BRPI0901315A2 - instrumento grampeador cirúrgico de retorno engrenado - Google Patents
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
-
- 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
- A61B17/295—Forceps for use in minimally invasive surgery combined with cutting implements
-
- 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
- A61B2017/00318—Steering mechanisms
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00681—Aspects not otherwise provided for
- A61B2017/00734—Aspects not otherwise provided for battery operated
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07271—Stapler heads characterised by its cartridge
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07285—Stapler heads characterised by its cutter
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B17/2909—Handles
- A61B2017/2912—Handles transmission of forces to actuating rod or piston
- A61B2017/2913—Handles transmission of forces to actuating rod or piston cams or guiding means
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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
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B17/2909—Handles
- A61B2017/2912—Handles transmission of forces to actuating rod or piston
- A61B2017/2913—Handles transmission of forces to actuating rod or piston cams or guiding means
- A61B2017/2916—Handles transmission of forces to actuating rod or piston cams or guiding means pins in guiding slots
-
- 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
- A61B17/2909—Handles
- A61B2017/2912—Handles transmission of forces to actuating rod or piston
- A61B2017/2923—Toothed members, e.g. rack and pinion
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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
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
- A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
- A61B2017/2943—Toothed members, e.g. rack and pinion
-
- 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
- A61B2017/2946—Locking means
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0807—Indication means
- A61B2090/0811—Indication means for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument
Abstract
INSTRUMENTO GRAMPEADOR CIRúRGICO DE RETORNO ENGRENADO. A presente invenção refere-se a um instrumento cirúrgico que inclui um acionador de disparo configurado para avançar seletivamente umelemento de disparo e/ou um elemento de corte com relação a um efetor de extremidade e, adicionalmente, um acionador reverso configurado para retrair seletivamente o elemento de disparo e/ou elemento de corte com relação ao efetor de extremidade. O acionador de disparo pode incluir uma garra que pode ser seletivamente engatada com o elemento de disparo a fim de avançar o elemento de disparo, em que a garra pode ser desengatada do elemento de disparo quando o acionador reverso é engatado com o elemento de disparo. O acionador reverso pode incluir um trem de engrenagempossuindo uma primeira engrenagem operacionaímente engatada com o elemento de disparo e, adicionalmente, uma segunda engrenagem operacionalmente engatada com a primeira engrenagem, em que a segunda engrenagem pode ser seletivamente operável com o gatilho de modo que um acionamento do gatilho possa retrair o elemento de disparo e/ou o elemento de corte através das primeira e segunda engrenagens.
Description
Relatório Descritivo da Patente de Invenção para "INSTRUMENTO GRAMPEADOR CIRÚRGICO DE RETORNO ENGRENADO".
Referência Gruzada a Pedido Relacionado
O presente pedido de patente é um pedido de patente continua-ção em parte reivindicando os benefícios sob 35 U.S.C. § 120 do pedido depatente copendente U.S. Ns 11/821.277, intitulado SURGICAL STAPLINGINSTRUMENTS, depositado em 22 de junho de 2007, a descrição do qual éincorporada aqui por referência.
Antecedentes
Campo da Invenção
A presente invenção refere-se a instrumentos grampeadorescirúrgicos e, mais particularmente, a grampeadores cirúrgicos possuindo umsistema de fechamento para o fechamento de um efetor de extremidade eum sistema de disparo para aplicar os grampos.
Descrição da Técnica Relacionada
Como ilustrado na técnica, os grampeadores cirúrgicos são fre-qüentemente utilizados para aplicar grampos em tecido mole a fim de reduzirou eliminar o sangramento do tecido mole, especialmente enquanto o tecidoestá sofrendo uma transeção, por exemplo. Os grampeadores cirúrgicos, talcomo um endocortador, por exemplo, podem compreender um efetor dé ex-tremidade que pode ser movido, ou articulado, com relação a um conjuntode eixo alongado. Os efetores de extremidade são freqüentemente configu-rados para prender o tecido mole entre os primeiro e segundo elementos demandíbula onde o primeiro elemento de mandíbula freqüentemente inclui umcartucho de grampos que é configurado para nele armazenar de forma re-movível grampos e o segundo elemento de mandíbula freqüentemente incluiuma placa de apoio. Tais grampeadores cirúrgicos podem incluir um sistemade encerramento para articular a placa de apoio com relação ao cartucho degrampos. Esses sistemas de encerramento, no entanto, não impedem que oefetor de extremidade seja articulado com relação ao conjunto de eixo de-pois que os elementos de mandíbula foram fechados. Como resultado disso,quando o efetor de extremidade é articulado, o efetor de extremidade podeaplicar uma força de cisalhamento ao tecido mole capturado entre os ele-mentos de mandíbula.
Os grampeadores cirúrgicos, como destacados acima, podemser configurados para articular a placa de apoio do efetor de extremidadecom relação ao cartucho de grampos a fim de capturar o tecido mole entreos mesmos. Em várias circunstâncias, a placa de apoio pode ser configura-da para aplicar uma força de fixação ao tecido mole a fim de reter o tecidomole o mais justo possível entre a placa de apoio e o cartucho de grampos.Se um cirurgião estiver insatisfeito com a posição do efetor de extremidade,no entanto, o cirurgião deve tipicamente ativar um mecanismo de liberaçãono grampeador cirúrgico para articular a placa de apoio para uma posiçãoaberta e então reposicionar o efetor de extremidade. Depois disso, os gram-pos são tipicamente aplicados a partir do cartucho de grampos por um acio-nador que atravessa um canal no cartucho de grampos e faz com que osgrampos sejam deformados contra a placa de apoio e camadas retidasde tecido mole. Freqüentemente, como sabido na técnica, os grampossão aplicados em várias linhas ou fileiras de grampos, a fim de prender deforma mais confiável as camadas de tecido. O efetor de extremidade tam-bém pode incluir um elemento de corte, tal como uma lâmina, por exemplo,que é avançado entre duas fileiras de grampos para formar uma ressecçãono tecido mole depois que as camadas de tecido molde foram grampeadasjuntas.
Depois que o acionador e o elemento de corte foram avançadosdentro do efetor de extremidade, é freqüentemente necessário se retrair oacionador e/ou elemento de corte para suas posições iniciais. Os grampea-dores cirúrgicos anteriores incluíam uma mola de retorno que retrai o ele-mento de corte com relação ao cartucho de grampos após o acionamento deum botão de liberação ou comutador tipo cotovelo no grampeador cirúrgico,por exemplo~Em-várias-modalidades, uma primeira extremidade da mola deretorno pode ser conectada ao alojamento do instrumento cirúrgico e umasegunda extremidade da mola pode ser conectada ao elemento de corte.Tais grampeadores, no entanto, são freqüentemente difíceis de se usar vistoque a força necessária para se estender a mola de retorno enquanto o ele-mento de corte é avançado é freqüentemente significativa. Adicionalmente,tais molas de retorno freqüentemente aplicam uma força de orientação aoelemento de corte à medida que o mesmo é avançado que pode, em váriascircunstâncias, retornar de forma prematura o elemento de corte, especial-mente nas modalidades onde múltiplos passos de um gatilho são necessá-rios para se avançar completamente o elemento de corte. O que se precisa éde um aperfeiçoamento sobre o acima exposto.
Sumário
Em pelo menos uma forma da invenção, um instrumento cirúrgi-co pode incluir um conjunto de eixo, e um efetor de extremidade móvel comrelação ao conjunto de eixo, e um mecanismo de travamento configuradopara engatar o conjunto de eixo e/ou o efetor de extremidade a fim de fixar,ou travar, a relação relativa entre o conjunto de eixo e o efetor de extremida-de. Em várias modalidades, o efetor de extremidade pode incluir uma placade apoio e um canal onde o canal pode ser configurado para receber umcartucho de grampos e a placa de apoio pode ser acoplada de forma móvelao canal. Em pelo menos uma modalidade, o instrumento cirúrgico pode in-cluir adicionalmente um sistema de encerramento configurado para gerar ummovimento de encerramento onde a placa de apoio pode responder ao mo-vimento de encerramento. Em várias modalidades, o sistema de encerra-mento pode ser adicionalmente configurado para engatar o mecanismo detravamento e impedir que o mecanismo de travamento destrave a relaçãorelativa entre o conjunto de eixo e o efetor de extremidade.
Em pelo menos uma forma da invenção, um instrumento cirúrgi-co pode incluir um sistema de encerramento configurado para mover umaplaca de apoio de um efetor de extremidade, por exemplo, entre uma posi-ção aberta, uma posição parcialmente fechada, e uma posição fechada. Emvárias modalidades o instrumento cirúrgico pode incluir adicionalmente umelemento de travamento configurado para engatar seletivamente e travar osistema de encerramento quando a placa de apoio é posicionada em uma desuas posições parcialmente fechada e fechada. Em pelo menos uma moda-lidade, o instrumento cirúrgico pode incluir um gatilho configurado para arti-cular a placa de apoio, por exemplo, onde o gatilho pode incluir uma superfí-cie de carne e um primeiro entalhe na superfície de carne. Em várias modali-dades, o elemento de travamento pode incluir uma parte seguidora e o acio-nador de encerramento pode incluir uma mola de travamento configuradapara orientar a parte seguidora contra a superfície de carne do gatilho deforma que a parte seguidora possa engatar o primeiro entalhe do gatilhoquando a placa de apoio é articulada para sua posição parcialmente fecha-da. Em pelo menos uma modalidade, quando a parte seguidora é engatadacom o primeiro entalhe, o primeiro entalhe pode impedir que a placa de a-poio seja articulada para sua posição abeta. Em várias modalidades, a partede carne pode adicionalmente incluir um segundo entalhe e a parte seguido-ra pode ser configurada para engatar o segundo entalhe quando a placa deapoio é articulada para sua posição fechada.
Em pelo menos uma forma da invenção, um instrumento cirúrgi-co pode incluir um acionador de disparo compreendendo um elemento dedisparo configurado para avançar um elemento de corte dentro de um efetorde extremidade, por exemplo, e uma faixa flexível conectada ao elemento dedisparo configurado para retrair o elemento de disparo. Em pelo menos umamodalidade, o instrumento cirúrgico pode incluir um freio configurado paraengatar a faixa, por exemplo, e, dessa forma, limitar o movimento do ele-mento de disparo. Em várias modalidades, o acionador de disparo pode in-cluir adicionalmente um carretei configurado para enrolar pelo menos umaparte da faixa quando o elemento de disparo é retraído. Em pelo menos umamodalidade, o acionador de disparo pode adicionalmente incluir um gatilhoengatado seletivamente com o elemento de disparo e o carretei de formaque, quando o gatilho é engatado de forma operacional com o elemento dedisparo, um acionamento do gatilho possa ser configurado para avançar oelemento de disparo, e, quando o gatilho é engatado de forma operacionalao carretei, um acionamento do gatilho pode ser configurado para girar ocarretei e retrair o elemento de disparo através da faixa.
Em pelo menos uma forma da invenção, um instrumento cirúrgi-co pode incluir um acionador de disparo configurado para avançar seletiva-mente um elemento de disparo e/ou o elemento de corte com relação a umefetor de extremidade ev em-adição a-isso, um acionador reverso configura-do para retrair seletivamente o elemento de disparo e/ou elemento de cortecom relação ao efetor de extremidade. Em várias modalidades, o acionadorde disparo pode ser configurado para avançar o elemento de disparo medi-ante um acionamento de um gatilho e o acionador reverso pode incluir umaengrenagem configurada para retrair o elemento de disparo mediante umacionamento subsequente do gatilho. Em pelo menos uma modalidade, oacionador de disparo pode incluir uma garra que pode ser seletivamente en-gatada com o elemento de disparo a fim de avançar o elemento de disparoonde a garra pode ser desengatada do elemento de disparo quando o acio-nador reverso é engatado com o elemento de disparo. Em várias modalida-des, o acionador reverso pode incluir um trem de engrenagem possuindouma primeira engrenagem engatada de forma operacional ao elemento dedisparo e, adicionalmente, uma segunda engrenagem engatada de formaoperacional ao gatilho, onde a segunda engrenagem pode ser seletivamenteoperável com a primeira engrenagem de modo que um acionamento do gati-lho possa retrair o elemento de disparo e/ou elemento de corte através dasprimeira e segunda engrenagens. Em várias modalidades, o instrumentocirúrgico pode, adicionalmente, incluir um comutador incluindo primeira esegunda partes relativamente móveis, onde a primeira parte pode ser confi-gurada para desengatar de forma operacional o acionador de disparo do e-lemento de disparo e engatar de forma operacional o acionador reverso como elemento de disparo. Em pelo menos uma modalidade, a segunda partepode incluir uma alça se estendendo a partir daí que pode ser motivada pelocirurgião a fim de engatar a segunda parte com a primeira parte e mover aprimeira parte para a posição.
Breve Descrição dos Desenhos
As características e vantagens mencionadas acima bem comooutras dessa invenção, e a forma de se alcançar as mesmas, se tornarãomais aparentes e a invenção propriamente dita será mais bem compreendi-da por referência à descrição a seguir das modalidades da invenção levadasem consideração em conjunto com os desenhos em anexo, nos quais:
A figura 1 é uma-vista em elevação de um instrumento cirúrgicode acordo com uma modalidade da presente invenção.
A figura 2 é uma vista em elevação de uma parte de alça do ins-trumento cirúrgico da figura 1.
A figura 3 é uma vista em elevação de um efetor de extremidadedo instrumento cirúrgico da figura 1.
A figura 4 é uma vista superior do efetor de extremidade da figura 3.
A figura 5 é uma vista em perspectiva de uma junta de articula-ção do instrumento cirúrgico da figura 1 com alguns componentes do instru-mento cirúrgico removidos.
A figura 6 é uma vista em perspectiva de um conjunto de eixoalongado e a junta de articulação do instrumento cirúrgico da figura 1 comalguns componentes do instrumento cirúrgico removidos.
A figura 7 é uma vista em perspectiva parcial da parte de alça edo conjunto de eixo alongado do instrumento cirúrgico da figura 1 com al-guns componentes do instrumento cirúrgico removidos.
A figura 8 é uma vista em elevação da parte de alça da figura 2com alguns componentes do instrumento cirúrgico removidos.
A figura 9 é uma vista em elevação da parte de alça da figura 2com componentes adicionais do instrumento cirúrgico removidos.
A figura 10 é uma vista em elevação de um acionador de ummecanismo de travamento de articulação e um sistema de encerramento deefetor de extremidade de um instrumento cirúrgico de acordo com uma mo-dalidade alternativa da presente invenção com alguns componentes do ins-trumento cirúrgico removidos.
A figura 11 é uma vista em elevação do instrumento cirúrgico dafigura 10 ilustrando o acionador do mecanismo de travamento de articulaçãoem uma posição destravada e o sistema de encerramento de efetor de ex-tremidade em uma configuração aberta.A figura 12 é uma vista em elevação do instrumento cirúrgico dafigura 10 ilustrando o acionador do mecanismo de travamento de articulaçãoem uma posição destravada e o sistema de encerramento de efetor de ex-tremidade em uma configuração parcialmente fechada.
A figura 13 é uma vista em elevação do instrumento cirúrgico dafigura 10 ilustrando o acionador de mecanismo de travamento de articulaçãoem uma posição travada e o sistema de encerramento de efetor de extremi-dade em uma configuração fechada.
A figura 14 é uma vista em elevação de um gatilho de encerra-mento de um sistema de encerramento de efetor de extremidade do instru-mento cirúrgico da figura 1.
A figura 15 é uma vista em perspectiva parcial do gatilho de en-cerramento da figura 15.
A figura 16 é uma vista em elevação parcial do gatilho de encer-ramento da figura 15.
A figura 17 é uma vista em perspectiva de uma trava de gatilhodo instrumento cirúrgico da figura 1.
A figura 18 é uma vista em elevação da trava de gatilho da figura 17.
A figura 19 é uma vista detalhada de um acionador de disparodo instrumento cirúrgico da figura 1 com alguns componentes do instrumentocirúrgico removidos.
A figura 20 é uma vista em perspectiva do acionador de disparoda figura 19.
A figura 21 é uma vista em detalhes parcial de um gatilho de dis-paro, garra e mecanismo de inclinação do acionador de disparo da figura 19.
A figura 22 é uma vista em elevação da garra, mecanismo deinclinação e uma mola de retorno de garra do acionador de disparo da figura 19.
A figura 23 é uma vista em elevação da garra da figura 22.
A figura 24 é uma vista detalhada do acionador de disparo dafigura 19 ilustrando a garra articulada para uma posição para engatar umaconexão de disparo do acionador de disparo.
A figura 25 é uma vista em perspectiva do mecanismo de incli-nação da figura 22.
A figura 26 é uma vista em perspectiva de uma estrutura do ins-trumento cirúrgico da figura ~1.
A figura 27 é uma vista detalhada de um acionador de disparode um instrumento cirúrgico de acordo com uma modalidade alternativa dapresente invenção com alguns componentes do instrumento cirúrgico remo-vidos.
A figura 28 é uma vista detalhada do acionador de disparo dafigura 27 ilustrando uma garra do acionador de disparo desengatada de umaconexão de disparo.
A figura 29 é uma vista em perspectiva de um mecanismo deretorno do instrumento cirúrgico da reivindicação 1 ilustrando o gatilho dedisparo em uma posição não-acionada com alguns componentes do instru-mento cirúrgico removidos.
A figura 30 é uma vista em perspectiva parcial do mecanismo deretorno da figura 29 ilustrando o gatilho de disparo em uma posição aciona-da com alguns componentes do mecanismo de retorno removidos.
A figura 31 é uma vista em elevação do mecanismo de retornoda figura 29 disposto na configuração ilustrada na figura 30.
A figura 32 é uma vista em elevação do mecanismo de retornoda figura 29 ilustrando um carrinho de retorno do mecanismo de retorno emuma posição acionada.
A figura 33 é uma vista em perspectiva parcial do mecanismo deretorno da figura 29 com alguns componentes do mecanismo de retorno re-movidos.
A figura 34 é uma vista em perspectiva da garra e pino de dispa-ro do acionador de disparo da figura 19.
A figura 35 é uma vista em perspectiva do mecanismo de retornoda figura 29 ilustrando o carrinho de retorno em uma posição acionada e ogatilho de disparo retornado para sua posição não fixada.
A figura 36 é uma vista em perspectiva parcial do mecanismo deretorno da figura 29 disposto na configuração ilustrada na figura 35 ilustran-do um pino de retorno do mecanismo de retorno engatado de forma opera-cional com o gatilho de disparo.
A figura 37 é uma vista em perspectiva parcial do mecanismo deretorno da figura 29 ilustrando o gatilho de disparo em uma posição aciona-da depois da rotação do pino de retorno.
A figura 38 é uma vista em perspectiva adicional do mecanismode retorno da figura 29 disposto na configuração ilustrada na figura 37.
A figura 39 é uma vista em perspectiva parcial do mecanismo deretorno da figura 29 ilustrando o gatilho de disparo retornado para sua posi-ção não-acionada.
A figura 40 é uma vista em perspectiva do mecanismo de retornoda figura 29 ilustrando o carrinho de retorno retornado para sua posição não-acionada.
A figura 41 é uma vista em perspectiva do mecanismo de retornoda figura 29 disposto na configuração da figura 40 ilustrando a relação relati-va entre uma mola de orientação e o pino de retorno do mecanismo de re-torno com alguns componentes do mecanismo de retorno removidos.
A figura 42 é uma vista em perspectiva do mecanismo de retornoda figura 29 disposto na configuração da figura 40 ilustrando o carrinho deretorno engatado de forma operacional com o pino de disparo do acionadorde disparo e o pino de retorno do mecanismo de retorno a fim de reconfigu-rar o acionador de disparo e o mecanismo de retorno para suas configura-ções iniciais.
A figura 43 é uma vista detalhada de um carretei do mecanismode retorno da figura 29 ilustrando a relação relativa entre uma faixa de retor-no do mecanismo de retorno e a estrutura do grampeador da figura 26.
A figura 44 é uma vista detalhada do carretei da figura 43 ilus-trando a relação relativa entre a faixa de retorno e uma modalidade alternati-va da estrutura do grampeador da figura 26.
A figura 45 é uma vista em perspectiva de um mecanismo deretorno de um instrumento cirúrgico de acordo com uma modalidade alterna-tiva da presente invenção possuindo um mecanismo de roda dentada antir-retorno.
A figura 46 é uma vista em elevação do mecanismo de retornoda figura 45 possuindo um carrinho de retorno em uma posição não-acionada.
A figura 47 é uma vista em perspectiva do mecanismo de retornoda figura 45 com alguns componentes do instrumento cirúrgico removidos.
A figura 48 é uma vista em perspectiva de uma engrenagem deretorno, pino de retorno, e garra antirretorno do mecanismo de roda dentadada figura 45.
A figura 49 é outra vista em elevação do mecanismo de retornoda figura 45.
A figura 50 é uma vista em perspectiva da junta de articulaçãoda figura 5.
A figura 51 é uma vista em perspectiva da junta de articulaçãoda figura 5 com alguns componentes do instrumento cirúrgico removidos.
A figura 52 é uma vista em perspectiva da junta de articulaçãoda figura 5 com componentes adicionais do instrumento cirúrgico removidos.
A figura 53 é uma vista em perspectiva de um elemento de tra-vamento do efetor de extremidade da figura 3.
A figura 54 é outra vista em perspectiva do elemento de trava doefetor de extremidade da figura 53.
A figura 55 é uma vista inferior do elemento de trava do efetor deextremidade da figura 53.
A figura 56 é uma vista em elevação do elemento de travamentodo efetor de extremidade da figura 53.
A figura 57 é uma vista em perspectiva parcial de uma junta dearticulação de um instrumento cirúrgico anterior.
A figura 58 é um avista em perspectiva da junta de articulaçãoda figura 5 com alguns componentes do efetor de extremidade e conjunto deeixo alongado removidos.
A figura 59 é outra vista em perspectiva da junta de articulaçãoda figura 5 com alguns componentes do efetor de extremidade e conjunto deeixo alongado removidos.
A figura 60 é uma vista em perspectiva do elemento de trava-mento do efetor de extremidade da figura 53 engatado de forma operacionalcom um elemento de travamento do conjunto de eixo alongado.
A figura 61 é uma vista em perspectiva do elemento de trava-mento de conjunto de eixo da figura 60.
A figura 62 é uma vista inferior do elemento de travamento deefetor de extremidade da figura 53 engatado de forma operacional com oelemento de travamento do conjunto de eixo da figura 60.
A figura 63 é uma vista em perspectiva de uma unta de articula-ção de um instrumento cirúrgico de acordo com uma modalidade alternativada presente invenção com alguns componentes do instrumento cirúrgico re-movidos.
A figura 64 é uma vista superior de um elemento de travamentode efetor de extremidade engatado de forma operacional com um elementode travamento de conjunto de eixo do instrumento cirúrgico da figura 63.
A figura 65 é uma vista em perspectiva do elemento de trava-mento de efetor de extremidade engatado de forma operacional com o ele-mento de travamento do conjunto de eixo da figura 64.
A figura 66 é uma vista em perspectiva do elemento de trava-mento de efetor de extremidade da figura 64.
A figura 67 é uma vista em elevação do elemento de travamentodo efetor de extremidade da figura 64.
A figura 68 é uma vista em elevação do instrumento cirúrgico deacordo com uma modalidade da presente invenção com alguns componen-tes do instrumento cirúrgico removidos.
A figura 69 é uma vista em elevação do instrumento cirúrgico dafigura 68 ilustrando um gatilho de encerramento em uma posição acionada.
A-figura 70 é uma vista em elevação do instrumento cirúrgico dafigura 68 ilustrando um gatilho de disparo em uma posição acionada depoisde um primeiro acionamento do gatilho de disparo.
A figura 71 e uma vista em perspectiva de um trem de engrena-gem de um mecanismo reverso do instrumento cirúrgico da figura 68 pararetrair um elemento de disparo.
A figura 72 é uma vista em elevação do instrumento cirúrgico dafigura 68 ilustrando o gatilho de disparo em uma posição não-acionada de-pois de ter sido liberado de seu primeiro acionamento.
A figura 73 é uma vista em elevação do instrumento cirúrgico dafigura 68 ilustrando o gatilho de disparo em uma posição acionada depois deum segundo acionamento do gatilho de disparo.
A figura 74 é uma vista em elevação do instrumento cirúrgico dafigura 68 ilustrando o gatilho de disparo em uma posição não-acionada de-pois de ter sido liberado de seu segundo acionamento.
A figura 75 é uma vista em elevação do instrumento cirúrgico dafigura 68 ilustrando o gatilho de disparo em uma posição acionada depois deum terceiro acionamento do gatilho de disparo.
A figura 76 é outra vista em elevação do instrumento cirúrgico dafigura 68 ilustrando um carrinho de retorno do mecanismo reverso depois deter sido girado para baixo em uma posição acionada.
A figura 77 é uma vista em perspectiva de uma engrenagem degatilho, engrenagem chave e um pino de retorno do trem de engrenagem domecanismo reverso da figura 71.
A figura 78 é uma vista transversal do instrumento cirúrgico dafigura 68 ilustrando o pino de retorno da figura 77 engatado de forma opera-cional com a engrenagem de gatilho e engrenagem chave do mecanismoreverso da figura 71.
A figura 79 é uma vista em perspectiva do pino de retorno dáfigura 77.
A figura 80 é outra vista em elevação do carrinho de retorno dafigura 76 em uma posição acionada.
A figura 81 é uma vista em perspectiva de um pino de disparoengatado com uma garra do acionador de disparo do instrumento cirúrgicoda figura 68.
A figura 82 é uma vista em elevação do carrinho de retorno doinstrumento cirúrgico da figura 68 em uma posição acionada e o mecanismoreverso engatado de forma operacional com o elemento de disparo.
A figura 83 e umavista em elevação do instrumento cirúrgico dafigura 68 ilustrando o gatilho de disparo em uma posição acionada depois deum quarto acionamento que retraiu o elemento de disparo.
A figura 84 é uma vista em perspectiva do mecanismo reversoda figura 76 com alguns componentes removidos.
A figura 85 é uma vista em elevação do instrumento cirúrgico dafigura 68 ilustrando o gatilho de disparo em uma posição não-acionada de-pois de ter sido liberado de seu quarto acionamento.
A figura 86 é uma vista em elevação do instrumento cirúrgico dafigura 68 ilustrando o carrinho de retorno da figura 76 girado para cima parauma posição não-acionada e também ilustrando o gatilho de encerramentoem sua posição não-acionada.
A figura 87 é uma vista em perspectiva de um instrumento cirúr-gico de acordo com uma modalidade alternativa da presente invenção comalguns componentes do instrumento cirúrgico removidos.
A figura 88 é uma vista em perspectiva de um mecanismo rever-so do instrumento cirúrgico da figura 87 incluindo um trem de engrenagemilustrando as direções nas quais as engrenagens do trem de engrenagempodem girar quando um elemento de disparo do instrumento cirúrgico foravançado.
A figura 89 é uma vista em perspectiva de uma engrenagem degatilho e um pino de retorno do mecanismo reverso da figura 88 ilustrando aengrenagem de gatilho em seção transversal.
A figura 90 é outra vista em perspectiva da engrenagem de gati-lho e pino de retorno da figura 89 ilustrando o pino de retorno para fora doengate operacional com a engrenagem de gatilho.
A figura 91 é Uma vista em perspeetiva da engrenagem de gati-lho e pino de retorno da figura 89 ilustrando o pino de retorno engatado no-vamente com a engrenagem de gatilho.
A figura 92 é uma vista em perspectiva do mecanismo reversoda figura 88 ilustrando as direções nas quais as engrenagens do trem deengrenagem giram quando o elemento de disparo é retraído.
A figura 93 é uma vista em perspectiva adicional do mecanismoreverso da figura 88.
A figura 94 é uma vista em perspectiva do instrumento cirúrgicoda figura 87 ilustrando uma trava de gatilho que é configurada para engataruma engrenagem do mecanismo reverso da figura 88 em adição ao gatilho.
A figura 95 é uma vista em elevação de um mecanismo reversode um instrumento cirúrgico de acordo com uma modalidade alternativa dapresente invenção ilustrando um carrinho de retorno em uma posição não-acionada com alguns componentes do instrumento cirúrgico removido.
A figura 96 é uma vista em perspectiva do mecanismo reversoda figura 95 ilustrando uma engrenagem de gatilho possuindo uma face deroda dentada e, em adição, uma engrenagem chave possuindo uma face deroda dentada com alguns componentes adicionais do instrumento cirúrgicoremovidos.
A figura 97 é uma vista transversal do mecanismo reverso dafigura 95 ilustrado na configuração da figura 96.
A figura 98 é uma vista em perspectiva de um pino de retorno domecanismo reverso da figura 95.
A figura 99 é uma vista em elevação do mecanismo reverso dafigura 95 ilustrando o carrinho de retorno em uma posição acionada.
A figura 100 é uma vista em perspectiva do mecanismo reversoda figura 95 onde as faces da roda dentada das engrenagens de gatilho echave são engatadas uma com a outra.
A figura 101 é uma vista em elevação de um instrumento cirúrgi-co de acordo com uma modalidade alternativa da presente invenção incluin-do o acionador de disparo e o acionador reverso do instrumento cirúrgico dafigura 68 com alguns componentes do instrumento cirúrgico removidos ondea garra do acionador de disparo é ilustrada como apareceria quando é reti-rada com relação ao elemento de disparo.
A figura 102 é uma vista em elevação do instrumento cirúrgicoda figura 101 ilustrando a garra engatada de forma operacional com o ele-mento de disparo.
A figura 103 é uma vista em elevação do instrumento cirúrgicoda figura 101 ilustrando a falta de alinhamento entre a garra e um recesso noelemento de disparo quando o elemento de disparo se retrai de forma nãointencional com relação à sua posição pretendida.
A figura 104 é uma vista em elevação de um instrumento cirúrgi-co de acordo com uma modalidade alternativa da presente invenção incluin-do um mecanismo antirretorno com alguns componentes do instrumento ci-rúrgico removidos.
A figura 105 é uma vista em perspectiva de um pino de retornodo mecanismo antirretorno da figura 104.
A figura 106 é uma vista detalhada de uma chave se estendendoa partir do pino de retorno da figura 105.
A figura 107 é uma vista em perspectiva de um elemento de in-dexação do mecanismo antirretorno da figura 104.
A figura 108 e uma vista em perspectiva do pino de retorno dafigura 105 engatado de forma operacional com o elemento de indexação dafigura 107.
A figura 109 é uma vista em perspectiva do pino de retorno e doelemento de indexação ilustrando a chave do pino de retorno posicionadadentro de uma primeira abertura no elemento de indexação.
A figura 110a é outra vista em perspectiva da chave do pino deretorno e do elemento de indexação da figura 109.
A figura 110b é uma vista em perspectiva da chave de pino deretorno pressionando o elemento de indexação quando a chave de pino deretorno é movida da primeira abertura para uma segunda abertura do ele-mento de indexação.
A figura 11 Qc é uma vista em perspectiva da parte chave do pinode retorno posicionado dentro da segunda abertura do elemento de indexação.
A figura 11 Od é uma vista em perspectiva da chave do pino deretorno pressionando o elemento de indexação quando a chave de pino deretorno é movida da segunda abertura para uma terceira abertura do ele-mento de indexação.
A figura -1 tOe é uma-vista em perspectiva da parte chave do pinode retorno posicionado dentro da terceira abertura do elemento de indexação.
A figura 11 Of é uma vista em perspectiva da chave do pino deretorno pressionando o elemento de indexação quando a chave de pino deretorno é movida da terceira abertura para uma quarta abertura do elementode indexação.
A figura 110g é uma vista em perspectiva da parte chave do pinode retorno posicionado dentro da quarta abertura do elemento de indexação.
A figura 111 é uma vista transversal do elemento de indexaçãoda figura 107.
A figura 112 é uma vista em perspectiva de um elemento de in-dexação de acordo com uma modalidade alternativa da presente invenção euma mola de retorno engatada de forma operacional com o elemento de in-dexação.
A figura 113 é uma vista transversal do elemento de indexaçãoda figura 112.
A figura 114 é uma vista em perspectiva de um elemento de in-dexação de acordo com outra modalidade alternativa da presente invenção.
A figura 115 é uma vista em perspectiva parcial de um instru-mento cirúrgico incluindo um mecanismo antirretorno de acordo com umamodalidade alternativa da presente invenção com alguns componentes doinstrumento cirúrgico removidos.
A figura 116 é uma vista transversal do mecanismo antirretornoda figura 115.
A figura 117 é uma vista em perspectiva do instrumento cirúrgicoda figura 115 ilustrando um-carrinho de retorno de um mecanismo reversoem uma posição acionada.
A figura 118 é uma vista transversal do mecanismo antirretornoda figura 115 quando o carrinho de retorno da figura 117 está na posiçãoacionada.
A figura 119 é uma vista em perspectiva de um instrumento ci-rúrgico deacordo com uma modalidade-alternativa da presente invençãocom alguns componentes do instrumento cirúrgico removidos para ilustrarum comutador para acionar um acionador reverso do instrumento cirúrgico.
A figura 120 é uma vista em elevação parcial de um instrumentocirúrgico de acordo com outra modalidade alternativa da presente invençãocom alguns componentes do instrumento cirúrgico removidos para ilustrarum comutador para acionar um acionador reverso do instrumento cirúrgico.
A figura 121 é uma vista em elevação parcial do instrumento ci-rúrgico da figura 120 ilustrando uma primeira parte do comutador em umaposição acionada.
A figura 122 é uma vista em elevação parcial do instrumento ci-rúrgico da figura 120 ilustrando uma segunda parte do comutador utilizadapara posicionar a primeira posição do comutador em sua posição acionada.
Caracteres de referência correspondentes indicam partes cor-respondentes por todas as várias vistas. As exemplificações apresentadasaqui ilustram as modalidades preferidas da invenção, em uma forma, e taisexemplificações não devem ser consideradas como limitadoras do escopoda invenção de forma alguma.
Descrição Detalhada
Determinadas modalidades ilustrativas serão agora descritaspara fornecer uma compreensão geral dos princípios da estrutura, função,fabricação e utilização dos dispositivos e métodos descritos aqui. Um oumais exemplos dessas modalidades são ilustrados nos desenhos em anexo.
Os versados na técnica compreenderão que os dispositivos e os métodosdescritos especificamente aqui e ilustrados nos desenhos em anexo sãomodalidades ilustrativas não-limitadoras e que o escopo das várias modali-dades da presente invenção é def inido apenas pelas-reivindicações. As ca-racterísticas ilustradas ou descritas com relação a uma modalidade ilustrati-va podem ser combinadas com as características de outras modalidades.
Tais modificações e variações devem ser incluídas no escopo da presenteinvenção.
Em várias modalidades, um instrumento cirúrgico de acordo coma presente invenção-pode ser configurado para-inserir-grampos cirúrgicosem tecido mole, por exemplo. Em pelo menos uma modalidade, com refe-rência às figuras de 1 a 4, o instrumento cirúrgico 100 pode incluir uma partede alça 102, um conjunto de eixo alongado 104, e um efetor de extremidade106. Em várias modalidades, com referência às figuras 3 e 4, o efetor deextremidade 106 pode incluir um canal de cartucho de grampos 108 e umcartucho de grampos 110, onde o cartucho de grampos 110 pode ser confi-gurado para armazenar de forma removível os grampos. Em pelo menosuma modalidade, o efetor de extremidade 106 pode adicionalmente incluiruma placa de apoio 112 que pode ser conectada de forma articulada ao ca-nal de cartucho de grampos 108 e pode ser articulada entre as posições a-berta e fechada por um sistema de encerramento de efetor de extremidade.A fim de se aplicar os grampos a partir do cartucho de grampo 110, o ins-trumento cirúrgico 100 pode incluir adicionalmente um acionador de gramposconfigurado para atravessar o cartucho de grampos 110 e um acionador dedisparo configurado para avançar o acionador de grampo dentro do cartuchode grampos. Em várias modalidades, a placa de apoio 112 pode ser configu-rada para deformar pelo menos uma parte dos grampos à medida que sãoaplicados a partir do cartucho de grampos. Apesar de várias modalidades deum sistema de encerramento do efetor de extremidade e um acionador de dis-paro serem descritos em maiores detalhes abaixo, várias modalidades dos sis-temas de encerramento de efetor de extremidade e dispositivos de disparo sãodescritas na patente U.S. N2 6.905.057 intitulada SURGICAL STAPLINGINSTRUMENT INCORPORATING A FIRING MECHANISM HAVING A LINKEDRACK TRANSMISSION, que foi expedida em 14 de unho de 2005 e a patenteU.S. N2 7.044.352, intitulada SURGICAL STAPLING INSTRUMENT HAVING ASINGLE LOCKOUT MECHANISM FOR PREVENTION OF FIRING, que foiexpedida em 16 de maio de 2006, a totalidade das descrições sendo incor-porada aqui por referência.
Em várias modalidades, um instrumento cirúrgico de acordo coma presente invenção pode incluir um sistema para mover, ou articular, umefetor de extremidade com relação a um conjunto de eixo alongado do ins-trumento cirúrgico. Em pelo menos uma modalidade, com referência às figu-ras de 3 a 7, o instrumento cirúrgico 100 pode incluir a junta de articulação114 que pode conectar de forma móvel o efetor de extremidade 106 e o con-junto de eixo alongado 104. Em várias modalidades, a junta de articulação114 pode permitir que o efetor de extremidade 106 seja movido com relaçãoao conjunto de eixo 104 em um único plano ou, alternativamente, em múlti-plos planos. Em qualquer caso, a junta de articulação 114 pode incluir um oumais eixos geométricos articulados 116 (figura 5) em torno dos quais o efetorde extremidade 106 pode ser articulado. Em várias modalidades, com refe-rência às figuras 5 e 6, o instrumento cirúrgico 100 pode incluir adicional-mente o mecanismo de travamento 118 que pode fixar, ou travar, a relaçãorelativa entre o efetor de extremidade 106 e o conjunto de eixo alongado104. Em pelo menos uma modalidade, o mecanismo de travamento 118 po-de incluir o elemento de travamento 120 que pode ser deslizado com relaçãoao efetor de extremidade 106 e engatar o efetor de extremidade 106 a fim deimpedir, ou pelo menos inibir parcialmente, o movimento relativo entre o efe-tor de extremidade 106 e o conjunto de eixo 104. Em pelo menos uma mo-dalidade, o elemento de travamento 120 pode ser configurado para engatarpelo menos um dos dentes 312 (figuras 5 e 6) do efetor de extremidade 106de forma que a interação entre o elemento de travamento 120 e os dentes312 possa impedir, ou pelo menos inibir parcialmente, a rotação do efetor deextremidade 106 em torno do eixo geométrico 116 como descrito em maio-res detalhes adicionalmente abaixo.
Em várias modalidades, com referência às figuras 7 a 9, o me-canismo de travamento 118 pode incluir adicionalmente o acionador 122 quepode ser conectado de forma operacional ao elemento de travamento 120.Em pelo menos uma modalidade, o acionador 122-pode incluir-um pino 124que pode ser recebido dentro da fenda 121 no elemento de travamento 120de forma que, quando o acionador 122 é deslizado com relação à parte dealça 102, o pino 124 possa se apoiar em uma parede lateral da fenda 121 emotivar o elemento de travamento 120 com relação ao efetor de extremidade106. Em pelo menos uma modalidade, o acionador 122 pode ser puxadopara longe do efetor de extremidade 106, isso é,-de-forma proximal, paradesengatar o elemento de travamento 120 do efetor de extremidade 106.
Apesar de não ser ilustrado, outras modalidades são vislumbradas onde oacionador 122 pode ser movido de forma distai, ou até mesmo girado, a fimde desengatar o elemento de travamento 120 do efetor de extremidade 106.
Em qualquer caso, o mecanismo de travamento 118 pode incluir adicional-mente a mola de retorno 126 (figura 6) que pode ser configurada para mover oelemento de travamento 120 na direção do efetor de extremidade 106, isso é,de forma distai, para engatar o elemento de travamento 120 com o efetor deextremidade 106 depois que o acionador 122 foi liberado. Outros mecanis-mos de travamento são descritos no pedido de patente U.S. N- 11/100.722,intitulado SURGICAL INSTRUMENT WITH ARTICULATING SHAFT WITHSINGLE PIVOT CLOSURE AND DOUBLE PIVOT FRAME GROUND, que foidepositado em 7 de abril de 2005, o pedido de patente U.S. N2 11/238.358,intitulado SURGICAL INSTRUMENT WITH ARTICULATING SHAFT WITH Rl-GID FIRING BAR SUPPORTS, que foi depositado em 29 de setembro de 2005,e o pedido de patente U.S. N2 11/491.626, intitulado SURGICAL STAPLINGAND CUTTING DEVICE AND METHOD FOR USING THE DEVICE, que foidepositado em 24 de julho de 2006, todas as descrições dos quais são in-corporadas aqui por referência.
Em várias modalidades, com referência às figuras 1 e 2, o acio-nador 122 pode ser contornado de modo que um cirurgião possa agarrar asuperfície externa do acionador 122 e puxar o acionador 122 de forma pro-ximal como descrito acima. Para mover o acionador 122, em pelo menosuma modalidade, um cirurgião pode colocar uma mão no agarre da alça 127,por exemplo, e colocar sua outra mão no acionador 122 de forma que o ci-rurgião possa mover o-aeionador 122 com relação ao agarre da alça 127.
Em outras várias modalidades, com referência às figuras de 10 a 13, o acio-nador 122' pode ser configurado de modo que o cirurgião possa precisar a-penas de uma mão para operar o instrumento cirúrgico. Mais particularmen-te, em pelo menos uma modalidade, o acionador 122' pode incluir ganchos,ou projeções 115 se estendendo a partir daí que podem permitir que o cirur-gião segure-oagarre da-alça -127 eom-uma mão e estenda pelo menos umdedo dessa mão de forma distai para agarrar pelo menos uma projeção 115e puxar o acionador 122' de forma proximal como descrito acima. Enquantoo acionador 122' é descrito aqui como possuindo projeções 115, o acionador122, ou qualquer outro acionador adequado, também pode incluir projeções115 e/ou quaisquer outros acessórios adequados que possam auxiliar o ci-rurgião na operação do instrumento cirúrgico 100 com uma mão. Em pelomenos uma modalidade, as projeções 115 podem ser pelo menos parcial-mente constituídas de e/ou revestidas com um material elástico ou de "toquemacio" que pode aperfeiçoar o agarre do cirurgião nas projeções 115 e podefornecer outros benefícios ergonômicos ao cirurgião. Em várias modalida-des, o acionador 122', por exemplo, pode ser engatado de forma operacionalcom o conjunto de eixo 104 de forma que o efetor de extremidade 106 e oconjunto de eixo 104 possam ser girados em torno de um eixo geométricolongitudinal pelo acionador 122'. Em tais modalidades, um cirurgião podeorientar o efetor de extremidade 106 em um local cirúrgico pela articulaçãodo efetor de extremidade 106 como descrito acima e/ou girando o efetor deextremidade 106 para a posição. Em pelo menos uma modalidade, o cirurgi-ão pode girar o acionador 122' pelo posicionamento de um dedo contra umadas projeções 115 e aplicação de uma força ao mesmo. Em várias modali-dades, o cirurgião pode reter o acionador 122' na posição pela colocação deum dedo contra uma projeção 115 e resistindo a qualquer movimento inde-sejado do acionador 122' e, de forma correspondente, do efetor de extremi-dade 106.
Em várias modalidades, um instrumento cirúrgico de acordo coma presente invenção pode incluir um sistema para o fechamento, ou fixação, deum efetor de extremidade no tecido mole, por exemplo. Em pelo menos umamodalidade, com referência às figuras 2, 5, 8 e 9, o instrumento cirúrgico100 pode incluir o gatilho de encerramento 128, a conexão de acionamento130, o acionador 132, e um tubo de encerramento 134. Em várias modalida-des, depois do acionamento do gatilho de encerramento 128, o gatilho deencerramento 128 pode ser configurado para deslocar a conexão de acio--namento-130, o acionador-1-32-e o tubo de encerramento-134 de forma dis-tai. Mais particularmente, em pelo menos uma modalidade, a conexão deacionamento 130 pode incluir uma primeira extremidade conectada de formaarticulada ao gatilho 128 e uma segunda extremidade conectada de formaarticulada ao acionador 132 de forma que a rotação do gatilho 128 na dire-ção do agarre da alça 127 possa acionar a conexão 130 para frente e desli-zar o acionador 132 ao longo de um eixo geométrico definido pelo guia deacionador 136 (figura 8). Em várias modalidades, o acionador 132 pode in-cluir projeções 133 que se estendem a parti daí que podem ser recebidas deforma deslizante dentro das fendas 136 no guia de acionador 136 de formaque as fendas 135 possam definir um percurso para o acionador 132 à me-dida que o mesmo é movido. Em várias modalidades, o tubo de encerramen-to 134 pode ser engatado de forma operacional com o acionador 132 deforma que, quando o acionador 132 é movido de maneira distai como descri-to acima, o tubo de encerramento 134 pode engatar a placa de apoio 112 ea placa de apoio articulada 112 para baixo. Com referência basicamente àfigura 5, o tubo de encerramento 134 pode ser configurado para deslizar so-bre a junta de articulação 114 e a placa de apoio articulada 112 com relaçãoao cartucho de grampos 110. Em pelo menos uma modalidade, como ilus-trado na figura 9, o tubo de encerramento 134 pode incluir uma extremidadeproximal possuindo projeção 135 se estendendo a partir daí que pode serrecebida na fenda 131 no acionador 132 de modo que o deslocamento doacionador 132 seja transmitido para o tubo de encerramento 134.
Em várias modalidades, como descrito acima, o mecanismo detravamento 118 pode impedir, ou pelo menos inibir parcialmente, o movi-mento relativo entre o efetor de extremidade 106 e o conjunto de eixo 104.Em circunstâncias nas quais o-tecido mole é preso entre a placa de apoio112 e o cartucho de grampos 110, por exemplo, o movimento relativo entre oefetor de extremidade 106 e o conjunto de eixo 104 pode aplicar uma forçade cisalhamento ao tecido mole preso entre os mesmos que pode danificar omesmo. Em várias modalidades, com referência às figuras de 10 a 13, a fimde impedir, ou pelo menos reduzir, o movimento relativo entre o efetor deextremidade-106 e o conjunto de eixo-104 quando-o-efetor de extremidade106 é fechado, o sistema de encerramento do efetor de extremidade podeser configurado para engatar o mecanismo de travamento 118 para impedirque o acionador 122' seja movido para sua posição destravada. Efetivamen-te, em pelo menos uma modalidade, o acionamento do gatilho de encerra-mento 128 pode não apenas fechar o efetor de extremidade 106, mas tam-bém impedir que o mecanismo de travamento 118 seja destravado. Em vá-rias modalidades, com referência às figuras de 10 a 13, o instrumento cirúr-gico 100' pode incluir o acionador 132 que pode ser configurado para apoiar,ou ser posicionado de forma adjacente ao acionador 122' quando o aciona-dor 132 é movido de forma distai pelo gatilho 128 e dessa forma evitar que oacionador 122' seja movido de maneira proximal como descrito acima comrelação ao acionador 122. Mais particularmente, antes de o gatilho 132 seracionado, como ilustrado nas figuras 10 e 11, o acionador 122' pode ser des-lizado de forma proximal a fim de deslizar o elemento de travamento 120com relação ao efetor de extremidade 106 e destravar a junta de articulação114. Depois do acionamento do gatilho 132, no entanto, com referência àfigura 13, o acionador 132 pode ser configurado para se apoiar, ou ser posi-cionado adjacente ao acionador 122' de forma que o acionador 122' nãopossa ser movido de maneira proximal para desengatar o elemento de tra-vamento 120 do efetor de extremidade 106. Como resultado disso, o sistemade encerramento do efetor de extremidade pode impedir que o efetor de ex-tremidade 106 seja articulado depois de ter sido fechado, reduzindo, assim,a possibilidade de uma força de cisalhamento ser transmitida para o tecidomole preso.
Adicionalmente ao acima exposto, o sistema de encerramentodo efetor de extremidade pode fornecer retorno para o cirurgião de que oefetor de extremidade foi fechado e, a fim de que o cirurgião destrave e arti-cule o efetor de extremidade, o cirurgião deve primeiro reabrir pelo menosparcialmente o efetor de extremidade antes de o efetor de extremidade po-der ser articulado. Mais particularmente, devido à interação entre o aciona-dor 132 e o acionador 122' quando o efetor de extremidade 106 é fechado,-quando um cirurgião-tenta puxar-o acionadoM22'deforma proximal paradestravar a junta de articulação 114, o acionador 132 pode impedir substan-cialmente que o acionador 122' mova sinalizando, assim, para o cirurgiãoque o efetor de extremidade 106 está fechado e o efetor de extremidade 106deve primeiro ser aberto antes de o acionador 122' poder ser movido e ajunta de articulação poder ser destravada. Em várias modalidades, tal siste-ma de encerramento de efetor de extremidade pode impedir que o cirurgiãodanifique o instrumento cirúrgico e/ou o tecido capturado dentro de ou cer-cando o efetor de extremidade. Mais particularmente, em pelo menos umamodalidade, quando o tubo de encerramento 134 foi avançado para fechar aplaca de apoio 112 como descrito acima, o tubo de encerramento 134 podeaplicar uma força à placa de apoio 112 para manter a placa de apoio 112 emuma posição fechada e, em várias circunstâncias, essa força pode criar for-ças de fricção dentro da junta de articulação 114 que podem inibir, se nãoimpedir, que o efetor de extremidade 106 gire em torno da junta de articula-ção 114. Nas modalidades sem o sistema de encerramento de efetor de ex-tremidade descrito acima, se um cirurgião tentar superar essas forças defricção sem primeiro pelo menos parcialmente abrir o efetor de extremidade,o cirurgião pode dobrar ou quebrar um ou mais componentes do instrumentocirúrgico, por exemplo. Em várias modalidades da presente invenção, noentanto, o acionador 132, por exemplo, pode impedir que o cirurgião libere atrava de articulação 120 como descrito acima e, como resultado disso, o ci-rurgião pode não ter a oportunidade de destravar a junta de articulação 114que dirá articular o efetor de extremidade 106.
Em várias modalidades, um instrumento cirúrgico de acordo coma presente invenção pode incluir um sistema de encerramento de efetor de-extremidade que pode posicionar a placa de apoio 112, por exemplo, emuma posição aberta, uma posição fechada, e uma posição parcialmente fe-chada. Em pelo menos uma modalidade, um cirurgião pode mover uma pla-ca de apoio 112 para uma posição parcialmente fechada e avaliar se o efetorde extremidade deve ser reposicionado ou articulado antes de a placa deapoio 112 ser movida para sua posição fechada. Em tais modalidades, aplaca de apoio 112 pode ser movida com relação ao tecido mole posicionadoentre a placa de apoio 112 e o cartucho de grampos 110 sem aplicação deuma força de cisalhamento, ou pelo menos uma força de cisalhamento subs-tancial, ao tecido mole antes de a placa de apoio 112 estar completamentefechada. Em pelo menos uma modalidade, a placa de apoio 112 pode serconfigurada de modo que não prenda o tecido mole posicionado entre a pla-ca de apoio 112 e o cartucho de grampos 110 quando estiver em sua posi-ção parcialmente fechada. Alternativamente, a placa de apoio 112 pode serconfigurada para aplicar uma força de fixação leve ao tecido mole quando aplaca de apoio 112 está em sua posição parcialmente fechada antes da apli-cação de uma força de fixação maior quando é movida para sua posiçãofechada. Em pelo menos uma modalidade como essa, o instrumento cirúrgi-co pode incluir um gatilho que pode ser movido entre uma primeira posição(figura 11) que corresponde à posição aberta da placa de apoio 112, umasegunda posição (figura 12) que corresponde à sua posição parcialmentefechada, e uma terceira posição (figura 13) que corresponde à sua posiçãofechada. Em várias modalidades, com referência às figuras 8 e 9, o gatilho128 pode ser montado de forma articulada ao alojamento 102 da parte dealça 102 de modo que o gatilho 128 possa ser girado em torno do pino 129entre suas primeira, segunda e terceiras posições. Em várias modalidades,com referência às figuras 8, 9, 17 e 18, o instrumento cirúrgico 100 pode in-cluir adicionalmente a trava de gatilho 148 que pode ser configurada paraengatar o gatilho 128 e travar seletivamente o gatilho 128 em pelo menosuma de suas primeira, segunda e terceira posições descritas acima. Em pelomenos uma modalidade, o gatilho 128 pode incluir a extremidade articulada138 compreendendo a superfície de carne 140, o primeiro entalhe 142, e umsegundo entalhe 144 onde a trava de gatilho 148 pode ser configurada paraengatar o primeiro entalhe 142 e o segundo entalhe 144. Mais preferivelmen-te, o instrumento cirúrgico 100 pode incluir adicionalmente, com referênciaàs figuras 8 e 9, a mola de travamento de gatilho 150 que pode ser configu-rada para orientar a parte seguidora 149 da trava de gatilho 148 contra asuperfície de carne 140 de modo que quando o primeiro entalhe 142 ou o-segundo entalhe-1-44 é-alinhado com a parte seguidora 149, a mola de travade gatilho 150 pode empurrar a parte seguidora 149 para o primeiro entalhe142 ou segundo entalhe 144, respectivamente. Em pelo menos uma modali-dade, com referência basicamente às figuras 8 e 9, a trava de gatilho 148pode ser montada de forma articulada ao alojamento 103 da parte de alça102 através do pino 151. Em várias modalidades, a mola de travamento degatilho 150 pode ser comprimida entre a parte de botão 152 da trava de gati-Iho 148 e o alojamento 103 de forma que a mola da trava de gatilho 150possa girar a trava de gatilho 148 em torno do pino 151 e orientar a trava degatilho 148 para baixo contra a superfície de carne 140 do gatilho 128.
Em adição ao acima exposto, em pelo menos uma modalidade,o primeiro entalhe 142 pode ser alinhado com a parte seguidora 149 quandoo gatilho 132 é movido para sua segunda posição e a placa de apoio 112 émovida para sua posição parcialmente fechada. Em várias modalidades, aparte seguidora 149 pode ser retida de forma segura dentro do primeiro en-talhe 142 de forma que a trava de gatilho 148 precise ser manualmente de-sengatada do gatilho 132 antes de o gatilho 132 poder ser movido para suaterceira posição e/ou retornado para sua primeira posição. Em pelo menosuma modalidade, com referência às figuras 8 e 9, um cirurgião pode pres-sionar a parte de botão 152 do elemento de trava 148 de modo que o ele-mento de trava 148 seja girado em torno do pino 151 e a parte seguidora149 seja erguida para cima e para fora do engate com o gatilho 128. Em ou-tras várias modalidades, o primeiro entalhe 142 pode ser configurado demodo que a parte seguidora 149 possa deslizar para fora do primeiro entalhe142 mediante a aplicação de uma força ao gatilho 132. Em qualquer caso,depois que a parte seguidora 149 foi desengatada do primeiro entalhe 142,um cirurgião pode mover seletivamente o gatilho 132 para sua terceira posi-ção ou liberar o gatilho 132 e permitir que uma mola de gatilho, por exemplo,retorne o gatilho 132 para sua primeira posição. Em pelo menos uma moda-lidade alternativa, o primeiro entalhe 142 e a parte seguidora 149 podem serconfigurados de forma que, depois que o gatilho 132 foi movido para suasegunda posição, o gatilho 132 seja movido para sua terceira posição antes-de-poder -ser retornado para- sua primeira- posição. -Em qualquer caso, empelo menos uma modalidade, o segundo entalhe 144 do gatilho 132 podeser alinhado com a parte seguidora 149 quando o gatilho 132 é movido parasua terceira posição e a placa de apoio 122 é movida para sua posição fe-chada. Similar ao primeiro entalhe 142, o segundo entalhe 144 pode ser con-figurado para reter a parte seguidora 149 até que o elemento de travamento148 seja desengatado do gatilho 132 e/ou uma força suficiente seja aplicadaao gatilho 132 para desalojar a parte seguidora 149 do segundo entalhe 144.
Depois disso, em várias modalidades, uma mola de gatilho pode mover ogatilho 132 de sua terceira posição para sua segunda posição onde o cirur-gião pode precisar, de forma similar à acima, desengatar a parte seguidora149 do primeiro entalhe 142. Em pelo menos uma modalidade alternativa, oprimeiro entalhe 142 pode ser configurado de modo que a parte seguidora149 possa deslizar além do primeiro entalhe 142 e permite que o gatilho 132seja movido de sua terceira posição para sua primeira posição sem o cirur-gião precisar desalojar a parte seguidora 149 do primeiro entalhe 142.
Em adição ao acima exposto, apesar de não ser ilustrado, a par-te de botão 152 do elemento de travamento 148 pode ter recessos, por e-xemplo, dentro do alojamento do instrumento cirúrgico 103 quando o gatilhode encerramento 128 está em sua primeira posição. Nas modalidades alter-nativas, a parte de botão 152 pode ser posicionada de forma nivelada com oalojamento 103 ou pode se estender ligeiramente do alojamento 103. Emqualquer caso, em pelo menos uma modalidade, a parte de botão 152 podese mover para fora com relação ao alojamento 103 quando o gatilho de en-cerramento 128 é movido para sua segunda posição. Tal movimento podefornecer um retorno visual para o cirurgião de que a placa de apoio do ins-trumento cirúrgico está em sua posição parcialmente fechada. Adicionalmen-te, o movimento da parte de botão 152 também pode ser realizado por umretorno audível e/ou tátil. Em qualquer caso, um cirurgião pode acessar aparte de botão 152 depois de ter sido movida para fora de modo que o ele-mento de travamento 148 possa ser desengatado do gatilho 128 como des-crito acima. Em várias modalidades, a parte de botão 152 pode mover parafora ainda mais quando o gatiího 128 é movido de sua segunda posição parasua terceira posição. Similar ao citado acima, tal movimento pode forneceruma dica visual para o cirurgião de que a placa de apoio está agora em suaposição fechada e pode ser acompanhado por um retorno audível e/ou tátil,como descrito acima. Apesar de o botão 152 ser descrito acima como mo-vendo para fora à medida que o gatilho 128 é movido entre suas primeira eterceira posições, a invenção não está limitada a isso. Ao contrário, o botão152, ou qualquer outro indicador adequado, pode fornecer retorno para ocirurgião de qualquer forma adequada.
Nas modalidades alternativas, apesar de não ser ilustrado, aplaca de apoio 112 pode ser mantida, ou retida, em mais do que três posi-ções descritas acima, isso é, suas posições aberta, fechada e parcialmentefechada. Em pelo menos uma modalidade, a placa de apoio 112 pode serretida em sua posição aberta, fechada e duas ou mais posições intermediá-rias. Em tais modalidades, a placa de apoio 112 pode ser passada atravésdessas posições intermediárias e aplicar uma força cada vez maior no tecidomole capturado no efetor de extremidade 106 à medida que a placa de apoio112 é movida na direção de sua posição fechada. Em pelo menos uma mo-dalidade, similar à acima, o gatilho 132 pode incluir uma pluralidade de enta-lhes que podem corresponder a várias posições intermediárias da placa deapoio 112. Em várias modalidades alternativas, apesar de não ser ilustrado,o sistema de encerramento do efetor de extremidade pode incluir um conjun-to de roda dentada que pode permitir que o gatilho 132, e, de forma corres-pondente, a placa de apoio 112 a ser mantida em uma pluralidade de posi-ções. Em tais modalidades, a placa de apoio 112 e o gatilho 132 podem sermantidos no lugar por uma garra engatada de forma articulada com uma ro-da dentada engatada de forma-operaeional com o gatilho 132.
Em várias modalidades, com referência às figuras de 10 a 13, omovimento relativo entre o acionador 122' e a parte de alça 102', como des-crito acima, pode ser limitado a fim de controlar a faixa através da qual o e-Iemento de travamento 120 pode ser deslocado. Mais particularmente, comreferência às figuras 10 e 11, a parte distai do acionador 122' pode incluir aprojeção 123 que se estende a partir daí que pode ser recebida na cavidade125 onde o deslocamento do acionador 122' pode ser limitado pela paredeproximal 117 e a parede distai 119 da cavidade 125. Em pelo menos umamodalidade, quando o gatilho 128 está em sua primeira posição, como ilus-trado nas figuras 10 e 11, o acionador 122 pode ser movido a partir de umaposição distai em que a projeção 123 pode se apoiar na parede distai 119,como ilustrado na figura 10, em uma posição mais proximal em que a proje-ção 123 não se apóia na parede distai 119, como ilustrado na figura 11.
Nessa posição mais distai, como descrito acima, o elemento de travamento120 pode ser desengatado do efetor de extremidade 106 e o efetor de ex-tremidade 106 pode ser girado com relação ao conjunto de eixo 104. Quan-do o gatilho 128 está em sua segunda posição, com referência à figura 12, oacionador 132 pode limitar a faixa do movimento do acionador 122' de formaque a projeção 123 não possa ser posicionada contra a parede proximal117. Em pelo menos uma modalidade, no entanto, o acionador 122' pode sermovido de forma proximal por uma distância suficiente para desengatar oelemento de travamento 120 do efetor de extremidade 106. Nessas circuns-tâncias, um cirurgião pode reposicionar o efetor de extremidade 106 apesarde a placa de apoio 122 poder ser parcialmente fechada no tecido mole, porexemplo. Quando o gatilho 128 estiver em sua terceira posição, como ilus-trado na figura 13, o acionador 132 pode forçar o acionador 122' de formadistai de modo que a projeção 132 se apóie, ou seja, posicionada adjacenteà parede distai 119 e o acionador 122' não possa ser movido o suficientepara travar a junta de articulação 114.
Em várias modalidades, um instrumento cirúrgico de acordo coma presente invenção pode incluir um acionador de disparo configurado paraavançar um elemento de corte e/ou o acionador de grampo dentro de umefetor de extremidade como descrito acima. Em pelo menos uma modalida-de, com referência às figuras 8, 9 e 19 a 25, a força de disparo do instrumen-to cirúrgico 100 pode incluir o gatilho de disparo 160, a primeira conexão dedisparo 162, a segunda conexão dè disparo 164 e o elemento de disparo166. Em várias modalidades, o gatilho de disparo 160 pode ser engatado deforma operaeional com pelo menos um dentre o elemento de disparo 166 econexões de disparo 162 e 164 a fim de avançar a barra de lâmina 168 den-tro do conjunto de eixo alongado 104. Em pelo menos uma modalidade, abarra de lâmina 168 pode ser engatada de forma operacional com um ele-mento de corte (não ilustrado) e um acionador de grampos (não ilustrado) noefetor de extremidade 106 onde o elemento de corte pode ser configuradopara fazer uma incisão no tecido, por exemplo, e o acionador de grampo po-de ser configurado para aplicar os grampos a partir do cartucho de grampos110. Os elementos de corte e os acionadores de grampo são bem-descritosnas patentes U.S. Nos. 6.905.057 e 7.044.352, que foram previamente in-corporados por referência no presente pedido de patente, e, como resultadodisso, esses dispositivos não são descritos em maiores detalhes aqui. Ou-tros elementos de corte e acionadores de grampo são descritos no pedidode patente U.S. N2 11/541.123, intitulado SURGICAL STAPLES HAVINGCOMPRESSIBLE OR CRUSHABLE MEMBERS FOR SECURING TISSUETHEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME,que foi depositado em 29 de setembro de 2006, e no pedido de patente U.S.N2 11/652.169, intitulado SURGICAL STAPLING DEVICE WITH A CURVEDCUTTING MEMBER, que foi depositado em 11 de janeiro de 2007, a totali-dade das descrições é incorporada aqui por referência.
Em várias modalidades, com referência basicamente às figuras19 e 20, o gatilho de disparo 160 pode ser conectado de forma articulada aoalojamento de instrumento cirúrgico 103 (figuras 8 e 9) pelo pino 161. Emuso, em pelo menos uma modalidade, o gatilho de disparo 160 pode ser arti-culado em torno do pino 161 a fim de avançar o elemento de disparo 166 eas conexões de disparo 162 e 164 de forma distai. Em várias modalidades, ogatilho-de disparo 160 pode-incluir fendas 159, onde as fendas 159 podemser configuradas para receber o pino de disparo 172. Em várias modalida-des, quando o gatilho de disparo 160 é acionado, ou girado, de sua posiçãoilustrada na figura 2 para uma posição adjacente ao agarre da alça 127, asparedes laterais das fendas 159 podem ser configuradas para engatar umpino de disparo de avanço 172 de forma distai. Em pelo menos uma modali-dade, com referência à figura 23, o acionador de disparo pode incluir adicio-nalmente a garra 170, onde a garra 170 pode incluir a abertura 171. Em vá-rias modalidades, a abertura 171 pode ser configurada para receber pelomenos uma parte do pino de disparo 172 de forma que, quando o pino dedisparo 172 é avançado de forma distai pelo gatilho 160, o pino de disparo172 pode avançar a garra 170 de forma distai também. Em várias modalida-des, com referência à figura 24, a garra 170 pode incluir um dente 174 e oelemento de disparo 166 pode incluir um recesso 167, onde o recesso 167pode ser configurado para receber o dente 174. Em uso, quando a garra 170é avançada de forma distai pelo pino de disparo 172 e o dente 174 é enga-tado com uma parede lateral do recesso 167, a garra 170 pode avançar oelemento de disparo 166 de forma distai também. Em várias modalidades, agarra 170 pode ser avançada de forma distai pelo pino de disparo 172 aolongo de um percurso substancialmente linear. Em tais modalidades, as fen-das 159 podem incluir perfis arqueados que podem, em cooperação com opino de disparo 172, converter o movimento rotativo do gatilho de disparo160 em movimento de translação da garra 170. Em pelo menos uma modali-dade, a força aplicada à garra 170 pode ser substancialmente, se não total-mente, direcionada na direção distai. Em tais modalidades, como resultadodisso, a possibilidade de a garra 170 se tornar unida ou aderia à estrutura dogrampeador 184 pode ser reduzida.
Em várias modalidades, a garra 170 pode ser articulada entreuma primeira posição em que a garra 170 é operacionalmente desengatadado elemento de disparo 166 e uma segunda posição, com referência às figu-ras 19 e 20, em que a garra 170 é operacionalmente engatada com o ele-mento de disparo 166. Com referência basicamente às figuras de 21 a 25, oacionador de disparo pode incluir adicionalmente o mecanismo de inclinação178 que pode ser configurado para articular a garra 170 entre suas primeirae segunda posições. Em uso, quando o gatilho de disparo 160 é acionado, agarra 170 pode ser movida, pelo menos inicialmente, com relação ao meca-nismo de inclinação 178 de forma que pelo menos uma parte da garra 170possa se apoiar no mecanismo de inclinação 178 e a garra articulada 170 deforma ascendente e em engate operacional com o elemento de disparo 166.Em pelo menos uma modalidade, a garra 170 pode incluir, com referênciabasicamente à figura 23, o sulco 175 que pode ser configurado para recebera projeção 179 (figura 25) se estendendo a partir da parte central do meca-nismo de inclinação 178. Em pelo menos uma modalidade, à medida que agarra 170 é avançada de forma distai, a parede proximal 176 do sulco 175pode entrar em contato com uma superfície de carne na projeção 179 e, de-vido à força aplicada à garra 170 pelo pino de articulação 172, a garra 170pode ser articulada, ou girada, ascendentemente de forma que o dente 174possa ser posicionado no recesso 167 do elemento de disparo 166 comodescrito acima. Depois que a garra 170 foi articulada, a garra 170 pode ar-rastar o mecanismo de inclinação 178 de forma distai à medida que a garra170 é avançada na direção do efetor de extremidade 106. Mais particular-mente, em pelo menos uma modalidade, o mecanismo de inclinação 178pode incluir elementos deformáveis 180 que podem ser recebidos dentro dasfendas 182 na estrutura do grampeador 184 de forma que a interação entreos elementos deformáveis 180 e a estrutura do grampeador 184 iniba pelomenos parcialmente o movimento do mecanismo de inclinação 178 com re-lação à estrutura do grampeador 184. De outra forma, devido às forças defricção estáticas entre os elementos deformáveis 180 e as paredes lateraisdas fendas 182, uma força suficiente para superar essas forças de fricçãodeve ser aplicada ao mecanismo de inclinação 178 antes de o mecanismode inclinação 178 poder ser "arrastado" com relação à estrutura do grampe-ador 184.
Depois que o gatilho de disparo 160 foi acionado e o elementode disparo 166 foi avançado, o gatilho 160 pode ser liberado e retornadopara sua posição não-acionada ilustrada na figura 2-e-a garra 170 pode serdesengatada do elemento de disparo 166 e retraída para sua posição inicialilustrada na figura 19. Mais particularmente, em pelo menos uma modalida-de, o instrumento cirúrgico 100 pode incluir adicionalmente uma mola de ga-tilho (não ilustrada) engatada de forma operacional com o gatilho 160 e oalojamento 103, por exemplo, onde a mola de gatilho pode ser configuradapara girar o-gatilho 160 em torno do-pino-161- e -acionar o-pino- de disparo172 de forma proximal depois que a garra 170 foi desengatada do elementode disparo 166. Em várias modalidades, a garra 170 pode ser desengatadado elemento de disparo 166 quando é articulada de sua segunda posição,como ilustrado na figura 24, para sua primeira posição, como descrito acimapelo mecanismo de inclinação 178. Em tais modalidades, a garra 170 podeser movida, pelo menos inicialmente, com relação ao mecanismo de inclina-ção 178 de forma que a parede distai 177 do sulco 175 possa entrar em con-tato com uma segunda superfície de carne na projeção 179 e possa, devidoa uma força aplicada ao pino de disparo 172 pelo gatilho 160 ou mola deretorno 186, girar a garra 170 para baixo de forma que o dente 174 da garra170 possa ser desengatado do recesso 167 no elemento de disparo 166.
Depois disso, o gatilho 160 e/ou a mola de retorno 186 pode puxar, ou retra-ir, a garra 170 com relação ao elemento de disparo 166. Em várias modali-dades, similares à acima, a garra 170 pode ser configurada para arrastar omecanismo de inclinação 178 de forma proximal dentro da fenda 182. Comoresultado do acima exposto, a garra 170 não precisa ser orientada para suasprimeira ou segunda posições. Em várias circunstâncias, a garra 170 podeser girada livremente entre suas primeira e segunda posições sem ter quesuperar uma força aplicada à mesma por uma mola de orientação. Efetiva-mente, em várias modalidades, a força para mover a garra 170 entre suasprimeira e segunda posições não precisa superar o peso da gravidade dagarra 170 e quaisquer forças de fricção entre a garra 170 e os componentescircundantes do instrumento cirúrgico.
Uma vez que a garra 170 é retornada para sua posição original,em pelo menos uma modalidade, o dente 174 da garra 170 pode não estarmais alinhado com o recesso 167 no elemento de disparo 166. Ao contrário,com referência geralmente às figuras 19 e 20, o dente 174 da garra 170 po-de ser alinhado com o recesso 163 na primeira conexão de disparo 162.
Mais particularmente, a primeira conexão de disparo 162 pode ser conecta-da de forma articulada ao elemento de disparo 166 de forma que, quando oelemento de disparo 166 é avançado de maneira distal, como descrito aci-maro elemento de disparo 166 pode puxar primeiro a conexão de disparo162 para a posição em que o elemento de disparo 166 se encontrava anteri-ormente. Como resultado disso, depois de um segundo acionamento do gati-lho de disparo 160, a garra 170 pode ser articulada a partir de sua primeiraposição para sua segunda posição de forma que o dente 174 seja engatadode forma operacional com o recesso 163 e a garra 170 pode avançar a co-nexão de disparo 162 de forma distai. Em pelo menos uma modalidade, aconexão de disparo 162 pode empurrar o elemento de disparo 166 e a barrade lâmina 168 de forma distai e, de forma correspondente, avançar o ele-mento de corte e o acionador de grampo de forma distai dentro do efetor deextremidade 106. Depois disso, a garra 170 pode mais ser articulada maisuma vez de sua segunda posição para sua primeira posição e pode ser re-traída com relação à primeira conexão de disparo 162. Uma vez que a garra170 é retornada para sua posição original pela segunda vez, o dente 174 dagarra 170 pode não estar mais alinhado com o recesso 163 da primeira co-nexão de disparo 162. Ao contrário, similar ao acima exposto, o dente 174pode estar alinhado com o recesso 165 na segunda conexão de disparo 164e o processo descrito acima pode ser repetido.
Apesar de não ser ilustrado, um instrumento cirúrgico de acordocom a presente invenção pode incluir mais de duas, ou menos de duas co-nexões de disparo a fim de avançar o elemento de corte e o acionador degrampo para suas posições desejadas dentro do efetor de extremidade 106.Em várias modalidades, como descrito em maiores detalhes abaixo, o ele-mento de disparo 166 pode incluir mais de um recesso 167 de forma que agarra 170 possa avançar diretamente o elemento de disparo 166 na direçãodo efetor de extremidade 106 mais de uma vez. Em pelo menos uma moda-lidade dessas, a garra 1-70 pode ser retraída depois de avançar o elementode disparo 166 de forma distai, como descrito acima, de modo que, quandoa garra 170 é mais uma vez inclinada para cima, a garra 170 pode engataroutro recesso 167 no elemento de disparo 166 e avançar o elemento de dis-paro 166 na direção do efetor de extremidade 106 mais uma vez. Como re-sultado disso, em pelo menos uma modalidade, as conexões de disparo 162e 164 podem não ser necessárias.
Em várias modalidades, um instrumento cirúrgico pode incluirum ou mais elementos de mola configurados para mover a garra 170 empelo menos uma de suas primeira e segunda posições. Em pelo menos umamodalidade, com referência às figuras 27 e 28, o acionador de disparo podeincluir a garra 170', o pino de disparo 172 e o mecanismo de inclinação 178'onde, de forma similar à acima, o mecanismo de inclinação 178' pode serconfigurado para articular a garra 170' para cima quando a garra 170' é a-vançada de forma distai. O acionador de disparo pode incluir adicionalmentea mola de articulação 188 que pode ser conectada de forma operacional àgarra 170' de modo que, quando a garra 170' é articulada para cima e paradentro de sua segunda posição como ilustrado na figura 27, a garra 170' po-de flexionar, ou dobrar de forma resiliente, a mola articulada 188. Depois quea garra 170' foi avançada, a garra 170' pode ser articulada para baixo parasua primeira posição pela mola de articulação 188 como ilustrado na figura28. Mais particularmente, devido à energia em potencial armazenada na mo-la de articulação 188 quando a mesma é flexionada, a mola 188 pode movera garra 170' para baixo uma vez que a garra 170' não é mais mantida emsua segunda posição pelo mecanismo de inclinação 178' e pino de disparo172. Depois disso, como descrito acima, a garra 170' pode ser retraída comrelação ao elemento de disparo 166 e/ou conexões de disparo 162 e 164.
Em várias modalidades, o mecanismo de inclinação 178' pode não incluiruma segunda superfície de carne para articular a garra 170 para sua primei-ra posição. Em tais modalidades, a garra 170' pode ser retraída por uma for-ça aplicada ao pino de disparo 172 como descrito acima. Em várias modali-dades alternativas, apesar de não ilustrado, o mecanismo de inclinação 178'e a garra-170' também podem incluir earaeterístieas-cooperantes para articu-lar a garra 170' para baixo para sua primeira posição.
Em várias modalidades, com referência às figuras 19 e 20, o ins-trumento cirúrgico 100 que inclui adicionalmente a faixa 190 que pode serconfigurada para mover o elemento de disparo 166 e as conexões de dispa-ro 162 e 164 com relação ao efetor de extremidade 106. Em pelo menosuma modalidade, uma primeira extremidade da banda 190 pode ser conec-tada ao elemento de disparo 166, por exemplo, de forma que, quando o e-lemento de disparo 166 é avançado de forma distai, a faixa 190 pode serpuxada de forma distai também. Em várias modalidades alternativas, a faixa190 pode ser conectada à primeira conexão de disparo 162 e/ou à segundaconexão de disparo 164. Em pelo menos uma modalidade, a faixa 190 podeser posicionada em torno de pelo menos uma parte do carretei 192 de modoque quando a faixa 190 é puxada pelo elemento de disparo 166, a faixa 190pode ser desdobrada, ou desenrolada, a partir do carretei 192. Em pelo me-nos uma modalidade, uma segunda extremidade da faixa 190 pode ser co-nectada ao carretei 192 de forma que a faixa 190 não possa ser prontamen-te desengatada do carretei 192 sob condições operacionais normais do ins-trumento cirúrgico 100. Em qualquer caso, quando a faixa 190 é puxada peloelemento de disparo 166, o carretei 192 pode ser girado em uma das dire-ções horária ou anti-horária, dependendo da forma em que a faixa 190 é po-sicionada em torno do carretei 192. A fim de se retrair o elemento de disparo166, o carretei 192 pode ser girado em uma direção oposta para mover oelemento de disparo 166, e as conexões de disparo 162 e 164, de formaproximal e enrolar a faixa 190 em torno do carretei 192.
Em várias modalidades, a faixa 190 pode ser enrolada em tornodo carretei 192 de forma que a faixa 190 seja enrolada em torno de uma su-perfície substancialmente cilíndrica no carretei 192. Em pelo menos umamodalidade, a distância entre um eixo geométrico de rotação do carretei 192e a superfície cilíndrica pode ser substancialmente equidistante em torno doperímetro do carretei 192. Nessas modalidades, a vantagem mecânica docarretei 192 pode permanecer substancialmente constante à medida que afaixa-190 é puxada de forma proximal como descrito acima e a capacidadedo carretei 192 de aplicar uma força de retração à faixa 190 pode permane-cer substancialmente igual. Nas modalidades alternativas, no entanto, o car-retei 192 pode ser configurado para fornecer uma vantagem mecânica variá-vel. Em pelo menos uma modalidade, o carretei 192 pode incluir uma super-fície não-cilíndrica em que a faixa 190 pode ser enrolada de modo que a dis--tâneia-entre o eixo geométrico de rotação do carretei 192 e a superfície não-cilíndrica não seja equidistante em torno do perímetro do carretei 192. Nes-sas modalidades, como resultado disso, a capacidade do carretei 192 emaplicar uma força de retração à faixa 190 pode mudar à medida que a faixa190 é enrolada em torno do carretei 192. Em pelo menos uma modalidade, ocarretei 192 pode agir como um carne e pode incluir um formato que podeser otimizado para fornecer força adicional à faixa 190 quando a mesma éinicialmente retraída, isso é, quando a força de retração do elemento de cor-te, por exemplo, pode estar no seu máximo.
Em várias modalidades, com referência às figuras 29 a 42, o ga-tilho de disparo 160 pode ser seletivamente engatado com um mecanismode retorno do instrumento cirúrgico 100. Em pelo menos uma modalidade,quando o gatilho de disparo 160 é engatado de forma operacional com oelemento de disparo 166 através da garra 170, como descrito acima, um a-cionamento do gatilho de disparo 160 pode avançar o elemento de disparo166 de forma distai e, quando o gatilho de disparo 160 é engatado de formaoperacional com o elemento de disparo 166 através da faixa 190, um acio-namento do gatilho de disparo 160 pode retrair o elemento de disparo 166de forma proximal. Em várias modalidades, o mecanismo de retorno podeser acionado manualmente para desengatar o gatilho de disparo 160 do e-Iemento de disparo 166 e engatar operacionalmente o gatilho de disparo 160com o carretei 192. Em pelo menos uma modalidade, o mecanismo de retor-no pode incluir um carrinho de retorno 194 que pode ser montado de formaarticulada no alojamento do instrumento cirúrgico 103 de forma que o carri-nho de retorno 194 possa ser articulado entre uma primeira posição não-acionada como ilustrado na figura 29 e uma segunda posição acionada co-mo ilustrado na figura 32. Em pelo menos - uma modalidade, o carrinho deretorno 194 pode incluir uma parte de botão de pressão 195 que, quandouma força é aplicada ao mesmo, pode ser configurado para mover o carrinhode retorno 194 de sua posição não-acionada para sua posição acionada.Quando o carrinho de retorno 194 é posicionado em sua posiçãonão-acionada ilustrada nas figuras de 29 a 31, o gatilho de disparo 160 podeser configurado para avançar o elemento de disparo 166 como descrito aci-ma e a parte de engrenagem 158 do gatilho 160 pode ser operacionalmenteengatada com a engrenagem do gatilho 196. Em várias modalidades, a partede engrenagem 158 e a parte de gatilho 196 podem ser engatadas de formaoperacional de modo que uma rotação do gatilho 160 em torno do pino 161possa acionar a engrenagem de gatilho 196 em torno de um eixo geométricodefinido pelo pino de retorno 198. Em pelo menos uma modalidade, quandoo carrinho de retorno 194 está em sua posição não-acionada, a engrenagemde gatilho 196 pode ser configurada para girar livremente em torno do pinode retorno 198 de modo que a rotação da engrenagem de gatilho 196 nãoseja transmitida, ou pelo menos não transmitida substancialmente, para opino de retorno 198. Mais particularmente, com referência à figura 30, a cha-ve 199 do pino de retorno 198 pode ser orientada para fora do engate com aengrenagem de gatilho 196 de forma que a rotação da engrenagem de gati-lho 196 não seja transmitida para a engrenagem chave 206 e o carretei 192.Como resultado disso, um acionamento da engrenagem de gatilho 196 nãogira, ou pelo menos não substancialmente, o carretei 192 quando o carrinhode retorno 194 está em sua posição não-acionada.
Depois que o elemento de corte e o acionador de grampo foramavançados dentro do efetor de extremidade 106, o carrinho de retorno 194pode ser movido para sua posição acionada. Em várias modalidades, comreferência à figura 30, o carretei 192 pode incluir o elemento de carne 202 seestendendo a partir daí que pode entrar em contato com o carrinho de retor-no 194 e girar o carrinho de retorno 194 para baixo. Em pelo menos umamodalidade, o elemento de carne 202 pode entrar em contato com o carrinhode retorno 194 durante o acionamento final do gatilho 160 que avança o e-- Iemento de-corte e o acionador de grampo dentro do efetor de extremidade106. Em pelo menos uma modalidade dessas, o elemento de carne 202 po-de entrar em contato com o carrinho de retorno 194 depois do terceiro acio-namento do gatilho de disparo 160. Em várias modalidades, com referênciaàs figuras 32 a 35, quando o carrinho de engrenagem 194 é movido parasua posição acionada, o carrinho de retorno 194 pode ser configurado paraengatar de forma operacional a engrenagem de gatilho 196 com o carretel192. Em pelo menos uma modalidade, com referência às figuras 33 e 35, ocarrinho de retorno 194 pode incluir a mola de orientação 200 onde, quandoo carrinho de retorno 194 está em sua posição não-acionada, a mola 200pode ser localizada na posição ilustrada na figura 33, e, quando o carrinhode retorno 194 é movido para sua posição acionada ilustrada na figura 35, amola 200 pode entrar em contato com o pino de retorno 198 e orientar o pinode retorno 198 na direção da engrenagem de acionamento 196. Em pelomenos uma modalidade, com referência à figura 31, a engrenagem de gati-lho 196 pode incluir a cavidade em formato de D 197 que pode, sob determi-nadas circunstâncias explicadas acima, receber a chave 199 que se estendea partir do pino de retorno 198 e engatar de forma operacional a engrena-gem de gatilho 196 com a engrenagem chave 206 e o carretei 192. Em vá-rias modalidades, o movimento do carrinho de retorno 194 para sua posiçãoacionada pode ser realizado por um retorno audível e/ou tátil para informarao cirurgião que o mecanismo de retorno do instrumento cirúrgico foi enga-tado com o gatilho 160.
Em adição ao acima exposto, quando o pino de retorno 198 édeslizado na direção da engrenagem de gatilho 196, a cavidade em formatode D 197 pode ser posicionada de modo que a chave 199 não entre imedia-tamente na cavidade 197. Ao contrário, com referência à figura 31, a mola200 pode orientar o pino de retorno 198 de modo que a chave 199 se apoieinicialmente na face 204 da engrenagem de gatilho 196. Depois que o gati-lho 160 é liberado e retornado para sua posição não-acionada, no entanto, acavidade em formato de D 197 pode ser girada e alinhada com a chave 199de modo que a mola 200 possa orientar a chave 199 para dentro da cavida-de 497 como-ilustrado na figura 36. Em pelo menos uma modalidade, comreferência à figura 31, quando o pino de retorno 198 é deslizado na direçãoda engrenagem de gatilho 196, uma extremidade do pino de retorno 198 po-de ser recebida na fenda 193 no carrinho de retorno 194 como ilustrado nafigura 32. Depois que a chave 199 é inserida na cavidade 197, um aciona-mento subsequente do gatilho 160 pode fazer com que a superfície de acio-namento 210 da cavidade em formato de D 197 se apoie na chave 199 egire o pino de retorno 198 para uma posição ilustrada nas figuras 37 e 38.
Efetivamente, um acionamento do gatilho 160, em pelo menos uma modali-dade, pode girar a chave 199 por aproximadamente metade de uma revolu-ção de forma que essa chave 199, que se estende inicialmente de formasubstancialmente descendente (figura 36), pode ser girada de modo que achave 199 se estenda substancialmente para cima (figura 37). Depois disso,o gatilho 160 pode ser liberado e a engrenagem de gatilho 194 pode ser gi-rada com relação à chave 199 onde a chave 199 pode permanecer orientadaem uma direção substancialmente ascendente como ilustrado nas figuras de39 a 41.
Em várias modalidades, com referência basicamente à figura 38,a engrenagem chave 206 pode ser engatada de forma operacional com opino de retorno 198 de modo que a rotação do pino de retorno 198 possa sertransmitida para a engrenagem chave 206. Em pelo menos uma modalidade,a engrenagem chave 206 pode incluir a abertura em formato de chave 212que pode ser configurada para receber de forma deslizante a chave 199 dopino de retorno 198. Em pelo menos uma dessas modalidades, a chave 199pode ser engatada de forma operacional com ambos o recesso 197 da en-grenagem de gatilho 196 e a abertura 212 da engrenagem de chave 206quando o pino de retorno 198 é engatado com a engrenagem de gatilho 196.Em várias modalidades alternativas, a engrenagem de chave 206 pode sermontada de forma fixa no pino de retorno 198. Em tais modalidades, quandoo pino de retorno 198 é deslizado com relação à engrenagem de gatilho 196,a engrenagem de chave 206 também pode ser deslizada com relação à en-grenagem de gatilho 196. Em várias modalidades, com referência de formageral à figura 38, o carretei 192 pode-incluir uma engrenagem de dentes re-tos 216 montada no mesmo, onde a engrenagem de dentes retos 216 podeser engatada de forma operacional com a engrenagem de chave 206 demodo que a rotação da engrenagem de chave 206 possa ser transmitidapara o carretei 192. Em pelo menos uma modalidade, a engrenagem dechave 206, quando deslizada na direção da engrenagem de gatilho 196 co-mo descrito acima pode ser deslizada em engate operacional com o carretei192. Nas modalidades alternativas, a engrenagem de dentes retos 216 podeser configurada de modo que a engrenagem de chave 206 esteja em engateoperacional independentemente de se a engrenagem de chave 206 foi orien-tada no sentido da engrenagem de gatilho 196.
Como resultado do acima exposto, quando o carrinho de retorno194 é posicionado em sua posição acionada ilustrada na figura 32, um acio-namento do gatilho 160 pode girar o carretei 192 e enrolar a faixa 190 emtorno de pelo menos uma parte do mesmo. No caso de a chave 199 não po-der ser engatada de forma operacional com a engrenagem de gatilho 196quando o carrinho de retorno 194 é acionado, o carretei 192 pode ser giradomanualmente para retrair a faixa 190. Em pelo menos uma modalidade des-sas, com referência às figuras 33 e 37, um parafuso ou fixador 218 pode serengatado de forma operacional com o carretei 192 de modo que a rotaçãodo parafuso 218 possa realizar a rotação do carretei 192. Em várias modali-dades, um cirurgião pode inserir o parafuso 218 através de uma abertura noalojamento do instrumento cirúrgico 103 e engatar o parafuso 218 com ocarretei 192. Em pelo menos uma modalidade, o instrumento cirúrgico 100pode incluir adicionaimente um mecanismo de contagem (não ilustrado) quepode contar os acionamentos do gatilho 160 e, em pelo menos uma modali-dade dessas, o parafuso 218, por exemplo, pode ser engatado de forma o-peracional com o mecanismo de contagem para girar o carretei 192. Em vá-rias modalidades, como resultado disso, o instrumento cirúrgico pode incluirum primeiro acionador ou acionado primário para enrolar o carretei 192 e umsegundo acionador que pode ser configurado para enrolar o carretei 192 nolugar do primeiro acionador.
Em várias modalidades, como descrito acima, o carretei 192 po-de ser configurado para puxar a faixa 190 e retrair o elemento de disparo166 e as conexões de disparo 162 e 164 de forma proximal. Mais particular-mente, como descrito acima, o elemento de disparo 166, e as conexões dedisparo 162 e 164 podem ser retraídos com relação à garra 170 a fim de re-posicionar o elemento de disparo 166 e as conexões de disparo 162 e 164em suas posições iniciais. Em tais modalidades, especialmente as modali-dades nas quais a garra 170 é articulável como descrito acima, o mecanismode retorno do instrumento cirúrgico 100 pode ser adicionalmente configuradopara manter a garra 170 fora do engate operacional com o elemento de dis-paro 166 e as conexões de disparo 162 e 164 enquanto são movidos comrelação à garra 170. Mais particularmente, quando o carrinho de retorno 194é movido para sua posição acionada ilustrada na figura 35, o carrinho deretorno 194 pode ser configurado para entrar em contato com uma extremi-dade do pino de disparo 172 e deslizar o pino de disparo 172 na direção dagarra 170 de forma que o pino de disparo 172 engate a garra 170 e impeçaque a garra 170 articule para cima. Mais particularmente, com referência àfigura 34, o pino de disparo 172 pode incluir a primeira extremidade 220 quepode incluir uma superfície chanfrada e/ou arredondada, por exemplo, onde,quando o carrinho de retorno 194 entra em contato com a primeira extremi-dade 220, o carrinho de retorno 194 pode empurrar o pino de disparo 172 nadireção da garra 170. Em pelo menos uma modalidade, a garra 170 podeincluir o recesso 173 que pode ser configurado para receber a chave 222 seestendendo a partir do pino de disparo 172 quando o pino de disparo 172 émovido na direção da garra 170. Quando a chave 222 e o recesso 173 sãoengatados de forma operacional, o pino de disparo 172 pode impedir que agarra 170 articule para cima em engate com o elemento de disparo 166 econexões de disparo 162 e 164.
Depois que o elemento de disparo 166 e as conexões de disparo162 e 164 foram retraídos, um novo cartucho de grampos 110 pode ser fixa-do no efetor de extremidade 106 e o instrumento cirúrgico 100 pode ser re-configurado de forma que possa ser utilizado para realizar uma incisão egrampear o tecido mole-mais uma vez. Em várias modalidades, com refe-rência às figuras 39 a 42, o carrinho de retorno 194 pode ser movido de suaposição acionada ilustrada na figura 32 para sua posição não-acionada ilus-trada na figura 40. Em pelo menos uma modalidade, o carrinho de retorno194 pode ser girado, ou articulado, ascendentemente quando uma força éaplicada à parte de botão 195. Alternativamente, o carrinho de retorno 194-pode-ser-movido ascendentemente quando, com referência à figura 29, atrava de gatilho 148 é girada ascendentemente para desengatar a parte se-guidora 140 do gatilho de encerramento 128 a fim de reabrir o efetor de ex-tremidade 106 como descrito acima. Mais particularmente, quando uma for-ça é aplicada à parte de botão 152 da trava de gatilho 148, a trava de gatilho148 pode ser girada ascendentemente de forma que a projeção 148 se es-tendendo a partir daí não possa entrar em contato com o carrinho de retorno194 e mover o carrinho de retorno 194 para cima também. Em qualquer ca-so, com referência à figura 42, quando o carrinho de retorno 194 é movidoascendentemente para sua posição não-acionada, o carrinho de retorno 194pode desengatar o pino de disparo 172 da garra 170 e, adicionalmente, de-sengatar o pino de retorno 198 da engrenagem de gatilho 196. Mais particu-larmente, o carrinho de retorno 194 pode ser configurado para se apoiar naextremidade chanfrada ou arredondada 221 do pino de disparo 172 de formaque, quando o carrinho de retorno 194 é girado ascendentemente, o carrinhode retorno 194 possa deslizar o pino de retorno 172 para longe da garra 170e desengatar a chave 22 do recesso 173. De forma similar, quando o carri-nho de retorno 194 é movido ascendentemente, uma parede lateral da fenda193 pode ser configurada para entrar em contato com uma extremidade dopino de retorno 198 e deslizar o pino de retorno 198 para longe da engrena-gem de gatilho 196 para desengatar a chave 199 do recesso em formato deD 197. De forma breve, em pelo menos a modalidade ilustrada, quando aparte de botão 152 do elemento de travamento 148 é pressionada e o carri-nho de retorno 194 é movido para cima, o instrumento cirúrgico pode serreconfigurado e pode ser reutilizado mais uma vez.
Apesar de os instrumentos cirúrgicos descritos acima poderemser reconfigurados depois que o elemento de corte e o acionador de grampoterem sido completamente avançados dentro do efetor de extremidade 106,a parte do botão 195 do carrinho de retorno 194, por exemplo, pode serpressionada depois que o elemento de corte e o acionador de grampos te-rem sido apenas parcialmente avançados dentro do efetor de extremidade106. Em várias modalidades, o carrinho de retorno 194 pode incluir adicio-nalmente o pino guia 191 se estendendo entre lados opostos do carrinho deretorno 194. Em pelo menos uma modalidade dessas, o pino guia 191 podeser recebido de forma deslizante dentro da fenda guia 185 (figura 31) na es-trutura 184 de forma que a fenda 185 e o pino 191 possam definir um per-curso para o carrinho de retorno 194. Em várias modalidades, o pino guia191 e a fenda guia 185 podem ser configurados para garantir que o carrinhode retorno 194 engate o pino de disparo 172 e o pino de retorno 198 e re-configure o instrumento cirúrgico quando o carrinho de retorno 194 é movidode sua posição acionada para sua posição não-acionada como descrito acima.
Em várias modalidades, o instrumento cirúrgico 100 pode incluiradicionalmente um freio para impedir, ou pelo menos parcialmente inibir, queo acionador de disparo avance e/ou retraia o elemento de corte e o aciona-dor de grampos, por exemplo, dentro do efetor de extremidade 106. Em pelomenos uma modalidade, com referência à figura 43, a estrutura 184 podeincluir a superfície de freio 187 onde a superfície de freio 187 pode ser confi-gurada para aplicar uma força de frenagem à faixa 190. Mais particularmen-te, quando a faixa 190 é puxada de forma proximal e/ou distai como descritoacima, a estrutura 184 pode ser configurada de modo que a faixa 190 desli-ze sobre a superfície de freio 187 e uma força de fricção seja criada entre asmesmas. Em várias modalidades, com referência à figura 44, a superfície defreio 187' pode ser configurada de modo que o percurso da faixa 190 entre oelemento de disparo 166 e o carretei 192 seja interrompido pela superfíciede freio 187' e uma força normal significativa possa ser aplicada à faixa 190.
Em pelo menos uma modalidade, a faixa 190 pode ser engatadacom a superfície de freio 187' quando a faixa 190 está em repouso de modoque uma força de fricção estática entre a faixa 190 e a superfície de freio187' possa impedir, pelo menos inicialmente, a faixa 190 de mover com rela-ção à superfície de freio 187' quando uma força de retração é aplicada à fai-xa 190. Quando a força de retração aplicada à faixa 190 excede a força defricção estática, a faixa 190 pode ser movida com relação à superfície defreio 187'. Tais modalidades podem ser particularmente úteis quando gatilho160 é acionado mais de uma vez-para avançar o elemento de corte e/ou oacionador de grampos dentro do efetor de extremidade 106. Mais particu-larmente, depois do acionamento do gatilho 160, a garra 170 pode ser retra-ída com relação ao elemento de disparo 166 como descrito acima e, em vá-rias modalidades, a força de fricção entre a faixa 190 e a superfície de freio187' pode impedir, ou pelo menos inibir parcialmente, o movimento proximale/ou distai do elemento de disparo 166 e/ou das conexões de disparo 162 e164, à medida que a garra 170 é retraída. Como resultado do acima exposto,o alinhamento entre o dente 174 da garra 170 e os recessos no elemento dedisparo 166 e conexões de disparo 162 e 164 pode ser mantido quando agarra 170 é movida com relação aos mesmos.
De forma similar, em pelo menos uma modalidade, a rigidez dafaixa 190 também pode auxiliar na retenção do elemento de disparo 166 edas conexões de disparo 162 e 164 na posição. Mais particularmente, a fimde que o elemento de disparo 166 "retorne", ou se mova de forma proximal,o elemento de disparo 166 terá que empurrar a faixa 190 de forma proximale, efetivamente, e enrolar a faixa 190 em torno do carretei 192. Em váriasmodalidades, a rigidez da faixa 190 pode ser tal que uma força significativapara enrolar a faixa 190 em torno do carretei 192 seja necessária e, comoresultado disso, o elemento de disparo 166 possa ser mantido no lugar. Paraaumentar ainda mais a força necessária para se enrolar a faixa 190 em tornodo carretei 192, com referência à figura 44, o percurso da faixa 190 pode sercontrolado de modo que não seja enrolada no carretei 192 em uma direçãotangencial. Mais particularmente, se o percurso da faixa 190 for tal que amesma seja enrolada no carretei 192 em uma direção não-tangencial, umaparte da força transmitida através da faixa 190 será perdida, resultando,dessa forma, em uma vantagem mecânica ruim para o enrolamento do car-retel 192.
Em várias modalidades, o instrumento cirúrgico 100 pode incluirum freio que pode ser engatado com o carretei 192, ou qualquer outro com-ponente adequado do acionador de disparo, para impedir que o elemento dedisparo 166 e/ou as conexões de disparo 162 e 164 sejam retraídos de for-ma não intencional, por exemplo-Em pelo menos uma-modalidade, apesarde não ilustrado, o freio pode ser movido entre uma primeira posição e umasegunda posição, onde, quando o freio está na primeira posição, o freio po-de aplicar uma primeira força de frenagem à faixa 190, por exemplo. Em pe-lo menos uma modalidade dessas, o freio pode aplicar, quando estiver nasegunda posição, uma segunda força de frenagem à faixa 190, por exemplo,que pode se superior a ou inferior à primeira força de frenagem. Em váriasmodalidades alternativas, o freio pode não estar engatado com a faixa 190ou qualquer outra parte do acionador de disparo quando o freio está na se-gunda posição. Em várias modalidades, apesar de não ilustrado, o instru-mento cirúrgico 100 pode incluir um mecanismo dentado que pode aplicaruma força de frenagem ao carretei 192 e/ou à faixa 190. Em pelo menosuma modalidade dessas, o mecanismo dentado pode incluir um entalhe es-férico e um elemento de mola para engatar de forma orientada o entalhe es-férico contra o carretei 192 e/ou faixa 190.
Em várias modalidades, o instrumento cirúrgico 100 pode incluiruma roda dentada que pode permitir que o carretei 192 gire em uma primeiradireção, mas pode, em várias circunstâncias, impedir que o carretei 192 gireem uma direção oposta à primeira direção. Em pelo menos uma modalidade,com referência às figuras 45 a 49, o instrumento cirúrgico 100 pode incluir oconjunto de roda dentada 230, onde o conjunto de roda dentada 230 podeincluir a roda dentada 232 e a garra de roda dentada 234. Em várias modali-dades, a roda dentada 232 pode operar substancialmente da mesma formaque a engrenagem de chave 206 descrita acima exceto que, com referênciabasicamente às figuras 47 e 48, a roda dentada 232 pode incluir dentes deroda dentada 236 que podem, devido a um engate de roda dentada com a-garra da roda dentada 234,-impedir que a roda dentada 232 seja girada emuma direção horária, por exemplo, quando o carrinho de retorno 194' estiverem sua posição não-acionada (figura 47). Mais particularmente, cada denteda roda dentada 236 pode incluir uma superfície plana 240 onde, com refe-rência à figura 48, pelo menos uma das superfícies planas 240 pode se a-poiar na borda 235 da garra 234 e, dessa forma, impedir que a roda dentada232 seja giradaem uma direção horária.
Cada dente da roda dentada 236 pode adicionalmente incluiruma superfície inclinada 238, onde as superfícies inclinadas 238 podem serconfiguradas para deslizar sob a garra 234 quando a roda dentada 232 égirada em uma direção anti-horária. Como resultado do acima exposto, oconjunto de roda dentada 230 pode permitir que a faixa 190 seja puxada deforma distai pelo elemento de disparo 166, por exemplo, mas impede, oupelo menos inibe substancialmente, que a faixa 190 seja movida de formaproximal, pelo menos quando o carrinho de retorno 194' estiver em sua posi-ção não-acionada. Quando o carrinho de retorno 194' é articulado descen-dentemente para sua posição acionada, como descrito acima com relaçãoao carrinho de retorno 194, a roda dentada 232 pode deslizar na direção daengrenagem de gatilho 196' e sair do engate operacional com a garra daroda dentada 234. Depois disso, como resultado, a roda dentada 232 podeser girada na direção horária ou anti-horária sem interferência, ou pelo me-nos interferência substancial, da garra da roda dentada 234. Em várias mo-dalidades alternativas, onde a roda dentada 232 não é deslizada na direçãoda engrenagem de gatilho 196', a garra da roda dentada 234 pode ser movi-da descendentemente e sair do engate operacional com os dentes da rodadentada 236 quando o carrinho de retorno 194' é movido para sua posiçãoacionada. Em qualquer caso, quando o carrinho de retorno 194' está em suaposição acionada, a engrenagem de gatilho 196' e o pino de retorno 198'podem girar a roda dentada 232 e o carne 192' para retrair a faixa 190 e oelemento de disparo 166.
Em várias modalidades, com referência às figuras 68 a 86, o ins-trumento cirúrgico 400 pode incluir um sistema de encerramento para encer-rar a placa de apoio de um efetor de extremidade, um acionador de disparopara avançar uma haste de disparo, o elemento de corte e/ou o acionador degrampo dentro do efetor de extremidade, e um acionador reverso acionadopor engrenagem para retrair pelo menos um dentre a haste de disparo, oelemento de corte, e/ou o acionador de grampo com relação ao efetor deextremidade. Em pelo menos uma modalidade, com referência à figura 68, osistemade eneerramento pode incluir o gatilho de encerramento 428, a co-nexão de acionamento 130, e o acionador 132 onde, similar ao descrito aci-ma, o gatilho de encerramento 428 pode ser configurado para deslocar aconexão de acionamento 130 e o acionador 132 quando o gatilho de encer-ramento 428 é movido de sua posição não-acionada ilustrada na figura 68para sua posição acionada ilustrada na figura 69. Em várias modalidades, oacionamento do gatilho de encerramento 428 pode destravar o acionador dedisparo. Em pelo menos uma modalidade, o acionador de disparo pode in-cluir o gatilho de disparo 460 que, quando o gatilho de encerramento 428 égirado na direção da alça 427, pode ser movido entre uma posição travadailustrada na figura 68 e uma posição destravada ilustrada na figura 69. Empelo menos uma modalidade dessas, o gatilho de encerramento 428 podeincluir a fenda, ou sulco, 128a que pode receber o pino, ou projeção, 160ase estendendo a partir do gatilho de disparo 460, onde uma parede lateral dafenda 128a pode ser configurada para impedir que o pino 160a, e o gatilhode disparo 460 se movam, ou pelo menos se movam substancialmente, comrelação ao gatilho de encerramento 428 quando o gatilho de encerramento428 está em sua posição não-acionada (figura 68). Quando o gatilho dé en-cerramento 428 é acionado, ou fechado, a parede lateral da fenda 128a po-de apoiar o pino 160a e mover o gatilho de disparo 460 entre sua posiçãotravada ilustrada na figura 68 e sua posição destravada ilustrada na figura69. Em tal posição destravada, a fenda 128a pode ser orientada para permi-tir que o pino 160a se mova dentro da fenda 128a permitindo, assim, que οgatilho de disparo 460 se mova com relação ao gatilho de encerramento 428e avance o acionador de disparo como descrito em maiores detalhes abaixo.
Em várias modalidades, com referência à figura 68, o acionadorde disparo pode compreender o gatilho de disparo 460, o pino de disparo172, e a garra 170 onde o gatilho de disparo 460 pode ser engatado de for-ma operacional à haste de disparo, ou elemento, 466 através da garra 170 edo pino de disparo 172 a fim de avançar o elemento de corte e o acionadorde grampo dentro do efetor de extremidade. Em pelo menos uma modalida-de, similar à acima, a garra 170 pode ser articulada ascendentemente emengate com o elemento de disparo 466 de forma que, quando o gatilho dedisparo 460 é acionado, com referência à figura 70, o gatilho de disparo 460possa avançar o pino de disparo 172, a garra 170, e o elemento de disparo466 de forma distai. Depois disso, com referência à figura 101, a garra 170pode ser articulada descendentemente para fora do engate com o elementode disparo 466 de forma que a garra 170 possa ser retraída de forma proxi-mal com relação ao elemento de disparo 466 quando o gatilho de disparo460 é liberado ou retornado para sua posição não-acionada e destravadailustrada na figura 72. Depois de se comparar as figuras 69 e 72, fica pron-tamente aparente que um primeiro ciclo do acionador de disparo moveu oelemento de disparo 466 de forma distai e também reposicionou a garra 170,o pino de disparo 172 e o gatilho de disparo 460 de modo que o gatilho dedisparo 460 possa ser acionado uma segunda vez para avançar adicional-mente o elemento de disparo 466. Em tais circunstâncias, com relação àfigura 102, a garra 170 pode ser articulada ascendentemente em engate o-peracional com o elemento de disparo 466 e avançada de forma distai peloacionamento do gatilho de disparo 460 mais uma vez.
Em várias modalidades, com referência às figuras 101 e 102, oelemento de disparo 466 pode incluir uma pluralidade de recessos 467 quepodem, cada um, receber pelo menos uma parte da garra 170 de forma quea garra 170 possa ser engatada de forma serial nos recessos 467 a fim deavançar o elemento de disparo 466 uma pluralidade de vezes como descritoacima. Mais particularmente, em pelo menos uma modalidade, o elementode disparo 466 pode incluir três recessos 467 que podem permitir que o e-Iemento de disparo 466 seja avançado pelo menos três vezes pelo gatilho460. Por meio de exemplo, a figura 73 ilustra o acionador de disparo depoisde um segundo acionamento do gatilho 460, a figura 74 ilustra o acionadorde disparo depois que o gatilho 460 retornou para sua posição não-acionadadepois de seu segundo acionamento, a figura 75 ilustra o acionador de dis-paro depois de um terceiro acionamento do gatilho 460, e a figura 82 ilustrao acionador de disparo depois que o gatilho 460 retornou para sua posiçãonão-acionada depois de seu terceiro acionamento. Em tal ponto, como des-crito em maiores detalhes abaixoy-o-acionador de disparo pode ser desenga-tado do elemento de disparo 466 e o acionador reverso pode ser engatadode forma operacional com o elemento de disparo 466 de forma que, em vá-rias modalidades, o elemento de disparo 466 possa ser retraído com relaçãoao efetor de extremidade e o instrumento cirúrgico possa ser reconfigurado.Apesar de o gatilho de disparo 460 ser acionado três vezes a fim de avançarcompletamente o elemento de disparo 466 na modalidade ilustrativa, outrasmodalidades são vislumbradas que podem utilizar mais ou menos de trêspassos ou acionamentos do gatilho de disparo.
Em várias modalidades, como destacado acima, o instrumentocirúrgico 400 pode incluir adicionalmente um acionador reverso acionado porengrenagem, ou mecanismo, que pode ser configurado para retrair o ele-mento de disparo 466, o elemento de corte, e/ou o acionador de grampocom relação ao efetor de extremidade do instrumento cirúrgico. Em pelo me-nos uma modalidade, o mecanismo reverso pode ser engatado de formaoperacional com o elemento de disparo 466, ou qualquer outra parte ade-quada do acionador de disparo, para mover o elemento de disparo 466 deforma proximal. Em pelo menos uma modalidade, com referência à figura 71,o acionador reverso pode incluir um trem de engrenagem compreendendo aengrenagem de gatilho 946, engrenagem de chave 406, engrenagem de pi-nhão 401, engrenagem intermediária 403, e engrenagem de dentes retos416, por exemplo. Em várias modalidades, com referência à figura 84, o a-cionador reverso pode incluir adicionalmente a parte de engrenagem 158que se estende do gatilho de disparo 460 que pode ser configurado de formaque, quando o gatilho de disparo 460 é girado em torno do pino 161, similarao acima exposto, a parte de engrenagem 158 possa girar a engrenagem degatilho 496 em torno de um eixo geométrico definido pelo pino de retorno498. Em pelo menos uma modalidade, a parte de engrenagem 158 e a en-grenagem de gatilho 496 podem incluir dentes e/ou recessos que podem serconfigurados para cooperar e transmitir o movimento de rotação entre osmesmos.
Com referência à figura 77, também similar ao acima, exposto, aengrenagem de gatilho 496 e o pino de retorno 498 podem ser configuradosde modo que possam ser seletivamente engatados e desengatados um como outro. Em pelo menos uma modalidade dessas, a engrenagem de gatilho496 pode ser operacionalmente desengatada com o pino de retorno 498quando o elemento de disparo 466 é avançado pelo acionador de disparo.Posto de outra forma, a engrenagem de gatilho 496 pode ser configurada demodo que não transmita, ou apenas de forma substancial, o movimento rota-tivo para o pino de retorno 498 quando o elemento de disparo 466 está sen-do avançado pelo acionador de disparo como descrito acima. Adicionalmen-te, em pelo menos uma modalidade, com referência às figuras 77 e 79, opino de retorno 498 pode incluir a chave 499 se estendendo a partir daí ondea chave 499 pode ser mantida fora do engate operacional com a cavidadeem formato de D 497 na engrenagem de gatilho 496 até que o acionadorreverso seja engatado de forma operacional com o elemento de disparo 466como descrito em maiores detalhes abaixo. A fim de se manter a chave 499fora do engate operacional com a engrenagem de gatilho 496, com referên-cia à figura 84, o pino de retorno 498 pode incluir a extremidade 498a quepode ser deslocada, e/ou mantida na posição, pelo carrinho de retorno 494de forma que a chave 499 seja posicionada fora da cavidade em formato deD 497.
Antes de a engrenagem de gatilho 496 e o pino de retorno 498serem engatados de forma operacional como mencionado acima, a engre-nagem de pinhão 401 do acionador reverso, com referência à figura 71, po-de ser engatada de forma operacional com a parte de cremalheira 405 doelemento de disparo 466 de forma que, quando o elemento de disparo 466 éavançado de forma distai pelo acionador de disparo como descrito acima, aparte de cremalheira 405 pode girar a engrenagem de pinhão 401 em tornode um eixo geométrico definido pelo eixo 407. Em várias modalidades, acremalheira 405 pode incluir uma pluralidade de dentes e/ou sulcos que po-dem ser configurados para converter o movimento de translação do elemen-to de disparo 466 em movimento rotativo da engrenagem de pinhão 401. Emvárias modalidades, a engrenagem intermediária 403 pode ser montada emou formada integralmente-com-a engrenagem de pinhão-40í-de forma que atranslação do elemento de disparo 466 possa girar a engrenagem intermedi-ária 403 também. Em pelo menos uma modalidade, a engrenagem interme-diária 403 e a engrenagem dè chave 406 podem incluir dentes e/ou recessosque podem ser configurados para cooperar e transmitir o movimento rotativoentre os mesmos. De forma similar, a engrenagem de dentes retos 416 podeincluir dentes e/ou recessos que podem ser configurados para cooperar comos dentes e/ou recessos da engrenagem de chave 406 e transmitem o mo-vimento rotativo entre os mesmos. Dessa forma, em vista do acima citado, oavanço do elemento de disparo 466 pode girar as engrenagens 401, 403,406 e 416 do trem de engrenagem.
Em pelo menos uma modalidade, com referência às figuras 71 e84, a engrenagem de dentes retos 416 pode ser montada em ou formadaintegralmente com a engrenagem indicadora 492 de forma que, quando aengrenagem de dentes retos 416 é girada pela engrenagem de chave 406como destacado acima, a engrenagem indicadora 492 pode ser girada pelaengrenagem de dentes retos 416. Dessa forma, em pelo menos uma moda-lidade, o avanço do elemento de disparo 466 pode girar a engrenagem indi-cadora 492 em torno de um eixo geométrico definido pela abertura 407. Emvárias modalidades, a engrenagem indicadora 492 pode incluir pelo menosum indício, tal como letras, números e/ou quaisquer outros símbolos ade-quados, por exemplo, para exibir o número de vezes em que o gatilho dedisparo 460 foi acionado, por exemplo. Em pelo menos uma modalidade, oalojamento do instrumento cirúrgico pode incluir uma janela ou abertura on-de um número "1", por exemplo, na engrenagem indicadora 492 pode seralinhado com a janela depois de um primeiro acionamento do gatilho de dis-paro 460. De forma similar, um número "2", por exemplo, na engrenagemindicadora 492 pode ser alinhada com a janela depois de um segundo acio-namento do gatilho de disparo e, de forma correspondente, um número "3",por exemplo, pode ser alinhado com a janela depois de um terceiro aciona-mento. Alternativamente, em pelo menos uma modalidade, a engrenagemindicadora 492 pode incluir indícios que podem corresponder ao número deacionamentos restantes que são necessários para se avançar totalmente oelemento de disparo 466, o elemento de corte, e/ou o acionador de grampocom relação ao efetor de extremidade.
Depois que o elemento de disparo 466 foi totalmente avançadocom relação ao efetor de extremidade, ou pelo menos adequadamente a-vançado, o carrinho de retorno 494 pode ser direcionado para baixo, comreferência às figuras 76 e 82, a fim de acoplar de forma operacional o acio-nador reverso, o gatilho de disparo 460 e o elemento de disparo 466. Emvárias modalidades, o carrinho de retorno 494 pode ser girado em torno dopino 494a de forma que o carrinho de retorno 494 não entre mais em contatoou pelo menos não um contato substancial com o pino de retorno 498. De-pois disso, com referência às figuras 77 e 78, a mola 400 pode deslizar oudeslocar o pino de retorno 498 na direção da engrenagem de gatilho 496 eposicionar pelo menos uma parte da chave 499 dentro da cavidade 497. Empelo menos uma modalidade, com referência à figura 78, a mola 400 podeser posicionada entre a estrutura 484 e a chave 499 do pino de retorno 498de modo que, quando o carrinho de retorno 494 não estiver mais em contatocom a extremidade 498a, a mola 400 possa expandir e deslocar a chave 499para dentro da cavidade 497. Em várias modalidades, com referência à figu-ra 80, o carrinho de retorno 494 também pode desengatar de forma opera-cional o acionador de disparo do elemento de disparo 466 quando o carrinhode retorno 494 é girado descendentemente como descrito acima. Mais parti-cularmente, com referência à figura 81, o carrinho de retorno 494 pode en-trar em contato com a extremidade 220 do pino de disparo 172 de forma queo pino de disparo 172 possa deslizar na direção da garra 170 e, como tam-bém descrito acima, o pino de disparo 172 pode incluir a chave 222 se es-tendendo a partir daí que pode engatar o recesso 173 na garra 170 para im-pedir que a garra 170 seja articulada ascendentemente para engatar o ele-mento de disparo 466. Dessa forma, quando a garra 170 é impedida de en-gatar de forma operacional o elemento de disparo 466, o acionador de dispa-ro não pode mais engatar o elemento de disparo 466 e o acionador reversopode retrair o elemento de disparo 466 sem interferência por parte do acio-nador de disparo.
Em adição ao acima exposto, em várias modalidades, o carrinhode retorno 494 pode ser girado descendentemente e manualmente por umcirurgião ou por outro médico, por exemplo. Em várias modalidades, comreferência geralmente às figuras 68 e 82, o cirurgião pode aplicar uma forçaà parte do botão 495 de forma que o carrinho de retorno 494 possa ser arti-culado descendentemente em torno de um eixo geométrico definido pelopino 494a. Tal força pode ser aplicada depois de uma quantidade predeter-minada de acionamentos do gatilho de disparo apesar de, em várias modali-dades, tal força poder ser aplicada antes da quantidade predeterminada deacionamentos do gatilho de disparo ser alcançada. Em adição a ou no lugardo acima exposto, pelo menos uma das engrenagens do mecanismo reversopode ser configurada para entrar em contato com o carrinho de retorno 494depois de um número predeterminado de acionamentos do gatilho de dispa-ro 460. Em várias modalidades, com referência à figura 76, a engrenagemindicadora 492 pode incluir um carne 402 que pode ser configurado para en-trar em contato com uma parte do carrinho de retorno 494 e aplicar uma for-ça ao mesmo depois do terceiro acionamento do gatilho de disparo 460. Empelo menos uma modalidade, o avanço do elemento de disparo 466 podegirar a engrenagem indicadora 492 uma quantidade predeterminada depoisde cada acionamento do gatilho 460 de forma que o carne 402 possa entrarem contato com o carrinho 494 depois do terceiro passo ou passo final dogatilho 460 que avança o elemento de disparo 466. Efetivamente, a engre-nagem indicadora 492, ou qualquer outra engrenagem adequada do meca-nismo reverso, pode ser configurada de forma a ser girada uma quantidadepredeterminada antes da comutação do instrumento cirúrgico de um modooperacional "avançar" para um modo operacional "reverter".
Uma vez que o pino de retorno 498 foi engatado de forma ope-racional com a engrenagem de gatilho 496 e o pino de disparo 172 ter sidoengatado com a garra 170 a fim de impedir que a garra 170 engate de formaoperacional o elemento de disparo 466 como descrito acima, o gatilho dedisparo 460 pode ser acionado mais uma vez a fim de retrair o elemento dedisparo 466. Em pelo menos-uma-modalidadero acionamento subsequentedo gatilho de disparo 466 pode girar a engrenagem de gatilho 492 e, devidoao engate operacional entre a engrenagem de gatilho 492 e o pino de retor-no 498, a engrenagem de gatilho 492 pode girar a engrenagem chave 406.Mais particularmente, com referência às figuras 71, 77 e 78, a chave de pinode retorno 499 pode ser engatada de forma operacional com a superfície deacionamento 410 da engrenagem de gatilho 492 em adição a uma paredelateral da cavidade 406a dentro da engrenagem de chave 406 de forma quea rotação da engrenagem de gatilho 496 seja transmitida para a engrena-gem de chave 406 através do pino de retorno 498. Em várias modalidades,com referência novamente à figura 71, a rotação da engrenagem de chave406 pode girar a engrenagem intermediária 403 e a engrenagem de pinhão401 a fim de acionar, ou retrair, o elemento de disparo 466 de forma proxi-mal. Efetivamente, quando o gatilho 460 é engatado de forma operacionalcom o acionador reverso, a engrenagem de pinhão 401 pode ser girada emuma direção que é oposta à direção em que é girada quando o gatilho dedisparo 460 é engatado de forma operacional com o acionador de disparo.
Em várias modalidades, o tamanho, ou raio de inclinação das engrenagens401, 403, 406, 492 e 496 e a parte de engrenagem 158 da engrenagem degatilho 460, por exemplo, pode ser selecionada de forma que o elemento dedisparo 466 possa ser retornado por um acionamento do gatilho 460, apesarde outras modalidades serem vislumbradas na quais mais ou menos que umacionamento do gatilho 460 possa ser utilizado.
Depois de o elemento de disparo 466 ter sido retraído, o carrinhode retorno 494 pode ser articulado ascendentemente para sua posição não-acionada a fim de reconfigurar o instrumento cirúrgico. Em várias modalida-des com referêneia às figuras 85-e 86, o cirurgião ou médico pode aplicaruma força à parte de botão 452 da trava de gatilho 448 de forma que a travade gatilho 448 possa girar ascendentemente e se apoiar no carrinho de re-torno 494. Em tais circunstâncias, a trava de gatilho 448 pode girar o carri-nho de retorno 494 ascendentemente também e posicionar o carrinho 494em sua posição não-acionada. Em se fazendo isso, o carrinho de retorno494 pode engatar a extremidade 221 do pino de disparo 172 a fim de desli-zar o pino de disparo 172 para longe da garra 170 e desengatar a chave 222do recesso 173 na garra 170 permitindo, assim, que a garra 170 engate no-vamente o elemento de disparo 466 depois de um acionamento subsequentedo gatilho de disparo 460. O carrinho de retorno 494 também pode engatarnovamente a extremidade 498a do pino de retorno 498 quando é girado as-cendentemente de forma a deslizar a chave 499 para longe da engrenagemde gatilho 496, desengatando, dessa forma, operacionalmente o pino de re-torno 498 da engrenagem de gatilho 496 e, de forma correspondente, de-sengatar de forma operacional o acionador reverso do elemento de disparo466. Depois disso, o cartucho de grampos gasto pode ser destacado do ins-trumento cirúrgico e substituído por um novo cartucho de grampos de formaque o instrumento cirúrgico possa ser utilizado novamente.
Em várias modalidades alternativas, um instrumento cirúrgicopode incluir uma embreagem configurada para engatar de forma operacionale desengatar um acionador reverso com um elemento de disparo. Em pelomenos uma modalidade, com referência às figuras 87 a 94, o instrumentocirúrgico 500, similar ao instrumento cirúrgico 400, pode incluir o gatilho dedisparo 4560 que pode ser configurado para acionar um pino de disparo euma garra de um acionador de disparo, por exemplo, de forma a avançar oelemento de disparo 566, um elemento de corte, e/ou o acionador de gram-pos com relação a um efetor de extremidade. Em várias modalidades, tam-bém de forma similar à citada acima, o instrumento cirúrgico pode incluir adi-cionalmente um acionador reverso compreendendo engrenagem de pinhão501, engrenagem intermediária 503, engrenagem de chave 506 e engrena-gem de dentes retos 516. Em pelo menos uma modalidade, devido ao enga-te operacional entre a parte de eremalheira 505 do elemento de disparo 496e a engrenagem de pinhão 501, o avanço do elemento de disparo 466 podegirar as engrenagens 501, 503, 506 e 516 descritas em maiores detalhesabaixo. Em várias modalidades, o retorno, a chave ou o pino 598 pode sermontado a ou formado integralmente com a engrenagem de chave 506 deforma que o movimento rotativo seja transmitido entre os mesmos. Em pelomenos uma modalidade, com referêneia à figura 89, pelo menos uma partedo pino de retorno 598 pode incluir uma seção transversal não-circular inclu-indo uma parte plana 598b, por exemplo, que pode, com referência à figura92, ser recebida de forma deslizante dentro de uma abertura de formato cor-respondente 506b na engrenagem chave 506. Além disso, de forma similar àdescrita acima, o atilho de disparo 560 pode incluir a parte de engrenagem558 que pode ser engatada de forma operacional com a engrenagem de ga-tilho 596 de forma que a parte de engrenagem 558 possa girar a engrena-gem de gatilho 596 em torno de um eixo geométrico definido pelo pino dechave 598, como descrito em maiores detalhes acima.
Em uso, depois do primeiro acionamento do gatilho de disparo560, o gatilho de disparo 560 pode, de forma similar à descrita acima, girar aengrenagem de gatilho 596 em torno do pino de chave 598 sem transmitirdiretamente o movimento rotativo para o pino de chave 598 através da en-grenagem de gatilho 596. Com referência à figura 88, o primeiro acionamen-to do gatilho de disparo 560 pode girar a engrenagem de disparo 596 emuma direção indicada pela seta "A", isso é, no sentido horário para fins des-sa discussão. Além disso, depois do primeiro acionamento do gatilho de dis-paro 560, o elemento de disparo 566 pode girar a engrenagem de pinhão501 e a engrenagem intermediária 503 em uma direção indicada pela seta"B", a engrenagem de chave 506 na direção indicada pela seta "C", e a en-grenagem de dentes retos 516 e a engrenagem indicadora 592 em uma di-reção indicada pela seta "D". Em várias modalidades, como ilustrado na figu-ra 88, a engrenagem de gatilho 596 e a engrenagem de chave 506 podemser giradas em direções opostas durante o primeiro acionamento do gatilho560 e podem não ser engatadas de forma operacional uma com a outra atédepois do primeiro acionamente do gatilho 560 como deserito adicionalmen-te abaixo. Quando o gatilho 560 é liberado ou retornado para sua posiçãonão-acionada depois de seu primeiro acionamento, a garra do acionador dedisparo, por exemplo, pode ser desengatada do elemento de disparo 566 deforma que a engrenagem de pinhão 501 e a engrenagem de chave 506, porexemplo, não sejam giradas, ou pelo menos substancialmente giradas,-quando-o-gatilho-560-é retornado-para sua posição inicial ou não-aeionada.
A engrenagem de gatilho 596, no entanto, pode ser girada pelo gatilho dedisparo 560 quando o gatilho 560 é retornado para sua posição não-acionada e, como resultado disso, a engrenagem de gatilho 596 pode sergirada com relação à engrenagem de chave 506 como ilustrado na figura 89.
À medida que o gatilho 560 é retornado para sua posição não-acionada, co-mo descrito acima, a superfície inclinada 509 da engrenagem de gatilho 596pode entrar em contato com um cão de embreagem 599 do pino de chave598 e deslocar o pino de chave 598 para longe da engrenagem de gatilho596 como ilustrado na figura 90. Depois disso, a engrenagem de gatilho 596pode ser adicionalmente girada pelo gatilho de disparo 560 até que a super-fície inclinada 509 tenha passado completamente pelo cão da embreagem599 e a mola 500 pode orientar o cão da embreagem 599 para uma posiçãoatrás da superfície de acionamento 510 como ilustrado na figura 91. Em talponto, o gatilho de disparo 560 pode estar em sua posição não-acionada.
Depois de um segundo acionamento do gatilho de disparo 560, agarra do acionador de disparo pode permanecer desengatada do elementode disparo 566 apesar de o segundo acionamento do gatilho de disparo 560poder mais uma vez girar a engrenagem de gatilho 596 em uma direção in-dicada pela seta A, com referência à figura 92. Devido à posição do cão 599atrás da superfície de acionamento 510 da engrenagem de gatilho 596, arotação da engrenagem de gatilho 596 pode fazer com que o pino de chave598 e a engrenagem de chave 506 girem em uma direção horária indicadapela seta A também, isso é, em uma direção oposta à seta C. De forma cor-respondente, a engrenagem chave 506 pode girar a engrenagem de pinhão501 e a engrenagem intermediária 503 em uma direção indicada pela seta E,isso-éi-uma direção oposta à direção-da seta B, e também girar a engrena-gem indicadora 592 em uma direção indicada pela seta F1 isso é, uma dire-ção oposta à seta D. Devido à rotação da engrenagem de pinhão 501 emuma direção oposta durante o segundo acionamento do gatilho 560, a en-grenagem de pinhão 501 pode retrair o elemento de disparo 566 com rela-ção ao efetor de extremidade e reposicionar, ou pelo menos substancialmen--te-reposieionar—o-elemento-de-disparo 566-em sua posição-inicial, ou não-acionada. Depois disso, o gatilho de disparo 566 pode ser liberado e retor-nado para sua posição não-acionada. Em tais circunstâncias, a superfície deacionamento 510 da engrenagem de gatilho 5976 pode ser girada para lon-ge do cão de embreagem 599 e, ao passo que a garra do acionador de dis-paro ainda pode ser desengatada de forma operacional do elemento de dis-paro 566, o pino de chave 598 e a engrenagem de chave 596 podem per-manecer em posição. A fim de se reconfigurar o instrumento cirúrgico, a gar-ra do acionador de disparo pode ser liberada de forma que possa engatarnovamente o elemento de disparo 566 depois do próximo acionamento dogatilho 560. Em tais modalidades, o cartucho de grampos gasto pode sersubstituído de forma que o instrumento cirúrgico possa ser utilizado maisuma vez.
Em várias modalidades, com referência à figura 94, o instrumentocirúrgico 500 pode incluir adicionalmente a trava de gatilho 548 que, similar àtrava de gatilho 148 descrita acima, pode ser utilizada para manter um gatilhode encerramento na posição. Em pelo menos uma modalidade, a trava degatilho 548 pode ser girada entre as posições acionada e não-acionada paratravar e destravar, respectivamente, um gatilho de encerramento tal como ogatilho de encerramento 428 (figura 68), por exemplo. Em pelo menos umamodalidade dessas, quando a trava de gatilho 548 está em sua posição não-acionada, a parte 548a da trava de gatilho 548 pode ser posicionada dentrodo recesso 592a do indicador 592 para impedir, ou pelo menos impedirsubstancialmente, que o trem de engrenagem e o elemento de disparo 566sejam motivados de forma não intencional. De outra forma, quando a parte548a é posicionada dentro do recesso 592a, os acionadores de disparo eHOversodeseri-tos--aeima^odem-seM©mados--subs-tane-ialmenteHnoperantese, como resultado disso, o elemento de disparo 566 não pode ser substanci-almente movido. Quando a trava de gatilho 548 é movida para sua posiçãoacionada para manter ou travar o gatilho de encerramento no lugar, a parte548a da trava de gatilho 548 pode ser movida, ou girada, para fora do reces-so 592a de modo que os acionadores de disparo e reverso descritos acimapossam ser operados.
Em várias modalidades alternativas, um instrumento cirúrgicopode incluir uma roda dentada configurada para engatar e desengatar deforma operacional um acionador reverso com um elemento de disparo. Empelo menos uma modalidade, com referência às figuras 95 a 100, o instru-mento cirúrgico 600 pode incluir o gatilho de disparo 600 que pode ser confi-gurado para acionar um pino de disparo e uma garra de um acionador dedisparo, por exemplo, de modo a avançar o elemento de disparo 666, umelemento de corte, e/ou o acionador de grampos com relação a um efetor deextremidade, similar ao acima. Em várias modalidades, também de formasimilar à exposta acima, o instrumento cirúrgico pode adicionalmente incluirum mecanismo reverso compreendendo uma engrenagem de pinhão 601,uma engrenagem de chave 606, e uma engrenagem de dentes retos 616onde o avanço do elemento de disparo 666 pode girar as engrenagens 601,606 e 616 devido ao engate operacional entre a parte de cremalheira 605 doelemento de disparo 696 e a engrenagem de pinhão 601. Em várias modali-dades, o pino de retorno ou chave 698 pode ser montado em ou formadointegralmente com a engrenagem de chave 606 de modo que o movimentode rotação possa ser transmitido entre os mesmos. Também de forma simi-lar à exposta acima, o gatilho de disparo 660 pode incluir uma parte de en-grenagem 658 que pode ser engatada de forma operacional com a engrena-gem de gatilho 696 de forma que a parte de engrenagem 658 possa girar aengrenagem de gatilho 696 em torno do eixo geométrico definido pelo pinode chave 698.
Em uso, depois do primeiro acionamento do gatilho de disparo660, o gatilho de disparo 660 pode girar a engrenagem de gatilho 696 emtorno do pino de chave 698 sem transmitir-diretamente o-movimento de rota-ção para o pino de chave 698 e a engrenagem de chave 606. Mais particu-larmente, com referência à figura 97, a engrenagem de gatilho 696 pode in-cluir abertura 696a que pode ser configurada de modo que exista um encai-xe com espaço entre o pino de chave 698 e as paredes laterais da abertura696a e, como resultado disso, o pino de chave 698 possa girar. Adicional-mente,com-referência à figura 96,-a-engrenagemde chave 606 pode incluira face da roda dentada 606c e a engrenagem de gatilho 696 pode incluir aface de roda dentada 696c que, quando o elemento de disparo 666 estásendo avançado pelo acionador de disparo, pode ser desengatada de formaoperacional, ou separada, uma da outra de forma que o movimento de rota-ção também não seja transmitido entre as mesmas. Depois que o elementode disparo 666 foi suficientemente avançado, de forma similar à exposta a-cima, o carrinho de retorno 694 pode ser girado para baixo em torno do pino694a, por exemplo, de forma que o carrinho de retorno 694, com referência àfigura 99, possa ser desengatado da extremidade 698a do pino de retorno698. Em tais circunstâncias, como descrito em maiores detalhes abaixo, opino de retorno 698 pode ser engatado de forma operacional com a engre-nagem de gatilho 696 e o elemento de disparo 666 pode ser retraído.
Em várias modalidades, adicionalmente ao acima, o carrinho deretorno 694 pode ser movido manualmente entre sua posição não-acionadailustrada na figura 95 para sua posição acionada ilustrada na figura 99, simi-lar ao carrinho de retorno 494. Em adição a ou no lugar do acima, pelo me-nos uma das engrenagens no trem de engrenagem, tal como a engrenagemindicadora 692, por exemplo, pode incluir um carne, tal como o carne 602,por exemplo, que pode entrar em contato com o carrinho de retorno 694 egirar o mesmo para baixo depois de uma quantidade predeterminada de a-cionamentos do gatilho de disparo 660. Depois disso, em qualquer caso, aengrenagem de chave 606 pode ser deslizada na direção da engrenagem degatilho 696 pela mola 600. Mais particularmente, com referência à figura100, a mola 600, que pode ser posicionada, ou comprimida, entre a engre-nagem de chave 606 e uma estrutura do instrumento cirúrgico, por exemplo,de forma que, uma vez-que o carrinho de retorno 694 tenha sido desengata-do da extremidade 698a do pino de retorno 698, a mola 600 pode expandirpara deslizar a engrenagem de chave deslizante 606 na direção da engre-nagem de gatilho 696. Adicionalmente, em pelo menos uma modalidade, opino de retorno 698 pode ser montado em ou formado integralmente com aengrenagem de chave 606 de forma que o pino de retorno 698 possa serdeslizado na direção da engrenagem de gatilho 696 com a engrenagem dechave 606. Em pelo menos uma modalidade, com referência à figura 97, opino de retorno 698 pode incluir o colar 698b no qual a engrenagem de cha-ve 606 pode se apoiar e empurrar o pino de retorno 698 na direção da en-grenagem de gatilho 696.
Em várias modalidades, como resultado do acima exposto, asfaces da roda dentada 606c e 696c podem ser posicionadas uma contra aoutra pela mola 600 quando o carrinho de retorno 694 é girado para baixoem sua posição acionada como ilustrado na figura 100. Em pelo menos umamodalidade, com referência à figura 97, as faces da roda dentada 606c e696c podem, cada uma, incluir dentes que se estendem a partir da mesma eque podem cooperar para transmitir o movimento rotativo entre as mesmas.Em uso, depois de um acionamento subsequente do gatilho de disparo 660,o gatilho de disparo 660 pode girar a engrenagem de gatilho 696, e a engre-nagem de chave 606, em uma direção horária indicada pela seta A, com re-ferência à figura 99, onde a engrenagem de chave 606 pode girar a engre-nagem de pinhão 601 em uma direção indicada pela seta E. Como resultadodo engate operacional entre a engrenagem de pinhão 601 e a parte de cre-malheira 605 do elemento de disparo 666, por exemplo, a engrenagem depinhão 601 pode retrair o elemento de disparo 666, o elemento de corte,e/ou o acionador de grampos com relação ao efetor de extremidade, similarao acima. Em pelo menos uma modalidade, as engrenagens 601, 606 e 696e a parte de engrenagem 658 podem ser configuradas de modo que o ele-mento de disparo 666 possa ser totalmente retraído com um acionamento dogatilho 460.
Depois disso, o gatilho de disparo 460 pode ser liberado e/ouretornado para sua posição não-acionada. Em pelo menos uma modalidade,as faces da roda dentada 606c e 696c podem incluir superfícies chanfradasque podem permitir que as faces da roda dentada 606c e 696c girem comrelação às mesmas quando o gatilho 660 é retornado para sua posição não-acionada. Em tais circunstâncias, a engrenagem de gatilho 696 pode sergirada em uma direção anti-horária, isso é, em uma direção oposta à indica-da pela seta A. Em pelo menos uma modalidade, as faces de roda dentada606c e 696c podem girar uma com relação à outra apesar de as faces daroda dentada estarem em contato uma com a outra. Depois disso, o carrinhode retorno 694 pode ser girado ascendentemente de modo que possa entrarem contato com a extremidade 698a do pino de retorno 698 e deslizar o pinode retorno 698 e a engrenagem de chave 606 para longe da engrenagem degatilho 696. Em tais circunstâncias, como resultado disso, a face da rodadentada 606c pode ser desengatada da face da roda dentada 696c de modoque as mesmas não estejam mais engatadas de forma operacional uma coma outra. Em pelo menos uma modalidade, o carrinho de retorno 694 podeaplicar uma força à extremidade 698a do pino de retomo 698, onde a forçapode ser transmitida para a engrenagem de chave 606 através do colar 698ba fim de deslocar a engrenagem de chave 606 para longe da engrenagemde gatilho 696.
Como descrito acima, os instrumentos cirúrgicos de acordo coma presente invenção podem incluir um acionador de disparo possuindo umagarra que pode ser configurada para avançar um elemento de disparo comrelação a um efetor de extremidade. Em várias modalidades, como descritoacima, a garra 170 pode ser articulada ascendentemente para engatar umrecesso 467 no elemento de disparo 466, por exemplo, e avançar o elemen-to de disparo 466 de forma distai. Depois disso, com referência mais umavez às figuras 101 e 102, a garra 170 pode ser articulada descendentementee retraída de forma proximal com relação ao elemento de disparo 466 demodo a reposicionar a garra 170 de forma que a garra 170 possa ser articu-lada ascendentemente mais uma vez para engatar outro recesso 467 e a -vançar adicionalmente o elemento de disparo 466. Em várias circunstancias,no entanto, a garra 170 pode não ser capaz de engatar um recesso 467quando é articulada ascendentemente como ilustrado na figura 103. Taiscircunstâncias podem surgir quando o elemento de disparo 466, por exem-plo, é movido de forma não intencional por forças ou energia transmitidasatravés de e/ou armazenadas dentro de vários mecanismos do instrumentocirúrgico. Se a garra for incapaz de engatar novamente o elemento de dispa-ro,o instrumento cirúrgico pode ser tornado inoperante e, como resultadodisso, o instrumento cirúrgico pode ter que ser reconfigurado manualmente.
A fim de melhorar essa condição, os instrumentos cirúrgicos de acordo comvárias modalidades da presente invenção podem incluir um mecanismo an-tirretorno que pode reter, ou pelo menos reter substancialmente, o elementode disparo em posição.
Em várias modalidades, com referência afigura 104, um meca-nismo antirretorno pode ser configurado para reter pelo menos uma parte deum acionador de disparo e/ou acionador reverso em posição enquanto a gar-ra 170 é retraída com relação ao elemento de disparo 466, por exemplo. Empelo menos uma modalidade, um mecanismo antirretorno pode incluir ummecanismo de indexação ou placa 711 que pode ser configurado para per-mitir que o pino de retorno 798 gire em uma direção anti-horária indicadapela seta B quando o elemento de disparo 466 é avançado, como descritoacima, mas ainda proibir, ou pelo menos proibir substancialmente, que o pi-no de retorno 798 gire em uma direção horária, isso é, em uma direção o-posta à da seta B. Efetivamente, visto que o pino de retorno 798 é engatadode forma rotativa com a engrenagem de chave 406, e a engrenagem dechave 406 é engatada de forma operacional com o elemento de disparo 466através da engrenagem intermediária 403 e engrenagem de pinhão 401, omecanismo de indexação 711 também pode impedir, ou pelo menos impedirsubstancialmente, que o elemento de disparo 466 seja retraído de formaproximal. Adicionalmente, como descrito em maiores detalhes abaixo, o me-canismo de indexação 711 também pode inibir o avanço não intencional dis-tai do elemento de disparo 466 também.
A fim de se impedir que o pino de retorno 798 gire de forma nãoHfiteneional como descrito acima, o elemento de-indexação 711 pode incluirum ou mais recessos e/ou aberturas para manter ou reter o pino de retorno798 em posição. Em várias modalidades, com referência às figuras 104, 107e 111, o mecanismo de indexação 711 pode compreender uma mola Iami-nada incluindo uma extremidade presa 711a que pode ser retida dentro dorecesso 784a da estrutura 784 de forma que o mecanismo de indexação 711possa flexionar e/ou-girar com relação ao tronco 784b da estrutura 784. Empelo menos uma modalidade, com referência às figuras 105 e 106, o pino deretorno 798 pode incluir a chave 799 se estendendo a partir do mesmo ondea chave 799 pode ser configurada para engatar o mecanismo de indexação711. Mais particularmente, em pelo menos uma modalidade, o mecanismode indexação 711 pode incluir uma pluralidade de recessos, ou aberturas713a-d, com referência às figuras 107 e 108, que podem ser, cada um, con-figurados para reter a projeção 799a se estendendo a partir da chave 799 e,dessa forma, reter o pino de retorno 798 em posição como descrito em maio-res detalhes abaixo.
Em uso, um efetor de extremidade do instrumento cirúrgico podeser fechado no tecido mole de um paciente, por exemplo, e, depois disso,como descrito acima, um elemento de disparo do instrumento cirúrgico podeser avançado por um acionador de disparo. Antes do avanço do elemento dedisparo, a projeção 799a do pino de retorno 798 pode ser recebida dentro daprimeira abertura 713a do elemento de indexação 711 como ilustrado nafigura 110a. Em várias modalidades, com referência às figuras 106 e 109, achave 799 pode incluir adicionalmente uma superfície inclinada ou chanfrada799b que pode ser configurada de modo que, quando o pino de retorno 798é girado em uma direção indicada pela seta B pelo elemento de disparo 466,a engrenagem de pinhão 401, a engrenagem intermediária 403, e a engre-nagem de chave 406 mediante o primeiro acionamento do gatilho 460, a su-perfície chanfrada 799b pode entrar em contato com a borda da abertura713a e desviar e/ou girar o mecanismo de indexação 711 para baixo comoilustrado na figura 110b. De forma perceptível, uma determinada quantidadede força pode ser necessária para se desviar e/ou girar o mecanismo de in-dexação 711 e,-como resultado disso, a-possibilidade-de o pino-de retorno798 ser deslocado de forma não intencional a partir dos recessos 713 podeser reduzida. Mais particularmente, sem uma grande força de retração apli-cada ao elemento de disparo 766, por exemplo, os recessos no elemento deindexação podem ser capazes de reter a chave 799 do pino de retorno 798e, de forma correspondente, a possibilidade de o elemento de disparo 466poder ser avançado de forma não intencional também pode ser reduzida.
No final do primeiro acionamento do gatilho de disparo 460, achave 799 pode ser posicionada dentro da segunda abertura 713b do meca-nismo de indexação 711 como ilustrado na figura 110c. Em tal posição, achave 799 pode ser impedida de se mover para trás e para dentro da abertu-ra 713a devido à superfície batente 799c. Mais particularmente, com refe-rência à figura 108, a chave 799 pode incluir adicionalmente a superfície ba-tente 799c, que pode ser configurada para apoiar no perímetro da abertura713b, por exemplo, e, devido à configuração da superfície batente 799c, aabertura 713b e a superfície batente 799c podem ser configuradas para im-pedir que a chave 799 desvie ou gire o mecanismo de indexação 711 parabaixo dentro do recesso 715 (figura 111) e permitindo que o pino de retorno798 seja girado em uma direção oposta à seta B. Em pelo menos uma mo-dalidade, a superfície batente 799c e o perímetro de abertura 713b podemincluir as superfícies que são paralelas uma à outra. Em outras várias moda-lidades, as superfícies de apoio podem incluir pelo menos partes parcialmen-te chanfradas que podem ser configuradas de forma que, quando a superfí-cie batente 799c é forçada contra a borda da abertura 713b, a chave 799pode ser adicionalmente puxada para dentro da abertura 713b em oposiçãoa ser erguida para fora da mesma. Em qualquer caso, devido à relação ope-racional entre o pino de retorno 798, as engrenagens do trem de engrena-gem, e o elemento de disparo 466 como descrito acima, o elemento de dis-paro 466 pode ser impedido, ou pelo menos substancialmente impedido, deretrair de forma proximal não intencional pelo elemento de indexação 711.
Em tais modalidades, como resultado disso, a possibilidade de a garra 170poder ser desalinhada com relação aos recessos 467 dentro do elemento dedisparo 466 quando a garra-170 é retraída com relação ao elemento de dis-paro 466, por exemplo pode ser reduzida.
Depois de um segundo acionamento do gatilho de disparo 460, oelemento de disparo 466 pode mais uma vez girar as engrenagens 401, 402e 406 de forma que o pino de retorno 798 seja girado em uma direção indi-cada pela seta B. Em várias modalidades, como resultado disso, a superfíciechanfrada 799b pode entrar em contato com a borda da segunda abertura713b e desviar e/ou girar o mecanismo de indexação 711 para baixo comoilustrado na figura 110d. No final do segundo acionamento do gatilho de dis-paro 460, a chave 799 pode ser posicionada dentro da terceira abertura713c do mecanismo de indexação 711 como ilustrado na figura 110e. Em talposição, a chave 799 pode ser impedida de mover para trás e para dentro dasegunda abertura 713b devido à superfície batente 799c, similar à acima.Adicionalmente, depois de um terceiro acionamento do gatilho de disparo460, o elemento de disparo 466 pode mais uma vez girar o pino de retorno798 em uma direção indicada pela seta B e, como resultado disso, a superfí-cie chanfrada 799b pode entrar em contato com a borda da terceira abertura713c e desviar e/ou girar o mecanismo de indexação 711 para baixo comoilustrado na figura 110f. No final do terceiro acionamento do gatilho de dispa-ro 460, a chave 799 pode ser posicionada dentro da quarta abertura 713d domecanismo de indexação 711 como ilustrado na figura 110g. Em tal posição,similar à acima, a chave 799 pode ser impedida de mover de volta para den-tro da terceira abertura 713c devido à superfície batente 799c.
Em tal ponto, a fim de se engatar de forma operacional o acio-nador reverso com o elemento de disparo, similar ao exposto acima, o pinode retorno 798 e a chave 799 podem ser movidos na direção da engrena-gem de gatilho 496 a fim de engatar operacionalmente a engrenagem dechave 406 com a engrenagem de gatilho 496. Em várias modalidades, comoresultado disso, a projeção 799a pode ser movida para longe do elementode indexação 711 e para fora da quarta abertura 713d. Depois disso, medi-ante o passo de retorno do gatilho de disparo 460, o elemento de disparo466 pode ser retraído e o pino de retorno 798 pode ser girado em uma dire-ção horária, isso é, em^ uma-direção oposta à seta B. Em tal ponto, o ele-mento de disparo 466 e a garra 170 terão ambos sidos retornados para suasposições iniciais, o pino de retorno 798 pode ser desengatado da engrena-gem de gatilho 496 de forma que a chave 499 seja deslizada para dentro doengate com a primeira abertura 713a. Depois disso, como resultado disso, oinstrumento cirúrgico pode ser utilizado mais uma vez.
Em várias modalidades alternativas,-com referência às figuras112 e 113, um mecanismo antirretorno pode incluir o elemento de indexa-ção, ou placa 811 que pode ser montado de forma rotativa dentro do recesso884a do quadro 884 de forma que a extremidade de articulação 811a possaser montada de forma rotativa na parte de pino 884b. Em pelo menos umamodalidade, similar à acima, o elemento de indexação 811 pode ser giradoe/ou desviado com relação ao pino 811b. Em várias modalidades, o meca-nismo antirretorno pode incluir adicionalmente pelo menos um elemento fle-xível, ou mola de retorno 811b dentro do recesso 815 que pode ser configu-rado para orientar o elemento de indexação 811 na posição ilustrada nasfiguras 112 e 113. De forma similar, a mola de retorno 811b pode ser adicio-nalmente configurada para restaurar o elemento de indexação para tal posi-ção depois de ter sido deformado pela chave 799 como descrito acima. Emvárias modalidades, a pelo menos uma mola de retorno pode ser posiciona-da entre o elemento de indexação 811 e uma parede lateral do recesso 815,por exemplo. Em várias modalidades alternativas, com referência à figura114, um mecanismo antirretorno pode incluir o elemento de indexação 911que, similar ao acima, pode ser montado dentro do recesso 984a da estrutu-ra 984. Em pelo menos uma dessas modalidades, a estrutura 984 pode in-cluir adicionalmente projeções de montagem 984b que podem ser configura-das para serem encaixadas por pressão dentro das aberturas 911a no ele-mento de indexação 911 de forma que o elemento de indexação 911 possaser deformado e/ou girado com relação à estrutura 984.
Em várias modalidades alternativas, um mecanismo antirretornode acordo com pelo menos uma modalidade da presente invenção pode in-cluir um mecanismo de roda dentada para impedir, ou pelo menos limitar, omovimento indesejável do elemento de disparo e/ou trem de engrenagem.
Em várias modalidades, com referência às figuras 115 a 118, o mecanismode roda dentada pode incluir uma garra que pode ser configurada para per-mitir que as engrenagens do trem de engrenagem, tal como a engrenagemindicadora 492 e a engrenagem de dentes retos 416, por exemplo, girem emuma primeira direção quando são acionadas pelo elemento de disparo, talcomo o elemento-de-disparo-466rpor-exemplo, porém proibir,-ou pelo menoslimitar, as engrenagens de girar em uma direção oposta quando a garra doacionador de disparo, tal como a garra 170, por exemplo, é retraída com re-lação ao elemento de disparo. Em pelo menos uma modalidade, com refe-rência à figura 116, o mecanismo de roda dentada pode incluir uma molalaminada, ou garra 1011 que pode limitar a rotação da engrenagem de den-tes retos 416 como descrito em maiores detalhes abaixo.
Adicionalmente ao exposto acima, quando o elemento de dispa-ro 466, por exemplo, é avançado pelo gatilho de disparo 460, por exemplo, oelemento de disparo 466 pode girar a engrenagem de dentes retos 416 emuma direção indicada pela seta D (figura 116) devido ao engate operacionalda engrenagem de pinhão 401, a engrenagem intermediária 403, a engrena-gem de chave 406, e a engrenagem de dentes retos 416 como descrito aci-ma. Quando a engrenagem de dentes retos 416 é girada na direção D, empelo menos uma modalidade, os dentes da engrenagem 416a da engrena-gem 416 podem ser configurados para entrar em contato e desviar a garra1011 de modo que os dentes da engrenagem 416a possam passar. No en-tanto, no caso de o elemento de disparo 466 ser retraído de forma não in-tencional e/ou a engrenagem de dentes retos 416 ser girada em uma direçãoindicada pela seta H. a garra 1011 pode ser configurada de modo que pelomenos uma parte da mesma possa ser posicionada entre dois dentes deengrenagem adjacentes 416a e impedir, ou pelo menos limitar, a engrena-gem de dentes retos 416 de girar na direção H. Em várias modalidades, comreferência à figura 116, pelo menos uma parte da garra 1011 pode ser cu-nhada entre os dentes de engrenagem 416a ou "morder" na engrenagem416 de forma que a engrenagem 416 não possa girar substancialmente nadireção H, pelo menos não-até que o acionador-reverso do instrumento ci-rúrgico seja engatado de forma operacional com o elemento de disparo co-mo descrito em maiores detalhes abaixo.
Em várias modalidades, o instrumento cirúrgico pode incluir umcarrinho de retorno que pode ser movido entre uma posição não-acionadacomo ilustrado nas figuras 115 e 116 e uma posição acionada como ilustra-do nas figuras- 1-1-7-e 11-8-para-colocar o instrumento cirúrgico em seu modode operação reverso ou de retração. Similar ao carrinho de retorno 494, empelo menos uma modalidade, o carrinho de retorno 1094 pode ser giradocom relação à estrutura 484 em torno do pino 1094a. Em várias modalida-des, com referência à figura 118, a garra 1011 pode ser montada no carrinhode retorno 1094 de forma que, quando o carrinho de retorno 1094 é giradodescendentemente para dentro de sua posição acionada, a garra 1011 podeser movida para fora do engate operacional com a engrenagem de dentesretos 416. Em tais circunstâncias, a engrenagem de dentes retos 416 podegirar em uma direção indicada pela seta H quando instrumento cirúrgico élocalizado em seu modo reverso. Quando a engrenagem de dentes retos416 pode girar na direção Η, o trem de engrenagem pode girar sem interfe-rência, ou pelo menos sem interferência substancial, a partir do mecanismoantirretorno de modo que o elemento de disparo possa ser retraído comodestacado acima. Depois de o elemento de disparo ter sido suficientementeretraído, o carrinho de retorno 1094 pode ser girado para cima e para suaposição não-acionada e a garra 1011 pode ser engatada novamente de for-ma operacional com a engrenagem de dentes retos 416.
Em várias circunstâncias, um acionador reverso de um instru-mento cirúrgico pode ser impedido de ser engatado de forma adequada comum elemento de disparo do instrumento cirúrgico. Em pelo menos uma mo-dalidade, o carrinho de retorno de um acionador reverso, tal como os carri-nhos de retorno 494 e 1094, por exemplo, podem não ser capazes de entrarem contato adequado e motivar o pino de disparo 172 e/ou pino de retorno498, por exemplo. Mais particularmente, o carrinho de retorno pode falharem deslocar adequadamente o pino de disparo 172 e/ou pino de retorno 498de forma que a engrenagem-de-chave-406 seja engatada de-forma opera-cional com o gatilho 496 e, adicionalmente, de forma que a garra 170 sejaimpedida de engatar de forma operacional o elemento de disparo 466. Emvárias modalidades, como destacado acima, um carrinho de retorno podeincluir uma parte de botão que pode ser configurada para girar manualmenteo carrinho de retorno descendentemente quando uma força é aplicada aomesmo. Em várias circunstâncias no entanto, essa forçapode ter uma ala-vancagem insuficiente para mover o carrinho de retorno, especialmente se ocarrinho de retorno e/ou um dos pinos 172 e 498 estiver colado na posição,por exemplo.
Em várias modalidades da presente invenção, um instrumentocirúrgico pode incluir um comutador que pode ser mais bem configurado pa-ra engatar manualmente o acionador reverso do instrumento cirúrgico com oelemento de disparo. Em pelo menos uma modalidade, com referência àfigura 119, o comutador pode incluir primeira e segunda partes, onde a pri-meira parte 1194 pode ser conectada de forma móvel com relação à estrutu-ra 1184, por exemplo, e onde a segunda parte 1118 também pode ser co-nectada de forma móvel com relação à estrutura 1184 também. Em váriasmodalidades, a primeira parte do comutador 1194 pode ser conectada deforma articulada à estrutura 1184 de forma que, quando a primeira parte decomutador 1194 é articulada para baixo por um carne, similar ao carne 402,por exemplo, a primeira parte 1194 pode ser configurada para desengatar opino de retorno 498 e permitir que a parte de chave 499 do pino de retorno498 engate a engrenagem de gatilho 496 como descrito acima. Em váriasmodalidades, apesar de não ilustrado na figura 119, o carrinho de retorno1194 pode incluir o braço 1194d se estendendo a partir daí que pode sermovido para longe da extremidade 498a do pino de retorno 498 de modoque uma mola, por exemplo, possa orientar o pino de retomo 498 para o en-gate operacional com a engrenagem de gatilho 496.
Em adição ao acima, a primeira parte de comutador 1194, quan-do articulada para baixo, pode ser configurada para entrar em contato com opino de retorno 172 e engatar de forma operacional a chave 222 do pino deretorno 172 com a garra 170 de forma que a garra 170 não possa ser articu-lada ascendentemente, como também descrito acima. Efetivamente, em pelomenos uma modalidade, a primeira parte de comutador 1194 pode compre-ender um carne que pode ser acionado para desengatar de forma operacio-nai o acionador de disparo a partir de e engatar de forma operacional o acio-nador reverso com o elemento de disparo. Em várias circunstâncias, apenasa operação da primeira-parte-1-194 pode ser necessária-a fim de se comutaro instrumento cirúrgico entre seus modos de operação de avanço e reverso.
No caso, no entanto, de o carne do acionador reverso, tal como o carne 402,por exemplo, não poder posicionar adequadamente, ou acionar, a primeiraparte de comutador 1194, a segunda parte 1118 do comutador pode ser uti-lizada para acionar a primeira parte do comutador 1194 como descrito emmaiores detalhes abaixo.
Adicionalmente ao acima exposto, a segunda parte do comuta-dor 1118 pode ser acionada a fim de acionar a primeira parte do comutador1194. Em várias modalidades, com referência novamente à figura 119, asegunda parte de comutador 1118 pode incluir a alça 1118b que pode serconfigurada para ser agarrada por um cirurgião, por exemplo, de forma queo cirurgião possa aplicar uma força e girar a parte de comutação 1118 emtorno da articulação 1118a. Em pelo menos uma modalidade, a segundaparte do comutador 1118 pode ser configurada para entrar em contato com aprimeira parte de comutador 1184 e mover a primeira parte 1184 entre suaposição não-acionada ilustrada na figura 119 e sua posição acionada comodescrito acima. Em várias modalidades, efetivamente, a segunda parte decomutador 1118 pode compreender um carne que pode entrar em contatocom a primeira parte 1194 e acionar a primeira parte 1194 para baixo deforma que a primeira parte 1194 entre em contato com o pino de disparo 172e o pino de retorno 498. Em pelo menos uma modalidade, com referência àfigura 119, a segunda parte de comutador 1118 pode incluir a superfície decontato 1118c que pode ser configurada para entrar em contato com a su-perfície 1194c da primeira parte de comutador 1194. Em várias modalidades,a superfície de contato 1118c pode ser posicionada diretamente acima dasuperfície de contato-1^94c de~forma que as superfícies 1118c e 1194c pos-sam ser alinhadas e a possibilidade de a segunda parte de comutador 1118não entrar em contato com a primeira parte de comutador 1194 pode serreduzida.Em várias modalidades, adicionalmente ao acima exposto, assuperfícies de contato 1118c e 1194c podem ser posicionadas e dispostas-de-modo-qüe-üiria-força-F2--aplicada-à-alça-1-1-98b-possua-uma vantagemmecânica suficiente para mover a primeira parte do comutador 1194 parasua posição acionada. Em pelo menos uma modalidade, a força de alça F2pode ser transmitida através do corpo da segunda parte de comutador 1118e para a primeira parte de comutador 1194 através das superfícies de conta-to 1118c e 1194c como a força de transmissão F3. De forma perceptível, emvárias modalidades, a força de transmissão F3 pode ser diferente da força dealça F2. Depois desse ponto, com referência à figura 119, os torques associ-ados com a força de alça F2 e a força de transmissão F3 a fim de mover ini-cialmente a primeira parte de comutador 1194 podem ser substancialmenteiguais, isso é, o produto da distância Da e força F2 pode ser substancialmen-te igual ao produto da distância dB e a força F3, onde a distância Da poderepresentar a distância entre a articulação 1118a e a aplicação da força F2, eonde a distância dB pode representar a distância entre a articulação 1118a ea transmissão da força F3. Dessa forma, quando a distância Da é menor doque a distância dB, como ilustrado na figura 119, a força F2 pode ser maiordo que a força F3. De acordo, a fim de a força F3 ser substancialmente igualà força F2, a alça 1118b deve ser posicionada substancialmente acima dassuperfícies 1118c e 1194c quando a força F2 é aplicada à alça 1118.
Em várias modalidades, adicionalmente ao acima exposto, a for-ça de transmissão F3 pode ser transmitida através do corpo para a primeiraparte de comutador 1194 para o pino de disparo 172 como a força de deslo-camento F1. Similar ao acima exposto, a força de deslocamento F1 pode serdiferente da força de transmissão F3. Depois desse ponto, com referêncianovamente à figura 119, os torques associados com a força de deslocamen-to F-i e a força de transmissão F3 a fim de deslocar inicialmente o pino dedisparo 172 na-direção da garra 170, como destacado-acima, podem sersubstancialmente iguais, isso é, o produto da distância Dc e força F1 podeser substancialmente igual ao produto da distância Dd e força F3, onde adistância Dc pode representar a distância entre a articulação 1194a e a apli-cação da força F3, e onde a distância Dd pode representar a distância entrea articulação 1194a e a transmissão da força F3. Dessa forma, quando a dis--tância -Dc é-menor-que a-distâneia Dd,-como ilustrado na figura 119, a forçaFi pode ser maior que a força F3. Efetivamente, a menor força de transmis-são F3 pode ser utilizada para aplicar uma maior força de deslocamento Fipara o pino de disparo 172, dependendo da seleção das distâncias Da, Db,Dc e Dd. Em várias modalidades, como resultado disso, as primeira e se-gunda partes do comutador podem ser configuradas de modo que a força F2suprida pelo cirurgião, por exemplo, possa ser suficiente para posicionarmanualmente a primeira parte do comutador em sua posição acionada atra-vés da segunda parte do comutador e, dessa forma, manipular o instrumentocirúrgico de um modo operacional de avanço para um modo operacional re-verso como destacado adicionalmente acima. A fim de retornar o instrumen-to cirúrgico para seu modo operacional de avanço, a primeira parte de comu-tador 1194, por exemplo, pode ser girada ascendentemente de modo que asegunda parte de comutador 1118 também possa ser girada ascendente-mente, reconfigurando, assim, o conjunto de comutador.
Em uma modalidade ilustrativa adicional, com referência às figu-ras 120 a 122, um instrumento cirúrgico pode incluir um conjunto de comuta-dor compreendendo a primeira parte 1294 que pode ser montada de formaarticulada à estrutura 1284 em torno do pino 1294a, e, adicionalmente, umasegunda parte 1218 que pode ser montada de forma articulada à estrutura1284 em torno da articulação 1218a. Apesar de as primeira e segunda par-tes de comutador poderem ser montadas de forma articulada na estrutura1284, as partes de comutador podem ser montadas de forma articulada aqualquer outra parte adequada do instrumento cirúrgico. Em várias modali-dades, similar ao exposto acima, a primeira parte de comutador 1294 podeser operada para comutar o instrumento cirúrgico entre os modos de opera-- ção-de avanço e reverso. Em pelo menos uma modalidade, a primeira partede comutador 1294 pode ser girada entre sua posição não-acionada ilustra-da na figura 120 e sua posição acionada ilustrada na figura 121. Similar aoexposto acima, a segunda parte do comutador 1218 pode ser movida parabaixo por uma força aplicada à alça 1218b a fim de mover a primeira parte1294 para baixo e para sua posição acionada.
Em várias modalidades, a segunda parte de comutador 1218,por exemplo, e o gatilho de disparo do instrumento cirúrgico, tal como o gati-lho de disparo 460, por exemplo, pode ser configurada de modo que a se-gunda parte 1218 possa ser impedida, ou pelo menos substancialmente im-pedida, de ser girada para baixo a menos que o gatilho de disparo esteja emsua posição não-acionada. Pela exigência de que o gatilho de disparo estejaem sua posição não-acionada antes de se permitir que o comutador sejaoperado, a primeira parte de comutador 1294 do mecanismo reverso podeser adequadamente alinhada com o pino de disparo do acionador de dispa-ro, tal como o pino de disparo 172, por exemplo, quando a primeira parte1294 é girada para baixo. Em várias modalidades, o instrumento cirúrgicopode ser configurado de modo que o pino de disparo seja posicionado den-tro de uma faixa predeterminada de modo que o pino de disparo possa sercontatado pela primeira parte de comutador 1294 e deslizado para entrar emengate com a garra do acionador de disparo, tal como a garra 170, por e-xemplo.
Em várias modalidades, com referência à figura 50, o instrumen-to cirúrgico 100 pode incluir um efetor de extremidade 106 e um conjunto deeixo alongado 104, onde o efetor de extremidade 106 e o conjunto de eixo104 podem ser conectados de forma articulada pela junta de articulação 114.Como destacado acima, a junta de articulação 114 pode permitir que o efetorde extremidade 106 seja movido, ou articulado, com relação ao conjunto deeixo 106 para acessar mais facilmente um local cirúrgico dentro do corpo deum paciente. Mais particularmente, um cirurgião pode inserir o efetor de ex-tremidade 106 e o conjunto de eixo 104 através de uma cânula pelo menosparcialmente inserida no corpo do paciente e, uma vez que o efetor de ex-tremidade 106 passou através da cânula, o efetor de extremidade 106 podeser articulado a fim de posicionar o efetor de extremidade 106 com relaçãoao tecido mole, por exemplo, no local cirúrgico que deve ser grampeado e/oucortado. Uma vez que o efetor de extremidade 106 foi posicionado, a relaçãorelativa entre o efetor de extremidade 106 e o conjunto de eixo 104 pode serfixada, ou travada, por um mecanismo de travamento como descrito emmaiores detalhes adicionalmente-abaixo.
Em pelo menos uma modalidade, com referência às figuras 51 e52, a junta de articulação 114 pode incluir o elemento de travamento do efe-tor de extremidade 300 e a articulação 302. Em várias modalidades, comreferências às figuras 53 a 56, o elemento de travamento do efetor de ex-tremidade 300 pode incluir a parte de conector 320 que pode prender o ele-mento de travamento 300 no efetor de extremidade 106 e, com referência àfigura 52, o conjunto de eixo 104 pode incluir o conector articulado 342, ondeo conector articulado 342 pode incluir a articulação 302 se estendendo a par-tir do mesmo. Em várias modalidades, o elemento de travamento 300 podeincluir a abertura 301 que pode ser dimensionada e configurada para rece-ber pelo menos uma parte da articulação 302. Em pelo menos uma modali-dade, a articulação 302 e a abertura 301 podem ser configuradas de modoque o efetor de extremidade 106 possa girar livremente em torno do eixogeométrico 116. Em várias modalidades, a articulação 302 e a abertura 301podem ser configuradas de modo que a fricção entre a articulação 302 e aabertura 301 possa resistir, apesar de permitir, o movimento relativo entre oefetor de extremidade 106 e o conjunto de eixo 104. Apesar de não ser ilus-trado, a junta de articulação 114 pode incluir mais de um eixo geométrico, ouarticulação, em torno do qual o efetor de extremidade 106 pode ser girado.
Em várias modalidades, um cirurgião pode articular o efetor deextremidade 106 com relação ao conjunto de eixo 104 empurrando o efetorde extremidade 106 contra uma parede lateral da cavidade cercando umlocal cirúrgico, por exemplo, e aplicando uma força ao conjunto de eixo 104de forma que o efetor de extremidade 106 articule em torno do eixo geomé-trico 116. Depois disso, se o cirurgião desejar centralizar novamente o efetorde extremidade 106, isso érorientar o efetor 106 e o conjunto de eixo 104 aolongo de uma linha, o cirurgião pode colocar o efetor de extremidade 106contra uma parede lateral da cavidade mais uma vez, por exemplo, e aplicaruma força ao conjunto de eixo 104 como descrito acima. Em várias modali-dades, com referência às figuras 51 e 52, o instrumento cirúrgico 100 podeincluir um mecanismo de nova centralização que pode centralizar novamentede forma automática-ou-pelo menos substancialmente centralizar novamen-te, o efetor de extremidade 106 com relação ao conjunto de eixo 104. Emvárias modalidades, o elemento de travamento do efetor de extremidade 300pode incluir superfícies de centralização 316 e o conjunto de eixo alongado104 pode incluir eixos de centralização 328 e elementos de orientação 330,onde os elementos de orientação 330 podem ser configurados para orientaros eixos de centralização 328 contra as superfícies de centralização 316. Empelo menos uma modalidade, as superfícies de centralização 316 podem serdispostas em lados substancialmente opostos do eixo geométrico 116 deforma que os eixos de centralização 328 possam aplicar um torque substan-cialmente igual, ou momento, ao elemento de travamento 300 e, sem umaforça de motivação adicional, manter o efetor de extremidade 106 em umaposição substancialmente centralizada. Quando o efetor de extremidade 106é articulado por tal força de motivação, como descrito acima, o elemento detravamento 300 pode ser configurado para deslocar um dos eixos de centra-lização 328 de forma proximal e comprimir o elemento de orientação 330engatado de forma operacional com o mesmo. Mais particularmente, o ele-mento de orientação 330 pode ser posicionado entre um guia 331 e pelomenos uma projeção 329 se estendendo a partir do eixo de centralização328 de forma que, quando a projeção 329 é movida de forma proximal peloeixo 328, o elemento de orientação 330 é comprimido entre os mesmos. De-pois que a força de motivação é removida, o elemento de orientação com-primido 330 pode expandir e girar o elemento de travamento 300 para suaposição central através do eixo de centralização 328, ou para uma posiçãoonde o torque aplicado pelos elementos de orientação 330 é substancial-mente equilibrado. Apesar de o elemento de orientação 330 ser ilustradocomo uma mola espiralada, o elemento de orientação-330 pode incluir qual-quer elemento elástico adequado.
Em várias modalidades, um mecanismo de travamento pode serutilizado para manter o efetor de extremidade 106 em sua posição articuladamesmo depois que a força de motivação foi removida. Em pelo menos umamodalidade, com referência às figuras 53 a 56, o elemento de travamento doefetor de-extremidade -300 pode incluir uma primeira parte possuindo umaprimeira superfície 308, uma segunda parte possuindo uma segunda super-fície 304, dentes 312, e recessos 314 definidos entre os dentes 312 onde,como descrito em maiores detalhes adicionalmente abaixo, os dentes 312 eos recessos 314 podem ser configurados para serem engatados de formaoperacional com um elemento de travamento de conjunto de eixo a fim defixar ou travar a relação relativa entre o efetor de extremidade 106 e o con-junto de eixo 104. Em várias modalidades, os dentes 312 e os recessos 314podem ser posicionados entre a primeira superfície 308 e a segunda super-fície 304. Em pelo menos uma modalidade, a primeira superfície 308 podese estender a partir da abertura 301 para o primeiro perímetro 310, e a se-gunda superfície 304 pode se estender da abertura 301 para o segundo pe-rímetro 306. Em várias modalidades, o primeiro perímetro 310 pode definirum primeiro plano e o segundo perímetro 306 pode definir um segundo pla-no onde os dentes 312 e os recessos 314 podem ser posicionados entre osprimeiro e segundo planos. Nas modalidades onde o primeiro perímetro 310é diferente do segundo perímetro 306, os dentes 312 podem se estender emum ângulo, ou chanfradura, entre os mesmos. Em várias modalidades, umdente 312 pode formar uma interseção com o primeiro perímetro 310 em umponto mais distante do eixo geométrico 116 do que um ponto no qual o den-te 316 forma uma interseção com o segundo perímetro 306. Em pelo menosuma modalidade, pelo menos um dos dentes 312 pode definir um primeiroeixo geométrico 313 que pode se estender entre a primeira superfície 308 ea segunda superfície 304 em uma direção que não é perpendicular à primei-ra superfície 308 e/ou eixo geométrico de rotação 116. Em tais modalidades,os dentes 312 podem deslizar sobre o tecido mole, por exemplo, que é posi-cionado adjacente à junta de articulação 114. Em outras palavras, devido àssuperfícies anguladas ou chanfradas dos dentes 112, a probabilidade de osdentes 112 agarrarem ou impingirem o tecido mole que cerca a junta de arti-culação 114 quando o efetor de extremidade 106 é articulado pode ser redu-zida. Em pelo menos uma modalidade, os dentes 312 podem não se esten-der além do primeiro perímetro 310 de forma que, no caso de pelo menosuma parte do primeiro perímetro 310 estar em contato com o tecido mole,por exemplo, o primeiro perímetro 310 e os dentes 312 podem, como acima,deslizar facilmente com relação ao tecido mole.
Em adição ao acima exposto, as modalidades da presente in-venção podem fornecer vantagens significativas sobre os instrumentos cirúr-gicos anteriores. Mais particularmente, com referência à figura 57, as juntasde articulação dos efetores de extremidade anteriores incluem elementos detravamento, tal como o elemento de travamento 299, por exemplo, que in-cluem dentes 298 que se estendem para fora a partir do perímetro do ele-mento de travamento. Como resultado disso, quando o efetor de extremida-de é articulado com relação ao conjunto de eixo do instrumento cirúrgico, osdentes 298 podem agarrar, ou impingir o tecido mole circundante e causartrauma em potencial ao mesmo. Em várias circunstâncias, o tecido pode sercapturado entre os dentes adjacentes 298 de forma que, quando o efetor deextremidade é articulado, o tecido mole possa ser puxado para dentro dajunta de articulação e pode ser apertado pelo movimento relativo dos com-ponentes da unta. Nas modalidades da presente invenção nas quais os den-tes do elemento de travamento são angulados, ou chanfrados, como desta-cado acima e ilustrado na figura 58, o tecido mole pode fluir mais facilmenteatravés dos dentes e reduzir a possibilidade de o tecido mole poder ser pu-xado para dentro da junta de articulação.
Como destacado acima, com referência às figuras 59 a 62, oinstrumento cirúrgico 100 pode incluir adicionalmente o elemento de trava-mento 120 que pode ser deslizado com relação ao efetor de extremidade106 e pode ser engatado de forma operacional com o efetor de extremidade106 para impedir, ou pelo menos limitar, o movimento relativo entre o con-junto de eixo 104 e o efetor de extremidade 106. Em pelo menos uma moda-lidade, o elemento de travamento 120 pode ser configurado para engatarpelo menos um dos dentes 312 de forma que o efetor de extremidade 106seja impedido de mover com relação ao elemento de travamento 120. Maisparticularmente, o elemento de travamento 120 pode incluir a parte de ex-tremidade 338 e a parte de eixo 340, onde a parte de extremidade 338 pode-incluir o-recesso-336-que pode-ser configurado para receber um dente 312do elemento de travamento 300 em uma relação de encaixe justo, ou mes-mo de encaixe por interferência. Em várias modalidades alternativas, a partede travamento 338 pode ser recebida dentro de pelo menos um dos reces-sos 314 em uma relação de encaixe justo ou encaixe por interferência similarà acima. Em qualquer caso, o instrumento cirúrgico 100 pode incluir adicio-nalmente a mola 126-que pode ser configurada para orientar o elemento detravamento 120 em engate com o elemento de travamento do efetor de ex-tremidade 300. No caso de o recesso 336 não ser alinhado com um dente312, em pelo menos uma modalidade, a força de orientação aplicada ao e-Iemento de travamento 120 pela mola 126 pode fazer com que o elementode travamento 120 entre em contato e gire o elemento de travamento do efe-tor de extremidade 300 em torno do eixo geométrico 116 até que um dosdentes 312 seja alinhado com o recesso 336. Em várias modalidades, a mo-la 126 pode compreender qualquer elemento de orientação adequado inclu-indo uma mola helicoidal, mola laminada ou outro material de orientação.
Em várias modalidades alternativas, com referência às figurasde 63 a 67, um instrumento cirúrgico pode incluir um elemento de travamen-to do efetor de extremidade 350 compreendendo a abertura 301, uma pri-meira parte incluindo primeira superfície 358, uma segunda parte incluindo asegunda superfície 354 (figura 67), e a parte de conector 320. O elementode travamento do efetor de extremidade 350 também pode compreenderdentes 362 e recessos 364 definidos entre os dentes 362 onde, em pelo me-nos uma modalidade, os dentes 362 e recessos 364 podem ser posicionadoentre a primeira superfície 358 e a segunda superfície 354. Em várias moda-lidades, com referência às figuras de 65 a 67, os dentes 362 podem não seestender-além do primeiro perímetro 357 da primeira superfície 358 e/ou se-gundo perímetro 353 da segunda superfície 354. Em pelo menos uma moda-lidade, os dentes 362 podem ser completamente posicionados, ou contidos,entre a primeira superfície 358 e a segunda superfície 354.. Em pelo menosuma modalidade alternativa, os dentes 362 podem se estender parcialmentedo primeiro perímetro 357 e/ou segundo perímetro 353. Em várias modalida-des,-© primeiro-perímetro 353podemdefinir umasuperfície externa entre os mesmos onde os recessos 364 podem ser defini-dos na superfície externa. Como resultado das características descritas aci-ma, o elemento de travamento do efetor de extremidade 350 pode deslizarcom relação ao tecido mole posicionado adjacente à junta de articulaçãosem impingir no tecido mole. Em várias modalidades, os dentes 362 podemser-cegos ou arredondados para facilitar adicionalmente o deslizamento rela-tivo descrito acima. Em pelo menos uma modalidade, com referência às figu-ras de 63 a 65, um mecanismo de travamento pode ser configurado paraengatar pelo menos um dos dentes 362 e recessos 364 e pode incluir umelemento de travamento 382 compreendendo a parte de extremidade 388 ea parte de eixo 390. Em pelo menos uma modalidade, similar à acima, a par-te de extremidade 388 pode incluir o recesso 394 que pode ser configuradopara engatar pelo menos um dos dentes 362, por exemplo.
Os dispositivos descritos aqui podem ser projetados a fim deserem eliminados após uma única utilização, ou podem ser projetados paraserem utilizados múltiplas vezes. Em qualquer caso, no entanto, o dispositi-vo pode ser recondicionado para reutilização depois de pelo menos uma uti-lização. O recondicionamento pode incluir qualquer combinação de etapasde desmontagem do dispositivo, seguido pela limpeza ou substituição depeças particulares, e nova montagem subsequente. Em particular, o disposi-tivo pode ser desmontado, e qualquer número de peças ou partes particula-res do dispositivo pode ser seletivamente substituído ou removido em qual-quer combinação. Depois da limpeza e/ou substituição de partes particula-res, o dispositivo pode ser remontado para uso subsequente em uma insta-lação de recondicionamento, ou por uma equipe de cirurgia imediatamenteantes de um procedimento cirúrgieorOs-versados -na-técnica -apreciarão queo recondicionamento de um dispositivo pode utilizar uma variedade de técni-cas de desmontagem, limpeza/substituição e remontagem. O uso de taistécnicas, e o dispositivo recondicionado resultante estão todos dentre doescopo do presente pedido.
Preferivelmente, a invenção descrita aqui será processada antesda cirurgia. Primeiro um instrumento novo ou usado é obtido e senecessá-rio limpo. O instrumento pode então ser esterilizado. Em uma técnica de es-terilização, o instrumento é colocado em um recipiente fechado e vedado, talcomo um saco plástico ou TYVEK. O recipiente e o instrumento são entãocolocados em um campo de radiação que pode penetrar o recipiente, talcomo radiação gama, raios X ou elétrons de alta energia. A radiação mataas bactérias no instrumento e no recipiente. O instrumento esterilizado podeentão ser armazenado no recipiente estéril. O recipiente vedado mantém oinstrumento estéril até que seja aberto na instalação médica.
Enquanto essa invenção foi descrita como apresentando dese-nhos ilustrativos, a presente invenção pode ser adicionalmente modificadadentro do espírito e escopo da descrição. Esse pedido é, portanto, destinadoa cobrir quaisquer variações, utilizações ou adaptações da invenção utilizan-do seus princípios gerais. Adicionalmente, esse pedido deve cobrir tais dis-tanciamentos da presente descrição que se encontrem dentro da práticacomum e normal da técnica à qual a invenção pertence.
Claims (30)
1. Instrumento cirúrgico compreendendo:um efetor de extremidade;um elemento de disparo;um gatilho;um acionador de disparo seletivamente engatável com o ditoelemento de disparo, em que o dito acionador de disparo inclui uma crema-Iheira configurada para avançar o dito elemento de disparo com relação aodito efetor de extremidade depois de um acionamento do dito gatilho; eum acionador reverso seletivamente engatável com a dita cre-malheira, em que o dito acionador reverso inclui uma engrenagem configu-rada para retrair a dita cremalheira e o dito elemento de disparo com relaçãoao dito efetor de extremidade mediante um acionamento subsequente dodito gatilho.
2. Instrumento cirúrgico, de acordo com a reivindicação 1, emque a dita engrenagem inclui uma primeira engrenagem, em que o dito gati-lho inclui uma parte de engrenagem, e em que o dito acionador reverso incluiadicionalmente:uma segunda engrenagem engatada de forma operacional coma dita primeira engrenagem;uma terceira engrenagem engatada de forma operacional com adita parte de engrenagem de gatilho, em que a dita segunda engrenagem éseletivamente engatada com a dita terceira engrenagem.
3. Instrumento cirúrgico, de acordo com a reivindicação 2, emque a dita segunda engrenagem não é engatada de forma operacional coma dita terceira engrenagem quando o dito acionamento de disparo é engata-do com o dito elemento de disparo.
4. Instrumento cirúrgico, de acordo com a reivindicação 2, emque a dita terceira engrenagem inclui uma face de roda dentada configuradapara engatar a dita segunda engrenagem, em que a dita face de roda denta-da é configurada para deslizar com relação à dita segunda engrenagemquando a dita terceira engrenagem é girada em uma primeira direção, e emque a dita face de roda dentada é configurada para acionar a dita segundaengrenagem quando a dita terceira engrenagem é girada em uma direçãooposta.
5. Instrumento cirúrgico, de acordo com a reivindicação 2 emque a dita segunda engrenagem é engatada de forma operacional com a ditaterceira engrenagem de forma que o dito acionamento subsequente do ditogatilho possa girar a dita terceira engrenagem, a dita segunda engrenagem,e a dita primeira engrenagem e retrair o dito elemento de disparo.
6. Instrumento cirúrgico, de acordo com a reivindicação 5, emque o dito acionador reverso inclui adicionalmente:um pino de chave seletivamente movível entre uma primeira po-sição e uma segunda posição, em que o dito pino de chave não é operacio-nalmente engatado com a dita terceira engrenagem quando o dito pino dechave está na dita primeira posição, e em que o dito pino de chave é enga-tado de forma operacional com a dita segunda engrenagem e a dita terceiraengrenagem quando o dito pino de chave está na dita segunda posição; euma mola configurada para orientar o pino de chave para a ditasegunda posição.
7. Instrumento cirúrgico, de acordo com a reivindicação 6, emque o dito acionador reverso inclui adicionalmente um acionador configuradopara posicionar o dito pino de chave na dita primeira posição quando o ditoacionador de disparo é engatado de forma operacional com o dito elementode disparo, e em que o dito acionador é movível para uma posição acionadapara permitir que a dita mola oriente o dito pino de chave para a dita segun-da posição e dessa forma engate de forma operacional o dito acionador re-verso com o dito elemento de disparo.
8. Instrumento cirúrgico, de acordo com a reivindicação 7, emque o dito acionador é adicionalmente configurado para desengatar o ditoacionador de disparo a partir do dito elemento de disparo quando o dito a-cionador é movido para a dita posição acionada.
9. Instrumento cirúrgico, de acordo com a reivindicação 2, emque o dito acionador reverso inclui adicionalmente uma embreagem configu-rada para engatar e desengatar de forma operacional a dita segunda engre-nagem e a dita terceira engrenagem.
10. Instrumento cirúrgico, de acordo com a reivindicação 9, emque a dita embreagem inclui um pino de chave engatado de forma operacio-nal com a dita segunda engrenagem e um cão se estendendo a partir da ditaterceira engrenagem, em que o dito cão é configurado para permitir que odito pino de chave gire com relação à dita terceira engrenagem em uma pri-meira direção, e em que o dito cão é configurado para girar o dito pino dechave em uma direção oposta à dita primeira direção.
11. Instrumento cirúrgico, de acordo com a reivindicação 2, emque o dito acionador reverso inclui adicionalmente uma engrenagem indica-dora engatada de forma operacional com a dita segunda engrenagem, e emque a dita engrenagem indicadora inclui pelo menos um indício para indicaro número de vezes que o dito gatilho foi acionado.
12. Instrumento cirúrgico, de acordo com a reivindicação 11, emque o avanço da dita cremalheira é configurado para girar a dita primeiraengrenagem, a dita segunda engrenagem e a dita engrenagem indicadora.
13. Instrumento cirúrgico, de acordo com a reivindicação 1, com-preendendo adicionalmente um mecanismo antirretorno configurado paraimpedir substancialmente que o dito elemento de disparo seja retraído comrelação ao dito efetor de extremidade antes do dito acionamento subsequen-te do dito gatilho.
14. Método de processamento de um instrumento para cirurgia,o método compreendendo:a obtenção do instrumento cirúrgico como definido na reivindicação 1;a esterilização do instrumento cirúrgico; eo armazenamento do instrumento cirúrgico em um recipienteestéril.
15. Instrumento cirúrgico compreendendo:um efetor de extremidadeum acionador de disparo, compreendendo:um gatilho;um elemento de disparo; euma garra engatada de forma operacional com o dito gatilho, emque o dito gatilho é configurado para avançar a dita garra, e em que a ditagarra é seletivamente engatada com o dito elemento de disparo para avan-çar o dito elemento de disparo com relação ao dito efetor de extremidademediante o acionamento do dito gatilho; eum mecanismo de retorno seletivamente engatado com o ditoelemento de disparo para retrair o dito elemento de disparo com relação aodito efetor de extremidade mediante um acionamento subsequente do ditogatilho, em que o dito mecanismo de retorno é configurado para seletiva-mente desengatar a dita garra do dito elemento de disparo quando o ditomecanismo de retorno é engatado com o dito elemento de disparo.
16. Instrumento cirúrgico, de acordo com a reivindicação 15, emque o dito mecanismo de retorno inclui um trem de engrenagem que é sele-tivamente engatado com o dito gatilho.
17. Instrumento cirúrgico, de acordo com a reivindicação 15, emque o dito gatilho inclui uma parte de engrenagem se estendendo a partirdaí, e em que o dito mecanismo de retorno inclui:uma primeira engrenagem engatada de forma operacional com adita parte de engrenagem; euma segunda engrenagem engatada de forma operacional como dito elemento de disparo, em que a dita segunda engrenagem é seletiva-mente engatada com a dita primeira engrenagem.
18. Instrumento cirúrgico, de acordo com a reivindicação 17, emque o dito mecanismo de retorno inclui adicionalmente uma engrenagemindicadora engatada de forma operacional com a dita segunda engrenagem,e em que a dita engrenagem indicadora inclui pelo menos um indício paraindicar o número de vezes que o dito gatilho foi acionado.
19. Instrumento cirúrgico de acordo com a reivindicação 15compreendendo adicionalmente um mecanismo antirretorno configurado pa-ra impedir substancialmente que o dito elemento de disparo seja retraídocom relação ao dito efetor de extremidade quando a dita garra e o dito me-canismo de retorno são desengatados do dito elemento de disparo.
20. -Método-de- processamento de um instrumento para cirurgia,o método compreendendo:a obtenção de um instrumento cirúrgico como definido na reivin-dicação 15;a esterilização do instrumento cirúrgico; eo armazenamento do instrumento cirúrgico em um recipienteestéril.
21. Instrumento cirúrgico compreendendo:um efetor de extremidade;um elemento de disparo;um gatilho;um acionador de disparo engatável de forma seletiva com o ditoelemento de disparo, em que o dito acionador de disparo inclui uma crema-lheira configurada para avançar o dito elemento de disparo com relação aodito efetor de extremidade depois do acionamento do dito gatilho; eum trem de engrenagem, compreendendo:uma primeira engrenagem engatada de forma operacional com odito elemento de disparo;uma segunda engrenagem engatada de forma operacional como dito gatilho, em que a dita segunda engrenagem é seletivamente operávelcom a dita primeira engrenagem de forma que um acionamento subsequentedo dito gatilho retraia a dita cremalheira e o dito elemento de disparo comrelação ao dito efetor de extremidade.
22. Instrumento cirúrgico, de acordo com a reivindicação 21, emque o dito trem de engrenagem compreende adicionalmente uma engrena-gem indicadora engatada de forma operacional com a dita segunda engre-nagem, e em que a dita engrenagem indicadora inclui pelo menos um indíciopara indicar o número de vezes que o dito gatilho foi acionado.
23. Instrumento cirúrgico, de acordo com a reivindicação 21, emque a dita primeira engrenagem é uma engrenagem de pinhão, e em que adita engrenagem de pinhão é configurada para acionar a dita cremalheira aolongo de um percurso predeterminado.
24. Instrumento cirúrgico,de acordo com a reivindicação 21,compreendendo adicionalmente um mecanismo antirretorno configurado pa-ra impedir substancialmente que o dito elemento de disparo seja retraídocom relação ao dito efetor de extremidade quando o dito acionador de dispa-ro é desengatado do dito elemento de disparo e a dita primeira engrenagemé desengatada de forma operacional da dita segunda engrenagem.
25. Método de processamento de um instrumento para cirurgia,o método compreendendo:a obtenção do instrumento cirúrgico como definido na reivindica-ção 21;a esterilização do instrumento cirúrgico; eo armazenamento do instrumento cirúrgico em um recipienteestéril.
26. Instrumento cirúrgico compreendendo:um efetor de extremidade;um elemento de disparo;um gatilho;um acionador de disparo seletivamente engatado com o dito e-Iemento de disparo, em que o dito acionador de disparo é configurado paraavançar o dito elemento de disparo com relação ao dito efetor de extremida-de mediante um primeiro acionamento do dito gatilho;um acionador reverso seletivamente engatado com o dito ele-mento de disparo para retrair o dito elemento de disparo com relação ao ditoefetor de extremidade depois de um acionamento subsequente do dito gatilho; eum mecanismo antirretorno configurado para impedir substanci-almente que o dito elemento de disparo seja retraído com relação ao ditoefetor de extremidade antes do dito acionamento subsequente do dito gatilho.
27. Instrumento cirúrgico, de acordo com a reivindicação 26, emque o dito mecanismo antirretorno inclui:um pino rotativo incluindo uma chave se estendendo a partir domesmo, em-que O-dito-pino é-associado de forma-operacional com o ditoelemento de disparo de modo que o avanço do dito elemento de disparo gireo dito pino em uma primeira direção; eum elemento de indexação incluindo um primeiro recesso e umsegundo recesso, em que a dita chave é configurada para ser recebida den-tro do dito primeiro recesso antes do dito primeiro acionamento do dito gati-lho, em que a dita chave é configurada para ser recebida dentro do dito se-gundo recesso depois do dito primeiro acionamento do dito gatilho e antesdo dito acionamento subsequente do dito gatilho, e em que a dita chave e odito segundo recesso são configurados para impedir que o dito pino retornepara o dito primeiro recesso antes do dito acionamento subsequente do ditogatilho.
28. Instrumento cirúrgico, de acordo com a reivindicação 27, emque o dito elemento de indexação pode ser movido entre uma primeira posi-ção e uma segunda posição para permitir que a dita chave seja movida dodito primeiro recesso para o dito segundo recesso.
29. Instrumento cirúrgico, de acordo com a reivindicação 27, emque o dito elemento de indexação compreende uma mola configurada paraflexionar entre uma primeira configuração e uma segunda configuração parapermitir que a dita chave seja movida do dito primeiro recesso para o ditosegundo recesso.
30. Método de processamento de um instrumento para cirurgia,o método compreendendo:a obtenção do instrumento cirúrgico, como definido na a reivindi-cação 27;a esterilização do instrumento cirúrgico; eo armazenamento do instrumento cirúrgico em um recipienteestéril.
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