BR112021003054A2 - ponta de bigorna deformável reforçada para bigorna de grampeador cirúrgico - Google Patents

ponta de bigorna deformável reforçada para bigorna de grampeador cirúrgico Download PDF

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BR112021003054A2
BR112021003054A2 BR112021003054-9A BR112021003054A BR112021003054A2 BR 112021003054 A2 BR112021003054 A2 BR 112021003054A2 BR 112021003054 A BR112021003054 A BR 112021003054A BR 112021003054 A2 BR112021003054 A2 BR 112021003054A2
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anvil
patent application
entitled
staple
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BR112021003054-9A
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Jason L. Harris
Taylor W. Aronhalt
Gregory J. Bakos
Chester O. Baxter Iii
Frederick E. Shelton Iv
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Ethicon Llc
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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
    • 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
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003—Steerable
    • 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
    • A61B2017/00473—Distal part, e.g. tip or head
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00477—Coupling
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831—Material properties
    • A61B2017/00862—Material properties elastic or resilient
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831—Material properties
    • A61B2017/00946—Material properties malleable
    • 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
    • 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
    • A61B17/28—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
    • A61B17/32—Surgical cutting instruments
    • A61B2017/320044—Blunt dissectors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0801—Prevention of accidental cutting or pricking
    • A61B2090/08021—Prevention of accidental cutting or pricking of the patient or his organs

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  • Heart & Thoracic Surgery (AREA)
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Abstract

PONTA DE BIGORNA DEFORMÁVEL REFORÇADA PARA BIGORNA DE GRAMPEADOR CIRÚRGICO. A presente invenção refere-se a uma bigorna para um grampeador cirúrgico. Em várias disposições, a bigorna compreende um corpo de bigorna que é fabricado a partir de um primeiro material e um membro de ponta que é fabricado a partir de um segundo material que difere do primeiro material. O membro de ponta pode compreender uma porção de fixação flexível que é configurada para ser recebida dentro de uma abertura em uma extremidade distal do corpo da bigorna. Um segundo membro de fixação é configurado para engatar de maneira não removível a primeira porção de fixação flexível para propender a primeira porção de fixação flexível no engate de retenção com as porções correspondentes da extremidade distal do corpo da bigorna.

Description

Relatório Descritivo da Patente de Invenção para "PONTA
DE BIGORNA DEFORMÁVEL REFORÇADA PARA BIGORNA DE GRAMPEADOR CIRÚRGICO". ANTECEDENTES
[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.
BREVE DESCRIÇÃO DOS DESENHOS
[0002] Várias características das modalidades aqui descritas, jun- tamente com suas vantagens, podem ser entendidas de acordo com a descrição apresentada a seguir, considerada em conjunto com os de- senhos 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 grampea- mento cirúrgico 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 in-
tercambiável 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 membro 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 inter- cambiável 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 aci- onamento cirúrgico intercambiável, com uma bigorna do mesmo em uma configuração 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 extremidade e da porção do conjunto de eixo de acionamento cirúrgico intercambiável 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 atuador de extremidade e porção de um outro conjunto de eixo de aci- onamento cirúrgico intercambiável, com uma bigorna e um membro de fechamento 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 atuador de extremidade e porção de um outro conjunto de eixo de aci- onamento cirúrgico intercambiável, com uma bigorna e um membro de fechamento da mesma em uma posição fechada;
[0034] a Figura 32 é uma outra vista em elevação lateral do atua- dor de extremidade do conjunto de eixo de acionamento cirúrgico in- tercambiável 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 Figura 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 fechamen- to da Figura 32 com a bigorna na posição mais fechada;
[0037] a Figura 35 é uma vista em elevação lateral de um outro atuador de extremidade e porção de um outro conjunto de eixo de aci- onamento cirúrgico intercambiável, com uma bigorna e um membro de fechamento 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 Figura 35 com a bigorna na posição fechada;
[0039] a Figura 37 é uma outra vista em elevação lateral do atua- dor de extremidade do conjunto de eixo de acionamento cirúrgico in- tercambiável 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 fechamen- to 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 anterior 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 Figu- ra 39;
[0043] a Figura 41 é uma vista em elevação lateral de uma moda- lidade do grampo cirúrgico anterior;
[0044] a Figura 42 é uma vista em elevação lateral de uma outra modalidade do grampo cirúrgico anterior;
[0045] a Figura 43 é uma vista de montagem explodida de uma porção de uma bigorna e de uma disposição de ponta de bigorna;
[0046] a Figura 44 é uma vista em elevação lateral da bigorna e da ponta da bigorna da Figura 43;
[0047] a Figura 45 é uma vista de topo da bigorna e da ponta da bigorna das Figuras 90 e 91;
[0048] a Figura 46 é uma vista de montagem explodida de uma porção de uma outra bigorna e da disposição da ponta da bigorna;
[0049] a Figura 47 é uma vista em perspectiva de fundo de uma porção da bigorna e da disposição da ponta da bigorna da Figura 46;
[0050] a Figura 48 é uma vista em perspectiva de uma porção de outra bigorna com uma disposição de ponta de bigorna mostrada em linha tracejada;
[0051] a Figura 49 é uma outra vista em perspectiva da bigorna da Figura 48 com a disposição da ponta da bigorna moldada à mesma;
[0052] a Figura 50 é uma vista de montagem explodida de uma porção de um conjunto de eixo de acionamento alongado; e
[0053] a Figura 51 é uma vista em perspectiva da bigorna da Figu- ra 50 com a disposição da ponta da bigorna fixada à mesma.
[0054] Caracteres de referência correspondentes indicam partes correspondentes através das várias vistas. Os exemplos aqui descritos ilustram várias modalidades da invenção, em uma forma, e tais exem- plos não devem ser considerados de forma alguma como limitadores do escopo da invenção.
DESCRIÇÃO DETALHADA
[0055] O requerente do presente pedido detém os seguintes pedi- dos de patente US, que foram depositados na mesma data do presen- te pedido e que estão, cada um, aqui incorporados a título de referên- cia em suas respectivas totalidades: - pedido de patente US nº de série , intitulado METHOD FOR FABRICATING SURGICAL STAPLER ANVILS, nº do documento do procurador END8577USNP/180088m; - pedido de patente US nº de série , intitu- lado SURGICAL STAPLER ANVILS WITH STAPLE DIRECTING PROTRUSIONS AND TISSUE STABILITY FEATURES, Nº DO DO- CUMENTO DO PROCURADOR END8579USNP/180089;
7INI7 - pedido de patente US nº de série , intitulado FABRICATING TECHNIQUES FOR SURGICAL STAPLER ANVILS, nº do documento do procurador END8580USNP/180090; - pedido de patente US nº de série , intitulado
SURGICAL STAPLING DEVICES WITH IMPROVED CLOSURE MEMBERS, nº do documento do procurador END8581USNP/180091; - pedido de patente US nº de série , intitulado
SURGICAL STAPLER ANVILS WITH TISSUE STOP FEATURES CONFIGURED TO AVOID TISSUE PINCH, nº do documento do pro- curador END8582USNP/180092; - pedido de patente US nº de série , intitulado METHOD FOR OPERATING A POWERED ARTICULATABLE SUR- GICAL INSTRUMENT, nº do documento do procurador END8583USNP/180093M; - pedido de patente US nº de série , intitulado
SURGICAL INSTRUMENTS WITH PROGRESSIVE JAW CLOSURE ARRANGEMENTS, nº do documento do procurador END8584USNP/180094; - pedido de patente US nº de série , intitulado POWERED SURGICAL INSTRUMENTS WITH CLUTCHING ARRAN-
GEMENTS TO CONVERT LINEAR DRIVE MOTIONS TO ROTARY DRIVE MOTIONS, nº do documento do procurador END8585USNP/180095; - pedido de patente US nº de série intitulado
POWERED ARTICULATABLE SURGICAL INSTRUMENTS WITH
CLUTCHING AND LOCKING ARRANGEMENTS FOR LINKING AN ARTICULATION DRIVE SYSTEM TO A FIRING DRIVE SYSTEM nº do documento do procurador END8586USNP/180096; - pedido de patente US nº de série , intitulado
ARTICULATABLE MOTOR POWERED SURGICAL INSTRUMENTS
WITH DEDICATED ARTICULATION MOTOR ARRANGEMENTS, nº do documento do procurador END8587USNP/180097; - pedido de patente US nº de série , intitulado SWITCHING ARRANGEMENTS FOR MOTOR POWERED ARTICU- LATABLE SURGICAL INSTRUMENTS, nº do documento do procura- dor END8588USNP/180098; e - pedido de patente de desenho industrial US nº de série, intitulado SURGICAL STAPLER ANVILS, nº do documento do procu- rador END8581USDP/180099D.
[0056] 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 tota- lidades: - pedido de patente US nº de série 15/386.185, intitulado
SURGICAL STAPLING INSTRUMENTS AND REPLACEABLE TOOL ASSEMBLIES THEREOF, publicação do pedido de patente US nº 2018-0168642; - pedido de patente US nº de série 15/386.230, intitulado ARTICULATABLE SURGICAL STAPLING INSTRUMENTS, publicação do pedido de patente US nº 2018-0168649; - pedido de patente US nº de série 15/386.221, intitulado LOCKOUT ARRANGEMENTS FOR SURGICAL END EFFECTORS, publicação do pedido de patente US nº 2018-01686; - pedido de patente US nº de série 15/386.209, intitulado SURGICAL END EFFECTORS AND FIRING MEMBERS THEREOF, publicação do pedido de patente US nº 2018-0168645; - pedido de patente US nº de série 15/386.198, intitulado
LOCKOUT ARRANGEMENTS FOR SURGICAL END EFFECTORS AND REPLACEABLE TOOL ASSEMBLIES, publicação do pedido de patente US nº 2018-0168644;
- pedido de patente US nº de série 15/386.240, intitulado
SURGICAL END EFFECTORS AND ADAPTABLE FIRING MEMBERS THEREFOR, publicação do pedido de patente US nº 2018-0168651; - pedido de patente US nº de série 15/385.939, intitulado
STAPLE CARTRIDGES AND ARRANGEMENTS OF STAPLES AND STAPLE CAVITIES THEREIN, publicação do pedido de patente US nº 2018-0168629; - pedido de patente US nº de série 15/385.941, intitulado SSURGICAL TOOL ASSEMBLIES WITH CLUTCHING ARRANGE-
MENTS FOR SHIFTING BETWEEN CLOSURE SYSTEMS WITH
CLOSURE STROKE REDUCTION FEATURES AND ARTICULATION AND FIRING SYSTEMS, publicação do pedido de patente US nº 2018- 0168630; - pedido de patente US nº de série 15/385.943, intitulado SURGICAL STAPLING INSTRUMENTS AND STAPLE-FORMING ANVILS, publicação do pedido de patente US nº 2018-0168631; - pedido de patente US nº de série 15/385.950, intitulado SURGICAL TOOL ASSEMBLIES WITH CLOSURE STROKE REDUC- TION FEATURES, publicação do pedido de patente US nº 2018- 0168635; - pedido de patente US nº de série 15/385.945, intitulado
STAPLE CARTRIDGES AND ARRANGEMENTS OF STAPLES AND STAPLE CAVITIES THEREIN; publicação do pedido de patente US nº 2018-0168632; - pedido de patente US nº de série 15/385.946, intitulado SURGICAL STAPLING INSTRUMENTS AND STAPLE-FORMING ANVILS, publicação do pedido de patente US nº 2018-0168633; - pedido de patente US nº de série 15/385.951, intitulado
SURGICAL INSTRUMENTS WITH JAW OPENING FEATURES FOR INCREASING A JAW OPENING DISTANCE, publicação do pedido de patente US nº 2018-0168636; - pedido de patente US nº de série 15/385.953, intitulado METHODS OF STAPLING TISSUE, publicação do pedido de patente US nº 2018-0168637; - pedido de patente US nº de série 15/385.954, intitulado FIRING MEMBERS WITH NON-PARALLEL JAW ENGAGEMENT FE- ATURES FOR SURGICAL END EFFECTORS, publicação do pedido de patente US nº 2018-0168638; - pedido de patente US nº de série 15/385.955, intitulado
SURGICAL END EFFECTORS WITH EXPANDABLE TISSUE STOP ARRANGEMENTS, publicação do pedido de patente US nº 2018- 0168639; - pedido de patente US nº de série 15/385.948, intitulado SURGICAL STAPLING INSTRUMENTS AND STAPLE-FORMING ANVILS, publicação do pedido de patente US nº 2018-0168584; - pedido de patente US nº de série 15/385.956, intitulado SURGICAL INSTRUMENTS WITH POSITIVE JAW OPENING FEA- TURES, publicação do pedido de patente US nº 2018-0168640; - pedido de patente US nº de série 15/385.958, intitulado
SURGICAL INSTRUMENTS WITH LOCKOUT ARRANGEMENTS
FOR PREVENTING FIRING SYSTEM ACTUATION UNLESS AN UNSPENT STAPLE CARTRIDGE IS PRESENT, publicação do pedido de patente US nº 2018-0168641; - pedido de patente US nº de série 15/385.947, intitulado
STAPLE CARTRIDGES AND ARRANGEMENTS OF STAPLES AND STAPLE CAVITIES THEREIN, publicação do pedido de patente US nº 2018-0168634; - pedido de patente US nº de série 15/385.896, intitulado
METHOD FOR RESETTING A FUSE OF A SURGICAL INSTRUMENT SHAFT, publicação do pedido de patente US nº 2018-0168597;
- pedido de patente US nº de série 15/385.898, intitulado STAPLE-FORMING POCKET ARRANGEMENT TO ACCOMMODATE DIFFERENT TYPES OF STAPLES, publicação do pedido de patente US nº 2018-0168599; - pedido de patente US nº de série 15/385.899, intitulado SURGICAL INSTRUMENT COMPRISING IMPROVED JAW CON- TROL, publicação do pedido de patente US nº 2018-0168600; - pedido de patente US nº de série 15/385.901, intitulado STAPLE CARTRIDGE AND STAPLE CARTRIDGE CHANNEL COM- PRISING WINDOWS DEFINED THEREIN, publicação do pedido de patente US nº 2018-0168602; - pedido de patente US nº de série 15/385.902, intitulado SURGICAL INSTRUMENT COMPRISING A CUTTING MEMBER, pu- blicação do pedido de patente US nº 2018-0168603; - pedido de patente US nº de série 15/385.904, intitulado
STAPLE FIRING MEMBER COMPRISING A MISSING CARTRIDGE AND/OR SPENT CARTRIDGE LOCKOUT, publicação do pedido de patente US nº 2018-0168605; - pedido de patente US nº de série 15/385.905, intitulado FIRING ASSEMBLY COMPRISING A LOCKOUT, publicação do pedi- do de patente US nº 2018-0168606; - pedido de patente US nº de série 15/385.907, intitulado SURGICAL INSTRUMENT SYSTEM COMPRISING AN END EFFEC- TOR LOCKOUT AND A FIRING ASSEMBLY LOCKOUT, publicação do pedido de patente US nº 2018-0168608; - pedido de patente US nº de série 15/385.908, intitulado FIRING ASSEMBLY COMPRISING A FUSE, publicação do pedido de patente US nº 2018-0168609; - pedido de patente US nº de série 15/385.909, intitulado FIRING ASSEMBLY COMPRISING A MULTIPLE FAILED-STATE FU-
SE, publicação do pedido de patente US nº 2018-0168610; - pedido de patente US nº de série 15/385.920, intitulado STAPLE-FORMING POCKET ARRANGEMERNTS, publicação do pedi- do de patente US nº 2018-0168620; - pedido de patente US nº de série 15/385.913, intitulado ANVIL ARRANGEMENTS FOR SURGICAL STAPLER, publicação do pedido de patente US nº 2018-0168614; - pedido de patente US nº de série 15/385.914, intitulado
METHOD OF DEFORMING STAPLES FROM TWO DIFFERENT
TYPES OF STAPLE CARTRIDGES WITH THE SAME SURGICAL STAPLING INSTRUMENT, publicação do pedido de patente nº 2018- 0168615; - pedido de patente US nº de série 15/385.893, intitulado BILATERALLY ASYMMETRIC STAPLE-FORMING POCKET PAIRS, publicação do pedido de patente US nº 2018-0168594; - pedido de patente US nº de série 15/385.929, intitulado
CLOSURE MEMBERS WITH CAM SURFACE ARRANGEMENTS
FOR SURGICAL INSTRUMENTS WITH SEPARATE AND DISTINCT CLOSURE AND FIRING SYSTEMS, publicação do pedido de patente US nº 2018-0168626; - pedido de patente US nº de série 15/385.911, intitulado
SURGICAL STAPLERS WITH INDEPENDENTLY ACTUATABLE CLOSING AND FIRING SYSTEMS, publicação do pedido de patente US nº 2018-0168612; - pedido de patente US nº de série 15/385.927, intitulado SURGICAL STAPLING INSTRUMENTS WITH SMART STAPLE CAR- TRIDGES, publicação do pedido de patente US nº 2018-0168625; - pedido de patente US nº de série 15/385.917, intitulado
STAPLE CARTRIDGE COMPRISING STAPLES WITH DIFFERENT CLAMPING BREADTHS, publicação do pedido de patente US nº
2018-0168617; - pedido de patente US nº de série 15/385.900, intitulado STAPLE-FORMING POCKET ARRANGEMENTS COMPRISING PRI- MARY SIDEWALLS AND POCKET SIDEWALLS, publicação do pedi- do de patente US nº 2018-0168601; - pedido de patente US nº de série 15/385.931, intitulado NO-CARTRIDGE AND SPENT CARTRIDGE LOCKOUT ARRANGE- MENTS FOR SURGICAL STAPLERS, publicação do pedido de paten- te US nº 2018-0168627; - pedido de patente US nº de série 15/385.915, intitulado FIRING MEMBER PIN ANGLE, publicação do pedido de patente US nº 2018-0168616; - pedido de patente US nº de série 15/385.897, intitulado STAPLE-FORMING POCKET ARRANGEMENTS COMPRISING ZO- NED FORMING SURFACE GROOVES, publicação do pedido de pa- tente US nº 2018-0168598; - pedido de patente US nº de série 15/385.922, intitulado
SURGICAL INSTRUMENT WITH MULTIPLE FAILURE RESPONSE MODES, publicação do pedido de patente US nº 2018-0168622; - pedido de patente US nº de série 15/385.924, intitulado SURGICAL INSTRUMENT WITH PRIMARY AND SAFETY PROCES- SORS, publicação do pedido de patente US nº 2018-0168624; - pedido de patente US nº de série 15/385.910, intitulado ANVIL HAVING A KNIFE SLOT WIDTH, publicação do pedido de pa- tente US nº 2018-0168611; - pedido de patente US nº de série 15/385.903, intitulado CLOSURE MEMBER ARRANGEMENTS FOR SURGICAL INSTRU- MENTS, publicação do pedido de patente US nº 2018-0168604; - pedido de patente US nº de série 15/385.906, intitulado FIRING MEMBER PIN CONFIGURATIONS, publicação do pedido de patente US nº 2018-0168607; - pedido de patente US nº de série 15/386.188, intitulado STEPPED STAPLE CARTRIDGE WITH ASYMMETRICAL STAPLES, publicação do pedido de patente US nº 2018-0168585; - pedido de patente US nº de série 15/386.192, intitulado
STEPPED STAPLE CARTRIDGE WITH TISSUE RETENTION AND GAP SETTING FEATURES, publicação do pedido de patente US nº 2018-0168643; - pedido de patente US nº de série 15/386.206, intitulado
STAPLE CARTRIDGE WITH DEFORMABLE DRIVER RETENTION FEATURES, publicação do pedido de patente US nº 2018-0168586; - pedido de patente US nº de série 15/386.226, intitulado DURABILITY FEATURES FOR END EFFECTORS AND FIRING AS- SEMBLIES OF SURGICAL STAPLING INSTRUMENTS, publicação do pedido de patente US nº 2018-0168648; - pedido de patente US nº de série 15/386.222, intitulado
SURGICAL STAPLING INSTRUMENTS HAVING END EFFECTORS WITH POSITIVE OPENING FEATURES, publicação do pedido de pa- tente US nº 2018-0168647; - pedido de patente US nº de série 15/386.236, intitulado
CONNECTION PORTIONS FOR DEPOSABLE LOADING UNITS FOR SURGICAL STAPLING INSTRUMENTS, publicação do pedido de pa- tente US nº 2018-0168650; - pedido de patente US nº de série 15/385.887, intitulado
METHOD FOR ATTACHING A SHAFT ASSEMBLY TO A SURGICAL INSTRUMENT AND, ALTERNATIVELY, TO A SURGICAL ROBOT, publicação do pedido de patente US nº 2018-0168589; - pedido de patente US nº 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 nº 2018-0168590; - pedido de patente US nº de série 15/385.890, intitulado
SHAFT ASSEMBLY COMPRISING SEPARATELY ACTUATABLE AND RETRACTABLE SYSTEMS, publicação do pedido de patente US nº 2018-0168591; - pedido de patente US nº de série 15/385.891, intitulado
SHAFT ASSEMBLY COMPRISING A CLUTCH CONFIGURED TO
ADAPT THE OUTPUT OF A ROTARY FIRING MEMBER TO TWO DIFFERENT SYSTEMS, publicação do pedido de patente US nº 2018- 0168592; - pedido de patente US nº de série 15/385.892, intitulado SURGICAL SYSTEM COMPRISING A FIRING MEMBER ROTATA-
BLE INTO AN ARTICULATION STATE TO ARTICULATE AN END EFFECTOR OF THE SURGICAL SYSTEM, publicação do pedido de patente US nº 2018-0168593; - pedido de patente US nº de série 15/385.894, intitulado SHAFT ASSEMBLY COMPRISING A LOCKOUT, publicação do pedi- do de patente US nº 2018-0168595; - pedido de patente US nº de série 15/385.895, intitulado SHAFT ASSEMBLY COMPRISING FIRST AND SECOND ARTICULA- TION LOCKOUTS, publicação do pedido de patente US nº 2018- 0168596; - pedido de patente US nº de série 15/385.916, intitulado SURGICAL STAPLING SYSTEMS, publicação do pedido de patente US nº 2018-0168575; - pedido de patente US nº de série 15/385.918, intitulado SURGICAL STAPLING SYSTEMS, publicação do pedido de patente US nº 2018-0168618; - pedido de patente US nº de série 15/385.919, intitulado
SURGICAL STAPLING SYSTEMS, publicação do pedido de patente US nº 2018-0168619; - pedido de patente US nº de série 15/385.921, intitulado
SURGICAL STAPLE CARTRIDGE WITH MOVABLE CAMMING MEMBER CONFIGURED TO DISENGAGE FIRING MEMBER LOCK- OUT FEATURES, publicação do pedido de patente US nº 2018- 0168621; - pedido de patente US nº de série 15/385.923, intitulado SURGICAL STAPLING SYSTEMS, publicação do pedido de patente US nº 2018-0168623; - pedido de patente US nº de série 15/385.925, intitulado JAW ACTUATED LOCK ARRANGEMENTS FOR PREVENTING AD- VANCEMENT OF A FIRING MEMBER IN A SURGICAL END EFFEC-
TOR UNLESS AN UNFIRED CARTRIDGE IS INSTALLED IN THE END EFFECTOR, publicação do pedido de patente US nº 2018- 0168576; - pedido de patente US nº de série 15/385.926, intitulado
AXIALLY MOVABLE CLOSURE SYSTEM ARRANGEMENTS FOR APPLYING CLOSURE MOTIONS TO JAWS OF SURGICAL INS- TRUMENTS, publicação do pedido de patente US nº 2018-0168577; - pedido de patente US nº de série 15/385.928, intitulado
PROTECTIVE COVER ARRANGEMENTS FOR A JOINT INTERFACE BETWEEN A MOVABLE JAW AND ACTUATOR SHAFT OF A SUR- GICAL INSTRUMENT, publicação do pedido de patente US nº 2018- 0168578; - pedido de patente US nº de série 15/385.930, intitulado SURGICAL END EFFECTOR WITH TWO SEPARATE COOPERA-
TING OPENING FEATURES FOR OPENING AND CLOSING END EFFECTOR JAWS, publicação do pedido de patente US 2018- 0168579;
- pedido de patente US nº de série 15/385.932, intitulado
ARTICULATABLE SURGICAL END EFFECTOR WITH ASYMMETRIC SHAFT ARRANGEMENT, publicação do pedido de patente US nº 2018-0168628; - pedido de patente US nº de série 15/385.933, intitulado
ARTICULATABLE SURGICAL INSTRUMENT WITH INDEPENDENT PIVOTABLE LINKAGE DISTAL OF AN ARTICULATION LOCK, publi- cação do pedido de patente US nº 2018-0168580; - pedido de patente US nº de série 15/385.934, intitulado
ARTICULATION LOCK ARRANGEMENTS FOR LOCKING AN END
EFFECTOR IN AN ARTICULATED POSITION IN RESPONSE TO ACTUATION OF A JAW CLOSURE SYSTEM, publicação do pedido de patente US nº 2018-0168581; - pedido de patente US nº de série 15/385.935, intitulado LATERALLY ACTUATABLE ARTICULATION LOCK ARRANGE- MENTS FOR LOCKING AN END EFFECTOR OF A SURGICAL INS- TRUMENT IN AN ARTICULATED CONFIGURATION, publicação do pedido de patente US nº 2018-0168582; - pedido de patente US nº de série 15/385.936, intitulado
ARTICULATABLE SURGICAL INSTRUMENTS WITH ARTICULATION STROKE AMPLIFICATION FEATURES, publicação do pedido de pa- tente US nº 2018-0168583; - pedido de patente US nº de série 14/318.996, intitulado FASTENER CARTRIDGES INCLUDING EXTENSIONS HAVING DIF- FERENT CONFIGURATIONS, publicação do pedido de patente US nº 2015-0297228; - pedido de patente US nº de série 14/319.006, intitulado FASTENER CARTRIDGE COMPRISING FASTENER CAVITIES IN- CLUDING FASTENER CONTROL FEATURES, agora patente US nº
10.010.324;
- pedido de patente US nº de série 14/318.991, intitulado
SURGICAL FASTENER CARTRIDGES WITH DRIVER STABILIZING ARRANGEMERNTS, agora patente US nº 9.833.241; - pedido de patente US nº de série 14/319.004, intitulado SURGICAL END EFFECTORS WITH FIRING ELEMENT MONITO- RING ARRANGEMENTS, agora patente US nº 9.844.369; - pedido de patente US nº de série 14/319.008, intitulado FASTENER CARTRIDGE COMPRISING NON-UNIFORM FASTE- NERS, agora publicação do pedido de patente US nº 2015-0297232; - pedido de patente US nº de série 14/318.997, intitulado FASTENER CARTRIDGE COMPRISING DEPLOYABLE TISSUE EN- GAGING MEMBERS, publicação do pedido de patente US nº 2015- 0297229; - pedido de patente US nº de série 14/319.002, intitulado FASTENER CARTRIDGE COMPRISING TISSUE CONTROL FEATU- RES, agora patente US nº 9.877.721; - pedido de patente US nº de série 14/319.013, intitulado
FASTENER CARTRIDGE ASSEMBLIES AND STAPLE RETAINER COVER ARRANGEMENTS, publicação do pedido de patente US nº 2015-0297233; e - pedido de patente US nº de série 14/319.016, intitulado FASTENER CARTRIDGE INCLUDING A LAYER ATTACHED THE- RETO, publicação do pedido de patente US nº 2015-0297235.
[0057] 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, aqui incorporados por referência em suas respec- tivas totalidades: - pedido de patente US nº de série 15/191.775, intitulado STAPLE CARTRIDGE COMPRISING WIRE STAPLES AND STAM- PED STAPLES;
- pedido de patente US nº de série 15/191.807, intitulado STAPLING SYSTEM FOR USE WITH WIRE STAPLES AND STAM- PED STAPLES; - pedido de patente US nº de série 15/191.834, intitulado "STAMPED STAPLES AND STAPLE CARTRIDGES USING THE SA- ME"; - pedido de patente US nº de série 15/191.788, intitulado STAPLE CARTRIDGE COMPRISING OVERDRIVEN STAPLES; e - pedido de patente US nº de série 15/191.818, intitulado STAPLE CARTRIDGE COMPRISING OFFSET LONGITUDINAL STA- PLE ROWS.
[0058] 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, aqui incorporados por referência em suas respec- tivas totalidades: - pedido de patente de desenho industrial US nº de série 29/569.218, intitulado SURGICAL FASTENER; - pedido de patente de desenho industrial US nº de série 29/569.227, intitulado SURGICAL FASTENER; - pedido de patente de desenho industrial US nº de série 29/569.259, intitulado "SURGICAL FASTENER CARTRIDGE"; e - pedido de patente de desenho industrial US nº de série 29/569.264, intitulado "SURGICAL FASTENER CARTRIDGE".
[0059] O requerente do presente pedido detém os seguintes pedi- dos de patente que foram depositados em 1 de abril de 2016 e que estão, cada um, aqui incorporados por referência em suas respectivas totalidades: - pedido de patente US nº de série 15/089.325, intitulado METHOD FOR OPERATING A SURGICAL STAPLING SYSTEM; - pedido de patente US nº de série 15/089.321, intitulado
MODULAR SURGICAL STAPLING SYSTEM COMPRISING A DIS- PLAY; - pedido de patente US nº de série 15/089.326, intitulado SURGICAL STAPLING SYSTEM COMPRISING A DISPLAY INCLU- DING A RE-ORIENTABLE DISPLAY FIELD; - pedido de patente US nº de série 15/089.263, intitulado SURGICAL INSTRUMENT HANDLE ASSEMBLY WITH RECONFI- GURABLE GRIP PORTION; - pedido de patente US nº de série 15/089.262, intitulado
ROTARY POWERED SURGICAL INSTRUMENT WITH MANUALLY ACTUATABLE BAILOUT SYSTEM; - pedido de patente US nº de série 15/089.277, intitulado
SURGICAL CUTTING AND STAPLING END EFFECTOR WITH ANVIL CONCENTRIC DRIVE MEMBER; - pedido de patente US nº de série 15/089.296, intitulado INTERCHANGEABLE SURGICAL TOOL ASSEMBLY WITH A SUR-
GICAL END EFFECTOR THAT IS SELECTIVELY ROTATABLE ABOUT A SHAFT AXIS; - pedido de patente US nº de série 15/089.258, intitulado
SURGICAL STAPLING SYSTEM COMPRISING A SHIFTABLE TRANSMISSION; - pedido de patente US nº de série 15/089.278, intitulado SURGICAL STAPLING SYSTEM CONFIGURED TO PROVIDE SE- LECTIVE CUTTING OF TISSUE; - pedido de patente US nº de série 15/089.284, intitulado
SURGICAL STAPLING SYSTEM COMPRISING A CONTOURABLE SHAFT; - pedido de patente US nº de série 15/089.295, intitulado SURGICAL STAPLING SYSTEM COMPRISING A TISSUE COM- PRESSION LOCKOUT;
- pedido de patente US nº de série 15/089.300, intitulado
SURGICAL STAPLING SYSTEM COMPRISING AN UNCLAMPING LOCKOUT; - pedido de patente US nº de série 15/089.196, intitulado
SURGICAL STAPLING SYSTEM COMPRISING A JAW CLOSURE LOCKOUT; - pedido de patente US nº de série 15/089.203, intitulado SURGICAL STAPLING SYSTEM COMPRISING A JAW ATTACH- MENT LOCKOUT; - pedido de patente US nº de série 15/089.210, intitulado SURGICAL STAPLING SYSTEM COMPRISING A SPENT CARTRID- GE LOCKOUT; - pedido de patente US nº de série 15/089.324, intitulado SURGICAL INSTRUMENT COMPRISING A SHIFTING MECHANISM; - pedido de patente US nº de série 15/089.335, intitulado
SURGICAL STAPLING INSTRUMENT COMPRISING MULTIPLE LOCKOUTS; - pedido de patente US nº de série 15/089.339, intitulado SURGICAL STAPLING INSTRUMENT; - pedido de patente US nº de série 15/089.253, intitulado SURGICAL STAPLING SYSTEM CONFIGURED TO APPLY ANNU- LAR ROWS OF STAPLES HAVING DIFFERENT HEIGHTS; - pedido de patente US nº de série 15/089.304, intitulado SURGICAL STAPLING SYSTEM COMPRISING A GROOVED FOR- MING POCKET; - pedido de patente US nº de série 15/089.331, intitulado ANVIL MODIFICATION MEMBERS FOR SURGICAL STAPLERS; - pedido de patente US nº de série 15/089.336, intitulado STAPLE CARTRIDGES WITH ATRAUMATIC FEATURES; - pedido de patente US nº de série 15/089.312, intitulado
CIRCULAR STAPLING SYSTEM COMPRISING AN INCISABLE TIS- SUE SUPPORT; - pedido de patente US nº de série 15/089.309, intitulado
CIRCULAR STAPLING SYSTEM COMPRISING ROTARY FIRING SYSTEM; e - pedido de patente US nº de série 15/089.349, intitulado CIRCULAR STAPLING SYSTEM COMPRISING LOAD CONTROL.
[0060] O requerente do presente pedido detém também os pedi- dos de patente US identificados abaixo, que foram depositados em 31 de dezembro de 2015, os quais estão, cada um, aqui incorporados a título de referência em suas respectivas totalidades: - pedido de patente US nº de série 14/984.488, intitulado "MECHANISMS FOR COMPENSATING FOR BATTERY PACK FAlI- LURE IN POWERED SURGICAL INSTRUMENTS"; - pedido de patente US nº de série 14/984.525, intitulado
MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS; e - pedido de patente US nº de série 14/984.552, intitulado "SURGICAL INSTRUMENTS WITH SEPARABLE MOTORS AND MO- TOR CONTROL CIRCUITS".
[0061] O requerente do presente pedido detém também os pedi- dos de patente US identificados abaixo, os quais foram depositados em 9 de fevereiro de 2016, os quais estão, cada um, aqui incorporados por referência em suas respectivas totalidades: - pedido de patente US nº de série 15/019.220, intitulado "SURGICAL INSTRUMENT WITH ARTICULATING AND AXIALLY TRANSLATABLE END EFFECTOR"; - pedido de patente US nº de série 15/019.228, intitulado "SURGICAL INSTRUMENTS WITH MULTIPLE LINK ARTICULATION ARRANGEMENTS";
- pedido de patente US nº de série 15/019.196, intitulado "SURGICAL INSTRUMENT ARTICULATION MECHANISM WITH SLOTTED SECONDARY CONSTRAINT"; - pedido de patente US nº 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 nº de série 15/019.215, intitulado "SURGICAL INSTRUMENTS WITH NON-SYMMETRICAL ARTICU- LATION ARRANGEMENTS"; - pedido de patente US nº de série 15/019.227, intitulado "ARTICULATABLE SURGICAL INSTRUMENTS WITH SINGLE ARTI- CULATION LINK ARRANGEMENTS"; - pedido de patente US nº de série 15/019.235, intitulado "SURGICAL INSTRUMENTS WITH TENSIONING ARRANGEMENTS FOR CABLE DRIVEN ARTICULATION SYSTEMS"; - pedido de patente US nº de série 15/019.230, intitulado "ARTICULATABLE SURGICAL INSTRUMENTS WITH OFF-AXIS Fl- RING BEAM ARRANGEMENTS"; e - pedido de patente US nº de série 15/019.245, intitulado "SURGICAL INSTRUMENTS WITH CLOSURE STROKE REDUCTION ARRANGEMENTS".
[0062] O requerente do presente pedido detém também os pedi- dos de patente US identificados abaixo, os quais foram depositados em 12 de fevereiro de 2016, os quais estão, cada um, aqui incorpora- dos por referência em suas respectivas totalidades: - pedido de patente US nº de série 15/043.254, intitulado
MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS; - pedido de patente US nº de série 15/043.259, intitulado
MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS; - pedido de patente US nº de série 15/043.275, intitulado
MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS; e - pedido de patente US nº de série 15/043.289, intitulado "MECHANISMS FOR COMPENSATING FOR DRIVETRAIN FAILURE IN POWERED SURGICAL INSTRUMENTS".
[0063] 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, aqui incorporados por referência em suas respectivas totalidades: - pedido de patente US nº de série 14/742.925, intitulado "SURGICAL END EFFECTORS WITH POSITIVE JAW OPENING AR- RANGEMENTS"; - pedido de patente US nº de série 14/742.941, intitulado "SURGICAL END EFFECTORS WITH DUAL CAM ACTUATED JAW CLOSING FEATURES"; - pedido de patente US nº de série 14/742.914, intitulado "MOVABLE FIRING BEAM SUPPORT ARRANGEMENTS FOR ARTI- CULATABLE SURGICAL INSTRUMENTS"; - pedido de patente US nº de série14/742.900, intitulado
ARTICULATABLE SURGICAL INSTRUMENTS WITH COMPOSITE
FIRING BEAM STRUCTURES WITH CENTER FIRING SUPPORT MEMBER FOR ARTICULATION SUPPORT; - pedido de patente US nº de série 14/742.885, intitulado "DUAL ARTICULATION DRIVE SYSTEM ARRANGEMENTS FOR ARTICULATABLE SURGICAL INSTRUMENTS"; e - pedido de patente US nº de série 14/742.876, intitulado "PUSH/PULL ARTICULATION DRIVE SYSTEMS FOR ARTICULATA-
BLE SURGICAL INSTRUMENTS".
[0064] 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, aqui incorporados por referência em suas respectivas totalidades: - Pedido de patente US nº de série 14/640.746, intitulado "POWERED SURGICAL STAPLER", agora publicação de pedido de patente US nº 2016/0256184; - pedido de patente US nº de série 14/640.795, intitulado
MULTIPLE LEVEL THRESHOLDS TO MODIFY OPERATION OF POWERED SURGICAL INSTRUMENTS, agora publicação de pedido de patente US nº 2016/02561185; - pedido de patente US nº de série 14/640.832, intitulado
ADAPTIVE TISSUE COMPRESSION TECHNIQUES TO ADJUST CLOSURE RATES FOR MULTIPLE TISSUE TYPES, agora publica- ção de pedido de patente US nº 2016/0256154; - pedido de patente US nº 14/640.935, intitulado OVERLAID MULTI SENSOR RADIO FREQUENCY (RF) ELECTRODE SYSTEM TO MEASURE TISSUE COMPRESSION, agora publicação de pedido de patente US nº 2016/0256071; - pedido de patente US nº de série 14/640.831, intitulado
MONITORING SPEED CONTROL AND PRECISION INCREMENTING OF MOTOR FOR POWERED SURGICAL INSTRUMENTS, agora pu- blicação de pedido de patente US nº 2016/0256153; - pedido de patente US nº de série 14/640.859, intitulado TIME DEPENDENT EVALUATION OF SENSOR DATA TO DETER- MINE STABILITY, CREEP, AND VISCOELASTIC ELEMENTS OF MEASURES, agora publicação de pedido de patente US nº 2016/0256187; - pedido de patente US nº de série 14/640.817, intitulado
INTERACTIVE FEEDBACK SYSTEM FOR POWERED SURGICAL INSTRUMENTS, agora publicação de pedido de patente US nº 2016/0256186; - pedido de patente US nº 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 nº 2016/ 0256155; - pedido de patente US nº de série 14/640.837, intitulado SMART SENSORS WITH LOCAL SIGNAL PROCESSING, agora, pu- blicação de pedido de patente US nº 2016/0256163; - pedido de patente nº de série US 14/640.765, intitulado SYSTEM FOR DETECTING THE MIS-INSERTION OF A STAPLE CARTRIDGE INTO A SURGICAL STAPLER, agora publicação de pe- dido de patente US nº 2016/0256160; - pedido de patente US nº 14/640.799, intitulado SIGNAL AND POWER COMMUNICATION SYSTEM POSITIONED ON A RO- TATABLE SHAFT, agora publicação de pedido de patente US nº 2016/0256162; e - pedido de patente US nº de série 14/640.780, intitulado
SURGICAL INSTRUMENT COMPRISING A LOCKABLE BATTERY HOUSING, agora publicação de pedido de patente US nº 2016/
0256161.
[0065] 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, aqui incorporados por referência em suas respec- tivas totalidades: - pedido de patente nº de série US 14/633.576, intitulado
SURGICAL INSTRUMENT SYSTEM COMPRISING AN INSPECTION STATION, agora publicação de pedido de patente US nº 2016/
0249919;
- pedido de patente US nº de série 14/633.546, intitulado "SURGICAL APPARATUS CONFIGURED TO ASSESS WHETHER A PERFORMANCE PARAMETER OF THE SURGICAL APPARATUS |IS WITHIN AN ACCEPTABLE PERFORMANCE BAND, agora publicação de pedido de patente US nº 2016/0249915;
- pedido de patente nº de série US 14/633.560, intitulado SURGICAL CHARGING SYSTEM THAT CHARGES AND/OR CONDI- TIONS ONE OR MORE BATTERIES, agora publicação de pedido de patente US nº 2016/0249910;
- pedido de patente US nº de série 14/633.566, intitulado CHARGING SYSTEM THAT ENABLES EMERGENCY RESOLUTI- ONS FOR CHARGING A BATTERY, agora publicação de pedido de patente US nº 2016/0249918;
- pedido de patente US nº de série 14/633.555, intitulado SYSTEM FOR MONITORING WHETHER A SURGICAL INSTRU- MENT NEEDS TO BE SERVICED, agora publicação de pedido de pa- tente US nº 2016/0249916;
- patente US nº de série 14/633.542, intitulado REINFOR- CED BATTERY FOR A SURGICAL INSTRUMENT, agora publicação de pedido de patente US nº 2016/0249908;
- pedido de patente US nº de série 14/633.548, intitulado POWER ADAPTER FOR A SURGICAL INSTRUMENT, agora publica- ção de pedido de patente US nº 2016/0249909;
- pedido de patente US nº de série 14/633.526, intitulado ADAPTABLE SURGICAL INSTRUMENT HANDLE, agora publicação de pedido de patente US nº 2016/0249945;
- pedido de patente US nº de série 14/633.541, intitulado MODULAR STAPLING ASSEMBLY, agora publicação de pedido de patente US nº 2016/0249927; e
- pedido de patente US nº de série 14/633.562, intitulado SURGICAL APPARATUS CONFIGURED TO TRACK AN END-OF- LIFE PARAMETER, agora publicação de pedido de patente US nº 2016/0249917.
[0066] 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, aqui incorporados por referência em suas respec- tivas totalidades: - pedido de patente US nº de série 14/574.478, intitulado SURGICAL INSTRUMENT SYSTEMS COMPRISING AN ARTICULA- TABLE END EFFECTOR AND MEANS FOR ADJUSTING THE FI- RING STROKE OF A FIRING MEMBER, agora publicação de pedido de patente US nº 2016/0174977; - pedido de patente US nº de série 14/574.483, intitulado
SURGICAL INSTRUMENT ASSEMBLY COMPRISING LOCKABLE SYSTEMS, agora publicação de pedido de patente US nº 2016/ 0174969; - pedido de patente US nº de série 14/575.139, intitulado DRIVE ARRANGEMENTS FOR ARTICULATABLE SURGICAL INS- TRUMENTS, agora, publicação de pedido de patente US nº 2016/ 0174978; - pedido de patente US nº 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 nº 2016/0174976; - pedido de patente US nº de série 14/575.130, intitulado
SURGICAL INSTRUMENT WITH AN ANVIL THAT IS SELECTIVELY MOVABLE ABOUT A DISCRETE NON-MOVABLE AXIS RELATIVE TO A STAPLE CARTRIDGE, agora publicação de pedido de patente US nº 2016/0174972;
- pedido de patente US nº de série 14/575.143, intitulado SURGICAL INSTRUMENTS WITH IMPROVED CLOSURE ARRAN- GEMENTS, agora, publicação de pedido de patente US nº 2016/ 0174983; - pedido de patente US nº de série 14/575.117, intitulado SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFEC- TORS AND MOVABLE FIRING BEAM SUPPORT ARRANGEMENTS, agora publicação de pedido de patente US nº 2016/0174975; - pedido de patente US nº de série 14/575.154, intitulado SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFEC- TORS AND IMPROVED FIRING BEAM SUPPORT ARRANGE- MENTS, agora publicação de pedido de patente US nº 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 nº 2016/0174970; e - pedido de patente US nº de série 14/574.500, intitulado
SURGICAL INSTRUMENT ASSEMBLY COMPRISING A LOCKABLE ARTICULATION SYSTEM, agora, publicação de pedido de patente US nº 2016/0174971.
[0067] 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, aqui incorporados por referência em suas respectivas totalidades: - pedido de patente US nº de série 13/782.295, intitulado "ARTICULATABLE SURGICAL INSTRUMENTS WITH CONDUCTIVE PATHWAYS FOR SIGNAL COMMUNICATION", agora publicação de pedido de patente US nº 2014/0246471; - pedido de patente US nº de série 13/782.323, intitulado "ROTARY POWERED ARTICULATION JOINTS FOR SURGICAL
INSTRUMENTS", agora publicação de pedido de patente US nº 2014/024647?2; - pedido de patente US nº de série 13/782.338, intitulado "THUMBWHEEL SWITCH ARRANGEMENTS FOR SURGICAL INS- TRUMENTS", agora publicação de pedido de patente US nº 2014/0249557; - pedido de patente US nº de série 13/782.499, intitulado
ELECTROMECHANICAL SURGICAL DEVICE WITH SIGNAL RELAY ARRANGEMERNT, agora patente US nº 9.358.003; - pedido de patente US nº de série 13/782.460, intitulado "MULTIPLE PROCESSOR MOTOR CONTROL FOR MODULAR SURGICAL INSTRUMENTS", agora publicação de pedido de patente US nº 2014/0246478; - pedido de patente US nº de série 13/782.358, intitulado JOYSTICK SWITCH ASSEMBLIES FOR SURGICAL INSTRUMENTS, agora patente US nº 9.326.767; - pedido de patente US nº de série 13/782.481, intitulado
SENSOR STRAIGHTENED END EFFECTOR DURING REMOVAL THROUGH TROCAR, agora patente US nº 9.468.438; - pedido de patente US nº de série 13/782.518, intitulado "CONTROL METHODS FOR SURGICAL INSTRUMENTS WITH RE- MOVABLE IMPLEMENT PORTIONS", agora publicação de pedido de patente US nº 2014/0246475; - pedido de patente US nº de série 13/782.375, intitulado
ROTARY POWERED SURGICAL INSTRUMENTS WITH MULTIPLE DEGREES OF FREEDOM, agora patente US nº 9.398.911; e - pedido de patente US nº de série 13/782.536, intitulado SURGICAL INSTRUMENT SOFT STOP, agora patente US nº
9.307.986.
[0068] 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, aqui incorporados por referência em suas respectivas totalidades:
- pedido de patente US nº de série 13/803.097, intitulado "ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A Fl- RING DRIVE", agora publicação de pedido de patente US nº 2014/0263542;
- pedido de patente US nº de série 13/803.193, intitulado CONTROL ARRANGEMENTS FOR A DRIVE MEMBER OF A SUR- GICAL INSTRUMENT, agora patente nº 9.332.987;
- pedido de patente US nº de série 13/803.053, intitulado "INTERCHANGEABLE SHAFT ASSEMBLIES FOR USE WITH A SURGICAL INSTRUMENT”", agora, publicação de pedido de patente US nº 2014/0263564;
- pedido de patente US nº de série 13/803.086, intitulado "ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN AR- TICULATION LOCK", agora publicação de pedido de patente US nº 2014/0263541;
- pedido de patente US nº de série 13/803.210, intitulado "SENSOR ARRANGEMENTS FOR ABSOLUTE POSITIONING SYS- TEM FOR SURGICAL INSTRUMENTS", agora publicação de pedido de patente US nº 2014/0263538;
- pedido de patente US nº de série 13/803.148, intitulado "MULTI-FUNCTION MOTOR FOR A SURGICAL INSTRUMENT", ago- ra publicação de pedido de patente US nº 2014/0263554;
- pedido de patente US nº de série 13/803.066, intitulado "DRIVE SYSTEM LOCKOUT ARRANGEMENTS FOR MODULAR SURGICAL INSTRUMENTS", agora publicação de pedido de patente US nº 2014/0263565;
- pedido de patente US nº de série 13/803.117, intitulado
ROBOTICALLY-CONTROLLED CABLE-BASED SURGICAL END EF- FECTORS, agora patente US nº 9.351.726; - pedido de patente US 13/803.130, intitulado DRIVE
TRAIN CONTROL ARRANGEMENTS FOR MODULAR SURGICAL INSTRUMENTS, agora patente US nº 9.351.727; e - pedido de patente US nº de série 13/803.159, intitulado "METHOD AND SYSTEM FOR OPERATING A SURGICAL INSTRU- MENT", agora publicação de pedido de patente US nº 2014/0277017.
[0069] O requerente do presente pedido também detém o seguinte pedido de patente que foi depositado em 7 de março de 2014 e está aqui incorporado por referência em sua totalidade: - pedido de patente US nº de série 14/200.111, intitulado "CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS", agora pu- blicação de pedido de patente US nº 2014/0263539.
[0070] 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, aqui incorporados por referência em suas respectivas totalidades: - pedido de patente US nº de série 14/226.106, intitulado "POWER MANAGEMENT CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS", agora publicação de pedido de patente US nº 2015/0272582; - pedido de patente US nº de série 14/226.099, intitulado "STERILIZATION VERIFICATION CIRCUIT", agora publicação de pe- dido de patente US nº 2015/0272581; - pedido de patente US nº de série 14/226.094, intitulado VERIFICATION OF NUMBER OF BATTERY EXCHANGES/PROCE- DURE COUNT, agora publicação de pedido de patente US nº 2015/ 0272580; - pedido de patente US nº de série 14/226.117, intitulado
"POWER MANAGEMENT THROUGH SLEEP OPTIONS OF SEG- MENTED CIRCUIT AND WAKE UP CONTROL", agora publicação de pedido de patente US nº 2015/0272574;
- pedido de patente US nº de série 14/226.075, intitulado "MODULAR POWERED SURGICAL INSTRUMENT WITH DETACHA- BLE SHAFT ASSEMBLIES", agora, publicação de pedido de patente US nº 2015/0272579;
- pedido de patente US nº de série 14/226.093, intitulado "FEEDBACK ALGORITHMS FOR MANUAL BAILOUT SYSTEMS FOR SURGICAL INSTRUMENTS", agora publicação de pedido de patente US nº 2015/0272569;
- pedido de patente US nº de série 14/226.116, intitulado "SURGICAL INSTRUMENT UTILIZING SENSOR ADAPTATION", ago- ra publicação de pedido de patente US nº 2015/0272571;
- pedido de patente US nº de série 14/226.071, intitulado "SURGICAL INSTRUMENT CONTROL CIRCUIT HAVING A SAFETY PROCESSOR", agora publicação de pedido de patente US nº 2015/0272578;
- pedido de patente US nº de série 14/226.097, intitulado "SURGICAL INSTRUMENT COMPRISING INTERACTIVE SYSTEMS", agora publicação de pedido de patente US nº 2015/0272570;
- pedido de patente US nº de série 14/226.126, intitulado "INTERFACE SYSTEMS FOR USE WITH SURGICAL INSTRU- MENTS", agora publicação de pedido de patente US nº 2015/0272572;
- pedido de patente US nº de série 14/226.133, intitulado "MODULAR SURGICAL INSTRUMENT SYSTEM", agora publicação de pedido de patente US nº 2015/0272557;
- pedido de patente US nº de série 14/226.081, intitulado "SYSTEMS AND METHODS FOR CONTROLLING A SEGMENTED CIRCUIT", agora publicação de pedido de patente US nº 2015/
0277471; - pedido de patente US nº de série 14/226.076, intitulado "POWER MANAGEMENT THROUGH SEGMENTED CIRCUIT AND VARIABLE VOLTAGE PROTECTION", agora publicação de pedido de patente US nº 2015/0280424; - pedido de patente US nº de série 14/226.111, intitulado "SURGICAL STAPLING INSTRUMENT SYSTEM", agora publicação de pedido de patente US nº 2015/0272583; e - pedido de patente US nº de série 14/226.125, intitulado "SURGICAL INSTRUMENT COMPRISING A ROTATABLE SHAFT", agora publicação de pedido de patente US nº 2015/0280384.
[0071] 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, aqui incorporados por referência em suas respectivas totalidades: - pedido de patente US nº de série 14/479.103, intitulado "CIRCUITRY AND SENSORS FOR POWERED MEDICAL DEVICE", agora, publicação de pedido de patente US nº 2016/0066912; - pedido de patente US nº de série 14/479.119, intitulado "ADJUNCT WITH INTEGRATED SENSORS TO QUANTIFY TISSUE COMPRESSION", agora, publicação de pedido de patente US nº 2016/0066914; - pedido de patente US nº de série 14/478.908, intitulado "MONITORING DEVICE DEGRADATION BASED ON COMPONENT EVALUATION", agora, publicação de pedido de patente US nº 2016/0066910; - pedido de patente US nº de série 14/478.895, intitulado "MULTIPLE SENSORS WITH ONE SENSOR AFFECTING A SECOND SENSOR'S OUTPUT OR INTERPRETATION", agora, publi- cação de pedido de patente US nº 2016/0066909;
- pedido de patente US nº de série 14/479.110, intitulado POLARITY OF HALL MAGNET TO DETECT MISLOADED CARTRID- GE, agora, publicação de pedido de patente US nº 2016/0066915; - pedido de patente US nº de série 14/479.098, intitulado "SMART CARTRIDGE WAKE UP OPERATION AND DATA RETEN- TION", agora, publicação de pedido de patente US nº 2016/0066911; - pedido de patente US nº de série 14/479.115, intitulado "MULTIPLE MOTOR CONTROL FOR POWERED MEDICAL DEVICE", agora, publicação de pedido de patente US nº 2016/0066916; e - pedido de patente US nº de série 14/479.108, intitulado "LOCAL DISPLAY OF TISSUE PARAMETER STABILIZATION", agora publicação de pedido de patente US nº 2016/0066913.
[0072] 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, aqui incorporados a título de referência em suas respectivas totalidades: - pedido de patente US nº de série 14/248.590, intitulado "MOTOR DRIVEN SURGICAL INSTRUMENTS WITH LOCKABLE DUAL DRIVE SHAFTS", agora, publicação de pedido de patente US nº 2014/0305987; - pedido de patente US nº de série 14/248.581, intitulado "SURGICAL INSTRUMENT COMPRISING A CLOSING DRIVE AND À FIRING DRIVE OPERATED FROM THE SAME ROTATABLE OU- TPUT", agora publicação de pedido de patente nº 2014/0305989; - pedido de patente US nº 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 nº 2014/0305988; - pedido de patente US nº de série 14/248.588, intitulado "POWERED LINEAR SURGICAL STAPLER", agora publicação de pe-
dido de patente US nº 2014/0309666; - pedido de patente US nº de série 14/248.591, intitulado TRANSMISSION ARRANGEMENT FOR A SURGICAL INSTRUMENT, agora publicação de pedido de patente US nº 2014/0305991; - pedido de patente US nº de série 14/248.584, intitulado "MODULAR MOTOR DRIVEN SURGICAL INSTRUMENTS WITH
ALIGNMENT FEATURES FOR ALIGNING ROTARY DRIVE SHAFTS WITH SURGICAL END EFFECTOR SHAFTS", agora, publicação de pedido de patente US nº 2014/0305994; - pedido de patente US nº de série 14/248.587, intitulado "POWERED SURGICAL STAPLER", agora publicação de pedido de patente US nº 2014/0309665; - pedido de patente US nº de série 14/248.586, intitulado "DRIVE SYSTEM DECOUPLING ARRANGEMENT FOR A SURGICAL INSTRUMENT", agora publicação de pedido de patente nº 2014/ 0305990; e - pedido de patente US nº de série 14/248.607, intitulado "MODULAR MOTOR DRIVEN SURGICAL INSTRUMENTS WITH STATUS INDICATION ARRANGEMENTS", agora publicação de pedi- do de patente US nº 2014/0305992.
[0073] O requerente do presente pedido detém também os seguin- tes pedidos de patente que foram depositados em 16 de abril de 2013 e que estão, cada um, aqui incorporados a título de referência em suas respectivas totalidades: - pedido de patente provisório US nº de série 61/812.365, intitulado "SURGICAL INSTRUMENT WITH MULTIPLE FUNCTIONS PERFORMED BY A SINGLE MOTOR"; - pedido de patente provisório US nº de série 61/812.376, intitulado "LINEAR CUTTER WITH POWER"; - pedido de patente provisório US nº de série 61/812.382,
intitulado "LINEAR CUTTER WITH MOTOR AND PISTOL GRIP"; - pedido de patente provisório US nº de série 61/812.385, intitulado "SURGICAL INSTRUMENT HANDLE WITH MULTIPLE AC- TUATION MOTORS AND MOTOR CONTROL"; e - pedido de patente provisório US nº de série 61/812.372, intitulado "SURGICAL INSTRUMENT WITH MULTIPLE FUNCTIONS PERFORMED BY A SINGLE MOTOR".
[0074] 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 revelados na pre- sente invenção podem ser representativos e ilustrativos. Podem ser feitas variações e alterações a isso, sem se desviar do escopo das rei- vindicações.
[0075] Os termos "compreende" (e qualquer forma de compreen- de, como "compreende" e "que compreende"), "tem" (e qualquer forma de tem, como "tem" e "que tem"), "inclui" (e qualquer forma de inclui, como "inclui" e "que inclui") e "contém" (e qualquer forma de contém, como "contém" e "que contém") são verbos de ligação irrestritos. Co- mo resultado, um sistema, dispositivo ou aparelho cirúrgico que "com- preende", "tem", "inclui" ou "contém" um ou mais elementos possui aqueles um ou mais elementos, mas não é limitado a possuir somente aqueles um ou mais elementos. Da mesma forma, um elemento de um sistema, dispositivo ou aparelho cirúrgico que "compreende", "tem", "inclui" ou "contém" um ou mais recursos possui aqueles um ou mais recursos, mas não é limitado a possuir somente aqueles um ou mais recursos.
[0076] 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 questão de conveniência e clareza, termos espaciais como "vertical", "horizontal", "para cima" e "para baixo" podem ser usados na presente invenção com relação aos desenhos. Entretanto, instrumentos cirúrgi- cos podem ser usados em muitas orientações e posições, e esses termos não se destinam a ser limitadores e/ou absolutos.
[0077] São fornecidos vários dispositivos e métodos exemplifica- dores para a realização de procedimentos cirúrgicos laparoscópicos e minimamente invasivos. Entretanto, o leitor entenderá prontamente que os vários métodos e dispositivos revelados na presente invenção podem ser usados em numerosos procedimentos e aplicações cirúrgi- cas, inclusive, por exemplo, procedimentos cirúrgicos abertos. Com o avanço da presente Descrição Detalhada, o leitor entenderá ainda que os vários instrumentos aqui revelados podem ser inseridos em um corpo de qualquer maneira, como através de um orifício natural, atra- vés de uma incisão ou perfuração formada em tecido, etc. As porções funcionais ou porções do atuador de extremidade dos instrumentos podem ser inseridas diretamente no corpo de um paciente ou podem ser inseridas por meio de um dispositivo de acesso que tenha um ca- nal de trabalho através do qual o atuador de extremidade e o eixo de acionamento alongado de um instrumento cirúrgico podem ser avan- çados.
[0078] Um sistema de grampeamento cirúrgico pode compreender um eixo de acionamento e um atuador de extremidade que se estende a partir do eixo de acionamento. O atuador de extremidade compreen- de uma primeira garra e uma segunda garra. A primeira garra compre- ende um cartucho de grampos. O cartucho de grampos é inserível na, e removível da, primeira garra; entretanto, são previstas outras moda- lidades nas quais um cartucho de grampos não é removível, ou ao menos prontamente substituível, da primeira garra. A segunda garra compreende uma bigorna configurada para deformar os grampos eje- tados a partir do cartucho de grampos. A segunda garra é pivotante em relação à primeira garra ao redor de um eixo geométrico de fe- chamento; entretanto, são previstas outras modalidades nas quais a primeira garra é pivotante em relação à segunda garra. O sistema de grampeamento cirúrgico compreende, adicionalmente, uma junta de articulação configurada para permitir que o atuador de extremidade seja girado ou articulado em relação ao eixo de acionamento. O atua- dor de extremidade é giratório em torno de um eixo geométrico de arti- culação que se estende através da junta de articulação. Outras moda- lidades são previstas que não incluem uma junta de articulação.
[0079] O cartucho de grampos compreende um corpo do cartucho. O corpo do cartucho inclui uma extremidade proximal, uma extremida- de distal, e uma plataforma que se estende entre a extremidade pro- ximal e a extremidade distal. Em uso, o cartucho de grampos é posici- onado 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 empregados no tecido. O corpo do cartucho inclui cavidades de grampo definidas no mesmo, sendo que os grampos são armazenados de modo removível nas ca- vidades de grampo. As cavidades de grampo são dispostas em seis fileiras longitudinais. Três fileiras de cavidades de grampo são posicio-
nadas em um primeiro lado de uma fenda longitudinal e três fileiras de cavidades de grampos são posicionadas em um segundo lado da fen- da longitudinal. Outras disposições de cavidades de grampo e gram- pos podem ser possíveis.
[0080] Os grampos são sustentados por acionadores de grampos no corpo do cartucho. Os acionadores são móveis entre uma primeira posição, ou posição não disparada, e uma segunda posição, ou posi- ção disparada, para ejetar os grampos das cavidades de grampo. Os acionadores são retidos no corpo do cartucho por um retentor que se estende em torno do fundo do corpo do cartucho e inclui membros re- silientes configurados para prender o corpo do cartucho e reter o re- tentor no corpo do cartucho. Os acionadores são móveis entre suas posições não disparadas e suas posições disparadas por um desliza- dor. O deslizador é móvel entre uma posição proximal adjacente à ex- tremidade proximal e uma posição distal adjacente à extremidade dis- tal. O deslizador compreende uma pluralidade de superfícies inclina- das configuradas para deslizar sob os acionadores e levantar os acio- nadores, e os grampos sustentados no mesmo, em direção à bigorna.
[0081] 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. À 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 ao menos parcialmente proximal às superfícies inclinadas de modo que os grampos sejam ejetados à frente da faca.
[0082] As Figuras 1 a 3 representam um instrumento cirúrgico de corte e fixação acionado por motor 1010 que pode ou não ser reutili- zado. Na modalidade ilustrada, o instrumento 1010 inclui um gabinete anterior 1012 que compreende uma empunhadura 1014 que é configu- rada para ser pega, manipulada e atuada pelo médico. O gabinete 1012 é configurado para fixação operacional a um conjunto de eixo de acionamento intercambiável 1200 que tem um atuador de extremidade cirúrgico 1300 operacionalmente acoplado ao mesmo que é configura- do 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 intercambi- áveis aqui reveladas podem também ser empregadas eficazmente em conexão com sistemas cirúrgicos roboticamente controlados. Dessa forma, o termo "gabinete" pode também abranger um compartimento ou porção similar de um sistema robótico que aloja ou, de outro modo, suporta operacionalmente ao menos um sistema de acionamento con- figurado para gerar e aplicar ao menos um movimento de controle que possa ser usado para acionar os conjuntos de eixo de acionamento intercambiáveis revelados na presente invenção e seus respectivos equivalentes. Além disso, vários componentes podem ser "alojados" ou contidos no gabinete ou vários componentes podem ser "associa- dos a" um gabinete. Em tais casos, os componentes podem não estar ontidos no gabinete ou suportados diretamente pelo gabinete. O termo "armação" pode referir-se a uma porção de um instrumento 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 operacional- mente o instrumento cirúrgico. Por exemplo, os conjuntos de eixo de acionamento intercambiáveis aqui revelados podem ser empregados com vários sistemas robóticos, instrumentos, componentes e métodos revelados na patente US nº 9.072.535, intitulada SURGICAL STA-
PLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMERNTS, a qual está aqui incorporada a título de referência, em sua totalidade.
[0084] O gabinete anterior 1012 representado na Figura 1 é mos- trado em conexão com um conjunto de eixo de acionamento intercam- biável 1200 (Figuras 2, 4 e 5) que inclui um atuador de extremidade 1300 que compreende um dispositivo cirúrgico de corte e fixação que é configurado para sustentar operacionalmente um cartucho de gram- pos cirúrgicos 4000 no mesmo. O gabinete 1012 pode ser configurado para uso em conexão com conjuntos de eixo de acionamento inter- cambiáveis que incluem atuadores de extremidade que são adaptados para suportar diferentes tamanhos e tipos de cartuchos de grampos, têm diferentes tamanhos e tipos de eixos de acionamento, etc. Além disso, o gabinete 1012 pode também ser empregado eficazmente com uma variedade de outros conjuntos de eixo de acionamento intercam- biáveis incluindo os conjuntos que são configurados para aplicar ou- tros movimentos e formas de energia como, por exemplo, energia de radiofrequência (RF), energia ultrassônica e/ou movimento a disposi- ções de atuador de extremidade adaptadas para uso em conexão com várias aplicações e procedimentos cirúrgicos. Além disso, os atuado- res de extremidade, os conjuntos de eixo de acionamento, as empu- nhaduras, 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 cartucho de prendedores que compreende uma pluralidade de prendedores nele armazenados de modo removível pode ser inserido de maneira removível dentro e/ou fixado ao atuador de extremidade de um conjunto de eixo de aci- onamento.
[0085] A Figura 1 ilustra o instrumento cirúrgico 1010 que inclui um conjunto de eixo de acionamento intercambiável 1200 operacional- mente acoplado a um gabinete 1012. A Figura 2 ilustra o conjunto de eixo de acionamento intercambiável 1200 solto do gabinete 1012 ou da empunhadura 1014. Como pode ser visto na Figura 3, a empunha- dura 1014 pode compreender um par de segmentos interconectáveis do compartimento de empunhadura 1016 e 1018 que podem ser inter- conectados por parafusos, membros de encaixe por pressão, adesivo, etc. Na disposição ilustrada, os segmentos do compartimento de em- punhadura 1016, 1018 cooperam para formar uma porção de preen- são da pistola 1019 que pode ser empunhada e manipulada pelo mé- dico. Como será discutido em mais detalhes abaixo, a empunhadura 1014 suporta operacionalmente, em seu interior, uma pluralidade de sistemas de acionamento que são configurados para gerar e aplicar vários movimentos de controle às porções correspondentes do conjun- to de eixo de acionamento intercambiável que está operacionalmente fixado ao mesmo.
[0086] Agora com referência à Figura 3, a empunhadura 1014 po- de 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 acio- namento ou sistema de acionamento de fechamento, designado, de modo geral, como 1030, que pode ser empregado para aplicar movi- mentos de fechamento e abertura ao conjunto de eixo de acionamento intercambiável 1200 que está fixado ou acoplado operacionalmente à mesma. Em ao menos uma forma, o sistema de acionamento de fe- chamento 1030 pode incluir um atuador sob a forma de um gatilho de fechamento 1032, suportado de modo pivotante pela armação 1020. Mais especificamente, conforme ilustrado na Figura 3, o gatilho de fe- chamento 1032 é acoplado de modo pivotante ao compartimento 1014 por um pino 1033. Essa disposição permite que o gatilho de fechamen- to 1032 seja manipulado por um médico, de modo que, quando o mé- dico pega a porção de pega da pistola 1019 da empunhadura 1014, o gatilho de fechamento 1032 possa ser facilmente pivotado de uma po- sição inicial ou "não atuada" para uma posição "atuada" e, mais parti- cularmente, para uma posição completamente comprimida ou comple- tamente atuada. O gatilho de fechamento 1032 pode ser propendido para a posição não atuada por meio de uma mola ou de outra disposi- ção de propensão (não mostrada). 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 con- junto de ligação de fechamento 1034 pode incluir uma primeira ligação de fechamento 1036 e uma segunda ligação de fechamento 1038 que são acopladas de modo pivotante ao gatilho de fechamento 1032 por um pino 1035. A segunda ligação de fechamento 1038 pode, também, ser chamada na presente invenção de "membro de fixação" e incluir um pino de fixação transversal 1037.
[0087] Ainda com referência à Figura 3, pode-se observar que a primeira 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 mo- do pivotante à armação 1020. Em ao menos uma forma, o conjunto de liberação de fechamento 1060 pode compreender um conjunto de bo- tão de liberação 1062 que tem uma lingueta de travamento que se pro- jeta distalmente 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 fe- chamento 1036 gira para cima para um ponto em que a lingueta de travamento 1064 cai em um engate de retenção com a parede de tra- vamento 1039 na primeira ligação de fechamento 1036, impedindo, assim, que o gatilho de fechamento 1032 retorne para a posição não atuada. Desse modo, o conjunto de liberação de fechamento 1060 serve para travar o gatilho de fechamento 1032 na posição completa- mente atuada. Quando o médico deseja destravar o gatilho de fecha- mento 1032 para permitir que o mesmo seja propendido para a posi- ção não atuada, o médico simplesmente gira o conjunto do botão de liberação de fechamento 1062, de modo que a lingueta 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 primeira liga- ção de fechamento 1036, o gatilho de fechamento 1032 pode pivotar de volta para a posição não atuada. Outras disposições para trava- mento e liberação do gatilho de fechamento também podem ser em- pregadas.
[0088] Um braço 1061 pode se estender desde o botão de libera- ção 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 posição 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 ao menos um sensor que é configurado para detectar o movimento do elemento magnético 1063. Em ao me- nos uma modalidade, por exemplo, um sensor de "efeito Hall" (não mostrado) pode ser montado na superfície de fundo da placa de circui-
to 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 movimento do elemento magnético 1063. O sensor de efeito Hall pode estar em comunicação de sinal com um microcon- trolador, 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 configu- ração aberta do atuador de extremidade, sua segunda posição, que está associada com a posição atuada do gatilho de fechamento 1032 e a configuração fechada do atuador de extremidade, e/ou qualquer po- sição entre a primeira posição e a segunda posição.
[0089] Em ao menos uma forma, a empunhadura 1014 e a arma- ção 1020 podem operacionalmente suportar um outro sistema de aci- onamento, chamado, na presente invenção, de um sistema de acio- namento de disparo 1080, que é configurado para aplicar movimentos de disparo às porções correspondentes do conjunto de eixo de acio- namento 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 empregar um motor elétrico 1082 que está locali- zado na porção de preensão da pistola 1019 da empunhadura 1014. Sob várias formas, o motor 1082 pode ser um motor de acionamento de corrente contínua com escovas, com uma rotação máxima de, aproximadamente, 25.000 rpm, por exemplo. Em outras disposições, o motor pode incluir um motor sem escovas, um motor sem fio, um mo- tor síncrono, um motor de passo ou qualquer outro motor elétrico ade- quado. O motor 1082 pode ser alimentado por uma fonte de alimenta- ção 1090 que, em uma forma, pode compreender uma fonte de ener- gia removível 1092. Como pode ser visto na Figura 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 gabi- nete distal 1096. A porção do gabinete proximal 1094 e a porção do gabinete distal 1096 são configuradas para suportar operacionalmente uma pluralidade de baterias 1098 nas mesmas. Cada uma das bateri- as 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 substituí- vel e/ou recarregável.
[0090] 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 aco- plamento 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 polaridade de tensão aplicada ao motor elétrico pela bateria pode ser revertida 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 membro de acionamento 1120 será axialmente ativado na direção proximal "PD". A empunhadura 1014 pode incluir uma chave que pode ser configurada para reverter a polaridade aplicada ao motor elétrico 1082 pela fonte de alimentação 1090. Assim como com as ou- tras formas descritas na presente invenção, a empunhadura 1014 também pode incluir um sensor que é configurado para detectar a po- sição do membro de acionamento 1120 e/ou a direção em que o membro de acionamento 1120 está sendo movido.
[0091] 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 médi- co 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 ao menos uma forma, o gatilho de disparo 1130 pode ser posicionado "fora" do gatilho de fechamento 132, como discutido acima. Em ao 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.
[0092] Como indicado acima, em ao 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 con- junto do redutor de engrenagem 1084. Ao 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 manualmente para engate de catraca com os dentes 1124 também fornecidos no membro de acionamento 1120. Dessa forma, o médico pode retrair manualmente o membro de acio- namento 1120 usando o conjunto de empunhadura de resgate 1142 para engrenar o membro de acionamento 1120 na direção proximal "DP". A patente US nº 8.608.045, intitulada POWERED SURGICAL CUTTING E STAPLING APPARATUS WITH MANUALLY RETRAC- TABLE FIRING SYSTEM, revela disposições de resgate e outros componentes, disposições e sistemas que podem também ser usados com os vários instrumentos aqui revelados. A patente US nº
8.608.045, é por meio desta aqui incorporada a título referência em sua totalidade.
[0093] Agora com relação às Figuras 2 e 5, o conjunto de eixo de acionamento intercambiável 1200 inclui um atuador de extremidade cirúrgico 1300 que compreende um canal alongado 1310 que é confi- gurado para suportar operacionalmente em seu interior um cartucho de grampos 4000. O atuador de extremidade 1300 pode incluir adicio- nalmente uma bigorna 2000 que é suportada de modo pivotante em relação ao canal alongado 1310. O conjunto de eixo de acionamento intercambiável 1200 pode adicionalmente incluir uma junta de articula- ção 3020 e uma trava de articulação 2140 que podem ser configura- das para prender de modo liberável o atuador 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 ao menos uma forma do atuador de extremidade 1300, da junta de articu- lação 3020 e das travas de articulação podem ser encontrados no pe- dido de patente US nº de série 13/803.086, depositado em 14 de mar- ço de 2013, intitulado ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK. A revelação completa do pedido de patente US nº de série 13/803.086, depositado em 14 de março de 2013, intitulado ARTICULATABLE SURGICAL INSTRU- MENT COMPRISING AN ARTICULATION LOCK está aqui incorpora- da, por referência. Como pode ser visto na Figura 4, o conjunto de eixo de acionamento intercambiável 1200 pode incluir, ainda, um gabinete proximal ou bocal 1201 composto de porções de bocal 1202 e 1203.
[0094] 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 extremida- de 1300. O conjunto de eixo de acionamento 1200 pode incluir uma coluna central 1210 que é configurada para, em primeiro lugar, supor- tar de maneira deslizante um membro de disparo no mesmo e, em se- gundo lugar, suportar de maneira deslizante o conjunto de membro de fechamento 3000 que se estende ao redor da coluna central 1210. Como pode ser visto na Figura 5, uma extremidade distal 1211 da co- luna central 1210 termina em um recurso de montagem de pino supe- rior 1270 e em um recurso de montagem de pino inferior 1280. O re- curso de montagem de pino superior 1270 é formado com uma fenda de pino 1272 no mesmo que é adaptada para suportar de forma passí- vel 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 ex- tremidade proximal 1312 do canal alongado 1310. A ligação de mon- tagem inferior 1284 inclui um pino de pivô inferior 1286 que é adaptado para ser recebido dentro de um orifício de pivô 1314 formado na por- ção de extremidade proximal 1312 do canal alongado 1310. Veja 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 ci- rúrgico 1300 pode articular em relação ao eixo geométrico de eixo de acionamento SA. Consulte a Figura 2.
[0095] No exemplo ilustrado, o atuador de extremidade cirúrgico 1300 é seletivamente articulável em torno do eixo geométrico de arti- culação AA por um sistema de articulação 2100. Em uma forma, o sis- tema 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 fi- xação de deslocamento 2114 é formado em uma extremidade distal 2112 do acionador de articulação proximal 2102. Um orifício de pivô 2116 é formado no pino de fixação de deslocamento 2114 e é configu- rado para receber de modo pivotante um pino de ligação proximal 2124 formado na extremidade 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 pivo- tante no mesmo um pino de canal 1317 formado na porção de extre- midade proximal 1312 do canal alongado 1310. Dessa forma, o movi- mento axial do acionador de articulação proximal 2102 irá, dessa for- ma, aplicar movimentos de articulação ao canal alongado 1310 para assim fazer com que o atuador de extremidade cirúrgico 1300 articule em torno do eixo geométrico de articulação AA em relação ao conjunto de coluna central 1210. Detalhes adicionais referentes à construção e operação do sistema de articulação 2100 podem ser encontrados em várias referências incorporadas a título de referência no presente do- cumento, incluindo no pedido de patente US nº de série 15/635.631, depositado em 28 de junho de 2017, intitulado SURGICAL INSTRU- MENT WITH AXIALLY MOVABLE CLOSURE MEMBER, cuja revela- ção está aqui incorporada, a título de referência, em sua totalidade. Em várias circunstâncias, o acionador 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. Detalhes adicionais referentes a um exemplo de uma trava de articulação 2140 podem ser encontrados no pedido de patente US nº de série 15/635.631, bem como em outras referências aqui incorporadas a título de referência na presente inven- ção.
[0096] Em várias circunstâncias, a coluna central 1210 pode com- preender uma extremidade proximal 1211 que é sustentada de manei- ra giratória 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 acio- namento SA em relação ao chassi 1240.
[0097] Com referência principalmente à Figura 4, o conjunto de eixo de acionamento intercambiável 1200 inclui um elemento recipro- cante 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 in- clui um par de ganchos que se projetam de maneira proximal 1252 que são configurados para fixação ao pino de fixação 1037 (Figuras 2 e 3) que é fixado ao segundo elo de fechamento 1038 conforme será discu- tido em mais detalhes abaixo. Em ao menos um exemplo, o conjunto de membro de fechamento 3000 compreende um segmento de mem- bro 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 pro- ximal 3012 do segmento de membro de fechamento proximal 3010 e é retido dentro das fendas verticais 1253 no elemento reciprocante de fechamento 1250. Essa disposição serve para fixar o segmento do tu- bo de fechamento proximal 3010 ao elemento de transporte de fecha- mento 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 re- dor do eixo geométrico do eixo de acionamento SA. Uma mola de fe- chamento 1268 é assentada sobre o segmento de tubo de fechamento proximal 3010 e serve para propender o segmento de tubo de fecha- mento 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 operacionalmente acoplado à empunhadura 1014.
[0098] Em ao 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 superior 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 proxi- mal superior em uma espiga que se projeta de maneira distal superior 3032 no segmento de tubo de fechamento distal 3030. Uma ligação de pivô duplo 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. Veja 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.
[0099] Como foi indicado acima, o conjunto de eixo de acionamen- to 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 intermediária de eixo de acionamento de disparo 1222 que é configu- rada 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 distal 1910. A fenda longitudinal 1223 e a aba da extremidade proximal 1912 podem ser dimensionadas e confi- guradas para permitir o movimento relativo entre as mesmas e podem compreender uma junta deslizante. A junta deslizante 1914 pode per- mitir 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 ao menos sem mover substanci- almente, a barra de corte 1910. Uma vez que o atuador de extremida- de 1300 tenha sido adequadamente orientado, a porção do eixo de acionamento de disparo intermediário 1222 pode ser avançada distal- mente 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 revelados em várias outras referências aqui incorpo- radas a título de referência.
[0100] 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 aci- onamento 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 adicio- nalmente aberturas ao 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 cilin- dro de comutação 1500 e o bocal proximal 1201. Os engastes também se estendem através das aberturas 3011 no segmento de tubo de fe- chamento 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 disposição, a rotação do cilindro de chaveamento 1500 pode ser ligada ao avanço axial do tubo de fechamento ou membro de fe- chamento.
Dessa forma, essencialmente, a atuação do sistema de fe- chamento pode engatar e desengatar operacionalmente o sistema de acionamento de articulação com o sistema de acionamento de disparo nas várias formas descritas em mais detalhes no pedido de patente US nº de série 13/803.086 e na patente US nº 9.913.642, intitulada SURGICAL INSTRUMENT COMPRISING A SENSOR SYSTEM, cujas revelações estão aqui incorporadas a título de referência em sua tota- lidade.
Por exemplo, quando o tubo de fechamento está em sua posi- ção mais proximal que corresponde a uma posição de "garras aber- tas", o segmento de tubo de fechamento 3010 terá posicionado o tam- bor 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 "garras fe- chadas", o tubo de fechamento gira o tambor de chaveamento 1500 para uma posição em que o sistema de articulação fica desconectado do sistema de acionamento de disparo.
[0101] 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 ao 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 ao 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 es- tender 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 nº de série 13/803.086, no pedido de patente US nº 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 nº de série 13/803.086, o pedido de patente US nº de série 13/800.067, e a patente US nº 9.345.481, os quais estão, cada um, aqui incorporados a título de referência em suas respectivas totalidades.
[0102] 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. Adicionalmente, 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 arti- cular 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 ao menos um sensor configurado para detectar a posição do cilindro de comutação 1500.
[0103] Novamente com referência à Figura 4, o chassi 1240 inclui ao 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. Consulte 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 tam- bém ser visto na Figura 22, um pino de fixação de eixo de acionamen- to 1226 é formado na extremidade proximal do eixo de acionamento de disparo intermediário 1222. Conforme será discutido com mais de- talhes abaixo, quando o conjunto de eixo de acionamento intercambiá- vel 1200 é acoplado 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 acionamento longitudinal 1120. Consulte a Figura 3.
[0104] Várias modalidades de conjuntos de eixo de acionamento empregam um sistema de travas 1710 para acoplar de modo removí- vel o conjunto de eixo de acionamento 1200 ao gabinete 1012 e mais especificamente à armação 1020. Como pode ser visto na Figura 4, por exemplo, em ao 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 recebido em orifícios correspondentes 1245 for- mados no chassi 1240. Tal disposição facilita a fixação pivotante da forquilha de travamento 1712 ao chassi 1240. A forquilha de travamen- to 1712 pode incluir dois pinos de travamento que se projetam proxi- malmente 1716 que são configurados para se engatarem de forma |i- berável aos detentores ou sulcos de travamento correspondentes 1704 no flange de fixação distal 1700 da estrutura 1020. Consulte a Figura
3. Em várias formas, a forquilha de travamento 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 bo- tão de travamento 1722 que é montado de maneira 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 propensão do botão de tra- vamento na direção distal, o que também faz com que a forquilha de travamento 1712 gire para fora de engate de retenção com o flange de fixação distal 1700 da estrutura 1020. Quando a forquilha de trava- mento 1712 está em engate de retenção com o flange de fixação distal 1700 da estrutura 1020, os pinos de travamento 1716 são assentados com retenção dentro dos detentores ou sulcos de travamento 1704 correspondentes no flange de fixação distal 1700.
[0105] Quando se emprega um conjunto de eixo de acionamento intercambiável que inclui um atuador de extremidade do tipo descrito aqui que é adaptado para cortar e prender o tecido, bem como outros tipos de atuadores de extremidade, pode ser desejável impedir o des- colamento inadvertido do conjunto de eixo de acionamento intercambi- ável 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 de- sejada. Quando o tecido alvo está posicionado dentro do atuador de extremidade 1300 em uma orientação desejada, o médico pode, en- tão, atuar completamente o gatilho de fechamento 1032 para fechar a bigorna 1306 e prender o tecido alvo na posição para corte e grampe- amento. Neste caso, o primeiro sistema de acionamento 1030 foi com- pletamente atuado. Após o tecido alvo ter sido preso no atuador de extremidade 1300, pode ser desejável evitar o desprendimento inad- vertido do conjunto de eixo de acionamento 1200 do gabinete 1012. Uma forma do sistema de travamento 1710 é configurada para impedir este descolamento inadvertido.
[0106] Como pode ser mais particularmente visto na Figura 4, a forquilha de travamento 1712 inclui ao 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 elemento reciprocante de fechamento 1250 está em uma posição não ativada (isto é, o primeiro sistema de acionamento 1030 está desativado e a bigorna 1306 está aberta), a forquilha de trava- mento 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 en- tram em contato com as porções do pino de travamento 1256 no ele- mento reciprocante de fechamento 1250. Entretanto, quando o ele- mento 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 travamento 1712 é impedida de ser girada para uma posição destravada. Em ou- tras palavras, se o médico tentasse pivotar a forquilha de travamento 1712 para uma posição destravada ou, por exemplo, se a forquilha de travamento 1712 estivesse inadvertidamente ressaltada ou colocada em contato de uma maneira que pudesse de outro modo fazer com que a mesma pivotasse distalmente, os ganchos de travamento 1718 na forquilha de travamento 1712 entrariam em contato com os pinos de travamento 1256 no membro móvel de fechamento 1250 e impedi- riam o movimento da forquilha de travamento 1712 para uma posição destravada.
[0107] 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 acionamen- to 1200 ao longo de um eixo geométrico de instalação que é perpendi- cular 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 componentes estão engatados entre si de tal modo que, mediante aplicação de um movimento de atuação aos mesmos, os componentes possam realizar a ação, função e/ou procedimento pretendidos.
[0108] Ao menos cinco sistemas do conjunto de eixo de aciona- mento intercambiável 1200 podem ser acoplados operacionalmente a ao menos cinco sistemas da empunhadura 1014 correspondentes. Um primeiro sistema pode compreender um sistema de estrutura que aco- pla 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 fe- chamento 1030 que pode conectar operacionalmente o gatilho de fe- chamento 1032 da empunhadura 1014 e o tubo de fechamento 1260 e a bigorna 2000 do conjunto de eixo de acionamento 1200. Conforme descrito acima, a forquilha de fixação 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 disparo 1080 que pode conectar operacionalmente o gatilho de disparo 1130 da empunhadura 1014 com o eixo de acionamento de disparo intermediário 1222 do conjunto de eixo de acionamento 1200. Conforme delineado acima, o pino de fixação de eixo de acionamento 1226 pode ser conectado ope- racionalmente com a base 1126 do membro de acionamento longitudi-
nal 1120. Um outro sistema pode compreender um sistema elétrico que pode sinalizar a um controlador na empunhadura 1014, como o microcontrolador, por exemplo, que um conjunto de eixo de aciona- mento, como o conjunto de eixo de acionamento 1200, por exemplo, foi engatado operacionalmente 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 operacionalmente à placa de circuito do eixo de acio- namento 1610. O conector elétrico 1810 é configurado para engate pareado com um conector elétrico correspondente 1800 no circuito de controle da empunhadura 1100. Detalhes adicionais sobre o conjunto de circuitos e os sistemas de controle podem ser encontrados no pedi- do de patente US nº de série 13/803.086, e no pedido de patente US nº de série 14/226.142, cujas revelações foram anteriormente incorpo- radas por referência. O quinto sistema pode consistir no sistema de travamento para travar de modo liberável o conjunto de eixo de acio- namento 1200 à empunhadura 1014.
[0109] Agora com referência às Figuras 5 a 7, a bigorna 2000 no exemplo ilustrado inclui um corpo de bigorna 2002 que termina na por- ção 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 dispo- sição ilustrada, um membro de pivô ou pino giratório de bigorna 2012 se estende lateralmente de cada lado lateral da porção de montagem da bigorna 2010 para ser recebido em uma base de pino giratório cor- respondente 1316 formada nas paredes verticais 1315 da porção de extremidade proximal 1312 do canal alongado 1310. Os pinos girató-
rios 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 recebi- dos de maneira retentora dentro das ranhuras ou entalhes de pino cor- respondentes formados nas paredes verticais 1315 da porção de ex- tremidade proximal 1312 do canal alongado 1310.
[0110] Ainda com referência às Figuras 7, 8 e 9, em ao menos uma disposição, o membro de fechamento distal ou o tubo de fecha- mento do atuador de extremidade 3050 usa dois recursos de abertura de garra positivos, 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 confi- gurados 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 pa- tente US nº de série 15/635.631, depositado em 28 de junho de 2017, intitulado SURGICAL INSTRUMENT WITH AXIALLY MOVABLE CLO- SURE, cuja revelação está aqui incorporada a título de referência, em sua totalidade. Outras disposições de abertura da garra podem ser usadas.
[0111] 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 mi- nimizar a quantidade de forças resultantes experimentadas pelo tubo de fechamento do atuador de extremidade 3050 à medida que a bigor- na 2000 é movida de uma posição completamente aberta para uma posição fechada e por fim uma posição mais fechada.
A porção de corpo de bigorna 2002 inclui uma subsuperfície de formação de gram- pos 2004 que tem uma série de bolsos formadores de bigorna (não mostrados) formados na mesma.
Uma fenda alongada 2006 se esten- de através da porção de corpo 2002 e da porção de montagem 2010 para facilitar a passagem da porção de faca ou "membro 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 compreende uma superfície de came de bigorna 2020 formada na mesma.
A super- fície de came da bigorna 2020 é dividida ou de outro modo cortada pe- la fenda alongada 2006. Como pode ser visto nas Figuras 6 e 7, uma porção de extremidade proximal 2032 da tampa de bigorna 2030 é ori- entada em um ângulo que corresponde ao ângulo/orientação das su- perfícies de came da bigorna 2020. As Figuras 10 e 11 ilustram a bi- gorna 2000 em sua posição completamente aberta.
Como pode ser visto na Figura 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 extre- midade 3050 não está aplicando quaisquer forças de fechamento às superfícies do came de fechamento 2020. Conforme o tubo de fecha- mento do atuador de extremidade 3050 é movido distalmente, a super- fície 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 extremidade proxi- mal 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.
[0112] Conforme o tubo de fechamento do atuador de extremidade 3050 continua a ser avançado distalmente para aplicar movimentos adicionais de fechamento à bigorna para finalmente mover a bigorna para uma posição "mais fechada", o tubo de fechamento de atuador de extremidade pode experimentar significativo estresse que pode, ao longo do tempo, fazer com que o tubo de fechamento do atuador de extremidade se torne alongado verticalmente (quando visto a partir de uma extremidade) 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 completa- mente fechada. É axiomático que quando um tubo ou cilindro com pa- redes delgadas é submetido a pressão interna, uma tensão circunfe- rente e um estresse longitudinal são produzidos na parede do tubo. Essa tensão circunferente age circunferencialmente e perpendicular- mente ao eixo geométrico e ao raio da parede do cilindro. Essa tensão circunferente pode ser calculada como: On = pd/(2t), em que: On = 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) Foram desenvolvidos tubos de fechamento do atuador de extremidade com várias configurações de parede de tubo. Exemplos de tais confi- gurações de tubo são revelados no pedido de patente US nº de série 15/385.903, depositado em 21 de dezembro de 2016, intitulado CLO- SURE MEMBER ARRANGEMENTS FOR SURGICAL INSTRU- MENTS, cuja inteira revelação está aqui incorporada a título de refe- rência na presente invenção.
[0113] 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 ao 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 espessura de parede CT ("wall thickness") que é uniforme ou constante ao longo de um comprimento do tubo de fechamento 3050 ou ao 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.
[0114] Novamente com referência à Figura 12, em pelo menos uma disposição, quando a bigorna 2000 está na "posição fechada", uma distância de folga "CD" ("clearance distance") pode ser observada entre o lado inferior de formação de grampos 2004 do corpo de bigor- na 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 transversal tomada ao longo da linha 13-13 na Figura 12 através das superfícies de came de fechamento 2020 bem como atra- vés 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 fechamen- to CF ("closure forces") são aplicadas à bigorna 2000 e ao canal alon- gado 1310 pelo tubo de fechamento do atuador de extremidade 3050. Por exemplo, as forças de fechamento são aplicadas sobre as superfí- cies de came de fechamento 2020 e a porção de extremidade proximal 2032 da tampa de bigorna 2030 bem como sobre o canal alongado
1310.
[0115] 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 posição fechada da bigorna 2000. Em ao menos uma disposição, ao menos dois locais de transferência de carga distintos estão localizados em cada lado de um plano vertical VP ("vertical plane") que bisseccio- na a bigorna 2000 quando a bigorna 2000 está na posição fechada. Por exemplo, na Figura 13, um primeiro local ou borda direita de trans- ferência de carga 2070R, um segundo local ou borda direita de trans- ferência 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.
[0116] Por exemplo, uma primeira quantidade de folga CR ("clea- rance") é formado entre a superfície interna 3076 do tubo de fecha- mento do atuador de extremidade 3050 que se estende entre o primei-
ro local direito de transferência de carga 2070R e o segundo local di- reito 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 di- reito de transferência de carga 2072R e o terceiro local direito de transferência de carga 2074R. Uma terceira quantidade de folga CR; 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 CL: é formada entre a superfície interna do tubo de fechamento do atuador de extremidade que se estende entre o pri- meiro local esquerdo de transferência de carga 2070L e o segundo local esquerdo de transferência de carga 2072L. A segunda quantida- de de folga CL, é formada entre a superfície interna 3076 do tubo de fechamento do atuador de extremidade que se estende entre o segun- do local esquerdo de transferência de carga 2072L e o terceiro local esquerdo de transferência de carga 2074L. Uma terceira quantidade de folga CL;3 é formada entre o terceiro local esquerdo de transferência de carga 2074L e o quarto local esquerdo de transferência de carga 2076L. Em ao menos uma disposição, as forças de fechamento CF ("closure forces") aplicadas às superfícies 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 transfe- rência de carga 2070L. Da mesma forma, as forças de fechamento CF aplicadas ao canal alongado 1310 podem ser uniformemente distribuí- das entre o quarto local direito de transferência de carga 2076R e o quarto local esquerdo de transferência de carga 2076L, por exemplo.
[0117] Em ao menos uma disposição, ao menos dois locais direi- tos de transferência de carga 2070R, 2072R e ao menos dois locais esquerdos de transferência de carga 2070L, 2072L estão localizados em um lado de um plano horizontal HP ("horizontal plane") que bissec- ciona o atuador de extremidade 1300. Conforme ilustrado na Figura 13, os dois locais direitos de transferência de carga 2070R, 2072R es- tão localizados em um lado oposto do plano vertical VP a partir dos dois locais esquerdos de transferência de carga 2070L, 2072L. Tam- bém em pelo menos uma disposição, o terceiro local direito de transfe- rência de carga 2074R e o quarto local direito de transferência de car- ga 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 simi- lar, o terceiro local esquerdo de transferência de carga 2074L e o quar- to local esquerdo de transferência de carga 2076L estão situados em um lado oposto do plano horizontal HP a partir do primeiro local es- querdo 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 formados a partir de superfícies contí- guas. Outros formatos de local de transferência de carga são contem- plados.
[0118] As Figuras 14 e 15 ilustram a bigorna 2000 e o tubo de fe- chamento do atuador de extremidade 3050 em um estado "mais fe- chado" que é criado à medida que o tubo de fechamento do atuador de extremidade 3050 é avançado adicionalmente distalmente após a bi- gorna 2000 ter atingido a posição fechada. Em ao menos um exemplo, a bigorna 2000 está em um "estado mais fechado" quando uma porção de extremidade distal 2003 da porção de corpo 2002 da bigorna 2000 está em contato com a plataforma de cartucho do cartucho de gram- pos que é operacionalmente suportada com o canal alongado 1310. Consulte a Figura 14. O avanço distal continuado do tubo de fecha- mento do atuador de extremidade 3050 após a bigorna 2000 ter atingi- do a posição fechada pode aumentar significativamente a tensão cir- cunferencial formada no tubo de fechamento do atuador de extremida- de 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 apli- cações futuras. Conforme pode ser visto na Figura 15, a primeira quantidade direita de folga CR: e a primeira quantidade esquerda de folga CL, podem cada uma ter uma largura de folga CW que está si- tuado sobre um lado comum do plano horizontal HP. Cada uma dentre a segunda quantidade direita de folga CR? e a segunda quantidade esquerda de folga CL> se estende através do plano horizontal HP. Dito de uma outra forma, porções da segunda quantidade direita de folga CR.» estão localizadas em cada lado do plano horizontal HP e porções da segunda quantidade esquerda de folga CL> estão localizadas em cada lado do plano horizontal HP.
[0119] 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 ao menos três locais de transferência de carga distintos 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. 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 preju- diciais estabelecidas no tubo de fechamento do atuador de extremida- de 3050 conforme ele se move distalmente para a posição mais fe- chada. Tais disposições permitem que o tubo de fechamento do atua- dor de extremidade 3050 seja produzido com uma espessura de pare- de constante conforme descrito acima, o que pode reduzir a quantida- de de custos de fabricação associados com a fabricação do tubo de fechamento do atuador de extremidade.
[0120] 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 Figura 17, o tubo de fechamento do atuador de ex- tremidade 3050' está em sua posição mais proximal quando a "segun- da garra" ou bigorna 2000' está em sua posição completamente aber- ta. Quando nessa posição, o tubo de fechamento do atuador de ex- tremidade 3050' não está aplicando quaisquer forças de fechamento às superfícies do came de fechamento 2020.
[0121] A Figura 23 ilustra uma forma de um atuador de extremida- de do tubo de fechamento 3050' que pode ser idêntica ao tubo de fe- chamento do atuador de extremidade 3050 descrito acima, exceto pe- las 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 ao menos uma forma, o tubo de fechamento 3050' tem uma espessura de parede constante WT: ("wall thickness") exceto por um segmento As da parede localiza- do no topo do tubo de fechamento do atuador de extremidade 3050'
que tem uma espessura de parede mais espessa WT> que é maior que a WT:. Tal disposição forma um único local de transferência de carga
2070.
[0122] As Figuras 19 e 20 ilustram as posições do tubo de fecha- mento do atuador de extremidade 3050' e da bigorna 2000' quando a bigorna 2000' está na posição fechada. Como pode ser visto na Figura 20, conforme 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 vertical VP que bissecciona o atuador de extremi- dade. O local de transferência de carga 2070' pode se estender atra- vés 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 Figura 20. Quando na posição fechada mostrada nas Figuras 19 e 20, essa disposição serve para formar um espaço 3077 entre as porções correspondentes da superfí- cie interna 3076' do tubo de fechamento do atuador de extremidade 3050" e as superfícies de came 2020' da porção de montagem de bi- gorna 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 Sp). Dessa forma, quando a bigorna 2000' é movida para uma posição fechada, há um primeiro local de transferên- cia de carga distinto 2070' localizado em um lado de um plano horizon- tal HP e dois locais de transferência de carga distintos 2072R', 2072L' localizados em um lado oposto do plano horizontal HP. O primeiro lo- cal de transferência de carga distinto 2070' é separado de cada um dos locais de transferência de carga distintos 2072R', 2072L' por es- paços 3077 quando a bigorna 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.
[0123] As Figuras 21 e 22 ilustram a inter-relação entre o tubo de fechamento do atuador de extremidade 3050' e a bigorna 2000' quan- do o tubo de fechamento do atuador de extremidade 3050' move a bi- gorna 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 dis- tintos 2074R', 2074L' pelos espaços 3079R, 3079L. O local de transfe- rência de carga distinto 2074R' é separado pelo local de transferência de carga distinto 2076R' por um espaço 3081R e o local de transferên- cia de carga distinto 2074L' é separado de um local de transferência de carga distinto 2076L' por um espaço 3081L. Dessa forma, nesta disposição, ao menos um local de transferência de carga distinto (2070') abrange um plano vertical VP que bissecciona o atuador de extremidade e ao menos dois locais de transferência de carga distintos abrangem um plano horizontal HP que bissecciona o atuador de ex- tremidade. Além disso, ao menos um local de transferência de carga distinto está situado em cada lado do plano horizontal HP e ao menos um local de transferência 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 verti- cal do tubo de fechamento do atuador de extremidade 3050".
[0124] 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 superfí- cie de came de bigorna arqueada 2020” e porções entalhadas ou re- baixadas direita e esquerda 2022”. As Figuras 24 e 25 ilustram a bi- gorna 2000” em sua posição 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 fechamento às superfí- cies do came de fechamento 2020”. A Figura 30 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 super- fície externa 3074” e uma superfície de parede interna 3076”. Em ao menos uma forma, o tubo de fechamento 3050” tem uma primeira es- pessura de parede WT1, uma segunda espessura de parede WT>2, uma terceira parede espessura WT3, e uma quarta parede espessura WTa.a que são dispostas conforme mostrado na Figura 30. Em ao menos uma disposição, por exemplo, WT1 < WT2 < WT3 < WTa.
Em alguns casos, WT3 > WTa.
A porção do tubo de fechamento do atuador de ex- tremidade 3050” que tem uma espessura de parede correspondente a WTa 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 bissecciona o tubo de fechamento do atuador de extremidade 3050”. As porções do tubo de fechamento do atuador de extremidade 3050” que têm uma espessura de parede WT3 formam locais de transferência de carga 2072R”, 2072L”. Em ao 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 bissecciona o tubo de fecha- mento do atuador de extremidade 3050”.
[0125] Agora com referência às Figuras 26 e 27, conforme o tubo de fechamento do atuador de extremidade 3050” é movido distalmen- te, o local de transferência de carga 2070” entra em contato com a su- perfície 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 fechamen- to do atuador de extremidade 3050” formam locais transferência de carga 2074R”, 2074L” que entram em contato com porções corres- pondentes 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 extre- midade 3050” e as superfícies de came 2020” da porção de monta- gem 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 transferência 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.
[0126] 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”.
[0127] Quando um atuador de extremidade 1300 do tipo e cons- trução aqui descritos é usado, um médico manipula a primeira e a se- gunda garras (a bigorna 2000 e o canal alongado 1310 que tem um cartucho de grampos cirúrgicos operacionalmente montado na mes- ma), 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 exem- plo, um cartucho de grampos cirúrgicos 4000 compreende um corpo de cartucho 4010 que é configurado para ser suportado de modo re- movível dentro do canal alongado 1310. O corpo de cartucho 4010 in- clui uma fenda de cartucho alongada 4016 que se estende de uma ex- tremidade proximal 4012 através do corpo de cartucho 4010 até uma porção de extremidade distal 4014 para permitir que o membro de faca ou membro de disparo 1920 passe através da mesma. O corpo do car- tucho 4010 define adicionalmente uma superfície de plataforma de car- tucho 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 re- movível um grampo ou grampos cirúrgicos na mesma. Em ao menos uma disposição de cartucho, 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 desali-
nhados em relação aos grampos nas duas linhas externas adjacentes. Os grampos são suportados por acionadores de grampos que são su- portados de modo móvel no interior de cada cavidade de grampo. Em ao 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 supor- tado de modo móvel no corpo de cartucho e é adaptado para ser axi- almente 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 cavida- des 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 su- portados 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.
[0128] Quando o médico inicialmente localiza o tecido-alvo entre a bigorna e o cartucho de grampos, é importante que o tecido-alvo este- ja situado de modo que a faca não corte no tecido-alvo a menos que o tecido-alvo seja primeiro grampeado. Em disposições de bigorna ante- riores, 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 fechamento do atuador de extremidade. Conforme o tubo de fecha- mento é movido distalmente para fechar a bigorna, o tecido que se es- tende para fora entre a bigorna e o cartucho irá ocasionalmente se tor- nar indesejavelmente preso ou apertado entre as extremidades proxi- mais dos bloqueios de tecido e a extremidade distal do tubo de fecha- mento do atuador de extremidade. Os exemplos revelados abaixo são configurados 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 in- venção.
[0129] Voltando à Figura 7, por exemplo, o cartucho de grampos 4000 inclui grampos (não mostrados) que são suportados de forma removível 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.
[0130] Em várias circunstâncias, para evitar que o tecido-alvo seja apertado proximal aos grampos nas cavidades de grampos mais pro- ximais 4022P, a bigorna 2000 inclui dois membros de bloqueio de teci- do 2040 que se projetam para baixo além da subsuperfície de forma- ção de grampos 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 tecido 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 pro- ximais 4022P. Como pode ser visto nas Figuras 7, 31 e 32, em ao me- nos uma disposição, os bloqueios de tecido 2040 são formadas inte- gralmente 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 superfícies de came cor- respondentes 2020 formadas na porção de montagem de bigorna
2010. No exemplo ilustrado, as extremidades proximais dos bloqueios de tecido 2040 são segmentadas em uma porção de extremidade pro- ximal superior 2042, uma porção de extremidade proximal inferior 2043 e uma porção de extremidade proximal de fundo 2044. Consulte 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 extremidade proximal de fundo 2044 e a superfície de came
2020. Na disposição 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 por- ção de extremidade proximal de fundo 2044 e o chanfro que a acom- panha 2047 corresponde à área atenuada 2084.
[0131] Conforme discutido acima, a bigorna 2000 é movida de uma posição completamente aberta à posição fechada e uma posição mais fechada pelo tubo de fechamento axialmente móvel do atuador de extremidade 3050. As Figuras 31 e 33 ilustram a posição do tubo de fechamento do atuador de extremidade 3050 em relação aos blo- queios de tecido 2040 quando a bigorna 2000 está na posição fecha- da. Como pode ser visto na Figura 33, a porção de extremidade pro- ximal superior 2042 e o chanfro que a acompanha 2045 são aproxi- madamente paralelos a uma porção correspondente de uma extremi- dade 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 extremidade distal 3051 do tubo de fechamento do atuador de extremidade 3050, a por- ção de extremidade proximal inferior 2043 e a porção de extremidade proximal de fundo 2044 do bloqueio de tecido 2040 e dos chanfros cor- respondentes 2046 e 2047 são anguladas na direção oposta da ex- tremidade distal 3051 do tubo de fechamento do atuador de extremi- dade 3050. Essa disposição tem o efeito prático de aumentar a distân- cia entre a porção de bloqueio de tecido e o tubo de fechamento do atuador de extremidade pode provavelmente encontrar o tecido adja- cente.
[0132] A Figura 33 é uma vista ampliada de uma porção do atua- dor de extremidade descrito na Figura 31 em que a bigorna 2000 está em uma posição fechada. Quando nessa posição, a porção de extre- midade proximal superior 2042 de cada bloqueio de tecido 2040 está situada em uma primeira distância de tecido TD a partir da extremida- de distal 3051 do tubo de fechamento do atuador de extremidade
3050. A porção de extremidade proximal de fundo 2044 de cada blo- queio de tecidos 2040 está situada em uma segunda distância de teci- do TD» a partir da extremidade distal 3051 do tubo de fechamento do atuador de extremidade 3050. Como pode ser visto na figura TD? > TD1. As Figuras 32 e 34 ilustram a bigorna 2000 em uma posição mais fechada. A primeira distância de tecido TD/' entre a porção de extre-
midade proximal superior 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 extremidade 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 ao menos um exemplo, TD2 e/ou TD2' podem ser aproximadamente dez milhares de uma polegada a aproximadamente vinte e cinco milhares de uma polegada. Entretan- to, outros vãos podem ser obtidos. Além disso, a inclusão das superfí- cies chanfradas 2045, 2046 e 2047 pode ajudar a reduzir a probabili- dade de aperto do tecido entre os bloqueios de tecido 2040 e a extre- midade 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 configu- rações 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.
[0133] 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 fe- chamento de atuador de extremidade 5050 pode de outro modo ser idêntico ao tubo de fechamento do atuador de extremidade 3050 des- crito 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 atuador de extremidade 5050. Para aliviar e minimizar tal possibilida- de, 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 formado na porção da extremidade distal 5031 do tubo de fechamen- to do atuador de extremidade 5030 que corresponde à porção da ex- tremidade 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 ter- mina em um canto de fundo 5070 e o ápice ou fundo 5064 está dire- tamente através do canto de fundo 5070 quando o tubo de fechamento do atuador de extremidade 5050 está na posição correspondente à posição fechada da bigorna 5000. Outros formatos de entalhe, entre- tanto, podem ser usados.
[0134] A Figura 36 é uma vista ampliada de uma porção do atua- dor de extremidade descrito na Figura 35 em que a bigorna 5000 está em uma posição fechada. Quando nessa posição, a porção da extre- midade proximal superior 5042, a porção da extremidade proximal in- ferior 5043 e a porção a extremidade proximal de fundo 5044 de cada bloqueio de tecido 5040 estão localizadas em uma primeira distância de tecido TD; 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? >
TD1. As Figuras 37 e 38 ilustram a bigorna 5000 em uma posição mais fechada. A primeira distância de tecido TD/' 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 TD2' 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.
[0135] A Figura 39 ilustra um cartucho de grampos cirúrgicos ante- rior 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 estende de uma extremidade proximal 4012 através do corpo de cartucho 4010 até uma porção da extremidade distal 4014 para permitir que o membro de faca ou membro de disparo 1920 (Figura 5) passe através da mesma. O corpo do cartucho 4010 define adicional- mente 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 re-
movível um grampo ou grampos cirúrgicos na mesma.
Em ao menos uma disposição de cartucho, três linhas de cavidades de grampo 4022 são fornecidas em cada lado da fenda alongada 4016. No exemplo ilustrado, as linhas são formadas de modo que os grampos em uma linha central estão desalinhados em relação aos grampos nas duas linhas externas adjacentes.
Os grampos são suportados por acionado- res de grampos que são suportados de modo móvel no interior de ca- da cavidade de grampo.
Em ao menos algumas disposições, os acio- nadores de grampos estão dispostos para serem colocados em conta- to 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 "cu- nha" ou deslizador 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 axialmen- te 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 correspondente entra em contato com um acionador de grampo, o acionador é acionado para cima no interior da cavidade de grampo desse modo acionando o grampo ou grampos suportados no mesmo para fora da cavidade de grampo através do tecido preso e em contato de formação com a subsuperfície de forma- ção de grampos de uma bigorna confrontante do atuador de extremi- dade.
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 na faca ou membro de disparo.
[0136] 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 compreendida de grampos alinhados linearmente pode fornecer uma quantidade limitada de flexibilidade ou estiramento uma vez que a li- nha de grampos pode se flexionar ou estirar entre os grampos linea- res.
Consequentemente, uma porção limitada da linha de grampos (por exemplo, a porção entre os grampos) é flexível.
Uma linha de grampos compreendida de grampos orientados de forma angular tam- bém 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 compreendida de grampos orienta- dos 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 ao menos 25% ou ao menos 50%, por exemplo.
A disposição de grampos inclui a ori- entação relativa dos grampos e o espaçamento entre os grampos, por exemplo.
A geometria dos grampos inclui o tamanho e o formato dos grampos, por exemplo.
As propriedades de flexibilidade e vedantes de uma linha de grampos pode mudar em posições longitudinais e/ou la- terais com base na disposição e/ou geometria dos grampos.
Em certos casos, é desejável alterar as propriedades de flexibilidade e/ou vedan- tes de uma linha de grampos em um ou mais locais ao longo da linha de grampos.
Por exemplo, pode ser desejável aumentar a flexibilidade da linha de grampos ou de uma porção da mesma.
Adicionalmente ou alternativamente, pode ser desejável diminuir a flexibilidade da linha de grampos ou de uma porção da mesma.
Também pode ser desejá- vel aumentar as propriedades vedantes da linha de grampos ou de uma porção da mesma.
Adicionalmente ou alternativamente, pode ser desejável diminuir as propriedades vedantes da linha de grampos ou de uma porção da mesma.
[0137] A disposição de cavidades de grampo em um cartucho de grampos corresponde à disposição de grampos em uma linha de grampos gerada pelo cartucho de grampos. Por exemplo, o espaça- mento e a orientação relativa de cavidades de grampo em um cartucho de grampos correspondem ao espaçamento e à orientação relativa de grampos em uma linha de grampos geradas pelo cartucho de gram- pos. Em vários casos, um cartucho de grampos pode incluir uma dis- posição de cavidades de grampos que é selecionada e/ou designada para otimizar as propriedades de flexibilidade e/ou vedantes da linha de grampos resultante. Um cirurgião pode selecionar um cartucho de grampos tendo uma disposição de cavidades de grampo em particular com base no procedimento cirúrgico a ser realizado e/ou nas proprie- dades do tecido a ser tratado durante o procedimento cirúrgico, por exemplo.
[0138] Em certos casos, pode ser desejável gerar uma linha de grampos 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 por- ção do mesmo. O primeiro padrão e o segundo padrão podem ser lon- gitudinalmente deslocados. Por exemplo, o primeiro padrão pode estar posicionado na extremidade 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 podem ser lateralmente deslocados e lon- gitudinalmente deslocados. Uma linha de grampos pode incluir ao me- nos dois padrões diferentes de grampos.
[0139] 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 principal pode abranger uma porção significativa da linha de grampos e pode incluir um subpadrão longitudinalmente repetitivo. Em certos casos, o padrão 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 grampea- do, e o padrão secundário 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 pa- drão secundário se estende ao longo de uma porção mais curta da li- nha de grampos, a flexibilidade do padrão secundário pode não impac- tar, ou pode não impactar significativamente, a flexibilidade total de toda a linha de grampos. O pedido de patente US nº de série 15/385.389, intitulado STAPLE CARTRIDGE AND ARRANGEMENTS OF STAPLES AND STAPLE CAVITIES THEREIN, agora publicação de pedido de patente US nº 2018/0168629, cuja revelação está, por meio desta, aqui incorporada em sua totalidade, a título de referência revela várias disposições de cartuchos de grampos e acionadores de grampos.
[0140] A patente US nº 9.801.627, intitulada FASTENER CAR- TRIDGE FOR CREATING FLEXIBLE STAPLE LINES, a inteira revela- ção da qual está aqui incorporada a título de referência na presente invenção revela várias disposições de cartuchos e bigorna para criar linhas de grampos cirúrgicos flexível.
[0141] Novamente com referência à Figura 39, a maior parte das cavidades de grampo 4022 no cartucho 4000 é disposta em um primei- ro padrão, ou padrão principal, 4030. O primeiro padrão 4030 é um padrão longitudinalmente repetitivo de cavidades de grampo orienta- das de forma angular 4022. Padrões longitudinalmente repetitivos são padrões em que um subpadrão ou disposição é longitudinalmente re- petido. Por exemplo, uma disposição de três cavidades de grampo em cada lado da fenda 4016 (uma cavidade interna de grampos, uma ca- vidade intermediária de grampos e uma cavidade externa de grampos) pode ser repetida ao longo de ao menos uma porção do comprimento do corpo do cartucho de grampos 4010. Vários padrões longitudinal- mente repetitivos de cavidades de grampos orientados de forma angu- lar são descritos no pedido de patente US nº 14/498.145, depositado em 26 de setembro de 2014, agora publicação do pedido de patente US nº 2016/0089142, intitulada METHOD FOR CREATING A FLEXI- BLE STAPLE LINE, que é incorporada a título de referência na presen- te invenção em sua totalidade. As aberturas 4024 das cavidades de grampo 4022 no primeiro padrão 4030 formam um padrão em zigue- zague tendo seis fileiras de aberturas de cavidade de grampos orien- tadas 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.
[0142] Cada abertura de cavidade de grampos 4024 tem uma ex- tremidade proximal 4027 e uma extremidade distal 4028. A extremida- de proximal 4027 e a extremidade distal 4028 das cavidades de gram- po 4022 no primeiro padrão 4030 são lateralmente deslocadas. Em outras palavras, cada cavidade de grampos 4022 no primeiro padrão 4030 é orientada de forma angular em relação ao eixo geométrico lon- gitudinal do cartucho de grampos SCA ("staple cartridge axis"). Um eixo geométrico de cavidade CA ("cavity axis") se estende entre a ex- tremidade 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 filei- ra intermediárias 4026b de cavidades de grampo 4022 são orientadas em 90 graus, ou cerca de 90 graus, em relação às aberturas 4024 das fileiras internas 4026a e das fileiras externas 4026c.
[0143] 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 pa- drão 4030. Mais especificamente, a orientação angular de cavidades de grampo proximais 4022a, 4022b, 4022c, e 4022d e de cavidades de grampos distais 4022e, 4022f, 40229, e 4022h não se conforma à dis- posição 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 angu- larmente deslocadas das cavidades de grampo 4022 no primeiro pa- drão 4030. As cavidades de grampo proximais 4022a, 4022b, 4022c, e 4022d são obliquamente orientadas em relação às cavidades de grampos 4022 no primeiro padrão 4030, e as cavidades de grampo distais 4022e€, 4022f, 40229, e 4022h também são obliquamente orien- tadas em relação às cavidades de grampos 4022 no primeiro padrão
4030. As cavidades de grampo proximais e distais 4022a a 4022h são orientadas paralelas à fenda 4016 e ao eixo geométrico longitudinal do cartucho de grampos SCA.
[0144] 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 tam- bém inclui um primeiro par de cavidades de grampo paralelas longitu- dinalmente alinhadas 4022e, 4022f no primeiro lado da fenda longitu- dinal 4016 e um segundo par de cavidades de grampo paralelas longi- tudinalmente alinhadas 40229, 4022h no segundo lado da fenda longi- tudinal 4016. Em outras instâncias, o padrão distal 4042 pode ser dife- rente do padrão proximal 4040.
[0145] 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 o padrão proximal 4040 ou o padrão distal 4042. Em outras instâncias, as cavidades de grampo 4022 definidas no corpo do cartucho de grampos 4010 podem incluir padrões adicionais e/ou diferentes de ca- vidades de grampo 4022.
[0146] 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 o tecido que é preso pelo atuador de ex- tremidade. 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 po- dem ser configurados para se estenderem nivelados com e/ou além das pontas das pernas de grampo para impedir que as pontas pene- trem prematuramente o tecido. Consequentemente, grampos maiores, por exemplo, grampos tendo pernas maiores, podem estar posiciona- dos nas cavidades de grampo 4022 tendo extensores atraumáticos 4050 posicionados 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 pa- drão 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 proximal 4040 e/ou no padrão distal 4042, e grampos maiores podem também ser posicionados em uma ou mais daquelas cavidades de grampo 4022a a 4022h.
[0147] O corpo do cartucho de grampos 4010 pode ser configura- do 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 re- presentada na Figura 40. Uma linha de grampos 4060 é compreendida de grampos 4062, e um grampo exemplificador 4062 para uso com vários cartuchos de grampos descritos na presente invenção é repre- sentado na Figura 41. O grampo 4062 pode ser compreendido de um fio dobrado, por exemplo. O fio pode ter um diâmetro de 0,0079 pole- gadas, ou aproximadamente 0,0079 polegadas. Em outras instâncias, o fio pode ter um diâmetro de 0,0089 polegadas, ou aproximadamente 0,0089 polegadas. Em ainda outras instâncias, o fio pode ter um dià- metro de 0,0094, ou aproximadamente 0,0094 polegadas. Em certos casos, o fio pode ter um diâmetro 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 primei- ra 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 substan- cialmente paralela à segunda perna 4068 e substancialmente perpen- dicular à base 4064. Quando implantada no tecido T, a orientação an- gular da base 4064 corresponde à orientação angular da abertura de cavidade de grampos 4024 a partir da qual o grampo 4062 foi dispara- do.
[0148] Um outro grampo exemplificador 4070 que pode ser usado com vários cartuchos de grampos descritos na presente invenção é representado na Figura 42. O grampo 4070 é um grampo substancial- mente 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 segunda perna 4076 que se estende a partir de uma segunda ex- tremidade da base 4072. A primeira perna 4074 é obliquamente orien- tada em relação à segunda perna 4076 e à base 4072. Quando im- plantada no tecido T, a orientação da base 4072 corresponde à orien- tação da abertura de cavidade de grampos 4024 a partir da qual o grampo 4070 foi disparado. O leitor entenderá que grampos tendo dife-
rentes geometrias também podem ser disparados a partir dos cartu- chos de grampos descritos na presente invenção.
[0149] 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.
[0150] A porção proximal 4063 é gerada a partir do padrão proxi- mal 4040 e forma a extremidade proximal da linha de grampos 4060. À porção distal 4065 é gerada a partir do padrão distal 4042 e forma a extremidade distal da linha de grampo 4060. Devido à orientação para- lela 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.
[0151] Conforme descrito aqui, os grampos são posicionados de maneira removível em um cartucho de grampos e disparados a partir do cartucho de grampos durante o uso. Em vários casos, 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 transladar através do car- tucho de grampos durante um golpe de disparo para acionar os gram- pos a partir do cartucho de grampos em direção a uma bigorna. Em certos casos, os grampos podem ser suportados por acionadores de grampo e o elemento de disparo pode levantar os acionadores de grampo para ejetar ou remover os grampos do cartucho de grampos.
[0152] 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 estampados na bigorna. Por exemplo, os bolsos formadores de gram- po 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 exemplo, um certo grau de arredondamento nos can- tos e/ou bordas do processo de formação de grampo pode ser um re- sultado intencional do processo de cunhagem. Esses recursos tam- bém podem ser designados para melhor formar os grampos em suas configurações formadas, incluindo grampos que são distorcidos e/ou de outro modo desalinhados durante a colocação.
[0153] Cada grampo no cartucho de grampos pode ser alinhado com um bolso formador de grampo da bigorna. Em outras palavras, a disposição 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 orienta- ção angular de cada cavidade de grampos pode corresponder à orien- tação angular do respectivo bolso formador de grampo. Por exemplo,
quando as cavidades de grampo são dispostas em um padrão de es- pinha de peixe, os bolsos formadores de grampo também podem ser dispostos em um padrão de espinha de peixe.
[0154] 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 mai- úscula tendo laços superiores e inferiores simétricos. Em outras ins- tâncias, a configuração disparada pode ser uma forma de B modifica- do, por exemplo, uma configuração em forma de B distorcida, na qual ao menos uma porção de uma perna de grampo realiza torque fora do plano com a base do grampo, ou uma configuração assimétrica em forma de B, na qual os laços superiores e inferiores da letra B maiús- cula são assimétricos. O tecido pode ser capturado ou preso dentro do grampo formado.
[0155] A disposição de grampos e/ou as cavidades de grampo em um cartucho de grampos podem ser configuradas para otimizar a dis- posição de bolsos formadores de grampo correspondente na superfí- cie de formação de uma bigorna complementar. Por exemplo, a orien- tação angular e o espaçamento de grampos em um cartucho de gram- pos podem ser projetadas para otimizar a superfície de formação de uma bigorna. Em certos casos, a área de projeção dos bolsos forma- dores de grampo em uma bigorna pode ser limitada pela geometria da bigorna. Em casos em que os bolsos formadores de grampo são obli- quamente orientados em relação a um eixo geométrico longitudinal, a largura da bigorna pode limitar o tamanho e o espaçamento dos bolsos formadores de grampo obliquamente orientados. Por exemplo, a largu- ra de uma fileira intermediária de bolsos formadores 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 confina- das entre uma borda interna na bigorna, como uma fenda de faca, e uma borda externa da bigorna.
[0156] 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 for- madores 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.
[0157] Novamente com referência ao cartucho de grampos anteri- or representado na Figura 39 e outros cartuchos de grampos anterio- res revelados na, por exemplo, patente US nº 9.801.627, intitulada
FASTENER CARTRIDGE FOR CREATING FLEXIBLE STAPLE LINES e/ou no pedido de patente US nº US 14/498.145, depositada em 26 de setembro de 2014, agora publicação de pedido de patente US nº 2016/0089142 intitulada METHOD FOR CREATING A FLEXIBLE STAPLE LINE, os diferentes ângulos dos grampos e cavidades de grampos em cada fileira podem ser selecionados para otimizar o ani- nhamento 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 formadores de grampos correspondente. Além disso, os bolsos forma- dores de grampos nas bigornas complementares podem ser mais lon- gos do que as cavidades de grampo em um esforço para facilitar que as pernas de grampo entrem em contato ou caiam dentro dos bolsos formadores 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 pa- ra fora durante o disparo. Em vários casos, os bolsos formadores de grampo podem ser 0,005 polegadas a 0,015 polegada mais longos do que as cavidades de grampo correspondentes e/ou os grampos. Adici- onalmente ou alternativamente, as concavidades receptoras de gram- po de cada bolso formador de grampo podem ser 0,005 polegadas a 0,015 polegada mais largas do que as cavidades de grampo corres- pondentes. Em outras instâncias, a diferença no comprimento e/ou largura pode ser menor que 0,005 polegadas ou maior que 0,015 po- legada.
[0158] 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 po- de facilitar ainda mais o aninhamento dos mesmos. Por exemplo, nos casos em que bolsos formadores de grampo em uma fileira intermedi- ária são mais curtos que os bolsos formadores de grampo em uma fi- leira interna ou em uma fileira externa, a largura da fileira intermediária dos bolsos formadores de grampo pode ser reduzida, o que pode re- duzir o espaçamento exigido entre a fileira interna e a fileira externa.
[0159] 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 longi- tudinalmente desalinhados em relação aos bolsos dispostos em uma fileira externa. Além disso, os bolsos na fileira interna podem parcial- mente sobrepor longitudinalmente os bolsos na fileira externa. Os bol- sos em uma fileira intermediária podem ser longitudinalmente desali- nhados em relação aos bolsos na fileira interna e aos bolsos na fileira externa. Por exemplo, os bolsos na fileira intermediária podem ser equidistantemente longitudinalmente deslocados dos bolsos na fileira externa e dos bolsos na fileira interna.
[0160] Agora com referência às Figuras 43 a 45, uma bigorna 9000 é ilustrada que pode ser similar às bigornas aqui descritas, exce- to que a bigorna 9000 inclui uma ponta de bigorna deformável 9010. A bigorna 9000 compreende um corpo de bigorna 9002 que inclui uma subsuperfície de formação de grampos genericamente designada co- mo 9004 através da qual uma fenda alongada 9006 passa. A subsu- perfície de formação de grampos 9004 define saliências 9008, 9010 que são situadas em cada lado da fenda alongada 9006 dentro do corpo de bigorna 9002 para engate deslizante por protuberâncias for- madas sobre ou fixadas à faca do membro de disparo que é configu- rado para passar através da fenda 9006 durante os processos de dis- paro de grampos e corte de tecido. Como pode ser visto na Figura 43 a 45, a ponta de bigorna deformável 9050 é fixada a uma extremidade distal; 9020 do corpo da bigorna 9002.
[0161] Na disposição ilustrada, o corpo da bigorna 9002 pode ser fabricado a partir de um primeiro material como um primeiro material de metal que pode compreender, por exemplo, aço inoxidável, titânio, etc. A ponta da bigorna deformável 9050 pode ser fabricada de um se- gundo material que é mais flexível e deformável do que o primeiro ma- terial, forma exemplo. O segundo material pode compreender um ma- terial plástico. Em ao menos uma disposição, a ponta de bigorna de-
formável 9050 pode ser fabricada de plástico termofixo que não se re- modela sob calor, por exemplo. No exemplo mostrado nas Figuras 43 a 45, a ponta de bigorna deformável 9050 inclui uma porção de fixação 9052 que compreende um primeiro conjunto de fixação flexível 9054. Em uma disposição, o primeiro conjunto de fixação flexível 9054 tem um formato de T quando visto de cima. O primeiro conjunto de fixação em formato de T 9054 é configurado para ser recebido de maneira deslizante dentro de uma disposição de fenda em formato de T 9022 que é formada na extremidade distal 9020 do corpo da bigorna 9002. O primeiro conjunto de fixação em formato de T 9054 é configurado para ser inserido na fenda 9022 em uma direção de inserção ID ("in- sertion direction") que é transversal a um eixo geométrico de bigorna ANA ("anvil axis") que é definido pelo corpo de bigorna 9002.
[0162] Ainda com referência às Figuras 43 a 45, o primeiro conjun- to de fixação em formato de T 9054 inclui um furo passante fendido 9056 que define uma aba de fixação flexível direita 9058 e uma aba de fixação flexível esquerda 9060. A aba de fixação flexível direita 9058 e a aba de fixação flexível esquerda 9060 são configuradas para serem recebidas de maneira deslizante nas porções correspondentes da dis- posição de fenda em formato de T 9022 na direção de inserção ID. Após o primeiro conjunto de fixação 9054 ter sido inserido na fenda em formato de T 9022 na extremidade distal 9020 do corpo de bigorna 9002, um segundo membro de fixação 9070 é inserido no furo passan- te fendido 9056 no primeiro conjunto de fixação 9054. Em ao menos uma disposição, o segundo membro de fixação 9070 compreende um corpo 9072 que inclui um membro transversal de topo 9074. O corpo 9072 compreende um recurso ou recursos de retenção sob a forma de roscas ou anteparos deformáveis 9076 formados no mesmo. Para fixar a ponta de bigorna deformável 9050 ao corpo de bigorna 9002, o pri- meiro conjunto de fixação 9054 é inserido na disposição de fenda em formato de T 9022 na direção de inserção e assentado no fundo do mesmo contra as saliências 9008, 9010. O corpo 9072 do segundo membro de fixação 9070 é inserido no furo passante fendido 9056 no primeiro conjunto de fixação 9054 na direção de inserção ID. Em ao menos uma disposição, o furo passante fendido 9056 é dimensionado em relação à porção de corpo 9072 do segundo membro de fixação 9070 de modo a fazer com que as abas de fixação flexíveis 9058, 9060 se flexionem lateralmente para fora em direções laterais de fixa- ção LAD ("lateral attachment directions") em engate de retenção lateral com as porções correspondentes da fenda em formato de T 9022. Após o segundo membro de fixação 9070 ter sido inserido no furo passante fendido 9056 no primeiro conjunto de fixação 9054, os ante- paros deformáveis 9076 no mesmo retêm o segundo membro 9070 em engate de retenção e impedem sua retenção do furo passante 9056. Em uma disposição, o segundo membro de fixação 9070 é inserido sob pressão no do furo passante fendido 9056. Em uma outra disposi- ção, o segundo membro de fixação 9070 é aquecido e inserido sob pressão (estaqueamento térmico) de modo que quando o segundo membro de fixação 9070 foi inserido e assentado no furo passante fendido 9056, os anteparos 9076 são permanentemente deformados para reter o segundo membro de fixação 9070 na posição de retenção.
[0163] Como também pode ser visto nas Figuras 43 a 45, a bigor- na 9000 pode compreender uma tampa de bigorna 9080 que é dimen- sionada para cobrir a fenda alongada 9006 no corpo de bigorna 9002. A tampa de bigorna 9080 pode ser fabricada com o mesmo material que compreende o corpo de bigorna 9002 e ser soldada ao corpo da bigorna 9002 após a ponta da bigorna deformável 9050 ter sido insta- lado da maneira descrita acima. A tampa de bigorna 9080 compreende uma extremidade distal 9082 que é configurada para ser recebida em uma cavidade 9062 fornecida na porção de fixação 9052 da ponta da bigorna deformável 9050. Tal disposição adicionalmente retém o se- gundo membro de fixação 9070 em posição. Após a ponta da bigorna deformável 9050 ter sido fixada ao corpo da bigorna 9002, uma porção de extremidade distal 9051 da ponta da bigorna 9050 se inclina abaixo da subsuperfície de formação de grampos 9004 do corpo de bigorna
9002. Consulte a Figura 44.
[0164] Voltando a seguir de Figuras 46 e 47, uma bigorna 9100 é mostrada que é similar à bigorna 9000 descrita acima, exceto para as diferenças a seguir. A bigorna 9100 compreende um corpo de bigorna 9102 que inclui uma subsuperfície de formação de grampos generica- mente designada como 9104 através da qual uma fenda alongada 9106 passa. A subsuperfície de formação de grampos 9104 serve para formar saliências 9108, 9110 em cada lado da fenda alongada 9106 dentro do corpo de bigorna 9102 para engate deslizante por protube- râncias formadas sobre ou fixadas a uma faca do membro de disparo que passa através da fenda 9106 durante os processos de disparo de grampos e corte de tecido. Como pode ser visto nas Figuras 46 a 47, a bigorna 9100 compreende uma ponta de bigorna deformável 9150 que é fixada a uma extremidade distal; 9120 do corpo da bigorna 9102.
[0165] Na disposição ilustrada, o corpo da bigorna 9102 pode ser fabricado a partir de um primeiro material como um primeiro material de metal que pode compreender aço inoxidável, titânio, etc. A ponta da bigorna deformável 9050 pode ser fabricada de um segundo material que é mais flexível e deformável do que o primeiro material e compre- ende, por exemplo, um material plástico. Em ao menos uma disposi- ção, a ponta de bigorna deformável 9050 é fabricada de plástico ter- mofixo que não se remodela sob calor, por exemplo. No exemplo mos- trado nas Figuras 46 e 47, a ponta de bigorna deformável 9050 inclui uma porção de fixação 9152 que compreende um primeiro conjunto de fixação flexível 9154. Em uma disposição, o primeiro conjunto de fixa-
ção flexível 9154 tem um formato de T quando visto de cima. O primei- ro conjunto de fixação em formato de T 9154 é configurado para ser recebido de maneira deslizante dentro de uma disposição de fenda em formato de T 9122 que é formada na extremidade distal 9120 do corpo da bigorna 9102. Como pode ser visto mais particularmente na Figura 46, a disposição de fenda em formato de T 9122 compreende duas cavidades 9124 formadas através da subsuperfície de formação de grampos 9104. Ao contrário da bigorna 9000 descrita acima, a disposi- ção de primeiro conjunto de fixação em formato de T 9154 é configu- rada para ser inserida na fenda 9122 partir do fundo da subsuperfície de formação de grampos 9104 em uma direção de inserção IDg que é transversal a um eixo geométrico de bigorna ANA que é definido pelo corpo de bigorna 9102.
[0166] Ainda com referência às Figuras 46 e 47, o primeiro conjun- to de fixação em formato de T 9154 inclui um furo passante fendido 9156 que define uma aba de fixação flexível direita 9158 e uma aba de fixação flexível esquerda 9160. A aba de fixação flexível direita 9158 e a aba de fixação flexível esquerda 9160 são configuradas para serem recebidas de maneira deslizante nas cavidades correspondentes 9124 da disposição de fenda em formato de T 9122 na direção de inserção IDg. Após o primeiro conjunto de fixação 9154 ter sido inserido na fen- da em formato de T 9122 na extremidade distal 9120 do corpo de bi- gorna 9102, um segundo membro de fixação 9170 é inserido no furo passante fendido 9156 no primeiro conjunto de fixação 9154. Em ao menos uma disposição, o segundo membro de fixação compreende um corpo 9172 que inclui um membro transversal de topo 9174. O corpo 9172 tem um recurso ou recursos de retenção sob a forma de roscas ou anteparos deformáveis 9176 formados no mesmo. Para fixar a ponta de bigorna deformável 9150 ao corpo de bigorna 9102, o pri- meiro conjunto de fixação 9154 é inserido na disposição de fenda em formato de T 9122 na direção de inserção IDg e assentado nas cavi- dades 9124. O corpo 9172 do segundo membro de fixação 9170 é in- serido no furo passante fendido 9156 no primeiro membro de fixação 9154 na direção de inserção IDg. Em ao menos uma disposição, o furo passante fendido 9156 é dimensionado em relação à porção de corpo 9172 do segundo membro de fixação 9170 de modo a fazer com que as abas de fixação flexíveis 9058, 9160 se flexionem lateralmente para fora em direções laterais de fixação em engate de retenção lateral com as cavidades correspondentes 9124. Após o segundo membro de fixa- ção 9170 ter sido inserido no furo passante fendido 9156 no primeiro conjunto de fixação 9154, os anteparos deformáveis 9176 no mesmo retêm o segundo membro 9170 em engate de retenção e impedem sua retenção do furo passante 9156. Em uma disposição, o segundo membro de fixação 9170 é inserido sob pressão no do furo passante fendido 9156. Em uma outra disposição, o segundo membro de fixa- ção 9170 é aquecido e inserido sob pressão (estaqueamento térmico) de modo que quando o segundo membro de fixação 9170 foi inserido e assentado no furo passante fendido 9156, os anteparos 9176 são permanentemente deformados para reter o segundo membro de fixa- ção 9170 em posição. No exemplo ilustrado, recursos ou nódulos de preensão de tecido 9178 são formados ou na porção de topo 9174 do segundo membro de fixação 9170 para auxiliar na preensão do tecido com a bigorna 9100. Como também pode ser visto na Figura 46, a bi- gorna 9100 pode compreender uma tampa de bigorna 9180 que é di- mensionada para cobrir a fenda alongada 9106 no corpo de bigorna
9102. A tampa de bigorna 9180 pode ser fabricada do mesmo material que compreende o corpo de bigorna 9102 e ser soldada ao corpo da bigorna 9102. Após a ponta da bigorna deformável 9150 ter sido fixada ao corpo da bigorna 9102, uma ponta distal 9151 da ponta da bigorna 9150 se inclina abaixo da subsuperfície de formação de grampos 9104 do corpo de bigorna 9102. Consulte a Figura 47. Em uma disposição, a ponta da bigorna deformável 9150 pode ter uma largura constante ao longo de todo o seu comprimento e também ter uma porção qua- drada relativa de extremidade distal.
[0167] Voltando a seguir às Figuras 48 e 49, é mostrada uma bi- gorna 9200 que compreende um corpo de bigorna 9202 que inclui uma subsuperfície de formação de grampos genericamente designada co- mo 9204. A bigorna 9200 compreende uma ponta de bigorna deformá- vel 9250 que é fixada a uma extremidade distal; 9220 do corpo da bi- gorna 9202. Na disposição ilustrada, o corpo da bigorna 9202 pode ser fabricado de um primeiro material que pode compreender um primeiro material de metal como aço inoxidável, titânio, etc. A ponta da bigorna deformável 9050 pode ser fabricada de um segundo material que é mais flexível e deformável do que o primeiro material e compreende, por exemplo, um material plástico. Em ao menos uma disposição, a ponta de bigorna deformável 9250 é fabricada de plástico termofixo que não se remodela sob calor, por exemplo. No exemplo mostrado nas Figuras 48 e 49, um membro de fixação que se estende distalmen- te ou conjunto de pino 9230 é formado na extremidade distal 9020 do corpo da bigorna 9202. Como pode ser visto na Figura 48, em uma disposição, o conjunto de fixação 9230 compreende uma primeira por- ção plana 9232 que se estende a partir de um anteparo de moldagem arqueado 9225 que se projeta a partir da extremidade distal 9220 do corpo de bigorna 9202. Uma porção de pino segmentada 9234 é fixa- da à primeira porção plana 9232 de modo que ela se estenda trans- versalmente a partir da mesma. A porção de fixação plana 9232 pode além disso ter um orifício 9236 na mesma para facilitar o fluxo do ma- terial da ponta flexível através da mesma quando a ponta da bigorna 9250 é moldada à mesma ponta. Como pode ser comum com vários conjuntos de bigorna, o corpo de bigorna dos mesmos pode ser reves-
tido com um material escorregadio para facilitar a formação aprimora- da dos grampos bem como a inserção através de cânulas de trocarte, etc. No exemplo ilustrado, a porção do corpo da bigorna 9202 que é proximal à posição de extremidade distal posição 9220 pode ser lubri- ficada dessa maneira, por exemplo. No entanto, o conjunto de fixação 9230 pode ser gravado para remover qualquer lubrificação dali e otimi- zar a adesão da ponta da bigorna deformável moldada com sobreposi- ção 9250 ao corpo da bigorna 9202. O processo de gravação pode criar uma superfície de adesão por atrito à qual o segundo material é melhor aderido. Em outras disposições, por exemplo, o conjunto de fixação pode ser coberto durante a aplicação da lubrificação ao corpo de bigorna para evitar que o meio de lubrificação seja aplicado ao con- junto de fixação. Após a ponta da bigorna deformável 9250 ter sido moldada ao corpo da bigorna 9202, uma porção de extremidade distal 9251 da ponta da bigorna 9250 se inclina abaixo da subsuperfície de formação de grampos 9204 do corpo de bigorna 9202. Em uma dispo- sição, a ponta da bigorna deformável 9250 pode ter uma largura cons- tante ao longo de todo o seu comprimento e também ter uma porção quadrada relativa de extremidade distal.
[0168] Com referência agora às Figuras 50 e 51, uma outra dispo- sição de bigorna 9300 compreende um corpo de bigorna 9302 que in- clui uma subsuperfície de formação de grampos genericamente desig- nada 9304 através da qual uma fenda alongada 9306 passa. Como pode ser visto nas Figuras 50 e 51, a bigorna 9300 inclui um conjunto de ponta de bigorna deformável 9350 que é fixado a uma extremidade distal; 9320 do corpo da bigorna 9302.
[0169] Na disposição ilustrada, o corpo da bigorna 9302 pode ser fabricado de um primeiro material que pode compreender um primeiro material de metal como aço inoxidável, titânio, etc. Uma primeira por- ção 9351 do conjunto de ponta de bigorna deformável 9350 pode ser fabricada de um segundo material que é mais flexível e deformável do que o primeiro material e pode compreender, por exemplo, material plástico.
Em ao menos uma disposição, o conjunto de ponta de bigor- na deformável 9350 compreende uma primeira porção de ponta 9351 que compreende um plástico termofixo que não se remodela sob calor, por exemplo.
No exemplo mostrado nas Figuras 50 e 51, a ponta de bigorna deformável 9350 inclui uma porção de fixação 9352 que com- preende uma aba de fixação que se estende proximalmente 9354. Em uma disposição, a aba de fixação 9354 é configurada para ser recebi- da em uma cavidade de formato correspondente 9322 que é formada na extremidade distal 9320 do corpo da bigorna 9302. A aba de fixa- ção 9354 é retida no interior da cavidade 9322 por uma tampa de bi- gorna 9380 que é dimensionada para cobrir a fenda 9306 no corpo de bigorna 9302. Quando a tampa de bigorna 9380 é fixada ao corpo da bigorna 9302, a tampa de bigorna 9380 retém a aba de fixação 9354 na cavidade 9322 para fixar o conjunto de ponta de bigorna deformá- vel 9350 ao corpo de bigorna 9302. Além disso, a primeira porção 9351 do conjunto de ponta de bigorna deformável 9350 pode também ser dotada de uma fenda 9355 que é configurada para receber em seu interior um elemento de inserção de ponta 9390. Em uma disposição, o elemento de inserção de ponta 9390 é fabricado a partir de um mate- rial que é mais rígido que o segundo material a partir do qual a primei- ra porção de ponta é fabricado.
Em um exemplo, a primeira porção 9351 do conjunto de ponta de bigorna 9350 pode ser moldada à ponta de inserção 9390. Em algumas disposições, o elemento de inserção de ponta 9390 pode ser adicionalmente soldado ou fixado ao corpo da bigorna 9302. Após o conjunto de ponta da bigorna deformável 9350 ter sido fixado ao corpo da bigorna 9302, uma porção de extremidade distal 9353 do conjunto de ponta da bigorna 9350 se inclina abaixo da subsuperfície de formação de grampos 9304 do corpo de bigorna
9302. Consulte as Figuras 50 e 51. Em uma disposição, o conjunto de ponta de bigorna 9350 pode tem uma largura constante ao longo de todo seu comprimento e também ter uma porção quadrada relativa de extremidade distal. Exemplos
[0170] Exemplo 1 - Uma bigorna para um grampeador cirúrgico que compreende um corpo de bigorna que é fabricado a partir de um primeiro material. O corpo de bigorna define um eixo geométrico longi- tudinal. Um membro de ponta é fabricado a partir de um segundo ma- terial que é diferente do primeiro material. O membro de ponta com- preende uma primeira porção de fixação flexível que é configurada pa- ra ser recebida dentro de uma abertura em uma extremidade distal do corpo da bigorna. Uma porção distal se projeta em um ângulo a partir da primeira porção de fixação flexível. A bigorna compreende adicio- nalmente um segundo membro de fixação que é configurado para en- gatar de maneira não removível a primeira porção de fixação flexível para propender a primeira porção de fixação flexível no engate de re- tenção com as porções correspondentes da extremidade distal do cor- po da bigorna.
[0171] Exemplo 2 - A bigorna do Exemplo 1, na qual a primeira porção de fixação flexível compreende uma abertura fendida através da mesma para receber o segundo membro de fixação no mesmo em uma direção de inserção que é transversal ao eixo geométrico de bi- gorna.
[0172] Exemplo 3 - A bigorna do Exemplo 2, na qual o segundo membro de fixação é inserido na abertura fendida sob uma aplicação de pressão e calor ao segundo membro de fixação.
[0173] Exemplo 4 - A bigorna dos Exemplos 1, 2 ou 3, na qual o segundo membro de fixação é fabricado a partir de material permanen- temente deformável.
[0174] Exemplo 5 - A bigorna dos Exemplos 1, 2, 3 ou 4, na qual o primeiro material compreende um metal e na qual o segundo material compreende um material plástico.
[0175] Exemplo 6 - A bigorna do Exemplo 5, na qual o metal com- preende titânio e na qual o segundo material compreende um plástico termofixo.
[0176] Exemplo 7 - A bigorna dos Exemplos 1, 2, 3, 4, 5 ou 6, na qual o corpo de bigorna compreende adicionalmente uma fenda alon- gada e uma subsuperfície de formação de grampos. A bigorna com- preende adicionalmente uma tampa de bigorna que é configurada para ser fixada ao corpo da bigorna para cobrir pelo menos uma porção de uma extremidade superior da fenda alongada e reter a primeira porção de fixação flexível dentro da abertura na extremidade distal do corpo da bigorna.
[0177] Exemplo 8 - A bigorna do Exemplo 7, na qual a tampa de bigorna é fabricada a partir do primeiro material e é configurada para ser soldada ao corpo da bigorna.
[0178] Exemplo 9 - A bigorna dos Exemplos 7 ou 8, na qual o membro de ponta é fixado à extremidade distal do corpo de bigorna e a porção distal do membro de ponta se estende abaixo da subsuperfi- cie de formação de grampos.
[0179] Exemplo 10 - A bigorna dos Exemplos 1, 2, 3, 4, 5,6,7,8 ou 9, na qual o segundo membro de fixação tem recursos de preensão de tecido no mesmo.
[0180] Exemplo 11 - A bigorna dos Exemplos 1, 2, 3, 4, 5, 6,7, 8, 9 ou 10, na qual o segundo membro de fixação inclui uma porção de corpo e uma porção transversal que se estende transversalmente a partir da porção de corpo. A porção de corpo transversal tem um re- curso de preensão de tecido na mesma. Recursos de retenção perma- nentemente deformáveis são fornecidos sobre a porção de corpo.
[0181] Exemplo 12 - Uma bigorna para um grampeador cirúrgico, sendo que a bigorna compreende um corpo de bigorna que é fabricado a partir de um primeiro material e compreende um membro de fixação que se estende distalmente que se projeta a partir de uma extremida- de distal do mesmo. Um membro de ponta é fabricado a partir de um segundo material que é diferente do primeiro material e é configurado para ser moldado ao redor do membro de fixação que se estende dis- talmente. O corpo de bigorna inclui um meio de lubrificação no mesmo; entretanto, o membro de fixação que se estende distalmente não tem meio de lubrificação no mesmo.
[0182] Exemplo 13 - A bigorna do Exemplo 12, na qual o corpo de bigorna define uma subsuperfície de formação de grampos e sendo que o membro de ponta compreende uma porção de fixação proximal e uma porção de extremidade distal que se estende em um ângulo a partir da porção de fixação proximal de modo que a porção de extre- midade distal se estenda abaixo da subsuperfície de formação de grampos do corpo de bigorna.
[0183] Exemplo 14 - A bigorna dos Exemplos 12 ou 13, na qual o primeiro material compreende um material de metal e na qual o se- gundo material compreende um material termoplástico.
[0184] Exemplo 15 - A bigorna dos Exemplos 12, 13 ou 14, na qual o membro de fixação que se estende distalmente compreende uma porção de fixação plana que se projeta distalmente a partir da extremi- dade distal do corpo da bigorna e uma porção transversal que é fixada à porção de fixação plana e se estende transversalmente a partir da mesma.
[0185] Exemplo 16 - A bigorna do Exemplo 15, na qual a porção transversal tem uma pluralidade de pinos formados na mesma.
[0186] Exemplo 17 - A bigorna do Exemplo 16, na qual a porção de fixação plana tem um orifício através da mesma.
[0187] Exemplo 18 - Uma bigorna para um grampeador cirúrgico, sendo que a bigorna compreende um corpo de bigorna que é fabricado a partir de um primeiro material e define uma fenda alongada que se estende através do mesmo. Um membro de ponta é fabricado a partir de um segundo material que é diferente do primeiro material. O mem- bro de ponta compreende uma primeira porção de fixação que é confi- gurada para ser recebida dentro de uma abertura em uma extremidade distal do corpo da bigorna. Uma porção distal se projeta em um ângulo a partir da primeira porção de fixação flexível. A bigorna compreende adicionalmente uma tampa de bigorna que é configurada para ser fi- xada ao corpo da bigorna para cobrir pelo menos uma porção de uma extremidade superior da fenda alongada e reter a primeira porção de fixação dentro da abertura na extremidade distal do corpo da bigorna.
[0188] Exemplo 19 - A bigorna do Exemplo 18, na qual o membro de ponta compreende adicionalmente um elemento de inserção que é fixado ao mesmo que é fabricado a partir de um material de inserção que difere do segundo material.
[0189] Exemplo 20 - A bigorna do Exemplo 19, na qual o material de inserção compreende um primeiro material.
[0190] Muitos dos sistemas de instrumento cirúrgico aqui descritos são acionados por um motor elétrico; entretanto, os sistemas de ins- trumento cirúrgico aqui descritos podem ser induzidos de qualquer maneira adequada. Em vários exemplos, os sistemas de instrumento cirúrgico aqui descritos podem ser induzidos, por exemplo, por um ga- tilho manualmente operado. Em certos casos, os motores revelados no presente documento podem compreender uma porção ou porções de um sistema roboticamente controlado. Além disso, qualquer um dos atu- adores de extremidade e/ou conjuntos de ferramenta apresentados na presente invenção pode ser utilizado com um sistema de instrumento cirúrgico robótico. O pedido de patente US nº de série 13/118.241, intitu-
lado SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS, agora patente US nº
9.072.535, por exemplo, revela vários exemplos de um sistema de ins- trumento cirúrgico robótico com mais detalhes.
[0191] Os sistemas de instrumento cirúrgico aqui descritos foram descritos em conexão com a implantação e a deformação dos gram- pos; 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 atuador de extremidade de acordo com certas modalidades, pode aplicar energia vibracional para vedar o tecido.
[0192] A totalidade das revelações de: - patente US nº 5.403.312, intitulada "ELECTROSURGICAL HEMOSTATIC DEVICE", que foi concedida em 4 de abril de 1995; - patente US nº 7.000.818, intitulada "SURGICAL STA-
PLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS", que foi concedida em 21 de fevereiro de 2006; - patente US nº 7.422.139, intitulada "MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITH TACTI- LE POSITION FEEDBACK", que foi concedida em 9 de setembro de 2008; - patente US nº 7.464.849, intitulada "ELECTRO-
MECHANICAL SURGICAL INSTRUMENT WITH CLOSURE SYSTEM AND ANVIL ALIGNMENT COMPONENTS", que foi concedida em 16 de dezembro de 2008;
- patente US nº 7.670.334, intitulada "SURGICAL INS- TRUMENT HAVING AN ARTICULATING END EFFECTOR", que foi concedida em 2 de março de 2010; - patente US nº 7.753.245, intitulada "SURGICAL STA- PLING INSTRUMENTS", que foi concedida em 13 de julho de 2010; - patente US nº 8.393.514, intitulada "SELECTIVELY ORI- ENTABLE IMPLANTABLE FASTENER CARTRIDGE", que foi conce- dida em 12 de março de 2013; - pedido de patente US nº de série 11/343.803, intitulado "SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES"; agora patente US nº 7.845.537; - pedido de patente US nº de série 12/031.573, intitulado "SURGICAL CUTTING AND FASTENING INSTRUMENT HAVING RF ELECTRODES", depositado em 14 de fevereiro de 2008; - pedido de patente US nº de série 12/031.873, intitulado "END EFFECTORS FOR A SURGICAL CUTTING AND STAPLING INSTRUMENT", depositado em 15 de fevereiro de 2008, agora patente US nº 7.980.443; - pedido de patente US nº de série 12/235.782, intitulado "MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT", agora pa- tente US nº 8.210.411; - pedido de patente US nº de série 12/235.972, intitulado MOTORIZED SURGICAL INSTRUMENT, agora patente US nº
9.050.083; - pedido de patente US nº de série 12/249.117, intitulado "POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLY RETRACTABLE FIRING SYSTEM", agora patente US nº 8.608.045; - pedido de patente US nº de série 12/647.100, intitulado "MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT WITH ELEC-
TRIC ACTUATOR DIRECTIONAL CONTROL ASSEMBLY", deposita- do em 24 de dezembro de 2009; agora patente US nº 8.220.688;
- pedido de patente US nº de série 12/893.461, intitulado "STAPLE CARTRIDGE", depositado em 29 de setembro de 2012, ago- ra patente US nº 8.733.613;
- pedido de patente US nº de série 13/036.647, intitulado "SURGICAL STAPLING INSTRUMENT", depositado em 28 de feverei- ro de 2011, agora patente US nº 8.561.870;
- pedido de patente US nº de série 13/118.241, intitulado "SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT —ARRANGEMENTS", agora patente US mn 2012/9.072.535;
- pedido de patente US nº de série 13/524.049, intitulado "ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A Fl- RING DRIVE", depositado em 15 de junho de 2012; agora patente US nº 9.101.358;
- pedido de patente US nº de série 13/800.025, intitulado "STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM", depositado em 13 de março de 2013, agora patente US nº 9.345.481;
pedido de patente US nº de série 13/800.067, intitulado "STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM", depositado em 13 de março de 2013, agora publicação de pedido de patente US nº 2014/0263552;
- publicação de pedido de patente US nº 2007/0175955, in- titulada "SURGICAL CUTTING AND FASTENING INSTRUMENT WITH CLOSURE TRIGGER LOCKING MECHANISM", depositada em 31 de janeiro de 2006; e
- publicação de pedido de patente US nº 2010/0264194, in- titulada "SURGICAL STAPLING INSTRUMENT WITH AN ARTICULA- TABLE END EFFECTOR", depositada em 22 de abril de 2010, agora patente US nº 8.308.040, estão aqui incorporados por referência.
[0193] Embora vários dispositivos tenham sido aqui descritos em conexão com determinadas modalidades, modificações e variações dessas modalidades podem ser implementadas. Os recursos, estrutu- ras ou características específicos podem ser combinados de qualquer maneira adequada em uma ou mais modalidades. Portanto, os recur- Sos, as estruturas ou as características específicos ilustrados ou des- critos em conexão com uma modalidade podem ser combinados, no todo ou em parte, com os recursos, estruturas ou características de uma ou mais outras modalidades, sem limitação. Além disso, quando forem revelados materiais para determinados componentes, outros materiais podem ser usados. Além disso, de acordo com várias moda- lidades, um único componente pode ser substituído por múltiplos com- ponentes e múltiplos componentes podem ser substituídos por um úni- co componente, para executar uma ou mais funções determinadas. À descrição mencionada anteriormente e as reivindicações seguintes são destinadas a abranger todas essas modificações e variações.
[0194] Os dispositivos aqui revelados podem ser projetados para serem descartados após um único uso, ou podem ser projetados para serem usados múltiplas vezes. Em qualquer um dos casos, entretanto, um dispositivo pode ser recondicionado para reuso após ao menos um uso. O recondicionamento pode incluir qualquer combinação das eta- pas incluindo, mas não se limitando a, a desmontagem do dispositivo seguida de limpeza ou substituição de peças específicas do dispositivo e remontagem subsequente do dispositivo. Em particular, uma instala- ção 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 subsequen- te. Os versados na técnica entenderão que o recondicionamento de um dispositivo pode usar uma variedade de técnicas para desmontar,
limpar/substituir e remontar. O uso dessas técnicas, bem como o dis- positivo recondicionado resultante, estão todos no escopo do presente pedido.
[0195] Os dispositivos revelados aqui podem ser processados an- tes da cirurgia. Primeiro, um instrumento novo ou usado pode ser obti- do e, se necessário, limpo. O instrumento pode ser, então, esterilizado. Em uma técnica de esterilização, o instrumento é disposto em um re- cipiente fechado e vedado, como uma bolsa plástica ou de TYVEK. O recipiente e o instrumento podem, então, ser colocados em um campo de radiação que possa penetrar no recipiente, como radiação gama, raios X e/ou elétrons de alta energia. A radiação pode exterminar as bactérias no instrumento e no recipiente. O instrumento esterilizado pode, então, ser armazenado em um recipiente estéril. O recipiente vedado pode manter o instrumento estéril até que seja aberto na insta- lação médica. Um dispositivo pode também ser esterilizado com o uso de qualquer outra técnica conhecida, incluindo, mas não se limitando a, radiação beta, radiação gama, óxido de etileno, peróxido de plasma e/ou vapor dágua.
[0196] 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 revelação. Pretende-se, portanto, que este pedido cubra quaisquer variações, usos ou adapta- ções da invenção com o uso de seus princípios gerais.

Claims (20)

REIVINDICAÇÕES
1. Bigorna para um grampeador cirúrgico, caracterizada por compreender: um corpo de bigorna fabricado a partir de um primeiro ma- terial e que define um eixo geométrico de bigorna; e um membro de ponta fabricado a partir de um segundo ma- terial que difere do dito primeiro material, sendo que o dito membro de ponta compreende: uma primeira porção de fixação flexível configurada para ser recebida dentro de uma abertura em uma extremidade distal do dito corpo de bigorna; e uma porção distal que se projeta em um ângulo a partir da dita primeira porção de fixação flexível e sendo que a dita bigorna compreende adicionalmente um segundo membro de fixação configu- rado para engatar de maneira não removível a dita primeira porção de fixação flexível para propender a dita primeira porção de fixação flexí- vel em engate de retenção com as porções correspondentes da dita extremidade distal do dito corpo de bigorna.
2. Bigorna, de acordo com a reivindicação 1, caracterizada por a dita primeira porção de fixação flexível compreender uma abertu- ra fendida através da mesma para receber o dito segundo membro de fixação na mesma em uma direção de inserção que é transversal ao dito eixo geométrico de bigorna.
3. Bigorna, de acordo com a reivindicação 2, caracterizada por o dito segundo membro de fixação ser inserido na dita abertura fendida sob uma aplicação de pressão e calor ao dito segundo mem- bro de fixação.
4. Bigorna, de acordo com a reivindicação 1, caracterizada por o dito segundo membro de fixação ser fabricada de material per- manentemente deformável.
5. Bigorna, de acordo com a reivindicação 1, caracterizada por o dito primeiro material compreender um metal e sendo que o dito segundo material compreende um material plástico.
6. Bigorna, de acordo com a reivindicação 5, caracterizada por o dito metal compreender titânio e sendo que o dito segundo mate- rial compreende um plástico termofixo.
7. Bigorna, de acordo com a reivindicação 1, caracterizada por o dito corpo de bigorna compreender adicionalmente: uma fenda alongada; e uma subsuperfície de formação de grampos e sendo que a dita bigorna compreende uma tampa de bigorna configurada para ser fixada ao dito corpo da bigorna para cobrir pelo menos uma porção de uma extremidade superior da dita fenda alongada e reter a dita primei- ra porção de fixação flexível dentro da dita abertura na dita extremida- de distal do dito corpo da bigorna.
8. Bigorna, de acordo com a reivindicação 7, caracterizada por a dita tampa de bigorna ser fabricada a partir do dito primeiro ma- terial e ser configurada para ser soldada ao dito corpo de bigorna.
9. Bigorna, de acordo com a reivindicação 7, caracterizada por o dito membro de ponta ser fixado à dita extremidade distal do dito corpo de bigorna e a dita porção distal do dito membro de ponta se estender abaixo da dita subsuperfície de formação de grampos.
10. Bigorna, de acordo com a reivindicação 2, caracterizada por o dito segundo membro de fixação compreender recursos de pre- ensão do tecido no mesmo.
11. Bigorna, de acordo com a reivindicação 10, caracteriza- da por o dito segundo membro de fixação compreender: uma porção de corpo; uma porção transversal que se estende transversalmente a partir da dita porção de corpo e que compreende os ditos recursos de preensão de tecido no mesmo; e recursos de retenção permanentemente deformáveis na di- ta porção de corpo.
12. Bigorna para um grampeador cirúrgico, caracterizada por compreender: um corpo de bigorna fabricado a partir de um primeiro ma- terial e que compreende um membro de fixação que se estende dis- talmente que se projeta a partir de uma extremidade distal do mesmo; e um membro de ponta fabricado a partir de um segundo ma- terial que difere do dito primeiro material e é configurado para ser mol- dado ao redor do dito membro de fixação que se estende distalmente, sendo que o dito corpo de bigorna compreende um meio de lubrifica- ção no mesmo e sendo que o dito membro de fixação que se estende distalmente não possui o dito meio de lubrificação.
13. Bigorna, de acordo com a reivindicação 12, caracteriza- da por o dito corpo de bigorna definir uma subsuperfície de formação de grampos e sendo que o dito membro de ponta compreende: uma porção de fixação proximal; e uma porção de extremidade distal que se estende em um ângulo a partir da dita porção de fixação proximal de modo que a dita porção de extremidade distal se estende abaixo da dita subsuperfície de formação de grampos do dito corpo de bigorna.
14. Bigorna, de acordo com a reivindicação 12, caracteriza- da por o dito primeiro material compreender um material de metal e sendo que o dito segundo material compreende um material termo- plástico.
15. Bigorna, de acordo com a reivindicação 12, caracteriza- da por o dito membro de fixação que se estende distalmente compre- ender:
uma porção de fixação plana que se projeta distalmente a partir da dita extremidade distal do dito corpo de bigorna; e uma porção transversal fixada à dita porção de fixação pla- na e que se estende transversalmente a partir da mesma.
16. Bigorna, de acordo com a reivindicação 15, caracteriza- da por a dita porção transversal compreender uma pluralidade de pi- nos formados na mesma.
17. Bigorna, de acordo com a reivindicação 15, caracteriza- da por a dita porção de fixação plana compreender um orifício através da mesma.
18. Bigorna para um grampeador cirúrgico, caracterizada por compreender: um corpo de bigorna fabricado a partir de um primeiro ma- terial e que define uma fenda alongada que se estende através do mesmo; um membro de ponta fabricado a partir de um segundo ma- terial que difere do dito primeiro material, o dito membro de ponta compreende: uma primeira porção de fixação configurada para ser rece- bida dentro de uma abertura em uma extremidade distal do dito corpo de bigorna; e uma porção distal que se projeta em um ângulo a partir da dita primeira porção de fixação flexível e sendo que a dita bigorna compreende adicionalmente uma tampa de bigorna configurada para ser fixada ao dito corpo de bigorna para cobrir ao menos uma porção de uma extremidade superior da dita fenda alongada e reter a dita pri- meira porção de fixação dentro da dita abertura na dita extremidade distal do dito corpo de bigorna.
19. Bigorna, de acordo com a reivindicação 18, caracteriza- da por o dito membro de ponta compreender adicionalmente um ele-
mento de inserção fixado ao mesmo que é fabricado a partir de um material de elemento de inserção que difere do dito segundo material.
20. Bigorna, de acordo com a reivindicação 19, caracteriza- da por o dito material de elemento de inserção compreender o dito primeiro material.
BR112021003054-9A 2018-08-20 2019-08-13 ponta de bigorna deformável reforçada para bigorna de grampeador cirúrgico BR112021003054A2 (pt)

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PCT/IB2019/056873 WO2020039305A2 (en) 2018-08-20 2019-08-13 Reinforced deformable anvil tip for surgical stapler anvil

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EP3613362A2 (en) 2020-02-26
US10912559B2 (en) 2021-02-09
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US20200054327A1 (en) 2020-02-20
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