado SSURGICAL TOOL ASSEMBLIES WITH CLUTCHING ARRANGE-
CLOSURE STROKE REDUCTION FEATURES AND ARTICULATION AND FIRING SYSTEMS, publicação do pedido de patente US n° 2018- 0168630; - pedido de patente US n° de série 15/385.943, intitulado SUR- GICAL STAPLING INSTRUMENTS AND STAPLE-FORMING ANVILS, publicação do pedido de patente US n° 2018-0168631;
- pedido de patente US n° de série 15/385.950, intitulado SUR-
GICAL TOOL ASSEMBLIES WITH CLOSURE STROKE REDUCTION FEATURES, publicação do pedido de patente US n° 2018-0168635; - pedido de patente US n° de série 15/385.945, intitulado STA-
PLE CARTRIDGES AND ARRANGEMENTS OF STAPLES AND STAPLE CAVITIES THEREIN; publicação do pedido de patente US n° 2018- 0168632; - pedido de patente US n° de série 15/385.946, intitulado SUR- GICAL STAPLING INSTRUMENTS AND STAPLE-FORMING ANVILS, publicação do pedido de patente US n° 2018-0168633; - pedido de patente US n° de série 15/385.951, intitulado SUR- GICAL INSTRUMENTS WITH JAW OPENING FEATURES FOR IN- CREASING A JAW OPENING DISTANCE, publicação do pedido de pa- tente US n° 2018-0168636; - pedido de patente US n° de série 15/385.953, intitulado ME- THODS OF STAPLING TISSUE, publicação do pedido de patente US n° 2018-0168637; - pedido de patente US n° de série 15/385.954, intitulado FI- RING MEMBERS WITH NON-PARALLEL JAW ENGAGEMENT FEATU- RES FOR SURGICAL END EFFECTORS, publicação do pedido de pa- tente US n° 2018-0168638; - pedido de patente US n° de série 15/385.955, intitulado SUR- GICAL END EFFECTORS WITH EXPANDABLE TISSUE STOP ARRAN- GEMENTS, publicação do pedido de patente US n° 2018-0168639; - pedido de patente US n° de série 15/385.948, intitulado SUR- GICAL STAPLING INSTRUMENTS AND STAPLE-FORMING ANVILS, publicação do pedido de patente US n° 2018-0168584; - pedido de patente US n° de série 15/385.956, intitulado SUR- GICAL INSTRUMENTS WITH POSITIVE JAW OPENING FEATURES, publicação do pedido de patente US n° 2018-0168640;
- pedido de patente US n° de série 15/385.958, intitulado
SURGICAL INSTRUMENTS WITH LOCKOUT ARRANGEMENTS FOR PREVENTING FIRING SYSTEM ACTUATION UNLESS AN UNS- PENT STAPLE CARTRIDGE IS PRESENT, publicação do pedido de patente US n° 2018-0168641; - pedido de patente US n° de série 15/385.947, intitulado STA-
PLE CARTRIDGES AND ARRANGEMENTS OF STAPLES AND STAPLE CAVITIES THEREIN, publicação do pedido de patente US n° 2018- 0168634; - pedido de patente US n° de série 15/385.896, intitulado ME-
THOD FOR RESETTING A FUSE OF A SURGICAL INSTRUMENT SHAFT, publicação do pedido de patente US n° 2018-0168597; - pedido de patente US n° de série 15/385.898, intitulado STAPLE-FORMING POCKET ARRANGEMENT TO ACCOMMODATE DIFFERENT TYPES OF STAPLES, publicação do pedido de patente US n° 2018-0168599; - pedido de patente US n° de série 15/385.899, intitulado SURGICAL INSTRUMENT COMPRISING IMPROVED JAW CON- TROL, publicação do pedido de patente US n° 2018-0168600; - pedido de patente US n° de série 15/385.901, intitulado STA-
PLE CARTRIDGE AND STAPLE CARTRIDGE CHANNEL COMPRISING WINDOWS DEFINED THEREIN, publicação do pedido de patente US n° 2018-0168602; - pedido de patente US n° de série 15/385.902, intitulado SUR- GICAL INSTRUMENT COMPRISING A CUTTING MEMBER, publicação do pedido de patente US n° 2018-0168603; - pedido de patente US n° de série 15/385.904, intitulado STA- PLE FIRING MEMBER COMPRISING A MISSING CARTRIDGE AND/OR SPENT CARTRIDGE LOCKOUT, publicação do pedido de patente US n° 2018-0168605;
- pedido de patente US n° de série 15/385.905, intitulado FIRING ASSEMBLY COMPRISING A LOCKOUT, publicação do pe- dido de patente US n° 2018-0168606; - pedido de patente US n° de série 15/385.907, intitulado SUR-
GICAL INSTRUMENT SYSTEM COMPRISING AN END EFFECTOR LOCKOUT AND A FIRING ASSEMBLY LOCKOUT, publicação do pedido de patente US n° 2018-0168608; - pedido de patente US n° de série 15/385.908, intitulado FI- RING ASSEMBLY COMPRISING A FUSE, publicação do pedido de pa- tente US n° 2018-0168609; - pedido de patente US n° de série 15/385.909, intitulado FI- RING ASSEMBLY COMPRISING A MULTIPLE FAILED-STATE FUSE, publicação do pedido de patente US n° 2018-0168610; - pedido de patente US n° de série 15/385.920, intitulado STA- PLE-FORMING POCKET ARRANGEMENTS, publicação do pedido de patente US n° 2018-0168620; - pedido de patente US n° de série 15/385.913, intitulado ANVIL ARRANGEMENTS FOR SURGICAL STAPLER, publicação do pedido de patente US n° 2018-0168614; - pedido de patente US n° de série 15/385.914, intitulado ME-
THOD OF DEFORMING STAPLES FROM TWO DIFFERENT TYPES OF STAPLE CARTRIDGES WITH THE SAME SURGICAL STAPLING INS- TRUMENT, publicação do pedido de patente n° 2018-0168615; - pedido de patente US n° de série 15/385.893, intitulado BI- LATERALLY ASYMMETRIC STAPLE-FORMING POCKET PAIRS, pu- blicação do pedido de patente US n° 2018-0168594; - pedido de patente US n° de série 15/385.929, intitulado CLO- SURE MEMBERS WITH CAM SURFACE ARRANGEMENTS FOR SUR-
GICAL INSTRUMENTS WITH SEPARATE AND DISTINCT CLOSURE AND FIRING SYSTEMS, publicação do pedido de patente US n° 2018-
0168626; - pedido de patente US n° de série 15/385.911, intitulado SUR-
GICAL STAPLERS WITH INDEPENDENTLY ACTUATABLE CLOSING AND FIRING SYSTEMS, publicação do pedido de patente US n° 2018- 0168612; - pedido de patente US n° de série 15/385.927, intitulado SURGICAL STAPLING INSTRUMENTS WITH SMART STAPLE CAR- TRIDGES, publicação do pedido de patente US n° 2018-0168625; - pedido de patente US n° de série 15/385.917, intitulado STA- PLE CARTRIDGE COMPRISING STAPLES WITH DIFFERENT CLAM- PING BREADTHS, publicação do pedido de patente US n° 2018-0168617; - pedido de patente US n° de série 15/385.900, intitulado STA- PLE-FORMING POCKET ARRANGEMENTS COMPRISING PRIMARY SIDEWALLS AND POCKET SIDEWALLS, publicação do pedido de pa- tente US n° 2018-0168601; - pedido de patente US n° de série 15/385.931, intitulado NO-
CARTRIDGE AND SPENT CARTRIDGE LOCKOUT ARRANGEMENTS FOR SURGICAL STAPLERS, publicação do pedido de patente US n° 2018-0168627; - pedido de patente US n° de série 15/385.915, intitulado FI- RING MEMBER PIN ANGLE, publicação do pedido de patente US n° 2018-0168616; - pedido de patente US n° de série 15/385.897, intitulado STA- PLE-FORMING POCKET ARRANGEMENTS COMPRISING ZONED FORMING SURFACE GROOVES, publicação do pedido de patente US n° 2018-0168598; - pedido de patente US n° de série 15/385.922, intitulado SUR- GICAL INSTRUMENT WITH MULTIPLE FAILURE RESPONSE MODES, publicação do pedido de patente US n° 2018-0168622;
- pedido de patente US n° de série 15/385.924, intitulado SUR- GICAL INSTRUMENT WITH PRIMARY AND SAFETY PROCESSORS, publicação do pedido de patente US n° 2018-0168624; - pedido de patente US n° de série 15/385.910, intitulado AN- VIL HAVING A KNIFE SLOT WIDTH, publicação do pedido de patente US n° 2018-0168611; - pedido de patente US n° de série 15/385.903, intitulado CLO- SURE MEMBER ARRANGEMENTS FOR SURGICAL INSTRUMENTS, publicação do pedido de patente US n° 2018-0168604; - pedido de patente US n° de série 15/385.906, intitulado FIRING MEMBER PIN CONFIGURATIONS, publicação do pedido de patente US n° 2018-0168607; - pedido de patente US n° de série 15/386.188, intitulado STEPPED STAPLE CARTRIDGE WITH ASYMMETRICAL STAPLES, publicação do pedido de patente US n° 2018-0168585; - pedido de patente US n° de série 15/386.192, intitulado
STEPPED STAPLE CARTRIDGE WITH TISSUE RETENTION AND GAP SETTING FEATURES, publicação do pedido de patente US n° 2018- 0168643; - pedido de patente US n° de série 15/386.206, intitulado
STAPLE CARTRIDGE WITH DEFORMABLE DRIVER RETENTION FEATURES, publicação do pedido de patente US n° 2018-0168586; - pedido de patente US n° de série 15/386.226, intitulado DU- RABILITY FEATURES FOR END EFFECTORS AND FIRING ASSEM- BLIES OF SURGICAL STAPLING INSTRUMENTS, publicação do pedido de patente US n° 2018-0168648; - pedido de patente US n° de série 15/386.222, intitulado SUR-
GICAL STAPLING INSTRUMENTS HAVING END EFFECTORS WITH POSITIVE OPENING FEATURES, publicação do pedido de patente US n° 2018-0168647;
- pedido de patente US n° de série 15/386.236, intitulado CON- NECTION PORTIONS FOR DEPOSABLE LOADING UNITS FOR SUR- GICAL STAPLING INSTRUMENTS, publicação do pedido de patente US n° 2018-0168650; - pedido de patente US n° de série 15/385.887, intitulado ME- THOD FOR ATTACHING A SHAFT ASSEMBLY TO A SURGICAL INS- TRUMENT AND, ALTERNATIVELY, TO A SURGICAL ROBOT, publi- cação do pedido de patente US n° 2018-0168589; - pedido de patente US n° de série 15/385.889, intitulado SHAFT ASSEMBLY COMPRISING A MANUALLY-OPERABLE RE-
TRACTION SYSTEM FOR USE WITH A MOTORIZED SURGICAL INSTRUMENT SYSTEM, publicação do pedido de patente US n° 2018- 0168590; - pedido de patente US n° de série 15/385.890, intitulado
SHAFT ASSEMBLY COMPRISING SEPARATELY ACTUATABLE AND RETRACTABLE SYSTEMS, publicação do pedido de patente US n° 2018- 0168591; - pedido de patente US n° de série 15/385.891, intitulado
SHAFT ASSEMBLY COMPRISING A CLUTCH CONFIGURED TO ADAPT THE OUTPUT OF A ROTARY FIRING MEMBER TO TWO DIF- FERENT SYSTEMS, publicação do pedido de patente US n° 2018- 0168592; - pedido de patente US n° de série 15/385.892, intitulado SUR-
AN ARTICULATION STATE TO ARTICULATE AN END EFFECTOR OF THE SURGICAL SYSTEM, publicação do pedido de patente US n° 2018- 0168593; - pedido de patente US n° de série 15/385.894, intitulado SHAFT ASSEMBLY COMPRISING A LOCKOUT, publicação do pe- dido de patente US n° 2018-0168595;
- pedido de patente US n° de série 15/385.895, intitulado SHAFT ASSEMBLY COMPRISING FIRST AND SECOND ARTICULA- TION LOCKOUTS, publicação do pedido de patente US n° 2018-0168596; - pedido de patente US n° de série 15/385.916, intitulado SUR- GICAL STAPLING SYSTEMS, publicação do pedido de patente US n° 2018-0168575; - pedido de patente US n° de série 15/385.918, intitulado SUR- GICAL STAPLING SYSTEMS, publicação do pedido de patente US n° 2018-0168618; - pedido de patente US n° de série 15/385.919, intitulado SUR- GICAL STAPLING SYSTEMS, publicação do pedido de patente US n° 2018-0168619; - pedido de patente US n° de série 15/385.921, intitulado SURGICAL STAPLE CARTRIDGE WITH MOVABLE CAMMING MEM-
BER CONFIGURED TO DISENGAGE FIRING MEMBER LOCKOUT FEATURES, publicação do pedido de patente US n° 2018-0168621; - pedido de patente US n° de série 15/385.923, intitulado SUR- GICAL STAPLING SYSTEMS, publicação do pedido de patente US n° 2018-0168623; - pedido de patente US n° de série 15/385.925, intitulado JAW ACTUATED LOCK ARRANGEMENTS FOR PREVENTING ADVANCE- MENT OF A FIRING MEMBER IN A SURGICAL END EFFECTOR UN- LESS AN UNFIRED CARTRIDGE IS INSTALLED IN THE END EFFEC- TOR, publicação do pedido de patente US n° 2018-0168576; - pedido de patente US n° de série 15/385.926, intitulado AXI- ALLY MOVABLE CLOSURE SYSTEM ARRANGEMENTS FOR AP- PLYING CLOSURE MOTIONS TO JAWS OF SURGICAL INSTRU- MENTS, publicação do pedido de patente US n° 2018-0168577; - pedido de patente US n° de série 15/385.928, intitulado
BETWEEN A MOVABLE JAW AND ACTUATOR SHAFT OF A SURGI- CAL INSTRUMENT, publicação do pedido de patente US n° 2018- 0168578; - pedido de patente US n° de série 15/385.930, intitulado SURGICAL END EFFECTOR WITH TWO SEPARATE COOPERA- TING OPENING FEATURES FOR OPENING AND CLOSING END EF- FECTOR JAWS, publicação do pedido de patente US 2018-0168579; - pedido de patente US n° de série 15/385.932, intitulado AR-
TICULATABLE SURGICAL END EFFECTOR WITH ASYMMETRIC SHAFT ARRANGEMENT, publicação do pedido de patente US n° 2018- 0168628; - pedido de patente US n° de série 15/385.933, intitulado AR- TICULATABLE SURGICAL INSTRUMENT WITH INDEPENDENT PI- VOTABLE LINKAGE DISTAL OF AN ARTICULATION LOCK, publica- ção do pedido de patente US n° 2018-0168580; - pedido de patente US n° de série 15/385.934, intitulado AR- TICULATION LOCK ARRANGEMENTS FOR LOCKING AN END EFFEC-
TOR IN AN ARTICULATED POSITION IN RESPONSE TO ACTUATION OF A JAW CLOSURE SYSTEM, publicação do pedido de patente US n° 2018-0168581; - pedido de patente US n° de série 15/385.935, intitulado LA-
FOR LOCKING AN END EFFECTOR OF A SURGICAL INSTRUMENT IN AN ARTICULATED CONFIGURATION, publicação do pedido de patente US n° 2018-0168582; - pedido de patente US n° de série 15/385.936, intitulado AR-
TICULATABLE SURGICAL INSTRUMENTS WITH ARTICULATION STROKE AMPLIFICATION FEATURES, publicação do pedido de patente US n° 2018-0168583;
- pedido de patente US n° de série 14/318.996, intitulado FAS-
TENER CARTRIDGES INCLUDING EXTENSIONS HAVING DIFFERENT CONFIGURATIONS, publicação do pedido de patente US n° 2015- 0297228; - pedido de patente US n° de série 14/319.006, intitulado FAS-
TENER CARTRIDGE COMPRISING FASTENER CAVITIES INCLUDING FASTENER CONTROL FEATURES, agora patente US n° 10.010.324; - pedido de patente US n° de série 14/318.991, intitulado
SURGICAL FASTENER CARTRIDGES WITH DRIVER STABILIZING ARRANGEMENTS, agora patente US n° 9.833.241; - pedido de patente US n° de série 14/319.004, intitulado SUR- GICAL END EFFECTORS WITH FIRING ELEMENT MONITORING AR- RANGEMENTS, agora patente US n° 9.844.369; - pedido de patente US n° de série 14/319.008, intitulado FASTENER CARTRIDGE COMPRISING NON-UNIFORM FASTE- NERS, agora publicação do pedido de patente US n° 2015-0297232; - pedido de patente US n° de série 14/318.997, intitulado FAS-
TENER CARTRIDGE COMPRISING DEPLOYABLE TISSUE ENGAGING MEMBERS, publicação do pedido de patente US n° 2015-0297229; - pedido de patente US n° de série 14/319.002, intitulado FASTENER CARTRIDGE COMPRISING TISSUE CONTROL FEATU- RES, agora patente US n° 9.877.721; - pedido de patente US n° de série 14/319.013, intitulado
FASTENER CARTRIDGE ASSEMBLIES AND STAPLE RETAINER COVER ARRANGEMENTS, publicação do pedido de patente US n° 2015-0297233; e - pedido de patente US n° de série 14/319.016, intitulado FASTENER CARTRIDGE INCLUDING A LAYER ATTACHED THE- RETO, publicação do pedido de patente US n° 2015-0297235.
[0048] O requerente do presente pedido detém os seguintes pedi- dos de patente US que foram depositados em 24 de junho de 2016, e que estão, cada um, no presente documento incorporados por referên- cia em suas respectivas totalidades: - pedido de patente US n° de série 15/191.775, intitulado STA- PLE CARTRIDGE COMPRISING WIRE STAPLES AND STAMPED STA- PLES; - pedido de patente US n° de série 15/191.807, intitulado STA- PLING SYSTEM FOR USE WITH WIRE STAPLES AND STAMPED STA- PLES; - pedido de patente US n° de série 15/191.834, intitulado "STAMPED STAPLES AND STAPLE CARTRIDGES USING THE SAME"; - pedido de patente US n° de série 15/191.788, intitulado STA- PLE CARTRIDGE COMPRISING OVERDRIVEN STAPLES; e - pedido de patente US n° de série 15/191.818, intitulado STA-
[0049] O requerente do presente pedido detém os seguintes pedi- dos de patente US que foram depositados em 24 de junho de 2016, e que estão, cada um, no presente documento incorporados por referên- cia em suas respectivas totalidades: - pedido de patente de desenho industrial US n° de série 29/569.218, intitulado SURGICAL FASTENER; - pedido de patente de desenho industrial US n° de série 29/569.227, intitulado SURGICAL FASTENER; - pedido de patente de desenho industrial US n° de série 29/569.259, intitulado "SURGICAL FASTENER CARTRIDGE"; e - pedido de patente de desenho industrial US n° de série 29/569.264, intitulado "SURGICAL FASTENER CARTRIDGE".
[0050] O requerente do presente pedido detém os seguintes pedidos de patente que foram depositados em 1 de abril de 2016 e que estão, cada um, no presente documento incorporados por referência em suas respec- tivas totalidades: - pedido de patente US n° de série 15/089.325, intitulado ME- THOD FOR OPERATING A SURGICAL STAPLING SYSTEM; - pedido de patente US n° de série 15/089.321, intitulado MO- DULAR SURGICAL STAPLING SYSTEM COMPRISING A DISPLAY; - pedido de patente US n° de série 15/089.326, intitulado SURGICAL STAPLING SYSTEM COMPRISING A DISPLAY INCLU- DING A RE-ORIENTABLE DISPLAY FIELD; - pedido de patente US n° de série 15/089.263, intitulado SUR-
GICAL INSTRUMENT HANDLE ASSEMBLY WITH RECONFIGURABLE GRIP PORTION; - pedido de patente US n° de série 15/089.262, intitulado
ROTARY POWERED SURGICAL INSTRUMENT WITH MANUALLY ACTUATABLE BAILOUT SYSTEM; - pedido de patente US n° de série 15/089.277, intitulado
SURGICAL CUTTING AND STAPLING END EFFECTOR WITH ANVIL CONCENTRIC DRIVE MEMBER; - pedido de patente US n° de série 15/089.296, intitulado IN-
END EFFECTOR THAT IS SELECTIVELY ROTATABLE ABOUT A SHAFT AXIS; - pedido de patente US n° de série 15/089.258, intitulado SUR- GICAL STAPLING SYSTEM COMPRISING A SHIFTABLE TRANSMIS- SION; - pedido de patente US n° de série 15/089.278, intitulado SUR-
- pedido de patente US n° de série 15/089.284, intitulado SUR- GICAL STAPLING SYSTEM COMPRISING A CONTOURABLE SHAFT; - pedido de patente US n° de série 15/089.295, intitulado SUR-
GICAL STAPLING SYSTEM COMPRISING A TISSUE COMPRESSION LOCKOUT; - pedido de patente US n° de série 15/089.300, intitulado SUR-
GICAL STAPLING SYSTEM COMPRISING AN UNCLAMPING LOCKOUT; - pedido de patente US n° de série 15/089.196, intitulado SUR-
GICAL STAPLING SYSTEM COMPRISING A JAW CLOSURE LOCKOUT; - pedido de patente US n° de série 15/089.203, intitulado SUR-
GICAL STAPLING SYSTEM COMPRISING A JAW ATTACHMENT LOCKOUT; - pedido de patente US n° de série 15/089.210, intitulado SUR-
GICAL STAPLING SYSTEM COMPRISING A SPENT CARTRIDGE LOCKOUT; - pedido de patente US n° de série 15/089.324, intitulado SUR- GICAL INSTRUMENT COMPRISING A SHIFTING MECHANISM; - pedido de patente US n° de série 15/089.335, intitulado SUR-
GICAL STAPLING INSTRUMENT COMPRISING MULTIPLE LOCKOUTS; - pedido de patente US n° de série 15/089.339, intitulado SUR- GICAL STAPLING INSTRUMENT; - pedido de patente US n° de série 15/089.253, intitulado SURGICAL STAPLING SYSTEM CONFIGURED TO APPLY ANNU- LAR ROWS OF STAPLES HAVING DIFFERENT HEIGHTS; - pedido de patente US n° de série 15/089.304, intitulado SUR- GICAL STAPLING SYSTEM COMPRISING A GROOVED FORMING PO- CKET;
- pedido de patente US n° de série 15/089.331, intitulado AN- VIL MODIFICATION MEMBERS FOR SURGICAL STAPLERS; - pedido de patente US n° de série 15/089.336, intitulado STA- PLE CARTRIDGES WITH ATRAUMATIC FEATURES; - pedido de patente US n° de série 15/089.312, intitulado CIR- CULAR STAPLING SYSTEM COMPRISING AN INCISABLE TISSUE SU- PPORT; - pedido de patente US n° de série 15/089.309, intitulado CIR- CULAR STAPLING SYSTEM COMPRISING ROTARY FIRING SYSTEM; e - pedido de patente US n° de série 15/089.349, intitulado CIR- CULAR STAPLING SYSTEM COMPRISING LOAD CONTROL.
[0051] O requerente do presente pedido detém também os pedidos de patente US identificados abaixo, que foram depositados em 31 de dezembro de 2015, os quais estão, cada um, no presente documento incorporados a título de referência em suas respectivas totalidades: - pedido de patente US n° de série 14/984.488, intitulado "MECHANISMS FOR COMPENSATING FOR BATTERY PACK FAI- LURE IN POWERED SURGICAL INSTRUMENTS"; - pedido de patente US n° de série 14/984.525, intitulado ME-
CHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS; e - pedido de patente US n° de série 14/984.552, intitulado "SUR-
[0052] O requerente do presente pedido detém também os pedidos de patente US identificados abaixo, os quais foram depositados em 9 de fevereiro de 2016, os quais estão, cada um, no presente documento incorporados por referência em suas respectivas totalidades:
- pedido de patente US n° de série 15/019.220, intitulado "SUR- GICAL INSTRUMENT WITH ARTICULATING AND AXIALLY TRANSLA- TABLE END EFFECTOR"; - pedido de patente US n° de série 15/019.228, intitulado "SUR- GICAL INSTRUMENTS WITH MULTIPLE LINK ARTICULATION ARRAN- GEMENTS"; - pedido de patente US n° de série 15/019.196, intitulado "SUR-
GICAL INSTRUMENT ARTICULATION MECHANISM WITH SLOTTED SECONDARY CONSTRAINT"; - pedido de patente US n° de série 15/019.206, intitulado "SURGICAL INSTRUMENTS WITH AN END EFFECTOR THAT IS
HIGHLY ARTICULATABLE RELATIVE TO AN ELONGATE SHAFT ASSEMBLY"; - pedido de patente US n° de série 15/019.215, intitulado "SUR- GICAL INSTRUMENTS WITH NON-SYMMETRICAL ARTICULATION ARRANGEMENTS"; - pedido de patente US n° de série 15/019.227, intitulado "AR- TICULATABLE SURGICAL INSTRUMENTS WITH SINGLE ARTICULA- TION LINK ARRANGEMENTS"; - pedido de patente US n° de série 15/019.235, intitulado "SUR-
GICAL INSTRUMENTS WITH TENSIONING ARRANGEMENTS FOR CABLE DRIVEN ARTICULATION SYSTEMS"; - pedido de patente US n° de série 15/019.230, intitulado "AR- TICULATABLE SURGICAL INSTRUMENTS WITH OFF-AXIS FIRING BEAM ARRANGEMENTS"; e - pedido de patente US n° de série 15/019.245, intitulado "SUR- GICAL INSTRUMENTS WITH CLOSURE STROKE REDUCTION AR- RANGEMENTS".
[0053] O requerente do presente pedido detém também os pedidos de patente US identificados abaixo, os quais foram depositados em 12 de fevereiro de 2016, os quais estão, cada um, no presente documento incorporados por referência em suas respectivas totalidades: - pedido de patente US n° de série 15/043.254, intitulado ME-
CHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS; - pedido de patente US n° de série 15/043.259, intitulado ME-
CHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS; - pedido de patente US n° de série 15/043.275, intitulado ME-
CHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS; e - pedido de patente US n° de série 15/043.289, intitulado "MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS".
[0054] O requerente do presente pedido detém os seguintes pedi- dos de patente que foram depositados em 18 de junho de 2015 e que estão, cada um, no presente documento incorporados por referência em suas respectivas totalidades: - pedido de patente US n° de série 14/742.925, intitulado "SUR- GICAL END EFFECTORS WITH POSITIVE JAW OPENING ARRANGE- MENTS"; - pedido de patente US n° de série 14/742.941, intitulado "SUR-
GICAL END EFFECTORS WITH DUAL CAM ACTUATED JAW CLOSING FEATURES"; - pedido de patente US n° de série 14/742.914, intitulado "MOVABLE FIRING BEAM SUPPORT ARRANGEMENTS FOR ARTI- CULATABLE SURGICAL INSTRUMENTS"; - pedido de patente US n° de série14/742.900, intitulado ARTI-
FOR ARTICULATION SUPPORT; - pedido de patente US n° de série 14/742.885, intitulado "DUAL ARTICULATION DRIVE SYSTEM ARRANGEMENTS FOR ARTI- CULATABLE SURGICAL INSTRUMENTS"; e - pedido de patente US n° de série 14/742.876, intitulado "PUSH/PULL ARTICULATION DRIVE SYSTEMS FOR ARTICULATA- BLE SURGICAL INSTRUMENTS".
[0055] O requerente do presente pedido detém os seguintes pedi- dos de patente que foram depositados em 6 de março de 2015 e que estão, cada um, no presente documento incorporados por referência em suas respectivas totalidades: - Pedido de patente US n° de série 14/640.746, intitulado "PO- WERED SURGICAL STAPLER", agora publicação de pedido de patente US n° 2016/0256184; - pedido de patente US n° de série 14/640.795, intitulado MUL-
TIPLE LEVEL THRESHOLDS TO MODIFY OPERATION OF POWERED SURGICAL INSTRUMENTS, agora publicação de pedido de patente US n° 2016/02561185; - pedido de patente US n° de série 14/640.832, intitulado ADAPTIVE TISSUE COMPRESSION TECHNIQUES TO ADJUST CLO- SURE RATES FOR MULTIPLE TISSUE TYPES, agora publicação de pe- dido de patente US n° 2016/0256154; - pedido de patente US n° 14/640.935, intitulado OVERLAID MULTI SENSOR RADIO FREQUENCY (RF) ELECTRODE SYSTEM TO MEASURE TISSUE COMPRESSION, agora publicação de pedido de pa- tente US n° 2016/0256071; - pedido de patente US n° de série 14/640.831, intitulado
MONITORING SPEED CONTROL AND PRECISION INCREMENTING OF MOTOR FOR POWERED SURGICAL INSTRUMENTS, agora publi- cação de pedido de patente US n° 2016/0256153;
- pedido de patente US n° de série 14/640.859, intitulado TIME DEPENDENT EVALUATION OF SENSOR DATA TO DETER- MINE STABILITY, CREEP, AND VISCOELASTIC ELEMENTS OF ME- ASURES, agora publicação de pedido de patente US n° 2016/0256187; - pedido de patente US n° de série 14/640.817, intitulado IN- TERACTIVE FEEDBACK SYSTEM FOR POWERED SURGICAL INS- TRUMENTS, agora publicação de pedido de patente US n° 2016/0256186; - pedido de patente US n° de série 14/640.844, intitulado CONTROL TECHNIQUES AND SUB-PROCESSOR CONTAINED
WITHIN MODULAR SHAFT WITH SELECT CONTROL PROCESSING FROM HANDLE; agora publicação de pedido de patente US n° 2016/0256155; - pedido de patente US n° de série 14/640.837, intitulado SMART SENSORS WITH LOCAL SIGNAL PROCESSING, agora, pu- blicação de pedido de patente US n° 2016/0256163; - pedido de patente n° de série US 14/640.765, intitulado SYS- TEM FOR DETECTING THE MIS-INSERTION OF A STAPLE CAR- TRIDGE INTO A SURGICAL STAPLER, agora publicação de pedido de patente US n° 2016/0256160; - pedido de patente US n° 14/640.799, intitulado SIGNAL AND POWER COMMUNICATION SYSTEM POSITIONED ON A RO- TATABLE SHAFT, agora publicação de pedido de patente US n° 2016/0256162; e - pedido de patente US n° de série 14/640.780, intitulado SUR- GICAL INSTRUMENT COMPRISING A LOCKABLE BATTERY HOU- SING, agora publicação de pedido de patente US n° 2016/0256161.
[0056] O requerente do presente pedido detém os seguintes pedi- dos de patente que foram depositados em 27 de fevereiro de 2015 e que estão, cada um, no presente documento incorporados por referên- cia em suas respectivas totalidades: - pedido de patente n° de série US 14/633.576, intitulado SUR- GICAL INSTRUMENT SYSTEM COMPRISING AN INSPECTION STA- TION, agora publicação de pedido de patente US n° 2016/0249919; - pedido de patente US n° de série 14/633.546, intitulado SUR- GICAL APPARATUS CONFIGURED TO ASSESS WHETHER A PER-
FORMANCE PARAMETER OF THE SURGICAL APPARATUS IS WITHIN AN ACCEPTABLE PERFORMANCE BAND, agora publicação de pedido de patente US n° 2016/0249915; - pedido de patente n° de série US 14/633.560, intitulado SUR- GICAL CHARGING SYSTEM THAT CHARGES AND/OR CONDITIONS ONE OR MORE BATTERIES, agora publicação de pedido de patente US n° 2016/0249910; - pedido de patente US n° de série 14/633.566, intitulado
CHARGING SYSTEM THAT ENABLES EMERGENCY RESOLUTIONS FOR CHARGING A BATTERY, agora publicação de pedido de patente US n° 2016/0249918; - pedido de patente US n° de série 14/633.555, intitulado SYS- TEM FOR MONITORING WHETHER A SURGICAL INSTRUMENT NE- EDS TO BE SERVICED, agora publicação de pedido de patente US n° 2016/0249916; - patente US n° de série 14/633.542, intitulado REINFOR- CED BATTERY FOR A SURGICAL INSTRUMENT, agora publicação de pedido de patente US n° 2016/0249908; - pedido de patente US n° de série 14/633.548, intitulado PO- WER ADAPTER FOR A SURGICAL INSTRUMENT, agora publicação de pedido de patente US n° 2016/0249909; - pedido de patente US n° de série 14/633.526, intitulado ADAPTABLE SURGICAL INSTRUMENT HANDLE, agora publicação de pedido de patente US n° 2016/0249945; - pedido de patente US n° de série 14/633.541, intitulado MO- DULAR STAPLING ASSEMBLY, agora publicação de pedido de patente US n° 2016/0249927; e - pedido de patente US n° de série 14/633.562, intitulado SURGICAL APPARATUS CONFIGURED TO TRACK AN END-OF- LIFE PARAMETER, agora publicação de pedido de patente US n° 2016/0249917.
[0057] O requerente do presente pedido detém os seguintes pedi- dos de patente que foram depositados em 18 de dezembro de 2014 e que estão, cada um, no presente documento incorporados por referên- cia em suas respectivas totalidades: - pedido de patente US n° de série 14/574.478, intitulado SURGICAL INSTRUMENT SYSTEMS COMPRISING AN ARTICULA-
TABLE END EFFECTOR AND MEANS FOR ADJUSTING THE FIRING STROKE OF A FIRING MEMBER, agora publicação de pedido de pa- tente US n° 2016/0174977; - pedido de patente US n° de série 14/574.483, intitulado SUR- GICAL INSTRUMENT ASSEMBLY COMPRISING LOCKABLE SYS- TEMS, agora publicação de pedido de patente US n° 2016/0174969; - pedido de patente US n° de série 14/575.139, intitulado DRIVE ARRANGEMENTS FOR ARTICULATABLE SURGICAL INSTRU- MENTS, agora, publicação de pedido de patente US n° 2016/0174978; - pedido de patente US n° de série 14/575.148, intitulado LOCKING ARRANGEMENTS FOR DETACHABLE SHAFT ASSEM- BLIES WITH ARTICULATABLE SURGICAL END EFFECTORS, agora publicação de pedido de patente US n° 2016/0174976; - pedido de patente US n° de série 14/575.130, intitulado
TO A STAPLE CARTRIDGE, agora publicação de pedido de patente US n° 2016/0174972; - pedido de patente US n° de série 14/575.143, intitulado SUR- GICAL INSTRUMENTS WITH IMPROVED CLOSURE ARRANGE- MENTS, agora, publicação de pedido de patente US n° 2016/0174983; - pedido de patente US n° de série 14/575.117, intitulado SUR-
GICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTORS AND MOVABLE FIRING BEAM SUPPORT ARRANGEMENTS, agora publica- ção de pedido de patente US n° 2016/0174975; - pedido de patente US n° de série 14/575.154, intitulado SUR-
GICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTORS AND IMPROVED FIRING BEAM SUPPORT ARRANGEMENTS, agora publi- cação de pedido de patente US n° 2016/0174973; - pedido de patente US 14/574.493, intitulado SURGICAL INSTRUMENT ASSEMBLY COMPRISING A FLEXIBLE ARTICULA- TION SYSTEM, agora publicação de pedido de patente US n° 2016/0174970; e - pedido de patente US n° de série 14/574.500, intitulado SUR- GICAL INSTRUMENT ASSEMBLY COMPRISING A LOCKABLE ARTI- CULATION SYSTEM, agora, publicação de pedido de patente US n° 2016/0174971.
[0058] O requerente do presente pedido detém os seguintes pedi- dos de patente que foram depositados em 1 de março de 2013 e que estão, cada um, no presente documento incorporados por referência em suas respectivas totalidades: - pedido de patente US n° de série 13/782.295, intitulado "ARTICULATABLE SURGICAL INSTRUMENTS WITH CONDUCTIVE PATHWAYS FOR SIGNAL COMMUNICATION", agora publicação de pedido de patente US n° 2014/0246471;
- pedido de patente US n° de série 13/782.323, intitulado "RO- TARY POWERED ARTICULATION JOINTS FOR SURGICAL INSTRU- MENTS", agora publicação de pedido de patente US n° 2014/0246472; - pedido de patente US n° de série 13/782.338, intitulado "THUMBWHEEL SWITCH ARRANGEMENTS FOR SURGICAL INS- TRUMENTS", agora publicação de pedido de patente US n° 2014/0249557; - pedido de patente US n° de série 13/782.499, intitulado
ELECTROMECHANICAL SURGICAL DEVICE WITH SIGNAL RELAY ARRANGEMENT, agora patente US n° 9.358.003; - pedido de patente US n° de série 13/782.460, intitulado "MULTIPLE PROCESSOR MOTOR CONTROL FOR MODULAR SUR- GICAL INSTRUMENTS", agora publicação de pedido de patente US n° 2014/0246478; - pedido de patente US n° de série 13/782.358, intitulado JOYSTICK SWITCH ASSEMBLIES FOR SURGICAL INSTRUMENTS, agora patente US n° 9.326.767; - pedido de patente US n° de série 13/782.481, intitulado SEN-
SOR STRAIGHTENED END EFFECTOR DURING REMOVAL THROUGH TROCAR, agora patente US n° 9.468.438; - pedido de patente US n° de série 13/782.518, intitulado "CONTROL METHODS FOR SURGICAL INSTRUMENTS WITH REMO- VABLE IMPLEMENT PORTIONS", agora publicação de pedido de patente US n° 2014/0246475; - pedido de patente US n° de série 13/782.375, intitulado RO- TARY POWERED SURGICAL INSTRUMENTS WITH MULTIPLE DE- GREES OF FREEDOM, agora patente US n° 9.398.911; e - pedido de patente US n° de série 13/782.536, intitulado SUR- GICAL INSTRUMENT SOFT STOP, agora patente US n° 9.307.986.
[0059] O requerente do presente pedido detém também os seguin- tes pedidos de patente que foram depositados em 14 de março de 2013 e que estão, cada um, no presente documento incorporados por referência em suas respectivas totalidades: - pedido de patente US n° de série 13/803.097, intitulado "ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FI- RING DRIVE", agora publicação de pedido de patente US n° 2014/0263542; - pedido de patente US n° de série 13/803.193, intitulado CON- TROL ARRANGEMENTS FOR A DRIVE MEMBER OF A SURGICAL INS- TRUMENT, agora patente n° 9.332.987; - pedido de patente US n° de série 13/803.053, intitulado "IN-
TERCHANGEABLE SHAFT ASSEMBLIES FOR USE WITH A SURGICAL INSTRUMENT", agora, publicação de pedido de patente US n° 2014/0263564; - pedido de patente US n° de série 13/803.086, intitulado "AR- TICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICU- LATION LOCK", agora publicação de pedido de patente US n° 2014/0263541; - pedido de patente US n° de série 13/803.210, intitulado "SEN-
SOR ARRANGEMENTS FOR ABSOLUTE POSITIONING SYSTEM FOR SURGICAL INSTRUMENTS", agora publicação de pedido de patente US n° 2014/0263538; - pedido de patente US n° de série 13/803.148, intitulado "MULTI-FUNCTION MOTOR FOR A SURGICAL INSTRUMENT", agora publicação de pedido de patente US n° 2014/0263554; - pedido de patente US n° de série 13/803.066, intitulado "DRIVE SYSTEM LOCKOUT ARRANGEMENTS FOR MODULAR SUR- GICAL INSTRUMENTS", agora publicação de pedido de patente US n° 2014/0263565;
- pedido de patente US n° de série 13/803.117, intitulado ROBOTICALLY-CONTROLLED CABLE-BASED SURGICAL END EF- FECTORS, agora patente US n° 9.351.726; - pedido de patente US 13/803.130, intitulado DRIVE TRAIN CONTROL ARRANGEMENTS FOR MODULAR SURGICAL INSTRU- MENTS, agora patente US n° 9.351.727; e - pedido de patente US n° de série 13/803.159, intitulado "METHOD AND SYSTEM FOR OPERATING A SURGICAL INSTRU- MENT", agora publicação de pedido de patente US n° 2014/0277017.
[0060] O requerente do presente pedido também detém o seguinte pedido de patente que foi depositado em 7 de março de 2014 e está no presente documento incorporado por referência em sua totalidade: - pedido de patente US n° de série 14/200.111, intitulado "CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS", agora publica- ção de pedido de patente US n° 2014/0263539.
[0061] O requerente do presente pedido detém também os seguin- tes pedidos de patente que foram depositados em 26 de março de 2014 e que estão, cada um, no presente documento incorporados por referência em suas respectivas totalidades: - pedido de patente US n° de série 14/226.106, intitulado "POWER MANAGEMENT CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS", agora publicação de pedido de patente US n° 2015/0272582; - pedido de patente US n° de série 14/226.099, intitulado "STERILIZATION VERIFICATION CIRCUIT", agora publicação de pe- dido de patente US n° 2015/0272581; - pedido de patente US n° de série 14/226.094, intitulado VERIFICATION OF NUMBER OF BATTERY EXCHANGES/PROCE- DURE COUNT, agora publicação de pedido de patente US n° 2015/0272580;
- pedido de patente US n° de série 14/226.117, intitulado "PO-
WER MANAGEMENT THROUGH SLEEP OPTIONS OF SEGMENTED CIRCUIT AND WAKE UP CONTROL", agora publicação de pedido de pa- tente US n° 2015/0272574; - pedido de patente US n° de série 14/226.075, intitulado "MO-
DULAR POWERED SURGICAL INSTRUMENT WITH DETACHABLE SHAFT ASSEMBLIES", agora, publicação de pedido de patente US n° 2015/0272579; - pedido de patente US n° de série 14/226.093, intitulado "FEEDBACK ALGORITHMS FOR MANUAL BAILOUT SYSTEMS FOR SURGICAL INSTRUMENTS", agora publicação de pedido de patente US n° 2015/0272569; - pedido de patente US n° de série 14/226.116, intitulado "SURGICAL INSTRUMENT UTILIZING SENSOR ADAPTATION", agora publicação de pedido de patente US n° 2015/0272571; - pedido de patente US n° de série 14/226.071, intitulado "SUR- GICAL INSTRUMENT CONTROL CIRCUIT HAVING A SAFETY PRO- CESSOR", agora publicação de pedido de patente US n° 2015/0272578; - pedido de patente US n° de série 14/226.097, intitulado "SUR- GICAL INSTRUMENT COMPRISING INTERACTIVE SYSTEMS", agora publicação de pedido de patente US n° 2015/0272570; - pedido de patente US n° de série 14/226.126, intitulado "INTERFACE SYSTEMS FOR USE WITH SURGICAL INSTRU- MENTS", agora publicação de pedido de patente US n° 2015/0272572; - pedido de patente US n° de série 14/226.133, intitulado "MODULAR SURGICAL INSTRUMENT SYSTEM", agora publicação de pedido de patente US n° 2015/0272557; - pedido de patente US n° de série 14/226.081, intitulado "SYS- TEMS AND METHODS FOR CONTROLLING A SEGMENTED CIRCUIT", agora publicação de pedido de patente US n° 2015/0277471;
- pedido de patente US n° de série 14/226.076, intitulado "PO- WER MANAGEMENT THROUGH SEGMENTED CIRCUIT AND VARIA- BLE VOLTAGE PROTECTION", agora publicação de pedido de patente US n° 2015/0280424; - pedido de patente US n° de série 14/226.111, intitulado "SURGICAL STAPLING INSTRUMENT SYSTEM", agora publicação de pedido de patente US n° 2015/0272583; e - pedido de patente US n° de série 14/226.125, intitulado "SURGICAL INSTRUMENT COMPRISING A ROTATABLE SHAFT", agora publicação de pedido de patente US n° 2015/0280384.
[0062] O requerente do presente pedido detém também os seguin- tes pedidos de patente que foram depositados em 5 de setembro de 2014 e que estão, cada um, no presente documento incorporados por referência em suas respectivas totalidades: - pedido de patente US n° de série 14/479.103, intitulado "CIRCUITRY AND SENSORS FOR POWERED MEDICAL DEVICE", agora, publicação de pedido de patente US n° 2016/0066912; - pedido de patente US n° de série 14/479.119, intitulado "ADJUNCT WITH INTEGRATED SENSORS TO QUANTIFY TISSUE COMPRESSION", agora, publicação de pedido de patente US n° 2016/0066914; - pedido de patente US n° de série 14/478.908, intitulado "MONITORING DEVICE DEGRADATION BASED ON COMPONENT EVALUATION", agora, publicação de pedido de patente US n° 2016/0066910; - pedido de patente US n° de série 14/478.895, intitulado "MUL- TIPLE SENSORS WITH ONE SENSOR AFFECTING A SECOND SEN- SOR'S OUTPUT OR INTERPRETATION", agora, publicação de pedido de patente US n° 2016/0066909;
- pedido de patente US n° de série 14/479.110, intitulado PO- LARITY OF HALL MAGNET TO DETECT MISLOADED CARTRIDGE, agora, publicação de pedido de patente US n° 2016/0066915; - pedido de patente US n° de série 14/479.098, intitulado "SMART CARTRIDGE WAKE UP OPERATION AND DATA RETEN- TION", agora, publicação de pedido de patente US n° 2016/0066911; - pedido de patente US n° de série 14/479.115, intitulado "MUL- TIPLE MOTOR CONTROL FOR POWERED MEDICAL DEVICE", agora, publicação de pedido de patente US n° 2016/0066916; e - pedido de patente US n° de série 14/479.108, intitulado "LOCAL DISPLAY OF TISSUE PARAMETER STABILIZATION", agora publicação de pedido de patente US n° 2016/0066913.
[0063] O requerente do presente pedido detém também os seguin- tes pedidos de patente que foram depositados em 9 de abril de 2014 e que estão, cada um, no presente documento incorporados a título de referência em suas respectivas totalidades: - pedido de patente US n° de série 14/248.590, intitulado "MOTOR DRIVEN SURGICAL INSTRUMENTS WITH LOCKABLE DUAL DRIVE SHAFTS", agora, publicação de pedido de patente US n° 2014/0305987; - pedido de patente US n° de série 14/248.581, intitulado "SUR-
GICAL INSTRUMENT COMPRISING A CLOSING DRIVE AND A FIRING DRIVE OPERATED FROM THE SAME ROTATABLE OUTPUT", agora publicação de pedido de patente n° 2014/0305989; - pedido de patente US n° de série 14/248.595, intitulado "SURGICAL INSTRUMENT SHAFT INCLUDING SWITCHES FOR CONTROLLING THE OPERATION OF THE SURGICAL INSTRU- MENT", agora, publicação de pedido de patente US n° 2014/0305988; - pedido de patente US n° de série 14/248.588, intitulado "PO- WERED LINEAR SURGICAL STAPLER", agora publicação de pedido de patente US n° 2014/0309666; - pedido de patente US n° de série 14/248.591, intitulado TRANSMISSION ARRANGEMENT FOR A SURGICAL INSTRUMENT, agora publicação de pedido de patente US n° 2014/0305991; - pedido de patente US n° de série 14/248.584, intitulado "MO- DULAR MOTOR DRIVEN SURGICAL INSTRUMENTS WITH ALIGN-
MENT FEATURES FOR ALIGNING ROTARY DRIVE SHAFTS WITH SURGICAL END EFFECTOR SHAFTS", agora, publicação de pedido de patente US n° 2014/0305994; - pedido de patente US n° de série 14/248.587, intitulado "PO- WERED SURGICAL STAPLER", agora publicação de pedido de patente US n° 2014/0309665; - pedido de patente US n° de série 14/248.586, intitulado "DRIVE SYSTEM DECOUPLING ARRANGEMENT FOR A SURGICAL INSTRUMENT", agora publicação de pedido de patente n° 2014/0305990; e - pedido de patente US n° de série 14/248.607, intitulado "MO-
DULAR MOTOR DRIVEN SURGICAL INSTRUMENTS WITH STATUS INDICATION ARRANGEMENTS", agora publicação de pedido de patente US n° 2014/0305992.
[0064] O requerente do presente pedido detém também os seguintes pedidos de patente que foram depositados em 16 de abril de 2013 e que estão, cada um, no presente documento incorporados a título de referência em suas respectivas totalidades: - pedido de patente provisório US n° de série 61/812.365, inti- tulado "SURGICAL INSTRUMENT WITH MULTIPLE FUNCTIONS PER- FORMED BY A SINGLE MOTOR"; - pedido de patente provisório US n° de série 61/812.376, inti- tulado "LINEAR CUTTER WITH POWER";
- pedido de patente provisório US n° de série 61/812.382, inti- tulado "LINEAR CUTTER WITH MOTOR AND PISTOL GRIP"; - pedido de patente provisório US n° de série 61/812.385, inti- tulado "SURGICAL INSTRUMENT HANDLE WITH MULTIPLE ACTUA- TION MOTORS AND MOTOR CONTROL"; e - pedido de patente provisório US n° de série 61/812.372, inti- tulado "SURGICAL INSTRUMENT WITH MULTIPLE FUNCTIONS PER- FORMED BY A SINGLE MOTOR".
[0065] Numerosos detalhes específicos são apresentados para fornecer um completo entendimento da estrutura, da função, da fabri- cação e do uso geral das modalidades descritas no relatório descritivo e ilustradas nos desenhos em anexo. Operações, componentes e ele- mentos bem conhecidos não foram descritos com detalhes de modo a não obscurecer as modalidades descritas no relatório descritivo. O lei- tor 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 descritos na pre- sente invenção podem ser representativos e ilustrativos. Podem ser feitas variações e alterações a isso, sem se desviar do escopo das reivindicações.
[0066] Os termos "compreende" (e qualquer forma de compre- ende, 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 irrestri- tos. Como resultado, um sistema, dispositivo ou aparelho cirúrgico que "compreende", "tem", "inclui" ou "contém" um ou mais elementos pos- sui aqueles um ou mais elementos, mas não é limitado a possuir so- mente 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 recursos, mas não é limitado a possuir somente aqueles um ou mais recursos.
[0067] Os termos "proximal" e "distal" são usados na presente in- venção com referência a um médico que manipula a porção de cabo do 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 ques- tão de conveniência e clareza, termos espaciais como "vertical", "hori- zontal", "para cima" e "para baixo" podem ser usados na presente in- venção 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.
[0068] São fornecidos vários dispositivos e métodos exemplificado- res para a realização de procedimentos cirúrgicos laparoscópicos e mi- nimamente invasivos. Entretanto, o leitor entenderá prontamente que os vários métodos e dispositivos descritos na presente invenção podem ser usados em numerosos procedimentos e aplicações cirúrgicas, inclusive, por exemplo, procedimentos cirúrgicos abertos. Com o avanço da pre- sente Descrição Detalhada, o leitor entenderá ainda que os vários ins- trumentos no presente documento descritos podem ser inseridos em um corpo de qualquer maneira, como através de um orifício natural, através de uma incisão ou perfuração formada em tecido, etc. As porções fun- cionais ou porções do atuador de extremidade dos instrumentos podem ser inseridas diretamente no corpo de um paciente ou podem ser inse- ridas por meio de um dispositivo de acesso que tenha um canal de tra- balho através do qual o atuador de extremidade e o eixo de acionamento alongado de um instrumento cirúrgico podem ser avançados.
[0069] O 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 pri- meira garra e uma segunda garra. A primeira garra compreende um cartu- cho 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 pelo menos prontamente subs- tituível, da primeira garra. A segunda garra compreende uma bigorna con- figurada para deformar os grampos ejetados a partir do cartucho de gram- pos. A segunda garra é pivotante em relação à primeira garra ao redor de um eixo geométrico de fechamento; entretanto, são previstas outras mo- dalidades nas quais a primeira garra é pivotante em relação à segunda garra. O sistema de grampeamento cirúrgico compreende, adicional- mente, uma junta de articulação configurada para permitir que o atuador de extremidade seja girado ou articulado em relação ao eixo de aciona- mento. O atuador de extremidade é giratório em torno de um eixo geomé- trico de articulação que se estende através da junta de articulação. Outras modalidades são previstas que não incluem uma junta de articulação.
[0070] O cartucho de grampos compreende um corpo do cartucho. O corpo do cartucho inclui uma extremidade proximal, uma extremidade dis- tal, 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 usados no tecido. O corpo do cartucho inclui cavidades de grampo definidas no mesmo, sendo que os grampos são armazenados de modo removível nas cavidades de grampo. As cavidades de grampo são dispostas em seis fileiras longitudinais. Três fileiras de cavidades de grampo são posicionadas em um primeiro lado de uma fenda longitudinal e três fileiras de cavidades de grampos são posicionadas em um segundo lado da fenda longitudinal. Outras disposições de cavidades de grampo e grampos podem ser possíveis.
[0071] Os grampos são sustentados por acionadores de grampos no corpo do cartucho. Os acionadores são móveis entre uma primeira posi- ção, ou posição não disparada, e uma segunda posição, ou posição dis- parada, para ejetar os grampos das cavidades de grampo. Os acionado- res são retidos no corpo do cartucho por um retentor que se estende em torno do fundo do corpo do cartucho e inclui membros resilientes confi- gurados para prender o corpo do cartucho e reter o retentor no corpo do cartucho. Os acionadores são móveis entre suas posições não dispara- das e suas posições disparadas por um deslizador. O deslizador é móvel entre uma posição proximal adjacente à extremidade proximal e uma po- sição distal adjacente à extremidade distal. O deslizador compreende uma pluralidade de superfícies inclinadas configuradas para deslizar sob os acionadores e levantar os acionadores, e os grampos sustentados no mesmo, em direção à bigorna.
[0072] Adicionalmente ao exposto acima, o deslizador é movido distalmente por um membro de disparo. O membro de disparo é confi- gurado para entrar em contato com o deslizador e empurrar o desliza- dor 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 en- gata à segunda garra. Conforme o membro de disparo é avançado dis- talmente, o primeiro came e o segundo came podem controlar a dis- tância, ou vão de tecido, entre a plataforma do cartucho de grampos e a bigorna. O membro de disparo compreende, também, uma faca con- figurada para fazer uma incisão no tecido capturado entre a bigorna e o cartucho de grampos. É desejável que a faca seja posicionada pelo menos parcialmente proximal às superfícies inclinadas de modo que os grampos sejam ejetados à frente da faca.
[0073] As Figuras 1 a 3 representam um instrumento cirúrgico de corte e fixação acionado por motor 1010 que pode ou não ser reutilizado. Na modalidade ilustrada, o instrumento 1010 inclui um gabinete precedente 1012 que compreende uma empunhadura 1014 que é configurada para ser pega, manipulada e atuada pelo médico. O gabinete 1012 é configu- rado para fixação operacional a um conjunto de eixo de acionamento in- tercambiável 1200 que tem um atuador de extremidade cirúrgico 1300 operacionalmente acoplado ao mesmo que é configurado para executar uma ou mais tarefas ou procedimentos cirúrgicos. Conforme prossegue a presente Descrição Detalhada, será entendido que as várias formas de conjuntos de eixo de acionamento intercambiáveis no presente documento descritas podem também ser usadas eficazmente em conexão com siste- mas cirúrgicos roboticamente controlados. Dessa forma, o termo "gabi- nete" pode também abranger um compartimento ou porção similar de um sistema robótico que aloja ou, de outro modo, suporta operacionalmente pelo menos um sistema de acionamento configurado para gerar e aplicar pelo menos um movimento de controle que possa ser usado para acionar os conjuntos de eixo de acionamento intercambiáveis descritos na pre- sente invenção e seus respectivos equivalentes. Além disso, vários com- ponentes podem ser "alojados" ou contidos no gabinete ou vários compo- nentes podem ser "associados a" um gabinete. Em tais casos, os compo- nentes podem não estar contidos no gabinete ou suportados diretamente pelo gabinete.
[0074] O termo "armação" pode referir-se a uma porção de um instru- mento cirúrgico de mão. O termo "armação" também pode representar uma porção de um instrumento cirúrgico roboticamente controlado e/ou uma porção do sistema robótico que pode ser usada para controlar opera- cionalmente o instrumento cirúrgico. Por exemplo, os conjuntos de eixo de acionamento intercambiáveis no presente documento descritos podem ser usados com vários sistemas robóticos, instrumentos, componentes e mé- todos descritos na patente US n° 9.072.535, intitulada SURGICAL STA- PLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT AR- RANGEMENTS, a qual está no presente documento incorporada a título de referência, em sua totalidade.
[0075] O gabinete precedente 1012 representado na Figura 1 é mos- trado em conexão com um conjunto de eixo de acionamento intercambi- ável 1200 (Figuras 2, 4 e 5) que inclui um atuador de extremidade 1300 que compreende um dispositivo cirúrgico de corte e fixação que é confi- gurado para sustentar operacionalmente um cartucho de grampos cirúr- gicos 4000 no mesmo. O gabinete 1012 pode ser configurado para uso em conexão com conjuntos de eixo de acionamento intercambiáveis que incluem atuadores de extremidade que são adaptados para suportar di- ferentes tamanhos e tipos de cartuchos de grampos, têm diferentes ta- manhos e tipos de eixos de acionamento, etc. Além disso, o gabinete 1012 pode também ser usado eficazmente com uma variedade de outros conjuntos de eixo de acionamento intercambiáveis incluindo os conjuntos que são configurados para aplicar outros movimentos e formas de ener- gia como, por exemplo, energia de radiofrequência (RF), energia ultras- sônica e/ou movimento a disposições de atuador de extremidade adap- tadas para uso em conexão com várias aplicações e procedimentos ci- rúrgicos. Além disso, os atuadores de extremidade, os conjuntos de eixo de acionamento, as empunhaduras, os instrumentos cirúrgicos e/ou os sistemas de instrumentos cirúrgicos podem usar quaisquer um ou mais prendedores adequados para prender os tecidos. Por exemplo, um car- tucho de prendedores que compreende uma pluralidade de prendedores nele armazenados de modo removível pode ser inserido de maneira re- movível dentro e/ou fixado ao atuador de extremidade de um conjunto de eixo de acionamento.
[0076] A Figura 1 ilustra o instrumento cirúrgico 1010 que inclui um conjunto de eixo de acionamento intercambiável 1200 operacionalmente acoplado a um gabinete 1012. A Figura 2 ilustra o conjunto de eixo de acionamento intercambiável 1200 solto do gabinete 1012 ou da empu- nhadura 1014. Como pode ser visto na Figura 3, a empunhadura 1014 pode compreender um par de segmentos interconectáveis do comparti- mento de empunhadura 1016 e 1018 que podem ser interconectados por parafusos, membros de encaixe por pressão, adesivo, etc. Na disposição ilustrada, os segmentos do compartimento de empunhadura 1016, 1018 cooperam para formar uma porção de preensão da pistola 1019 que pode ser empunhada e manipulada pelo médico. Como será discutido em mais detalhes abaixo, a empunhadura 1014 suporta operacionalmente, em seu interior, uma pluralidade de sistemas de acionamento que são confi- gurados para gerar e aplicar vários movimentos de controle às porções correspondentes do conjunto de eixo de acionamento intercambiável que está operacionalmente fixado ao mesmo.
[0077] Agora com referência à Figura 3, a empunhadura 1014 pode incluir, também, uma armação 1020 que sustenta operacionalmente uma pluralidade de sistemas de acionamento. Por exemplo, a armação 1020 pode suportar operacionalmente um "primeiro" sistema de aciona- mento ou sistema de acionamento de fechamento, designado, de modo geral, como 1030, que pode ser usado para aplicar movimentos de fe- chamento e abertura ao conjunto de eixo de acionamento intercambiá- vel 1200 que está fixado ou acoplado operacionalmente à mesma. Em pelo menos uma forma, o sistema de acionamento de fechamento 1030 pode incluir um atuador sob a forma de um gatilho de fechamento 1032, suportado de modo pivotante pela armação 1020. Mais especifica- mente, conforme ilustrado na Figura 3, o gatilho de fechamento 1032 é acoplado de modo pivotante ao compartimento 1014 por um pino 1033.
Essa disposição permite que o gatilho de fechamento 1032 seja mani- pulado por um médico, de modo que, quando o médico pega a porção de pega da pistola 1019 da empunhadura 1014, o gatilho de fechamento 1032 possa ser facilmente pivotado de uma posição inicial ou "não atu- ada" para uma posição "atuada" e, mais particularmente, para uma po- sição completamente comprimida ou completamente atuada. O gatilho de fechamento 1032 pode ser propendido para a posição não atuada por meio de uma mola ou de outra disposição de propensão (não mos- trada). Em várias formas, o sistema de acionamento de fechamento 1030 inclui adicionalmente um conjunto de ligação de fechamento 1034 que é acoplado de modo pivotante ao gatilho de fechamento 1032. Como pode ser visto na Figura 3, o conjunto de ligação de fechamento 1034 pode incluir uma primeira ligação de fechamento 1036 e uma se- gunda ligação de fechamento 1038 que são acopladas de modo pivo- tante ao gatilho de fechamento 1032 por um pino 1035. A segunda liga- ção de fechamento 1038 pode, também, ser chamada na presente in- venção de "membro de fixação" e incluir um pino de fixação transversal
1037.
[0078] Ainda com referência à Figura 3, pode-se observar que a pri- meira ligação de fechamento 1036 pode ter na mesma uma parede ou extremidade de travamento 1039, configurada para cooperar com um conjunto de liberação de fechamento 1060 que é acoplado de modo pi- votante à armação 1020. Em pelo menos uma forma, o conjunto de libe- ração de fechamento 1060 pode compreender um conjunto de botão de liberação 1062 que tem uma lingueta de travamento que se projeta dis- talmente 1064 formada sobre a mesma. O conjunto do botão de liberação 1062 pode ser girado em sentido anti-horário por uma mola de liberação (não mostrada). Quando o médico pressiona o gatilho de fechamento 1032 de sua posição não atuada em direção à porção de pega da pistola 1019 da empunhadura 1014, a primeira ligação de fechamento 1036 gira para cima para um ponto em que a lingueta de travamento 1064 cai em um engate de retenção com a parede de travamento 1039 na primeira ligação de fechamento 1036, impedindo, assim, que o gatilho de fecha- mento 1032 retorne para a posição não atuada. Desse modo, o conjunto de liberação de fechamento 1060 serve para travar o gatilho de fecha- mento 1032 na posição completamente atuada. Quando o médico deseja destravar o gatilho de fechamento 1032 para permitir que o mesmo seja propendido para a posição não atuada, o médico simplesmente gira o conjunto do botão de liberação de fechamento 1062, de modo que a lin- gueta de travamento 1064 seja movida para fora do engate com a parede de travamento 1039 na primeira ligação de fechamento 1036. Quando a lingueta de travamento 1064 for movida para fora de engate com a pri- meira ligação de fechamento 1036, o gatilho de fechamento 1032 pode pivotar de volta para a posição não atuada. Outras disposições para tra- vamento e liberação do gatilho de fechamento também podem ser usa- das.
[0079] Um braço 1061 pode se estender desde o botão de liberação de fechamento 1062. Um elemento magnético 1063, como um magneto permanente, por exemplo, pode ser montado ao braço 1061. Quando o botão de liberação de fechamento 1062 é girado de sua primeira posi- ção para sua segunda posição, o elemento magnético 1063 pode se mover em direção a uma placa de circuito 1100. A placa de circuito 1100 pode incluir pelo menos um sensor que é configurado para detectar o movimento do elemento magnético 1063. Em pelo menos uma modali- dade, por exemplo, um sensor de "efeito Hall" (não mostrado) pode ser montado na superfície de fundo da placa de circuito 1100. O sensor de efeito Hall pode ser configurado para detectar alterações em um campo magnético que circunda o sensor de efeito Hall causadas pelo movi- mento do elemento magnético 1063. O sensor de efeito Hall pode estar em comunicação de sinal com um microcontrolador, por exemplo, que pode determinar se o botão de liberação de fechamento 1062 está na sua primeira posição, que está associada com a posição não atuada do gatilho de fechamento 1032 e a configuração aberta do atuador de ex- tremidade, sua segunda posição, que está associada com a posição atuada do gatilho de fechamento 1032 e a configuração fechada do atu- ador de extremidade, e/ou qualquer posição entre a primeira posição e a segunda posição.
[0080] Em pelo menos uma forma, a empunhadura 1014 e a arma- ção 1020 podem operacionalmente suportar um outro sistema de acio- namento, chamado, na presente invenção, de um sistema de aciona- mento de disparo 1080, que é configurado para aplicar movimentos de disparo às porções correspondentes do conjunto de eixo de acionamento intercambiável fixado ao mesmo. O sistema de acionamento de disparo 1080 também pode ser chamado, na presente invenção, de "segundo sistema de acionamento". O sistema de acionamento de disparo 1080 pode usar um motor elétrico 1082 que está localizado na porção de pre- ensão da pistola 1019 da empunhadura 1014. Sob várias formas, o motor 1082 pode ser um motor de acionamento de corrente contínua com es- covas, com uma rotação máxima de, aproximadamente, 25.000 rpm, por exemplo. Em outras disposições, o motor pode incluir um motor sem es- covas, um motor sem fio, um motor síncrono, um motor de passo ou qual- quer outro motor elétrico adequado. O motor 1082 pode ser alimentado por uma fonte de alimentação 1090 que, em uma forma, pode compre- ender uma fonte de energia removível 1092. Como pode ser visto na Fi- gura 3, por exemplo, o pacote de energia 1092 pode compreender uma porção de gabinete proximal 1094 que é configurada para fixação a uma porção de gabinete distal 1096. A porção do gabinete proximal 1094 e a porção do gabinete distal 1096 são configuradas para suportar operacio- nalmente uma pluralidade de baterias 1098 nas mesmas. Cada uma das baterias 1098 pode compreender, por exemplo, uma bateria de íons de lítio ("LI") ou outra bateria adequada. A porção de compartimento distal 1096 é configurada para fixação operável removível ao conjunto da placa de circuito 1100 que também está operacionalmente acoplada ao motor
1082. Várias baterias 1098, que podem ser conectadas em série, podem ser usadas como a fonte de energia para o instrumento cirúrgico 1010. Além disso, a fonte de energia 1090 pode ser substituível e/ou recarre- gável.
[0081] Como descrito acima em relação a outras várias formas, o motor elétrico 1082 pode incluir um eixo de acionamento giratório (não mostrado), que, de modo operacional, faz interface com um conjunto redutor de engrenagem 1084, que está montado em engate de acopla- mento com um conjunto, ou cremalheira, de dentes de acionamento 1122 em um membro de acionamento longitudinalmente móvel 1120. Em uso, uma polaridade de tensão fornecida pela fonte de energia 1090 pode operar o motor elétrico 1082 no sentido horário, sendo que a po- laridade de tensão aplicada ao motor elétrico pela bateria pode ser re- vertida de modo a operar o motor elétrico 1082 no sentido anti-horário. Quando o motor elétrico 1082 é girado em uma direção, o membro de acionamento 1120 será axialmente acionado na direção distal "DD". Quando o motor 82 é acionado em uma direção giratória oposta, o mem- bro de acionamento 1120 será axialmente ativado na direção proximal "PD". A empunhadura 1014 pode incluir uma chave que pode ser confi- gurada para reverter a polaridade aplicada ao motor elétrico 1082 pela fonte de alimentação 1090. Assim como com as outras formas descritas na presente invenção, a empunhadura 1014 também pode incluir um sensor que é configurado para detectar a posição do membro de acio- namento 1120 e/ou a direção em que o membro de acionamento 1120 está sendo movido.
[0082] A atuação do motor 1082 pode ser controlada por um gati-
lho de disparo 1130 que é suportado de modo pivotante na empunha- dura 1014. O gatilho de disparo 1130 pode ser pivotado entre uma po- sição não atuada e uma posição atuada. O gatilho de disparo 1130 pode ser propendido para a posição não atuada por meio de uma mola 1132 ou outra disposição de propensão de modo que, quando o mé- dico libera o gatilho de disparo 1130, o mesmo possa ser pivotado ou de outro modo retornado à posição não atuada por meio da mola 1132 ou da disposição de propensão. Sob pelo menos uma forma, o gatilho de disparo 1130 pode ser posicionado "fora" do gatilho de fechamento 132, como discutido acima. Em pelo menos uma forma, um botão de segurança do gatilho de disparo 1134 pode ser montado de maneira articulada ao gatilho de fechamento 1032 pelo pino 1035. O botão de segurança 1134 pode ser posicionado entre o gatilho de disparo 1130 e o gatilho de fechamento 1032 e ter um braço de pivô 1136 que se projeta a partir do mesmo. Consulte a Figura 21. Quando o gatilho de fechamento 1032 está na posição não atuada, o botão de segurança 1134 está contido na empunhadura 1014, onde o médico não pode acessá-lo prontamente e movê-lo entre uma posição de segurança, que impede a atuação do gatilho de disparo 1130, e uma posição de disparo na qual o gatilho de disparo 1130 pode ser disparado. Quando o médico pressiona o gatilho de fechamento 1032, o botão de segu- rança 1134 e o gatilho de disparo 1130 pivotam para baixo, para uma posição em que eles possam, então, ser manipulados pelo médico.
[0083] Como indicado acima, em pelo menos uma forma, o membro de acionamento longitudinalmente móvel 1120 tem uma cremalheira de dentes 1122 formada no mesmo para o engate por engrenamento com uma engrenagem de acionamento correspondente 1086 do conjunto do redutor de engrenagem 1084. Pelo menos uma forma inclui também um conjunto de "resgate" 1140 manualmente atuável, que é configurado para possibilitar que o médico retraia manualmente o membro de acionamento longitudinalmente móvel 1120, caso o motor 1082 deixe de funcionar. O conjunto de resgate 1140 pode incluir uma alavanca ou um conjunto de empunhadura de retração 1142 que é configurado para ser girado manu- almente para engate de catraca com os dentes 1124 também fornecidos no membro de acionamento 1120. Dessa forma, o médico pode retrair ma- nualmente o membro de acionamento 1120 usando o conjunto de empu- nhadura de resgate 1142 para engrenar o membro de acionamento 1120 na direção proximal "PD". A patente US n° 8.608.045, intitulada POWE- RED SURGICAL CUTTING E STAPLING APPARATUS WITH MANU- ALLY RETRACTABLE FIRING SYSTEM, revela disposições de resgate e outros componentes, disposições e sistemas que podem também ser usa- dos com os vários instrumentos no presente documento descritos. A pa- tente US n° 8.608.045, é por meio desta no presente documento incorpo- rada a título referência em sua totalidade.
[0084] Agora com relação às Figuras 2 e 5, o conjunto de eixo de aci- onamento intercambiável 1200 inclui um atuador de extremidade cirúrgico 1300 que compreende um canal alongado 1310 que é configurado para suportar operacionalmente em seu interior um cartucho de grampos 4000. O atuador de extremidade 1300 pode incluir adicionalmente uma bigorna 2000 que é suportada de modo pivotante em relação ao canal alongado
1310. O conjunto de eixo de acionamento intercambiável 1200 pode adici- onalmente incluir uma junta de articulação 3020 e uma trava de articulação 2140 que podem ser configuradas para prender de modo liberável o atua- dor de extremidade 1300 em uma posição desejada em relação a um eixo geométrico do eixo de acionamento SA (shaft axis). Exemplos de vários recursos de pelo menos uma forma do atuador de extremidade 1300, da junta de articulação 3020 e das travas de articulação podem ser encontra- dos no pedido de patente US n° de série 13/803.086, depositado em 14 de março de 2013, intitulado ARTICULATABLE SURGICAL INSTRU- MENT COMPRISING AN ARTICULATION LOCK. A descrição completa do pedido de patente US n° de série 13/803.086, depositado em 14 de março de 2013, intitulado ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK está no presente documento incorporada, por referência. Como pode ser visto na Figura 4, o conjunto de eixo de acionamento intercambiável 1200 pode incluir, ainda, um gabi- nete proximal ou bocal 1201 composto de porções de bocal 1202 e 1203.
[0085] O conjunto de eixo de acionamento intercambiável 1200 pode incluir adicionalmente um tubo de fechamento 3000 que pode ser usado para fechar e/ou abrir a bigorna 2000 do atuador de extremidade
1300. O conjunto de eixo de acionamento 1200 pode incluir uma coluna central 1210 que é configurada para, em primeiro lugar, suportar de maneira deslizante um membro de disparo no mesmo e, em segundo lugar, suportar de maneira deslizante o conjunto de membro de fecha- mento 3000 que se estende ao redor da coluna central 1210. Como pode ser visto na Figura 5, uma extremidade distal 1211 da coluna central 1210 termina em um recurso de montagem de pino superior 1270 e em um recurso de montagem de pino inferior 1280. O recurso de montagem de pino superior 1270 é formado com uma fenda de pino 1272 no mesmo que é adaptada para suportar de forma passível de montagem uma ligação de montagem superior 1274 na mesma. De modo similar, o recurso de engaste de pino inferior 1280 é formado com uma fenda de pino 1282 no mesmo que é adaptada para apoiar de forma passível de montagem uma ligação de montagem inferior 1284 no mesmo. A ligação de montagem superior 1274 inclui um so- quete de pivô 1276 no mesmo que é adaptado para receber de forma giratória nele um pino de pivô 1292 que é formado em uma tampa de canal ou retentor de bigorna 1290 que é fixado a uma porção de extre- midade proximal 1312 do canal alongado 1310. A ligação de monta- gem inferior 1284 inclui um pino de pivô inferior 1286 que é adaptado para ser recebido dentro de um orifício de pivô 1314 formado na porção de extremidade proximal 1312 do canal alongado 1310. Consulte a Fi- gura 5. O pino de pivô inferior 1286 é verticalmente alinhado com o soquete de pivô 1276 para definir um eixo geométrico de articulação AA (articulation axis) em torno do qual o atuador de extremidade cirúr- gico 1300 pode articular em relação ao eixo geométrico de eixo de aci- onamento SA. Consulte a Figura 2.
[0086] No exemplo ilustrado, o atuador de extremidade cirúrgico 1300 é seletivamente articulável em torno do eixo geométrico de articu- lação AA por um sistema de articulação 2100. Em uma forma, o sistema de articulação 2100 inclui acionador de articulação proximal 2102 que é acoplado de modo pivotante a uma ligação de articulação 2120. Como pode ser visto mais particularmente na Figura 5, um pino de fixação de deslocamento 2114 é formado em uma extremidade distal 2112 do aci- onador de articulação proximal 2102. Um orifício de pivô 2116 é formado no pino de fixação de deslocamento 2114 e é configurado para receber de modo pivotante um pino de ligação proximal 2124 formado na extre- midade proximal 2122 da ligação de articulação 3020. Uma extremidade distal 2126 do elo de articulação 2120 inclui um orifício de pivô 2128 que é configurado para receber de modo pivotante no mesmo um pino de canal 1317 formado na porção de extremidade proximal 1312 do canal alongado 1310. Dessa forma, o movimento axial do acionador de articu- lação proximal 2102 irá, dessa forma, aplicar movimentos de articulação ao canal alongado 1310 para assim fazer com que o atuador de extre- midade cirúrgico 1300 articule em torno do eixo geométrico de articula- ção AA em relação ao conjunto de coluna central 1210. Detalhes adici- onais referentes à construção e operação do sistema de articulação 2100 podem ser encontrados em várias referências incorporadas a título de referência no presente documento, incluindo no pedido de patente US n° de série 15/635.631, depositado em 28 de junho de 2017, intitu- lado SURGICAL INSTRUMENT WITH AXIALLY MOVABLE CLOSURE
MEMBER, cuja descrição está no presente documento incorporada, a título de referência, em sua totalidade. Em várias circunstâncias, o aci- onador de articulação proximal 2102 pode ser mantido em posição pela trava de articulação 2140 quando o acionador de articulação proximal 2102 não estiver sendo movido nas direções proximal ou distal. Deta- lhes adicionais referentes a um exemplo de uma trava de articulação 2140 podem ser encontrados no pedido de patente US n° de série 15/635.631, bem como em outras referências no presente documento incorporadas a título de referência na presente invenção.
[0087] Em várias circunstâncias, a coluna central 1210 pode compre- ender uma extremidade proximal 1211 que é sustentada de maneira gira- tória em um chassi 1240. Em uma disposição, por exemplo, a extremidade proximal 1211 da coluna central 1210 tem uma rosca 1214 formada na mesma para fixação rosqueada a um rolamento da coluna central 1216 configurado para ser sustentado dentro do chassi 1240. Consulte a Figura
4. Essa disposição facilita a fixação giratória da coluna 1210 ao chassi 1240, de modo que a coluna 1210 possa ser girada seletivamente ao redor de um eixo geométrico do eixo de acionamento SA em relação ao chassi
1240.
[0088] Com referência principalmente à Figura 4, o conjunto de eixo de acionamento intercambiável 1200 inclui um elemento reciprocante de fechamento 1250 que é suportado de maneira deslizante dentro do chassi 1240, de modo que possa ser movido axialmente em relação ao mesmo. O elemento reciprocante de fechamento 1250 inclui um par de ganchos que se projetam de maneira proximal 1252 que são configura- dos para fixação ao pino de fixação 1037 (Figuras 2 e 3) que é fixado ao segundo elo de fechamento 1038 conforme será discutido em mais deta- lhes abaixo. Em pelo menos um exemplo, o conjunto de membro de fe- chamento 3000 compreende um segmento de membro de fechamento proximal 3010 que tem uma extremidade proximal 3012 que é acoplada ao elemento reciprocante de fechamento 1250 para rotação relativa à mesma. Por exemplo, um conector em forma de U 1263 é inserido em uma fenda anular 3014 na extremidade proximal 3012 do segmento de membro de fechamento proximal 3010 e é retido dentro das fendas ver- ticais 1253 no elemento reciprocante de fechamento 1250. Essa disposi- ção serve para fixar o segmento do tubo de fechamento proximal 3010 ao elemento de transporte de fechamento 1250 para deslocamento axial com o mesmo, ao mesmo tempo em que se possibilita que o segmento do tubo de fechamento 3010 gire em relação ao elemento de transporte de fechamento 1250 ao redor do eixo geométrico do eixo de acionamento SA. Uma mola de fechamento 1268 é assentada sobre o segmento de tubo de fechamento proximal 3010 e serve para propender o segmento de tubo de fechamento proximal 3010 na direção proximal "PD", o que pode servir para pivotar o gatilho de fechamento 1032 para a posição não atuada quando o conjunto de eixo de acionamento estiver operacional- mente acoplado à empunhadura 1014.
[0089] Em pelo menos uma forma, o conjunto de eixo de aciona- mento intercambiável 1200 pode incluir, também, uma junta de articu- lação 3020. Outros conjuntos de eixo de acionamento intercambiáveis, contudo, podem não ser capazes de articulação. Como pode ser visto na Figura 5, por exemplo, um membro de fechamento distal ou seg- mento de tubo de fechamento distal 3030 é acoplado à extremidade distal do segmento de membro de fechamento proximal 3010. A junta de articulação 3020 inclui um conjunto de luva de fechamento de pivô duplo 3022. De acordo com várias formas, o conjunto de luva de fe- chamento de pivô duplo 3022 inclui um tubo de fechamento de atuador de extremidade 3050 que tem espigas que se projetam distalmente su- perior e inferior 3052, 3054. Uma ligação de pivô duplo superior 3056 inclui pinos de pivô distal e proximal que se projetam para cima que engatam, respectivamente, um orifício distal superior na espiga que se projeta de maneira proximal superior 3052 e um orifício proximal supe- rior em uma espiga que se projeta de maneira distal superior 3032 no segmento de tubo de fechamento distal 3030. Uma ligação de pivô du- plo inferior 3058 inclui pinos de pivô distal e proximal que se projetam para cima que engatam, respectivamente, um orifício distal inferior na espiga que se projeta de maneira proximal inferior 3054 e um orifício proximal inferior na espiga que se projeta de maneira distal inferior
3034. Consulte as Figuras 4 e 5. Conforme será discutido em mais detalhes abaixo, o conjunto de tubo de fechamento 3000 é transladado distalmente (direção DD) para fechar a bigorna 2000, por exemplo, em resposta à atuação do gatilho de fechamento 1032. A bigorna 2000 é aberta mediante a translação proximal do conjunto de tubo de fecha- mento 3000 que faz com que a luva de fechamento do atuador de ex- tremidade interaja com a bigorna 2000 e pivote-a para uma posição aberta.
[0090] Como foi indicado acima, o conjunto de eixo de acionamento intercambiável 1200 inclui adicionalmente um membro de disparo 1900 que é sustentado para realizar um deslocamento axial na coluna do eixo de acionamento 1210. O membro de disparo inclui uma porção intermedi- ária de eixo de acionamento de disparo 1222 que é configurada para se conectar a uma porção de corte distal ou barra de corte 1910. A porção do eixo de acionamento de disparo intermediário 1222 pode incluir uma fenda longitudinal 1223 em sua extremidade distal, a qual pode ser configurada para receber uma aba 1912 na extremidade proximal da barra de faca dis- tal 1910. A fenda longitudinal 1223 e a aba da extremidade proximal 1912 podem ser dimensionadas e configuradas para permitir o movimento rela- tivo entre as mesmas e podem compreender uma junta deslizante. A junta deslizante 1914 pode permitir que uma porção intermediária de eixo de acionamento de disparo 1222 do acionamento de disparo seja movida para articular o atuador de extremidade 1300 sem mover, ou pelo menos sem mover substancialmente, a barra de corte 1910. Uma vez que o atu- ador de extremidade 1300 tenha sido adequadamente orientado, a porção do eixo de acionamento de disparo intermediário 1222 pode ser avançada distalmente até uma parede lateral proximal da fenda longitudinal 1223 en- trar em contato com a aba 1912 a fim de avançar a barra de corte 1910 e disparar o cartucho de grampos 4000 posicionado no interior do canal alongado 1310. A barra de corte 1910 inclui uma porção de faca 1920 que inclui uma lâmina ou gume cortante de tecido 1922 e inclui uma aba de engate de bigorna superior 1924 e abas de engate do canal inferior 1926. Várias configurações de membro de disparo e as operações são descritos em várias outras referências no presente documento incorporadas a título de referência.
[0091] Conforme pode ser visto na Figura 4, o conjunto de eixo de acionamento 1200 inclui adicionalmente um cilindro de comutação 1500 que é recebido de modo giratório no tubo de fechamento 1260. O cilindro de comutação 1500 compreende um segmento de eixo de acionamento oco 1502 que tem uma saliência de eixo de acionamento formada no mesmo, destinada a receber em seu interior um pino de atuação que se projeta para fora. Em várias circunstâncias, o pino de atuação se estende através de uma fenda longitudinal fornecida na luva de travamento para facilitar o movimento axial da luva de trava- mento quando a mesma é engatada com o acionador de articulação. Uma mola de torção giratória 1420 é configurada para engatar a sali- ência no cilindro de comutação 1500 e uma porção do alojamento do bocal 1203 para aplicar uma força de alteração ao cilindro de comuta- ção 1500. O cilindro de comutação 1500 pode compreender adicional- mente aberturas pelo menos parcialmente circunferenciais 1506 defi- nidas no mesmo, que podem ser configuradas para receber engastes circunferenciais que se estendem a partir das metades do bocal 1202, 1203 e permitir a rotação relativa, mas não a translação, entre o cilindro de comutação 1500 e o bocal proximal 1201. Os engastes também se estendem através das aberturas 3011 no segmento de tubo de fecha- mento proximal 3010 para serem assentados em reentrâncias 1219 no eixo de acionamento da coluna central 1210. A rotação do cilindro de comutação 1500 em torno do eixo geométrico de eixo de acionamento SA irá resultar, por fim, na rotação do pino de atuação e da luva de travamento entre suas posições engatada e desengatada. Em uma dis- posição, a rotação do cilindro de chaveamento 1500 pode ser ligada ao avanço axial do tubo de fechamento ou membro de fechamento. Dessa forma, essencialmente, a atuação do sistema de fechamento pode engatar e desengatar operacionalmente o sistema de aciona- mento de articulação com o sistema de acionamento de disparo nas várias formas descritas em mais detalhes no pedido de patente US n° de série 13/803.086 e na patente US n° 9.913.642, intitulada SURGI- CAL INSTRUMENT COMPRISING A SENSOR SYSTEM, cujas descri- ções estão no presente documento incorporadas a título de referência em sua totalidade. Por exemplo, quando o tubo de fechamento está em sua posição mais proximal que corresponde a uma posição de "gar- ras abertas", o segmento de tubo de fechamento 3010 terá posicionado o tambor de comutação 1500 para ligar o sistema de articulação ao sistema de acionamento de disparo. Quando o tubo de fechamento foi movido para sua posição distal correspondente a uma posição de "gar- ras fechadas", o tubo de fechamento gira o tambor de chaveamento 1500 para uma posição em que o sistema de articulação fica desco- nectado do sistema de acionamento de disparo.
[0092] Também como ilustrado na Figura 4, o conjunto de eixo de acionamento 1200 pode compreender um conjunto de anel deslizante 1600 que pode ser configurado para conduzir energia elétrica ao atua- dor de extremidade 1300 e/ou a partir dele e/ou comunicar sinais ao atuador de extremidade 1300 e/ou a partir dele, por exemplo.
O con- junto de anel deslizante 1600 pode compreender um flange de conec- tor proximal 1604 que é montado a um flange de chassi 1242 que se estende a partir do chassi 1240 e um flange de conector distal que é posicionado no interior de uma fenda definida nos gabinetes de eixo de acionamento.
O flange conector proximal 1604 pode compreender uma primeira face e o flange conector distal pode compreender uma segunda face que está posicionada adjacente e é móvel em relação à primeira face.
O flange de conector distal pode girar em relação ao flange de conector proximal 1604 ao redor do eixo geométrico do eixo de acionamento SA.
O flange conector proximal 1604 pode compreen- der uma pluralidade de condutores concêntricos, ou pelo menos subs- tancialmente concêntricos, definidos na sua primeira face.
Um conec- tor pode ser montado no lado proximal do flange conector e pode ter uma pluralidade de contatos, sendo que cada contato corresponde e está em contato elétrico com um dos condutores.
Tal disposição per- mite a rotação relativa entre o flange conector proximal 1604 e o flange conector distal, porém mantendo o contato elétrico entre os mesmos.
O flange de conector proximal 1604 pode incluir um conector elétrico 1606 que pode colocar os condutores em comunicação de sinal com uma placa de circuito de eixo de acionamento 1610 montada no chassi de eixo de acionamento 1240, por exemplo.
Em pelo menos um caso, um chicote elétrico que compreende uma pluralidade de condutores pode se estender entre o conector elétrico 1606 e a placa de circuito do eixo de acionamento 1610. O conector elétrico 1606 pode se esten- der de maneira proximal através de uma abertura do conector 1243 definida no flange de montagem do chassi 1242. Consulte a Figura 4. Mais detalhes relacionados ao conjunto de anel deslizante 1600 po- dem ser encontrados no pedido de patente US n° de série 13/803.086, no pedido de patente US n° de série 13/800.067, intitulado STAPLE
CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, depositado em 13 de março de 2013, e na patente US 9.345.481, intitulada STA- PLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, por exemplo. O pedido de patente US n° de série 13/803.086, o pedido de patente US n° de série 13/800.067, e a patente US n° 9.345.481, os quais estão, cada um, no presente documento incorporados a título de referência em suas respectivas totalidades.
[0093] Conforme discutido acima, o conjunto de eixo de aciona- mento 1200 pode incluir uma porção proximal que é montada de forma fixável à empunhadura 1014, e uma porção distal que é giratória em torno de um eixo geométrico longitudinal. A porção giratória distal do eixo de acionamento pode ser girada em relação à porção proximal ao redor do conjunto de anel deslizante 1600, conforme discutido acima. O flange de conector distal do conjunto de anel deslizante 1600 pode ser posicionado na porção giratória distal do eixo de acionamento. Adi- cionalmente, além do exposto acima, o cilindro de comutação 1500 também pode ser posicionado dentro da porção giratória distal do eixo de acionamento. Quando a porção giratória distal do eixo de aciona- mento é girada, o flange de conector distal e o cilindro de comutação 1500 podem ser girados sincronicamente um ao outro. Além disso, o cilindro de comutação 1500 pode ser girado entre uma primeira posi- ção e uma segunda posição em relação ao flange conector distal. Quando o cilindro de comutação 1500 estiver na sua primeira posição, o sistema de acionamento de articulação pode ser desengatado ope- racionalmente do sistema de acionamento de disparo e, dessa forma, o funcionamento do sistema de acionamento de disparo pode não ar- ticular o atuador de extremidade 1300 do conjunto de eixo de aciona- mento 1200. Quando o cilindro de comutação 1500 estiver na sua se- gunda posição, o sistema de acionamento de articulação pode ser en- gatado operacionalmente com o sistema de acionamento de disparo e,
dessa forma, o funcionamento do sistema de acionamento de disparo pode articular o atuador de extremidade 1300 do conjunto de eixo de acionamento 1200. Quando o cilindro de comutação 1500 é movido entre sua primeira posição e sua segunda posição, o cilindro de comu- tação 1500 é movido em relação ao flange conector distal. Em vários casos, o conjunto de eixo de acionamento 1200 pode compreender pelo menos um sensor configurado para detectar a posição do cilindro de comutação 1500.
[0094] Novamente com referência à Figura 4, o chassi 1240 inclui pelo menos uma, e de preferência, duas porções de fixação afuniladas 1244 formadas no mesmo que são adaptadas para serem recebidas dentro das fendas de encaixe correspondentes 1702 formadas dentro de uma porção de flange de fixação distal 1700 da armação 1020. Con- sulte a Figura 3. Cada fenda de encaixe 1702 pode ser afunilada ou, em outras palavras, ter um formato aproximado de V para receber de forma assentada as porções de fixação 1244. Conforme pode também ser visto na Figura 22, um pino de fixação de eixo de acionamento 1226 é formado na extremidade proximal do eixo de acionamento de disparo intermediário 1222. Conforme será discutido com mais detalhes abaixo, quando o conjunto de eixo de acionamento intercambiável 1200 é aco- plado à empunhadura 1014, o pino de fixação de eixo de acionamento 1226 é recebido em uma base de fixação de eixo de acionamento de disparo 1126 formada na extremidade distal 1125 do membro de acio- namento longitudinal 1120. Consulte a Figura 3.
[0095] Várias modalidades de conjuntos de eixo de acionamento usam um sistema de travas 1710 para acoplar de modo removível o con- junto de eixo de acionamento 1200 ao gabinete 1012 e mais especifica- mente à armação 1020. Como pode ser visto na Figura 4, por exemplo, em pelo menos uma forma, o sistema de trava 1710 inclui um membro de travamento ou forquilha de travamento 1712 que é acoplado de forma móvel ao chassi 1240. Na modalidade ilustrada, por exemplo, a forquilha de travamento 1712 tem um formato de U com duas pernas espaçadas que se estendem para baixo 1714. As pernas 1714 têm, cada uma, um pino de pivô 1715 formado nas mesmas que é adaptado para ser rece- bido em orifícios correspondentes 1245 formados no chassi 1240. Tal disposição facilita a fixação pivotante da forquilha de travamento 1712 ao chassi 1240. A forquilha de travamento 1712 pode incluir dois pinos de travamento que se projetam proximalmente 1716 que são configurados para se engatarem de forma liberável aos detentores ou sulcos de trava- mento correspondentes 1704 no flange de fixação distal 1700 da estru- tura 1020. Consulte a Figura 3. Em várias formas, a forquilha de trava- mento 1712 é propendida na direção proximal pela mola ou membro de propensão (não mostrado). A atuação da forquilha de travamento 1712 pode ser feita por um botão de travamento 1722 que é montado de ma- neira deslizante em um conjunto do atuador de trava 1720 que é montado no chassi 1240. O botão de travamento 1722 pode ser forçado em uma direção proximal em relação à forquilha de travamento 1712. Conforme será discutido em mais detalhes abaixo, a forquilha de travamento 1712 pode ser movida para uma posição destravada por forçar o botão de tra- vamento na direção distal, o que também faz com que a forquilha de tra- vamento 1712 gire para fora de engate de retenção com o flange de fixa- ção distal 1700 da estrutura 1020. Quando a forquilha de travamento 1712 está em engate de retenção com o flange de fixação distal 1700 da estrutura 1020, os pinos de travamento 1716 são assentados com reten- ção dentro dos detentores ou sulcos de travamento 1704 corresponden- tes no flange de fixação distal 1700.
[0096] Quando se usa um conjunto de eixo de acionamento intercam- biável que inclui um atuador de extremidade do tipo descrito no presente documento que é adaptado para cortar e prender o tecido, bem como ou-
tros tipos de atuadores de extremidade, pode ser desejável impedir o des- colamento inadvertido do conjunto de eixo de acionamento intercambiável do compartimento durante a atuação do atuador de extremidade. Por exemplo, em uso, o médico pode atuar o gatilho de fechamento 1032 para empunhar e manipular o tecido alvo para uma posição desejada. Quando o tecido alvo está posicionado dentro do atuador de extremidade 1300 em uma orientação desejada, o médico pode, então, atuar completamente o gatilho de fechamento 1032 para fechar a bigorna 1306 e prender o tecido alvo na posição para corte e grampeamento. Neste caso, o primeiro sis- tema de acionamento 1030 foi completamente atuado. Após o tecido alvo ter sido preso no atuador de extremidade 1300, pode ser desejável evitar o desprendimento inadvertido do conjunto de eixo de acionamento 1200 do gabinete 1012. Uma forma do sistema de travamento 1710 é configu- rada para impedir este descolamento inadvertido.
[0097] Como pode ser mais particularmente visto na Figura 4, a for- quilha de travamento 1712 inclui pelo menos um e, de preferência, dois ganchos de travamento 1718 que são adaptados para entrar em contato com as porções de pino de travamento correspondentes 1256 que são formadas no elemento reciprocante de fechamento 1250. Quando o ele- mento reciprocante de fechamento 1250 está em uma posição não ativada (isto é, o primeiro sistema de acionamento 1030 está desativado e a bi- gorna 1306 está aberta), a forquilha de travamento 1712 pode ser pivotada em uma direção distal para destravar o conjunto de eixo de acionamento intercambiável 1200 do gabinete 1012. Quando nesta posição, os ganchos de travamento 1718 não entram em contato com as porções do pino de travamento 1256 no elemento reciprocante de fechamento 1250. Entre- tanto, quando o elemento reciprocante de fechamento 1250 é movido para uma posição atuada (isto é, o primeiro sistema de acionamento 1030 é atuado e a bigorna 1306 está na posição fechada), a forquilha de trava- mento 1712 é impedida de ser girada para uma posição destravada. Em outras palavras, se o médico tentasse pivotar a forquilha de travamento 1712 para uma posição destravada ou, por exemplo, se a forquilha de tra- vamento 1712 estivesse inadvertidamente ressaltada ou colocada em con- tato de uma maneira que pudesse de outro modo fazer com que a mesma pivotasse distalmente, os ganchos de travamento 1718 na forquilha de tra- vamento 1712 entrariam em contato com os pinos de travamento 1256 no membro móvel de fechamento 1250 e impediriam o movimento da forqui- lha de travamento 1712 para uma posição destravada.
[0098] A fixação do conjunto de eixo de acionamento intercambiá- vel 1200 na empunhadura 1014 será agora descrita. Para iniciar o pro- cesso de acoplamento, o médico pode posicionar o chassi 1240 do conjunto de eixo de acionamento intercambiável 1200 acima ou adja- cente à porção de flange de fixação distal 1700 da armação 1020 de modo que as porções de fixação afuniladas 1244 formadas no chassi 1240 estejam alinhadas com as fendas de encaixe 1702 na estrutura
1020. O médico pode, então, mover o conjunto de eixo de acionamento 1200 ao longo de um eixo geométrico de instalação que é perpendicu- lar ao eixo geométrico do eixo de acionamento SA para assentar as porções de fixação 1244 em "engate operacional" com as correspon- dentes fendas receptoras em formato de cauda de andorinha 1702. Ao fazer isto, o pino de fixação do eixo de acionamento 1226 no eixo de acionamento de disparo intermediário 1222 também será assentado na base 1126 no membro de acionamento móvel longitudinalmente 1120 e as porções do pino 1037 no segundo elo de fechamento 1038 serão assentadas nos ganchos correspondentes 1252 na forquilha de fechamento 1250. Como usado na presente invenção, o termo "engate operável" em referência a dois componentes significa que os dois com- ponentes estão engatados entre si de tal modo que, mediante aplica- ção de um movimento de atuação aos mesmos, os componentes pos- sam realizar a ação, função e/ou procedimento pretendidos.
[0099] Pelo menos cinco sistemas do conjunto de eixo de aciona- mento intercambiável 1200 podem ser acoplados operacionalmente a pelo menos cinco sistemas da empunhadura 1014 correspondentes.
Um pri- meiro sistema pode compreender um sistema de estrutura que acopla e/ou alinha a estrutura ou a coluna central do conjunto de eixo de acionamento 1200 com a estrutura 1020 da empunhadura 1014. Um outro sistema pode compreender um sistema de acionamento de fechamento 1030 que pode conectar operacionalmente o gatilho de fechamento 1032 da empunha- dura 1014 e o tubo de fechamento 1260 e a bigorna 2000 do conjunto de eixo de acionamento 1200. Conforme descrito acima, a forquilha de fixa- ção do tubo de fechamento 1250 do conjunto de eixo de acionamento 1200 pode ser engatada com o pino 1037 no segundo elo de fechamento 1038. Um outro sistema pode compreender o sistema de acionamento de dis- paro 1080 que pode conectar operacionalmente o gatilho de disparo 1130 da empunhadura 1014 com o eixo de acionamento de disparo intermediá- rio 1222 do conjunto de eixo de acionamento 1200. Conforme delineado acima, o pino de fixação de eixo de acionamento 1226 pode ser conectado operacionalmente com a base 1126 do membro de acionamento longitu- dinal 1120. Um outro sistema pode compreender um sistema elétrico que pode sinalizar a um controlador na empunhadura 1014, como o microcon- trolador, por exemplo, que um conjunto de eixo de acionamento, como o conjunto de eixo de acionamento 1200, por exemplo, foi engatado opera- cionalmente com a empunhadura 1014 e/ou, dois, conduzir energia e/ou sinais de comunicação entre o conjunto de eixo de acionamento 1200 e a empunhadura 1014. Por exemplo, o conjunto de eixo de acionamento 1200 pode incluir um conector elétrico 1810 que é montado operacional- mente à placa de circuito do eixo de acionamento 1610. O conector elétrico 1810 é configurado para engate pareado com um conector elétrico corres- pondente 1800 no circuito de controle da empunhadura 1100. Detalhes adicionais sobre o conjunto de circuitos e os sistemas de controle podem ser encontrados no pedido de patente US n° de série 13/803.086, e no pedido de patente US n° de série 14/226.142, cujas descrições foram pre- cedentemente incorporadas por referência. O quinto sistema pode consis- tir no sistema de travamento para travar de modo liberável o conjunto de eixo de acionamento 1200 à empunhadura 1014.
[0100] Agora com referência às Figuras 5 a 7, a bigorna 2000 no exemplo ilustrado inclui um corpo de bigorna 2002 que termina na porção de montagem de bigorna 2010. A porção de montagem de bigorna 2010 é suportada de modo móvel ou pivotante no canal alongado 1310 para deslocamento pivotante seletivo em relação ao mesmo ao redor de um eixo geométrico de pivô PA (pivot axis) de bigorna fixo que é transversal ao eixo geométrico do eixo de acionamento SA. Na disposição ilustrada, um membro de pivô ou pino giratório de bigorna 2012 se estende lateral- mente de cada lado lateral da porção de montagem da bigorna 2010 para ser recebido em uma base de pino giratório correspondente 1316 for- mada nas paredes verticais 1315 da porção de extremidade proximal 1312 do canal alongado 1310. Os pinos giratórios da bigorna 2012 são retidos de modo pivotante na sua base de pino giratório correspondente 1316 pela tampa do canal ou retentor da bigorna 1290. A tampa do canal ou o retentor da bigorna 1290 inclui um par de pinos de fixação que são configurados para serem recebidos de maneira retentora dentro das ra- nhuras ou entalhes de pino correspondentes formados nas paredes ver- ticais 1315 da porção de extremidade proximal 1312 do canal alongado
1310.
[0101] Ainda com referência às Figuras 7, 8 e 9, em pelo menos uma disposição, o membro de fechamento distal ou o tubo de fechamento do atuador de extremidade 3050 usa dois recursos de abertura de garra po- sitivos, proximal e distal, axialmente deslocados 3060 e 3062. Na Figura 7, o recurso de abertura positiva da garra proximal 2060 está localizado no lado direito (como visto por um usuário do conjunto de ferramenta) do eixo geométrico do eixo de acionamento SA. Os recursos positivos de abertura de garra 3060, 3062 são configurados para interagir com as áreas em relevo correspondentes 3064, 3066 e as porções escalonadas formadas na porção de montagem de bigorna 2010 conforme descrito em maiores detalhes no pedido de patente US n° de série 15/635.631, depo- sitado em 28 de junho de 2017, intitulado SURGICAL INSTRUMENT WITH AXIALLY MOVABLE CLOSURE, cuja descrição está no presente documento incorporada a título de referência, em sua totalidade. Outras disposições de abertura da garra podem ser usadas.
[0102] As Figuras 6 e 7 ilustram uma forma de uma bigorna 2000 que inclui uma porção de corpo de bigorna alongada 2002 que termina em uma porção de montagem 2010 que é configurada para interagir com a luva de fechamento do atuador de extremidade 3050 para minimizar a quantidade de forças resultantes experimentadas pelo tubo de fechamento do atuador de extremidade 3050 à medida que a bigorna 2000 é movida de uma po- sição completamente aberta para uma posição fechada e por fim uma po- sição mais fechada. A porção de corpo de bigorna 2002 inclui uma subsu- perfície de formação de grampos 2004 que tem uma série de bolsos for- madores de bigorna (não mostrados) formados na mesma. Uma fenda alongada 2006 se estende através da porção de corpo 2002 e da porção de montagem 2010 para facilitar a passagem da porção de faca ou "mem- bro de disparo" 1920 através da mesma. Além disso, uma cobertura de bigorna 2030 é fixada ao corpo da bigorna 2002 para cobrir a fenda 2006. Em várias circunstâncias, a porção de montagem de bigorna 2010 com- preende uma superfície de came de bigorna 2020 formada na mesma. A superfície de came da bigorna 2020 é bissecionada ou de outro modo di- vidida pela fenda alongada 2006. Como pode ser visto nas Figuras 6 e 7, uma porção de extremidade proximal 2032 da tampa de bigorna 2030 é orientada em um ângulo que corresponde ao ângulo/orientação das su- perfícies de came da bigorna 2020. As Figuras 10 e 11 ilustram a bigorna
2000 em sua posição completamente aberta. Como pode ser visto na Fi- gura 10, o tubo de fechamento do atuador de extremidade ou distal 3050 está em sua posição mais proximal quando a "segunda garra" ou a bigorna 2000 está na sua posição completamente aberta. Quando nessa posição, uma superfície de came 3072 formada sobre a extremidade distal 3070 do tubo de fechamento do atuador de extremidade 3050 não está aplicando quaisquer forças de fechamento às superfícies do came de fechamento
2020. Conforme o tubo de fechamento do atuador de extremidade 3050 é movido distalmente, a superfície de came 3072 no tubo de fechamento do atuador de extremidade 3050 entra em contato com as superfícies de came de fechamento 2020 sobre a porção de montagem da bigorna 2010 e uma superfície de fechamento 2034 correspondente na porção de extre- midade proximal 2032 da tampa de bigorna 2030 para girar a bigorna 2000 para uma posição "fechada". As Figuras 12 e 13 ilustram as posições do tubo de fechamento do atuador de extremidade 3050 e da bigorna 2000 quando a bigorna 2000 está na posição fechada.
[0103] Conforme o tubo de fechamento do atuador de extremidade 3050 continua a ser avançado distalmente para aplicar movimentos adi- cionais de fechamento à bigorna para finalmente mover a bigorna para uma posição "mais fechada", o tubo de fechamento de atuador de ex- tremidade pode experimentar significativo estresse que pode, ao longo do tempo, fazer com que o tubo de fechamento do atuador de extremi- dade se torne alongado verticalmente (quando visto a partir de uma ex- tremidade) ou, dito de uma outra forma, se tornar um tanto em formato oval que podem por fim levar à falha ou de outro modo afetar de forma prejudicial a capacidade de atingir uma posição completamente fe- chada. É axiomático que quando um tubo ou cilindro com paredes del- gadas é submetido a pressão interna, uma tensão circunferente e um estresse longitudinal são produzidos na parede do tubo. Essa tensão circunferente age circunferencialmente e perpendicularmente ao eixo geométrico e ao raio da parede do cilindro. Essa tensão circunferente pode ser calculada como: σh = pd/(2t), em que: σh = tensão circunferente (MPa, psi) p = pressão interna no tubo ou cilindro (MPa, psi) d = diâmetro interno do tubo ou cilindro (mm, pol) t = espessura da parede do tubo ou cilindro (mm, pol)
[0104] Foram desenvolvidos tubos de fechamento do atuador de extremidade com várias configurações de parede de tubo. Exemplos de tais configurações de tubo são descritos no pedido de patente US n° de série 15/385.903, depositado em 21 de dezembro de 2016, inti- tulado CLOSURE MEMBER ARRANGEMENTS FOR SURGICAL INS- TRUMENTS, cuja inteira descrição está no presente documento incor- porada a título de referência na presente invenção.
[0105] As Figuras 8 e 9 ilustram uma forma de um tubo de fecha- mento do atuador de extremidade 3050. O tubo de fechamento 3050 compreende uma superfície externa 3074 e uma superfície de parede interna 3076. Em pelo menos uma forma, o tubo de fechamento 3050 compreende um diâmetro interno constante ID (internal diameter) e um diâmetro externo constante OD (external diameter) para definir uma es- pessura de parede CT (wall thickness) que é uniforme ou constante ao longo de um comprimento do tubo de fechamento 3050 ou pelo menos a porção do tubo de fechamento que é configurada para fazer interface com garras do atuador de extremidade como a bigorna 2000 e o canal alongado 1310.
[0106] Novamente com referência à Figura 12, em pelo menos uma disposição, quando a bigorna 2000 está na "posição fechada", uma dis- tância de folga "CD" (clearance distance) pode ser observada entre o lado inferior de formação de grampos 2004 do corpo de bigorna 2002 e a superfície de plataforma de cartucho de um cartucho que é suportado dentro do canal alongado 1310 quando nenhum tecido está preso entre a bigorna 2000 e o cartucho. A Figura 13 é uma vista em seção trans- versal tomada ao longo da linha 13-13 na Figura 12 através das super- fícies de came de fechamento 2020 bem como através de uma porção de extremidade distal do tubo de fechamento do atuador de extremidade 3050 bem como da porção de montagem de bigorna 2020 e da porção de extremidade proximal do canal alongado 1310. Como pode ser visto naquela figura, várias forças de fechamento CF (closure forces) são apli- cadas à bigorna 2000 e ao canal alongado 1310 pelo tubo de fecha- mento do atuador de extremidade 3050. Por exemplo, as forças de fe- chamento são aplicadas sobre as superfícies de came de fechamento 2020 e a porção de extremidade proximal 2032 da tampa de bigorna 2030 bem como sobre o canal alongado 1310.
[0107] No exemplo ilustrado nas Figuras 6 a 15, a porção de mon- tagem de bigorna 2020 é formada para estabelecer uma pluralidade de locais de transferência de carga distintos que são configurados para ficarem em contato com a superfície interna 3076 do tubo de fecha- mento do atuador de extremidade 3050 quando o tubo de fechamento do atuador de extremidade 3050 está na posição correspondente à po- sição fechada da bigorna 2000. Em pelo menos uma disposição, pelo menos dois locais de transferência de carga distintos estão localizados em cada lado de um plano vertical VP (vertical plane) que bisseciona a bigorna 2000 quando a bigorna 2000 está na posição fechada. Por exemplo, na Figura 13, um primeiro local ou borda direita de transfe- rência de carga 2070R, um segundo local ou borda direita de transfe- rência de carga 2072R, um terceiro local ou borda direita de transfe- rência de carga 2074R e um quarto local ou borda direita de transfe- rência de carga 2076R são formados em um lado direito do plano ver- tical VP. De modo similar, um primeiro local ou borda esquerda de transferência de carga 2070L, um segundo local ou borda esquerda de transferência de carga 2072L, um terceiro local ou borda esquerda de transferência de carga 2074L e um quarto local ou borda esquerda de transferência de carga 2076L são formados em um lado esquerdo do plano vertical VP. Como usado neste contexto, o termo "pelo menos dois locais de transferência de carga distintos" significa que os locais de transferência de carga são formados um em relação ao outro de modo que um espaço ou folga é formado entre a porção da porção de montagem de bigorna 2010 que se estende entre os locais de transfe- rência de carga 3076 e a superfície interna do tubo de fechamento do atuador de extremidade 3050.
[0108] Por exemplo, uma primeira quantidade de folga CR1 (clea- rance) é formado entre a superfície interna 3076 do tubo de fechamento do atuador de extremidade 3050 que se estende entre o primeiro local direito de transferência de carga 2070R e o segundo local direito de transferência de carga 2072R. A segunda quantidade de folga CR 2 é formada entre a superfície interna do tubo de fechamento do atuador de extremidade 3050 que se estende entre o terceiro local direito de trans- ferência de carga 2072R e o terceiro local direito de transferência de carga 2074R. Uma terceira quantidade de folga CR3 é formada entre o terceiro local direito de transferência de carga 2074R e o quarto local direito de transferência de carga 2076R. Uma primeira quantidade de folga CL1 é formada entre a superfície interna do tubo de fechamento do atuador de extremidade que se estende entre o primeiro local esquerdo de transferência de carga 2070L e o segundo local esquerdo de trans- ferência de carga 2072L. A segunda quantidade de folga CL2 é formada entre a superfície interna 3076 do tubo de fechamento do atuador de extremidade que se estende entre o segundo local esquerdo de trans- ferência de carga 2072L e o terceiro local esquerdo de transferência de carga 2074L. Uma terceira quantidade de folga CL3 é formada entre o terceiro local esquerdo de transferência de carga 2074L e o quarto local esquerdo de transferência de carga 2076L. Em pelo menos uma dispo- sição, as forças de fechamento CF (closure forces) aplicadas às super- fícies de came de fechamento 2020, bem como às porção proximal 2032 da tampa de bigorna 2030 podem ser uniformemente distribuídas entre o primeiro local direito de transferência de carga 2070R e o primeiro local esquerdo de transferência de carga 2070L. Da mesma forma, as forças de fechamento CF aplicadas ao canal alongado 1310 podem ser uniformemente distribuídas entre o quarto local direito de transferência de carga 2076R e o quarto local esquerdo de transferência de carga 2076L, por exemplo.
[0109] Em pelo menos uma disposição, pelo menos dois locais di- reitos de transferência de carga 2070R, 2072R e pelo menos dois locais esquerdos de transferência de carga 2070L, 2072L estão localizados em um lado de um plano horizontal HP (horizontal plane) que bisseciona o atuador de extremidade 1300. Conforme ilustrado na Figura 13, os dois locais direitos de transferência de carga 2070R, 2072R estão loca- lizados em um lado oposto do plano vertical VP a partir dos dois locais esquerdos de transferência de carga 2070L, 2072L. Também em pelo menos uma disposição, o terceiro local direito de transferência de carga 2074R e o quarto local direito de transferência de carga 2076R estão situados em um lado oposto do plano horizontal HP a partir do primeiro local direito de transferência de carga 2070R e do segundo local direito de transferência de carga 2072R. De modo similar, o terceiro local es- querdo de transferência de carga 2074L e o quarto local esquerdo de transferência de carga 2076L estão situados em um lado oposto do plano horizontal HP a partir do primeiro local esquerdo de transferência de carga 2070L e do segundo local esquerdo de transferência de carga 2072L. Os locais direitos de transferência de carga 2074R, 2076R estão localizados em um lado oposto do plano vertical VP a partir dos dois locais esquerdos de transferência de carga 2074L, 2076L. Como pode ser visto nas Figuras 6 e 10, os locais de transferência de cargas podem ser formados por áreas recortadas ou atenuadas 2080, 2082, 2084 de modo que os locais de transferência de carga compreendem cantos for- mados a partir de superfícies contíguas. Outros formatos de local de transferência de carga são contemplados.
[0110] As Figuras 14 e 15 ilustram a bigorna 2000 e o tubo de fecha- mento do atuador de extremidade 3050 em um estado "mais fechado" que é criado à medida que o tubo de fechamento do atuador de extremi- dade 3050 é avançado adicionalmente distalmente após a bigorna 2000 ter atingido a posição fechada. Em pelo menos um exemplo, a bigorna 2000 está em um "estado mais fechado" quando uma porção de extremi- dade distal 2003 da porção de corpo 2002 da bigorna 2000 está em con- tato com a plataforma de cartucho do cartucho de grampos que é opera- cionalmente suportada com o canal alongado 1310. Consulte a Figura
14. O avanço distal continuado do tubo de fechamento do atuador de extremidade 3050 após a bigorna 2000 ter atingido a posição fechada pode aumentar significativamente a tensão circunferencial formada no tubo de fechamento do atuador de extremidade 3050 que pode fazer com que o tubo de fechamento do atuador de extremidade falhe se alongue verticalmente o que pode afetar forma prejudicial o fechamento adequado da bigorna quando usada em aplicações futuras. Conforme pode ser visto na Figura 15, a primeira quantidade direita de folga CR1 e a primeira quantidade esquerda de folga CL1 podem cada uma ter uma largura de folga CW1 que está situado sobre um lado comum do plano horizontal HP. Cada uma dentre a segunda quantidade direita de folga CR2 e a se- gunda quantidade esquerda de folga CL2 se estende através do plano horizontal HP. Dito de uma outra forma, porções da segunda quantidade direita de folga CR2 estão localizadas em cada lado do plano horizontal HP e porções da segunda quantidade esquerda de folga CL2 estão loca- lizadas em cada lado do plano horizontal HP.
[0111] A formação de pelo menos dois locais de transferência de carga distintos localizados em cada lado do plano vertical pode reduzir a quantidade de tensões circunferentes prejudiciais estabelecidas no tubo de fechamento do atuador de extremidade 3050 conforme ele se move distalmente para a posição mais fechada. Ao formar pelo menos três locais de transferência de carga distintos localizados em cada lado do plano ver- tical pode reduzir adicionalmente a quantidade de tensões circunferentes prejudiciais estabelecidas no tubo de fechamento do atuador de extremi- dade 3050 conforme ele se move distalmente para a posição mais fe- chada. A formação de pelo menos quatro locais de transferência de carga localizados em cada lado do plano vertical pode reduzir adicionalmente a quantidade de tensões circunferentes prejudiciais estabelecidas no tubo de fechamento do atuador de extremidade 3050 conforme ele se move distalmente para a posição mais fechada. Tais disposições permitem que o tubo de fechamento do atuador de extremidade 3050 seja produzido com uma espessura de parede constante conforme descrito acima, o que pode reduzir a quantidade de custos de fabricação associados com a fabricação do tubo de fechamento do atuador de extremidade.
[0112] As Figuras 16 a 22 ilustram uma bigorna alternativa 2000’ que é substancialmente idêntica à bigorna 2000 descrita acima, exceto pelas diferenças mostradas abaixo. Como pode ser visto na Figura 16, a porção de montagem de bigorna 2010’ é formada com superfícies de came 2020’ da bigorna arqueada contínuo que não são interrompidas por quaisquer locais de transferência de carga. As Figuras 17 e 18 ilustram a bigorna 2000’ em sua posição completamente aberta. Como pode ser visto na Fi- gura 17, o tubo de fechamento do atuador de extremidade 3050’ está em sua posição mais proximal quando a "segunda garra" ou bigorna 2000’ está em sua posição completamente aberta. Quando nessa posição, o tubo de fechamento do atuador de extremidade 3050’ não está aplicando quaisquer forças de fechamento às superfícies do came de fechamento
2020’. A Figura 23 ilustra uma forma de um atuador de extremidade do tubo de fechamento 3050’ que pode ser idêntica ao tubo de fechamento do atuador de extremidade 3050 descrito acima, exceto pelas diferenças observadas abaixo. O tubo de fechamento do atuador de extremidade 3050’ compreende uma superfície externa 3074’ e uma superfície de pa- rede interna 3076’. Em pelo menos uma forma, o tubo de fechamento 3050’ tem uma espessura de parede constante WT1 (wall thickness) ex- ceto por um segmento As da parede localizado no topo do tubo de fecha- mento do atuador de extremidade 3050’ que tem uma espessura de pa- rede mais espessa WT2 que é maior que a WT1. Tal disposição forma um único local de transferência de carga 2070’.
[0113] As Figuras 19 e 20 ilustram as posições do tubo de fechamento do atuador de extremidade 3050’ e da bigorna 2000’ quando a bigorna 2000’ está na posição fechada. Como pode ser visto na Figura 20, con- forme o atuador de extremidade do tubo de fechamento 3050’ é movido distalmente, o local de transferência de carga 2070’ no tubo de fechamento do atuador de extremidade 3050’ entra em contato com a superfície de came 2034 sobre a porção proximal 2032 da tampa de bigorna 2030. O tubo de fechamento do atuador de extremidade 3050’ também entra em contato com porções do canal alongado 1310 em cada lado do plano ver- tical VP que bisseciona o atuador de extremidade. O local de transferência de carga 2070’ pode se estender através de toda a superfície de came 2034 para entrar em contato com uma porção superior das superfícies de came 2020’ em cada lado do plano vertical VP conforme mostrado na Fi- gura 20. Quando na posição fechada mostrada nas Figuras 19 e 20, essa disposição serve para formar um espaço 3077 entre as porções corres- pondentes da superfície interna 3076’ do tubo de fechamento do atuador de extremidade 3050’' e as superfícies de came 2020’ da porção de mon- tagem de bigorna 2010’ conforme mostrado na Figura 20. Cada espaço 3077 se estende a partir do local de transferência de carga 2070’ e a área em que a superfície interna 3076’ entra em contato com o canal alongado 1310 (distância do espaço SD). Dessa forma, quando a bigorna 2000’ é movida para uma posição fechada, há um primeiro local de transferência de carga distinto 2070’ localizado em um lado de um plano horizontal HP e dois locais de transferência de carga distintos 2072R’, 2072L’ localizados em um lado oposto do plano horizontal HP. O primeiro local de transferên- cia de carga distinto 2070’ é separado de cada um dos locais de transfe- rência de carga distintos 2072R’, 2072L’ por espaços 3077 quando a bi- gorna 2000’ está na posição fechada. Consulte a Figura 20. Como também pode ser visto na Figura 20, os locais de transferência de cargas 2072R’, 2072L’ estão localizados em lados opostos do plano vertical VP.
[0114] As Figuras 21 e 22 ilustram a inter-relação entre o tubo de fechamento do atuador de extremidade 3050’ e a bigorna 2000’ quando o tubo de fechamento do atuador de extremidade 3050’ move a bigorna 2000’ em uma orientação mais fechada. Como pode ser visto na Figura 22, quando na posição mais fechada, o tubo de fechamento do atuador de extremidade 3050’ entra em contato com a bigorna 2000’ e o canal alongado 1310 para formar um local de transferência de carga distinto 2070’ que é separado dos locais de transferência de carga distintos 2074R’, 2074L’ pelos espaços 3079R, 3079L. O local de transferência de carga distinto 2074R’ é separado pelo local de transferência de carga distinto 2076R’ por um espaço 3081R e o local de transferência de carga distinto 2074L’ é separado de um local de transferência de carga distinto 2076L’ por um espaço 3081L. Dessa forma, nesta disposição, pelo me- nos um local de transferência de carga distinto (2070’) abrange um plano vertical VP que bisseciona o atuador de extremidade e pelo me- nos dois locais de transferência de carga distintos abrangem um plano horizontal HP que bisseciona o atuador de extremidade. Além disso, pelo menos um local de transferência de carga distinto está situado em cada lado do plano horizontal HP e pelo menos um local de transferên- cia de carga distinto local está situado em cada lado do plano vertical VP. Tal disposição dos locais de transferência de carga do modo acima descrito pode ajudar a evitar alongamento vertical do tubo de fecha- mento do atuador de extremidade 3050’.
[0115] As Figuras 24 a 30 ilustram uma bigorna alternativa 2000’’ que é substancialmente idêntica à bigorna 2000 descrita acima, exceto pelas diferenças mostradas abaixo. Como pode ser visto na Figura 24, a porção de montagem de bigorna 2010’’ é formada com uma superfície de came de bigorna arqueada 2020’’ e porções entalhadas ou rebaixadas direita e esquerda 2022’’. As Figuras 24 e 25 ilustram a bigorna 2000’’ em sua po- sição completamente aberta. Como pode ser visto na Figura 24, o tubo de fechamento do atuador de extremidade 3050’’ está em sua posição mais proximal quando a "segunda garra" ou bigorna 2000’’ está em sua posição completamente aberta. Quando nessa posição, o tubo de fechamento do atuador de extremidade 3050’’ não está aplicando quaisquer forças de fe- chamento às superfícies do came de fechamento 2020’’. A Figura 30 ilus- tra uma forma de um atuador de extremidade do tubo de fechamento 3050’’ que pode ser idêntica ao tubo de fechamento do atuador de extre- midade 3050 descrito acima, exceto pelas diferenças observadas abaixo. O tubo de fechamento do atuador de extremidade 3050’’ compreende uma superfície externa 3074’’ e uma superfície de parede interna 3076’’. Em pelo menos uma forma, o tubo de fechamento 3050’’ tem uma primeira espessura de parede WT1, uma segunda espessura de parede WT2, uma terceira parede espessura WT3, e uma quarta parede espessura WT4 que são dispostas conforme mostrado na Figura 30. Em pelo menos uma dis- posição, por exemplo, WT1 < WT2 < WT3 ≤ WT4. Em alguns casos, WT3 > WT4. A porção do tubo de fechamento do atuador de extremidade 3050’’ que tem uma espessura de parede correspondente a WT4 forma um local de transferência de carga 2070’’. Na disposição ilustrada, por exemplo, a o local de transferência de carga 2070’’ se estende através de um plano vertical VP que bisseciona o tubo de fechamento do atuador de extremi- dade 3050’’. As porções do tubo de fechamento do atuador de extremi- dade 3050’’ que têm uma espessura de parede WT3 formam locais de transferência de carga 2072R’’, 2072L’’. Em pelo menos uma disposição, conforme mostrado na Figura 30, os locais de transferência de carga 2072R’’, 2072L’’ se estende através de um plano horizontal HP que bisse- ciona o tubo de fechamento do atuador de extremidade 3050’’.
[0116] Agora com referência às Figuras 26 e 27, conforme o tubo de fechamento do atuador de extremidade 3050’’ é movido distalmente, o local de transferência de carga 2070’’ entra em contato com a super- fície de came 2034 na porção proximal 2032 da tampa da bigorna 2030. Os locais de transferência de carga 2072R’’, 2072L’’ também entram em contato com as porções correspondentes da porção de montagem de bigorna 2010’’. Também, porções do tubo de fechamento do atuador de extremidade 3050’’ formam locais transferência de carga 2074R’’, 2074L’’ que entram em contato com porções correspondentes do canal alongado 1310 para mover a bigorna 2000’’ para a posição fechada mostrada nas Figuras 26 e 27. Quando na posição fechada mostrada nas Figuras 26 e 27, essa disposição serve para formar um espaço 3077’’, 3079’’ entre as porções correspondentes da superfície interna 3076’’ do tubo de fechamento do atuador de extremidade 3050’’ e as superfícies de came 2020’’ da porção de montagem de bigorna 2010’’ conforme mostrado na Figura 27. Os espaços 3077’’ estão localizadas entre o local de transferência de carga 2070’’ e os locais de transferên- cia de carga 2072R’’, 2072L’’. Os espaços 3079’’ estão localizadas entre os locais de transferência de cargas 2072R’’, 2072L’’ e os locais de transferência de carga 2074R, 2074L’’ conforme mostrado na Figura 27.
[0117] As Figuras 28 e 29 ilustram a inter-relação entre o tubo de fechamento do atuador de extremidade 3050’’ e a bigorna 2000’’
quando o tubo de fechamento do atuador de extremidade 3050’’ move a bigorna 2000’’ para uma orientação mais fechada. Como pode ser visto na Figura 29, além dos locais de transferência de carga 2070’’, 2072R’’, 2072L’’, 2074R’’, 2074L’’, locais de transferência de carga dis- tintas 2076R’’, 2076L’’ são formados pela borda das porções rebaixa- das 2022’’ formadas sobre a poção de montagem de bigorna 2010’’. Esses locais de transferência de carga distintos 2076R’’, 2076L’’ são separados dos locais de transferência de carga distintos correspon- dentes 2072R’’, 2072L’’ pelos espaços correspondentes 3081’’. A pro- visão dos locais de transferência de carga distintos do modo acima descrito pode ajudar a evitar o alongamento vertical do tubo de fecha- mento do atuador de extremidade 3050’’.
[0118] Quando um atuador de extremidade 1300 do tipo e constru- ção no presente documento descritos é usado, um médico manipula a primeira e a segunda garras (a bigorna 2000 e o canal alongado 1310 que tem um cartucho de grampos cirúrgicos operacionalmente montado na mesma), para capturar o tecido a ser cortado e grampeado (o "tecido- alvo") entra as mesmas. Como pode ser visto nas Figuras 5 e 7, por exemplo, um cartucho de grampos cirúrgicos 4000 compreende um corpo de cartucho 4010 que é configurado para ser suportado de modo remo- vível dentro do canal alongado 1310. O corpo de cartucho 4010 inclui uma fenda de cartucho alongada 4016 que se estende de uma extremi- dade proximal 4012 através do corpo de cartucho 4010 até uma porção de extremidade distal 4014 para permitir que o membro de faca ou mem- bro de disparo 1920 passe através da mesma. O corpo do cartucho 4010 define adicionalmente uma superfície de plataforma de cartucho 4020 em cada lado da fenda alongada 4016. Uma pluralidade de cavidades para grampo 4022 é fornecida no corpo do cartucho 4010 em cada lado da fenda alongada 4016. Cada cavidade 4022 se abre através da superfície de plataforma 4020 para suportar de modo removível um grampo ou grampos cirúrgicos na mesma. Em pelo menos uma disposição de cartu- cho, três linhas de cavidades de grampo 4022 são fornecidas em cada lado da fenda alongada 4016. As linhas são formadas de modo que os grampos em uma linha central estão desalinhados em relação aos gram- pos nas duas linhas externas adjacentes. Os grampos são suportados por acionadores de grampos que são suportados de modo móvel no in- terior de cada cavidade de grampo. Em pelo menos algumas disposições, os acionadores de grampos estão dispostos para serem colocados em contato ou "disparados" para cima quando entram em contato com um membro de came ou porções de came associadas ao membro de faca 1920, por exemplo. Em algumas disposições, um deslizador de cunha ou deslizador de came é suportado de modo móvel no corpo de cartucho e é adaptado para ser axialmente deslocado através do corpo de cartucho conforme o membro de faca 1920 é axialmente posicionado através do cartucho a partir da porção de extremidade proximal 4012 até a porção de extremidade distal 4014 do corpo de cartucho 4010. O deslizador de cunha inclui um membro de came ou cunha associado com cada linha de cavidades de grampos de modo a implantar em série os acionadores de grampo suportados no mesmo. Conforme o came entra em contato com um acionador de grampo, o acionador é acionado para cima no interior da cavidade de grampo acionando o grampo ou grampos suportados no mesmo fora da cavidade de grampo através do tecido preso e em contato de formação com a subsuperfície de formação de grampos da bigorna. O deslizador de cunha ou membro de came está situado distal à faca ou gume cortante de tecido da faca ou membro de disparo 1920, de modo que o tecido é grampeado antes de ser cortado pelo gume cortante de tecido.
[0119] Quando o médico inicialmente localiza o tecido-alvo entre a bigorna e o cartucho de grampos, é importante que o tecido-alvo esteja situado de modo que a faca não corte no tecido-alvo a menos que o tecido-alvo seja primeiro grampeado. Em disposições de bigorna prece- dentes, bloqueios de tecido são fornecidos na extremidade proximal do corpo da bigorna para evitar que o tecido-alvo se mova proximalmente além dos bolsos para grampo mais proximais no cartucho de grampos. Tais bloqueios de tecido formam extremidades proximais abrutadas que confrontam ou estão voltadas para a extremidade distal do tubo de fe- chamento do atuador de extremidade. Conforme o tubo de fechamento é movido distalmente para fechar a bigorna, o tecido que se estende para fora entre a bigorna e o cartucho irá ocasionalmente se tornar in- desejavelmente preso ou apertado entre as extremidades proximais dos bloqueios de tecido e a extremidade distal do tubo de fechamento do atuador de extremidade. Os exemplos descritos abaixo são configura- dos para minimizar a possibilidade de o tecido ser apertado entre os bloqueios de tecido e o tubo de fechamento do atuador de extremidade quando a bigorna está sendo movida para as posições fechada e mais fechada nas várias maneiras descritas na presente invenção.
[0120] Voltando à Figura 7, por exemplo, o cartucho de grampos 4000 inclui grampos (não mostrados) que são suportados de forma re- movível ou armazenados em cada uma das cavidades de grampos mais proximais 4022P localizadas nas linhas de cavidades de grampo 4022 localizadas no corpo de cartucho 4010 em cada lado da fenda alongada
4016. Em várias circunstâncias, para evitar que o tecido-alvo seja aper- tado proximal aos grampos nas cavidades de grampos mais proximais 4022P, a bigorna 2000 inclui dois membros de bloqueio de tecido 2040 que se projetam para baixo além da subsuperfície de formação de gram- pos em cada lado do corpo da bigorna. Quando a bigorna está em uma posição fechada ou numa posição mais fechada, cada um dos membros de bloqueio 2040 se projetam para baixo do tecido em cada lado do corpo de cartucho 4010. A Figura 7 ilustra a bigorna 2000 em uma configuração aberta. Como pode ser visto nessa figura, cada um dos bloqueios de te- cido 2040 se estende abaixo da superfície de plataforma de cartucho para evitar que o tecido-alvo se estenda proximalmente além dos grampos nas cavidades de grampo mais proximais 4022P. Como pode ser visto nas Figuras 7, 31 e 32, em pelo menos uma disposição, os bloqueios de te- cido 2040 são formadas integralmente com a porção do corpo de bigorna
2002. A porção do corpo de bigorna 2002 e as extremidades proximais dos bloqueios de tecido 2040 se estendem ligeiramente acima das su- perfícies de came correspondentes 2020 formadas na porção de monta- gem de bigorna 2010. No exemplo ilustrado, as extremidades proximais dos bloqueios de tecido 2040 são segmentadas em uma porção de ex- tremidade proximal superior 2042, uma porção de extremidade proximal inferior 2043 e uma porção de extremidade proximal de fundo 2044. Con- sulte as Figuras 31 e 32. Como também pode ser visto nas Figuras 31 e 32, uma superfície em ângulo ou superfície de chanfro 2045 é formada entre a porção de extremidade proximal superior 2042 e a superfície de came 2020 na porção de montagem de bigorna. Uma superfície angulada ou superfície de chanfro 2046 é formada entre a porção de extremidade proximal inferior 2043 e a superfície de came 2020 e uma superfície em ângulo ou superfície de chanfro 2047 é formada entre a porção de extre- midade proximal de fundo 2044 e a superfície de came 2020. Na dispo- sição ilustrada em que áreas recortadas ou atenuadas 2080, 2082, 2084 são formadas na porção de montagem de bigorna 2010, o chanfro 2045 corresponde à área atenuada 2080. Consulte a Figura 33. A porção de extremidade proximal inferior 2043 e o chanfro que a acompanha 2046 correspondem à área atenuada 2082 e a porção de extremidade proximal de fundo 2044 e o chanfro que a acompanha 2047 corresponde à área atenuada 2084.
[0121] Conforme discutido acima, a bigorna 2000 é movida de uma posição completamente aberta à posição fechada e uma posição mais fe- chada pelo tubo de fechamento axialmente móvel do atuador de extremi- dade 3050. As Figuras 31 e 33 ilustram a posição do tubo de fechamento do atuador de extremidade 3050 em relação aos bloqueios de tecido 2040 quando a bigorna 2000 está na posição fechada. Como pode ser visto na Figura 33, a porção de extremidade proximal superior 2042 e o chanfro que a acompanha 2045 são aproximadamente paralelos a uma porção correspondente de uma extremidade distal 3051 do tubo de fechamento do atuador de extremidade 3050. Para reduzir a possibilidade de o tecido ser inadvertidamente apertado entre os bloqueios de tecido 2040 e a ex- tremidade distal 3051 do tubo de fechamento do atuador de extremidade 3050, a porção de extremidade proximal inferior 2043 e a porção de extre- midade proximal de fundo 2044 do bloqueio de tecido 2040 e dos chanfros correspondentes 2046 e 2047 são anguladas na direção oposta da extre- midade distal 3051 do tubo de fechamento do atuador de extremidade
3050. Essa disposição tem o efeito prático de aumentar a distância entre a porção de bloqueio de tecido e o tubo de fechamento do atuador de ex- tremidade pode provavelmente encontrar o tecido adjacente.
[0122] A Figura 33 é uma vista ampliada de uma porção do atuador de extremidade descrito na Figura 31 em que a bigorna 2000 está em uma posição fechada. Quando nessa posição, a porção de extremidade proximal superior 2042 de cada bloqueio de tecido 2040 está situada em uma primeira distância de tecido TD1 a partir da extremidade distal 3051 do tubo de fechamento do atuador de extremidade 3050. A porção de extremidade proximal de fundo 2044 de cada bloqueio de tecidos 2040 está situada em uma segunda distância de tecido TD2 a partir da extremidade distal 3051 do tubo de fechamento do atuador de extremi- dade 3050. Como pode ser visto na figura TD2 > TD1. As Figuras 32 e 34 ilustram a bigorna 2000 em uma posição mais fechada. A primeira distância de tecido TD1’ entre a porção de extremidade proximal supe- rior 2042 de cada bloqueio de tecido 2040 ainda é ligeiramente menor que a segunda distância de tecido TD2’ entre a porção de extremidade proximal de fundo 2044 de cada bloqueio de tecido 2040 e a extremi- dade distal 3051 do tubo de fechamento do atuador de extremidade 3050 que ainda irá reduzir a probabilidade de aperto do tecido entre as mesmas. Em pelo menos um exemplo, TD2 e/ou TD2’ podem ser apro- ximadamente dez milhares de uma polegada a aproximadamente vinte e cinco milhares de uma polegada. Entretanto, outros vãos podem ser obtidos. Além disso, a inclusão das superfícies chanfradas 2045, 2046 e 2047 pode ajudar a reduzir a probabilidade de aperto do tecido entre os bloqueios de tecido 2040 e a extremidade distal 3051 do tubo de fechamento do atuador de extremidade 3050 quando a bigorna 200 é movida para as posições fechada e mais fechada. A pessoa versada na técnica compreenderá que as configurações de bloqueio de tecidos des- critas acima também irão funcionar com outras formas de disposições de tubo de fechamento do atuador de extremidade e de membro de fe- chamento.
[0123] As Figuras 35 a 38 ilustram uma outra modalidade de bi- gorna 5000 que é idêntica à bigorna 2000 descrita acima exceto pelas diferenças relativas aos bloqueios de tecido 5040. Os bloqueios de te- cido 5040 podem ser idênticos aos bloqueios de tecido 2040 exceto que porções de extremidade proximal 5042, 5043, 5044 de cada blo- queio de tecido e suas respectivas superfícies de chanfro 5045, 5046, 5047 estão aproximadamente paralelas à extremidade distal 5031 do tubo de fechamento do atuador de extremidade 5030. O tubo de fecha- mento de atuador de extremidade 5050 pode de outro modo ser idên- tico ao tubo de fechamento do atuador de extremidade 3050 descrito acima, exceto pelas diferenças discutidas abaixo. As Figuras 35 e 36 ilustram a bigorna 5000 na posição fechada. Nessa disposição, uma área que pode de outro modo ser suscetível ao aperto do tecido é a borda da porção de extremidade proximal 5044 de fundo e a porção confrontante da extremidade distal 5031 do tubo de fechamento do atu- ador de extremidade 5050. Para aliviar e minimizar tal possibilidade, uma área atenuada 5060 é formada na extremidade distal 5031 do tubo de fechamento de atuador de extremidade 5030 que confronta ou, dito de outra forma, está oposto da extremidade proximal de fundo 5044 de cada um dos bloqueios de tecido 5040. No exemplo ilustrado, cada área atenuada 5060 compreende um entalhe arqueado 5062 que é for- mado na porção da extremidade distal 5031 do tubo de fechamento do atuador de extremidade 5030 que corresponde à porção da extremi- dade proximal de fundo 5044 de cada bloqueio de tecido 5040. Nas disposições ilustradas, por exemplo, a porção da extremidade proximal de fundo 5044 de cada um dos bloqueios de tecido 5040 termina em um canto de fundo 5070 e o ápice ou fundo 5064 está diretamente através do canto de fundo 5070 quando o tubo de fechamento do atu- ador de extremidade 5050 está na posição correspondente à posição fechada da bigorna 5000. Outros formatos de entalhe, entretanto, po- dem ser usados.
[0124] A Figura 36 é uma vista ampliada de uma porção do atuador de extremidade descrito na Figura 35 em que a bigorna 5000 está em uma posição fechada. Quando nessa posição, a porção da extremi- dade proximal superior 5042, a porção da extremidade proximal inferior 5043 e a porção a extremidade proximal de fundo 5044 de cada blo- queio de tecido 5040 estão localizadas em uma primeira distância de tecido TD1 partir da extremidade distal 3051 do tubo de fechamento do atuador de extremidade 5050. A porção da extremidade proximal de fundo 5044 de cada bloqueio de tecidos 5040 está situada em uma segunda distância de tecido TD2 a partir do ápice ou fundo 5064 do entalhe 5062 na extremidade distal 5051 do tubo de fechamento do atuador de extremidade 5050. Como pode ser visto na figura TD 2 > TD1. As Figuras 37 e 38 ilustram a bigorna 5000 em uma posição mais fechada. A primeira distância de tecido TD1’ entre a porção da extre- midade proximal de fundo 5044 de cada bloqueio de tecido 5040 ainda é ligeiramente menor que a segunda distância de tecido TD 2’ entre a porção da extremidade proximal de fundo 5044 de cada bloqueio de tecido 2040 e o ápice 5064 do entalhe correspondente 5062 na extre- midade distal 5051 do tubo de fechamento do atuador de extremidade 5050 que ainda irá reduzir a probabilidade de aperto do tecido entre as mesmas. Além disso, a inclusão das superfícies chanfradas 5045, 5046 e 5047 pode ajudar a reduzir a probabilidade de aperto do tecido entre os bloqueios de tecido 5040 e a extremidade distal 5051 do tubo de fechamento do atuador de extremidade 5050 quando a bigorna 5000 é movida para as posições fechada e mais fechada. A pessoa versada na técnica compreenderá que as configurações de bloqueio de tecidos descritas acima também irão funcionar com outras formas de disposições de tubo de fechamento do atuador de extremidade e de membro de fechamento.
[0125] A Figura 39 ilustra um cartucho de grampos cirúrgicos prece- dente 4000 que inclui um corpo de cartucho 4010 que é dimensionado para ser suportado de modo removível no canal alongado 1310. O corpo de cartucho 4010 inclui uma fenda de cartucho alongada 4016 que se es- tende de uma extremidade proximal 4012 através do corpo de cartucho 4010 até uma porção da extremidade distal 4014 para permitir que o mem- bro de faca ou membro de disparo 1920 (Figura 5) passe através da mesma. O corpo do cartucho 4010 define adicionalmente uma superfície de plataforma de cartucho 4020 em cada lado da fenda alongada 4016. Consulte a Figura 39. Uma pluralidade de cavidades para grampo 4022 é fornecida no corpo do cartucho 4010 em cada lado da fenda alongada
4016. Cada cavidade 4022 se abre através da superfície de plataforma
4020 para suportar de modo removível um grampo ou grampos cirúrgicos na mesma. Em pelo menos uma disposição de cartucho, três linhas de cavidades de grampo 4022 são fornecidas em cada lado da fenda alon- gada 4016. No exemplo ilustrado, as linhas são formadas de modo que os grampos em uma linha central estão desalinhados em relação aos gram- pos nas duas linhas externas adjacentes. Os grampos são suportados por acionadores de grampos que são suportados de modo móvel no interior de cada cavidade de grampo. Em pelo menos algumas disposições, os acionadores de grampos estão dispostos para serem colocados em con- tato ou "disparados" para cima quando entram em contato com um mem- bro de came ou porções de came associadas ao membro de faca 1920, por exemplo. Em algumas disposições, um deslizador de "cunha" ou des- lizador de came é suportado de modo móvel no corpo de cartucho 4010 e é adaptado para ser axialmente deslocado através do corpo de cartucho 4010 conforme o membro de faca 1920 é axialmente posicionado através do cartucho a partir da porção da extremidade proximal 4012 até a porção da extremidade distal 4014 do corpo de cartucho 4010. O deslizador de cunha inclui um membro de came ou cunha associado com cada linha de cavidades de grampos de modo a implantar em série os acionadores de grampo suportados no mesmo. Conforme a cunha ou came correspon- dente entra em contato com um acionador de grampo, o acionador é aci- onado para cima no interior da cavidade de grampo desse modo acio- nando o grampo ou grampos suportados no mesmo para fora da cavidade de grampo através do tecido preso e em contato de formação com a sub- superfície de formação de grampos de uma bigorna confrontante do atua- dor de extremidade. O deslizador de cunha ou membro de came está situ- ado distal à faca ou gume cortante de tecido da faca ou membro de disparo 1920, de modo que o tecido é grampeado antes de ser cortado pelo gume cortante de tecido na faca ou membro de disparo.
[0126] As variações da disposição e/ou geometria de grampos em uma linha de grampos podem afetar as propriedades de flexibilidade e vedantes da linha de grampos.
Por exemplo, uma linha de grampos com- preendida de grampos alinhados linearmente pode fornecer uma quanti- dade limitada de flexibilidade ou estiramento uma vez que a linha de grampos pode se flexionar ou estirar entre os grampos lineares.
Conse- quentemente, uma porção limitada da linha de grampos (por exemplo, a porção entre os grampos) é flexível.
Uma linha de grampos compreen- dida de grampos orientados de forma angular também pode se flexionar ou estirar entre os grampos.
Entretanto, os grampos orientados de forma angular também são capazes de girar, o que fornece um grau adicional de estiramento dentro da linha de grampos.
Uma linha de grampos com- preendida de grampos orientados de forma angular pode ser capaz de estirar em excesso de 60%, por exemplo.
Em certos casos, uma linha de grampos compreendida de grampos orientados de forma angular pode estirar pelo menos 25% ou pelo menos 50%, por exemplo.
A disposição de grampos inclui a orientação relativa dos grampos e o espaçamento entre os grampos, por exemplo.
A geometria dos grampos inclui o tama- nho e o formato dos grampos, por exemplo.
As propriedades de flexibili- dade e vedantes de uma linha de grampos pode mudar em posições lon- gitudinais e/ou laterais com base na disposição e/ou geometria dos gram- pos.
Em certos casos, é desejável alterar as propriedades de flexibilidade e/ou vedantes de uma linha de grampos em um ou mais locais ao longo da linha de grampos.
Por exemplo, pode ser desejável aumentar a flexi- bilidade da linha de grampos ou de uma porção da mesma.
Adicional- mente ou alternativamente, pode ser desejável diminuir a flexibilidade da linha de grampos ou de uma porção da mesma.
Também pode ser dese- jável aumentar as propriedades vedantes da linha de grampos ou de uma porção da mesma.
Adicionalmente ou alternativamente, pode ser dese- jável diminuir as propriedades vedantes da linha de grampos ou de uma porção da mesma.
[0127] A disposição de cavidades de grampo em um cartucho de grampos corresponde à disposição de grampos em uma linha de gram- pos gerada pelo cartucho de grampos. Por exemplo, o espaçamento e a orientação relativa de cavidades de grampo em um cartucho de gram- pos correspondem ao espaçamento e à orientação relativa de grampos em uma linha de grampos geradas pelo cartucho de grampos. Em vários casos, um cartucho de grampos pode incluir uma disposição de cavida- des de grampos que é selecionada e/ou designada para otimizar as pro- priedades de flexibilidade e/ou vedantes da linha de grampos resultante. Um cirurgião pode selecionar um cartucho de grampos tendo uma dis- posição de cavidades de grampo em particular com base no procedi- mento cirúrgico a ser realizado e/ou nas propriedades do tecido a ser tratado durante o procedimento cirúrgico, por exemplo.
[0128] Em certos casos, pode ser desejável gerar uma linha de gram- pos com diferentes padrões de grampo. Uma linha de grampos pode incluir um primeiro padrão de grampos para uma primeira porção do mesmo e um segundo padrão de grampos para uma segunda porção do mesmo. O primeiro padrão e o segundo padrão podem ser longitudinalmente deslo- cados. Por exemplo, o primeiro padrão pode estar posicionado na extre- midade proximal ou distal da linha de grampos. Em outras instâncias, o primeiro padrão e o segundo padrão podem ser lateralmente deslocados e, em ainda outras instâncias, o primeiro padrão e o segundo padrão po- dem ser lateralmente deslocados e longitudinalmente deslocados. Uma li- nha de grampos pode incluir pelo menos dois padrões diferentes de gram- pos.
[0129] Em certos casos, a maioria dos grampos em uma linha de grampos pode formar um padrão principal e outros grampos na linha de grampos podem formar um ou mais padrões secundários. O padrão prin- cipal pode abranger uma porção significativa da linha de grampos e pode incluir um subpadrão longitudinalmente repetitivo. Em certos casos, o pa- drão secundário, ou irregularidade, pode desviar do padrão principal. O padrão secundário pode ser uma anomalia em um ou mais locais ao longo do comprimento da linha de grampos, por exemplo. Os diferentes padrões em uma linha de grampos podem ser configurados para produzir diferentes propriedades em locais predefinidos. Por exemplo, o padrão principal pode ser um padrão altamente flexível ou elástico, que pode permitir o extenso estiramento do tecido grampeado, e o padrão secun- dário pode ser menos flexível ou menos elástico. Pode ser desejável que a maioria da linha de grampos seja altamente flexível e que um ou mais porções limitadas seja menos flexível, por exemplo. Em outras instâncias, o padrão secundário pode ser mais flexível que o padrão principal. Em certos casos, uma vez que o padrão secundário se estende ao longo de uma porção mais curta da linha de grampos, a flexibilidade do padrão secundário pode não impactar, ou pode não impactar significativamente, a flexibilidade total de toda a linha de grampos. O pedido de patente US n° de série 15/385.389, intitulado STAPLE CARTRIDGE AND ARRAN- GEMENTS OF STAPLES AND STAPLE CAVITIES THEREIN, agora pu- blicação de pedido de patente US n° 2018/0168629, cuja descrição está, por meio desta, no presente documento incorporada em sua totalidade, a título de referência revela várias disposições de cartuchos de grampos e acionadores de grampos.
[0130] A patente US n° 9.801.627, intitulada FASTENER CAR- TRIDGE FOR CREATING FLEXIBLE STAPLE LINES, a inteira descri- ção da qual está no presente documento incorporada a título de refe- rência na presente invenção revela várias disposições de cartuchos e bigorna para criar linhas de grampos cirúrgicos flexível.
[0131] Novamente com referência à Figura 39, a maior parte das ca- vidades de grampo 4022 no cartucho 4000 é disposta em um primeiro pa-
drão, ou padrão principal, 4030. O primeiro padrão 4030 é um padrão lon- gitudinalmente repetitivo de cavidades de grampo orientadas de forma an- gular 4022. Padrões longitudinalmente repetitivos são padrões em que um subpadrão ou disposição é longitudinalmente repetido. Por exemplo, uma disposição de três cavidades de grampo em cada lado da fenda 4016 (uma cavidade interna de grampos, uma cavidade intermediária de grampos e uma cavidade externa de grampos) pode ser repetida ao longo de pelo menos uma porção do comprimento do corpo do cartucho de grampos
4010. Vários padrões longitudinalmente repetitivos de cavidades de gram- pos orientados de forma angular são descritos no pedido de patente US n° 14/498.145, depositado em 26 de setembro de 2014, agora publicação do pedido de patente US n° 2016/0089142, intitulada METHOD FOR CREA- TING A FLEXIBLE STAPLE LINE, que é incorporada a título de referência na presente invenção em sua totalidade. As aberturas 4024 das cavidades de grampo 4022 no primeiro padrão 4030 formam um padrão em zigueza- gue tendo seis fileiras de aberturas de cavidade de grampos orientadas de forma angular 4024 na superfície de plataforma de cartucho 4020. Uma fileira interna 4026a, uma fileira intermediária 4026b e uma fileira externa 4026c de cavidades de grampo 4022 são posicionadas em cada lado da fenda 4016.
[0132] Cada abertura de cavidade de grampos 4024 tem uma ex- tremidade proximal 4027 e uma extremidade distal 4028. A extremi- dade proximal 4027 e a extremidade distal 4028 das cavidades de grampo 4022 no primeiro padrão 4030 são lateralmente deslocadas. Em outras palavras, cada cavidade de grampos 4022 no primeiro pa- drão 4030 é orientada de forma angular em relação ao eixo geométrico longitudinal do cartucho de grampos SCA (staple cartridge axis). Um eixo geométrico de cavidade CA (cavity axis) se estende entre a extre- midade proximal 4027 e a extremidade distal 4028 de cada abertura
4024. Os eixos geométricos de cavidade CA são obliquamente orien- tados em relação à fenda 4016. Mais especificamente, as aberturas 4024 nas fileiras internas 4026a de cavidades de grampo 4022 e as fileiras externas 4026c de cavidades de grampo 4022 são orientadas em 45 graus, ou cerca de 45 graus, em relação ao eixo geométrico longitudinal do cartucho de grampos SCA, e as aberturas 4024 na fi- leira intermediárias 4026b de cavidades de grampo 4022 são orienta- das em 90 graus, ou cerca de 90 graus, em relação às aberturas 4024 das fileiras internas 4026a e das fileiras externas 4026c.
[0133] No exemplo da Figura 39, certas cavidades de grampo no corpo do cartucho 4010 são orientadas em um ângulo que é anômalo ou irregular em relação às cavidades de grampo 4022 no primeiro padrão
4030. Mais especificamente, a orientação angular de cavidades de grampo proximais 4022a, 4022b, 4022c, e 4022d e de cavidades de grampos distais 4022e, 4022f, 4022g, e 4022h não se conforma à dispo- sição em ziguezague das cavidades de grampo 4022 no primeiro padrão
4030. Em vez disso, as cavidades de grampo proximais 4022a a 4022d e as cavidades de grampo distais 4022e a 4022h são angularmente des- locadas das cavidades de grampo 4022 no primeiro padrão 4030. As ca- vidades de grampo proximais 4022a, 4022b, 4022c, e 4022d são obliqua- mente orientadas em relação às cavidades de grampos 4022 no primeiro padrão 4030, e as cavidades de grampo distais 4022e, 4022f, 4022g, e 4022h também são obliquamente orientadas em relação às cavidades de grampos 4022 no primeiro padrão 4030. As cavidades de grampo proxi- mais e distais 4022a a 4022h são orientadas paralelas à fenda 4016 e ao eixo geométrico longitudinal do cartucho de grampos SCA.
[0134] As cavidades de grampo proximais 4022a a 4022d formam um padrão proximal 4040 que é distinto do primeiro padrão 4030, e as cavidades de grampo distais 4022e a 4022h formam um padrão distal 4042 que também é distinto do primeiro padrão 4030. Na disposição representada, o padrão proximal 4040 inclui um primeiro par de cavi- dades de grampo paralelas longitudinalmente alinhadas 4022a, 4022b em um primeiro lado da fenda 4016 e um segundo par de cavidades de grampo paralelas longitudinalmente alinhadas 4022c, 4022d em um segundo lado da fenda longitudinal 4016. O padrão distal 4042 também inclui um primeiro par de cavidades de grampo paralelas longitudinal- mente alinhadas 4022e, 4022f no primeiro lado da fenda longitudinal 4016 e um segundo par de cavidades de grampo paralelas longitudi- nalmente alinhadas 4022g, 4022h no segundo lado da fenda longitudi- nal 4016. Em outras instâncias, o padrão distal 4042 pode ser diferente do padrão proximal 4040.
[0135] O padrão proximal 4040 e o padrão distal 4042 são simétri- cos em relação ao eixo geométrico longitudinal do cartucho de gram- pos SCA. Em outros casos, o padrão proximal 4040 e/ou o padrão dis- tal 4042 podem ser assimétricos em relação ao eixo geométrico longi- tudinal do cartucho de grampos SCA. Por exemplo, as cavidades de grampo 4022e e 4022f podem ser longitudinalmente deslocadas das cavidades de grampo 4022g e 4022h e/ou as cavidades de grampo 4022a e 4022b podem ser longitudinalmente deslocadas das cavida- des de grampo 4022c e 4022d. Adicionalmente ou alternativamente, em certos casos, o corpo do cartucho de grampos 4010 pode incluir tanto o padrão proximal 4040 quanto o padrão distal 4042. Em outras instâncias, as cavidades de grampo 4022 definidas no corpo do cartu- cho de grampos 4010 podem incluir padrões adicionais e/ou diferentes de cavidades de grampo 4022.
[0136] Como pode ser adicionalmente visto na Figura 39, extenso- res atraumáticos 4050 se estendem ou se projetam a partir da superfí- cie da plataforma 4020 em torno de uma porção das cavidades de grampo 4022 no primeiro padrão 4030. Os extensores atraumáticos
4050 circundam as extremidades proximal e distal 4027 e 4028, res- pectivamente, das aberturas 4024 das cavidades de grampo 4022 no primeiro padrão 4030. Os extensores atraumáticos 4050 podem ser configurados para prender tecido que é preso pelo atuador de extremi- dade. Adicionalmente ou alternativamente, em certos casos, as pontas das pernas de grampo podem se projetar a partir do corpo do cartucho
4010. Nesses casos, os extensores atraumáticos 4050 podem ser con- figurados para se estenderem nivelados com e/ou além das pontas das pernas de grampo para impedir que as pontas penetrem prematura- mente o tecido. Consequentemente, grampos maiores, por exemplo, grampos tendo pernas maiores, podem estar posicionados nas cavida- des de grampo 4022 tendo extensores atraumáticos 4050 posiciona- dos em torno dos mesmos. Por exemplo, com relação novamente à Figura 39, grampos maiores podem ser posicionados nas cavidades de grampo 4022 no primeiro padrão 4030 em relação aos grampos nas cavidades de grampo no padrão proximal 4040 e no padrão distal 4042 sem risco de perfuração prematura de tecido pelas pernas maiores de grampo. Em certos casos, extensores atraumáticos 4050 podem ser posicionados em torno de cavidades de grampos 4022 no padrão pro- ximal 4040 e/ou no padrão distal 4042, e grampos maiores podem ser posicionados em uma ou mais daquelas cavidades de grampo 4022a- 4022h, também.
[0137] O corpo do cartucho de grampos 4010 pode ser configurado para gerar uma linha de grampos tendo diferentes propriedades ao longo do comprimento da mesma. Uma linha de grampos 4060 gerada pelo corpo do cartucho de grampos 4010 e embutida no tecido T é represen- tada na Figura 40. Uma linha de grampos 4060 é compreendida de gram- pos 4062, e um grampo exemplificador 4062 para uso com vários cartu- chos de grampos descritos na presente invenção é representado na Fi- gura 41. O grampo 4062 pode ser compreendido de um fio dobrado, por exemplo. O fio pode ter um diâmetro de 0,0079 polegadas, ou aproxima- damente 0,0079 polegadas. Em outras instâncias, o fio pode ter um diâ- metro de 0,0089 polegadas, ou aproximadamente 0,0089 polegadas. Em ainda outras instâncias, o fio pode ter um diâmetro de 0,0094, ou aproxi- madamente 0,0094 polegadas. Em certos casos, o fio pode ter um diâ- metro menor que 0,0079 polegadas ou mais que 0,0094 polegadas. O leitor entenderá que o diâmetro do fio pode determinar o diâmetro do grampo. O grampo 4062 é um grampo substancialmente em formato de U tendo uma base 4064, uma primeira perna 4066 que se estende a partir de uma primeira extremidade da base 4064, e uma segunda perna 4068 que se estende a partir de uma segunda extremidade da base 4064. A primeira perna 4066 é substancialmente paralela à segunda perna 4068 e substancialmente perpendicular à base 4064. Quando implantada no tecido T, a orientação angular da base 4064 corresponde à orientação angular da abertura de cavidade de grampos 4024 a partir da qual o grampo 4062 foi disparado.
[0138] Um outro grampo exemplificador 4070 que pode ser usado com vários cartuchos de grampos descritos na presente invenção é re- presentado na Figura 42. O grampo 4070 é um grampo substancialmente em formato em V tendo uma base 4072, uma primeira perna 4074 que se estende a partir da primeira extremidade da base 4072, e uma se- gunda perna 4076 que se estende a partir de uma segunda extremidade da base 4072. A primeira perna 4074 é obliquamente orientada em rela- ção à segunda perna 4076 e à base 4072. Quando implantada no tecido T, a orientação da base 4072 corresponde à orientação da abertura de cavidade de grampos 4024 a partir da qual o grampo 4070 foi disparado. O leitor entenderá que grampos tendo diferentes geometrias também po- dem ser disparados a partir dos cartuchos de grampos descritos na pre- sente invenção.
[0139] Com referência novamente à Figura 40, a linha de grampos
4060 inclui uma primeira porção 4061, uma porção proximal 4063 e uma porção distal 4065. A primeira porção 4061 é gerada a partir do primeiro padrão, ou padrão principal, 4030 e se estende ao longo de uma porção substancial da linha de grampos 4030. Devido à orienta- ção angular dos grampos 4062 na primeira porção 4030, a primeira porção 4061 é substancialmente flexível ou compatível. Por exemplo, uma vez que os grampos orientados de forma angular 4062 podem girar dentro do tecido grampeado T enquanto reduzem o trauma ao tecido T, a primeira porção 4061 é configurada para se estirar ou se estender longitudinalmente e/ou lateralmente conforme o tecido gram- peado estira.
[0140] A porção proximal 4063 é gerada a partir do padrão proximal 4040 e forma a extremidade proximal da linha de grampos 4060. A por- ção distal 4065 é gerada a partir do padrão distal 4042 e forma a extre- midade distal da linha de grampo 4060. Devido à orientação paralela dos grampos 4062 na porção proximal 4063 e na porção distal 4065 da linha de grampos 4060, a porção proximal 4063 e a porção distal 4065 da linha de grampos 4060 podem ser menos flexíveis do que a primeira porção 4061. Entretanto, a flexibilidade reduzida da porção proximal 4063 e da porção distal 4065 pode não impactar, ou pode não impactar substancialmente, a flexibilidade total da linha de grampos 4060. Além disso, conforme descrito na presente invenção, a porção proximal 4063 e a porção distal 4065 podem não se estender adjacentes à linha de corte e, em certos casos, a porção proximal 4063 pode estar ausente ou faltando na linha de grampos 4060.
[0141] Conforme descrito no presente documento, os grampos são posicionados de maneira removível em um cartucho de grampos e dis- parados a partir do cartucho de grampos durante o uso. Em vários ca- sos, os grampos podem ser acionados para fora das cavidades de grampo no cartucho de grampos e para entrar em contato de formação com uma bigorna. Por exemplo, um elemento de disparo pode transla- dar através do cartucho de grampos durante um golpe de disparo para acionar os grampos a partir do cartucho de grampos em direção a uma bigorna. Em certos casos, os grampos podem ser suportados por aci- onadores de grampo e o elemento de disparo pode levantar os aciona- dores de grampo para ejetar ou remover os grampos do cartucho de grampos.
[0142] Uma bigorna pode incluir uma subsuperfície de formação de grampos tendo bolsos formadores de grampos definidos em seu interior. Em certos casos, os bolsos formadores de grampo podem ser estampa- dos na bigorna. Por exemplo, os bolsos formadores de grampo podem ser cunhados em uma superfície plana da bigorna. O leitor entenderá que determinados recursos dos bolsos formadores de grampo podem ser uma consequência deliberada de um processo de cunhagem. Por exem- plo, um certo grau de arredondamento nos cantos e/ou bordas do pro- cesso de formação de grampo pode ser um resultado intencional do pro- cesso de cunhagem. Esses recursos também podem ser designados para melhor formar os grampos em suas configurações formadas, inclu- indo grampos que são distorcidos e/ou de outro modo desalinhados du- rante a colocação.
[0143] Cada grampo no cartucho de grampos pode ser alinhado com um bolso formador de grampo da bigorna. Em outras palavras, a disposi- ção de cavidades de grampo e os grampos em um cartucho de grampos para um atuador de extremidade podem corresponder ou coincidir com a disposição de bolsos formadores de grampo em uma bigorna do atuador de extremidade. Mais especificamente, a orientação angular de cada ca- vidade de grampos pode corresponder à orientação angular do respectivo bolso formador de grampo. Por exemplo, quando as cavidades de grampo são dispostas em um padrão de espinha de peixe, os bolsos formadores de grampo também podem ser dispostos em um padrão de espinha de peixe.
[0144] Quando os grampos são acionados a partir do cartucho de grampos e para entrar em contato de formação com a bigorna, os grampos podem ser formados em uma configuração "disparada". Em vários casos, a configuração disparada pode ser uma configuração em forma de B, na qual as pontas das pernas de grampo são dobradas em direção à base ou coroa do grampo para formar uma letra B maiúscula tendo laços superio- res e inferiores simétricos. Em outras instâncias, a configuração disparada pode ser uma forma de B modificado, por exemplo, uma configuração em forma de B distorcida, na qual pelo menos uma porção de uma perna de grampo realiza torque fora do plano com a base do grampo, ou uma con- figuração assimétrica em forma de B, na qual os laços superiores e inferi- ores da letra B maiúscula são assimétricos. O tecido pode ser capturado ou preso dentro do grampo formado.
[0145] A disposição de grampos e/ou as cavidades de grampo em um cartucho de grampos podem ser configuradas para otimizar a disposição de bolsos formadores de grampo correspondente na superfície de forma- ção de uma bigorna complementar. Por exemplo, a orientação angular e o espaçamento de grampos em um cartucho de grampos podem ser proje- tadas para otimizar a superfície de formação de uma bigorna. Em certos casos, a área de projeção dos bolsos formadores de grampo em uma bi- gorna pode ser limitada pela geometria da bigorna. Em casos em que os bolsos formadores de grampo são obliquamente orientados em relação a um eixo geométrico longitudinal, a largura da bigorna pode limitar o tama- nho e o espaçamento dos bolsos formadores de grampo obliquamente ori- entados. Por exemplo, a largura de uma fileira intermediária de bolsos for- madores de grampo pode definir uma distância mínima entre a primeira fileira (por exemplo, uma fileira externa) em um lado da fileira intermediária e a segunda fileira (por exemplo, uma fileira interna) no outro lado da fileira intermediária. Além disso, as fileiras de bolsos formadores de grampo são confinadas entre uma borda interna na bigorna, como uma fenda de faca, e uma borda externa da bigorna.
[0146] Em vários casos, os bolsos podem ser adjacentemente ani- nhados ao longo de uma subsuperfície de formação de grampos da bigorna. Por exemplo, um bolso intermediário pode ser aninhado entre um bolso interno e um bolso externo. A orientação angular dos bolsos pode variar de fileira para fileira para facilitar o aninhamento dos mes- mos. Por exemplo, os bolsos formadores de grampo em uma fileira interna podem ser orientados em um primeiro ângulo, os bolsos forma- dores de grampo em uma fileira intermediária podem ser orientados em um segundo ângulo, e os bolsos formadores de grampo em uma fileira externa podem ser orientados em um terceiro ângulo. O primeiro ângulo, o segundo ângulo e o terceiro ângulo podem ser diferentes, o que pode facilitar a disposição próxima dos bolsos formadores de grampo.
[0147] Novamente com referência ao cartucho de grampos prece- dente representado na Figura 39 e outros cartuchos de grampos pre- cedentes descritos na, por exemplo, patente US n° 9.801.627, intitu- lada FASTENER CARTRIDGE FOR CREATING FLEXIBLE STAPLE LINES e/ou no pedido de patente US n° US 14/498.145, depositada em 26 de setembro de 2014, agora publicação de pedido de patente US n° 2016/0089142 intitulada METHOD FOR CREATING A FLEXI- BLE STAPLE LINE, os diferentes ângulos dos grampos e cavidades de grampos em cada fileira podem ser selecionados para otimizar o aninhamento dos bolsos formadores de grampos em uma bigorna com- plementar. Para cada de tal cartucho de grampos, uma bigorna com- plementar pode ser configurada para ter uma disposição de bolsos for- madores de grampos correspondente. Além disso, os bolsos formado- res de grampos nas bigornas complementares podem ser mais longos do que as cavidades de grampo em um esforço para facilitar que as pernas de grampo entrem em contato ou caiam dentro dos bolsos for- madores de grampos. Por exemplo, as pernas de grampo podem ser propendidas para fora, como no caso de grampos em formato de V (vide a Figura 42) e a área de projeção mais longa dos bolsos forma- dores de grampos pode prender as pernas de grampo deslocadas para fora durante o disparo. Em vários casos, os bolsos formadores de grampo podem ser 0,005 polegadas a 0,015 polegadas mais longos do que as cavidades de grampo correspondentes e/ou os grampos. Adici- onalmente ou alternativamente, as concavidades receptoras de grampo de cada bolso formador de grampo podem ser 0,005 polega- das a 0,015 polegadas mais largas do que as cavidades de grampo correspondentes. Em outras instâncias, a diferença no comprimento e/ou largura pode ser menor que 0,005 polegadas ou maior que 0,015 polegadas.
[0148] Nos casos em que o tamanho dos grampos varia dentro de um cartucho de grampos, o tamanho dos bolsos formadores de gram- pos pode variar correspondentemente dentro de uma bigorna comple- mentar. A variação do tamanho dos bolsos formadores de grampo pode facilitar ainda mais o aninhamento dos mesmos. Por exemplo, nos casos em que bolsos formadores de grampo em uma fileira inter- mediária são mais curtos que os bolsos formadores de grampo em uma fileira interna ou em uma fileira externa, a largura da fileira intermediá- ria dos bolsos formadores de grampo pode ser reduzida, o que pode reduzir o espaçamento exigido entre a fileira interna e a fileira externa.
[0149] O espaçamento dos bolsos formadores de grampo também pode ser configurado para otimizar o aninhamento dos mesmos. Por exemplo, os bolsos dispostos em uma fileira interna podem ser longitudi- nalmente desalinhados em relação aos bolsos dispostos em uma fileira externa. Além disso, os bolsos na fileira interna podem parcialmente so- brepor longitudinalmente os bolsos na fileira externa. Os bolsos em uma fileira intermediária podem ser longitudinalmente desalinhados em relação aos bolsos na fileira interna e aos bolsos na fileira externa. Por exemplo, os bolsos na fileira intermediária podem ser equidistantemente longitudi- nalmente deslocados dos bolsos na fileira externa e dos bolsos na fileira interna. Exemplos
[0150] Exemplo 1 - Um atuador de extremidade cirúrgico que compre- ende uma primeira garra que inclui uma primeira porção de extremidade proximal de garra e uma primeira porção de extremidade distal de garra. O atuador de extremidade cirúrgico compreende adicionalmente uma se- gunda garra que inclui uma segunda porção de extremidade distal de garra e uma segunda porção de montagem proximal de garra que é suportada de modo pivotante na primeira porção de extremidade proximal de garra de modo que a segunda garra é pivotante em relação à primeira garra ao redor de um eixo geométrico de pivô entre uma posição aberta, uma posi- ção fechada e uma posição mais fechada e uma posição mais fechada, sendo que a segunda porção de extremidade distal de garra está em con- tato com a primeira porção de extremidade distal de garra. Um tubo de fechamento do atuador de extremidade é seletivamente móvel em direção à segunda porção de montagem proximal de garra durante um curso de fechamento para engate com isso. O tubo de fechamento do atuador de extremidade compreende uma superfície de parede externa e uma super- fície da parede interna que é configurada para engatar a segunda porção de montagem proximal de garra para mover a segunda porção de extre- midade distal de garra em direção à primeira porção de extremidade distal de garra durante o curso de fechamento. O tubo de fechamento do atuador de extremidade inclui adicionalmente uma espessura de parede uniforme entre a superfície de parede externa e a superfície da parede interna. O tubo de fechamento do atuador de extremidade está em contato com pelo menos dois locais de transferência de carga distintos na segunda porção de montagem de garra que estão situados em cada lado de um plano ver- tical que bisseciona o atuador de extremidade quando a segunda garra está na posição mais fechada.
[0151] Exemplo 2 - O atuador de extremidade cirúrgico do Exemplo 1, no qual os pelo menos dois locais de transferência de carga distintos que estão situados em cada lado do plano vertical compreendem dois pares de locais de transferência de carga distintos. Cada par de locais de transferência de carga distintos compreende um primeiro local de transferência de carga distinto e um segundo local de transferência de carga distinto que é espaçado em relação ao primeiro local de transfe- rência de carga distinto.
[0152] Exemplo 3 - O atuador de extremidade cirúrgico do Exemplo 2, no qual o segundo local de transferência de carga distinto é espaçado em relação ao primeiro local de transferência de carga distinto em um lado do plano vertical por uma primeira área atenuada na porção de montagem proximal da segunda garra de modo que uma porção correspondente do tubo de fechamento do atuador de extremidade que se estende entre o primeiro local de transferência de carga discreto em um lado do plano ver- tical não está em contato com a segunda porção de montagem proximal de garra quando a segunda garra está na posição mais fechada.
[0153] Exemplo 4 - O atuador de extremidade cirúrgico dos Exem- plos 2 ou 3, no qual o tubo de fechamento do atuador de extremidade está em contato com um terceiro local de transferência de carga distinto que está situado na segunda garra em cada lado do plano vertical quando a segunda garra está na posição mais fechada.
[0154] Exemplo 5 - O atuador de extremidade cirúrgico do Exemplo 4, no qual o terceiro local de transferência de carga distinto é espaçado em relação ao segundo local de transferência de carga distinto em um lado correspondente do plano vertical por uma segunda área atenuada na segunda garra de modo que um outra porção correspondente que se estende entre o segundo local de transferência de carga distinto e o terceiro local de transferência de carga distinto no um lado correspon- dente do plano vertical não está em contato com a segunda garra quando a segunda garra está na posição completamente fechada.
[0155] Exemplo 6 - O atuador de extremidade cirúrgico do Exemplo 5, no qual o primeiro e o segundo locais de transferência de carga distin- tos em um lado do plano vertical estão situados em um lado de um plano horizontal que bisseciona o atuador de extremidade cirúrgico e o terceiro local de transferência de carga distinto em um lado do plano vertical está situado em um outro lado do plano horizontal.
[0156] Exemplo 7 - O atuador de extremidade cirúrgico dos Exem- plos 2 ou 3, no qual cada primeiro local de transferência de carga distinto compreende uma primeira borda que é configurada para estar em con- tato com o tubo de fechamento do atuador de extremidade e no qual cada segundo local de transferência de carga distinto compreende uma segunda borda que é configurada para estar em contato com o tubo de fechamento do atuador de extremidade.
[0157] Exemplo 8 - O atuador de extremidade cirúrgico do Exemplo 7, no qual a primeira borda compreende um primeiro canto axialmente alongado e no qual a segunda borda compreende um segundo canto axialmente alongado.
[0158] Exemplo 9 - O atuador de extremidade cirúrgico do Exemplo 3, no qual cada primeira área atenuada compreende uma primeira área recortada na segunda porção de montagem proximal de garra.
[0159] Exemplo 10 - O atuador de extremidade cirúrgico dos Exem- plos 5 ou 6, no qual cada segunda área atenuada compreende uma primeira área recortada que está situada na porção de montagem pro- ximal da segunda guerra.
[0160] Exemplo 11 - Um instrumento cirúrgico que compreende um canal alongado que é configurado para suportar operacionalmente um cartucho de grampos cirúrgicos no mesmo. Uma bigorna é acoplada de modo pivotante ao canal alongado para deslocamento pivotante seletivo entre uma posição aberta e uma posição mais fechada em relação ao canal alongado. Um conjunto de eixo de acionamento alongado é opera- cionalmente acoplado ao canal alongado e compreende um membro de fechamento axialmente móvel. O membro de fechamento axialmente mó- vel inclui uma superfície de parede externa e uma superfície de parede interna que é configurada para engatar o canal alongado e a bigorna para girar a bigorna da posição aberta em direção a um cartucho de grampos cirúrgicos no canal alongado durante um curso de fechamento do mem- bro de fechamento axialmente móvel. O membro de fechamento axial- mente móvel tem adicionalmente uma espessura de parede uniforme en- tre a superfície de parede externa e a superfície de parede interna e é configurada para entrar em contato com pelo menos dois locais de con- tato distintos sobre a bigorna. Os dois locais de contato discretos são espaçados um em relação ao outro em cada lado de um plano vertical que bisseciona a bigorna quando a bigorna está na posição mais fe- chada.
[0161] Exemplo 12 - O instrumento cirúrgico do Exemplo 11, no qual pelo menos dois locais de contato distintos situados em cada lado do plano vertical compreendem um primeiro local de contato distinto e um segundo local de contato distinto que é separado do primeiro local de contato distinto por uma porção recortada da bigorna.
[0162] Exemplo 13 - O instrumento cirúrgico dos Exemplos 11 ou 12, no qual o membro de fechamento axialmente móvel entra em con- tato com um terceiro local de contato distinto na bigorna que está situ- ado em cada lado do plano vertical quando a bigorna está na posição mais fechada.
[0163] Exemplo 14 - O instrumento cirúrgico do Exemplo 13, no qual cada um dos dois locais de contato distintos em um lado do plano verti- cal é espaçado em relação ao terceiro local de contato distinto no lado correspondente do plano vertical por uma segunda área atenuada na bigorna.
[0164] Exemplo 15 - O instrumento cirúrgico do Exemplo 13 ou 14, no qual o primeiro e o segundo locais de contato distintos situados em um lado do plano vertical estão localizados em um lado de um plano horizontal que se estende através do eixo geométrico de pivô e no qual o terceiro local de contato discreto em um lado do plano vertical está situado em um outro lado do plano horizontal.
[0165] Exemplo 16 - O instrumento cirúrgico dos Exemplos 12, 13, 14 ou 15, no qual cada primeiro local de contato distinto compreende uma primeira borda que é formada na bigorna e é configurada para con- tato pelo membro de fechamento axialmente móvel e no qual cada se- gundo local de contato distinto compreende uma segunda borda que é formada na bigorna e é configurada para contato pelo membro de fe- chamento axialmente móvel.
[0166] Exemplo 17 - O instrumento cirúrgico do Exemplo 16, no qual a primeira borda compreende um primeiro canto axialmente alongado e no qual a segunda borda compreende um segundo canto axialmente alongado.
[0167] Exemplo 18 - O instrumento cirúrgico do Exemplo 13, no qual cada primeiro local de contato distinto compreende uma primeira borda que é formada na bigorna e é configurada para contato pelo membro de fechamento axialmente móvel e no qual cada segundo lo- cal de contato distinto compreende um segundo canto que é formado na bigorna e é configurado para contato pelo membro de fechamento axialmente móvel. Cada terceiro local de contato distinto compreende um terceiro canto que é formado na bigorna e é configurado para con- tato com o membro de fechamento axialmente móvel.
[0168] Exemplo 19 - O instrumento cirúrgico do Exemplo 18, no qual o primeiro canto é espaçado em relação ao segundo canto que está situ- ado em um mesmo lado do plano vertical por uma primeira área recortada na bigorna e no qual um dentre os segundos cantos é espaçado em rela- ção ao terceiro canto que está situado no mesmo lado do plano vertical por uma segunda área recortada na bigorna.
[0169] Exemplo 20 - Um instrumento cirúrgico que compreende um canal alongado que é configurado para suportar operacionalmente um cartucho de grampos cirúrgicos no mesmo. O instrumento cirúrgico com- preende adicionalmente uma bigorna que inclui um corpo de bigorna que tem uma extremidade distal e uma porção de montagem proximal que é suportada de modo pivotante no canal alongado para facilitar o desloca- mento pivotante da bigorna em relação ao canal alongado entre uma po- sição aberta e uma posição mais fechada. A bigorna compreende adici- onalmente pelo menos uma porção de bloqueio de tecido que está situ- ada distal à porção de montagem proximal. O instrumento cirúrgico com- preende adicionalmente um conjunto de eixo de acionamento alongado que é operacionalmente acoplado ao canal alongado e compreende um membro de fechamento axialmente móvel. O elemento axialmente móvel inclui uma superfície externa e uma superfície de parede interna que é configurada para engatar o canal alongado e a porção de montagem pró- xima para pivotar a bigorna da posição aberta para a posição mais fe- chada durante um curso de fechamento do membro de fechamento axi- almente móvel. O tubo de fechamento do atuador de extremidade inclui adicionalmente uma espessura de parede uniforme entre a superfície de parede externa e a superfície da parede interna. O membro de fecha- mento axialmente móvel é configurado para entrar em contato com pelo menos dois locais de contato distintos sobre a porção de montagem pro- ximal da bigorna. Os pelo menos dois locais de contato discretos são es- paçados um em relação ao outro em cada lado de um plano vertical que bisseciona a porção de montagem proximal da bigorna quando a bigorna está na posição mais fechada.
[0170] Muitos dos sistemas de instrumento cirúrgico no presente documento descritos são acionados por um motor elétrico; entretanto, os sistemas de instrumento cirúrgico no presente documento descritos podem ser induzidos de qualquer maneira adequada. Em vários exem- plos, os sistemas de instrumento cirúrgico no presente documento des- critos podem ser induzidos, por exemplo, por um gatilho manualmente operado. Em certos casos, os motores descritos no presente documento podem compreender uma porção ou porções de um sistema robotica- mente controlado. Além disso, qualquer um dos atuadores de extremi- dade e/ou conjuntos de ferramenta apresentados na presente invenção pode ser utilizado com um sistema de instrumento cirúrgico robótico. O pedido de patente US n° de série 13/118.241, intitulado SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DE- PLOYMENT ARRANGEMENTS, agora patente US n° 9.072.535, por exemplo, revela vários exemplos de um sistema de instrumento cirúr- gico robótico com mais detalhes.
[0171] Os sistemas de instrumento cirúrgico no presente docu- mento 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 vedar 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 atu- ador de extremidade de acordo com certas modalidades, pode aplicar energia vibracional para vedar o tecido.
[0172] A totalidade das descrições de: - patente US n° 5.403.312, intitulada "ELECTROSURGICAL HEMOSTATIC DEVICE", que foi concedida em 4 de abril de 1995; - patente US n° 7.000.818, intitulada "SURGICAL STAPLING
INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS", que foi concedida em 21 de fevereiro de 2006; - patente US n° 7.422.139, intitulada "MOTOR-DRIVEN SUR- GICAL CUTTING AND FASTENING INSTRUMENT WITH TACTILE PO- SITION FEEDBACK", que foi concedida em 9 de setembro de 2008; - patente US n° 7.464.849, intitulada "ELECTRO-MECHANI-
CAL SURGICAL INSTRUMENT WITH CLOSURE SYSTEM AND ANVIL ALIGNMENT COMPONENTS", que foi concedida em 16 de dezembro de 2008; - patente US n° 7.670.334, intitulada "SURGICAL INSTRU- MENT HAVING AN ARTICULATING END EFFECTOR", que foi conce- dida em 2 de março de 2010; - patente US n° 7.753.245, intitulada "SURGICAL STAPLING INSTRUMENTS", que foi concedida em 13 de julho de 2010; - patente US n° 8.393.514, intitulada "SELECTIVELY ORI- ENTABLE IMPLANTABLE FASTENER CARTRIDGE", que foi conce- dida em 12 de março de 2013; - pedido de patente US n° de série 11/343.803, intitulado "SUR- GICAL INSTRUMENT HAVING RECORDING CAPABILITIES"; agora pa- tente US n° 7.845.537; - pedido de patente US n° de série 12/031.573, intitulado "SUR- GICAL CUTTING AND FASTENING INSTRUMENT HAVING RF ELEC- TRODES", depositado em 14 de fevereiro de 2008; - pedido de patente US n° de série 12/031.873, intitulado "END EFFECTORS FOR A SURGICAL CUTTING AND STAPLING INSTRU- MENT", depositado em 15 de fevereiro de 2008, agora patente US n°
7.980.443; - pedido de patente US n° de série 12/235.782, intitulado "MO- TOR-DRIVEN SURGICAL CUTTING INSTRUMENT", agora patente US n° 8.210.411; - pedido de patente US n° de série 12/235.972, intitulado MOTORIZED SURGICAL INSTRUMENT, agora patente US n°
9.050.083; - pedido de patente US n° de série 12/249.117, intitulado "PO- WERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MA- NUALLY RETRACTABLE FIRING SYSTEM", agora patente US n°
8.608.045; - pedido de patente US n° de série 12/647.100, intitulado "MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT WITH ELEC- TRIC ACTUATOR DIRECTIONAL CONTROL ASSEMBLY", depositado em 24 de dezembro de 2009; agora patente US n° 8.220.688; - pedido de patente US n° de série 12/893.461, intitulado "STA- PLE CARTRIDGE", depositado em 29 de setembro de 2012, agora pa- tente US n° 8.733.613; - pedido de patente US n° de série 13/036.647, intitulado "SURGICAL STAPLING INSTRUMENT", depositado em 28 de fevereiro de 2011, agora patente US n° 8.561.870; - pedido de patente US n° de série 13/118.241, intitulado "SUR- GICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DE- PLOYMENT ARRANGEMENTS", agora patente US n° 9.072.535; - pedido de patente US n° de série 13/524.049, intitulado "ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FI- RING DRIVE", depositado em 15 de junho de 2012; agora patente US n° 9.101.358; - pedido de patente US n° de série 13/800.025, intitulado "STA- PLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM", depositado em 13 de março de 2013, agora patente US n° 9.345.481; pedido de patente US n° de série 13/800.067, intitulado "STA- PLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM", depositado em 13 de março de 2013, agora publicação de pedido de patente US n° 2014/0263552; - publicação de pedido de patente US n° 2007/0175955, intitu- lada "SURGICAL CUTTING AND FASTENING INSTRUMENT WITH CLOSURE TRIGGER LOCKING MECHANISM", depositada em 31 de ja- neiro de 2006; e - publicação de pedido de patente US n° 2010/0264194, in- titulada "SURGICAL STAPLING INSTRUMENT WITH AN ARTICULA- TABLE END EFFECTOR", depositada em 22 de abril de 2010, agora patente US n° 8.308.040, estão no presente documento incorporados por referência.
[0173] Embora vários dispositivos tenham sido no presente docu- mento descritos em conexão com determinadas modalidades, modifica- ções e variações dessas modalidades podem ser implementadas. Os recursos, estruturas ou características específicos podem ser combina- dos de qualquer maneira adequada em uma ou mais modalidades. Por- tanto, os recursos, as estruturas ou as características específicos ilus- trados ou descritos em conexão com uma modalidade podem ser com- binados, no todo ou em parte, com os recursos, estruturas ou caracte- rísticas de uma ou mais outras modalidades, sem limitação. Além disso, quando forem descritos materiais para determinados componentes, ou- tros materiais podem ser usados. Além disso, de acordo com várias mo- dalidades, 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 precedentemente e as reivindicações seguin- tes são destinadas a abranger todas essas modificações e variações.
[0174] Os dispositivos no presente documento descritos 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 pelo menos um uso. O recondicionamento pode incluir qualquer combinação das etapas incluindo, mas não se limitando a, a desmonta- gem do dispositivo seguida de limpeza ou substituição de peças espe- cíficas 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 recondici- onamento 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.
[0175] Os dispositivos descritos no presente documento 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 coloca- dos 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 esterili- zado 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 d´água.
[0176] Embora esta invenção tenha sido descrita como tendo de- signs exemplificadores, a presente invenção pode ser adicionalmente modificada dentro do espírito e do escopo da descrição. Pretende-se, portanto, que este pedido cubra quaisquer variações, usos ou adapta- ções da invenção com o uso de seus princípios gerais.
Claims (20)
1. Atuador de extremidade cirúrgico, caracterizado por com- preender: uma primeira garra que compreende uma primeira porção de extremidade proximal de garra e uma primeira porção de extremidade dis- tal de garra; uma segunda garra que compreende uma segunda porção de extremidade distal de garra e uma segunda porção de montagem proximal de garra que é suportada de modo pivotante na dita primeira porção de extremidade proximal de garra de modo que a segunda garra é pivotante em relação à dita primeira garra ao redor de um eixo geométrico de pivô entre uma posição aberta, uma posição fechada e uma posição mais fechada sendo que a dita segunda porção de extre- midade distal de garra está em contato com a dita primeira porção de extremidade distal de garra; e um tubo de fechamento do atuador de extremidade seletiva- mente móvel em direção à segunda porção de montagem proximal de garra durante um curso de fechamento para engate com isso, sendo que o dito tubo de fechamento do atuador de extremidade compreende: uma superfície de parede externa; e uma superfície da parede interna configurada para engatar a dita segunda porção de montagem proximal de garra para mover a dita segunda porção de extremidade distal de garra em direção à dita primeira porção de extremidade distal de garra durante o dito curso de fechamento, sendo que o dito tubo de fechamento do atuador de ex- tremidade compreende uma espessura de parede uniforme entre a dita superfície de parede externa e a dita superfície de parede interna, e sendo que o dito tubo de fechamento do atuador de extremidade está em contato com pelo menos dois locais de transferência de carga dis- cretos na dita segunda porção de montagem de garra situada em cada lado de um plano vertical que bisseciona o dito atuador de extremidade quando a dita segunda garra está na dita posição mais fechada.
2. Atuador de extremidade cirúrgico, de acordo com a reivin- dicação 1, caracterizado por os ditos locais de transferência de carga distintos situados em cada lado do dito plano vertical compreenderem dois pares de locais de transferência de carga distintos, sendo que cada dito par dos locais de transferência de carga distintos compreende: um primeiro local de transferência de carga distinto; e um segundo local da transferência de carga distinto espa- çado em relação ao dito primeiro local de transferência de carga dis- tinto.
3. Atuador de extremidade cirúrgico, de acordo com a rei- vindicação 2, caracterizado por o dito segundo local de transferência de carga distinto ser espaçado em relação ao dito primeiro local de transferência de carga distinto em um lado do plano vertical por uma primeira área atenuada na dita segunda porção de montagem próxima de garra de modo que uma porção correspondente do dito tubo de fe- chamento do atuador de extremidade se estende entre o dito primeiro local de transferência de carga distinto e o dito segundo local de trans- ferência de carga distinto no um lado do plano vertical não está em contato com a dita porção de montagem próxima da dita segunda garra quando a dita segunda garra está na dita posição mais fechada.
4. Atuador de extremidade cirúrgico, de acordo com a reivin- dicação 2, caracterizado por o tubo de fechamento do atuador de extre- midade estar em contato com um terceiro local de transferência de carga distinto situado na segunda garra em cada lado do plano vertical quando a segunda garra está na posição mais fechada.
5. Atuador de extremidade cirúrgico, de acordo com a reivin- dicação 4, caracterizado por o dito terceiro local de transferência de carga distinto ser espaçado em relação ao dito segundo local de trans- ferência de carga em um lado correspondente do plano vertical por uma segunda área atenuada na dita segunda garra, de modo que uma outra porção correspondente do dito tubo de fechamento do atuador de extre- midade se estende entre o dito segundo local de transferência de carga distinto e o dito terceiro local de transferência de carga distinto no um lado correspondente do plano vertical não está em contato com a dita segunda garra quando a dita segunda garra está na dita posição com- pletamente fechada.
6. Atuador de extremidade cirúrgico, de acordo com a reivin- dicação 5, caracterizado por os ditos primeiro e segundo locais de trans- ferência de carga distintos no dito um lado do dito plano vertical estarem situados em um lado de um plano horizontal que bisseciona o atuador de extremidade cirúrgico e o dito terceiro local de transferência de carga distinto no dito um lado do dito plano vertical estar situado em um outro lado do dito plano horizontal.
7. Atuador de extremidade cirúrgico, de acordo com a rei- vindicação 2, caracterizado por cada dito primeiro local de transferên- cia de carga distinto compreender uma primeira borda configurada para estar em contato com o dito tubo de fechamento do atuador de extremidade e em que cada segundo local de transferência de carga distinto compreende uma segunda borda configurada para estar em contato com o dito tubo de fechamento do atuador de extremidade.
8. Atuador de extremidade cirúrgico, de acordo com a reivin- dicação 7, caracterizado por a dita primeira borda compreender um pri- meiro canto axialmente alongado e em que a segunda borda compre- ende um segundo canto axialmente alongado.
9. Atuador de extremidade cirúrgico, de acordo com a reivin- dicação 3, caracterizado por cada dita primeira área atenuada compre- ender uma primeira área recortada na dita segunda garra porção de montagem proximal.
10. Atuador de extremidade cirúrgico, de acordo com a rei- vindicação 5, caracterizado por cada dita segunda área atenuada com- preender uma segunda área recortada na dita porção de montagem pró- xima da dita segunda garras.
11. Instrumento cirúrgico, caracterizado por compreender: um canal alongado configurado para suportar um cartucho de grampos cirúrgicos no mesmo; uma bigorna suportada de modo pivotante no dito canal alon- gado para deslocamento pivotante seletivo entre uma posição aberta e uma posição mais fechada em relação ao dito canal alongado em torno de um eixo geométrico de pivô; um conjunto de eixo de acionamento alongado é operacional- mente acoplado ao dito canal alongado e compreende um membro de fe- chamento axialmente móvel que compreende: uma superfície de parede externa; e uma superfície da parede interna configurada para engatar o dito canal e a dita bigorna para girar a dita bigorna da posição aberta em direção a um cartucho de grampos cirúrgicos no dito canal alongado durante um curso de fechamento do dito membro de fechamento axial- mente móvel, sendo que o dito membro de fechamento axialmente mó- vel compreende uma espessura de parede uniforme entre a dita super- fície de parede externa e a dita superfície da parede interna e sendo que o dito membro de fechamento axialmente móvel é configurado para en- trar em contato com pelo menos dois locais de contato distintos na dita bigorna, sendo os ditos pelo menos dois locais de contato distintos es- paçados um em relação ao outro em cada lado de um plano vertical que bisseciona a dita bigorna quando a dita bigorna está na dita posição mais fechada.
12. Instrumento cirúrgico, de acordo com a reivindicação 11,
caracterizado por os ditos pelo menos dois locais de contato distintos em cada lado do plano vertical compreenderem: um primeiro local de contato distinto; e um segundo local de contato distinto separado do dito pri- meiro local de contato distinto por uma porção recortada da bigorna.
13. Instrumento cirúrgico, de acordo com a reivindicação 13, caracterizado por o dito membro de fechamento axialmente móvel en- trar em contato com um terceiro local de contato distinto na dita bigorna em cada lado do plano vertical quando a dita bigorna está na dita po- sição mais fechada.
14. Instrumento cirúrgico, de acordo com a reivindicação 11, caracterizado por cada um dos ditos dois locais de contato distintos em um lado do dito plano vertical ser espaçado em relação a um terceiro local de contato distinto no um lado correspondente do plano vertical por uma segunda área atenuada na dita bigorna.
15. Instrumento cirúrgico, de acordo com a reivindicação 14, caracterizado por os ditos primeiro e segundo locais de contato distin- tos no dito um lado do dito plano vertical estarem situados em um lado de um plano horizontal que se estende através do dito eixo geométrico de pivô e o dito terceiro local de contato distinto no dito um lado do dito plano vertical estar situado em um outro lado do dito plano horizontal.
16. Instrumento cirúrgico, de acordo com a reivindicação 12, caracterizado por cada dito primeiro local de contato distinto compre- ender uma primeira borda formada na dita bigorna e configurada para contato pelo dito membro de fechamento axialmente móvel e em que cada dito segundo local de contato distinto compreende uma segunda borda formada na dita bigorna e configurada para contato pelo dito membro de fechamento axialmente móvel.
17. Instrumento cirúrgico, de acordo com a reivindicação 16, caracterizado por a dita primeira borda compreender um primeiro canto axialmente alongado e em que a dita segunda borda axialmente alon- gado compreende um segundo canto axialmente alongado.
18. Instrumento cirúrgico, de acordo com a reivindicação 13, caracterizado por a cada dito primeiro local de contato discreto com- preende um primeiro canto formado na dita bigorna e configurado para entrar em contato com o dito membro de fechamento axialmente móvel e sendo que cada dito segundo local de contato descontínuo compre- ende um segundo canto formado na dita bigorna e configurado para entrar em contato com o dito membro de fechamento axialmente móvel e sendo que cada dito terceiro local de contato discreto compreende um terceiro canto formado na dita bigorna e configurado para contato com o membro de fechamento axialmente móvel.
19. Instrumento cirúrgico, de acordo com a reivindicação 18, caracterizado por o dito primeiro canto ser espaçado em relação ao dito segundo canto situado em um mesmo lado do plano vertical por uma primeira área recortada na dita bigorna e sendo que um dentre os ditos segundos cantos é espaçado em relação ao dito terceiro canto situado no dito mesmo lado do plano vertical por uma segunda área recortada na dita bigorna.
20. Instrumento cirúrgico, caracterizado por compreender: um canal alongado configurado para suportar um cartucho de grampos cirúrgicos no mesmo; uma bigorna que compreende: um corpo de bigorna que compreende: uma extremidade distal; uma porção de montagem proximal suportada de modo pi- votante sobre o dito canal alongado para facilitar o deslocamento pivo- tante da dita bigorna em relação ao dito canal alongado entre uma po- sição aberta e uma posição mais fechada; e pelo menos uma porção de bloqueio de tecido situada distal à dita porção de montagem próxima e em que o dito instrumento cirúrgico compreende adicionalmente: um conjunto de eixo de acionamento alongado é operacional- mente acoplado ao dito canal alongado e compreende um membro de fe- chamento axialmente móvel que compreende: uma superfície externa; e uma superfície de parede interna configurada para engatar o dito canal alongado e a dita porção de montagem proximal para girar a dita bigorna da posição aberta para a posição mais fechada durante um curso de fechamento do dito membro de fechamento axialmente móvel, sendo que o dito membro de fechamento axialmente móvel compreende uma espessura de parede uniforme entre a dita superfície externa e a dita superfície de parede interna e sendo que o dito membro de fecha- mento axialmente móvel é configurado para estar em contato com pelo menos dois locais de contato distintos na dita porção de montagem pro- ximal da dita bigorna, sendo que o dito pelo menos dois locais de con- tato distinto é espaçado um em relação ao outro em cada lado de um plano vertical que bisseciona a dita porção de montagem proximal da dita bigorna quando a dita bigorna está na dita posição muito fechada.
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US20070084897A1 (en) | 2003-05-20 | 2007-04-19 | Shelton Frederick E Iv | Articulating surgical stapling instrument incorporating a two-piece e-beam firing mechanism |
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