BRPI0904474A2 - efetuador de extremidade para uso com um instrumento de corte e grampeamento cirúrgico - Google Patents
efetuador de extremidade para uso com um instrumento de corte e grampeamento cirúrgico Download PDFInfo
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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
- 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
- A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
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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
- A61B2017/07271—Stapler heads characterised by its cartridge
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0807—Indication means
- A61B2090/0811—Indication means for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument
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- Oral & Maxillofacial Surgery (AREA)
- Surgical Instruments (AREA)
Abstract
EFETUADOR DE EXTREMIDADE PARA USO COM UM INSTRUMENTO DE CORTE E GRAMPEAMENTO CIRúRGICO. A presente invenção refere-se a um efetuador de extremidade para um instrumento de corte e grampeamento cirúrgico. Em várias modalidades, o efetuador de extremidade pode incluir um canal alongado que é configurado para suportar o cartucho de grampo e que é também operavelmente suportado com relação ao instrumento de corte e grampeamento cirúrgico. Uma bigoma pode ser suportada de modo móvel com relação ao canal alongado para movimento seletivo entre as posições aberta e fechada, em que o tecido está preso entre a bigorna e um cartucho de grampos suportado dentro do canal alongado em resposta a um movimento de fechamento aplicado no mesmo a partir do instrumento de corte e grampeamento cirúrgico. Pelo menos uma fonte de luz pode ser fornecida em pelo menos um do cartucho de grampos e do canal alongado. As fontes de luz podem interfacear com a bigorna para fornecer uma indicação visual visível através de uma parte da bigoma para indicar uma posição do tecido preso entre a bigorna e o cartucho de grampos.
Description
Relatório Descritivo da Patente de Invenção para "EFETUADOROE EXTREMIDADE PARA USO COM UM INSTRUMENTO DE CORTE EGRAMPEAMENTO CIRÚRGICO".
CAMPO DA INVENÇÃO
A presente invenção refere-se em geral a instrumentos cirúrgi-cos endoscópicos que são capazes de manipular tecido e aplicar linhas degrampos no tecido enquanto cortam o tecido entre aqueles grampos e, maisparticularmente, a aperfeiçoamentos relacionados a efetuadores de extremi-dade para tais instrumentos.
ANTECEDENTES DA INVENÇÃO
Grampeadores cirúrgicos têm sido usados na técnica anteriorpara fazer simultaneamente incisão longitudinal em tecido e aplicar linhas degrampos em lados opostos da incisão. Tais instrumentos incluem comumen-te um par de elementos de mordente cooperantes que, se o instrumento épretendido para aplicações endoscópicas ou laparoscópicas, são capazesde passar através de uma passagem de cânula. Um dos elementos de mor-dente é configurado para receber um cartucho de grampo equipado com fi-leiras de grampos lateralmente espaçadas. O outro elemento de mordentecompreende comumente uma bigorna que tem bolsos de formação degrampos que são alinhados com as fileiras de grampos no cartucho. Várioscartuchos possuem cunhas que, quando acionadas distalmente através docartucho, engatam acionadores nos quais os grampos são suportados paraefetuar o disparo dos grampos na direção da bigorna.
Quando se empregam tais instrumentos de corte e grampea-mento, no entanto, o médico deve posicionar apropriadamente o tecido a sercortado dentro do efetuador antes de disparar o dispositivo. Esta tarefa podeser complicada devido à localização do tecido e/ou a posição do efetuadorde extremidade dentro da cavidade do corpo.
Consequentemente, existe uma necessidade significante paraum efetuador de extremidade aperfeiçoado que é configurado para prover omédico com uma indicação da posição do tecido dentro do efetuador de ex-tremidade.BREVE SUMÁRIO DA INVENÇÃO
De acordo com várias modalidades da presente invenção, é for-necido um efetuador de extremidade para um instrumento de corte e gram-peamento cirúrgico. O efetuador de extremidade pode compreender um ca-nal alongado que é configurado para suportar o cartucho de grampo e que éoperavelmente suportado com relação ao instrumento de corte e grampea-mento cirúrgico. Uma bigorna pode ser suportada de modo móvel com rela-ção ao canal alongado para movimento seletivo entre as posições aberta efechada. O tecido pode se preso entre a bigorna e um cartucho de grampossuportado dentro do canal alongado em resposta a um movimento de fe-chamento aplicado no mesmo a partir do instrumento de corte e grampea-mento cirúrgico. Pelo menos uma fonte de luz pode ser fornecida em pelomenos um cartucho de grampos e o canal alongado. As fontes de luz podemestar dispostas para interfacear com a bigorna para fornecer uma indicaçãovisual da posição do tecido entre a bigorna e o cartucho de grampos.
De acordo com outra modalidade da presente invenção, é forne-cido um cartucho de grampos para uso com um instrumento de corte egrampeamento cirúrgico. Em várias modalidades, o cartucho de grampospode compreender um corpo de cartucho que tem uma pluralidade de canaisde recepção de grampos. Cada canal de recepção de grampos pode supor-tar de modo operável pelo menos um grampo cirúrgico no mesmo. Uma plu-ralidade de fontes de luz pode ser suportada dentro do corpo de cartuchopara projetar luz na direção de uma parte de bigorna do instrumento de cortee grampeamento cirúrgico quando o cartucho de grampo é operavelmentesuportado no mesmo e a parte de bigorna é orientada em uma posição desujeição de tecido.
De acordo com outra modalidade da presente invenção, é forne-cido um cartucho de grampos para uso com um instrumento de corte egrampeamento cirúrgico que tem pelo menos uma fonte de luz no mesmo.
Várias modalidades podem compreender um corpo de cartucho que temuma pluralidade de canais de recepção de grampos. Cada canal de recep-ção de grampos pode suportar de modo operável pelo menos um grampocirúrgico no mesmo. Uma pluralidade de aberturas de projeção de luz pode eestender através do corpo do cartucho em tais posições de modo a projetarluz da fonte de luz para uma parte de bigorna do instrumento de corte egrampeamento cirúrgico quando o cartucho de grampos é operavelmentesuportado e a parte de bigorna é orientada em uma posição de sujeição detecido.
De acordo com outra modalidade da presente invenção é forne-cido um instrumento de corte e grampeamento cirúrgico que pode incluir umconjunto de cabo e uma haste alongada que é operavelmente acoplada noconjunto de cabo. Um canal alongado pode ser operavelmente acoplado nahaste alongada e pode ser configurado para suportar de modo operável umcartucho de grampos. Uma bigorna pode ser suportada de modo móvel comrelação ao canal alongado para movimento seletivo entre uma posição aber-ta e uma posição fechada em que o tecido é preso entre a bigorna e um car-tucho de grampos suportado dentro do canal alongado em resposta aos mo-vimentos de abertura e fechamento aplicados no mesmo a partir da hastealongada. Pelo menos uma fonte de luz pode ser fornecida em pelo menosum do cartucho de grampos e do canal alongado. As fontes de luz interfa-ceiam com a bigorna para fornecer indicação visual, visível através de umaparte da bigorna para indicar uma posição de tecido preso entre a bigorna eo cartucho de grampos.
Consequentemente, várias modalidades da invenção fornecemsoluções para os inconvenientes de outros efetuadores de extremidade usa-dos para prender e/ou manipular tecido, bem como aqueles efetuadores deextremidade desenhados para cortar e grampear tecido. Aqueles versadosna técnica apreciarão facilmente, no entanto, que estes e outros detalhes,aspectos e vantagens se tornarão adicionalmente evidentes na medida emque a descrição detalhada seguinte prossegue.
BREVE DESCRIÇÃO DAS FIGURAS
Os desenhos anexos, que são incorporados e constituem umaparte deste relatório, ilustram modalidades da invenção, e junto com a des-crição geral da invenção dada acima, e a descrição detalhada das modalida-des fornecidas abaixo, servem para explicar nos princípios da presente in-venção.
A figura 1 representa uma vista em elevação lateral parcialmenterecortada de um instrumento de corte e grampeamento cirúrgico de umamodalidade da presente invenção em uma posição aberta.
A figura 2 representa uma vista de detalhe em elevação lateralem seção transversal ao longo da linha 2-2 da figura 1 do efetuador de ex-tremidade.
A figura 3 é uma vista em seção transversal do efetuador de ex-tremidade da figura 2 com a bigorna em uma posição fechada.
A figura 4 representa uma vista em elevação lateral de uma par-te de cabo de uma extremidade proximal do instrumento de corte e grampe-amento cirúrgico da figura 1, com um lado esquerdo removido para exporpartes interiores, em uma posição não-disparada ("partida"), não presa.
A figura 5 representa uma vista explodida, em perspectiva daparte de cabo da extremidade proximal do instrumento de corte e grampea-mento cirúrgico da figura 1.
A figura 6 representa uma vista em elevação lateral da parte decabo da extremidade proximal do instrumento de corte e grampeamento ci-rúrgico da figura 1 com o lado esquerdo removido para expor partes interio-res na posição fechada ("presa").
A figura 7 representa uma vista em elevação lateral da parte decabo da extremidade proximal do instrumento de corte e grampeamento ci-rúrgico da figura 1, com o lado esquerdo removido para expor partes interio-res, na posição grampeada e cortada ("disparada").
A figura 8 é uma vista em perspectiva de uma modalidade deefetuador de extremidade da figura 1 da presente invenção prendendo umaparte de tecido "T" entre a bigorna e o cartucho de grampos.
A figura 9 é uma vista em perspectiva do efetuador de extremi-dade da figura 8 com a bigorna removida do mesmo por clareza.
A figura 10 é uma vista em perspectiva de uma parte do cartu-cho de grampos representada na figura 9.A figura 11 é uma vista explodida isométrica da parte de imple-mento do instrumento de corte e grampeamento cirúrgico da figura 1.
A figura 12 representa uma vista em elevação lateral parcialmen-te recortada de um instrumento de corte e grampeamento cirúrgico de outramodalidade da presente invenção em uma posição aberta.
A figura 13 é uma vista em seção transversal do efetuador deextremidade da figura 12 com a bigorna em uma posição fechada.
A figura 14 é uma vista em perspectiva de outra modalidade deefetuador de extremidade da presente invenção prendendo uma parte dotecido "T" entre a bigorna e o cartucho de grampo.
A figura 15 é uma vista em perspectiva do efetuador de extremi-dade da figura 14 com a bigorna removida por clareza.
A figura 16 é uma vista em perspectiva de uma parte do cartu-cho de grampos representado na figura 15.
A figura 17 é uma vista em seção transversal do efetuador deextremidade das figuras 14-16 com a bigorna em uma posição fechada.
DESCRIÇÃO DETALHADA DA INVENÇÃO
Voltando para os desenhos, em que numerais iguais indicamcomponentes iguais por todas as várias vistas, as figuras 1 e 2 representamuma modalidade de um instrumento de corte e grampeamento cirúrgico 10que é capaz de praticar os benefícios únicos da presente invenção. Na me-dida em que a Descrição Detalhada prossegue, o leitor apreciará, no entan-to, que os aspectos únicos e novos da presente invenção podem ser empre-gados vantajosamente em conexão com uma variedade de outros grampea-dores, instrumento de grampear e mesmo instrumentos de agarrar tecidosem se afastar do espírito e escopo da presente invenção. Consequente-mente, o escopo de proteção fornecido às várias modalidades da presenteinvenção não deve ser limitado ao uso somente com o tipo específico deinstrumentos de corte e grampeamento cirúrgicos descritos aqui.
As figuras 1 e 2, ilustram uma forma de um instrumento de cortee grampeamento cirúrgico em geral designado como 10 que pode ser efeti-vamente empregado em conexão com várias modalidades da presente in-venção. Como pode ser visto a partir daquelas figuras, o instrumento de cor-te e grampeamento cirúrgico 10 pode incluir um conjunto de cabo 20 que éconectado a uma parte de implemento 22, a última ainda compreendendouma haste alongada 23 terminando distalmente em um efetuador de extre-midade 12. O conjunto de cabo 20 pode incluir um punho de pistola 24 parao qual um gatilho de fechamento 26 pode ser articuladamente puxado pelomédico para causar a sujeição, ou fechamento, de uma bigorna 18 na dire-ção de um canal alongado 16 do efetuador de extremidade 12. Um gatilhode disparo 28 pode ser montado de modo operável mais afastado do ladoexterno do gatilho de fechamento 26 e pode ser articuladamente puxado pe-lo médico para causar o corte e grampeamento do tecido preso no efetuadorde extremidade 12.
Será apreciado que os termos "proximal" e "distai" são usadoscom referência a um médico agarrando um cabo de um instrumento. Assim oefetuador de extremidade 12 é distai com respeito ao conjunto de cabo 20mais proximal. Será adicionalmente apreciado que, por conveniência e cla-reza, os termos espaciais tais como "vertical" e "horizontal" são usados aquicom respeito aos desenhos. No entanto, instrumentos cirúrgicos são usadosem muitas orientações e posições, e estes termos não pretendem ser Iimi-tantes e absolutos.
Várias modalidades do instrumento 10 podem também incluiruma luva de fechamento 32 que é montada de modo móvel em uma arma-ção 34. A armação 34 pode encerrar um elemento de acionamento de dispa-ro 36 que é atuado pelo gatilho de disparo 28. A armação 34 conecta o con-junto de cabo 20 no efetuador de extremidade 12. Em particular, a extremi-dade distai da armação 34 é acoplada ao canal alongado 16 do efetuador deextremidade 12 que pode ser configurado para suportar de modo removívelum cartucho de grampo 300.
Como pode ser visto na figura 3, o cartucho de grampo 300 temuma fenda vertical alongada 49 se estendendo através do mesmo para per-mitir que a barra de disparo 14 passe através do mesmo. A barra de disparo14 tem uma borda de corte 48 na mesma para cortar o tecido preso. Váriostipos e configurações de barras de disparo são conhecidos. Por exemplo,aquelas barras de disparo descritas na Patente U.S. N0 6.978.921, emitidaem 27 de dezembro de 2005, a descrição da qual é aqui incorporada porreferência em sua totalidade, pode ser efetivamente empregada. No entanto,o instrumento de corte e grampeamento cirúrgico 10 pode também usar ou-tras disposições de barra de disparo.
Com referência às figuras 4-7, o conjunto de cabo 20 pode con-sistir em primeira e segunda seções de base 50 e 52, que podem ser molda-das a partir de um material polimérico tal como policarbonato enchido comvidro. A primeira seção de base 50 pode ser fornecida com uma pluralidadede pinos formatados cilindricamente 54. A segunda seção de base 52 podeinclui uma pluralidade de elementos de extensão 56, cada um tendo umaabertura em formato hexagonal 58. Os pinos formatados cilindricamente 54podem ser recebidos dentro das aberturas em formato hexagonal 58 e sermantidos por fricção nas mesmas para manter as primeira e segunda seçõesde base 50 e 52 em montagem.
Várias modalidades podem também incluir um botão rotativo 60que tem um furo 62 estendendo-se completamente através dele para enga-tar e rodar a parte de implemento 22 em torno de seu eixo longitudinal. Obotão rotativo 60 pode incluir uma saliência projetada internamente 64 quese estende ao longo de pelo menos uma parte do furo 62. A saliência proje-tada 64 pode ser recebida dentro de uma fenda longitudinal 66 formada emuma parte proximal da luva de fechamento 32 tal que a rotação do botãorotativo 60 efetua a rotação da luva de fechamento 32. A saliência 64 podeainda se estender através da armação 34 em contato com uma parte do e-Iemento de acionamento de disparo 36 para efetuar sua rotação também.
Assim, o efetuador de extremidade 12 (não-mostrado nas figuras 4-7) podeser rodado com o botão rotativo 60.
Uma extremidade 68 da armação 34 pode passar de modo pro-ximal através do botão rotativo 60 e pode ainda ter um entalhe circunferenci-al 70 que é engatado por elementos de fixação de canal opostos 72 esten-dendo-se respectivamente a partir das seções de base 50 e 52. Somente oelemento de fixação de canal 72 da segunda seção de base 52 é mostrado.Os elementos de fixação de canal 72, se estendendo a partir das seções debase 50, 52 servem para prender a armação 34 no conjunto de cabo 20 talque a armação 34 não se move longitudinalmente com relação ao conjuntode cabo 20.
O gatilho de fechamento 26 pode ter uma seção de cabo 74,uma seção de segmento de engrenagem 76, e uma seção intermediária 78.
Um furo 80 pode estender-se através da seção intermediária 78. Um ele-mento de suporte cilíndrico 82 pode estender-se da segunda seção de base52 e passar através do furo 80 para montar articuladamente o gatilho de fe-chamento 26 no conjunto de cabo 20. Um segundo elemento de suporte ci-líndrico 83 estendendo-se a partir da segunda seção de base 52 pode pas-sar através de um furo 81 do gatilho de disparo 28 para montar articulada-mente no conjunto de cabo 20. Uma abertura hexagonal 84 pode ser forne-cida no elemento de suporte cilíndrico 83 para receber um pino de fixação(não-mostrado) que se estende a partir da primeira seção de base 50.
Um estribo de fechamento 86 pode ser alojado dentro do conjun-to de cabo 20 para movimento alternado e pode servir para transferir movi-mento do gatilho de fechamento 26 para a luva de fechamento 32. Os ele-mentos de suporte 88 estendendo-se da segunda seção de base 52 e doelemento de fixação 72, que se estende através de um recesso 89 no estribo86, pode suportar o estribo 86 dentro do conjunto de cabo 20. Uma extremi-dade proximal 90 da luva de fechamento 32 pode ser fornecida com umflange 92 que é encaixado por pressão em um recesso de recepção 94 for-mado em uma extremidade distai 96 do estribo 86. Uma extremidade proxi-mal 98 do estribo 86 pode ter uma cremalheira de engrenagens 100 que éengatada pela seção de segmento de engrenagens 76 do gatilho de fecha-mento 26. Quando o gatilho de fechamento 26 é movido para o punho depistola 24 do conjunto de cabo 20, o estribo 86 e, portanto, a luva de fecha-mento 32, movem-se distalmente, comprimindo uma mola 102 que orienta oestribo 86 de modo proximal. O movimento distai da luva de fechamento 32efetua o movimento de translação pivotante da bigorna 18 para o canal a-Iongado 16 do efetuadorde extremidade 12 e o movimento proximal efetua aabertura, como discutido abaixo.
O gatilho de fechamento 26 pode ser orientado para frente paraa posição aberta por uma superfície dianteira 130 interagindo com uma su-perfície de engate 128 do gatilho de disparo 28. Um primeiro gancho 104que pivota do topo para a traseira no conjunto de cabo 20 em torno de umpino 106 pode restringir o movimento do gatilho de disparo 28 para o punhode pistola 24 até que o gatilho de fechamento 26 seja preso em sua posiçãofechada. O gancho 104 pode restringir o movimento do gatilho de disparo 28engatando um pino de travamento 107 no gatilho de disparo 28. O gancho104 pode também estar em contato com o gatilho de fechamento 26. Emparticular, uma projeção avançada 108 do gancho 104 pode também engatarum elemento 110 na seção intermediária 78 do gatilho de fechamento 26, oelemento 100 estando para fora do furo 80 para a seção de cabo 74. O gan-cho 104 pode ser orientado para contato com o elemento 110 do gatilho defechamento 26 e engate com o pino de travamento 107 no gatilho de disparo28 por uma mola de liberação 112. Quando o gatilho de fechamento 26 épressionado, o gancho 104 é movido do topo para trás, comprimindo a molade liberação 112 que é capturada entre uma projeção para trás 114 no gan-cho 104 e uma projeção para frente 116 no botão de liberação 30.
Quando o estribo 86 se move distalmente em resposta ao movi-mento proximal do gatilho de fechamento 26, um braço de engate superior118 do botão de liberação 30 se move ao longo de uma superfície superior120 no estribo 86 até cair dentro de um recesso apresentado ascendente-mente 122 em uma parte inferior proximal do estribo 86. A mola de liberação112 impele o botão de liberação 30 para fora, que pivota o braço de engatesuperior 118 descendentemente em engate com o recesso apresentado as-cendentemente 122, desse modo travando o gatilho de fechamento 26 emuma posição de sujeição de tecido, tal como representado na figura 6.
O braço de engate 118 pode ser movido para fora do recesso122 para liberar a bígorna 18 empurrando o botão de liberação 30 para den-tro. Especificamente, o braço de engate superior 118 pivota para cima emtorno do pino 123 da segunda seção de base 52. O estribo 86 é então permi-tido mover-se de modo proximal em resposta ao movimento de retorno dogatilho de fechamento 26. uma mola de retorno de gatilho de disparo 124pode estar localizada dentro da conjunto de cabo 20 com uma extremidadefixada no pino 106 da segunda seção de base 52 e a outra extremidade fixa-da em um pino 126 no gatilho de disparo 28. A mola de retorno de disparo124 se aplica a uma força de retorno para o pino 126 para orientar o gatilhode disparo 28 em uma direção afastada do punho de pistola 24 da parte decabo 20. O gatilho de fechamento 26 é também orientado para longe do pu-nho de pistola 24 engatando a superfície 128 do gatilho de disparo 28, orien-tando a superfície dianteira 130 do gatilho de fechamento 26.
Quando o gatilho de fechamento 26 é movido para o punho depistola 24, sua superfície dianteira 130 engata com a superfície de engate128 no gatilho de disparo 28 fazendo o gatilho de disparo 28 mover-se parasua posição de "disparo". Quando em sua posição de disparo, o gatilho dedisparo 28 pode estar localizado a um ângulo de aproximadamente 45° como punho de pistola 24. Depois do disparo de grampo, a mola 124 faz o gati-lho de disparo 28 retornar para sua posição inicial. Durante o movimento deretorno do gatilho de disparo 28, sua superfície de engate 128 empurra con-tra a superfície dianteira 130 do gatilho de fechamento 26 fazendo o gatilhode fechamento 26 retornar para sua posição inicial. Um elemento de batente132 pode se estender da segunda seção de base 52 para impedir o gatilhode fechamento 26 de rodar além de sua posição inicial.
O instrumento de grampeamento e corte cirúrgico 10 adicional-mente inclui uma seção alternada 134, um multiplicador 136 e um elementode acionamento 138. A seção alternada 134 compreende um carrinho decunha na parte de implemento 22 (não-mostrada nas figuras 4-7) e uma va-reta de acionamento metálica 140. O elemento de acionamento 138 podeincluir primeira e segunda cremalheiras de engrenagens 141 e 142. Um pri-meiro entalhe 144 pode ser fornecido no elemento de acionamento 138 in-termediário às primeira e segunda cremalheiras de engrenagens 141, 142.
Durante o movimento de retorno do gatilho de disparo 28, um dente 146 nogatilho de disparo 28 engata com o primeiro entalhe 144 para retornar o e-Iemento de acionamento 138 para sua posição inicial depois do disparo degrampo. Um segundo entalhe 148 pode estar localizado em uma extremida-de proximal da vareta de acionamento metálica 140 para travar a vareta deacionamento metálica 140 no braço de engate superior 118 do botão de libe-ração 30 em sua posição não-disparada.
O multiplicador 136 compreende primeira e segunda engrena-gens de pinhão integrais 150 e 152. A primeira engrenagem de pinhão inte-gral 150 'pode ser engatada com uma primeira cremalheira de engrenagens154 fornecida na vareta de acionamento metálica 140. A segunda engrena-gem de pinhão integrada 152 pode ser engatada com a primeira cremalheirade engrenagens 141 no elemento de acionamento 138. A primeira engrena-gem de pinhão integral 150 pode ter um primeiro diâmetro e a segunda en-grenagem de pinhão integral 152 pode ter um segundo diâmetro que é me-nor que o primeiro diâmetro.
As figuras 4, 6 e 7 representam respectivamente o conjunto decabo 20 na posição de partida (aberta e não-disparada), uma posição presa(fechada e não-disparada) e uma posição disparada. O gatilho de disparo 28pode ser fornecido com uma seção de segmento de engrenagem 156. A se-ção de segmento de engrenagem 156 pode engatar com a segunda crema-lheira de engrenagens 142 no elemento de acionamento 138 tal que o mo-vimento do gatilho de disparo 28 faz o elemento de acionamento 138 se mo-ver para trás e para frente entre uma primeira posição de acionamento, mos-trada na figura 8, e uma segunda posição de acionamento, mostrada na figu-ra 9. A fim de impedir o disparo de grampo antes da sujeição de tecido ocor-rer, o braço de engate superior 118 no botão de liberação 39 pode ser enga-tado com o segundo entalhe 148 no elemento de acionamento 138 tal que avareta de acionamento metálica 140 é travada em sua posição mais proxi-mal, como representado na figura 4. Quando o braço de engate superior 118cai no recesso 1222, o braço de engate superior 118 desengata com o se-gundo entalhe 148 para permitir o movimento distai da vareta de acionamen-to metálica 140, como representado na figura 7.Porque a primeira cremalheira de engrenagens 141 no elementode acionamento 138 e a cremalheira de engrenagem 154 na vareta de acio-namento metálica 140 são engatadas com o multiplicador 136, o movimentodo gatilho de disparo 28 faz a vareta de acionamento metálica 140 se alter-nar entre uma primeira posição alternada, mostrada na figura 8, e uma se-gunda posição alternada, mostrada na figura 7. Desde que o diâmetro daprimeira engrenagem de pinhão 150 é maior que o diâmetro da segunda en-grenagem de pinhão 152, o multiplicador 136 move a seção alternada 134uma distância maior que o elemento de acionamento 138 é movido pelo gati-Iho de disparo 28. Os diâmetros das primeira e segunda engrenagens depinhão 150 e 152 podem ser mudados para permitir que o comprimento docurso do gatilho de disparo 28 e a força exigida para movê-lo devam ser va-riados. Será apreciado que o conjunto de cabo 20 é ilustrativo e que outrosmecanismos de atuação podem ser empregados. Por exemplo, os movimen-tos de fechamento e disparo podem ser gerados por meios automáticos.
Uma modalidade de um efetuador de extremidade 12 do instru-mento de corte e grampeamento cirúrgico 10 é representada nas figuras 3 e8-10. Como descrito acima, a conjunto de cabo 20 pode produzir movimen-tos de fechamento e disparo separados e distintos que atuam o efetuador deextremidade 12. O efetuador de extremidade 12 pode manter vantajosamen-te a flexibilidade clínica deste fechamento e disparo separados e distintos(isto é, grampeamento e corte). A figura 9 representa uma modalidade decartucho de grampos 300 da presente invenção instalada no canal alongado16 do efetuador de extremidade 12 com a barra de disparo 14 em sua posi-ção proximal não-disparada. O cartucho de grampos 300 tem um corpo decartucho 302 que é dividido por uma fenda alongada 310 que se estende deuma extremidade proximal 304 do cartucho 300 para uma ponta externa a-funilada 306. Uma pluralidade de canais de recepção de grampos 320a-320fé formada dentro do corpo de cartucho de grampos 302. Em várias modali-dades, por exemplo, os canais de recepção de grampos 320a-320f podemestar dispostos em seis fileiras longitudinais lateralmente espaçadas comtrês fileiras em cada lado da fenda alongada 310. Posicionados dentro doscanais de recepção de grampos 320a-320f são os grampos 222 (figura 3)que podem ser suportados em acionadores móveis 330 como é conhecido.
Por exemplo, disposições de acionador de grampos, tais como aquelas des-critas na Publicação de Pedido de Patente U.S. N0 2007/0045379 do mesmoproprietário, intitulado "Staple Cartridges For Forming Staples Having Diffe-ring Formed Staple Heights", a descrição da qual é aqui incorporada por re-ferência em sua totalidade, podem ser empregadas. No entanto, outros tiposde grampos e disposições de acionador de grampos podem ser efetivamenteempregados sem se afastar do espírito e escopo da presente invenção.
A bigorna 18 'pode ser fixada de modo móvel na extremidadeproximal do canal alongado 16 em uma variedade de disposições conheci-das tal que, quando os movimentos de abertura e fechamento são aplicadosna bigorna 18, por exemplo, pela luva de fechamento 32, a bigorna 18 é feitase mover entre as posições aberta e fechada. A bigorna 18 pode ter umaparte de corpo 200 que tem uma superfície de formação de grampos 202que tem uma pluralidade de bolsos de formação de grampos na mesma(não-mostrados) que coincidem com os canais de grampos 320a, 320b,320c, 320d, 320e e 320f fornecidos no cartucho de grampos 300. A bigornatambém tem uma superfície de topo ou externa 204. por exemplo, a bigorna18 pode ser acoplada de modo pivotante na extremidade proximal do canalalongado por moentes 232 articulados em fendas 230 na extremidade pro-ximal do canal alongado 16 (figura 11) tal que quando na posição aberta, asuperfície de formação de grampos 202 da bigorna 18 é espaçada de umcartucho de grampos 300 montado dentro do canal alongado 16 e quandoum movimento de fechamento é aplicado na bigorna 28 pela luva de fecharmento 32, a superfície de formação de grampos 202 da bigorna 18 é coloca-da em relação de confronto com o cartucho de grampos 300 para permitirque o tecido "T" seja preso entre os mesmos como mostrado na figura 8. Noentanto, a bigorna 18 pode ser suportada de modo móvel com relação aocartucho de grampos 300 usando uma variedade de disposições de fixaçãode bigorna conhecidas diferentes.
Como pode ser visto nas figuras 3 e 11, o corpo de cartucho 302pode ser montado dentro de uma bandeja de cartucho 224. Como ilustradona figura 3, o corpo de cartucho 302 pode ser formado com duas fendas seestendendo longitudinalmente para dentro 390 e duas fendas se estendendolongitudinalmente para fora 392. As fendas 390 e 392 se estendem da ex-tremidade proximal 304 do cartucho para sua ponta externa afunilada 306.
Esta modalidade de cartucho 300 pode ainda incluir um carrinho de cunha400 que é deslizantemente suportado na bandeja de cartucho 224. Um amodalidade de carrinho de cunha 400 inclui um par de carnes de carrinhointernos 410, em que um carne de carrinho interno 410 corresponde a umadas fendas estendendo-se longitudinalmente para dentro 390 e em que ooutro carne de carrinho interno 410 corresponde à outra fenda se estenden-do longitudinalmente para dentro 390. Vide figura 3. O carrinho de cunha400 pode ainda incluir um par de carnes de carrinho externos 420, em queum carne de carrinho externo 420 corresponde a uma das fendas se esten-dendo longitudinalmente para fora 392 e o outro came de carrinho externo420 corresponde com a outra fenda estendendo-se longitudinalmente parafora 392 como mostrado na figura 19. Quando montada, a bandeja de cartu-cho 224 prende o carrinho de cunha 400 e os acionadores 330 dentro docorpo do cartucho 302.
Como pode ser visto na figura 11, o canal alongado 16 pode teruma cavidade de fixação colocada de modo proximal 226 para receber umelemento de fixação de canal 228 na extremidade distai da armação 34 parafixar o efetuador de extremidade 12 na conjunto de cabo 20. A luva de fe-chamento 32 que pode abranger a armação 34 inclui uma aba apresentadadistalmente 234 que engata um dispositivo de bigorna 236 próximo mas dis-tai ao pivô de bigorna 232 na bigorna 18 para desse modo efetuar a aberturae fechamento da bigorna 18. O elemento de acionamento de disparo 36 émostrado como sendo montado a partir da barra de disparo 14 fixada a umconector de disparo 238 por pinos 240, que por sua vez é fixado de modorotativo e proximal na vareta de acionamento metálica 140. A barra de dispa-ro 14 é guiada em uma extremidade distai da armação por um guia com fen-das 239 inserido na mesma.Retornando às figuras 3 e 8-10, em várias modalidades da pre-sente invenção, pelo menos uma, e de preferência várias fontes de luz 500são suportadas dentro do canal alongado 16. Em uma modalidade, por e-xemplo, as fontes de luz 500 podem compreender diodos de emissão de luz(LEDs) que estão em comunicação elétrica com uma fonte de energia elétri-ca 600 montada dentro da conjunto de cabo 20 (figura 1) por condutores 602que se estendem através do canal alongado 16 e a armação 34. Em váriasmodalidades, por exemplo, a fonte de energia elétrica pode compreenderuma ou mais baterias. Em ainda outras modalidades, no entanto, as fontesde luz 500 podem ser acionadas por corrente alternada (CA). Mais particu-larmente, o conjunto de cabo 20 pode ser equipada com um fio de força(não-mostrado) que pode ser encaixado em uma saída de CA. Em aindaoutras modalidades, a fonte de energia elétrica pode compreender uma oumais baterias suportadas de modo operável dentro da armação 34.
Como pode ser visto na figura 3, cada fonte de luz 500 pode sermontada dentro do orifício de recepção de luz 510 fornecido no canal alon-gado 16. A bandeja de cartucho 224 e o corpo do cartucho 302 podem serfornecidos com aberturas ou passagens de recepção de luz 228, 520, res-pectivamente, que correspondem a cada fonte de luz 500 para desse modopermitir que a luz emitida por cada fonte de luz 500 passe através das pas-sagens de recepção de luz 228, 520 através do corpo do cartucho 302 verti-calmente. Assim, quando o médico está inicialmente segurando, movendo emanipulando o tecido "T" antes de prender o tecido , a luz que passa atravésdo corpo de cartucho 302 pode ajudar a iluminar a área e o tecido circundante.
Como pode ser mais particularmente visto nas figuras 3 e 8, noentanto, várias modalidades da presente invenção podem também ter pas-sagens de recepção de luz 530 que se estendem através do corpo de bigor-na 200. Cada passagem de recepção e luz 530 corresponde a uma passa-gem de recepção de luz 520 no corpo do cartucho 302 tal que, quando abigorna 18 está na posição fechada como mostrado na figura 3, a luz passa-rá das passagens de recepção de luz 520 no corpo do cartucho 302 atravésdas passagens de recepção de luz correspondentes 530 no corpo da bigor-na 200. Assim, quando o médico prende o tecido "T" entre a bigorna 18 e ocartucho 300, como visto na figura 8, aquelas passagens de recepção de luz228, 520, que são bloqueadas pelo tecido "T", não receberão luz de sua fon-te de luz correspondente 500. No entanto, a luz passará através daquelaspassagens 228, 520, 530 que não estão bloqueadas pelo tecido "T". Assim,o médico será capaz de acertar a posição do tecido "T" que está preso noefetuador de extremidade 12 notando que as passagens 530 estão emitindoluz. Em várias modalidades, a bigorna 18 pode também ser equipada compelo menos um, e de preferência dois, Iocalizadores de tecido se estenden-do descendentemente 19 que servem para ajudar a posicionar o tecido "T"dentro do efetuador de extremidade 12.
As figuras 12 e 13 ilustram um instrumento de corte e grampea-mento cirúrgico alternativo 10' que tem uma modalidade de efetuador de ex-tremidade alternativa 12' que pode ser substancialmente idêntica ao efetua-dor de extremidade 12 descrito acima, exceto pelas diferenças discutidasabaixo. Por exemplo, nesta modalidade de efetuador de extremidade 12',pelo menos um, e de preferência pelo menos dois cabos de fibra ótica 700são montados dentro dos canais 702 fornecidos no canal alongado 16 comomostrado na figura 13. Os cabos de fibra ótica 700 podem cooperar com pe-lo menos uma fonte de luz 800 montada no conjunto de cabo 20 ou na ar-mação 34. A pelo menos uma fonte de luz 800 pode compreender um oumais diodos de emissão de luz, etc. Os cabos de fibra ótica 700 servem paracomunicar a luz sendo emitida da fonte de luz 800 dentro das passagens derecepção de luz correspondentes 228 no cartucho de bandeja 224 e as pas-sagens de recepção de luz 520 no corpo do cartucho 302 para descarregaratravés das passagens de recepção de luz 530 no corpo da bigorna 200.
As figuras 14-17 ilustram outra modalidade de efetuador de ex-tremidade alternativo 12" que pode ser substancialmente idêntica ao efetua-dor de extremidade 12 descrito acima, exceto pelas diferenças discutidasabaixo. Por exemplo, nesta modalidade de efetuador de extremidade 12",uma pluralidade de fontes de luz 800 é montada no corpo de cartucho degrampos 302. Em várias modalidades, as fontes de luz 800 compreendemdiodos de emissão de luz que são acoplados eletricamente por condutorescorrespondentes 802 em contatos 804 montados na superfície de fundo docorpo de cartucho 302 e se estendendo através da bandeja de cartucho 224.
Vide figura 17. Quando o cartucho de grampos 300 é instalado dentro docanal alongado 16, os primeiros contatos são retidos em contato elétricocom segundos contatos correspondentes montados no canal alongado 16 eem contato elétrico com uma fonte de energia elétrica tal como, por exemplo,uma bateria ou baterias montadas na armação 34 ou na conjunto de cabo20. Assim, quando o cartucho 300 é instalado no canal alongado 16, as fon-tes de luz 800 são acionadas em virtude da interconexão elétrica entre osprimeiro e segundo contatos correspondentes 804, 806.
Nas várias modalidades de efetuador de extremidade escritasaqui, os diodos de emissão de luz de cores diferentes podem ser emprega-dos, por exemplo, para diferenciar entre partes diferentes do efetuador deextremidade para ajudar adicionalmente o médico a determinar a posição dotecido dentro do efetuador de extremidade. Por exemplo, a parte de extremi-dade distai do efetuador de extremidade pode ser equipada com luzes ver-melhas. A parte central do efetuador de extremidade pode ter luzes verdes ea parte de extremidade proximal pode ter luzes amarelas, etc.
Em uso, o instrumento de grampeamento e corte cirúrgico 10 éusado como representado nas figuras 1-2. Nas figuras 1-2, o instrumento 10está em sua posição de partida, tendo um cartucho de grampos completa-mente carregado, não disparado 300 encaixado por pressão dentro da ex-tremidade distai do canal alongado 16. Ambos os gatilhos 26, 28 estão parafrente e o efetuador de extremidade 12 está aberto, tal como seria típico de-pois da inserção do efetuador de extremidade 12 através e um trocarte ououtra abertura em uma cavidade corporal. O instrumento 10 é então manipu-lado pelo médico tal que o tecido "T" a ser grampeado e cortado está posi-cionado entre o cartucho de grampos 300 e a bigorna 18, como representa-do nas figuras 8 e 14. o médico então move o gatilho de fechamento 26 demodo proximal até posicionar diretamente adjacente ao punho de pistola 24 ,travando a parte de cabo 20 na posição fechada e presa. A barra de disparoretraída 14 no efetuador de extremidade 12 não impede a abertura e o fe-chamento seletivos do efetuador de extremidade 12, mas em vez disto resi-de dentro do bolso de bigorna 40. Com a bigorna 187 fechada e presa, abarra e disparo 14 é alinhada para disparar através do efetuador de extremi-dade 12. Depois que a sujeição do tecido ocorre, o médico move o gatilho dedisparo 28 de modo proximal fazendo a barra de disparo 14 se mover dis-talmente no efetuador de extremidade 12. O médico continua a mover o gati-lho de disparo 28 até ser colocado próximo ao gatilho de fechamento 26 epunho de pistola 24. Desse modo, todas as extremidades dos grampos 222são curvadas sobre si mesmas como um resultado de seu engate com a bi-gorna 18. A borda de corte 48 atravessou completamente através do tecido.
O processo está completo liberando o gatilho de disparo 28 e então pressio-nado o botão de liberação 30 enquanto aperta simultaneamente o gatilho defechamento 26 para abrir o efetuador de extremidade 12.
Enquanto a presente invenção foi ilustrada pela descrição dasvárias modalidades e enquanto as modalidades ilustrativas foram descritasem detalhe considerável, não é a intenção do requerente restringir, ou dequalquer maneira limitar, o escopo das reivindicações anexas a tal detalhe.
Vantagens adicionais e modificações podem aparecer facilmente para aque-les versados na técnica. As várias modalidades da presente invenção repre-sentam vastos aperfeiçoamentos sobre efetuadores de extremidade anteriores.
Consequentemente, a presente invenção foi discutida em termosde procedimentos e aparelho endoscópicos. No entanto, o uso aqui de ter-mos tal como "endoscópico" não deve ser construído para limitar a presenteinvenção a um instrumento de grampeamento e corte cirúrgico para uso so-mente em conjunto com um tubo endoscópico (isto é, trocarte). Ao contrário,acredita-se que a presente invenção possa encontrar uso em qualquer pro-cedimento onde o acesso é limitado a uma pequena incisão, incluindo masnão limitado a procedimentos laparoscópicos, tal como procedimentos aber-tos. No entanto, os aspectos únicos e novos das várias modalidades de efe-tuador de extremidade da presente invenção podem encontrar utilidadequando usados em conexão com outras formas de efetuadores de extremi-dade e aparelhos de grampeamento sem se afastar do espírito e escopo dapresente invenção. Por exemplo, os vários aspectos novos e únicos das vá-rias modalidades da presente invenção podem ser efetivamente empregadoscom outras formas de efetuadores de extremidade de segurar tecido e mani-pular tecido. Assim, como usado aqui, o termo "efetuador de extremidade"não deve se limitado a efetuadores de extremidade de corte e grampeamen-to. Em adição, vários efetuadores de extremidade descritos aqui são dese-nhados para serem usados com uma disposição de faca/barra de disparoreutilizável que compreende uma parte do instrumento de corte e grampea-mento cirúrgico e que não está disposta com o cartucho de grampos gasto.
Aqueles versados na técnica apreciarão, no entanto, que as vantagens easpectos únicos e novos das várias modalidades da presente invenção po-dem ser efetivamente empregados em conexão com efetuadores de extre-midade conhecidos na técnica como "unidades de carga descartáveis" - ouunidades, por exemplo, em que a barra de faca está disposta com o cartu-cho de grampos gasto. Consequentemente, o termo "efetuador de extremi-dade" como usado aqui, também pretende abranger tais unidades de cargadescartáveis.
Além do mais, os dispositivos descritos aqui podem ser dese-nhados para serem descartados depois de um único uso ou podem ser de-senhados para serem usados múltiplas vezes. Em cada caso, no entanto, odispositivo pode ser recondicionado para reutilização depois de pelo menosum uso. O recondicionamento pode incluir qualquer combinação das etapasde desmontagem do dispositivo, seguida por limpeza e substituição de pe-ças particulares, e subsequente remontagem. Em particular, o dispositivopode ser desmontado, e qualquer número de peças particulares ou partes dodispositivo pode ser seletivamente substituído ou removido em qualquercombinação. Na limpeza e/ou substituição de partes particulares, o dispositi-vo pode ser remontado para uso subsequente tanto em uma instalação derecondicionamento, ou por uma equipe cirúrgica imediatamente antes de umprocedimento cirúrgico. Aqueles versados na técnica apreciarão que o re-condicionamento do dispositivo pode utilizar uma variedade de técnicas dife-rente para desmontagem, limpeza/substituição, e remontagem. O uso de taistécnicas, e o dispositivo recondicionado resultante, estão todos dentro doescopo do presente pedido.
De preferência, a invenção descrita aqui será processada antesda cirurgia. Primeiro um instrumento novo ou usado é obtido, se necessário,limpo. O instrumento pode então ser esterilizado. Em uma técnica de esteri-lização, o instrumento é colocado em um recipiente fechado e vedado, talcomo um saco plástico ou TYVEK®. O recipiente e instrumento são entãocolocados em um campo de radiação que pode penetrar o recipiente, talcomo radiação gama, raios χ ou elétrons de energia mais alta. A radiaçãomata as bactérias no instrumento e no recipiente. O instrumento esterilizadopode então ser armazenado no recipiente estéril. O recipiente vedado man-tém o instrumento estéril até ser aberto na instalação médica.
Qualquer patente, publicação, ou outro material de descrição,em todo ou em parte, que é dito ser incorporado aqui por referência, somen-te na medida em que os materiais incorporados não entrem em conflito comdefinições, declarações existentes, ou outro material de descrição apresen-tado nesta descrição. Como tal, e no alcance necessário, a descrição comoexplicitamente apresentada aqui substitui qualquer material conflitante incor-porado aqui por referência. Qualquer material, ou parte do mesmo, que édito ser incorporado aqui por referência, mas que conflita com as definições,declarações existentes, ou outro material de descrição aqui apresentadosomente será incorporado na medida em que nenhum conflito surge entreeste material incorporado e o material de descrição existente.
A invenção que pretende ser protegida mas não deve ser cons-truída como limitada às modalidades particulares descritas. As modalidadesdevem, portanto, ser vistas como ilustrativas em vez de restritivas. Variaçõese mudanças podem ser feitas por outros sem se afastar do espírito da pre-sente invenção. Consequentemente, é expressamente pretendido que todosos equivalentes, variações e mudanças que se encontram dentro do espíritoe escopo da presente invenção, como definida pelas reivindicações ,sejamincluídas desse modo.
Claims (20)
1. Efetuador de extremidade para um instrumento de corte egrampeamento cirúrgico, o dito efetuador de extremidade compreendendo:um canal alongado configurado para suportar o cartucho degrampo e operavelmente suportado com relação ao instrumento de corte egrampeamento cirúrgico;uma bigorna suportada de modo móvel com relação ao dito ca-nal alongado para movimento seletivo entre as posições aberta e fechada,em que o tecido pode ser preso entre a dita bigorna e um cartucho de gram-pos suportado dentro do dito canal alongado em resposta a um movimentode fechamento aplicado no mesmo a partir do instrumento de corte e gram-peamento cirúrgico; epelo menos uma fonte de luz em pelo menos um do cartucho degrampos e do dito canal alongado, a dita pelo menos uma fonte de luz inter-faceando com a dita bigorna para fornecer uma indicação visual visível atra-vés de uma parte da dita bigorna para indicar uma posição do tecido presoentre a dita bigorna e o cartucho de grampos.
2. Efetuador de extremidade, de acordo com a reivindicação 1,em que a dita bigorna tem uma pluralidade de aberturas de visualização deluz através da mesma, através das quais a dita pelo menos uma fonte de luzpode se projetar quando a dita bigorna está na dita posição fechada.
3. Efetuador de extremidade, de acordo com a reivindicação 1,em que a dita pelo menos uma fonte de luz compreende uma pluralidade dediodos de emissão de luz no dito cartucho de grampos.
4. Efetuador de extremidade, de acordo com a reivindicação 1,em que a dita bigorna tem pelo menos um Iocalizador de tecido na mesma.
5. Efetuador de extremidade, de acordo com a reivindicação 1,em que a dita pelo menos uma fonte de luz é eletricamente acoplada a umafonte de energia elétrica suportada pelo instrumento de corte e grampea-mento cirúrgico.
6. Efetuador de extremidade, de acordo com a reivindicação 1,em que o dito canal alongado é acoplado a uma armação alongada do ins-trumento cirúrgico que suporta a dita fonte de energia elétrica no mesmo.
7. Efetuador de extremidade, de acordo com a reivindicação 1,em que a dita pelo menos uma fonte de luz compreende pelo menos um e-Iemento de fibra ótica suportado dentro do dito canal alongado e comunica-se de modo operável com uma fonte de luz suportada em um do canal alon-gado e do instrumento de corte e grampeamento cirúrgico.
8. Efetuador de extremidade, de acordo com a reivindicação 1,em que o dito canal alongado é acoplado de modo operável em uma arma-ção alongada do instrumento de corte e grampeamento cirúrgico que suportaa dita fonte de luz.
9. Efetuador de extremidade, de acordo com a reivindicação 8,em que a dita armação alongada é acoplada de modo operável a um conjun-to de cabo do aparelho de corte e grampeamento cirúrgico que suporta adita fonte de luz.
10. Método para processar um efetuador de extremidade paracirurgia, o método compreendendo:obter o efetuador de extremidade da reivindicação 1;esterilizar o efetuador de extremidade; earmazenar o efetuador de extremidade em um recipiente estéril.
11. cartucho de grampos para uso com um instrumento de cortee grampeamento cirúrgico, o dito cartucho de grampos compreendendo:um corpo de cartucho que tem uma pluralidade de canais de re-cepção de grampos, cada dito canal de recepção de grampos suportando demodo operável pelo menos um grampo cirúrgico no mesmo; euma pluralidade de fontes de luz suportada dentro do dito corpode cartucho para projetar luz na direção de uma parte de bigorna do instru-mento de corte e grampeamento cirúrgico quando o cartucho de grampo éoperavelmente suportado no mesmo e a parte de bigorna é orientada emuma posição de sujeição de tecido.
12. Cartucho de grampos, de acordo com a reivindicação 11, emque a dita pluralidade de fontes de luz compreende uma pluralidade de dio-dos de emissão de luz.
13. Cartucho de grampos, de acordo com a reivindicação 12, emque os ditos diodos de emissão de luz são eletricamente acoplados a umafonte de energia elétrica no instrumento de corte e grampeamento cirúrgicoquando o corpo de cartucho é acoplado de modo operável no mesmo.
14. Cartucho de grampos para uso com um instrumento de cortee grampeamento cirúrgico que tem pelo menos uma fonte de (uz no mesmo,o dito cartucho de grampos compreendendo;um corpo de cartucho que tem uma pluralidade de canais de re-cepção de grampos, cada dito canal de recepção de grampos suportando demodo operável pelo menos um grampo cirúrgico no mesmo; euma pluralidade de aberturas de projeção de luz estendendo-seatravés do dito corpo do cartucho em tais posições de modo a projetar luz dafonte de luz para uma parte de bigorna do instrumento de corte e grampea-mento cirúrgico quando o cartucho de grampos é operavelmente suportado ea parte de bigorna é orientada em uma posição de sujeição de tecido.
15. Instrumento de corte e grampeamento cirúrgico compreendendo:um conjunto de cabo;uma haste alongada operavelmente acoplada no conjunto decabo;um canal alongado operavelmente acoplado na dita haste alon-gada e configurado para suportar de modo operável um cartucho de grampos;uma bigorna suportada de modo móvel com relação ao dito ca-nal alongado para movimento seletivo entre uma posição aberta e uma posi-ção fechada em que o tecido é preso entre a dita bigorna e um cartucho degrampos suportado dentro do dito canal alongado em resposta aos movi-mentos de abertura e fechamento aplicados no mesmo a partir da haste a longada; epelo menos uma fonte de luz em pelo menos um do cartucho degrampos e do canal alongado, a dita pelo menos uma fonte de luz interface-ando com a dita bigorna para fornecer indicação visual, visível através deuma parte da dita bigorna para indicar uma posição de tecido preso entre adita bigorna e o cartucho de grampos.
16. Instrumento de corte e grampeamento cirúrgico, de acordocom a reivindicação 15, em que a dita bigorna tem uma pluralidade de pas-sagens de recepção de luz através da mesma , que a dita pelo menos umafonte de luz pode projetar quando a dita bigorna está na dita posição fechada.
17. Instrumento de corte e grampeamento cirúrgico, de acordocom a reivindicação 15, em que a dita pelo menos uma fonte de luz compreende:pelo menos um elemento de emissão de luz suportado em umada dita haste alongada e do dito conjunto de cabo; epelo menos um cabo de fibra ótica suportado dentro do dito ca-nal alongado se comunicando de modo operável com a dita pelo menos umafonte de luz para receber luz da mesma.
18. Instrumento de corte e grampeamento cirúrgico, de acordocom a reivindicação 15, em que a dita pelo menos uma fonte de luz compre-ende uma pluralidade de fontes de luz acionadas eletricamente no cartuchode grampos e em que o dito instrumento de corte e grampeamento cirúrgicoainda compreende pelo menos um contato elétrico suportado no dito canalalongado e em comunicação elétrica com uma fonte de energia elétrica talque quando o cartucho de grampos é operavelmente suportado dentro dodito canal alongado, o dito pelo menos um contato elétrico interfaceia eletri-camente com um pelo menos um contato elétrico correspondente no cartu-cho de grampo para transmitir energia elétrica para a pluralidade de fontesde luz no mesmo.
19. Instrumento de corte e grampeamento cirúrgico, de acordocom a reivindicação 18, em que a dita pluralidade de fontes de luz acionadaseletricamente compreende uma pluralidade de diodos de emissão de luz.
20. Instrumento de corte e grampeamento cirúrgico, de acordocom a reivindicação 19, em que a dita pluralidade de diodos de emissão deluz são fornecidos em pelo menos duas cores diferentes.
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- 2009-09-18 BR BRPI0904474-4A patent/BRPI0904474B1/pt not_active IP Right Cessation
- 2009-09-18 CN CN200910171921.3A patent/CN101683279B/zh not_active Expired - Fee Related
- 2009-09-18 CA CA2679226A patent/CA2679226C/en not_active Expired - Fee Related
Also Published As
Publication number | Publication date |
---|---|
US8083120B2 (en) | 2011-12-27 |
CA2679226C (en) | 2016-12-20 |
CA2679226A1 (en) | 2010-03-18 |
JP2010069304A (ja) | 2010-04-02 |
RU2009134906A (ru) | 2011-03-27 |
US20100065605A1 (en) | 2010-03-18 |
EP2165654A1 (en) | 2010-03-24 |
JP5465498B2 (ja) | 2014-04-09 |
RU2508910C2 (ru) | 2014-03-10 |
EP2165654B1 (en) | 2017-12-13 |
PL2165654T3 (pl) | 2018-05-30 |
CN101683279B (zh) | 2014-03-26 |
CN101683279A (zh) | 2010-03-31 |
BRPI0904474B1 (pt) | 2019-07-02 |
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