BRPI0901447B1 - Instrumento cirúrgico de corte e fixação - Google Patents
Instrumento cirúrgico de corte e fixação Download PDFInfo
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- BRPI0901447B1 BRPI0901447B1 BRPI0901447-0A BRPI0901447A BRPI0901447B1 BR PI0901447 B1 BRPI0901447 B1 BR PI0901447B1 BR PI0901447 A BRPI0901447 A BR PI0901447A BR PI0901447 B1 BRPI0901447 B1 BR PI0901447B1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
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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
-
- 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
- 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
- A61B90/90—Identification means for patients or instruments, e.g. tags
- A61B90/98—Identification means for patients or instruments, e.g. tags using electromagnetic means, e.g. transponders
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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
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1442—Probes having pivoting end effectors, e.g. forceps
- A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00203—Electrical control of surgical instruments with speech control or speech recognition
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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
- A61B17/00234—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
- A61B2017/00323—Cables or rods
- A61B2017/00327—Cables or rods with actuating members moving in opposite directions
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
- A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
- A61B2017/00464—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable for use with different instruments
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00477—Coupling
- A61B2017/00482—Coupling with a code
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00681—Aspects not otherwise provided for
- A61B2017/00734—Aspects not otherwise provided for battery operated
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/0725—Stapler heads with settable gap between anvil and cartridge, e.g. for different staple heights at different shots
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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
- A61B2017/2901—Details of shaft
- A61B2017/2905—Details of shaft flexible
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00053—Mechanical features of the instrument of device
- A61B2018/0016—Energy applicators arranged in a two- or three dimensional array
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00988—Means for storing information, e.g. calibration constants, or for preventing excessive use, e.g. usage, service life counter
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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
- A61B90/03—Automatic limiting or abutting means, e.g. for safety
- A61B2090/031—Automatic limiting or abutting means, e.g. for safety torque limiting
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- Health & Medical Sciences (AREA)
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- Veterinary Medicine (AREA)
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- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
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- Heart & Thoracic Surgery (AREA)
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- Oral & Maxillofacial Surgery (AREA)
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Abstract
operação de corte cirúrgico motorizada e instrumento de fixação possuindo fonte de energia baseada em manivela. a presente invenção refere-se a um instrumento cirúrgico de corte e fixação. o instrumento compreende uma extremidade executora, um eixo conectado à extremidade executora, e um manípulo conectado ao eixo. o manípulo compreende um motor elétrico de cc conectado a um trem de transmissão do eixo para o acionamento do trem de transmissão. o manípulo compreende ainda uma fonte de força que compreende pelo menos um dispositivo acumulador de carga conectado ao motor de cc para o acionamento do motor de cc.
Description
REFERÊNCIA CRUZADA COM PEDIDOS RELACIONADOS [001] O presente pedido refere-se a e incorpora, a título de referência, os seguintes pedidos depositados na mesma data do presente pedido:
[002] Motorized Surgical Cutting and Fastening Instrument Having a Magnetic Drive Train Torque Limiting Device, Caso do Procurador N° END6267USNP/070389;
[003] Motorized Surgical Cutting and Fastening Instrument, Caso do Procurador N° END6268USNP/070390;
[004] Surgical Cutting and Fastening Instrument Having RF Electrodes, Caso do Procurador N. END6270USNP/070392;
[005] Motorized Cutting and Fastening Instrument Having Control Circuit For Optimizing Battery Usage, Caso do Procurador N° END6271USNP/070393;
ANTECEDENTES [006] Na técnica anterior, eram usados grampeadores cirúrgicos para simultaneamente fazer uma incisão longitudinal em um tecido e aplicar linhas de grampos nos lados opostos da incisão. Estes instrumentos geralmente incluem um par de membros de garra cooperantes que, se o instrumento for concebido para aplicações endoscópicas ou laparoscópicas, poderá passar por uma passagem de cânula. Um destes membros de garra recebe um cartucho de grampos tendo pelo menos duas fileiras de grampos lateralmente espaçadas de grampos. O outro membro de garra define uma bigorna dotada de bolsas de formação de grampos alinhadas às fileiras de grampos do cartucho. Estes instrumentos tipicamente incluem uma pluralidade de cunhas alternadas que, quando acionadas no sentido distal, passam pelas aberturas do cartucho de grampos e se encaixam nos direcionadores
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2/49 que suportam os grampos a fim de realizar o disparo dos grampos na direção da bigorna.
[007] Um exemplo de grampeador cirúrgico adequado para endoscopia é descrito na Publicação da Patente U.S. N° 2004/0232196 A1, intitulada Surgical Stapling Instrument Having Separate Distinct Closing And Firing Systems, cuja descrição é incorporada ao presente documento à guisa de referência. Em uso, o médico consegue fechar os membros de garra do grampeador sobre o tecido de modo a posicionar o tecido antes do disparo. Quando o médico determina que os membros de garra estão prendendo de maneira apropriada o tecido, o médico poderá disparar o grampeador cirúrgico, deste modo cortando e grampeando o tecido. As etapas simultâneas de corte e grampeamento evitam as complicações que podem surgir ao se executar tais ações em sequência com ferramentas cirúrgicas distintas que, respectivamente, apenas cortam ou grampeiam.
[008] Além disso, é igualmente conhecido, na técnica anterior, incluir eletrodos no operador terminal, o qual pode ser usado para emitir / receber energia de RF de modo a formar uma linha hemostática ao longo da linha de corte. A Patente U.S. N° 5 403 312, intitulada Electrosurgical Hemostatic Device (doravante Patente 312), incorporada ao presente documento à guisa de referência, apresenta um instrumento eletrocirúrgico com um operador terminal que comprime o tecido entre um polo (ou eletrodo) de uma fonte de energia bipolar sobre uma superfície de interface e um segundo polo (ou eletrodo) sobre uma segunda superfície de interface. A energia de RF é aplicada ao longo do tecido comprimido no operador terminal, cauterizando o tecido. O operador terminal descrito na Patente 312 inclui ainda grampos para fechar o tecido comprimido no operador terminal.
[009] Instrumentos de corte e fixação cirúrgicos acionados a motor, nos quais o motor aciona o instrumento de corte, são igualmente
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3/49 conhecidos na técnica anterior, tais como os descritos na Publicação do Pedido U.S. N° 2007/0175962 A1, intitulado Motor-driven Surgical Cutting And Fastening Instrument With Tactile Position Feedback, incorporado ao presente documento à guisa de referência.
SUMÁRIO DA INVENÇÃO [0010] Em um aspecto geral, as modalidades da presente invenção tratam de instrumentos cirúrgicos de corte e fixação. Os instrumentos podem ser instrumentos endoscópicos, tais como os cortadores endoscópicos lineares ou circulares, ou os instrumentos laparoscópicos. Os instrumentos podem ser constituídos de grampos e/ou eletrodos de RF para a fixação do tecido preso no operador terminal.
[0011] Diversas modalidades aqui apresentadas dizem respeito a instrumentos acionados a motor sem corda. Os instrumentos podem ser acionados por uma fonte de alimentação (power pack) compreendendo uma fonte de alimentação de corrente CC (corrente contínua), como, por exemplo, células de baterias conectadas em uma ou mais séries. Uma chave de seleção de células pode controlar o número de células de bateria utilizadas para acionar o motor em um dado momento de modo a controlar a força disponível para o motor. Isto permite que o operador do instrumento tenha um controle maior sobre a velocidade como também sobre a força do motor. Em uma outra modalidade, o instrumento pode compreender um regulador de tensão, incluindo, por exemplo, um conversor de corrente CC para CC, que regula a voltagem suprida para o motor. Além disso, o ponto de ajuste de voltagem para o regulador de tensão pode ser ajustado de modo que a tensão liberada a partir da fonte de alimentação seja menor que a tensão na qual a fonte de alimentação libera uma força máxima. Desta maneira, a fonte de alimentação (por exemplo, o número de células de bateria conectadas em série) pode operar no lado esquerdo ou crescente da curva de tensão, de modo a disponibilizar aumentos de tenPetição 870190001013, de 04/01/2019, pág. 6/58
4/49 são.
[0012] Além disso, de acordo com várias modalidades, a fonte de alimentação pode compreender dispositivos acumuladores secundários, tais como as baterias recarregáveis ou os supercapacitores. Estes dispositivos acumuladores secundários podem ser repetidamente carregados por baterias descartáveis. Um circuito de gerenciamento de carga pode controlar a carga dos dispositivos acumuladores secundários e prover diferentes sinais de status, como, por exemplo, de alerta, quando a carga dos dispositivos acumuladores secundários está completa.
[0013] Em uma outra modalidade, uma fonte de alimentação compreendendo dispositivos acumuladores secundários pode ser removível do instrumento e conectável a uma base carregadora remota. A base carregadora pode carregar dispositivos acumuladores secundários, por exemplo, a partir de um conduto elétrico de CA ou uma batería. A base carregadora pode compreender ainda um processador e uma unidade de memória. Os dados armazenados em uma memória da fonte de alimentação removível podem ser transferidos para a base carregadora, de onde os mesmos podem ser carregados para uso e análise posterior, por parte de um usuário (por exemplo, um médico), do fabricante ou distribuidor do instrumento, etc. Os dados podem compreender parâmetros operacionais, como, por exemplo, informações do ciclo de carga, assim como os valores de ID para os vários componentes descartáveis do instrumento, por exemplo, o cartucho de grampos.
[0014] Além disso, o instrumento pode compreender um dispositivo limitador de torque a fim de limitar o torque suprido pelo motor, no sentido de limitar, assim, as forças de atuação que poderão danificar os componentes do instrumento. De acordo com as diversas modalidades, os dispositivos limitadores de torque podem ser um ímã ele
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5/49 tromagnético ou permanente, ou dispositivos de embreagem mecânica conectados (direta ou indiretamente) ao polo de saída do motor.
[0015] Em um outro aspecto geral, a presente invenção trata de instrumentos de RF (isto é, instrumentos cirúrgicos de corte e fixação com eletrodos no operador terminal para aplicação de energia de RF ao tecido preso pelo operador terminal) com novos tipos de configurações de eletrodo. Em geral, as novas configurações de eletrodo incluem combinações de eletrodos menores ativos e eletrodos de retorno maiores. Os eletrodos menores ativos são usados para concentrar a energia terapêutica no tecido, enquanto os eletrodos de retorno maiores são de preferência usados para completar o circuito com um impacto mínimo sobre aquela interface de tecido. Os eletrodos de retorno tipicamente possuem uma massa maior e, deste modo, são capazes de continuar mais frios durante uma aplicação eletrocirúrgica.
[0016] Além disso, o operador terminal, de acordo com várias modalidades, pode compreender diversos eletrodos ativos segmentados, colineares. Os eletrodos segmentados podem ser acionados de maneira síncrona ou, mais preferivelmente, em sequência. A atuação dos eletrodos segmentados em sequência provê as vantagens (1) de uma menor necessidade de tensão instantânea devido a uma área-alvo menor de coagulação de tecido e (2) da possibilidade de outros segmentos acionarem se um entrar em curto-circuito.
[0017] Além disso, são apresentados neste documento vários mecanismos para a ativação dos eletrodos de RF e para a articulação do operador terminal.
FIGURAS [0018] As diversas modalidades da presente invenção são descritas no presente documento a título de exemplo em conjunto com as figuras a seguir, nas quais:
[0019] As Figuras 1 e 2 são vistas em perspectiva de um instru
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6/49 mento cirúrgico de corte e fixação de acordo com várias modalidades da presente invenção;
[0020] As Figuras 3 a 5 são vistas explodidas de um operador terminal e de um eixo do instrumento de acordo com várias modalidades da presente invenção;
[0021] A Figura 6 é uma vista lateral do operador terminal de acordo com várias modalidades da presente invenção;
[0022] A Figura 7 é uma vista explodida do manipulo do instrumento de acordo com várias modalidades da presente invenção;
[0023] As Figuras 8 e 9 são vistas parciais, em perspectiva, do manipulo de acordo com várias modalidades da presente invenção;
[0024] A Figura 10 é uma vista lateral do manipulo de acordo com várias modalidades da presente invenção;
[0025] A Figura 11 é um diagrama esquemático de um circuito utilizado no instrumento de acordo com várias modalidades da presente invenção;
[0026] As Figuras 12 a 14 e 17 são diagramas esquemáticos de circuitos utilizados para acionar o motor do instrumento de acordo com várias modalidades da presente invenção;
[0027] A Figura 15 é um diagrama em blocos ilustrando um circuito de gerenciamento de carga de acordo com várias modalidades da presente invenção;
[0028] A Figura 16 é um diagrama em blocos ilustrando uma base carregadora de acordo com várias modalidades da presente invenção;
[0029] A Figura 18 ilustra uma curva de força típica de uma bateria;
[0030] As Figuras 19 a 22 ilustram modalidades de um dispositivo limitador de torque do tipo embreagem, eletromagnético, de acordo com várias modalidades da presente invenção;
[0031] As Figuras 23 a 25, 27, 28, e 59 são vistas da superfície
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7/49 inferior da bigorna do instrumento de acordo com várias modalidades da presente invenção;
[0032] As Figuras 26, 53, 54, e 68 são vistas frontais, em seção transversal, do operador terminal de acordo com várias modalidades da presente invenção;
[0033] As Figuras 29 a 32 mostram uma modalidade do operador terminal dotado de eletrodos de RF de acordo com várias modalidades da presente invenção;
[0034] As Figuras 33 a 36 mostram uma outra modalidade do operador terminal dotada de eletrodos de RF de acordo com várias modalidades da presente invenção;
[0035] As Figuras 37 a 40 mostram uma outra modalidade do operador terminal dotada de eletrodos de RF de acordo com várias modalidades da presente invenção;
[0036] As Figuras 41 a 44 mostram uma outra modalidade do operador terminal dotada de eletrodos de RF de acordo com várias modalidades da presente invenção;
[0037] As Figuras 45 a 48 mostram uma outra modalidade do operador terminal dotada de eletrodos de RF de acordo com várias modalidades da presente invenção;
[0038] As Figuras 49 a 52 mostram uma outra modalidade do operador terminal dotado de eletrodos de RF de acordo com várias modalidades da presente invenção;
[0039] As Figuras 55 e 56 mostram vistas laterais do operador terminal de acordo com várias modalidades da presente invenção;
[0040] A Figura 57 é um diagrama do manipulo do instrumento de acordo com uma outra modalidade da presente invenção;
[0041] A Figura 58 é uma vista seccionada do manipulo da modalidade da Figura 57 de acordo com várias modalidades da presente invenção;
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8/49 [0042] As Figuras 60 a 66 ilustram uma placa de circuito de múltiplas camadas de acordo com várias modalidades da presente invenção;
[0043] A Figura 67 é um diagrama que ilustra um operador terminal de acordo com as várias modalidades da presente invenção; e [0044] As Figuras 69 e 70 são diagramas de um instrumento que compreende um conjunto de pescoço flexível, de acordo com várias modalidades da presente invenção.
DESCRIÇÃO [0045] As Figuras 1 e 2 ilustram um instrumento cirúrgico de corte e fixação 10 de acordo com várias modalidades da presente invenção. A modalidade ilustrada é um instrumento endoscópico e, em geral, as modalidades do instrumento 10 descrito no presente documento são instrumentos cirúrgicos de corte e fixação endoscópicos. Deve-se notar, no entanto, que, de acordo com outras modalidades da presente invenção, o instrumento pode ser um instrumento cirúrgico de corte e fixação não endoscópico, como, por exemplo, um instrumento laparoscópico.
[0046] O instrumento cirúrgico 10 ilustrado nas Figuras 1 e 2 compreende um manipulo 6, um eixo 8, e um operador terminal de articulação 12 conectada de maneira pivotável ao eixo 8 em um pivô de articulação 14. Um controle de articulação 16 pode ser provido adjacente ao manipulo 6 a fim de realizar a rotação do operador terminal 12 sobre o pivô de articulação 14. Na modalidade ilustrada, o operador terminal 12 é configurado de modo a atuar como um endocortador para prender, cortar e grampear tecido, embora, em outras modalidades, diferentes tipos de o operadores terminais possam ser utilizadas, tais como as o operadores terminais para outros tipos de dispositivos cirúrgicos, como, por exemplo, prendedores, cortadores, grampeadores, aplicadores de grampos, dispositivos de acesso, dispositivos de tera
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9/49 pia de fármacos/genes, dispositivos de ultrassom, RF, ou a laser, etc. Mais detalhes relativos aos dispositivos de RF podem ser encontrados na Patente '312.
[0047] O manipulo 6 do instrumento 10 pode incluir um gatilho de fechamento 18 e um gatilho de acionamento 20 para a atuação do operador terminal 12. Será apreciado que os instrumentos dotados de operadores terminais concebidos para diferentes tarefas cirúrgicas podem ter diferentes números ou tipos de gatilhos ou outros controles adequados para o funcionamento do operador terminal 12. O operador terminal 12 é mostrada separada do manipulo 6 por meio de um eixo preferivelmente alongado 8. Em uma modalidade, um médico ou operador do instrumento 10 pode articular o operador terminal 12 com relação ao eixo 8 utilizando o controle de articulação 16, conforme descrito em mais detalhes na Publicação da Patente U.S. N° 2007/0158385 A1, intitulada Surgical Instrument Having An Articulating End Effector, de Geoffrey C. Hueil et al., incorporada ao presente documento à guisa de referência.
[0048] O operador terminal 12 inclui, neste exemplo, entre outras coisas, um canal de grampos 22 e um membro de grampeamento transladável de maneira pivotável, tal como uma bigorna 24, que é mantida em um espaçamento que garante um efetivo corte e grampeamento do tecido preso no operador terminal 12. O manipulo 6 inclui um cabo de pistola 26 na direção do qual um gatilho de fechamento 18 é arrastado de maneira pivotável pelo médico de modo a fazer o grampeamento ou o fechamento da bigorna 24 no sentido do canal de grampos 22 do operador terminal 12 para, assim, prender o tecido posicionado entre a bigorna 24 e o canal 22. O gatilho de acionamento 20 fica distante do gatilho de fechamento 18. Quando o gatilho de fechamento 18 é travado na posição de fechamento, conforme descrito em mais detalhes abaixo, o gatilho de acionamento 20 pode girar sua
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10/49 vemente para o cabo de pistola 26 de modo a poder ser alcançado pelo operador com o uso de uma mão. Em seguida, o operador poderá arrastar de maneira pivotável o gatilho de acionamento 20 no sentido do cabo de pistola 12 de modo a cortar e grampear o tecido preso no operador terminal 12. Em outras modalidades, diferentes tipos de membros de grampeamento além da bigorna 24 podem ser usados, tais como, por exemplo, uma garra oposta, etc.
[0049] Será apreciado que os termos proximal e distal são usados no presente documento com referência a um médico que agarra o manipulo 6 do instrumento 10. Sendo assim, o operador terminal 12 fica distal com relação ao manipulo mais proximal 6. Será ainda apreciado que, para fins de conveniência e clareza, termos espaciais, tais como vertical e horizontal, são usados no presente documento com relação aos desenhos. No entanto, os instrumentos cirúrgicos são usados em muitas orientações e posições, e que estes termos não pretendem ser limitantes e absolutos.
[0050] O gatilho de fechamento 18 pode ser acionado primeiro. Quando o médico está satisfeito com o posicionamento do operador terminal 12, o médico pode puxar para trás o gatilho de fechamento 18 para a sua posição totalmente fechada, travada, próxima ao cabo de pistola 26. O gatilho de acionamento 20 pode em seguida ser acionado. O gatilho de acionamento 20 volta para a posição aberta (mostrada nas Figuras 1 e 2) quando o médico retira a pressão, conforme descrito em mais detalhes abaixo. Um botão de liberação no manipulo 6, quando apertado, poderá soltar o gatilho de fechamento travado 18. O botão de liberação pode ser implementado de várias formas, tais como, por exemplo, um botão de liberação deslizável 160 mostrado na Figura 7 ou qualquer outro mecanismo descrito na Publicação do Pedido de Patente U.S. N° 2007/01755955 A1, incorporado ao presente documento à guisa de referência.
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11/49 [0051] A Figura 3 é uma vista explodida do operador terminal 12 de acordo com várias modalidades. Conforme mostrado na modalidade ilustrada, o operador terminal 12 pode incluir, além do canal 22 e da bigorna 24 acima mencionados, um instrumento de corte 32, um trenó 33, um cartucho de grampos 34 assentado de maneira removível no canal 22, e um eixo rosado helicoidal 36. O instrumento de corte 32 pode ser, por exemplo, uma faca. A bigorna 24 pode ser aberta ou fechada de maneira pivotável em um ponto de pivô 25 conectado à extremidade próxima do canal 22. A bigorna 24 pode também incluir uma aba 27 em sua extremidade próxima inserida em um componente do sistema de fechamento mecânico (descrito em mais detalhes abaixo) a fim de abrir e fechar a bigorna 24. Quando o gatilho de fechamento 18 é acionado, ou seja, arrastado pelo usuário do instrumento 10, a bigorna 24 poderá pivotar sobre o ponto de pivô 25 para a posição grampeada ou fechada. Quando o grampeamento do operador terminal 12 é satisfatório, o operador poderá atuar o gatilho de acionamento 20 que, conforme explicado em mais detalhes abaixo, faz com que a faca 32 e o trenó 33 façam um percurso longitudinal ao longo do canal 22, cortando, assim, o tecido grampeado no interior do operador terminal 12. O movimento do trenó 33 ao longo do canal 22 faz com que os grampos do cartucho de grampos 34 sejam direcionados através do tecido cortado e contra a bigorna fechada 24, o que faz com que os grampos prendam o tecido cortado. Em várias modalidades, o trenó 33 pode ser um componente integral do cartucho 34. A Patente U.S. N° 6 978 921, intitulada Surgical Stapling Instrument Incorporating An Ebeam Firing Mechanism, incorporada ao presente documento a título de referência, oferece mais detalhes sobre tais instrumentos de corte e fixação de dois passos. O trenó 33 pode fazer parte do cartucho 34, de tal modo que, quando a faca 32 se retrai, seguindo a operação de corte, o trenó 33 não se retrai.
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12/49 [0052] Deve-se notar que, embora as modalidades do instrumento 10 descritas no presente documento empreguem um operador terminal 12 que grampeia o tecido cortado, em outras modalidades, diferentes técnicas para a fixação ou vedação do tecido cortado poderão ser utilizadas. Por exemplo, os operadores terminais que usam energia de RF ou adesivos para prender o tecido cortado poderão também ser usadas. A Patente U.S. N° 5 709 680, intitulada Electrosurgical Hemostatic Device, de Yates et al., e a Patente U.S. N° 5 688 270, intitulada Electrosurgical Hemostatic Device With Recessed And / Or Offset Electrodes, de Yates, et al., incorporadas ao presente documento à guisa de referência, apresentam um instrumento de corte endoscópico que utiliza energia de RF para vedar o tecido cortado. A Publicação da Patente U.S. N° 2007/0102453 A1 de Jerome R. Morgan, et al. e a Publicação da Patente U.S. N° 2007/0102452 A1 de Frederick E. Shelton, IV, et al., também incorporadas ao presente documento a título de referência, apresentam instrumentos de corte endoscópicos que usam adesivos para prender o tecido cortado. Por conseguinte, embora a presente descrição a seguir se refira a operações de corte e grampeamento e similares, deve-se reconhecer que esta é uma modalidade exemplar, não sendo concebida como limitante. Outras técnicas de fixação de tecido podem também ser usadas.
[0053] As Figuras 4 e 5 são vistas explodidas e a Figura 6 é uma vista lateral do operador terminal 12 e do eixo 8 de acordo com várias modalidades. Conforme mostrado na modalidade ilustrada, o eixo 8 pode incluir um tubo de fechamento proximal 40 e um tubo de fechamento distal 42 ligado de maneira pivotável por elos de pivô 44. O tubo de fechamento distal 42 inclui uma abertura 45 dentro da qual a aba 27 da bigorna 24 é inserida a fim de abrir e fechar a bigorna 24, conforme descrito abaixo. Disposto dentro dos tubos de fechamento 40, 42, pode haver um tubo central proximal 46. Disposto dentro do tubo
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13/49 central proximal 46 pode haver um eixo de transmissão rotacional principal (ou proximal) 48 que se comunica com um eixo de transmissão secundário (ou distal) 50 através de um conjunto de engrenagem biselada 52. O eixo de transmissão secundário 50 é conectado a uma engrenagem de transmissão 54 que se encaixa em uma engrenagem de transmissão proximal 56 do eixo de parafuso helicoidal 36. A engrenagem biselada vertical 52b pode se assentar e pivotar em uma abertura 57 na extremidade distal do tubo central proximal 46. Um tubo central distal 58 pode ser usado para encerrar o eixo de transmissão secundário 50 e as engrenagens de transmissão 54, 56. Coletivamente, o eixo de transmissão principal 48, o eixo de transmissão secundário 50, e o conjunto de articulação (por exemplo, o conjunto de engrenagens biseladas 52a a c) são aqui, algumas vezes, referidos como o conjunto de eixo de transmissão principal.
[0054] Um mancai 38, posicionado em uma extremidade distal do canal de grampos 22, recebe o parafuso de acionamento helicoidal 36, permitindo que o parafuso de acionamento helicoidal 36 gire livremente com relação ao canal 22. O eixo de parafuso helicoidal 36 pode fazer interface com uma abertura roscada (não mostrada) da faca 32, de tal modo que a rotação do eixo 36 faça com que a faca 32 translade distal ou proximalmente (dependendo da direção da rotação) através do canal de grampos 22. Por conseguinte, quando o eixo de transmissão principal 48 gira em função do acionamento do gatilho de acionamento 20 (conforme explicado em mais detalhes abaixo), o conjunto de engrenagem biselada 52a a c faz com que o eixo de transmissão secundário 50 gire, o que, por sua vez, devido ao engate das engrenagens de transmissão 54, 56, faz com que o eixo de parafuso helicoidal 36 gire, fazendo com que o membro de acionamento de faca 32 faça um percurso longitudinal ao longo do canal 22 de modo a cortar qualquer tecido preso no operador terminal. O trenó 33 pode ser feito,
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14/49 por exemplo, de plástico, e pode ter uma superfície distal inclinada. À medida que o trenó 33 passa pelo canal 22, a superfície dianteira inclinada poderá empurrar ou acionar os grampos do cartucho de grampos através do tecido preso e contra a bigorna 24. A bigorna 24 gira os grampos, grampeando, assim, o tecido cortado. Quando a faca 32 se retrai, a faca 32 e o trenó 33 podem se desencaixar, deixando, assim, o trenó 33 na extremidade distal do canal 22.
[0055] As Figuras 7 a 10 ilustram uma modalidade exemplar do endocortador acionado a motor. A modalidade ilustrada provê uma realimentação ao usuário quanto ao desenvolvimento e ao carregamento de força do instrumento de corte no operador terminal. Além disso, a modalidade pode usar a força provida pelo usuário na retração do gatilho de acionamento 29 a fim de acionar o dispositivo (um assim chamado modo com auxílio de tensão). Conforme mostrado na modalidade ilustrada, o manipulo 6 inclui peças laterais inferiores externas 59, 60 e peças laterais superiores externas 61, 62 que se encaixam entre si de modo a formar, em geral, o exterior do manipulo 6. Uma bateria 64, como, por exemplo, uma bateria de íon de lítio, pode ser provida na porção de cabo de pistola 26 do manipulo 6. A bateria 64 aciona um motor 65 disposto em uma porção superior da porção de cabo de pistola 26 do manipulo 6. De acordo com várias modalidades, um número de células de bateria conectadas em série pode ser usado para acionar o motor 65.
[0056] O motor 65 pode ser um motor de transmissão escovado de CC com uma rotação máxima de aproximadamente 25.000 RPM semcarga. O motor 64 pode acionarem 90° um conjunto de engrenagem biselada 66 compreendendo uma primeira engrenagem biselada 68 e uma segunda engrenagem biselada 70. O conjunto de engrenagem biselada 66 pode acionar um conjunto de engrenagem planetária 72. O conjunto de engrenagem planetária 72 pode incluir uma engrenagem
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15/49 de pinhão 74 conectada a um eixo de transmissão 76. A engrenagem de pinhão 74 pode acionar uma engrenagem de anéis conjugados 78 que aciona um tambor de engrenagem helicoidal 80 por meio de um eixo de transmissão 82. Um anel 84 pode ser roscado sobre o tambor de engrenagem helicoidal 80. Deste modo, quando o motor 65 gira, o anel 84 faz um percurso ao longo do tambor de engrenagem helicoidal 80 por meio do conjunto de engrenagem biselada interposta 66, do conjunto de engrenagem planetária 72, e pela engrenagem de anéis 78.
[0057] O manipulo 6 pode incluir ainda um sensor de motor de partida 110 em comunicação com o gatilho de acionamento 20 a fim de detectar quando o gatilho de acionamento 20 é arrastado (ou fechado) na direção da porção de cabo de pistola 26 do manipulo 6 por parte do operador de modo a atuar, assim, a operação de corte / grampeamento do operador terminal 12. O sensor 110 pode ser um sensor proporcional, como, por exemplo, um reostato, ou um resistor variável. Quando o gatilho de acionamento 20 é arrastado para dentro, o sensor 110 detecta o movimento e envia um sinal elétrico indicativo da voltagem (ou tensão) a ser suprido para o motor 65. Quando o sensor 110 é um resistor variável ou similar, a rotação do motor 65 pode ser de modo geral proporcional à quantidade de movimento do gatilho de acionamento 20. Ou seja, quando o operador apenas arrasta ou fecha o gatilho de acionamento 20 em um bit pequeno, a rotação do motor 65 se torna relativamente baixa. Quando o gatilho de acionamento 20 é totalmente arrastado para dentro (ou para a posição totalmente fechada), a rotação do motor 65 fica em seu máximo. Ou seja, quanto mais forte o usuário puxa o gatilho de acionamento 20, maior tensão é aplicada ao motor 65, provocando taxas de rotação mais elevadas.
[0058] O manipulo 6 pode incluir uma peça de manipulo interme
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16/49 diária 104 adjacente à porção superior do gatilho de acionamento 20. O manipulo 6 pode compreender ainda uma mola de polarização 112 conectada entre os pontaletes da peça de manipulo intermediária 104 e o gatilho de acionamento 20. A mola de polarização 112 pode polarizar o gatilho de acionamento 20 para a sua posição totalmente aberta. Desta maneira, quando o operador solta o gatilho de acionamento 20, a mola de polarização 112 empurrará o gatilho de acionamento 20 para a sua posição aberta, deste modo removendo o acionamento do sensor 110, e interrompendo a rotação do motor 65. Além disso, graças à mola de polarização 112, a qualquer momento que o usuário fecha o gatilho de acionamento 20, ele poderá perceber uma resistência à operação de fechamento, deste modo retornando ao usuário uma realimentação quanto à quantidade de rotação exercida pelo motor 65. Além disso, o operador pode interromper a retração do gatilho de acionamento 20 para, assim, remover a força do sensor 100 e, por conseguinte, parar o motor 65. Assim sendo, o usuário pode interromper a aplicação do operador terminal 12, deste modo provendo uma medida de controle da operação de corte / fixação ao operador.
[0059] A extremidade distal do tambor de engrenagem helicoidal 80 inclui um eixo de transmissão distal 120 que aciona uma engrenagem de anéis 122, que se combina com uma engrenagem de pinhão 124. A engrenagem de pinhão 124 é conectada ao eixo de transmissão principal 48 do conjunto de eixo de transmissão principal. Desta maneira, a rotação do motor 65 faz com que o conjunto de eixo de transmissão principal gire, provocando a atuação do operador terminal 12, conforme acima descrito.
[0060] O anel 84 roscado sobre o tambor de engrenagem helicoidal 80 pode incluir um pontalete 86 disposto dentro de uma fenda 88 de um braço fendido 90. O braço fendido 90 é do lado de uma abertura 92 a sua extremidade oposta 94 que recebe um pino pivô 96 conecta
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17/49 do entre as peças laterais externas de manípulo 59, 60. O pino pivô 96 é igualmente disposto através de uma abertura 100 do gatilho de acionamento 20 e de uma abertura 102 da peça de manípulo intermediária 104.
[0061] Além disso, o manípulo 6 pode incluir 6 um motor reverso (ou sensor de fim de curso) 130 e um sensor de motor de trava (ou de início de curso) 142. Em várias modalidades, o sensor de motor reverso 130 pode ser uma chave limite localizada na extremidade distal do tambor de engrenagem helicoidal 80 de tal modo que o anel 84 roscado sobre o tambor de engrenagem helicoidal 80 contate e se desengate do sensor de motor reverso 130 quando o anel 84 atinge a extremidade distal do tambor de engrenagem helicoidal 80. O sensor de motor reverso 130, quando ativado, envia um sinal para o motor 65 a fim de inverter a sua direção de rotação, deste modo eliminando a faca 32 do operador terminal 12, após a operação de corte. O sensor de motor de trava 142 pode ser, por exemplo, uma chave de limite normalmente fechada. Em várias modalidades, o mesmo pode ser localizado na extremidade proximal do tambor de engrenagem helicoidal 80 de modo que o anel 80 se desengate da chave 142 quando o anel 84 atinge a extremidade proximal do tambor de engrenagem helicoidal 80.
[0062] Em funcionamento, quando um operador do instrumento 10 empurra o gatilho de acionamento 20 para trás, o sensor 110 detecta a aplicação do gatilho de acionamento 20 e envia um sinal para o motor 65 de modo a provocar a rotação dianteira do motor 65, por exemplo, a uma taxa proporcional à força empregada pelo operador ao puxar o gatilho de acionamento 20 para trás. A rotação dianteira do motor 65, por sua vez, faz com que a engrenagem de anel 78 na extremidade distal do conjunto de engrenagem planetária 72 gire, deste modo fazendo com que o tambor de engrenagem helicoidal 80 gire, e fazendo com que o anel 84 roscado sobre o tambor de engrenagem helicoidal
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18/49 faça uma trajetória distai ao longo do tambor de engrenagem helicoidal 80. A rotação do tambor de engrenagem helicoidal 80 também aciona o conjunto de eixo de transmissão principal, conforme acima descrito, que, por sua vez, provoca o desdobramento da faca 32 no operador terminal 12. Ou seja, a faca 32 e o trenó 33 atravessam o canal 22 no sentido longitudinal, cortando, assim, o tecido preso no operador terminal 12. Da mesma forma, a operação de grampeamento do operador terminal 12 acontece nas modalidades nas quais um operador terminal do tipo grampo é utilizada.
[0063] Quando a operação de corte / grampeamento do operador terminal 12 termina, o anel 84 sobre o tambor de engrenagem helicoidal 80 chega à extremidade distai do tambor de engrenagem helicoidal 80, deste modo fazendo com que o sensor de motor reverso 130 se desengate, enviando um sinal para o motor 65 de modo a fazer com que o motor 65 inverta a sua rotação. Isto, por sua vez, faz com que a faca 32 se retraia, e ainda faz com que o anel 84 sobre o tambor de engrenagem helicoidal 80 se movimente para trás para a extremidade proximal do tambor de engrenagem helicoidal 80.
[0064] A peça de manipulo intermediária 104 inclui um ressalto traseiro 106 que se encaixa no braço fendido 90, como melhor mostrado nas Figuras 8 e 9. A peça de manipulo intermediária 104 tem ainda uma trava de movimento dianteira 107 que se encaixa no gatilho de acionamento 20. O movimento do braço fendido 90 é controlado, como explicado acima, pela rotação do motor 65. Quando o braço fendido 90 gira CCW quando o anel 84 faz uma trajetória da extremidade proximal do tambor de engrenagem helicoidal 80 para a extremidade distai, a peça de manipulo intermediária 104 ficará livre para girar CCW. Sendo assim, à medida que o usuário aperta o gatilho de acionamento 20, o gatilho de acionamento 20 se encaixará na trava de movimento dianteira 107 da peça de manipulo intermediária 104, fa
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19/49 zendo com que a peça de manipulo intermediária 104 gire CCW. Devido ao ressalto traseiro 106 que se encaixa no braço fendido 90, no entanto, a peça de manipulo intermediária 104 só será capaz de girar CCW até onde o braço fendido 90 permitir. Desta maneira, quando o motor 65, por algum motivo, para de girar, o braço fendido 90 parará de girar, e o usuário não mais poderá apertar o gatilho de acionamento 20, uma vez que a peça de manipulo intermediária 104 não estará livre para girar CCW devido ao braço fendido 90.
[0065] São ainda mostrados nas Figuras 7 a 10, os componentes do sistema de fechamento exemplar para o fechamento (ou grampeamento) da bigorna 24 do operador terminal 12 por meio da retração do gatilho de fechamento 18. Na modalidade ilustrada, o sistema de fechamento inclui uma culatra 250 conectada ao gatilho de acionamento 18 por meio de um pino 251 inserido através das aberturas alinhadas tanto no gatilho de fechamento 18 como na culatra 250. Um pino de pivô 252, sobre o qual o gatilho de fechamento 18 pivota, é inserido por uma outra abertura do gatilho de fechamento 18 desviado do lugar onde o pino 251 é inserido através do gatilho de fechamento 18. Sendo assim, a retração do gatilho de fechamento 18 faz com que a parte superior do gatilho de fechamento 18, ao qual a culatra 250 é fixada através do pino 251, a fim de girar CCW. A extremidade distal da culatra 250 é conectada, através de um pino 254, a um primeiro suporte de fechamento 256. O primeiro suporte de fechamento 256 se conecta a um segundo suporte de fechamento 258. Em termos coletivos, os suportes de fechamento 256, 258 definem uma abertura na qual a extremidade proximal do tubo de fechamento principal 40 (vide Figura 4) é assentada e fixada de tal modo que o movimento longitudinal dos suportes de fechamento 256, 258 provoque o movimento longitudinal do tubo de fechamento proximal 40. O instrumento 10 inclui ainda uma haste de fechamento 260 disposta dentro do tubo de fechamento pro
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20/49 ximal 40. A haste de fechamento 260 pode incluir uma janela 261 dentro da qual uma coluna 263 sobre uma das peças externas de manipulo, tais como a peça lateral inferior externa 59 na modalidade ilustrada, disposta de modo a conectar fixamente a haste de fechamento 260 ao manipulo 6. Desta maneira, o tubo de fechamento proximal 40 é capaz de se movimentar longitudinalmente com relação à haste de fechamento 260. A haste de fechamento 260 pode incluir ainda um colar distal 267 que se encaixa em uma cavidade 269 no tubo de espinha proximal 46 e fica retida no mesmo por meio de uma tampa 271 (vide Figura 4).
[0066] Em funcionamento, quando a culatra 250 gira devido à retração do gatilho de fechamento 18, os suportes de fechamento 256, 258 fazem com que o tubo de fechamento proximal 40 se movimente no sentido distal (isto é, para longe da extremidade de manipulo do instrumento 10), o que faz com que o tubo de fechamento distal 42 se movimente distalmente, fazendo com que a bigorna 24 gire sobre o ponto pivô 25 para a posição grampeada ou fechada. Quando o gatilho de fechamento 18 é destravado da posição travada, o tubo de fechamento proximal 40 desliza proximamente, fazendo com que o tubo de fechamento distal 42 deslize proximalmente, o que, devido ao fato de a aba 27 ser inserida na janela 45 do tubo de fechamento distal 42, faz com que a bigorna 24 pivote sobre o ponto pivô 25 para a posição aberta ou não-grampeada. Desta maneira, ao se retrair e travar o gatilho de fechamento 18, um operador poderá prender o tecido entre a bigorna 24 e o canal 22, e poderá soltar o tecido após a operação de corte / grampeamento ao destravar o gatilho de fechamento 20 da posição travada.
[0067] A Figura 11 é um diagrama esquemático de um circuito elétrico do instrumento 10 de acordo com várias modalidades da presente invenção. Quando o operador inicialmente puxa o gatilho de aciona
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21/49 mento 20 para dentro depois de travar o gatilho de fechamento 18, o sensor 110 é ativado, permitindo que a corrente flua através do mesmo. Quando a chave de sensor de motor reverso normalmente aberta 130 é aberta (ou seja, quando não é alcançado o fim do curso do operador terminal), a corrente fluirá para um relé de duplo golpe é único polo 132. Uma vez que a chave de sensor de motor reverso 130 não está fechada, o indutor 134 do relé 132 não será acionado, e, assim, o relé 132 ficará em seu estado não-energizado. O circuito inclui ainda um sensor de trava de cartucho 136. Quando o operador terminal 12 inclui um cartucho de grampos 34, o sensor 136 fica em uma condição fechada, permitindo que a corrente flua. De outra forma, quando o operador terminal 12 não inclui um cartucho de grampos 34, o sensor 136 se abrirá, impedindo, então, que a bateria 64 acione o motor 65.
[0068] Quando o cartucho de grampos 34 está presente, o sensor 136 se fecha, o que energiza um relé de único curso e único polo 138. Quando o relé 138 é energizado, a corrente flui pelo relé 136, através do sensor de resistor variável 110, e para o motor 65, por meio de um relé de duplo golpe e duplo polo 140, desta forma acionando o motor 65, e permitindo que o mesmo gire na direção dianteira. Quando o operador terminal 12 atinge o fim de seu curso, o sensor de motor reverso 130 será ativado, desta forma fechando a chave 130 e energizando o relé 134. Isto faz com que o relé 134 assuma o seu estado energizado (não mostrado na Figura 13), fazendo com que a corrente passe pelo sensor de trava de cartucho 136 e o resistor variável 110, e, em contrapartida, faz com que a corrente flua tanto para o relé de duplo golpe e duplo polo normalmente fechado 142 como também de volta para o motor 65, porém em uma maneira, através do relé 140, fazendo com que o motor 65 inverta a sua direção rotacional. Uma vez que a chave de sensor de motor de trava 142 é normalmente fechada, a corrente fluirá novamente para o relé 134 a fim de manter o mesmo
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22/49 fechado até que a chave 142 se abra. Quando a faca 32 se retrai totalmente, a chave de sensor de motor de trava 142 é ativada, fazendo com que a chave 142 se abra, deste modo removendo a força do motor 65.
[0069] Em outras modalidades, ao invés de um sensor do tipo proporcional 110, pode ser usado um sensor do tipo liga - desliga. Em tais modalidades, a taxa de rotação do motor 65 não é proporcional à força aplicada pelo operador. Em contrapartida, o motor 65 normalmente gira a uma taxa constante. Mas, ainda assim, o operador experimenta uma realimentação de força, uma vez que o gatilho de acionamento 20 está engrenado no trem de acionamento de engrenagem.
[0070] Configurações adicionais aos instrumentos cirúrgicos motorizados são descritas na Publicação do Pedido U.S. publicado N° 2007/0175962 A1, intitulada Motor-driven Surgical Cutting And Fastening Instrument With Tactile Position Feedback, incorporada ao presente documento à guisa de referência.
[0071] Em um instrumento cirúrgico motorizado, como, por exemplo, um dos instrumentos endoscópicos motorizados descritos acima, ou em um instrumento cortador circular motorizado, o motor pode ser acionado por meio de diversas células de bateria conectadas em série. Além disso, pode ser desejável em certas circunstâncias acionar o motor com uma determinada fração dentre o número total de células de bateria. Por exemplo, conforme mostrado na Figura 12, o motor 65 pode ser acionado por meio de uma fonte de alimentação 299 compreendendo seis (6) células de bateria 310 conectadas em série. As células de bateria 310 podem ser, por exemplo, células de bateria de lítio de 3 volts, tais como as células de bateria CR 123A, embora, em outras modalidades, diferentes tipos de células de bateria possam ser usados (inclusive as células de bateria com diferentes níveis de tensão e/ou diferentes produtos químicos). Quando seis células de bateria de
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23/49 volts são conectadas em série a fim de acionar o motor 65, a voltagem total disponível para acionar o motor 65 seria de 18 volts. As células de bateria 310 podem compreender células de bateria recarregáveis ou não-recarregáveis.
[0072] Em tal modalidade, sob cargas mais pesadas, a tensão de entrada para o motor 65 pode desviar em cerca de nove a dez volts. Nesta condição operacional, a fonte de alimentação 299 libera uma tensão máxima para o motor 65. Por conseguinte, conforme mostrado na Figura 12, o circuito pode incluir uma chave 312 que seletivamente permite que o motor 65 seja acionado (1) por todas as células de bateria 310 ou (2) por uma fração das células de bateria 310. Conforme mostrado na Figura 12, por meio de uma seleção apropriada, a chave 312 poderá permitir que o motor 65 seja acionado por todas as seis células de bateria ou por quatro células de bateria. Desta maneira, a chave 312 pode ser usada para acionar o motor 65 com 18 volts (ao utilizar todas as seis células de bateria 310) ou com 12 volts (ao usar, por exemplo, quatro dentre as segundas células de bateria). Em várias modalidades, a escolha do desenho para o número de células de bateria na fração usada para acionar o motor 65 pode se basear na tensão requerida pelo motor 65 ao operar a uma saída máxima para as cargas mais pesadas.
[0073] A chave 312 pode ser, por exemplo, uma chave eletromecânica, como, por exemplo, uma microchave. Em outras modalidades, a chave 312 pode ser implementada com uma chave de estado sólido, tal como um transistor. Uma segunda chave 314, como, por exemplo, uma chave de botão de empurrar, pode ser usada para controlar se uma tensão é aplicada ao motor 65. Ainda, uma chave dianteira / reversa (F/R) 316 pode ser usada para controlar se o motor 65 gira no sentido dianteiro ou no sentido reverso. A chave dianteira / reversa 316 pode ser implementada com uma chave de duplo golpe e duplo
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24/49 polo, como, por exemplo, o relé 140 mostrado na Figura 11.
[0074] Em funcionamento, o usuário do instrumento 10 pode selecionar o nível de tensão desejado por meio do uso de algum tipo de controle de chave, como, por exemplo, uma chave dependente de posição (não mostrada), tal como uma tecla de alavanca, uma tecla de alavanca mecânica, ou um came, que controla a posição da chave 312. Em seguida, o usuário poderá acionar a segunda chave 314 a fim de conectar as células de bateria selecionadas 310 ao motor 65. Além disso, o circuito mostrado na Figura 12 pode ser usado para acionar o motor de outros tipos de instrumentos cirúrgicos motorizados, tais como cortadores circulares e/ou instrumentos laparoscópicos. Mais detalhes relativos aos cortadores circulares podem ser encontrados nas Publicações de Pedidos de Patente U.S. publicados N° 2006/0047307 A1 e na Publicação N° 2007/02621116 A1, incorporadas ao presente documento à guisa de referência.
[0075] Em outras modalidades, conforme mostrado na Figura 13, uma fonte de alimentação primária 340, como, por exemplo, uma célula de bateria, como, por exemplo, uma célula de bateria CR2 ou CR123A, pode ser usada para carregar um número de dispositivos acumuladores secundários 342. A fonte de alimentação principal 340 pode compreender uma ou várias células de bateria conectadas em série, que, de preferência, são substituíveis na modalidade ilustrada. Os dispositivos acumuladores secundários 342 podem compreender, por exemplo, as células de bateria e/ou os supercapacitores recarregáveis (também conhecidos como ultracapacitores ou capacitores eletroquímicos de camada dupla (EDLC)). Os supercapacitores são capacitores eletroquímicos dotados de uma densidade de energia raramente alta em comparação aos capacitores eletrolíticos comuns, tipicamente da ordem de milhares de vezes maiores que um capacitor eletrolítico de alta capacidade.
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25/49 [0076] A fonte de alimentação principal 340 pode carregar os dispositivos acumuladores secundários 342. Quando suficientemente carregada, a fonte de tensão primária 340 pode ser removida e os dispositivos acumuladores secundários 342 podem ser usados para acionar o motor 65 durante um procedimento ou operação. Em várias circunstâncias, os dispositivos de acumulação 342 podem demorar de cerca de quinze a trinta minutos para carregar. Os supercapacitores possuem a característica de poderem carregar e descarregar de uma forma extremamente rápida em comparação às baterias convencionais. Além disso, enquanto as baterias são boas para apenas um número limitado de ciclos de carga / descarga, os supercapacitores podem, com frequência, ser repetidamente carregados / descarregados, às vezes dezenas de milhões de ciclos. Para as modalidades que usam supercapacitores como os dispositivos acumuladores secundários 342, os supercapacitores poderão compreender nanotubos de carbono, polímeros condutivos (por exemplo, poliacenos), ou aerogéis de carbono.
[0077] Conforme mostrado na Figura 14, um circuito de gerenciamento de carga 344 pode ser empregado a fim de determinar quando os dispositivos acumuladores secundários 342 se encontram suficientemente carregadores. O circuito de gerenciamento de carga 344 pode incluir um indicador, tal como um ou mais LEDs, um visor de LCD, etc., ativados para alertar a um usuário quanto ao instrumento 10 quando os dispositivos acumuladores secundários 342 se encontram suficientemente carregados.
[0078] A fonte de alimentação principal 340, os dispositivos acumuladores secundários 342, e o circuito de gerenciamento de carga 344 podem fazer parte da fonte de alimentação na porção de cabo de pistola 26 do manipulo 6 do instrumento 10, ou em uma outra parte do instrumento 10. A fonte de alimentação pode ser removível da porção de cabo de pistola 26, em cujo caso, quando o instrumento 10 tiver
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26/49 que ser usado para cirurgia, a fonte de alimentação poderá ser inserida assepticamente na porção de cabo de pistola 26 (ou em outra posição no instrumento de acordo com outras modalidades), por exemplo, por uma enfermeira próxima que auxilia na cirurgia. Após a inserção da fonte de alimentação, a enfermeira pode colocar a fonte de alimentação principal substituível 340 na fonte de alimentação de modo a carregar os dispositivos acumuladores secundários 342 por um determinado período de tempo antes do uso do instrumento 10, por exemplo, trinta minutos. Quando os dispositivos acumuladores secundários 342 são carregados, o circuito de gerenciamento de carga 344 poderá indicar que a fonte de alimentação se encontra pronto para uso. Neste momento, a fonte de alimentação principal substituível 340 poderá ser removida. Durante a operação, o usuário do instrumento 10 poderá, em seguida, acionar o motor 65, por exemplo, por meio da ativação da chave 314, por meio do que os dispositivos acumuladores secundários 342 acionarão o motor 65. Sendo assim, ao invés de ter um número de baterias descartáveis para acionar o motor 65, uma bateria descartável (como a fonte de alimentação principal 340) poderá ser usada em tal modalidade, e os dispositivos acumuladores secundários 342 poderão ser reutilizados. Em modalidades alternativas, no entanto, deve-se notar que os dispositivos acumuladores secundários 342 podem ser nãorecarregáveis e/ou não-reutilizáveis. Os acumuladores secundários 342 podem ser usados com a chave de seleção de células 312 descrita acima com relação à Figura 12.
[0079] O circuito de gerenciamento de carga 344 pode incluir ainda indicadores (por exemplo, LEDs ou um visor de LCD) que indicam quanta carga permanece nos dispositivos acumuladores secundários 342. Desta maneira, o cirurgião (ou outro usuário do instrumento 10) poderá ver quanta carga permanece durante o procedimento envolvendo o instrumento 10.
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27/49 [0080] O circuito de gerenciamento de carga 344, conforme mostrado na Figura 15, pode compreender um medidor de carga 345 de modo a medir a carga através dos acumuladores secundários 342. O circuito de gerenciamento de carga 344 pode compreender ainda uma memória não-volátil 346, como, por exemplo, uma memória flash ou memória ROM, e um ou mais processadores 348. O(s) processadores) 348 pode(m) ser conectado(s) à memória 346 a fim de controlar a memória. Além disso, o(s) processador(es) 348 pode(m) ser conectado^) ao medidor de carga 245 a fim de fazer as leituras do ou, ainda, controlar o medidor de carga 345. Além disso, o(s) processadores) 348 pode(m) controlar os LEDs ou outros dispositivos de saída do circuito de gerenciamento de carga 344. O(s) processador(es) 348 pode(m) armazenar parâmetros do instrumento 10 na memória 346. Os parâmetros podem incluir os parâmetros operacionais do instrumento detectados por vários sensores que podem ser instalados ou empregados no instrumento 10, tais como, por exemplo, o número de acionamentos, os níveis de forças envolvidas, a distância do espaço de compressão entre as garras opostas do operador terminal 12, a quantidade de articulação, etc. Além disso, os parâmetros armazenados na memória 346 podem compreender os valores de ID dos diversos componentes do instrumento 10 que o circuito de gerenciamento de carga 344 pode ler e armazenar. Os componentes tendo tais IDs podem ser os componentes substituíveis, tais como o cartucho de grampos 34. Os IDs podem ser, por exemplo, RFID que o circuito de gerenciamento de carga 344 lê através de um transponder de RFID 350. O transponder de RFID 350 pode ler RFID dos componentes do instrumento, tais como o cartucho de grampos 34, incluindo as etiquetas de identificação RFID. Os valores ID podem ser lidos, armazenados na memória 346, e comparados pelo processador 348 a uma lista de valores ID aceitáveis armazenados na memória 346 ou em um ou
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28/49 tro armazenador associado ao circuito de gerenciamento de carga a fim de determinar, por exemplo, se o componente removível / substituível associado ao valor ID lido é autêntico e/ou adequado. De acordo com várias modalidades, quando o processador 348 determina que o componente removível / descartável associado ao valor de identificador ID lido não é autêntico, o circuito de gerenciamento de carga 344 poderá impedir o uso da fonte de alimentação por parte do instrumento 10, tal como pela chave de abertura (não-mostrada) que impediría que a tensão da fonte de alimentação fosse liberada para o motor 65. De acordo com várias modalidades, diversos parâmetros que o processador 348 pode avaliar no sentido de determinar se o componente é autêntico e/ou adequado incluem: o código de data; o modelo / tipo de componente; o fabricante; as informações regionais; e os códigos de erro anteriores.
[0081] O circuito de gerenciamento de carga 344 pode também compreender uma interface i/o (entrada/saída) 352 para comunicação com outro dispositivo, tal como descrito a seguir. Desta maneira, os parâmetros armazenados na memória 346 podem ser transferidos para outro dispositivo. A interface i/o 353 pode, por exemplo, ser uma interface com fio ou sem fio.
[0082] Conforme acima mencionado, a fonte de alimentação pode compreender os acumuladores secundários 342, o circuito de gerenciamento de carga 344, e/ou chave f/r (dianteira/reversa) 316. De acordo com as diversas modalidades, conforme mostradas na Figura 16, a fonte de alimentação 299 pode ser conectada a uma base carregadora 362, que poderá, entre outras coisas, carregar os acumuladores secundários 342 na fonte de alimentação. A base carregadora 362 pode ser conectada à fonte de alimentação 299 ao conectar assepticamente a base carregadora 362 à fonte de alimentação 299 enquanto a fonte de alimentação é instalada no instrumento 10. Em outras modalidades,
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29/49 nas quais a fonte de alimentação é removível, a base carregadora 362 pode ser conectada à fonte de alimentação 299 ao se remover a fonte de alimentação 299 do instrumento 10 e conectar o mesmo à base carregadora 362. Para tais modalidades, depois de a base carregadora 362 carregar suficientemente os acumuladores secundários 342, a fonte de alimentação 299 poderá ser assepticamente instalada no instrumento 10.
[0083] Conforme mostrado na Figura 16, a base carregadora 362 pode compreender uma fonte de alimentação 364 para carregar os acumuladores secundários 342. A fonte de alimentação 364 da base carregadora 362 pode ser, por exemplo, uma bateria (ou várias baterias conectadas em série), ou um conversor CA / CC que converte tensão de CA, como, por exemplo, de cabos de tensão elétricos, em CC, ou em qualquer outra fonte de alimentação adequada para carregar os acumuladores secundários 342. A base carregadora 362 pode compreender ainda dispositivos indicadores, tais como LEDs, um visor de LCD, etc., a fim de mostrar a condição de carga dos acumuladores secundários 342.
[0084] Além disso, conforme mostrado na Figura 16, a base carregadora 362 pode compreender um ou mais processadores 366, uma ou mais unidades de memória 368, e interfaces de i/o 370, 372. Através da primeira interface de i/o 370, a base carregadora 362 pode se comunicar com a fonte de alimentação 299 (através da interface de i/o da fonte de alimentação 352). Desta maneira, por exemplo, os dados armazenados na memória 346 da fonte de alimentação 299 podem ser transferidos para a memória 368 da base carregadora 362. Desta forma, o processador 366 poderá avaliar os valores ID para os componentes removíveis / substituíveis, transferidos do circuito de gerenciamento de carga 344, a fim de determinar a autenticidade e a adequação dos componentes. Os parâmetros operacionais transferidos do
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30/49 circuito de gerenciamento de carga 344 podem ser também armazenados na memória 368, e em seguida transferidos para outro dispositivo computacional através da segunda interface de i/o 372 para avaliação e análise, por exemplo, pelo sistema hospitalar no qual a operação envolvendo o instrumento 10 é feita, pelo consultório do cirurgião, pelo distribuidor do instrumento, pelo fabricante do instrumento, etc.
[0085] A base carregadora 362 pode compreender ainda um medidor de carga 374 para medir a carga através dos acumuladores secundários 342. O medidor de carga 374 pode ficar em comunicação com o(s) processador(es) 366, de modo que o(s) processador(es) 366 possa(m) determinar em tempo real a adequação da fonte de alimentação 299 para uso com a garantia de alto desempenho.
[0086] Em outra modalidade, conforme mostrado na Figura 17, o circuito de baterias pode compreender um regulador de tensão 320 de modo a controlar a tensão suprida pelos economizadores de energia 310 ao motor 65. O regulador de tensão 320 pode também fazer parte da fonte de alimentação 299, ou pode ser componente separado. Conforme acima mencionado, o motor 65 pode ser um motor de CC escovado. A velocidade dos motores de CC escovados é, de modo geral, proporcional à voltagem de entrada aplicada. O regulador de tensão 320 pode prover uma voltagem de saída altamente regulada ao motor 65 de modo que o motor 65 opere a uma velocidade constante (ou substancialmente constante). De acordo com várias modalidades, o regulador de tensão 320 pode compreender um conversor de energia de modo chave, como, por exemplo, um conversor abaixadorelevador, conforme mostrado no exemplo da Figura 17. Tal conversor abaixador-elevador 320 pode compreender uma chave elétrica 322, como, por exemplo, um FET, um retificador 32, um indutor 326, e um capacitor 328. Quando a chave de força 322 é ligada, a fonte de tensão de entrada (por exemplo, as fontes de alimentação 310) é direta
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31/49 mente conectada ao indutor 326, que armazena a energia neste estado. Neste estado, o capacitor 328 supre energia para a carga de saída (por exemplo, o motor 65). Quando a chave de força 320 está desligada, o indutor 326 é conectado à carga de saída (por exemplo, ao motor 65) e ao capacitor 328, de modo que a energia seja transferida do indutor 326 para o capacitor 328 e para a carga 65. Um circuito de controle 330 pode controlar a chave de força 322. O circuito de controle 330 pode empregar alças de controle digital e/ou analógico. Além disso, em outras modalidades, o circuito de controle 330 pode receber informações de controle de um controlador-mestre (não mostrado) por meio de um enlace de comunicação, como, por exemplo, um barramento de dados digitais serial ou paralelo. O ponto de regulagem de voltagem para a saída do regulador de tensão 320 pode ser ajustado, por exemplo, à metade da voltagem de circuito aberto, em cujo momento a força máxima disponível a partir da fonte torna-se disponível.
[0087] Em outras modalidades, diferentes topologias de conversor de energia podem ser empregadas, incluindo os conversores de energia lineares ou de modo chave. Outras topologias de modo chave que podem ser empregadas incluem um conversor de retorno, um conversor direto, um conversor abaixador, elevador, e um conversor SEPIC. A tensão de ponto de regulagem para o regulador de tensão 320 pode ser alterada dependendo de quantas células de bateria são usadas para acionar o motor 65. Além disso, o regulador de tensão 320 pode ser usado com os dispositivos acumuladores secundários 342 mostrados na Figura 13. Além disso, a chave dianteira - reversa 316 pode ser incorporada no regulador de tensão 320, embora a mesma seja mostrada separadamente na Figura 17.
[0088] As baterias podem ser tipicamente modeladas como uma fonte de voltagem ou como uma resistência de fonte ideal. Para um modelo ideal, quando a fonte e a resistência de carga se combinam, a
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32/49 tensão máxima é transferida para a carga. A Figura 18 mostra uma típica curva de tensão para uma bateria. Quando o circuito de bateria é aberto, a voltagem através da bateria é alta (em seu valor de circuito aberto) e a corrente extraída da bateria é zero. A tensão liberada da bateria é também zero. Quanto mais corrente é extraída da bateria, a voltagem através da bateria diminui. A tensão liberada pela bateria é o produto da corrente e da voltagem. A tensão atinge o seu pico em torno de um nível de voltagem menor que a voltagem de circuito aberto. Conforme mostrado na Figura 18, na maior parte dos membros químicos da bateria ocorre uma queda acentuada de voltagem / energia em uma corrente maior, em função do membro químico ou do coeficiente de temperatura positiva (PTC), ou em função de um dispositivo de proteção de bateria.
[0089] Particularmente nas modalidades que usam uma bateria (ou baterias) para acionar o motor 65 durante um procedimento, o circuito de controle 330 pode monitorar a voltagem de saída e controlar o ponto de regulagem do regulador 320 de modo que a bateria opere no lado esquerdo ou no lado de aumento de tensão da curva de potência. Quando a bateria atinge o nível de tensão de pico, o circuito de controle 330 poderá modificar (por exemplo, baixar) o ponto de regulagem de modo que uma menor tensão total seja demandada por parte da bateria. O motor 65 em seguida se desacelera. Desta maneira, a demanda da fonte de alimentação raramente excedería o pico de tensão disponível de modo a se poder evitar uma situação de privação de tensão durante um procedimento.
[0090] Além disso, de acordo com outras modalidades, a tensão extraída a partir da bateria pode ser otimizada de tal modo que as reações químicas dentro das células da bateria tenham tempo de se recuperar, para, assim, otimizar a corrente e a tensão disponível a partir da bateria. Nas cargas pulsadas, as baterias tipicamente provêm mais
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33/49 tensão no início do pulso do que no fim do pulso. Isto se deve a diversos fatores, incluindo: (1) o PTC pode alterar a sua resistência durante o pulso; (2) a temperatura da bateria pode ser alterada; e (3) a taxa de reação eletroquímica se altera devido ao eletrólito no cátodo que é desgastado e a taxa de difusão do eletrólito novo limita a taxa de reação. De acordo com as várias modalidades, o circuito de controle 330 pode controlar o conversor 320 no sentido de extrair uma corrente menor da bateria de modo a permitir que a bateria se recupere antes de ser novamente pulsada.
[0091] De acordo com outras modalidades, o instrumento 10 pode compreender um dispositivo limitador de torque do tipo embreagem. O dispositivo limitador de torque do tipo embreagem pode se localizar, por exemplo, entre o motor 65 e a engrenagem biselada 68, entre a engrenagem biselada 70 e o conjunto de engrenagem planetária 72, ou sobre o eixo de saída do conjunto de engrenagem planetária 72. De acordo com várias modalidades, o dispositivo limitador de torque pode usar uma embreagem eletromagnética magnética ou permanente.
[0092] As Figuras 19 a 22 mostram uma embreagem eletromagnética de amostra 400 que pode ser usada no instrumento 10 de acordo com várias modalidades. A embreagem 400 pode compreender um estator em forma de ferradura 402 tendo discos magnéticos 404, 406 em cada extremidade. O primeiro disco 404 pode ser conectado a uma peça de polo rotativo, axialmente móvel 408, tal como o polo de saída do motor 65. O segundo disco magnético 406 pode ser conectado a uma peça de polo rotativo, axialmente estacionária 410, tal como um polo de entrada a uma caixa de engrenagem do instrumento 10. Nas Figuras 19 e 20, a primeira peça de polo 408 é axialmente puxada para fora da segunda peça de polo 410 através de um espaço 412 de tal modo que os discos magnéticos 404, 406 não fiquem encaixados. Uma bobina em espiral (não mostrada) que pode ser enrolada em tor
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34/49 no do estator 402 pode ser usada para criar o fluxo eletromagnético necessário para atuar a embreagem 400. Quando a bobina conduz uma corrente elétrica, o fluxo magnético resultante pode fazer com que os dois discos magnéticos 404, 406 se atraiam, fazendo com que a primeira peça de polo 408 se movimente axialmente na direção da segunda peça de polo 410, deste modo fazendo com que os dois discos magnéticos 404, 406 se encaixem, conforme mostrado nas Figuras 21 e 22, de tal modo que as duas peças de polo 408, 410 girem juntas até que o torque exceda o torque de fricção gerado entre as faces dos discos magnéticos 404 e 406.
[0093] A força atrativa entre os dois discos 404, 406 e a capacidade de torque correspondente da embreagem 400 podem ser controladas por meio do controle do diâmetro dos discos 404, 406, o coeficiente de fricção entre as faces de contato dos discos magnéticos 404 e 406, e por meio do uso dos materiais magnéticos para os discos 404, 406 que se saturam a uma densidade de fluxo conhecida e controlável. Sendo assim, quando há uma condição operacional na qual mais corrente passa pela bobina, o material magnético dos discos 404, 406 não gera uma força atrativa maior e um torque limitante subsequente.
[0094] A utilização de tal embreagem traz muitos benefícios potenciais adicionais. Sendo eletricamente controlada, a embreagem 400 pode ser rapidamente desativada por meio da remoção da corrente do fio no sentido de limitar a quantidade de calor gerado dentro da embreagem 400 e dentro do motor 65. Ao desconectar o motor do trem de acionamento, via a embreagem 400, a maior parte da energia inercial armazenada no trem de acionamento é desconectada, limitando o choque quando a saída tem de ser bloqueada repentinamente. Além disso, por ser eletricamente controlada, certo deslizamento limitado pode ser projetado a fim de ajudar na redução dos choques ao novamente partir o trem de acionamento sob carga. Além disso, devido às
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35/49 propriedades de saturação magnética de um ou mais componentes (por exemplo, os discos magnéticos 404, 406) dentro da embreagem que podem ser usadas para controlar o limite de torque ao longo da corrente da bobina, a embreagem 400 é menos sensível às mudanças de voltagem do sistema. O limite de torque em tais modalidades é basicamente uma função das dimensões físicas dos componentes da embreagem (por exemplo, os discos magnéticos 404, 406) e não requer reguladores de voltagem ou outros componentes externos para uma operação apropriada.
[0095] Em uma outra modalidade, ao invés de se usar uma embreagem eletromagnética, o dispositivo limitador de torque pode compreender um ímã permanente (não mostrado). O ímã permanente pode ser conectado, por exemplo, à primeira peça de polo, axialmente móvel 408, e atrair a segunda peça de polo axialmente fixa 410, ou vice-versa. Em tais modalidades, um dos discos 404, 406 pode ser feito de um ímã permanente e o outro de um material magnético do tipo ferro. Em uma pequena variação, o estator 402 pode ser feito na forma de um ímã permanente, fazendo com que os discos magnéticos 404 e 406 se atraíam entre si. Em função do ímã permanente, os dois discos 404, 406 sempre se encaixam. O uso de um ímã permanente não provê um controle de torque tão preciso quanto a configuração de embreagem eletromagnética acima descrita, contudo tem as vantagens de: (1) não requerer controles ou uma lógica de controle para controlar a corrente através da bobina; (2) ser mais compacto que a configuração de embreagem eletromagnética; e (3) simplificar o desenho do instrumento 10.
[0096] Conforme acima mencionado, o operador terminal 12 pode emitir uma energia de RF no sentido de coagular o tecido preso no operador terminal. A energia de RF pode ser transmitida entre os eletrodos no operador terminal 12. Uma fonte de RF (não mostrada),
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36/49 compreendendo, por exemplo, um oscilador e um amplificador, entre outros componentes, que podem suprir uma energia de RF ao eletrodo, pode se localizar no próprio instrumento, como, por exemplo, no manipulo 6 para um instrumento sem fio 10, ou a fonte de RF pode ser externa ao instrumento 10. A fonte de RF pode ser ativada conforme descrito em mais detalhes abaixo.
[0097] De acordo com várias modalidades, o operador terminal 12 pode compreender múltiplas seções (ou segmentos) de eletrodos. Por exemplo, conforme mostrado no exemplo da Figura 23, a superfície inferior da bigorna 24 (isto é, a superfície que faceia o cartucho de grampos 34) pode compreender três segmentos de RF colineares. Neste exemplo, cada segmento possui o mesmo comprimento (por exemplo, 20 mm), embora, em outras modalidades, possa haver mais ou menos segmentos, e os segmentos podem ter diferentes comprimentos. No exemplo da Figura 23, há três pares de terminais ou eletrodos ativos ou de anodos 500 alinhados longitudinalmente ao longo de cada lado do comprimento de canal sobre a superfície inferior da bigorna 24. Em particular, na modalidade ilustrada, há um par de eletrodos distais 500i, um par de eletrodos intermediários 5002, e um par de eletrodos proximais 5003 sobre cada lado do canal de faca 516. A porção ou canal externo metálico 22 do operador terminal 12 ou a bigorna metálica 24 pode servir como um contraeletrodo (ou cátodo) para cada um dos três eletrodos ativos superiores (ou anodos) 500. Os eletrodos superiores 500 podem ser acoplados à fonte de RF. Quando energizada, a energia de RF pode se propagar entre os eletrodos superiores 500 e 0 contra eletrodo, coagulando 0 tecido preso entre os eletrodos.
[0098] Os eletrodos 500 podem ser energizados simultaneamente ou em várias ordens, como, por exemplo, sequencialmente. Nas modalidades em que os eletrodos 500 são acionados de acordo com uma
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37/49 sequência, a sequência poderá ser automática (controlada, por exemplo, por um controlador (não mostrado) em comunicação com a fonte de RF) ou por meio de uma seleção do usuário. Por exemplo, os eletrodos proximais 5003 podem ser energizados primeiro; em seguida os eletrodos intermediários 5OO2; em seguida os eletrodos distais 500i. Desta maneira, 0 operador (por exemplo, 0 cirurgião operador) pode seletivamente coagular as áreas da linha de grampos. Os eletrodos em tal modalidade podem ser controlados por um multiplexador e/ou por um gerador de saída múltiplo, conforme descrito em mais detalhes abaixo. Desta maneira, 0 tecido sob cada eletrodo 500 pode ser tratado individualmente de acordo com as necessidades de coagulação. Cada eletrodo do par pode ser conectado à fonte de RF de modo que ambos possam ser acionados ao mesmo tempo. Ou seja, para 0 par distal de eletrodos ativos distais 500i, cada qual, nos lados opostos do canal de faca, pode ser acionado pela fonte de RF ao mesmo tempo. O mesmo para 0 par intermediário dos eletrodos 5002 e para 0 par de eletrodos proximais 5003, embora, em uma modalidade na qual os pares de eletrodos são energizados em sequência, 0 par distal não será energizado ao mesmo tempo como os pares intermediário e proximal, e assim por diante.
[0099] Além disso, vários parâmetros elétricos, tais como impedância, energia ou potência liberada, etc., podem ser monitorados e a saída para os eletrodos particulares 500 pode ser modificada de modo a produzir 0 efeito de tecido mais desejável. Ademais, uma outra vantagem é no caso de um grampo de metal ou outro objeto eletricamente condutivo deixado a partir do acionamento de instrumento ou procedimento cirúrgico anterior que pode provocar um curto dos eletrodos. Tal situação de curto pode ser detectada pelo gerador e/ou multiplexador, e a energia pode ser modulada de uma maneira apropriada para 0 curto-circuito.
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38/49 [00100] Além disso, energizando os eletrodos 500 em sequência reduz a energia instantânea requerida a partir da fonte de RF em comparação a um desenho que tem um conjunto de eletrodos tão longo quanto o comprimento combinado dos três eletrodos segmentados 500 mostrados na Figura 23. Por exemplo, para as configurações de eletrodo conforme mostradas na Patente '312, foi demonstrado que o mesmo precisa de cinquenta a cem watts para coagular com sucesso linhas de quarenta e cinco mm em ambos os lados da linha de corte. Ao se usar eletrodos ativos menores (por exemplo, os eletrodos superiores 500) com menos área de superfície que os eletrodos de retorno maiores (por exemplo, a bigorna metálica 24), os eletrodos ativos menores 500 podem concentrar a energia terapêutica no tecido, enquanto o eletrodo de retorno, maior é usado para completar o circuito com um impacto mínimo sobre a interface de tecido. Além disso, o eletrodo de retorno tem uma massa maior e, deste modo, poderá ficar mais frio durante uma aplicação eletrocirúrgica.
[00101] Os eletrodos 500 podem ser envolvidos por um material eletricamente isolante 504, podendo compreender um material cerâmico.
[00102] A Figura 24 mostra uma outra modalidade tendo eletrodos de RF segmentados. Na modalidade mostrada na Figura 24, existem quatro eletrodos segmentados colineares 500i-4 de igual comprimento (15 mm, neste exemplo). Como na modalidade da Figura 23, os eletrodos 500 da Figura 24 podem ser acionados simultaneamente ou em sequência.
[00103] A Figura 25 mostra ainda uma outra modalidade, na qual os eletrodos segmentados possuem comprimentos diferentes. Na modalidade ilustrada, há quatro eletrodos segmentados colineares, mas os eletrodos mais distais 500i, 5002 têm 10 mm de comprimento, e os dois eletrodos proximais 5003, 5004 têm 20 mm de comprimento. Os
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39/49 eletrodos distais curtos podem oferecer a vantagem de concentrar a energia terapêutica, conforme acima mencionado.
[00104] A Figura 59 mostra uma modalidade tendo quinze pares de eletrodos de RF segmentados 500 em uma placa de circuito 570, ou outro tipo de substrato adequado, sobre a superfície inferior da bigorna 24 (isto é, sobre a superfície que faceia o canal 22). Os vários pares de eletrodo são acionados pela fonte de RF (ou gerador) 574. O multiplexador 576 pode distribuir a energia de RF para os diversos pares de eletrodo, conforme desejado, sob o controle de um controlador 578. De acordo com várias modalidades, a fonte de RF 574, o multiplexador 576, e o controlador 578 podem se localizar no manipulo 6 do instrumento.
[00105] Em tal modalidade, a placa de circuito 570 pode compreender múltiplas camadas que proveem conexões elétricas entre o multiplexador 576 e os diversos pares de eletrodo. Por exemplo, conforme mostrado nas Figuras 60 a 63, a placa de circuito pode compreender três camadas 580i-3, cada camada 580 provendo conexões para cinco pares de eletrodo. Por exemplo, a camada mais superior 5803 pode prover conexões para os cinco pares de eletrodo mais proximal, conforme mostrado nas Figuras 60 e 61; a camada intermediária 5802 pode prover conexões aos cinco pares de eletrodos intermediários, conforme mostrado nas Figuras 60 e 62; e a camada mais inferior 580i pode prover conexões para os cinco pares de eletrodo mais distais, conforme mostrado nas Figuras 60 e 63.
[00106] A Figura 64 mostra uma vista de extremidade em seção transversal da bigorna 24 de acordo com tal modalidade. A placa de circuito 570, adjacente às bolsas de grampo 584, compreende três camadas condutoras 580i-3, tendo camadas isolantes 582i-4 entre as mesmas. As Figuras 65 e 66 mostram como as diversas camadas 580i-3 podem ser empilhadas de modo a se conectarem também ao
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40/49 multiplexador 576 no manipulo.
[00107] Uma vantagem de se ter muitos eletrodos de RF no operador terminal 12, conforme mostrado na Figura 67 é que, no caso de uma linha de grampos de metal 590 ou outro objeto eletricamente condutivo deixado no tecido 592 a partir de um acionamento de instrumento ou procedimento cirúrgico anterior que pode provocar um curto dos eletrodos, tal situação de curto pode ser detectada pelo gerador ou multiplexador, e a energia pode ser modulada de uma maneira apropriada para o curto-circuito.
[00108] A Figura 27 mostra um outro operador terminal 12 com eletrodos de RF. Nesta modalidade, o operador terminal 12 compreende apenas os eletrodos distais 500i, com a bigorna metálica 24 servindo como um eletrodo de retorno. Os eletrodos distais 500i não se estendem por todo o comprimento da bigorna 24, mas apenas por uma fração do comprimento. Na modalidade ilustrada, os eletrodos distais 500i têm apenas aproximadamente 20 mm de comprimento ao longo da bigorna de 60 mm, de modo que os eletrodos distais 500i só cubram aproximadamente 1/3 do comprimento mais distal da bigorna. Em outras modalidades, os eletrodos distais 500i podem de cobrir 1/10 a 1/2 do comprimento mais distal da bigorna. Estas modalidades podem ser usadas para uma coagulação do ponto, conforme descrito na Patente U.S. N° 5 599 350, incorporada ao presente documento à guisa de referência.
[00109] A Figura 28 mostra ainda uma outra modalidade do operador terminal 12 com eletrodos de RF. Nesta modalidade, um eletrodo ativo 500 é posicionado na ponta distal da bigorna 24, isolado pela bigorna 24 por meio de um isolante não-condutivo eletricamente 504, que pode ser feito de material cerâmico. Esta modalidade pode ser usada para uma coagulação de ponto.
[00110] As Figuras 29 a 32 ilustram outras modalidades do opera
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41/49 dor terminal 12 que podem ser úteis na coagulação de ponto. Nestas modalidades, a bigorna 24 compreende um par de eletrodos 500i, 5002 na extremidade distal da bigorna 24 e ao longo de um lado lateral da bigorna 24. A Figura 29 é uma vista de extremidade dianteira da bigorna 24 de acordo com tal modalidade, a Figura 30 é uma vista lateral, a Figura 31 é uma vista de extremidade frontal fragmentada, e ampliada, e a Figura 32 é uma vista de topo. Em tal modalidade, a bigorna metálica 24 pode atuar como 0 eletrodo de retorno. Os eletrodos ativos 500i, 5002 podem ser isolados da bigorna 24 por meio de isolantes eletricamente não-condutivos 504 que podem compreender um material cerâmico.
[00111] As Figuras 33 a 36 mostram uma modalidade, na qual a bigorna 24 compreende dois eletrodos distais 500i, 5002 localizados na parte de topo central da bigorna 24. Mais uma vez, a bigorna metálica 24 pode atuar como 0 eletrodo de retorno, e os eletrodos ativos 500i, 5002 podem ficar isolados da bigorna 24 por meio de isolantes eletricamente não-condutivos 504.
[00112] As Figuras 37 a 40 mostram uma modalidade na qual um eletrodo ativo 500i (por exemplo, 0 eletrodo ativo) fica posicionado sobre a bigorna 24, e um outro eletrodo ativo 5002 fica posicionado sobre a garra inferior 22, e, de preferência, sobre 0 cartucho 34. A bigorna metálica 24 poderá servir como 0 eletrodo de retorno. O eletrodo de bigorna 500i fica isolado da bigorna 24 graças ao isolante 504. O eletrodo 5002 que fica posicionado no cartucho 34, que é de preferência feito de um material não condutivo, como, por exemplo, plástico, fica isolado do canal metálico 22 por meio do cartucho 34.
[00113] As Figuras 41 a 44 mostram uma modalidade na qual a bigorna 24 possui dois eletrodos ativos 500i, 5002 na extremidade mais distal da bigorna 24 que se estendem completamente a partir da superfície superior da bigorna 24 para a superfície inferior. Mais uma
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42/49 vez, a bigorna metálica 24 pode atuar como o eletrodo de retorno, e os eletrodos ativos 500i, 5002 podem ficar isolados da bigorna 24 por meio dos isolantes eletricamente não-condutivos 504.
[00114] As Figuras 45 a 48 mostram uma modalidade na qual 0 cartucho 34 tem dois eletrodos ativos 500i, 5002 na extremidade mais distal do cartucho de grampos 34. Em tal modalidade, a bigorna metálica 24 ou 0 canal metálico 22 pode atuar como 0 eletrodo de retorno. Na modalidade ilustrada, os eletrodos 500i, 5002 são conectados aos insertos isolantes 503, porém, em outras modalidades, os insertos isolantes 503 podem ser omitidos e 0 cartucho de plástico 34 pode servir como isolante aos eletrodos 500i, 5002.
[00115] As Figuras 49 a 52 mostram uma modalidade tendo um eletrodo ativo 500i na extremidade mais distal da bigorna 24 e um outro eletrodo ativo 5002 na extremidade muito mais distal do cartucho 34. Mais uma vez, em tal modalidade, a bigorna 24 ou 0 canal metálico 22 pode atuar como 0 eletrodo de retorno. Nesta modalidade ilustrada, 0 eletrodo 5002 é conectado aos insertos isolantes 503, 505, porém, em outras modalidades, os insertos isolantes 503, 505 podem ser omitidos e 0 cartucho de plástico 34 pode servir como isolante ao eletrodo 5002. [00116] A Figura 57 é uma vista lateral e a Figura 58 é uma vista lateral em seção transversal do manipulo 6 de acordo com outras modalidades da presente invenção. A modalidade ilustrada inclui apenas um gatilho, 0 gatilho de fechamento 18. A ativação da faca, dos extratores de grampo, e/ou dos eletrodos de RF, na presente modalidade, pode ser feita através de outros meios além de um gatilho de acionamento separado. Por exemplo, conforme mostrado na Figura 57, 0 acionamento da faca, dos extratores de grampo, e/ou dos eletrodos de RF pode ser acionado por uma chave de botão de empurrar 540 ou outro tipo de chave que fica em uma posição conveniente ao operador. Na Figura 57, a chave 540 é mostrada na porção mais proximal do
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43/49 manipulo 6. Em uma outra modalidade, a chave pode ser posicionada próxima à extremidade distai 6 do manipulo de modo que o puxar do bocal 539 ative a chave no sentido de provocar o acionamento do instrumento. Em tal modalidade, uma chave (não mostrada) pode ser colocada sob ou próxima ao bocal 539 de modo que o movimento dos bocais segure a chave.
[00117] De maneira alternativa, o acionamento da faca, dos extratores de grampo, e/ou dos eletrodos de RF pode ser feito por meio de comandos de voz ou outro som detectado por um microfone 542. Em outras modalidades, o manipulo 6 pode compreender um transceptor de RF ou sônico 541, que pode receber e/ou transmitir sinais de RF ou sônicos a fim de acionar o instrumento. Ainda, conforme mostrado na Figura 58, um pedal ou uma chave 544 pode ser usado no sentido de acionar o instrumento 10. O pedal 544 pode ser conectado ao manipulo 6 por um cabo 545. Ainda, o manipulo 6 pode compreender um controle de discar 546 ou um outro tipo de dispositivo de controle a fim de controlar o acionamento dos eletrodos segmentados de RF (vide, por exemplo, as Figuras 23 a 24). Com o uso de tal dispositivo de controle 546, o operador poderá acionar em série os diversos pares de eletrodos de RF 500 no operador terminal 12.
[00118] O instrumento 10 mostrado nas Figuras 57 e 58 inclui ainda muitos sistemas de realimentação ao usuário. Conforme acima mencionado, o instrumento 10 pode compreender o alto-falante 543 para comandos ou instruções audíveis ao operador. Além disso, o manipulo 6 pode compreender indicadores visuais 548, tais como LEDs ou outras fontes de luz que proveem uma realimentação visual relativa ao acionamento dos diversos eletrodos segmentados de RF. Por exemplo, cada um dos indicadores visuais 548 pode corresponder a um dentre os pares de eletrodos segmentados de RF. O indicador visual correspondente 548 pode ser ativado quando o par de eletrodos seg
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44/49 mentados de RF é acionado. Além disso, o manipulo 6 pode compreender um visor alfanumérico 550, que pode ser um LED ou um visor de LCD, por exemplo. O visor 550 pode ser conectado a uma placa de circuito 552 dentro do manipulo 6. O manipulo 6 pode compreender ainda um vibrador 554 na porção de cabo de pistola 26 que pode prover um retorno vibracional ao operador. Por exemplo, o vibrador 554 pode vibrar a cada vez que um dos pares de eletrodos segmentados de RF no operador terminal 12 é acionado.
[00119] A Figura 26 é uma vista em seção transversal do operador terminal 12 de acordo com várias modalidades, nas quais os eletrodos ficam sobre a garra superior 24 (ou bigorna). Na modalidade ilustrada, os eletrodos ativos 500 são posicionados adjacentes à fenda de faca 516. A bigorna metálica 24 pode servir como o eletrodo de retorno. Os isolantes 504, que podem ser feitos de cerâmica, isolam os eletrodos 500 da bigorna metálica 24. A modalidade da Figura 68 é similar à da Figura 26, exceto que os eletrodos 500 são menores, de tal modo que uma porção dos isolantes 504 possa se estender entre os respectivos eletrodos 500 e as bordas do canal de faca 516.
[00120] A Figura 53 é uma vista de extremidade em seção transversal do operador terminal 12 de acordo com uma outra modalidade. Nesta modalidade, como na modalidade da Figura 26, os eletrodos ativos 500i, 5002 ficam sobre a bigorna 24 do lado oposto do canal de faca. Os eletrodos 500i, 5002 são isolados da bigorna metálica pelos isolantes 504, que também compreendem, de preferência, um material cerâmico. Na presente modalidade, no entanto, os isolantes 504 são muito finos (em comparação aos da Figura 26). Os isolantes 504 muito finos oferecem a vantagem potencial de a bigorna 24 poder incluir uma seção metálica relativamente grande 520 acima dos eletrodos 500, desta forma, potencialmente, suportando um perfil de bigorna mais fino para uma dada rigidez de bigorna, ou um perfil mais rígido para uma
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45/49 dada dimensão em seção transversal de bigorna. Os isolantes 504 podem ser fundidos ou revestidos porfaiscação sobre a bigorna 24.
[00121] A Figura 54 ilustra uma outra modalidade. Nesta modalidade, os eletrodos ativos 500i, 5002 são revestidos por faiscação ou ligados aos isolantes 504, os quais podem ser também revestidos por faiscação ou ligados à bigorna. Como na modalidade da Figura 53, este desenho permite mais material de bigorna acima dos eletrodos. Em tal modalidade, os eletrodos 500i, 5002 podem compreender prata, que vem a ser um bom condutor de eletricidade e apresenta propriedades antimicrobianas.
[00122] A Figura 55 mostra uma vista lateral do operador terminal de acordo com uma outra modalidade. Nesta modalidade, um filme fino de material eletricamente isolante 530 é depositado sobre a face do cartucho 34. O filme isolante 530 compreende de preferência um material resistente ao calor e ao arco, como, por exemplo, cerâmica. Isto tendería a aumentar a resistência do cartucho 34 à trilha e ao curto de arco, permitindo mais acionamentos entre as mudanças de cartucho 34. Além disso, quando 0 cartucho 34 é um condutor elétrico fraco, 0 mesmo suportará um aquecimento mais rápido do tecido e reduzirá a necessidade geral de energia. Os eletrodos ativos (não mostrados na Figura 55) podem estar na bigorna 24, conforme descrito nas modalidades acima.
[00123] A Figura 56 mostra uma modalidade similar à mostrada na Figura 55, exceto que, na Figura 56, uma camada fina 532 de um material leve e eletricamente condutivo é depositada sobre 0 topo do filme isolante 530. A condutividade da camada fina, levemente condutiva 532 pode ser menor que a condutividade do tecido preso no operador terminal 12 para tratamento. Assim sendo, a camada fina, levemente condutiva 532 proveria uma passagem de condutividade reduzida para prover um aquecimento adicional do tecido preso. Isto tendería a redu
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46/49 zir o tempo necessário para aquecer o tecido e obter coagulação. [00124] Conforme acima descrito, o instrumento 10 pode compreender um pivô de articulação 14 para articular o operador terminal 12. Um médico ou operador do instrumento 10 pode articular o operador terminal 12 com relação ao eixo 8 por meio do controle de articulação 16, conforme descrito em mais detalhes na Publicação do Pedido de Patente U.S. publicado N° 2007/0158385 A1, intitulada Surgical Instrument Having An Articulating End Effector, de Geoffrey C. Hueil et al., incorporado ao presente documento a título de referência. Em outra modalidade, ao invés de um dispositivo de controle integrado ao instrumento 10, o operador terminal 12 pode ser articulada por um instrumento separado, como, por exemplo, uma pinça que é inserida no paciente de modo que a sua porção operativa fique próxima do operador terminal 12 e possa articular o operador terminal 12 conforme desejado. O instrumento separado pode ser inserido através de uma outra abertura além do operador terminal 12, ou pela mesma abertura. Da mesma forma, diferentes operadores podem operar os instrumentos separados, ou uma única pessoa poderá operar ambos os instrumentos, a fim de articular o operador terminal 12. Em um outro cenário de articulação passiva, o operador terminal 12 pode ser articulada, empurrando o mesmo cuidadosamente contra outras partes do paciente de modo a obter a articulação desejada.
[00125] Em uma outra modalidade, o operador terminal 12 pode ser conectado ao manipulo por meio de um cabo flexível. Em tal modalidade, o operador terminal 12 pode ser posicionada conforme desejado e mantida em posição por meio do uso de um outro instrumento, por exemplo, um instrumento de pinça separado. Além disso, em outras modalidades, o operador terminal 12 pode ser posicionado por meio de um instrumento separado e preso por um segundo instrumento separado. Além disso, o operador terminal 12 pode ser feita suficiente
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47/49 mente pequena, com uma largura de, por exemplo, 8 a 9 mm por 10 a 11 mm de altura, de maneira que um mecanismo do tipo puxar para fechar possa ser usado para prender o operador terminal no manipulo
6. O mecanismo de puxar para fechar pode ser adaptado a partir do descrito na Patente U.S. N° 5 562 701, intitulada Cable-Actuated Jaw Assembly For Surgical Instruments, incorporada ao presente documento à guisa de referência. O cabo 600 pode ser disposto dentro ou ao longo de um endoscópio flexível para uso, por exemplo, nos procedimentos do trato gastrointestinal superior ou inferior.
[00126] Em uma outra modalidade ainda, conforme mostrado nas Figuras 69 e 70, o instrumento 10 pode compreender um conjunto de pescoço flexível 732, permitindo a articulação do operador terminal 12. Quando um conjunto de transmissão de articulação 731 acoplado ao eixo 8 é girado, o mesmo poderá provocar uma articulação remota do conjunto de pescoço flexível 732. O conjunto de pescoço flexível 732 pode compreender uma primeira e uma segunda porções de pescoço flexíveis 733, 734, que alojam um primeiro e um segundo conjuntos de banda flexíveis 735, 736. Após a rotação do conjunto de transmissão de articulação 731, um dentre o primeiro e o segundo conjuntos de banda de transmissão flexíveis 735, 736 se movimenta para frente e o outro conjunto de banda se movimenta para trás. Em resposta ao movimento alternativo dos conjuntos de banda dentro das primeira e segunda porções de pescoço flexível 733, 734 do conjunto de pescoço flexível 732, o conjunto de haste flexível 732 se curva de modo a prover uma articulação. Uma descrição mais abrangente da haste flexível é feita na Patente U.S. N° 5 704 534, incorporada ao presente documento à guisa de referência.
[00127] Os dispositivos aqui apresentados podem ser concebidos para serem descartados após um único uso, ou podem ser concebidos para múltiplos usos. Em ambos os casos, no entanto, o dispositivo po
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48/49 de ser recondicionado para uma reutilização após pelo menos um uso. O recondicionamento pode incluir qualquer combinação das etapas de desmontagem do dispositivo, seguido da limpeza ou troca de peças particulares, e remontagem subsequente. Em particular, o dispositivo pode ser desmontado, e qualquer número de peças ou partes determinadas do dispositivo pode ser seletivamente substituído ou removido em qualquer combinação. Após limpeza e/ou troca de peças particulares, o dispositivo pode ser remontado, para uso subsequente, na instalação de recondicionamento ou por uma equipe cirúrgica imediatamente antes de um procedimento cirúrgico. Os versados na técnica apreciarão que o recondicionamento de um dispositivo pode utilizar uma variedade de técnicas para desmontagem, limpeza / troca, e remontagem. O uso de tais técnicas e o dispositivo recondicionado resultante estão dentro do âmbito de aplicação do presente pedido.
[00128] De preferência, as várias modalidades da presente invenção descritas no presente documento são processadas antes de uma cirurgia. Primeiramente, um instrumento novo ou usado é obtido e, se necessário, limpo. O instrumento pode, em seguida, ser esterilizado. Em uma técnica de esterilização, o instrumento é colocado em um recipiente fechado e vedado, como em um invólucro de plástico termoformado revestido com uma folha de TYVEK. O recipiente e o instrumento são, em seguida, colocados em um campo de radiação que pode penetrar o recipiente, como, por exemplo, uma radiação gama, raios X, ou elétrons de alta energia. A radiação mata as bactérias no instrumento e no recipiente. O instrumento esterilizado pode, em seguida, ser armazenado no recipiente estéril. O recipiente selado mantém o instrumento estéril até que seja aberto no consultório médico.
[00129] É preferido que o dispositivo seja esterilizado. Isto pode ser feito de diversas maneiras conhecidas pelos versados na técnica, incluindo por radiação beta ou gama, por óxido de etileno, a vapor ou
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49/49 por meio de outros métodos.
[00130] Embora a presente invenção tenha sido ilustrada por meio da descrição de diversas modalidades e embora as modalidades ilustrativas sejam descritas em consideráveis detalhes, não vem a ser intenção da Requerente restringir ou de alguma forma limitar o escopo de aplicação das reivindicações em apenso a tais detalhes. Vantagens e modificações adicionais podem, de pronto, surgir aos versados na técnica. As várias modalidades da presente invenção representam vastos aperfeiçoamentos sobre os métodos de grampeamento anteriores, que requerem o uso de diferentes tamanhos de grampo em um único cartucho a fim de obter grampos de diferentes alturas (finais).
[00131] Por conseguinte, a presente invenção foi apresentada em termos de procedimentos e aparelhos endoscópicos. No entanto, o uso de termos, tais como endoscópico, não deve ser concebido no sentido de limitar a presente invenção a um instrumento cirúrgico de corte e grampeamento para uso somente em conjunto com um tubo endoscópico (isto é, um trocarte). Ao contrário, acredita-se que a presente invenção possa encontrar uso em qualquer procedimento no qual o acesso seja limitado, incluindo, porém, não se limitando a, procedimentos laparoscópicos, assim como a procedimentos abertos. Além disso, os aspectos únicos e novos das várias modalidades de cartucho de grampos da presente invenção podem encontrar utilidade quando usados com relação a outras formas de aparelhos de grampeamento, sem se afastar do espírito e do escopo da presente invenção.
Claims (7)
- REIVINDICAÇÕES1. Instrumento cirúrgico de corte e fixação compreendendo: um operador terminal (12);um eixo (8) conectado ao operador terminal (12), o eixo (8) compreendendo um trem de acionamento para acionar o operador terminal (12); e um manipulo (6) conectado ao eixo (8), o manipulo compreendendo:um motor elétrico de CC (65) conectado ao trem de acionamento para acionar o trem de acionamento;uma fonte de alimentação que compreende pelo menos um dispositivo acumulador de carga (342) conectado ao motor de CC para acionar o motor de CC e pelo menos uma bateria (340), adaptada e disposta para carregar o pelo menos um dispositivo acumulador de carga (342);caracterizado pelo fato de que a bateria (340) é substituível.
- 2. Instrumento cirúrgico de corte e fixação, de acordo com a reivindicação 1, caracterizado pelo fato de que o pelo menos um dispositivo acumulador de carga (342) compreende uma pluralidade de dispositivos acumuladores de carga conectados em série, tais como uma pluralidade de supercapacitores conectados em série.
- 3. Instrumento cirúrgico de corte e fixação, de acordo com a reivindicação 2, caracterizado pelo fato de que a fonte de alimentação é removível do manipulo (6).
- 4. Instrumento cirúrgico de corte e fixação, de acordo com a reivindicação 1, caracterizado pelo fato de que a fonte de alimentação compreende um circuito de gerenciamento de carga (344) conectado aos dispositivos acumuladores de carga para determinar um nível de carga dos dispositivos acumuladores de carga.Petição 870190001013, de 04/01/2019, pág. 53/582/2
- 5. Instrumento cirúrgico de corte e fixação, de acordo com a reivindicação 4, caracterizado pelo fato de que o circuito de gerenciamento de carga (344) compreende:uma memória (346) para armazenamento de dados; e um processador conectado à memória.
- 6. Instrumento cirúrgico de corte e fixação, de acordo com a reivindicação 5, caracterizado pelo fato de que a memória (346) é para armazenar parâmetros relativos à fonte de alimentação.
- 7. Instrumento cirúrgico de corte e fixação, de acordo com a reivindicação 5, caracterizado pelo fato de que a memória (346) é ainda para armazenar valores de RFID para componentes do instrumento, e em que o circuito de gerenciamento de carga (344) ainda compreende um transponder de RFID para leitura dos valores de RFID.
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US12/031,567 US8657174B2 (en) | 2008-02-14 | 2008-02-14 | Motorized surgical cutting and fastening instrument having handle based power source |
US12/031,567 | 2008-02-14 |
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BRPI0901447A2 BRPI0901447A2 (pt) | 2010-01-26 |
BRPI0901447B1 true BRPI0901447B1 (pt) | 2019-07-16 |
BRPI0901447B8 BRPI0901447B8 (pt) | 2021-06-22 |
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BRPI0901447A BRPI0901447B8 (pt) | 2008-02-14 | 2009-02-13 | instrumento cirúrgico de corte e fixação |
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EP (3) | EP2090243B1 (pt) |
JP (1) | JP5405139B2 (pt) |
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AT (1) | ATE512629T1 (pt) |
BR (1) | BRPI0901447B8 (pt) |
HK (1) | HK1135883A1 (pt) |
RU (1) | RU2496432C2 (pt) |
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-
2008
- 2008-02-14 US US12/031,567 patent/US8657174B2/en active Active
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2009
- 2009-02-13 EP EP09250378A patent/EP2090243B1/en active Active
- 2009-02-13 EP EP17151831.9A patent/EP3222223B1/en active Active
- 2009-02-13 AT AT09250378T patent/ATE512629T1/de not_active IP Right Cessation
- 2009-02-13 JP JP2009031862A patent/JP5405139B2/ja active Active
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EP2090243B1 (en) | 2011-06-15 |
EP2090243A3 (en) | 2009-10-28 |
EP3222223B1 (en) | 2020-03-25 |
HK1135883A1 (en) | 2010-06-18 |
BRPI0901447A2 (pt) | 2010-01-26 |
US8657174B2 (en) | 2014-02-25 |
US20130190757A1 (en) | 2013-07-25 |
BRPI0901447B8 (pt) | 2021-06-22 |
US20110125176A1 (en) | 2011-05-26 |
US9522029B2 (en) | 2016-12-20 |
EP2090243A2 (en) | 2009-08-19 |
EP3222223A1 (en) | 2017-09-27 |
JP5405139B2 (ja) | 2014-02-05 |
JP2009189837A (ja) | 2009-08-27 |
EP2366341A3 (en) | 2011-11-23 |
CN101507622A (zh) | 2009-08-19 |
EP2366341B1 (en) | 2017-01-18 |
RU2496432C2 (ru) | 2013-10-27 |
ATE512629T1 (de) | 2011-07-15 |
EP2366341A2 (en) | 2011-09-21 |
RU2009105078A (ru) | 2010-08-20 |
US20090209990A1 (en) | 2009-08-20 |
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