BRPI0903940A2 - instrumento cirúrgico motorizado - Google Patents
instrumento cirúrgico motorizado Download PDFInfo
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- BRPI0903940A2 BRPI0903940A2 BRPI0903940-6A BRPI0903940A BRPI0903940A2 BR PI0903940 A2 BRPI0903940 A2 BR PI0903940A2 BR PI0903940 A BRPI0903940 A BR PI0903940A BR PI0903940 A2 BRPI0903940 A2 BR PI0903940A2
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- 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
- A61B2017/00681—Aspects not otherwise provided for
- A61B2017/00734—Aspects not otherwise provided for battery operated
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07278—Stapler heads characterised by its sled or its staple holder
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
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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
- A61B17/32—Surgical cutting instruments
- A61B2017/320052—Guides for cutting instruments
Abstract
INSTRUMENTO CIRúRGICO MOTORIZADO. A presente invenção refere-se a um instrumento cirúrgico de fixação e corte que é motorizado, O instrumento compreende em uma modalidade um dispositivo acumulador de carga, separado da bateria, que fornece força adicional ao motor em certas circunstâncias. Adicionalmente, o motor pode compreender múltiplas bobinas.
Description
Relatório Descritivo da Patente de Invenção para "INSTRU-MENTO CIRÚRGICO MOTORIZADO".
Antecedentes da Técnica
Grampeadores cirúrgicos têm sido usados na técnica anteriorpara, simultaneamente, fazer uma incisão longitudinal em um tecido e aplicarlinhas de grampos em lados opostos da incisão. Tais instrumentos incluemcomumente um par de membros em mandíbula cooperativos que, se o ins-trumento tem o propósito para aplicações endoscópicas ou laparoscópicas,são capazes de passar através de uma passagem de cânula. Um dos mem-bros em mandíbula recebe um cartucho com grampos tendo pelo menoscarreiras de grampos espaçadas lateralmente. O outro membro em mandí-bula se define em uma bigorna tendo bolsos em forma de grampos alinha-dos com as carreiras de grampos no cartucho. Tais instrumentos incluemtipicamente uma pluralidade de cunhas que, quando dirigidas distalmente,passam através das aberturas no cartucho de grampo e empenham direçãosuportando os grampos para efetuar a ignição dos grampos na direção dabigorna.
Um exemplo de grampo cirúrgico próprio para aplicações endos-cópicas é descrito em um pedido publicado de Patente N0 U.S. 2004/023196A1, intitulado, "Surgical stapling instrument having separate distinct closingand firing systems," a descrição deste é aqui incorporada para referência.Em uso, um clínico é capaz de fechar os membros em mandíbulas do gram-po contra o tecido para posição do tecido anterior à ignição. Uma vez que oclínico tenha determinado que os membros em mandíbulas estejam aper-tando propriamente o tecido, o clínico pode disparar o grampo cirúrgico, eassim afastando e grampeando o tecido. As etapas de separar e grampearsimultaneamente impedem complicações que possam aparecer quando es-sas ações são desempenhadas sequecialmente com ferramentas cirúrgicasdiferentes que repetidamente apenas separam e grampeiam.
Instrumentos cirúrgicos de fixação e incisão a motor, quandoum motor energiza o instrumento de incisão, são também conhecidos emtécnicas anteriores, como as descritas no pedido publicado sob N0 U.S.2007/0175962, intitulado, "Motor-driven surgical cutting and festening ins-trument with tactile position feedback", o qual é incorporada aqui para refe-rência. Nessa referência, a bateria no manipulo é usada para energizar omotor eletricamente.
SUMÁRIO
Em aspecto geral, as modalidades da presente invenção sãodirecionadas para instrumentos cirúrgicos motorizados. Os instrumentos po-dem ser instrumentos endoscópicos, assim como endocortadores linearesou cortadores circulares, ou instrumentos laparoscópicos. Os instrumentospodem ser compreendidos de grampos e/ou eletrodos RF para fixação dotecido grampeado no efetor de extremidade.
Várias modalidades reveladas aqui são pertinentes para instru-mentos a motor sem fio. Em uma modalidade, o instrumento compreendeum dispositivo acumulador de carga, separado da bateria, que fornece ener-gia adicional ao motor elétrico quando necessário. O dispositivo acumuladorde carga pode ser inicialmente carregado pela bateria. Então, o dispositivopode ser tirado do fio até o tempo certo de energia extra que o dispositivoacumulador de carga é necessário. Nesse tempo, o dispositivo de acumula-dor de carga é conectado em séries com a bateria para fornecer energia adi-cional ao motor.
Em outra modalidade, o motor pode compreender pelo menosdois enrolamentos. Em um modo de operação, os enrolamentos estão co-nectados em séries e em outro modo de operação os enrolamentos são co-nectados em paralelo. Quando os enrolamentos são conectados em séries,o motor pode ter uma alta velocidade de baixo torque de saída. Quando osenrolamentos estão conectados em paralelo, o motor pode ter uma baixavelocidade de alto torque de saída. Dessa forma, por exemplo, o motor po-deria exibir ambos os modos de operação, sem que o instrumento tenhamúltiplos motores.
Em, ainda, outra modalidade, o instrumento utiliza um pacote debateria reutilizável (possivelmente recarregável) para energizar eletricamenteo motor. O pacote de bateria pode compreender uma pluralidade de célulasde bateria. Um primeiro conjunto de células de baterias pode estar conecta-do em séries no pacote de bateria, e um segundo conjunto de células debateria pode estar conectado em séries com o pacote de bateria, mas, den-tro do pacote de bateria, o primeiro conjunto não está conectado em sériescom o segundo conjunto. Preferivelmente, o instrumento pode compreenderuma célula de bateria conectada ao manipulo, por exemplo, que conecta oprimeiro conjunto em séries com o segundo conjunto quando o pacote debateria é instalado ou colocado no instrumento.
Esse e outros benefícios da presente invenção serão apresenta-dos pela descrição abaixo.
FIGURAS
Várias modalidades da presente invenção são descritas aquipela forma de exemplo em conjunção com as figuras seguintes, em que:
as Figuras 1 e 2 são vistas em perspectiva do instrumento cirúr-gico de fixação e incisão de acordo com várias modalidades da presenteinvenção;
as Figuras 3 a 5 são vistas explodidas de um efetor de extremi-dade e haste do instrumento de acordo com várias modalidades da presenteinvenção;
a Figura 6 é uma vista lateral do efetor de extremidade de acor-do com várias modalidades da presente invenção;
a Figura 7 é uma vista explodida do manipulo do instrumento deacordo com várias modalidades da presente invenção;
as Figuras 8 e 9 são vistas parciais em perspectiva do manipulode acordo com várias modalidades da presente invenção;
a Figura 10 é uma vista lateral do manipulo de acordo com vá-rias modalidades da presente invenção;
a Figura 11 é um diagrama esquemático do circuito usado noinstrumento de acordo com várias modalidades da presente invenção;
as Figuras 12a14e17 são diagramas esquemáticos de circui-tos usados para energizar o motor do instrumento de acordo com várias mo-dalidades da presente invenção;a Figura 15 é um diagrama em bloco ilustrando um circuito dearmazenamento de carga de acordo com várias modalidades da presenteinvenção;
a Figura 16 é um diagrama em bloco ilustrando uma base decarga de acordo com várias modalidades da presente invenção;
a Figura 18 ilustra uma típica curva de energia de uma bateria;
as Figuras 19 e 20 são diagramas esquemáticos de circuitos u-sados no instrumento de acordo com várias modalidades da presente invenção;
as Figuras 21 e 23 são diagramas do instrumento de acordo comvárias modalidades da presente invenção; e
as Figuras 22 e 24 são diagramas dos pacotes de bateria de a-cordo com várias modalidades da presente invenção.
DESCRIÇÃO
As Figuras 1 e 2 retratam um instrumento cirúrgico de fixação eincisão 10 de acordo com várias modalidades da presente invenção. A mo-dalidade ilustrada é um instrumento endoscópico e, em geral, as modalida-des do instrumento 10 descritas aqui são instrumentos endoscópicos cirúrgi-cos de fixação e incisão. Deve ser notado, entretanto, que de acordo comoutras modalidades da presente invenção, o instrumento pode ser um ins-trumento não endoscópico cirúrgico de fixação e incisão, assim como uminstrumento laparoscópico.
O instrumento cirúrgico 10 retratado nas Figuras 1 e 2 compre-ende em um manipulo 6, uma haste 8, e um efetor de extremidade de articu-lação 12 conectado pivotalmente à haste 8 em um pivô de articulação 14.
Um controle de articulação 16 pode ser fornecido adjacente ao manipulo 6para efetuar a rotação no efetor de extremidade 12 na região do pivô de arti-culação 14. Na modalidade ilustrada, o efetor de extremidade 12 é configu-rado para agir como um endocortador para prender, separar e grampear otecido, embora, em outras modalidades, tipos diferentes de efetores de ex-tremidade podem ser usados, assim como efetor de extremidade para outrostipos de dispositivos cirúrgicos, assim como agarradores, cortadores, gram-peadores, aplicadores de clipes, dispositivos de acesso, dispositivos de te-rapia por fármaco/gene, ultra-som, dispositivos de laser ou RF etc. Mais de-talhes sobre dispositivos RF podem ser achados na Patente '312.
O manipulo 6 do instrumento 10 pode incluir um gatilho de fe-chamento 18 e um gatilho de ignição 20 para atuação no efetor de extremi-dade 12. Será apreciado que instrumentos tendo efetores de extremidadedirecionados para tarefas cirúrgicas diferentes podem ter números ou tiposdiferentes de gatilhos ou outros controles adequados para operação do efe-tor de extremidade 12. O efetor de extremidade 12 é apresentado separadodo manipulo 6 por uma haste preferivelmente alongada 8. Em uma modali-dade, um clínico ou operador do instrumento 10 pode articular o efetor deextremidade 12 relativo à haste 8 utilizando o controle de articulação 16,como descrito em mais detalhes no pedido de patente publicado de N0 U.S.2007/0158385 A1, intitulada "Surgical Instrument Having An Articulating Efe-tor de extremidade", por Geoffrey C. Hueil et al., o qual é aqui incorporadopara referência.
O efetor de extremidade 12 inclui neste exemplo, entre outrascoisas, um canal de grampo 22 e um membro prendedor traduzível pivotal-mente, assim como uma bigorna 24, a qual é mantida em um espaço queassegura uma separação e grampeamento efetivo do tecido preso no efetorde extremidade 12. O manipulo 6 inclui uma pistola em garras 26 em direçãoa qual um gatilho de fechamento 18 é puxado pivotalmente pelo clínico paraprender ou fechar a bigorna 24 na direção do canal de grampos 22 do efetorde extremidade 12 para assim grampear o tecido posicionado entre a bigor-na 24 e o canal 22. O gatilho de ignição 20 é do lado externo posterior dogatilho de fechamento 18. Uma vez que o gatilho de fechamento 18 é tran-cado na posição de fechamento como descrito adicionalmente abaixo, o gati-lho de ignição 20 pode rotacionar vagarosamente na direção da pistola emgarras 26 desse jeito pode ser alcançado pelo operador usando apenas umadas mãos. Então o operador pode puxar pivotalmente o gatilho de ignição 20em direção a pistola em garra 12 para separar e grampear o tecido preso noefetor de extremidade 12. Em outras modalidades, tipos de membros gram-peadores diferentes da bigorna 24 podem ser usadas, assim como, por e-xemplo, uma mandíbula oposta etc.
Será apreciado que os termos "proximal" e "distai" são usadosaqui como referência a um clínico segurando o manipulo 6 de um instrumen-to 10. Assim, o efetor de extremidade 12 é distai no que diz respeito ao ma-nipulo 6 mais próximo. Será apreciado adicionalmente que, para conveniên-cia e claridade, termos espaciais como "vertical" e "horizontal" são usadosaqui no que diz respeito aos desenhos. Porém, instrumentos cirúrgicos sãousados em muitas orientações e posições, e esses termos não são propos-tos para limitar e restringir.
O gatilho de fechamento 18 pode ser acionado primeiro. Umavez que o clínico esteja satisfeito com o posicionamento do efetor de extre-midade 12, o clínico pode puxar para trás o gatilho de fechamento 18 paraseu fechamento completo, trancando a posição próxima à pistola em garras26. O gatilho de ignição 20 pode então ser acionado. O gatilho de ignição 20retorna para a posição de abertura (mostrado nas Figuras 1 e 2) quando oclínico remove a pressão, como descrito mais completamente abaixo. Umbotão de soltura no manipulo 6, quando apertado pode soltar o gatilho defechamento 18 trancado. O botão de soltura pode ser implementado em vá-rias formas assim como, por exemplo, como um botão de soltura 160 desli-zante mostrado na Figura 7 ou qualquer dos mecanismos descritos no pedi-do de patente publicado sob o N0 U.S. 2007/01755955 A1, o qual é incorpo-rado aqui para referência.
A Figura 3 é uma vista explodida do efetor de extremidade 12 deacordo com várias modalidades. Como mostrado na modalidade ilustrada, oefetor de extremidade 12 pode incluir, adicionalmente ao canal 22 e bigorna24 anteriormente mencionado, um instrumento de incisão 32, um martelo 33,um cartucho de grampos 34 que é alocado de forma removível no canal 22,e uma haste parafuso em forma de hélice 36. O instrumento de incisão 32pode ser, por exemplo, uma faca. A bigorna 24 pode ser aberta e fechadapivotalmente no ponto pivô 25 conectado próximo ao final do canal 22. Abigorna 24 pode também incluir uma Iingueta 27 em proximidade com seufinal que é inserido em um componente do sistema de fechamento mecânico(descrito adicionalmente abaixo) para abrir e fechar a bigorna 24. Quando ogatilho de fechamento 18 é acionado, isto é, puxado por um usuário do ins-trumento 10, a bigorna 24 pode pivotar na região do ponto pivô 25 na posi-ção grampeada ou fechada. Se grampeamento do efetor de extremidade 12seja satisfatório, o operador pode acionar o gatilho de ignição 20, o qual,como explicado em mais detalhes abaixo, causa a viagem longitudinalmenteda faca 32 e do martelo 33 pelo canal 22, assim realizando uma incisão otecido grampeado dentro do efetor de extremidade 12. O movimento do mar-telo 33 pelo canal 22 direciona os grampos do cartucho de grampos 24 pelotecido preso e contra a bigorna 24 fechada, a qual faz os grampos seremfixados no tecido preso. Em várias modalidades, o martelo 33 pode ser umcomponente integral do cartucho 34. Patente U.S. 6.978.921, intitulada "Sur-gical stapling instrument incorporating na E-beam firing mechanism," a qualé aqui incorporada para referência, fornece mais detalhes sobre tais instru-mentos de fixação e incisão de dois cursos. O martelo 33 pode ser parte docartucho 34, assim como quando a faca 32 retrai seguindo a operação deincisão, o martelo 33 não retrai.
Deve ser notado que por mais que as modalidades do instru-mento 10 descritas aqui empregam um efetor de extremidade 12 que gram-peia o tecido preso, em outras modalidades podem ser usadas técnicas dife-rentes para fixação ou vedação do tecido preso. Por exemplo, podem serusados um efetor de extremidade que usa energia RF ou adesivos para fixaro tecido preso. Patente N0 U.S. 5.709.680 intitulada "Electrosurgical Hemos-tatic Dispositivo" por Yates et al. e Patente N0 U.S. 5.688.270 intitulada "E-Iectrosurgical Hemostatic Dispositivo with Recessed and/or Offset Electro-des" por Yates et al., as quais são aqui incorporadas para referência, reve-lando um instrumento de incisão endoscópica que usa energia RF para ve-dar o tecido preso. O pedido de patente publicado sob o N0 U.S.2007/0102453 A1 por Jerome R. Morgan, et al. e pedido de patente publica-do sob o N0 U.S. 2007/0102452 A1 por Frederick E. Shelton IV, et al. asquais são, também, aqui incorporadas para referência, revelando um instru-mento de incisão endoscópico que usam adesivos para fixar o tecido preso.Sendo assim, por mais que esta descrição se refira a operações de inci-são/grampeamento e o jeito abaixo, seve ser reconhecido que este é umamodalidade exemplificativa e não para ser limitativa. Outras técnicas de fixa-ção de tecido podem ser usadas.
As Figuras 4 e 5 são vistas explodidas e a Figura 6 é uma vistalateral do efetor de extremidade 12 e uma haste 8 de acordo com várias mo-dalidades. Como mostrada na modalidade ilustrada, a haste 8 pode incluirum tubo de fechamento próximo 40 e um tubo de fechamento distai 42 Iiga-dos pivotalmente pelas ligações pivô 44. O tubo de fechamento distai 42 in-clui uma abertura 45 na qual a Iingueta 27 está inserida na bigorna 24 paraabrir e fechar a bigorna 24, como descrito adicionalmente abaixo. Dispostosdentro dos tubos de fechamento 40, 42 podem ter um tubo espinhal próximo46. Dispostos dentro do tubo espinhal próximo 46 podem ter uma haste dedireção principal rotacional (ou proximal) 48 que se comunica com a hastede direção secundária (ou distai) 50 através de uma junta engrenada oblíqua52. A haste de direção secundária 50 é conectada a uma engrenagem dedireção 54 que empenha uma engrenagem de direção próxima 56 da hasteparafuso em forma de hélice 36. A engrenagem oblíqua vertical 52b podeencaixar e pivotar em uma abertura 57 na extremidade do distai do tubo es-pinhal próximo 46. Um tubo espinhal distai 58 pode ser usado para escondera haste de direção secundária 50 e as engrenagens de direção 54, 56. Cole-tivamente, a haste de direção principal 48, a haste de direção secundária 50,e a junta de articulação (isto é, junta de engrenagens oblíqua 52a a c) são,às vezes, referidas aqui como "junta de haste de direção principal".
Um mancai 38, posicionado em uma extremidade distai do canalde grampo 22, recebe o parafuso de direção em forma de hélice 36, permi-tindo o parafuso de direção em forma de hélice 36 à rotacionar livremente noque diz respeito ao canal 22. A haste parafuso em forma de hélice 36 podeinterfacear uma abertura ameaçada (não mostrada) da faca 32 tanto que arotação da haste 36 faz a faca 32 transladar distalmente ou proximamente(dependendo da direção da rotação) através do canal de grampos 22. Sendoassim, quando a haste de direção principal 48 é forçada a rotacionar por a-cionamento do gatilho de ignição 20 (como explicado em mais detalhes a-baixo), a junta de engrenagens oblíqua 52a a c faz a haste de direção se-cundária 50 a rotacionar, sucessivamente, por causa do encaixe das engre-nagens de direção 54, 56, faz a haste parafuso em forma de hélice 36 rota-cionar, o que faz o membro direcional da faca 32 se movimentar longitudi-nalmente pelo canal 22 para cortar qualquer tecido preso dentro do efetor deextremidade. O martelo 33 pode ser feito de, por exemplo, plástico e podeter uma superfície distai inclinada. Como o martelo 33 atravessa o canal 22,a superfície avançada inclinada pode empurrar ou direcionar os grampos nocartucho de grampo para o tecido preso e contra a bigorna 24. A bigorna 24gira os grampos, e assim grampeando o tecido preso. Quando a faca 32 éretraída, a faca 32 e o martelo 33 podem desengrenar, e assim levando omartelo 33 à extremidade distai do canal 22.
As Figuras 7 a 10 ilustram uma modalidade exemplar de um en-docortador acionado por motor. A modalidade ilustrada fornece uma infor-mação de retorno sobre a força de disposição e carregamento do instrumen-to de corte no efetor de extremidade. Assim, a modalidade pode usar a forçafornecida pelo usuário na retração do gatilho de ignição 20 para acionar odispositivo (um auto intitulado modo "acionamento assistido"). Como mos-trado na modalidade ilustrada, o manipulo 6 inclui pedaços laterais exterio-res baixos 59, 60 e pedaços laterais superiores exteriores 61, 62 que se en-caixam juntos para formar, em geral, o exterior do manipulo 6. A bateria 64aciona um motor elétrico 65 disposto em uma porção superior da porção depistola de garra 26 do manipulo 6. De acordo com várias modalidades, umnúmero de células de baterias em séries podem ser usadas para acionar omotor 65.
O motor 65 pode ser um motor de direção escovado que possuiuma rotação máxima de aproximadamente 25.000 RPM sem carga. Em ou-tras modalidades, o motor 65 pode incluir um motor sem escova, um motorsem corda, um motor sincrônico, um motor de passo ou qualquer outro mo-tor elétrico apropriado. O motor 64 pode direcionar uma junta de engrena-gem oblíqua 66 em 90° que compreende uma primeira engrenagem oblíqua68 e uma segunda engrenagem oblíqua 70. A junta de engrenagens oblíqua66 pode direcionar uma junta de engrenagens terrestres 72. A junta de en-grenagens terrestres 72 pode incluir uma engrenagem de roda dentada 74conectada com um eixo de direção 76. A engrenagem de roda dentada 74pode direcionar uma engrenagem de anel casado 78 que direciona um tam-bor de engrenagem de hélice 80 através do eixo de direção 82. O anel 84pode ser alinhado no tambor de engrenagens de hélice 80. Assim, quando omotor 65 rotacionar, o anel 84 ocasiona o movimento ao longo do tambor deengrenagem de hélice 80 por meio da junta de engrenagens oblíqua inter-posta 66, junta de engrenagens terrestres 72 e engrenagem de anel 78.
O manipulo 6 pode, também, incluir um sensor de motor de cor-rente 110 em comunicação com o gatilho de ignição 20 para detectar quan-do o gatilho de ignição 20 foi puxado (ou "fechado") na direção da porção depistola de garra 26 do manipulo 6 pelo operador para assim acionar a opera-ção corte/grampeamento pelo efetor de extremidade 12. O sensor 110 podeser um sensor proporcional assim como, por exemplo, um reostato ou resis-tor variável. Quando o gatilho de ignição 20 é puxado, o sensor 110 detectao movimento e envia um sinal elétrico indicativo de voltagem (ou força) paraser disponibilizado para o motor 65. Quando o sensor 110 é um resistor vari-ável ou outros mais, a rotação do motor 65 pode ser comumente proporcio-nal à quantidade de movimento do gatilho de ignição 20. Isto é, se o opera-dor apenas puxar ou fechar o gatilho de ignição 20 um pouco, a rotação domotor 65 é relativamente baixa. Quando o gatilho de ignição 20 é totalmentepuxado (ou em posição completamente fechada), a rotação do motor 65 émáxima. Em outras palavras, quanto mais forte o usuário empurrar o gatilhode ignição 20, mais voltagem é aplicada ao motor 65, ocasionando grandestaxas de rotação.
O manipulo 6 pode incluir um pedaço de manipulo médio 104adjacente à porção superior do gatilho de ignição 20. O manipulo 6, também,pode compreender uma mola de polarização 112 conectada entre as colu-nas do pedaço do manipulo do meio 104 e o gatilho de ignição 20. A molade polarização 112 pode tensionar o gatilho de ignição 20 para sua posiçãode abertura completa. Desse modo, quando o operador libera o gatilho deignição 20, a mola de polarização 112 irá empurrar o gatilho de ignição 20para sua posição de abertura, e assim removendo a atuação do sensor 110,e assim parando a rotação do motor 65. Além disso, por virtude da mola depolarização 112, a qualquer hora um usuário fecha o gatilho de ignição 20, ousuário irá experimentar a resistência à operação de fechamento, e assimfornece ao usuário uma informação de retorno como a quantidade de rota-ção exercida pelo motor 65. Adicionalmente, o operador poderia parar a re-tração do gatilho de ignição 20 para, assim, remover a força do sensor 100,para assim parar o motor 65. Assim como, o usuário pode parar a disposiçãodo efetor de extremidade 12, assim fornecer o controle de medição da ope-ração de corte/grampeamento do operador.
A extremidade distai do tambor de engrenagem de hélice 80 in-clui um eixo de direção distai 120 que direciona uma engrenagem de anel122, que se emparelha com uma engrenagem de roda dentada 124. A en-grenagem de roda dentada 124 é conectada ao eixo de direção principal 48da junta do eixo de direção principal. Desse modo, a rotação do motor 65ocasiona a rotação da junta do eixo de direção principal, que ocasiona a a -tuação do efetor de extremidade 12, como descrito acima.
O anel 84 alinhado no tambor de engrenagem de hélice 80 podeincluir uma coluna 86 que está disposta em uma abertura 88 de um braçoaberto 90. O braço aberto 90 tem uma abertura 92 em sua extremidade o-posta 94 que recebe um pino de pivô 96 que está conectado entre os peda-ços laterais exteriores do manipulo 59, 60. O pino de pivô 96 está, também,disposto ao longo de uma abertura 100 no gatilho de ignição 20 e uma aber-tura 102 no pedaço do manipulo do meio 104.
Adicionalmente, o manipulo 6 pode incluir um motor reverso (ousensor de final de curso) 130 e um sensor de motor de parada (ou início decurso) 142. Em várias modalidades, o sensor de motor reverso 130 pode terum comutador de limite localizado na extremidade distai do tambor de en-grenagem de hélice 80 de modo que o anel 84 alinhado no tambor de en-grenagem de hélice 80 contata e desengata o sensor de motor reverso 130quando o anel 84 atinge a extremidade distai do tambor de engrenagem dehélice 80. O sensor de motor reverso 130, quando acionado, envia um sinalao motor 65 para reverter sua direção de rotação, e assim retracionando afaca 32 do efetor de extremidade 12 seguindo a operação de corte. O sensorde motor de parada 142 pode ser, por exemplo, um comutador limite fecha-do normalmente. Em várias modalidades, pode ser localizado em uma ex-tremidade próxima ao tambor de engrenagem de hélice 80 assim que o anel84 reverte o comutador 142 quando o anel 84 atinge a extremidade próximado tambor de engrenagem de hélice 80.
Na operação, quando um operador do instrumento 10 empurrade volta o gatilho de ignição 20, o sensor 110 detecta a disposição do gatilhode ignição 20 e envia um sinal ao motor 65 para ocasionar a rotação avan-çada do motor 65 em, por exemplo, uma taxa proporcional para o operadorempurrar de volta de maneira forte o gatilho de ignição 20. A rotação avan-çada do motor 65 em contrapartida ocasiona a rotação da engrenagem deanel 78 na extremidade próxima da junta de engrenagem terrestre 72, e as-sim ocasiona a rotação do tambor de engrenagem de hélice, que ocasiona omovimento distai do anel 84 alinhado no tambor de engrenagem de hélice 80ao longo do tambor de engrenagem de hélice 80. A rotação do tambor deengrenagem de hélice 80, também direciona a junta de eixo de direção prin-cipal como descrito acima, que em contrapartida ocasiona a disposição dafaca 32 no efetor de extremidade 12. Isto é, a faca 32 e o martelo 33 sãoocasionados para atravessar longitudinalmente o canal 22, e assim cortar otecido grampeado no efetor de extremidade 12. Também, a operação degrampear do efetor de extremidade é ocasionada para acontecer em moda-lidades quando é usado um efetor de extremidade de tipo grampeador.
Nesse tempo está finalizada a operação de corte/grampeamentodo efetor de extremidade 12, o anel 84 no tambor de engrenagem de hélice80 terá atingido a extremidade distai do tambor de engrenagem de hélice 80,e assim ocasionando a movimentação do sensor de motor reverso 130, queenvia um sinal ao motor 65 para ocasionar a rotação reversa do motor 65.Em contrapartida, ocasiona a retração da faca 32 e, também, ocasiona omovimento de volta do anel 84 no tambor de engrenagem de hélice 80 paraa extremidade próxima do tambor de engrenagem de hélice 80.
O pedaço do manipulo do meio 104 inclui um ombro traseiro 106que engata o braço aberto 90 como melhor mostrado nas Figuras 8 e 9. Opedaço do manipulo do meio 104, também, tem uma ação de parada avan-çada 107 que engata com o gatilho de ignição 20. O movimento do braçoaberto 90 é controlado, como explicado acima, pela rotação do motor 65.Quando o braço aberto 90 rotaciona em CCW enquanto o anel 84 se movi-menta de uma extremidade próxima do tambor de engrenagem de hélice 80para a extremidade distai, o pedaço do manipulo do meio 104 será liberadopara rotação CCW. Assim, enquanto o usuário puxa o gatilho de ignição 20,o gatilho de ignição 20 engatará uma ação de parada avançada 107 do pe-daço do manipulo do meio 104, que ocasiona a rotação CCW do pedaço domanipulo do meio 104. Por causa do ombro traseiro 106 engatando o braçoaberto 90, porém, o pedaço do manipulo do meio 104 apenas estará dispo-nível para rotacionar em CCW quanto mais distante permitir o braço aberto90. Dessa forma, se o motor 65 precisar parar a rotação por algum motivo, obraço aberto 90 parará sua rotação, e o usuário não poderá puxar adiante ogatilho de ignição 20 porque o pedaço do manipulo de meio 104 não estarálivre para rotacionar em CCW devido ao braço aberto 90.
Componentes de um sistema de fechamento exemplar para fe-char (ou grampear) a bigorna 24 do efetor de extremidade 12 que retrai ogatilho de fechamento 18 são também mostrados nas Figuras 7 a 10. Namodalidade ilustrada, o sistema de fechamento inclui um estribo 250 conec-tado ao gatilho de fechamento 18 por um pino 251 que está inserido ao lon-go das aberturas alinhadas no gatilho de fechamento 18 e no estribo 250.Um pino de pivô 252, o qual o gatilho de fechamento 18 pivota, está inseridoao longo de outra abertura no gatilho de fechamento 18 que é ramificada deonde o pino 251 está inserido ao longo do gatilho de fechamento 18. Assim,a retração do gatilho de fechamento 18 ocasiona a rotação em CCW da par-te superior do gatilho de fechamento 18, o qual o estribo 250 é anexado a-través do pino 251. A extremidade distai do estribo 250 é conectada, atravésde um pino 254, em um primeiro suporte de fechamento 256. O primeiro su-porte de fechamento 256 se conecta a um segundo suporte de fechamento258. Coletivamente, os suportes de fechamento 256, 258 definem uma aber-tura em qual a extremidade próxima do tubo de fechamento próximo 40 (verFigura 4) é ajustada e segurada de modo que o movimento longitudinal dossuportes de fechamento 256, 258 ocasionam uma ação longitudinal pelo tu-bo de fechamento próximo 40. O instrumento 10, também, inclui uma barrade fechamento 260 disposta dentro do tubo de fechamento próximo 40. Abarra de fechamento 260 pode incluir uma janela 261 na qual uma coluna263 em um dos pedaços exteriores do manipulo, assim como pedaços late-rais inferiores exteriores 59 em uma modalidade ilustrada, é disposta paraconectar fixadamente a barra de fechamento 260 ao manipulo 6. Desse mo-do, o tubo de fechamento próximo 40 é capaz de mover-se Iongitudinalmen-te relativo à barra de fechamento 260. A barra de fechamento 260 pode,também, incluir uma argola distai 267 que encaixa dentro da cavidade 269no tubo espinhal próximo 46 e está retido aqui por uma cápsula 271 (ver Fi-gura 4).
Na operação, quando o estribo 250 rotaciona devido à retraçãodo gatilho de fechamento 18, os suportes de fechamento 256, 258 ocasio-nam um movimento distai do tubo de fechamento próximo (isto é, para longeda extremidade do manipulo do instrumento 10), que ocasiona o movimentodistai do tubo de fechamento distai 42, que ocasiona a rotação da bigorna 24no ponto pivô 25 na posição grampeada ou fechada. Quando o gatilho defechamento 18 é destravado da posição travada, o deslizamento próximo éocasionado no tubo de fechamento próximo 40, que ocasiona o deslizamen-to próximo do tubo de fechamento distai 42, que, por virtude da Iingueta 27estar inserida na janela 45 do tubo de fechamento distai 42, ocasiona o pivo-tamento da bigorna 24 no ponto de pivô 25 na posição aberta ou não gram-peada. Desse modo, retraindo ou travando o gatilho de fechamento 18, umoperador pode grampear o tecido entre a bigorna 24 e o canal 22, e podedesgrampear o tecido seguindo a operação corte/grampeamento destravan-do o gatilho de fechamento 20 da posição travada.
Configurações adicionais para instrumentos cirúrgicos motoriza-dos são descritas no pedido de patente publicado N0 U.S. 2007/0175962 A1,intitulado "Motor-driven surgical cutting and fastening instrument with tactileposition feedback", que está aqui incorporado para referência em sua totali-dade.
A Figura 11 é um diagrama esquemático do circuito de controlemotor de acordo com várias modalidades da presente invenção. Em váriasmodalidades, o circuito de controle motor pode incluir um ou mais circuitosintegrados (ICs), assim como, por exemplo, um processador, memória, mi-crocontrolador, circuito de tempo etc. Em outras modalidades, o circuito decontrole motor pode não compreender nenhum ICs. Pois um circuito de con-trole motor não IC pode ser vantojoso porque é frenquentemente difícil,complicado e caro a esterilazação de um instrumento cirúrgico incluindo osICs.
Quando um operador empurra inicialmente para o gatilho de ig-nição 20 após travado o gatilho de fechamento 18, o sensor 110 é ativado(ou fechado, onde o sensor 110 for um comutador), permitindo que a corren-te flua através. Se o comutador de sensor de motor reverso 130 que abrenormalmente é aberto (significando que o final do curso do efetor de extre-midade não foi atingido), a corrente irá fluir para um polo único, motor auxili-ar de curso duplicado 132. Quando o comutador de sensor de motor reverso130 não está fechado, uma bobina 134 do motor auxiliar 132 não será acio-nada, então o motor auxiliar 132 ficará em seu estado desacionado.
Conforme mostrado na Figura 11, o circuito também pode incluirum elemento resistivo 144 e um comutador 146 conectado em paralelo, comos elementos paralelos conectados em série com o relê 132. O elementoresistivo 144 e o comutador 146 também são conectados à fonte de alimen-tação 64. O comutador 146 pode ser controlado por um circuito de controle148 que responde ao sensor de posição do instrumento de corte 150. Deacordo com várias modalidades, o circuito de controle 148 pode abrir o co-mutador 146 quando o instrumento de corte 32 está (i) muito próximo aocomeço de seu curso e (ii) muito próximo ao término de seu curso. Por e-xemplo, o circuito de controle pode abrir o comutador quando o instrumentode corte 32 estiver (i) a 0,00254 cm (0,001 polegada) do ponto de início deseu curso e (ii) a 0,00254 cm (0,001 polegada) do término de seu curso, con-forme determinado pelo sensor de posição do instrumento de corte 150.Com o comutador 146 aberto, a corrente flui através do elemento resistivo144 e, então, através do relê 132, do relê 138, do comutador de sensor domotor de operação 110 para o motor 65. A corrente que flui através do ele-mento resistivo 144 reduz a magnitude da corrente distribuída ao motor 65,reduzindo assim a potência distribuída pelo motor 65. Dessa forma, quandoo instrumento de corte 32 está (i) muito próximo ao começo de seu curso ou(ii) muito próximo ao término de seu curso, a potência distribuída pelo motor65 é reduzida. Adversamente, uma vez que o instrumento de corte 32 semova suficientemente longe de seu ponto de início ou término do ponto docurso, o circuito de controle 148 pode fechar o comutador 146, encurtandoassim o elemento resistivo 144, por meio disso aumentando a corrente parao motor 65, causando assim um aumento na potência distribuída pelo motor.
De acordo com várias modalidades, o circuito elétrico inclui adi-cionalmente comutadores de sensor de travamento 136a a-d que definemcoletivamente um circuito de bloqueio 137 através do qual a corrente do relê132, quando desenergizada, passa com a finalidade de iniciar a operaçãoelétrica do motor 65. Cada comutador de sensor de travamento 136a a-dpode ser configurado para manter um estado de comutador aberto (isto é,não-condutivo) ou um estado de comutador fechado (isto é, condutivo) emresposta à presença ou ausência, respectivamente, de uma condição cor-respondente. Qualquer uma das condições correspondentes, se presentequando o instrumento 10 é acionado, pode resultar em uma operação degrampeamento e corte insatisfatória e/ou dano ao instrumento 10. As condi-ções para as quais os comutadores de sensor de travamento 136a-d podemrespondes incluem, por exemplo, (a) a ausência de cartucho de grampo 34no canal 22, (b) a presença de um cartucho de grampo gasto (por exemplo,anteriormente acionado) 34 no canal 22 e (c) uma posição aberta da bigorna24 (ou de outro modo insuficientemente fechada) em relação ao canal 22.Outras condições para as quais os comutadores de sensor de travamento136a-d podem responder, tal como desgaste do componente, podem serdeduzidas com base em um número acumulado de operações de igniçãoproduzido pelo instrumento 10. Consequentemente, em várias modalidades,se qualquer uma destas condições existir, os comutadores de sensor de tra-vamento 136a-d correspondentes mantêm um estado de comutador aberto,evitando assim a passagem da corrente necessária para iniciar a operaçãodo motor 65. A passagem de corrente pelos sensores de travamento 136a-dé permitida, em várias modalidades, somente após todas as condições te-rem sido remediadas. Ficará entendido que as condições descritas acimasão fornecidas somente com caráter exemplificativo, e que comutadores adi-cionais de sensor de travamento para responder a outras condições prejudi-ciais à operação do instrumento 10 podem ser fornecidos. Ficará entendidoda mesma forma que para as modalidades nas quais uma ou mais das con-dições descritas acima podem não existir ou não estarem relacionadas aonúmero de comutadores de sensor de travamento pode ser menor que oapresentado.
Conforme mostrado na Figura 11, o comutador de sensor de tra-vamento 136a pode ser implantado usando uma configuração de comutadornormalmente aberta de modo que um estado de comutador fechado sejamantido quando o cartucho de grampo 34 estiver em uma posição corres-pondente ao seu recebimento anterior pelo canal 22. Quando o cartucho degrampo 34 não está instalado no canal 22, ou está instalado indevidamente(por exemplo, desalinhado), o comutador de sensor de travamento 136amantém um estado de comutador aberto. O comutador de sensor de trava-mento 136b pode ser implantado usando uma configuração de comutadornormalmente aberta de modo que um estado de comutador fechado sejamantido somente quando um cartucho de grampo não gasto 34 (isto é, umcartucho de grampo 34 com um martelo 33 na posição desacionada) estiverpresente no canal 22. A presença de um cartucho de grampo gasto 34 nocanal 22 faz com que o comutador de sensor de travamento 136b mantenhaum estado de comutador aberto. O comutador de sensor de travamento136c pode ser implantado usando uma configuração de comutador normal-mente aberta de modo que um estado de comutador fechado seja mantidoquando a bigorna 24 está em uma posição fechada em relação ao canal 22.
O comutador de sensor de travamento 136c pode ser controlado de acordocom uma característica de atraso de tempo em que um estado de comutadorfechado é mantido somente após a bigorna 24 estar na posição fechada porum período de tempo predeterminado.
O comutador de sensor de travamento 136d pode ser implanta-do usando uma configuração de comutador normalmente fechada de modoque um estado de comutador fechado seja mantido somente quando umnúmero acumulado de ignições produzidas pelo instrumento 10 seja menorque um número predeterminado. O comutador de sensor de travamento136d pode estar em um comunicação com um contador 139 configurado pa-ra manter uma contagem representativa do número acumulado de opera-ções de ignição executadas pelo instrumento 10, comparando a contagemao número predeterminado, e controlar o estado do comutador do comutadorde sensor de travamento 136d com base na comparação. Embora mostradoseparadamente na Figura 11, ficará entendido que o contador 139 pode serintegral ao comutador de sensor de travamento 136d com a finalidade deformar um dispositivo comum. Preferencialmente, o contador 139 é implan-tado como um dispositivo eletrônico que possui uma entrada para incremen-tar a contagem mantida com base na transição de um sinal elétrico discretofornecido para isto. Ficará claro que um contador mecânico configurado paramanter a contagem com base em uma entrada mecânica (por exemplo, re-tração do gatilho de ignição 20) pode ser usado em vez disso. Quando im-plantado como um dispositivo eletrônico, qualquer sinal discreto presente nocircuito elétrico que transita uma vez por cada operação de ignição pode serutilizado para a entrada do contador 139. Conforme mostrado na Figura 11,por exemplo, o sinal elétrico discreto que resulta da atuação do sensor detérmino de curso 130 pode ser utilizado. O contador 139 pode controlar oestado do comutador do comutador de sensor de travamento 136d de modoque um estado de comutador fechado seja mantido quando a contagemmantida é menor que um número predeterminado armazenado no contador
139. Quando a contagem mantida é igual ao número predeterminado, o con-tador 139 faz com que o comutador de sensor de travamento 136d mante-nha um estado de comutador aberto, evitando assim a passagem de corren-te através do mesmo. Ficará entendido que o número predeterminado arma-zenado pelo contador 139 pode ser seletivamente ajustado conforme for exi-gido. De acordo com várias modalidades, o contador 304 pode estar em co-municação com um visor externo (não mostrado), como visor de LCD1 inte-gral ao instrumento 10 para indicar a um usuário tanto a contagem mantidaquanto a diferença entre o número predeterminado e a contagem mantida.
De acordo com várias modalidades, o circuito de bloqueio 137pode compreender um ou mais indicadores visíveis para o usuário do ins-trumento 10 para exibir uma situação de ao menos um dos comutadores desensor de travamento 136a-d. Mais detalhes relacionados a tais indicadorespodem ser encontrados no pedido de patente publicado ne US2007/0175956, intitulado "Electronic Iockouts and surgical instrument includingsame," que é incorporado no presente documento a título de referência emsua totalidade. Este pedido também inclui disposições e configurações demontagem exemplificativas para os comutadores de sensor de travamento136a-d.
Na modalidade ilustrada, quando os comutadores de sensor detravamento 136a-d mantêm coletivamente um estado de comutador fechado,um relê unipolar, de único pólo, 138 é energizado. Quando o relê 138 é e-nergizado, a corrente flui através do relê 138, através do sensor do comuta-dor do motor de operação 110 e para o motor 65 através de um relê DPDT140, alimentando assim o motor 65, permitindo sua rotação na direção adi-ante. De acordo com várias modalidades, devido à saída do relê 138, umavez energizada, mantém o relê 138 em um estado energizado até que o relê132 esteja energizado, o circuito de bloqueio 137 não funcionará para evitara operação do motor 165 uma vez iniciado, mesmo se um ou mais dos co-mutadores de sensor de travamento 136a-d subseqüentemente mantiveremum estado de comutador aberto. Em outras modalidades, entretanto, podeser necessário ou, de outro modo, desejável conectar o circuito de bloqueio137 e o relê 138 de modo que um ou mais comutadores de sensor de trava-mento 136a-d devam manter um estado de comutador fechado a fim de sus-tentar a operação do motor 165 iniciado.
A rotação do motor na direção dianteira faz com que o anel 84se mova distalmente e, por meio disso, desative o comutador de sensor domotor de parada 142 em várias modalidades. Devido ao fato de o comutador142 estar normalmente fechado, um solenoide 141 conectado ao comutador142 pode ser energizado. O solenoide 141 pode ser um solenoide de empur-rar convencional que, quando energizado, faz com que um êmbolo (nãomostrado) se estenda axialmente. A extensão do êmbolo pode operar parareter o gatilho de fechamento 18 na posição retraída, evitando assim que abigorna 24 se abra enquanto uma operação de ignição está em progresso(isto é, enquanto o comutador 142 não está atuado). Mediante a desenergi-zação do solenoide 141, o êmbolo é retraído de modo que a liberação ma-nual do gatilho de fechamento 18 seja possível.
Quando o efetor de extremidade 12 alcança o término de seucurso, o sensor de motor reverso 130 será ativado, fechando assim o comu-tador 130 e energizando o relê 132. Isto faz com que o relê 132 assuma seuestado energizado (não mostrado na Figura 11), que faz com que a correntedesvie do circuito de bloqueio 137 e do comutador de sensor do motor deoperação 110 e, adversamente, faz com que a corrente flua pelo relê DPDT140 normalmente fechado e de volta para o motor 65, porém, de uma manei-ra, através do relê 140, que faz com que o motor 65 reverta sua direção ro-tacional. Devido ao fato de o comutador de sensor do motor de parada 142estar normalmente fechado, a corrente irá fluir de volta para o relê 132 paramanter isto energizado até que o comutador 142 abre. Quando a faca 32está completamente retraída, o comutador de sensor do motor de parada142 é ativado, fazendo com que o comutador 142 se abra, removendo assima potência do motor 65 e desenergizando o solenoide 141.
Em outras modalidades, outras alternativas podem ser usadaspara limitar a corrente fornecida ao motor 65 durante certos períodos detempo durante o ciclo do curso de corte. Outras modalidades são descritasno pedido de patente sob o n- de série US12/235.782, que é incorporada nopresente documento a título de referência em sua totalidade.
Em alguns casos, pode ser vantajoso fornecer um aumento mo-mentâneo na corrente para o motor 65 para aumentar o torque de saída. AFigura 19 mostra uma modalidade de um circuito para fornecer um aumentomomentâneo para o motor 65 de acordo com várias modalidades. O circuitoé semelhante àquele mostrado na Figura 11, exceto pelo fato de que o cir-cuito da Figura 19 inclui adicionalmente um dispositivo acumulador de carga1000 conectado à fonte de alimentação 64. O dispositivo acumulador decarga 1000 pode ser qualquer dispositivo que possa armazenar carga, talcomo um capacitor. Por exemplo, o dispositivo acumulador de carga 1000pode compreender um ultracapacitor (algumas vezes chamado de superca-pacitor). Quando o motor 65 é primeiramente ligado, tal como quando o co-mutador 110 é fechado devido à retração do gatilho de ignição 20, o comu-tador S1 pode ser fechado de modo que a bateria 64 possa alimentar o mo-tor 65 conforme descrito acima. Adicionalmente, o comutador S3 tambémpode ser fechado por somente um breve período de tempo ("o período decarregamento") para carregar o dispositivo acumulador de carga 1000 atra-vés do resistor R1. Por exemplo, de acordo com várias modalidades, o co-mutador S3 pode ser fechado por um a dez constantes de tempo RC, ondeR é a resistência do resistor R1 e C é a capacitância do dispositivo acumula-dor de carga 1000.
A carga no dispositivo acumulador de carga 1000 pode perma-necer não-usada durante as condições operacionais normais, porém se hou-ver um momento no procedimento onde o profissional de saúde necessitarde torque de saída adicional do motor 65, o dispositivo acumulador de carga1000 poderia ser colocado em série com a bateria 64. Isto poderia ser feito,por exemplo, através da abertura do comutador S1 e do fechamento do co-mutador S2 (com S3 permanecendo aberto após o período de carregamen-to). Com o comutador S2 fechado, o dispositivo acumulador de carga 1000seria conectado em série à bateria 64, fornecendo assim corrente adicionalao motor 65.
A condição que requer o dispositivo acumulador de carga 1000pode ser detectada de várias maneiras. Por exemplo, pode haver um resistorou mola variável conectada ao gatilho de ignição 20. Quando o gatilho deignição é retraído além de um certo ponto ou com uma força de nível limítro-fe, o dispositivo acumulador de carga 1000 pode ser conectado em série àbateria 64. Adicional ou alternativamente, o manipulo 6 pode compreenderum comutador externo (não mostrado) que o profissional de saúde poderiaativar para conectar o dispositivo acumulador de carga 1000 em série com abateria 64.
O dispositivo acumulador de carga 1000 poderia ser usado comou sem a corrente que limita os dispositivos supracitados em conjunto com aFigura 11.
Em alguns momentos durante o uso do instrumento 10, pode servantajosos ter o motor 65 funcionando em alta velocidade, mais com saídado torque relativamente baixa. Em outros momentos, pode ser desejável tero motor 65 com uma saída de torque alta, mas com baixas velocidades. Deacordo com várias modalidades, esta funcionalidade pode ser executadacom um motor 65 tendo múltiplas trajetórias (por exemplo, duas ou três),conforme mostrado na Figura 20. Na modalidade ilustrada, o motor tem duastrajetórias. A primeira trajetória 1200 pode ter metades da trajetória (ou por-ções) 1201 e 1202. Uma segunda trajetória 1204 pode ter metades da traje-tória (ou porções) 1206 e 1208. O motor 65 neste exemplo pode ter um mo-tor guia de 6 ou 8 com um circuito de acionamento bipolar 1210 (vide Figu-ras 11 e 12, por exemplo). Quando o modo de baixo torque e alta velocidadeé desejado, os dois conjuntos de trajetória podem ser conectados em série.Neste modo, conforme mostrado na Figura 20, os comutadores S1 e S4 sãofechados, e os comutadores S2, S3, S5 e S6 são abertos. Quando o modode alto torque e baixa velocidade é desejado, os dois conjuntos de trajetóriaspodem ser conectados em paralelo. Neste modo, os comutadores S1 e S4são abertos, e os comutadores S2, S3, S5 e S6 são fechados. A capacidadede transição entre os dois modos cria de modo eficaz uma transmissão deduas velocidades com nenhuma parte móvel adicional. Isto também permiteque o mesmo motor gere tanto altas velocidades e altas saídas de torquesaídas, embora não ao mesmo tempo. Uma vantagem desta configuração éque esta evita o uso de motores múltiplos. Adicionalmente, pode ser possíveleliminar alguma engrenagem, pois o motor 65 pode gerar torque extra quan-do no modo paralelo e velocidade extra quando no modo em série. Alémdisso, as trajetórias adicionais poderiam ser empregadas de modo que umnúmero maior de modos operacionais possa ser realizado. Por exemplo, po-deria haver trajetórias para múltiplas combinações de conexões de trajetóriaparalelas e em série. Ademais, algumas trajetórias podem ser usadas paracaptar as condições do motor etc.
De acordo com várias modalidades, o manipulo 6 pode compre-ender um comutador de seleção de modo de motor externo 1220, conformemostrado na Figura 21. Através do uso do comutador 1220, o operador doinstrumento 10 poderia selecionar o motor 65 no modo de baixo torque e altavelocidade ou no modo de alto torque e baixa velocidade. Outros circuitos decomutação também poderiam ser usados para alternar o motor 65 entre osmodos operacionais, tais como circuitos de comutação que comutam auto-maticamente o modo do motor com base nas entradas do sensor.
Em um instrumento cirúrgico motorizado, tal como um dos ins-trumentos endoscópicos motorizados descritos acima ou em um instrumentode corte circular motorizado, o motor pode ser alimentado por inúmeras célu-las de bateria conectadas em série. Adicionalmente, pode ser desejável emcertas circunstâncias alimentar o motor com alguma fração do número totalde células de bateria. Por exemplo, conforme mostrado na Figura 12, o mo-tor 65 pode ser alimentado por um pacote de potência 299 que compreendeseis (6) células de bateria 310 conectadas em série. As células de bateria310 podem ser, por exemplo, células de bateria de lítio de 3 V, como célulasde bateria CR 123A, embora em outras modalidades, diferentes tipos de cé-lulas de bateria poderiam ser usados (incluindo células de bateria com dife-rentes níveis de voltagem e/ou químicas diferentes). Se as células de bateriade 3 V 310 forem conectadas em série para alimentar o motor 65, a volta-gem total disponível para alimentar o motor 65 seria de 18 volts. As célulasde bateria 310 podem compreender células de bateria recarregáveis ou não-recarregáveis.
Em tal modalidade, sob as cargas mais pesadas, a voltagem deentrada para o motor 65 pode cair para cerca de nove a dez volts. Nestacondição operacional, o pacote de potência 299 está distribuindo a potênciamáxima ao motor 65. Consequentemente, conforme mostrado na Figura 12,o circuito pode incluir um comutador 312 que permite seletivamente que omotor 65 seja alimentado tanto por (1) todas as células de bateria 310 quan-to por (2) uma fração das células de bateria 310. Conforme mostrado in Fi-gure 12, através da seleção apropriada, o comutador 312 pode permitir queo motor 65 seja alimentado por todas as seis células de bateria ou quatrodas células de bateria. Deste modo, o comutador 312 poderia ser usado pa-ra alimentar o motor 65 tanto com 18 volts (quando usar todas as seis célu-las de bateria 310) quanto por 12 volts (tal quando usa quatro das segundascélulas de bateria). Em várias modalidades, a escolha do projeto para o nú-mero de células de bateria na fração que é usada para alimentar o motor 65pode ser baseada na voltagem exigida pelo motor 65 quando operado emsaída máxima para as cargas mais pesadas.
O comutador 312 pode ser, por exemplo, um comutador eletro-mecânico, tal como um microcomutador. Em outras, o comutador 312 podeser implantado com um comutador de estado sólido, tal como um transistor.Um segundo comutador 314, tal como um comutador com botão de apertar,pode ser usado para controlar se a potência esta sendo totalmente aplicadaao motor 65. Ademais, um comutador de progressão/reversão 316 pode serusado para controlar se o motor 65 gira na direção dianteira ou na direçãoreversa. O comutador de progressão/reversão 316 pode ser implantado comum comutador DPDT, tal como o relê 140 mostrado na Figura 11.
Em operação, o usuário do instrumento 10 poderia selecionar onível de potência desejado através do uso de alguma espécie de controle decomutador, tal como um comutador dependente de posição (não mostrado),tal como um comutador de alternância, um comutador de alavanca mecânicaou um carne, que controla a posição do comutador 312. Então, o usuáriopode ativar o segundo comutador 314 para conectar as células de bateria310 selecionadas ao motor 65. Além disso, o circuito mostrado na Figura 12poderia ser usado para alimentar o motor de outros tipos de instrumento ci-rúrgico motorizados, tais como cortadores circulares e/ou instrumentos Iapa-roscópicos. Mais detalhes a respeito de cortadores circulares podem ser en-contrados nos pedidos de patente publicados ns 2006/0047307 A1 e n22007/0262116 A1, que são incorporados no presente documento a título dereferência.
Em outras modalidades, conforme mostrado na Figura 13, umafonte de alimentação principal 340, tal como uma célula de bateria, tal comouma célula de bateria CR2 ou CR123A, pode ser usada para carregar umnúmero de dispositivos acumuladores secundários 342. A fonte de alimenta-ção principal 340 pode compreender uma ou inúmeras células de bateriaconectadas em série, que são preferencialmente substituíveis na modalidadeilustrada. Os dispositivos acumuladores secundários 342 podem compreen-der, por exemplo, células de bateria e/ou supercapacitores recarregáveis(também conhecidos como "ultracapacitores" ou "capacitores eletroquímicosde camada dupla" (EDLC)). Os supercapacitores são capacitores eletroquí-micos que têm uma densidade de energia alta não-usual quando comparadaa capacitores eletrolíticos comuns, tipicamente na grandeza de milhares devezes maiores que um capacitor eletrolítico de alta capacidade.
A fonte de alimentação primária 340 pode carregar os dispositi-vos acumuladores secundários 342. Uma vez que esteja suficientementecarregada, a fonte de alimentação primária 340 pode ser removida e os dis-positivos acumuladores secundários 342 podem ser usados para alimentar omotor 65 durante uma operação ou procedimento. Os dispositivos de acu-mulação 342 podem levar de cerca de quinze a trinta minutos para seremcarregados em várias circunstâncias. Os supercapacitores possuem a carac-terística de que eles podem ser carregados e descarregados de maneiraextremamente rápida em comparação com as baterias convencionais. Adi-cionalmente, visto que as baterias são boas somente para um número limi-tado de ciclos de carga/descarga, os supercapacitores podem ser freqüen-temente carregados/descarregados repetidamente, ocasionalmente paradezenas de milhões de ciclos. Para as modalidades que utilizam supercapa-citores como os dispositivos acumuladores secundários 342, os supercapaci-tores podem compreender nanotubos de carbono, polímeros condutivos (porexemplo, poliacenos), ou aerogéis de carbono.
Como mostrado na Figura 14, um circuito de gerenciamento decarga 344 pode ser empregado para determinar quando os dispositivos a-cumuladores secundários 342 estiverem suficientemente carregados. O cir-cuito de gerenciamento de carga 344 pode incluir um indicador, tal como umou mais LEDs, uma tela LCD etc., que é ativado para alertar um usuário doinstrumento 10 quando os dispositivos acumuladores secundários 342 esti-verem suficientemente carregados.
A fonte de alimentação primária 340, os dispositivos acumulado-res secundários 342, e o circuito de gerenciamento de carga 344 podem serparte de um pacote de potência na porção do cabo de pistola 26 do manipu-lo 6 do instrumento 10, ou em uma outra parte do instrumento 10. O pacotede potência pode ser removível da porção do cabo de pistola 26, caso emque, quando o instrumento 10 estiver para ser usado em uma cirurgia, o pa-cote de potência poderá ser inserido de forma assepsia na porção do cabode pistola 26 (ou outra posição no instrumento de acordo com outras moda-lidades) por, por exemplo, uma enfermeira assistente que auxilia na cirurgia.Após a inserção do pacote de potência, a enfermeira poderá colocar a fontede alimentação primária substituível 340 no pacote de potência para carre-gar os dispositivos acumuladores secundários 342 em um determinado perí-odo de tempo anterior ao uso do instrumento 10, tal como trinta minutos.Quando os dispositivos acumuladores secundários 342 estiverem carrega-dos, o circuito de gerenciamento de carga 344 poderá indicar que o pacotede potência está pronto para o uso. Nesse ponto, a fonte de alimentaçãoprimária substituível 340 poderá ser removida. Durante a operação, o usuá-rio do instrumento 10 poderá então ativar o motor 65, como pela ativação docomutador 314, pelo qual os dispositivos acumuladores secundários 342alimentam o motor 65. Assim, em vez de ter inúmeras baterias descartáveispara alimentar o motor 65, uma bateria descartável (como a fonte de alimen-tação primária 340) pode ser usada nessa modalidade, e os dispositivos a-cumuladores secundários 342 podem ser reutilizados. Em modalidades al-ternativas, no entanto, deve-se notar que os dispositivos acumuladores se-cundários 342 podem ser não recarregáveis e/ou não reutilizáveis. Os acu-muladores secundários 342 podem ser usados com o comutador de seleçãode célula 312 descrito acima em conexão com a Figura 12.
O circuito de gerenciamento de carga 344 pode também incluirindicadores (por exemplo, LEDs ou tela LCD) que indicam quanta carga res-ta nos dispositivos acumuladores secundários 342. Dessa forma, o cirurgião(ou outro usuário do instrumento 10) pode ver quanta carga resta através docurso do procedimento envolvendo o instrumento 10.
O circuito de gerenciamento de carga 344, como mostrado naFigura 15, pode compreender um medidor de carga 345 para medir a cargaao longo dos acumuladores secundários 342. O circuito de gerenciamentode carga 344 também pode compreender uma memória não volátil 346, talcomo uma memória rápida ou ROM, e um ou mais processadores 348. Oprocessador(s) 348 pode ser conectado à memória 346 para controlar amemória. Adicionalmente, o processador(s) 348 pode ser conectado ao me-didor de carga 345 para ler as leituras de e, por outro lado, controlar o medi-dor de carga 345. Adicionalmente, o processador(s) 348 pode controlar osLEDs ou outros dispositivos de saída do circuito de gerenciamento de carga344. O processador(s) 348 pode armazenar os parâmetros do instrumento10 na memória 346. Os parâmetros podem incluir parâmetros de operaçãodo instrumento que são sentidos por vários sensores que podem ser instala-dos ou empregados no instrumento 10, como, por exemplo, o número deignições, os níveis de forças envolvidos, a distância do vão de compressãoentre os mordentes opostos do efetor de extremidade 12, a quantidade dearticulação etc. Adicionalmente, os parâmetros armazenados na memória346 podem compreender valores de ID para vários componentes do instru-mento 10 que o circuito de gerenciamento de carga 344 pode ler e armaze-nar. Os componentes que possuem tais IDs podem ser componentes substi-tuíveis, tais como o cartucho de grampo 34. Os IDs podem ser, por exemplo,RFIDs que o circuito de gerenciamento de carga 344 lê por meio de umtransponder de RFID 350. O transponder de RFID 350 pode ler RFIDs a par-tir de componentes do instrumento, como o cartucho de grampo 34, que in-clui identificações de RFID. Os valores de ID podem ser lidos, armazenadosna memória 346, e comparados pelo processador 348 a uma lista de valoresde ID aceitáveis armazenados na memória 346 ou outro armazenamentoassociado ao circuito de gerenciamento de carga, para determinar, por e-xemplo, se o componente removível/substituível associado com a leitura dovalor de ID é autêntico e/ou apropriado. De acordo com várias modalidades,se o processador 348 determina que o componente removível/substituívelassociado com a leitura do valor de ID não é autêntico, o circuito de gerenci-amento de carga 344 pode impedir o uso do pacote de potência pelo instru-mento 10, como pela abertura de um comutador (não mostrado) que poderimpedir que a potência do pacote de potência seja entregue ao motor 65. Deacordo com várias modalidades, vários parâmetros que o processador 348pode avaliar para determinar se o componente é autêntico e/ou apropriadoinclui: código de dados; modelo de componente/tipo; fabricante; informaçõesregionais; e códigos de erros prévios.
O circuito de gerenciamento de carga 344 pode também com-preender uma interface i/o 352 para a comunicação com outro dispositivo,como descrito abaixo. Dessa forma, os parâmetros armazenados na memó-ria 346 podem ser transferidos por download a um outro dispositivo. A inter-face i/o 352 pode ser, por exemplo, um interface cabeada ou sem fio.
Como mencionado anteriormente, o pacote de potência podecompreender os acumuladores secundários 342, o circuito de gerenciamentode carga 344, e/ou o comutador f/r 316. De acordo com várias modalidades,como mostrado na Figura 16, o pacote de potência 299 pode ser conectadoa uma base carregadora 362, que pode, entre outras coisas, carregar os a-cumuladores secundários 342 no pacote de potência. A base carregadora362 pode ser conectada ao pacote de potência 299 conectando de formaassepsia a base carregadora 362 ao pacote de potência 299 enquanto o pa-cote de potência for instalado no instrumento 10. Em outras modalidades emque o pacote de potência é removível, a base carregadora 362 pode ser co-nectada ao pacote de potência 299 através da remoção do pacote de potên-cia 299 do instrumento 10 e conectando-o à base carregadora 362. Paraessas modalidades, após a base carregadora 362 carregar suficientementeos acumuladores secundários 342, o pacote de potência 299 pode ser insta-lado de forma assepsia no instrumento 10.
Como mostrado na Figura 16, a base carregadora 362 podecompreende uma fonte de alimentação 364 para carregar os acumuladoressecundários 342. A fonte de alimentação 364 da base carregadora 362 podeser, por exemplo, uma bateria (ou inúmeras bateria conectadas em séries),ou um conversor CAJCC que converte a potência CA, como a partir de meiosde potência elétrica, para CC, ou para qualquer outra fonte de alimentaçãoadequada para carregar os acumuladores secundários 342. A base carrega-dora 362 pode também compreender dispositivos indicadores, tais comoLEDs, uma tela LCD etc., para mostrar a situação da carga dos acumulado-res secundários 342.
Adicionalmente, como mostrado na Figura 16, a base carregado-ra 362 pode compreender um ou mais processadores 366, uma ou mais uni-dades de memória 368, e as interfaces i/o 370, 372. Através da primeira in-terface i/o 370, a base carregadora 362 pode se comunicar com o pacote depotência 299 (por meio da interface i/o 352 do pacote de potência). Dessemodo, por exemplo, os dados armazenados na memória 346 do pacote depotência 299 podem ser transferidos por download para a memória 368 dabase carregadora 362. Desta forma, o processador 366 pode avaliar os valo-res de ID para os componentes removíveis/substituíveis, transferidos pordownload a partir do circuito de gerenciamento de carga 344, para determi-nar a autenticidade e a compatibilidade dos componentes. Os parâmetros deoperação transferidos por download a partir do circuito de gerenciamento decarga 344 podem também ser armazenados na memória 368, e então po-dem ser transferidos por download a um outro dispositivo de computador pormeio da segunda interface i/o 372 para avaliação e análise, como pelo sis-tema de hospital no qual a operação envolvendo o instrumento 10 é realiza-da, pelo consultório do cirurgião, pelo distribuidor do instrumento, pelo fabri-cante do instrumento etc.
A base carregadora 362 pode também compreender um medidorde carga 374 para medir a carga ao longo dos acumuladores secundários342. O medidor de carga 374 pode estar em comunicação com o processa-dor(s) 366, para que o processador(s) 366 possa determinar em tempo reala compatibilidade do pacote de potência 299 para o uso, para assegurar umalto desempenho.
Em outra modalidade, como mostrado na Figura 17, o circuito debateria pode compreender um regulador de potência 320 para controlar apotência fornecida pelos economizadores de potência 310 ao motor 65. Oregulador de potência 320 pode também ser parte do pacote de potência299, ou ele pode ser um componente separado. Como mencionado acima, omotor 65 pode ser um motor escovado. A velocidade dos motores escova-dos geralmente é proporcional à voltagem de entrada aplicada. O reguladorde potência 320 pode fornecer uma voltagem de saída altamente reguladapara o motor 65 para que o motor 65 opere em uma velocidade constante(ou substancialmente constante). De acordo com várias modalidades, o re-gulador de potência 320 pode compreender um conversor de potência demodo do comutador, como um conversor redutor-elevador, como mostradono exemplo da Figura 17. Esse conversor redutor-elevador 320 pode com-preender um comutador de potência 322, como um FET, um retificador 32,um indutor 326, e um capacitor 328. Quando o comutador de potência 322está ligado, a fonte de voltagem de entrada (por exemplo, as fontes de ali-mentação 310) é diretamente conectada ao indutor 326, que armazena apotência nesse estado. Nesse estado, o capacitor 328 fornece energia àcarga de saída (por exemplo, o motor 65). Quando o comutador de potência320 está no estado desligado, o indutor 326 é conectado à carga de saída(por exemplo, o motor 65) e o capacitor 328, para que a energia seja transfe-rida do indutor 326 para o capacitor 328 e à carga 65. Um circuito de contro-le 330 pode controlar o comutador de potência 322. O circuito de controle330 pode empregar laços de controle análogos e/ou digitais. Adicionalmente,em outras modalidades, o circuito de controle 330 pode receber informaçõesde controle de um controlador principal (não mostrado) por meio de um linkde comunicação, como um barramento de dados digital serial ou paralelo. Oponto de ajuste de voltagem para a saída do regulador de potência 320 podeser ajustado, por exemplo, para uma metade da voltagem de circuito aberto,na qual o ponto de potência máxima disponível da fonte está disponível.
Em outras modalidades, diferentes tipologias de conversores depotência podem ser empregadas, incluindo conversores de modo do comu-tador linear ou de potência. Outras tipologias de modo do comutador quepodem ser empregadas incluem um retorno, direto, redutor, elevador, e SE-PIC. O ponto de ajuste de voltagem para o regulador de potência 320 podeser alterado dependendo de quantas células de bateria estiverem sendo u-sadas para alimentar o motor 65. Adicionalmente, o regulador de potência320 pode ser usado com os dispositivos acumuladores secundários 342mostrados na Figura 13. Além disso, o comutador reverso direto 316 podeser incorporado no regulador de potência 320, ainda que ele seja mostradode maneira separada na Figura 17.
As baterias podem tipicamente ser moldadas como uma fonte devoltagem ideal e uma resistência de fonte. Para um modelo ideal, quando aresistência de fonte e de carga é casada, a potência máxima é transferidapara a carga. A Figura 18 mostra uma típica curva de potência para umabateria. Quando o circuito de bateria está aberto, a voltagem ao longo dabateria é alta (em seu valor de circuito aberto) e a corrente puxada da bate-ria é zero. A potência entregue a partir da bateria é zero também. Comomais correntes são puxadas da bateria, a voltagem ao longo da bateria dimi-nui. A potência entregue pela bateria é o produto da corrente e da voltagem.
A potência alcança seu pico em torno de um nível de voltagem que é maisbaixo do que a voltagem do circuito abeto. Como mostrado na Figura 18,com mais químicas de bateria há uma queda acentuada na voltagem/ potên-cia em uma corrente mais alta por causa da química ou do coeficiente positi-vo de temperatura (PTC)1 ou por causa de um dispositivo de proteção debateria.
Particularmente, para as modalidades que utilizam uma bateria(ou baterias) para alimentar o motor 65 durante um procedimento, o circuitode controle 330 pode monitorar a voltagem de saída e controlar o ponto deajuste do regulador 320 para que a bateria opere na "esquerda" ou no ladode aumento de potência da curva de potência. Se a bateria alcançar o picodo nível de potência, o circuito de controle 330 pode alterar (por exemplo,mais baixo) o ponto de ajuste do regulador para que menos do total de po-tência seja exigido da bateria. O motor 65 pode então se desacelerar. Dessaforma, a exigência do pacote de potência pode ser rara se alguma vez exce-der o pico de potência disponível para que uma situação de falta de potênciadurante um procedimento possa ser evitada.
Adicionalmente, de acordo com outras modalidades, o puxamen-to de potência da bateria pode ser otimizado de tal modo que as reaçõesquímicas dentro das células de baterias tenham tempo para se recuperarem,para, como isso, otimizarem a corrente e a potência disponível da bateria.
Nas cargas pulsadas, as baterias tipicamente fornecem mais potência noinício do pulso do que no sentido do final do pulso. Isso acontece devido amuitos fatores, que incluem: (1) o PTC pode alterar sua resistência durante opulso; (2) a temperatura da bateria pode ser alterada; e (3) a taxa de reaçãoeletroquímica é alterada devido ao eletrólito no catódio ser esvaziado e àtaxa de difusão dos limites dos eletrólitos recentes da taxa de reação. Deacordo com várias modalidades, o circuito de controle 330 pode controlar oconversor 320 para que ele puxe uma corrente mais baixa da bateria parapermitir que a bateria se recupere antes que ocorra novamente um pulso.
Como mencionado acima, de acordo com várias modalidades, opacote de bateria 299 pode compreender múltiplas células de bateria 310. AFigura 22 mostra uma modalidade com seis (6) células de baterias 310. Ascélulas de bateria 310 podem ser, por exemplo, baterias primárias de lítio.
De acordo com várias modalidades, o pacote de bateria 299 pode ter so-mente uma fração das células de baterias conectada internamente. Por e-xemplo, como mostrado na Figura 22, a célula 310a está conectada à célula310b, a célula 310c está conectada à célula 31 Odl e a célula 31 Oe está co-nectada á célula 31 Of. No entanto, a célula 310b não está internamente co-nectada no pacote de bateria para a célula 310c, e a célula 31 Od não estáinternamente conectada no pacote de bateria para a célula 31 Oe. O manipu-lo 6 do instrumento 10 em algumas modalidades pode compreender um co-nector de célula de bateria 1300 que conecta as células 310 em séries co-mente quando o pacote de bateria 299 é fisicamente inserido no instrumento10. Por exemplo, o conector 1300 pode compreender um terminal de saídapositivo 1302, um conector 1304 que conecta em série a célula 310b à célula310c, um conector 1306 que conecta a célula 31 Od à célula 31 Oe1 e um ter-minal de saída negativo 1308.
A Figura 23 mostra uma modalidade do instrumento 10 onde umpacote de bateria substituível, removível 299 é instalado no manipulo 6 do"instrumento 10. Como mostrado na Figura 23, o conector de célula de bate-ria 1300 pode ser integrado ao manipulo 6 de modo que, quando o pacotede bateria 299 for inserido no manipulo 6, o conector de célula de bateria1300 torna necessárias as conexões de células de bateria.
É claro, em outras modalidades, os pacotes de bateria com umnúmero diferente de células internas e diferentes números de células conec-tadas internamente podem ser usados. Por exemplo, a Figura 24 mostrauma modalidade com seis células 310a-f, onde dois conjuntos de três célu-las (células 31 Oa-c e as células 310d-f) são conectados juntos.
Os dispositivos revelados aqui podem ser definidos para seremdescartados após um único uso, ou eles podem ser definidos para seremusados múltiplas vezes. Em ambos os casos, no entanto, o dispositivo podeser recondicionado para uma reutilização após pelo menos um uso. Recon-dicionar pode incluir qualquer combinação das etapas de desmonte do dis-positivo, seguido da limpeza ou pela substituição de peças particulares e,subseqüentemente, a remontagem. Em particular, o dispositivo pode serdesmontado, e qualquer número das peças ou partes particulares do dispo-sitivo pode ser seletivamente substituído ou removido em qualquer combina-ção. Mediante a limpeza e/ou substituição de partes particulares, o dispositi-vo pode ser remontado para um uso subsequente tanto com uma facilidadede recondicionamento, quanto por uma equipe cirúrgica imediatamente an-tes de um procedimento cirúrgico. Aqueles versados na técnica irão verificarque o recondicionamento de um dispositivo pode utilizar uma variedade detécnicas para o desmonte, limpeza/substituição, e remontagem. O uso detais técnicas, e o dispositivo recondicionado resultante, estão todos dentrodo escopo do presente pedido.
Preferivelmente, as várias modalidades da invenção descritasaqui serão processadas antes da cirurgia. Primeiro, um instrumento novo ouusado é obtido e, se necessário, é limpo. O instrumento poderá então seresterilizado. Em uma técnica de esterilização, o instrumento é colocado emum recipiente fechado e selado, como uma carcaça de plástico termoforma-da coberta com uma lâmina de TYVEK. O recipiente e o instrumento sãoentão colocados em um campo de radiação que pode penetrar o recipiente,como a radiação gamma, os raios x, ou elétrons de alta energia. A radiaçãomata as bactérias do instrumento e do recipiente. O instrumento esterilizadopode então ser armazenado no recipiente esterilizado. O recipiente seladomantém o instrumento esterilizado até que ele seja aberto na instalação médica.
Prefere-se que o dispositivo seja esterilizado. Isso pode ser feitopor qualquer número de meios conhecidos por aqueles versados na técnicaincluindo a radiação beta ou gamma, oxido de etileno, vaporização e outrosmétodos.
Visto que a presente invenção foi ilustrada através da descriçãode muitas modalidades e visto que as modalidades ilustrativas foram descri-tas em detalhes consideráveis, não é a intenção do depositante de restringirou de limitar, de qualquer modo, o escopo das reivindicações anexadas aesses detalhes. As vantagens adicionais e as modificações podem ser pron-tamente aparentes para aqueles versados na técnica. As várias modalidadesda presente invenção representam vastos aperfeiçoamentos sobre os méto-dos de grampeamento que requerem o uso de diferentes tamanhos degrampos em um púnico cartucho para alcançar os grampos que foram for-mados (final) em diferentes alturas.
Consequentemente, a presente invenção foi discutida nos ter-mos de procedimentos e aparelhos endoscópicos. No entanto, o uso nestetrabalho dos termos tal como "endoscópico" não devem ser interpretadoscomo limitadores da presente invenção para um grampeamento cirúrgico eum instrumento rigoroso para o uso somente em conjunção com um tuboendoscópico (por exemplo, trocar). Ao contrário, acredita-se que a presenteinvenção pode encontrar um uso em um procedimento em que o acesso élimitado, que inclui, mas que não está limitado aos procedimentos Iaparos-cópicos, bem como procedimentos abertos. Além disso, os aspectos únicose novos das várias modalidades de cartucho de grampo da presente inven-ção podem encontrar um uso quando utilizados em conexão com outrasformas de aparelhos de grampeamento sem se afastarem do espírito e es-copo da presente invenção.
Claims (17)
1. Instrumento cirúrgico que compreende:um efetor de extremidade que compreende um instrumento decorte móvel;um eixo conectado de sua extremidade distai ao efetor de ex-tremidade; eumo manipulo conectada à extremidade próxima do eixo, emque o manipulo compreende:um motor elétrico para atuação do instrumento de corte;um circuito de controle motor para controle do motor, em que ocircuito de controle motor compreende:uma fonte de alimentação conectada ao motor para acionar ele-tricamente o motor;um dispositivo acumulador de carga; eum circuito comutador conectado à fonte de alimentação e aodispositivo acumulador de carga para (i) conectar temporariamente o dispo-sitivo acumulador de carga à fonte de alimentação para carregar o dispositi-vo acumulador de carga e (ii) conectar seletivamente o dispositivo acumula-dor de carga em séries com a fonte de alimentação para fornecer força adi-cional ao motor.
2. Instrumento cirúrgico, de acordo com a reivindicação 1, emque o dispositivo acumulador de carga compreende um capacitor.
3. Instrumento cirúrgico, de acordo com a reivindicação 2, emque o dispositivo acumulador de carga compreende um uItracapacitor.
4. Instrumento cirúrgico, de acordo com a reivindicação 1, emque a fonte de alimentação compreende uma pluralidade de séries conecta-das a células de bateria.
5. Instrumento cirúrgico, de acordo com a reivindicação 4, com-preendendo adicionalmente um comutador de seleção de fonte de alimenta-ção conectado à fonte de alimentação para conectar, quando em um primei-ro estado, todas as fontes de energia ao motor e, quando em um segundoestado, um subconjunto da fonte de alimentação ao motor.
6. Instrumento cirúrgico de fixação e corte, de acordo com a rei-vindicação 1, em que o efetor de extremidade compreende um efetor de ex-tremidade de corte circular.
7. Instrumento cirúrgico de fixação e corte, de acordo com a rei-vindicação 1, em que o efetor de extremidade compreende um efetor de ex-tremidade de corte linear.
8. Instrumento cirúrgico, de acordo com a reivindicação 1, emque o circuito de controle motor compreende adicionalmente um circuito decontrole corrente, conectada à fonte de alimentação, para variar a correntefornecida ao motor da fonte de alimentação, de modo que o motor tenha pelo menos:um primeiro, modo operacional de baixa potência para um pri-meira porção de ciclo de curso de corte do instrumento de corte; eum segundo, modo operacional de alta potência para uma pri-meira porção de um ciclo de curso de corte do instrumento de corte.
9. Instrumento cirúrgico, de acordo com a reivindicação 1, em que:o motor compreende pelo menos duas bobinas; eo circuito de controle motor seja para conectar seletivamentepelo menos duas bobinas em séries ou em paralelo.
10. Instrumento cirúrgico que compreende:um efetor de extremidade que compreende um instrumento decorte móvel;um eixo conectado de sua extremidade distai ao efetor de ex-tremidade; eumo manipulo conectada à extremidade próxima ao eixo, emque o manipulo compreenda:um motor elétrico para atuação do instrumento de corte, em queo motor compreende pelo menos duas bobinas;um circuito de controle motor conectado ao motor que conectaseletivamente pelo menos duas bobinas do motor em séries ou em paralelo.
11. Instrumento cirúrgico, de acordo com a reivindicação 10, emque o manipulo compreende adicionalmente uma fonte de alimentação co-nectada ao motor.
12. Instrumento cirúrgico, de acordo com a reivindicação 11, emque a fonte de alimentação compreende uma pluralidade de fontes de ali-mentação conectadas em série.
13. Instrumento cirúrgico, de acordo com a reivindicação 12, quecompreende adicionalmente um comutador de seleção de fonte de alimenta-ção conectado à fonte de alimentação para conectar, quando em um primei-ro estado, todas as fontes de alimentação ao motor e, quando um segundoestado, um subconjunto das fontes de alimentação ao motor.
14. Instrumento cirúrgico que compreende:um efetor de extremidade que compreende um instrumento decorte móvel;um eixo conectado de sua extremidade distai ao efetor de ex-tremidade; eum manipulo conectada à extremidade próxima do eixo, em queo manipulo compreende:um motor elétrico para atuação do instrumento de corte;um pacote de bateria substituível para acionar o motor, em que opacote de bateria compreende uma pluralidade de células de bateria, emque a pluralidade de células de bateria compreende uma primeira pluralida-de de células de bateria conectadas em série e uma segunda pluralidade decélulas de bateria conectadas em série; eum conector de células de bateria, separado do pacote de bate-ria, que conecta em séries a primeira pluralidade de células de baterias co-nectadas em série com a segunda pluralidade de células de baterias conec-tadas em série quando o pacote de bateria for instalado no instrumento.
15. Instrumento cirúrgico, de acordo com a reivindicação 14, emque o pacote de bateria compreende uma terceira pluralidade de células debaterias conectadas em série e em que o conector de célula de bateria co-necte em séries a primeira, segunda e terceira pluralidade de células de ba-terias conectadas em série quando o pacote de bateria for instalado no ins-trumento.
16. Instrumento cirúrgico, de acordo com a reivindicação 14, emque a primeira pluralidade de células de baterias conectadas em série com-preende de três células de baterias de Lítio primário conectadas em série e asegunda pluralidade de células de baterias conectadas em série compreen-da três células de baterias de Lítio primário conectadas em série.
17. Instrumento cirúrgico, de acordo com a reivindicação 14, emque o manipulo compreende adicionalmente:um dispositivo acumulador de carga; eum circuito de comutação conectado ao pacote de bateria e aodispositivo acumulador de carga para (i) conectar temporariamente o dispo-sitivo acumulador de carga ao pacote de bateria para carregar o dispositivoacumulador de carga e (ii) conectar seletivamente o dispositivo acumuladorde carga em séries com o pacote de alimentação para fornecer força adicio-nal ao motor.
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EP2570086B8 (en) | 2016-12-21 |
CA2921857C (en) | 2019-01-08 |
CA2921857A1 (en) | 2010-03-23 |
EP2561813A1 (en) | 2013-02-27 |
RU2009135314A (ru) | 2011-03-27 |
EP2570086B1 (en) | 2016-10-26 |
EP2570086A1 (en) | 2013-03-20 |
PL2570086T3 (pl) | 2017-07-31 |
US20110125177A1 (en) | 2011-05-26 |
BRPI0903940B8 (pt) | 2021-06-22 |
US20100076475A1 (en) | 2010-03-25 |
US9028519B2 (en) | 2015-05-12 |
EP2165660A3 (en) | 2010-04-28 |
EP2165660B1 (en) | 2016-02-10 |
EP2572655B1 (en) | 2016-04-13 |
RU2532300C2 (ru) | 2014-11-10 |
CN101683281A (zh) | 2010-03-31 |
BRPI0903940B1 (pt) | 2020-05-05 |
CN101683281B (zh) | 2014-01-29 |
US9050083B2 (en) | 2015-06-09 |
EP2572655A1 (en) | 2013-03-27 |
CA2922135A1 (en) | 2010-03-23 |
PL2561813T3 (pl) | 2017-07-31 |
EP2561813B1 (en) | 2016-11-09 |
CA2679512A1 (en) | 2010-03-23 |
PL2165660T3 (pl) | 2016-08-31 |
EP2165660A2 (en) | 2010-03-24 |
JP5528752B2 (ja) | 2014-06-25 |
CA2679512C (en) | 2017-01-03 |
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